Bethesda Conference #36 and the European Society of Cardiology Consensus Recommendations Revisited. A Comparison of U.S. and European Criteria for Eligibility and Disqualification of Competitive Athletes With Cardiovascular Abnormalities

Antonio Pelliccia, Douglas P. Zipes, Barry J. Maron

Research output: Contribution to journalReview article

208 Scopus citations


Aspiration to reduce the risks of athletic field deaths prompted the American Heart Association and European Society of Cardiology (ESC) to establish consensus guidelines for eligibility/disqualification decisions in competitive athletes with cardiovascular abnormalities. Since 2005, the Bethesda Conference #36 and the ESC consensus documents have been relied upon by physicians from different parts of the world. The 2 consensus documents emanate from largely different cultural, social, and legal backgrounds existing in the U.S. and Europe and, although several recommendations are similar, in some instances the Bethesda Conference #36 and the ESC consensus documents suggest different approaches to disqualification decisions and implications for clinical practice, raising the possibility that confusion and discrepancies will contaminate the management of competitive athletes with cardiovascular disease. In the present article, the differences between the 2 documents are critically viewed, with special attention to genetic cardiovascular diseases relevant to sudden death in young athletes, through the prism of different cultural backgrounds, societal attitudes, and also perceptions regarding exposure to legal liability in the U.S. and Europe. In conclusion, it seems appropriate at some time to consider assembling updated recommendations for sports eligibility/disqualification that assimilate both the U.S. and European perspectives, with the aspiration of creating a unique and authoritative document applicable to the global sports medicine community.

Original languageEnglish (US)
Pages (from-to)1990-1996
Number of pages7
JournalJournal of the American College of Cardiology
Issue number24
StatePublished - Dec 9 2008



  • cardiovascular disease
  • competitive athletes
  • guidelines for eligibility/disqualification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this