{"id":10674,"date":"2023-07-24T06:00:32","date_gmt":"2023-07-24T05:00:32","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=10674"},"modified":"2023-07-22T08:01:50","modified_gmt":"2023-07-22T07:01:50","slug":"rapid-assessment-and-management-of-palpitations-during-sports-proposal-for-a-step-by-step-device-inclusive-guide","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2023\/07\/24\/rapid-assessment-and-management-of-palpitations-during-sports-proposal-for-a-step-by-step-device-inclusive-guide\/","title":{"rendered":"Rapid Assessment and Management of Palpitations During Sports: Proposal for a Step-by-Step, Device-inclusive Guide"},"content":{"rendered":"

How healthcare professionals can assess and manage arrhythmias in athletes without transient loss of consciousness using smart ECG devices.\u00a0<\/strong><\/p>\n

Keywords: <\/b>Athlete, Palpitations, ECG.\u00a0<\/span><\/p>\n

Introduction\u00a0<\/b><\/p>\n

Palpitations due to arrhythmias during sports can be a serious concern for athletes, and\u00a0 prompt assessment and management are crucial to ensure adequate diagnosis and\u00a0 treatment. As arrhythmias are time-sensitive and can potentially cause sudden cardiac\u00a0 death, timely assessment and management can help prevent adverse outcomes and allow\u00a0 athletes to continue their sports safely. In this blog post, we propose a guide for healthcare\u00a0 professionals to efficiently assess and manage athletes with palpitations using novel\u00a0 electrocardiography (ECG) devices, as there is currently a lack of guidance on using these\u00a0 devices in sports.\u00a0\u00a0<\/span><\/p>\n

    \n
  1. Smart ECG device\u00a0<\/b><\/li>\n<\/ol>\n

    Traditional approaches may not include rapid ECG assessment on the pitch. Smart ECG\u00a0 devices like smartwatches and portable ECG devices may provide single- or multi-lead ECGs\u00a0 [1,2]. These devices provide the healthcare professional the opportunity to obtain a real time assessment of a potential arrhythmia in an exercising athlete (see <\/span>Figure 1 below<\/span><\/i>)<\/span>.\u00a0<\/span><\/p>\n

    \"\"<\/i><\/span><\/p>\n

    Figure 1: <\/i>Smart ECG Device Algorithm for palpitations during sports\u00a0<\/span><\/p>\n

      \n
    1. First Assessment\u00a0<\/b><\/li>\n<\/ol>\n

      Athletes who present with hemodynamic\/respiratory instability or transient loss of consciousness require immediate assessment for basic life support and eventually\u00a0 connection to an AED [3]. In such cases, emergency response protocols should be initiated immediately. Hemodynamically\/respiratory stable athletes can be preliminarily assessed by\u00a0 obtaining an ECG with a portable ECG device. We recommended using a device with multiple\u00a0 leads, but priority should be given to rapid assessment with the device available.\u00a0\u00a0<\/span><\/p>\n

        \n
      1. Broad Complex Tachycardias\u00a0<\/b><\/li>\n<\/ol>\n

        If the QRS is wider than 120 milliseconds on the ECG, the assumption should be that the\u00a0 athlete has ventricular tachycardia (VT) until proven otherwise [4,5]. Play should be stopped,\u00a0 and an AED should be applied. Emergency response protocols should be initiated. Experienced healthcare professionals may deviate from this protocol for justified reasons,\u00a0 e.g., if the player has a documented aberrant conducting supra ventricular tachycardia or a\u00a0 personalised treatment plan.\u00a0<\/span><\/p>\n

          \n
        1. Narrow Complex Tachycardias\u00a0<\/b><\/li>\n<\/ol>\n

          If the ECG shows a narrow complex tachycardia (QRS shorter than 120 milliseconds),\u00a0 differentiation is warranted between sinus tachycardia and supraventricular tachycardia\u00a0 (SVT). A 2-to-3-minute resting period is central to this differentiation. If the narrow complex\u00a0 tachycardia persists after rest (> 150 beats per minute), we recommend performing a\u00a0 maximum of two modified Valsalva manoeuvres with passive leg elevation and supine\u00a0 positioning at the end of the manoeuvre (see video: <\/span>Modified Valsalva manoeuvre for <\/span>\u00a0<\/span>supraventricular tachycardia – YouTube<\/span>) [6]. If the tachycardia does not persist or if\u00a0 terminated, the athlete should remain asymptomatic for palpitations during mobilization,\u00a0 before returning to sports.\u00a0<\/span><\/p>\n

            \n
          1. Recording and Documenting Arrhythmias\u00a0<\/b><\/li>\n<\/ol>\n

            It is <\/span>essential <\/b>to record and document any arrhythmia for further diagnostic and\u00a0 management purposes. If digital documentation cannot easily or completely be obtained\u00a0 from the ECG device, healthcare professionals should strongly consider documenting\u00a0 arrhythmias, with the athlete\u2019s consent, using smartphones or other devices with camera\u00a0 capability.\u00a0<\/span><\/p>\n

            Conclusion:\u00a0<\/b><\/p>\n

            Rapid assessment and management of arrhythmias in athletes are crucial to prevent adverse\u00a0 outcomes, but also to allow athletes to continue their sports safely. Our proposed step-by step guide, which utilizes novel smart and small ECG devices, can aid healthcare\u00a0 professionals in quickly assessing and managing palpitations on the pitch. By differentiating\u00a0 between broad and narrow complex tachycardias and performing vagal manoeuvres when\u00a0 appropriate, adverse outcomes can be prevented, and athletes can continue to pursue their\u00a0 sporting activities safely. We encourage healthcare professionals to consider incorporating\u00a0 our guide into their practice to improve the care of athletes with palpitations.<\/span><\/p>\n

            \"\"<\/p>\n

            Author names & affiliations:\u00a0<\/b><\/p>\n

            M.A. van Diepen, MD<\/span>1 <\/span>m.a.vandiepen@amsterdamumc.nl J.C. van Hattum, MD<\/span>1 <\/span>j.c.vanhattum@amsterdamumc.nl B.M. Pluim, MD PhD<\/span>2,3,4 <\/span>b.pluim@knltb.nl\u00a0<\/span><\/p>\n

            C.A.C.M. Wijne, MD<\/span>5 <\/span>c.a.wijne@amsterdamumc.nl M.H. Moen, MD PhD<\/span>6 <\/span>maarten.moen@nocnsf.nl\u00a0 Prof. M. B\u00f6rjesson, MD<\/span>7 <\/span>mats.borjesson@gu.se Prof. A.A.M. Wilde, MD PhD<\/span>1 <\/span>a.a.wilde@amsterdamumc.nl H.T. J\u00f8rstad, MD PhD<\/span>1,8 <\/span>h.t.jorstad@amsterdamumc.nl\u00a0<\/span><\/p>\n

            1\u00a0<\/span>Amsterdam UMC location University of Amsterdam, Department of Cardiology, Amsterdam,\u00a0 The Netherlands; Amsterdam Cardiovascular Sciences (ACS), Amsterdam, The Netherlands <\/span><\/p>\n

            2 <\/span>Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South\u00a0 Africa\u00a0<\/span><\/p>\n

            3\u00a0<\/span>Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Centre of\u00a0 Excellence, Amsterdam, the Netherlands\u00a0<\/span><\/p>\n

            4\u00a0<\/span>Medical Department, Royal Netherlands Lawn Tennis Association (KNLTB), Amstelveen, the\u00a0 Netherlands\u00a0<\/span><\/p>\n

            5\u00a0<\/span>Sports Physicians, OLVG Location West, Amsterdam, The Netherlands<\/span><\/p>\n

            6\u00a0<\/span>Dutch Olympic Committee*Dutch Sports Federation (NOC*NSF) High Performance Team <\/span><\/p>\n

            7\u00a0<\/span>Inst Medicine, Sahlgrenska Academy, Gothenburg University and Sahlgrenska University\u00a0 Hospital, Gothenburg, Sweden\u00a0<\/span><\/p>\n

            8\u00a0<\/span>Amsterdam Movement Sciences (AMS), Amsterdam, The Netherlands\u00a0<\/span><\/p>\n

            Competing Interests:\u00a0<\/b><\/p>\n

            The authors declare no competing interests.\u00a0<\/span><\/p>\n

            References:\u00a0<\/b><\/p>\n

            1. Jewson JL, Orchard JW, Semsarian C, <\/span>et al. <\/span><\/i>Use of a smartphone electrocardiogram to\u00a0 diagnose arrhythmias during exercise in athletes: a case series. <\/span>Eur Heart J Case Rep <\/span><\/i>2022;<\/span>6<\/b>:ytac126. doi:10.1093\/ehjcr\/ytac126\u00a0<\/span><\/p>\n

            2. Kassam N, Aziz O, Aghan E, <\/span>et al. <\/span><\/i>Smart Watch Detection of Supraventricular\u00a0 Tachycardia (SVT): First Case from Tanzania. <\/span>Int Med Case Rep J <\/span><\/i>2021;<\/span>Volume 14<\/b>:563\u2013 6. doi:10.2147\/IMCRJ.S328167\u00a0<\/span><\/p>\n

            3. de Jong JS, Jorstad HT, Thijs RD, <\/span>et al. <\/span><\/i>How to recognise sudden cardiac arrest on the\u00a0 pitch. <\/span>Br J Sports Med <\/span><\/i>2020;<\/span>54<\/b>:1178\u201380. doi:10.1136\/bjsports-2019-101159 <\/span><\/p>\n

            4.Ringwald M, Crich A, Beysard N. Smart watch recording of ventricular tachycardia:\u00a0 Case study. <\/span>Am J Emerg Med <\/span><\/i>2020;<\/span>38<\/b>:849.e3-849.e5. doi:10.1016\/j.ajem.2019.10.040 <\/span><\/p>\n

            5.<\/span>Burke J, Haigney MCP, Borne R, <\/span>et al. <\/span><\/i>Smartwatch detection of ventricular\u00a0 tachycardia: Case series. <\/span>HeartRhythm Case Rep <\/span><\/i>2020;<\/span>6<\/b>:800\u20134.\u00a0<\/span>doi:10.1016\/j.hrcr.2020.08.003\u00a0<\/span><\/p>\n

            6. Brugada J, Katritsis DG, Arbelo E, <\/span>et al. <\/span><\/i>2019 ESC Guidelines for the management of\u00a0 patients with supraventricular tachycardiaThe Task Force for the management of\u00a0<\/span>patients with supraventricular tachycardia of the European Society of Cardiology\u00a0 (ESC). <\/span>Eur Heart J <\/span><\/i>2020;<\/span>41<\/b>:655\u2013720. doi:10.1093\/eurheartj\/ehz467<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

            How healthcare professionals can assess and manage arrhythmias in athletes without transient loss of consciousness using smart ECG devices.\u00a0 Keywords: Athlete, Palpitations, ECG.\u00a0 Introduction\u00a0 Palpitations due to arrhythmias during sports can be a serious concern for athletes, and\u00a0 prompt assessment and management are crucial to ensure adequate diagnosis and\u00a0 treatment. As arrhythmias are time-sensitive and […]<\/p>\n

            Read More…<\/a><\/p>\n","protected":false},"author":463,"featured_media":10685,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[2508,16068,16191],"class_list":["post-10674","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-ecgekg","tag-featured","tag-palpitations"],"yoast_head":"\nRapid Assessment and Management of Palpitations During Sports: Proposal for a Step-by-Step, Device-inclusive Guide - BJSM blog - social media's leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/?p=10674\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Rapid Assessment and Management of Palpitations During Sports: Proposal for a Step-by-Step, Device-inclusive Guide - BJSM blog - social media's leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"How healthcare professionals can assess and manage arrhythmias in athletes without transient loss of consciousness using smart ECG devices.\u00a0 Keywords: Athlete, Palpitations, ECG.\u00a0 Introduction\u00a0 Palpitations due to arrhythmias during sports can be a serious concern for athletes, and\u00a0 prompt assessment and management are crucial to ensure adequate diagnosis and\u00a0 treatment. 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