array:25 [
  "pii" => "S2174204915001166"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2015.05.004"
  "estado" => "S300"
  "fechaPublicacion" => "2015-06-01"
  "aid" => "608"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "ssu"
  "cita" => "Rev Port Cardiol. 2015;34:411-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4240
    "formatos" => array:3 [
      "EPUB" => 198
      "HTML" => 3150
      "PDF" => 892
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:20 [
      "pii" => "S0870255115000438"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2014.11.007"
      "estado" => "S300"
      "fechaPublicacion" => "2015-06-01"
      "aid" => "608"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "ssu"
      "cita" => "Rev Port Cardiol. 2015;34:411-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4680
        "formatos" => array:3 [
          "EPUB" => 185
          "HTML" => 3627
          "PDF" => 868
        ]
      ]
      "pt" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Artigo de Revis&#227;o</span>"
        "titulo" => "Utiliza&#231;&#227;o de cardioversores desfibrilhadores implant&#225;veis em desportistas&#58; revis&#227;o sistem&#225;tica"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "tieneResumen" => array:2 [
          0 => "pt"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "411"
            "paginaFinal" => "419"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Use of implantable cardioverter&#8208;defibrillators in athletes&#58; A systematic review"
          ]
        ]
        "contieneResumen" => array:2 [
          "pt" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 2479
                "Ancho" => 2623
                "Tamanyo" => 345268
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Diagrama ilustrando a sele&#231;&#227;o dos estudos&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Ricardo Liz Almeida, Rui Provid&#234;ncia, Lino Gon&#231;alves"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Ricardo"
                "apellidos" => "Liz Almeida"
              ]
              1 => array:2 [
                "nombre" => "Rui"
                "apellidos" => "Provid&#234;ncia"
              ]
              2 => array:2 [
                "nombre" => "Lino"
                "apellidos" => "Gon&#231;alves"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204915001166"
          "doi" => "10.1016/j.repce.2015.05.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001166?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115000438?idApp=UINPBA00004E"
      "url" => "/08702551/0000003400000006/v1_201506170141/S0870255115000438/v1_201506170141/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2174204915001129"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2014.11.007"
    "estado" => "S300"
    "fechaPublicacion" => "2015-06-01"
    "aid" => "610"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Rev Port Cardiol. 2015;34:421&#46;e1-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4228
      "formatos" => array:3 [
        "EPUB" => 160
        "HTML" => 3219
        "PDF" => 849
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Recurrent constrictive pericarditis&#58; A diagnostic and therapeutic challenge"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "421&#46;e1"
          "paginaFinal" => "421&#46;e5"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Pericardite constritiva recorrente &#8211; um desafio diagn&#243;stico e terap&#234;utico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 649
              "Ancho" => 1950
              "Tamanyo" => 133985
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Coronary angiography showing no coronary artery disease and marked calcification of the cardiac silhouette&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Raquel Ferreira, Anabela Gonzaga, Lu&#237;s Santos, Jos&#233; Ant&#243;nio Santos"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Raquel"
              "apellidos" => "Ferreira"
            ]
            1 => array:2 [
              "nombre" => "Anabela"
              "apellidos" => "Gonzaga"
            ]
            2 => array:2 [
              "nombre" => "Lu&#237;s"
              "apellidos" => "Santos"
            ]
            3 => array:2 [
              "nombre" => "Jos&#233; Ant&#243;nio"
              "apellidos" => "Santos"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255115000451"
        "doi" => "10.1016/j.repc.2014.11.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115000451?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001129?idApp=UINPBA00004E"
    "url" => "/21742049/0000003400000006/v1_201506200223/S2174204915001129/v1_201506200223/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2174204915001348"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2015.01.006"
    "estado" => "S300"
    "fechaPublicacion" => "2015-06-01"
    "aid" => "639"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2015;34:403-10"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2722
      "formatos" => array:3 [
        "EPUB" => 180
        "HTML" => 1894
        "PDF" => 648
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Impact of atrial fibrillation type during acute coronary syndromes&#58; Clinical features and prognosis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "403"
          "paginaFinal" => "410"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Impacto do tipo de fibrilha&#231;&#227;o auricular no contexto das s&#237;ndromes coron&#225;rias agudas &#8211; caracter&#237;sticas cl&#237;nicas e progn&#243;stico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1181
              "Ancho" => 1646
              "Tamanyo" => 119342
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier survival curves for patients with new-onset AF&#44; pre-existing AF and without AF&#46; AF&#58; atrial fibrillation&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Carlos Galv&#227;o Braga, V&#237;tor Ramos, Juliana Martins, Carina Arantes, Gl&#243;ria Abreu, Catarina Vieira, Alberto Salgado, Ant&#243;nio Gaspar, Pedro Azevedo, Miguel &#193;lvares Pereira, S&#243;nia Magalh&#227;es, Jorge Marques"
          "autores" => array:12 [
            0 => array:2 [
              "nombre" => "Carlos Galv&#227;o"
              "apellidos" => "Braga"
            ]
            1 => array:2 [
              "nombre" => "V&#237;tor"
              "apellidos" => "Ramos"
            ]
            2 => array:2 [
              "nombre" => "Juliana"
              "apellidos" => "Martins"
            ]
            3 => array:2 [
              "nombre" => "Carina"
              "apellidos" => "Arantes"
            ]
            4 => array:2 [
              "nombre" => "Gl&#243;ria"
              "apellidos" => "Abreu"
            ]
            5 => array:2 [
              "nombre" => "Catarina"
              "apellidos" => "Vieira"
            ]
            6 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Salgado"
            ]
            7 => array:2 [
              "nombre" => "Ant&#243;nio"
              "apellidos" => "Gaspar"
            ]
            8 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Azevedo"
            ]
            9 => array:2 [
              "nombre" => "Miguel"
              "apellidos" => "&#193;lvares Pereira"
            ]
            10 => array:2 [
              "nombre" => "S&#243;nia"
              "apellidos" => "Magalh&#227;es"
            ]
            11 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Marques"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0870255115001225"
        "doi" => "10.1016/j.repc.2015.01.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001225?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001348?idApp=UINPBA00004E"
    "url" => "/21742049/0000003400000006/v1_201506200223/S2174204915001348/v1_201506200223/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>"
    "titulo" => "Use of implantable cardioverter-defibrillators in athletes&#58; A systematic review"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "411"
        "paginaFinal" => "419"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Ricardo Liz Almeida, Rui Provid&#234;ncia, Lino Gon&#231;alves"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "Ricardo"
            "apellidos" => "Liz Almeida"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "Rui"
            "apellidos" => "Provid&#234;ncia"
            "email" => array:1 [
              0 => "rui&#95;providencia&#64;yahoo&#46;com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Lino"
            "apellidos" => "Gon&#231;alves"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Universidade de Coimbra&#44; Faculdade de Medicina&#44; Coimbra&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servi&#231;o de Cardiologia&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#44; Coimbra&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Utiliza&#231;&#227;o de cardioversores desfibrilhadores implant&#225;veis em desportistas&#58; revis&#227;o sistem&#225;tica"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2479
            "Ancho" => 2625
            "Tamanyo" => 362531
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Diagram illustrating the study selection process&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0045" class="elsevierStylePara elsevierViewall">Sudden cardiac death &#40;SCD&#41; in athletes&#44; its prevention by means of implantable cardioverter-defibrillators &#40;ICDs&#41;&#44; and whether athletes with ICDs should be disqualified from participating in competitive sport&#44; are currently the subject of intense controversy&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The recommendations of the 36th Bethesda Conference &#40;BC&#35;36&#41;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> and the European Society of Cardiology &#40;ESC&#41;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">25</span></a> exclude athletes with ICDs from all but low-intensity sports &#40;category IA of the BC&#35;36 classification<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a>&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; These recommendations are based on the perceived risks&#44; including failure of the device to deliver appropriate therapies&#44; injury resulting from loss of consciousness or control caused by an ICD shock or the arrhythmia itself&#44; and damage to the device or leads&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> The guidelines were developed on the basis of expert consensus rather than on the results of studies&#44; and there is as yet no solid evidence concerning the actual risks to ICD patients arising from participation in competitive sports&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Implantation of ICDs has grown exponentially in recent decades&#44; often in individuals with normal myocardial function but with genetic mutations that could lead to fatal arrhythmias&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> The result is an increasing number of young individuals with ICDs&#44; many of whom are athletes and&#44; according to the guidelines&#44; should be disqualified from participating in competitive sports&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">2&#44;25</span></a> The problem is even more serious for professional athletes who are thereby prevented from exercising their profession and suffer the inevitable consequences&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Despite the existence of the guidelines&#44; according to a 2006 survey&#44; many clinicians do not follow them and opt to make their decisions based on the individual athlete&#44; medical condition and sport concerned&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a> In recent years&#44; the subject has been explored by some centers&#59; their findings may support evidence-based decision-making and lead to changes in the management of these patients&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The aim of the present study is to systematically review the state of the art in this area&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Methods</span><p id="par0070" class="elsevierStylePara elsevierViewall">The review was based on information in articles indexed in MEDLINE &#40;via PubMed&#41; using the following search string&#58; &#8220;&#40;&#40;sudden cardiac death&#41; AND &#40;sport OR physical exercise&#41;&#41; AND defibrillator&#8221;&#46; Filters were defined to restrict searches to articles in English&#44; Portuguese or Spanish&#44; with available abstracts&#44; published between 1985 and 2014&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Articles were selected on the basis of their abstract&#44; which was used to assess their relevance and whether they were likely to meet the inclusion and exclusion criteria defined below&#46; The full text of each relevant article was read to determine whether it was to be included&#46; The inclusion criteria were&#58; &#40;1&#41; research on individuals with ICDs who participate in sports&#44; whether &#40;a&#41; only athletes with ICDs&#44; &#40;b&#41; athletes and non-athletes with ICDs&#44; or &#40;c&#41; athletes with and without ICDs&#59; &#40;2&#41; registries characterizing epidemiological aspects of SCD in athletes&#59; &#40;3&#41; consensus documents and international guidelines on the subject&#46; Letters to the Editor&#44; case reports&#44; and review articles that did not provide new observational data were excluded&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Additional searches were performed with alternative search strings in different search engines&#44; including Sci-Hub and B-on&#44; and the reference lists of the selected articles were consulted to identify other potentially relevant material&#44; which was analyzed using the same inclusion and exclusion criteria&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">The search string produced a total of 378 results&#44; of which 340 were excluded after a reading of the abstract indicated they were not relevant to the current review&#46; The remaining 38 manuscripts&#44; together with others identified from other sources&#44; were analyzed using the same inclusion and exclusion criteria and a total of 36 were selected for the review&#58; 35 articles<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">3&#8211;30&#44;32&#8211;36</span></a> and a poster presented at a congress&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a> The selection process is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Definition and epidemiology of sudden cardiac death</span><p id="par0090" class="elsevierStylePara elsevierViewall">SCD&#44; mainly caused by malignant ventricular arrhythmias&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a> is one of the leading causes &#40;&#62;50&#37;&#41; of cardiovascular death worldwide&#46; It is defined as unexpected natural death from a cardiac cause within a short time period&#44; generally &#8804;1 hour from the onset of symptoms&#44; in a person without any prior condition that would appear fatal&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a> Although rare in the young&#44; participation in competitive sports increases the risk of SCD<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a>&#59; the annual incidence of SCD in athletes aged &#60;35 years is reported as 1&#58;100<span class="elsevierStyleHsp" style=""></span>000&#8211;300<span class="elsevierStyleHsp" style=""></span>000&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a> although recent studies have suggested that this is an underestimate and that 1&#58;50<span class="elsevierStyleHsp" style=""></span>000 is more realistic&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a> It is more common in males&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Causes of sudden cardiac death</span><p id="par0095" class="elsevierStylePara elsevierViewall">The fatal event is usually caused by rhythm disturbances&#44; particularly tachyarrhythmias such as ventricular fibrillation&#46; The arrhythmia may have various causes &#40;ischemia&#44; primary arrhythmia&#44; rapid atrioventricular conduction&#41;&#44; but the common denominator is electrical instability<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The most common cause of SCD in young athletes is hypertrophic cardiomyopathy &#40;HCM&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a> although in a study in the region of Veneto&#44; Italy&#44; the leading cause was arrhythmogenic right ventricular dysplasia &#40;ARVD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a> This may be explained by regional differences between Europe and the USA and by the different screening methods used in Italy&#44; where all competitive athletes aged under 35 undergo testing consisting of a thorough clinical and family history&#44; physical examination and 12-lead ECG&#46; Such screening is more likely to detect HCM &#40;in which over 95&#37; of cases present a pathological ECG&#41; than ARVD&#44; most cases of which are only diagnosed on autopsy and which contribute significantly to mortality in young athletes&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> In athletes aged over 35&#44; the leading cause of SCD is atherosclerotic coronary disease&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Definition of sports and of athletes</span><p id="par0105" class="elsevierStylePara elsevierViewall">According to the BC&#35;36&#44; a competitive athlete is defined as one who participates in a team or individual sport&#44; competes regularly&#44; and undergoes systematic training &#40;usually intense&#41; to achieve excellence&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> A sport is an organized&#44; competitive&#44; entertaining&#44; and skillful activity requiring commitment&#44; strategy&#44; and fair play&#44; in which a winner can be defined by objective means&#46; It is governed by a set of rules or customs&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a> This definition does not include recreational or leisure activities&#44; since they are not competitive&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a> and according to the BC&#35;36 and ESC guidelines&#44; sport is considered more demanding than other recreational activities&#44; placing the individual at higher risk of a fatal arrhythmia&#46; However&#44; it should be borne in mind that some competitive sports may incur less risk than certain leisure activities&#59; for example&#44; competitive shooting is less likely to lead to SCD than amateur weightlifting&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> The BC&#35;36 recommendations accordingly classify sports by the intensity of their static and dynamic components &#40;low&#44; moderate or high&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; On this basis&#44; weightlifting has a large static component and running has a large dynamic component&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Use of implantable cardioverter-defibrillators in athletes</span><p id="par0110" class="elsevierStylePara elsevierViewall">The sooner defibrillation is performed&#44; the more effectively ventricular fibrillation can be terminated&#46; If the shock is delivered within 30 s&#44; there is a 90&#37; probability that it will be successful&#44; but this falls by 7&#37;&#8211;10&#37; for every minute that passes&#44; and if defibrillation is begun 10 min after the event the likelihood of resuscitation is only 10&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The location of an ICD means that it can interpret the cardiac rhythm and apply a shock almost immediately&#44; which leads to success rates of 95&#37;&#8211;99&#37;&#46; As a result&#44; in the last 20 years ICDs have become the gold standard treatment for ventricular arrhythmias&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The indications for ICD implantation in athletes in the ESC<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6&#44;20</span></a> and American College of Cardiology&#47;American Heart Association &#40;ACC&#47;AHA&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a> guidelines are similar to those for the general population&#46; The main complications are lead dislodgment or fracture&#44; inappropriate shocks&#44; and generator migration or pocket erosion&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The number of individuals with ICDs for primary prevention has risen sharply in recent years&#44; due to more widespread screening of families with a history of inherited arrhythmia syndromes&#44; channelopathies and cardiomyopathies&#44; as well as improved identification of silent mutation carriers&#46; As a consequence&#44; there are increasing numbers of apparently healthy and highly active individuals who&#44; due to their increased risk of suffering an arrhythmic event &#40;or to prevent recurrence&#41;&#44; have an ICD to prevent SCD&#44; which can be the first manifestation of disease&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Specific risks associated with implantable cardioverter-defibrillators in athletes</span><p id="par0130" class="elsevierStylePara elsevierViewall">There are various considerations specific to athletes that can affect the safety and efficacy of ICDs in this population and thus influence the decision whether they can resume their sporting activity after implantation &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> A major concern is that the ICD may not reliably defibrillate under athletic conditions&#44; because of physiological alterations such as increased circulating catecholamine levels&#44; leading to dehydration&#44; acidosis&#44; electrolyte disturbances and volume depletion&#44; which in turn make the occurrence and perpetuation of arrhythmias more likely&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a> There is little evidence on the efficacy of ICD shocks under the metabolic conditions of intense exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Furthermore&#44; strenuous exercise worsens certain conditions such as ARVD and dilated cardiomyopathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Another potential problem is that inappropriate shocks may be more frequent during exercise&#44; due to sinus or supraventricular tachycardia or atrial fibrillation&#46; Moreover&#44; an athlete &#40;and&#44; in the case of motor sports&#44; spectators&#41; may be injured as a result of transient loss of consciousness and&#47;or control due to arrhythmia or ICD shock&#46; In addition&#44; the ICD or leads may be damaged&#44; particularly due to repeated energetic arm movements&#44; as found in sports such as golf and boxing&#44; or to direct impacts on the ICD itself or the subclavian region &#40;&#8220;subclavian crush&#8221;&#41;&#44; as may occur in any contact sport&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> Finally&#44; those who argue that athletes with ICDs should be excluded from competition point out that inappropriate shocks can have a negative psychological effect on these individuals&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In light of the above&#44; current guidelines recommend that athletes with ICDs should be disqualified from all competitive sports except those with low static and dynamic components&#44; such as golf&#44; billiards or bowling &#40;category IA of the BC&#35;36 classification&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">New studies and controversy</span><p id="par0150" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> summarizes the main results of studies assessing the use of ICDs in athletes&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">A 2006 survey<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a> of physician members of the Heart Rhythm Society designed to assess the decisions being made regarding sports participation in patients with ICDs painted a very different picture from that to be expected from the guidelines&#58; of the 614 physicians who responded&#44; only 62 &#40;10&#37;&#41; followed the BC&#35;36 and ESC guidelines strictly by excluding patients from all sports except those in category IA&#44; while most &#40;n&#61;464&#59; 76&#37;&#41; only recommended avoidance of contact&#44; 273 &#40;45&#37;&#41; recommended avoidance of competitive sports&#44; and 71&#37; reported caring for patients who participated in sports&#44; including vigorous&#44; competitive sports&#46; More than two-thirds based restrictions on patients&#8217; underlying heart disease and not solely on the guidelines&#46; It is worth noting that 40&#37; of responders had over 10 years&#8217; experience with ICD patients&#46; Although a high proportion of patients participated in sports&#44; and shocks were common&#44; adverse events were rare&#46; Most complications were due to device failure such as lead fracture or migration attributed to repetitive arm movements &#40;n&#61;28&#41;&#44; most commonly weightlifting &#40;n&#61;16&#41;&#44; tennis &#40;n&#61;2&#41; and golf &#40;n&#61;5&#41;&#46; Interestingly&#44; the latter is classified as IA and thus not excluded by the guidelines&#46; While there was agreement that heart failure and ischemic heart disease should limit sports participation&#44; physicians disagree concerning long QT syndrome and Brugada syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In view of the observation that despite the guidelines&#44; ICD patients continue to take part in competitive sports&#44; Lampert et al&#46; established a multicenter international registry&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a> Participants were recruited via mailings to physicians and by direct communication with patients via patient group Internet sites and mailing lists&#46; Data were collected through telephone contact every six months and medical records were obtained from 41 sites in North America and 18 in Europe&#46; Patients were queried about shocks received&#44; sequelae&#44; preshock activity and any change in sports participation&#44; health or ICD status&#46; Of the 372 participants&#44; 328 were participating in organized sports and 44 were participating in high-risk sports&#46; Median age was 33 years and 33&#37; were female&#46; The most frequent diagnoses were long QT syndrome &#40;n&#61;73&#41;&#44; HCM &#40;n&#61;63&#41;&#44; and ARVD &#40;n&#61;55&#41;&#59; the most common sports were running &#40;n&#61;106&#41;&#44; soccer &#40;n&#61;69&#41; and basketball &#40;n&#61;56&#41;&#44; while the most common high-risk sport was skiing&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">During a median follow-up of 31 months&#44; there were no tachyarrhythmic deaths&#44; resuscitated cardiac arrests&#44; or injuries related to arrhythmias or shocks during sports participation&#46; There were 49 shocks in 37 participants &#40;10&#37; of the study population&#41; during competition&#47;practice&#44; 39 shocks in 29 participants &#40;8&#37;&#41; during other physical activity&#44; and 33 shocks in 24 participants &#40;6&#37;&#41; at rest&#46; More individuals received shocks during either competition&#47;practice or physical activity than during rest &#40;16&#37; vs&#46; 6&#37;&#59; p&#60;0&#46;0001&#41;&#44; but there was no significant difference between the proportion receiving a shock during competition&#47;practice and those receiving a shock during other physical activity &#40;10&#37; vs&#46; 8&#37;&#59; p&#61;0&#46;34&#41;&#46; Similarly&#44; the proportion receiving appropriate shocks during either competition&#47;practice or other physical activity was greater than the proportion receiving appropriate shocks during rest &#40;8&#37; vs&#46; 3&#37;&#59; p&#61;0&#46;006&#41;&#44; but there was no difference between competition&#47;practice and other physical activity &#40;6&#37; vs&#46; 4&#37;&#59; p&#61;0&#46;18&#41;&#46; Of a subgroup of 60 highly competitive athletes&#44; all &#8804;21 years of age&#44; 17 &#40;28&#37;&#41; experienced a total of 25 shocks&#46; In this subgroup there was no significant difference between the number of shocks in this subgroup during competition&#47;practice &#40;1&#37;&#41; and at rest &#40;4&#37;&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">There were no reported ICD malfunctions in 97&#37; of the participants at five years and in 90&#37; at 10 years&#46; Most &#40;70&#37;&#41; of athletes who received shocks during sports chose to continue playing&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">These findings suggest that many athletes can safely participate in various contact or high-intensity sports without risk of injury&#44; device damage&#44; or ineffective defibrillation&#46; Shock rates in the study population were generally similar to those in ICD patients who do not play sports or are less active&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">27&#44;28</span></a> The rate of lead failure or fracture was also similar to five-year rates seen in other populations &#40;85&#37;&#8211;98&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Disqualifying athletes with ICDs from sports can significantly affect their quality of life&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> particularly younger individuals&#44; who describe feelings of exclusion and being considered &#8216;not normal&#8217; as the main problem with having an ICD&#46; The fact that most athletes in the study continued to play even after receiving shocks suggests that the benefits of sport outweigh the negative impact that shocks may have&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Following publication of the above studies&#44; other researchers have set out to investigate further&#46; Saarel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a> recently presented preliminary results of a registry of 21 young patients with ICDs who choose to play competitive or dangerous sports greater than IA in both static and dynamic components&#46; Ten had congenital heart disease&#44; six had inherited arrhythmia syndromes and five had cardiomyopathy&#46; Mean follow-up was five years&#59; the most common sports were basketball and baseball&#46; There were no cardiac deaths and no increase in morbidity after four years&#46; One participant received two appropriate shocks for supraventricular tachycardia during a basketball game and subsequently retired from competitive sports&#59; no other participant suffered more frequent shocks&#44; appropriate or inappropriate&#44; during sports&#44; and no increase in device malfunction was reported&#46; All participants were under beta-blocker therapy to prevent inappropriate shocks due to sinus or ventricular tachycardia&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Discussion</span><p id="par0190" class="elsevierStylePara elsevierViewall">Recent studies<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">5&#44;26&#44;31</span></a> appear to show that participation in sports by ICD patients is not as harmful as previously thought&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The decision whether to disqualify athletes with ICDs should be taken on an individual basis&#46; In recent years&#44; there has been a growing trend in medicine towards patient-centered decision-making&#44; in which patients&#8217; motivations and preferences are taken more into account&#44; increasing their empowerment and role in decisions&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a> However&#44; it is important to avoid the opposite extreme&#44; in which the physician acts merely as a provider of information and the patient is given complete autonomy to take decisions&#44; irrespective of the physician&#39;s opinion&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">33&#44;34</span></a> The guidelines are still based largely on input from cardiologists as the main decision-makers&#44; and the question of the degree of empowerment that athletes with ICDs do or should have with regard to disqualification or retirement from sports is still an open one&#46; These patients require counseling&#44; taking the time to provide them with careful and clear explanations of the known risks of participation in sports&#44; and the benefits and risks of ICDs&#44; as well as aspects for which there is insufficient evidence&#44; and to answer any questions they may have&#44; in order to give them a greater sense of control and to enable joint and informed decisions&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">There is consensus among physicians that heart failure&#44; HCM and ischemic heart disease should limit participation in sports&#44; but this is not the case with long QT syndrome and Brugada syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> In HCM&#44; different sports&#44; such as football or boxing&#44; can be associated with different levels of risk&#46; In certain cases the decision is not likely to be difficult&#44; such as in left ventricular dysfunction with exercise-induced arrhythmia&#44; but in ICD patients without left ventricular dysfunction other factors need to be taken into consideration&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">Although ICD shocks can have a negative impact on quality of life&#44; exclusion from playing sports can have a similar or even worse effect&#46; Physical activity considerably reduces cardiovascular morbidity and mortality through a variety of mechanisms&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a> It should be stressed that in many cases the athlete will be forced to abandon their professional or recreational sports activity&#44; which can have severe personal repercussions&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Limitations</span><p id="par0210" class="elsevierStylePara elsevierViewall">This review has certain limitations&#46; Firstly&#44; there are few studies assessing the use of ICDs in athletes&#46; Secondly&#44; follow-up times for athletes with ICDs are short and there are no data on long-term efficacy and safety in this population&#46; Thirdly&#44; the use of automated external defibrillators was not examined&#44; since there is extensive evidence and consensus in the medical community on this subject&#46; Finally&#44; most of the results relate to devices with intravascular leads&#59; data on subcutaneous ICDs are still scarce&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0215" class="elsevierStylePara elsevierViewall">Management of athletes with ICDs should be individualized to the patient&#44; according to the heart disease and sport in question&#46; Disqualifying almost all ICD patients from participating in sports&#44; without taking into consideration their individual needs and characteristics&#44; may be prejudicial to a considerable number of patients by preventing them from exercising their profession or engaging in recreational sport&#44; for which their risk of sudden cardiac death may be low&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The BC&#35;36 guidelines are now 10 years old and based solely on expert consensus and the evidence available at the time&#46; Recent studies may lead to a revision of the guidelines&#59; however&#44; there is still little evidence and further studies will be needed to provide solid data and clear answers to the many questions in this area&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical disclosures</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Protection of human and animal subjects</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Confidentiality of data</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Right to privacy and informed consent</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres525249"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec545486"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres525248"
          "titulo" => "Resumo"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec545487"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Results"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Definition and epidemiology of sudden cardiac death"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Causes of sudden cardiac death"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Definition of sports and of athletes"
            ]
            3 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Use of implantable cardioverter-defibrillators in athletes"
            ]
            4 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Specific risks associated with implantable cardioverter-defibrillators in athletes"
            ]
            5 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "New studies and controversy"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Limitations"
        ]
        9 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conclusions"
        ]
        10 => array:3 [
          "identificador" => "sec0065"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        11 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Conflicts of interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-10-15"
    "fechaAceptado" => "2014-11-15"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec545486"
          "palabras" => array:6 [
            0 => "Implantable cardioverter-defibrillator"
            1 => "Sudden cardiac death"
            2 => "Arrhythmia"
            3 => "Athlete"
            4 => "Sports"
            5 => "Disqualification"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec545487"
          "palabras" => array:6 [
            0 => "Cardioversor desfibrilhador implant&#225;vel"
            1 => "Morte s&#250;bita card&#237;aca"
            2 => "Arritmia"
            3 => "Atletas"
            4 => "Desporto"
            5 => "Desqualifica&#231;&#227;o"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">International guidelines exclude athletes with implantable cardioverter-defibrillators &#40;ICDs&#41; from participating in sports&#44; except those of low intensity &#40;category IA&#44; such as golf&#44; billiards or bowling&#41;&#46; However&#44; these guidelines are based on expert consensus&#44; and thus the safety and risks of participating in sports in this population are still largely unknown in the medical community&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a systematic review of the literature in PubMed using the following search string&#58; &#8220;&#40;&#40;sudden cardiac death&#41; AND &#40;sport OR physical exercise&#41;&#41; AND defibrillator&#8221;&#46; After the application of pre-defined inclusion and exclusion criteria&#44; 36 results were selected&#44; which are explored in this paper&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Preliminary results on ICD use in this population appear to demonstrate the safety and efficacy of the device in this context&#46; Further studies&#44; with longer follow-up and with larger samples&#44; may provide stronger evidence to support these findings&#46; In the meantime&#44; disqualifying almost all ICD patients from participating in sports&#44; without taking into consideration their individual needs and characteristics&#44; may be prejudicial to a considerable number of patients by preventing them from exercising their profession or engaging in recreational sport&#44; for which their risk of sudden cardiac death may be low&#46;</p></span>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">As recomenda&#231;&#245;es internacionais excluem todos os atletas possuidores de um cardioversor desfibrilhador implant&#225;vel &#40;CDI&#41; da pr&#225;tica de todos os desportos exceto os de baixa intensidade&#44; inseridos na categoria IA &#40;golfe&#44; bilhar&#44; <span class="elsevierStyleItalic">bowling</span>&#41;&#46; No entanto&#44; estas recomenda&#231;&#245;es s&#227;o baseadas em consensos de peritos e a seguran&#231;a ou riscos resultantes da pr&#225;tica desportiva nesta popula&#231;&#227;o ainda s&#227;o largamente desconhecidos da comunidade m&#233;dica&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Foi realizada uma revis&#227;o sistem&#225;tica da literatura existente na PubMed utilizando a seguinte express&#227;o&#58; &#171;&#40;<span class="elsevierStyleItalic">sudden cardiac death</span>&#41; AND &#40;<span class="elsevierStyleItalic">sport OR physical exercise</span>&#41; AND <span class="elsevierStyleItalic">defibrillator</span>&#187;&#46; Ap&#243;s a avalia&#231;&#227;o de crit&#233;rios de inclus&#227;o e exclus&#227;o pr&#233;-definidos&#44; foram selecionados 36 resultados que s&#227;o explorados neste manuscrito&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Aesultados preliminares da utiliza&#231;&#227;o de CDI nesta popula&#231;&#227;o parecem atestar a sua seguran&#231;a e efic&#225;cia&#46; Estudos futuros&#44; permitindo o seguimento de um maior n&#250;mero de desportistas por um per&#237;odo mais duradouro&#44; poder&#227;o fornecer mais robustez e evid&#234;ncia mais forte a suportar estes achados&#46; Entretanto&#44; a abordagem ao desportista portador de CDI deve ser personalizada e adequada ao paciente&#44; de acordo com a cardiopatia e tipo de desporto em quest&#227;o&#46; Uma abordagem generalista com desqualifica&#231;&#227;o de quase todos os desportistas sem atender &#224;s suas especificidades pode prejudicar uma quantidade consider&#225;vel de doentes aos quais ser&#225; vedada a possibilidade de manter a sua profiss&#227;o ou pr&#225;tica&#44; para a qual poderiam eventualmente apresentar um risco baixo de morte s&#250;bita card&#237;aca&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Liz Almeida R&#44; Provid&#234;ncia R&#44; Gon&#231;alves L&#46; Utiliza&#231;&#227;o de cardioversores desfibrilhadores implant&#225;veis em desportistas&#58; revis&#227;o sistem&#225;tica&#46; Rev Port Cardiol&#46; 2015&#59;34&#58;411&#8211;419&#46;</p>"
      ]
    ]
    "nomenclatura" => array:1 [
      0 => array:3 [
        "identificador" => "nom0005"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0025">List of abbreviations</span>"
        "listaDefinicion" => array:1 [
          0 => array:1 [
            "definicion" => array:8 [
              0 => array:2 [
                "termino" => "ARVD"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">arrhythmogenic right ventricular dysplasia</p>"
              ]
              1 => array:2 [
                "termino" => "BC&#35;36"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">36th Bethesda Conference</p>"
              ]
              2 => array:2 [
                "termino" => "DCM"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">dilated cardiomyopathy</p>"
              ]
              3 => array:2 [
                "termino" => "ESC"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">European Society of Cardiology</p>"
              ]
              4 => array:2 [
                "termino" => "ICD"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">implantable cardioverter-defibrillator</p>"
              ]
              5 => array:2 [
                "termino" => "HCM"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">hypertrophic cardiomyopathy</p>"
              ]
              6 => array:2 [
                "termino" => "SCD"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">sudden cardiac death</p>"
              ]
              7 => array:2 [
                "termino" => "ACC&#47;AHA"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">American College of Cardiology&#47;American Heart Association</p>"
              ]
            ]
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2479
            "Ancho" => 2625
            "Tamanyo" => 362531
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Diagram illustrating the study selection process&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tablaImagen" => array:1 [
                0 => array:4 [
                  "imagenFichero" => "fx1.jpeg"
                  "imagenAlto" => 1673
                  "imagenAncho" => 2778
                  "imagenTamanyo" => 393113
                ]
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Classification of sports &#40;adapted from Maron et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a>&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ARVD&#58; arrhythmogenic right ventricular dysplasia&#59; HCM&#58; hypertrophic cardiomyopathy&#59; LVH&#58; left ventricular hypertrophy&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of athletes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HCM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Commotio cordis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Coronary artery anomalies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LVH of indeterminate causation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Myocarditis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ruptured aortic aneurysm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ARVD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Myocardial bridging&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Aortic valve stenosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Atherosclerotic coronary artery disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Dilated cardiomyopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Myxomatous mitral valve degeneration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Asthma &#40;or other pulmonary condition&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Heat stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Drug abuse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Other cardiovascular cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Long QT syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Cardiac sarcoidosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Trauma involving structural cardiac injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ruptured cerebral artery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab847216.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Causes of sudden death in 387 young athletes &#40;adapted from Maron et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a>&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ARVD&#58; arrhythmogenic right ventricular dysplasia&#59; DCM&#58; dilated cardiomyopathy&#59; ICD&#58; implantable cardioverter-defibrillator&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Increased exercise-induced ventricular arrhythmias</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Fear of ICD failure to defibrillate under athletic conditions</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Worsening of ARVD and DCM</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Increased inappropriate shocks due to sinus or supraventricular tachycardia or atrial fibrillation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Injury due to momentary loss of consciousness and&#47;or control due to arrhythmia or ICD shock</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Damage to ICD mechanism&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#46; Lead fracture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#46; Generator migration or pocket erosion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#46; Traumatic damage to or destruction of generator or reset&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Lack of evidence of ICD effectiveness under conditions of intense exercise</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab847217.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Factors affecting the use of implantable cardioverter-defibrillators in athletes &#40;adapted from Lawless et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a>&#41;&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">ICD&#58; implantable cardioverter-defibrillator&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main findings and conclusions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Limitations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lampert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">614 physicians involved in assessing athletes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">- Only 10&#37; followed the guidelines strictly- More than two-thirds based restrictions on patients&#8217; underlying heart disease- Many patients with ICDs continue to participate in vigorous and even competitive sports&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">- A survey&#44; not a prospective study- Participants were self-selected- Responses may not reflect the opinions of all physician members of the Heart Rhythm Society- Recollection of events may have been selective- Factors potentially predisposing to shocks were not determined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lampert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">372 athletes with ICDs&#44; 137 highly competitive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Many athletes with ICDs can engage in vigorous competitive sports without increased risk of arrhythmia or of damage to the ICD system&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">- Study participants were self-selected- Most subjects had excellent ejection fractions- Not all shocks were reported immediately&#44; some only at six-monthly follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Saarel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 competitive athletes with ICDs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sports-related complications &#40;n&#61;0&#44; 0&#37;&#41;&#44; appropriate shocks &#40;n&#61;7&#44; 33&#37;&#41; and inappropriate shocks &#40;n&#61;1&#44; 5&#37;&#41; were rare- Patients chose to continue to participate because it appeared to be safe to do so&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">- Small sample&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab847215.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Main studies assessing the use of implantable cardioverter-defibrillators in athletes&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:37 [
            0 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exercise and competitive sports in patients with an implantable cardioverter-defibrillator"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Heidbuchel"
                            1 => "F&#46; Carre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehu130"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2014"
                        "volumen" => "35"
                        "numero" => "44"
                        "paginaInicial" => "3097"
                        "paginaFinal" => "3102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24713647"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "36th Bethesda Conference&#58; eligibility recommendations for competitive athletes with cardiovascular abnormalities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;J&#46; Maron"
                            1 => "D&#46;P&#46; Zipes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2005"
                        "volumen" => "45"
                        "paginaInicial" => "1313"
                        "paginaFinal" => "1375"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implantable cardioverter defibrillators in athletes&#58; rationale for use and issues surrounding return to play"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46;E&#46; Lawless"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Sports Med Rep"
                        "fecha" => "2008"
                        "volumen" => "7"
                        "paginaInicial" => "86"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22908402"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators&#58; calendar year 2009 &#8211; a World Society of Arrhythmia&#39;s project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46;G&#46; Mond"
                            1 => "A&#46; Proclemer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1540-8159.2011.03150.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pacing Clin Electrophysiol"
                        "fecha" => "2011"
                        "volumen" => "34"
                        "paginaInicial" => "1013"
                        "paginaFinal" => "1027"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21707667"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety of sports participation in patients with implantable cardioverter defibrillators&#58; a survey of heart rhythm society members"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Lampert"
                            1 => "D&#46; Cannom"
                            2 => "B&#46; Olshansky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1540-8167.2005.00331.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cardiovasc Electrophysiol"
                        "fecha" => "2006"
                        "volumen" => "17"
                        "paginaInicial" => "11"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16426392"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACC&#47;AHA&#47;ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death&#58; a report of the American College of Cardiology&#47;American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines &#40;Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death&#41;&#58; developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;P&#46; Zipes"
                            1 => "A&#46;J&#46; Camm"
                            2 => "M&#46; Borggrefe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.106.178233"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2006"
                        "volumen" => "114"
                        "paginaInicial" => "e385"
                        "paginaFinal" => "e484"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16935995"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sudden cardiac death"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;P&#46; Zipes"
                            1 => "H&#46;J&#46;J&#46; Wellens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1998"
                        "volumen" => "98"
                        "paginaInicial" => "2334"
                        "paginaFinal" => "2351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9826323"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does sports activity enhance the risk of sudden death in adolescents and young adults&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Corrado"
                            1 => "C&#46; Basso"
                            2 => "G&#46; Rizzoli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2003"
                        "volumen" => "42"
                        "paginaInicial" => "1959"
                        "paginaFinal" => "1963"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14662259"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002914912022850"
                          "estado" => "S300"
                          "issn" => "00029149"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of sudden cardiac death in athletes&#58; a state-of-the-art review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46;G&#46; Harmon"
                            1 => "J&#46;A&#46; Drezner"
                            2 => "M&#46;G&#46; Wilson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Heart"
                        "fecha" => "2014"
                        "paginaInicial" => "1227"
                        "paginaFinal" => "1234"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long- and short-term risk of sudden coronary death"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;A&#46; Cupples"
                            1 => "D&#46;R&#46; Gagnon"
                            2 => "W&#46;B&#46; Kannel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1992"
                        "volumen" => "85"
                        "numero" => "1 Suppl&#46;"
                        "paginaInicial" => "I11"
                        "paginaFinal" => "I18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1370216"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sudden death in young athletes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;J&#46; Maron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMra022783"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2003"
                        "volumen" => "349"
                        "paginaInicial" => "1064"
                        "paginaFinal" => "1075"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12968091"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Corrado"
                            1 => "C&#46; Basso"
                            2 => "A&#46; Pavei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.296.13.1593"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2006"
                        "volumen" => "296"
                        "paginaInicial" => "1593"
                        "paginaFinal" => "1601"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17018804"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and clinical meaning of isolated increase of QRS voltages in hypertrophic cardiomyopathy versus athlete&#39;s heart&#58; relevance to athletic screening"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Calore"
                            1 => "P&#46; Melacini"
                            2 => "A&#46; Pelliccia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2013.06.123"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2013"
                        "volumen" => "168"
                        "paginaInicial" => "4494"
                        "paginaFinal" => "4497"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23928341"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The editor&#39;s roundtable&#58; sudden cardiac death in athletes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46;E&#46; Friedewald"
                            1 => "B&#46;J&#46; Maron"
                            2 => "W&#46;C&#46; Roberts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2007.07.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2007"
                        "volumen" => "100"
                        "paginaInicial" => "1451"
                        "paginaFinal" => "1459"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17950807"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bethesda Conference &#35;36 and the European Society of Cardiology Consensus Recommendations revisited a comparison of U&#46;S&#46; and European criteria for eligibility and disqualification of competitive athletes with cardiovascular abnormalities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Pelliccia"
                            1 => "D&#46;P&#46; Zipes"
                            2 => "B&#46;J&#46; Maron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.08.055"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "1990"
                        "paginaFinal" => "1996"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19055990"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Task Force 8&#58; classification of sports"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;H&#46; Mitchell"
                            1 => "W&#46; Haskell"
                            2 => "P&#46; Snell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2005.02.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2005"
                        "volumen" => "45"
                        "paginaInicial" => "1364"
                        "paginaFinal" => "1367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15837288"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improving survival from sudden cardiac arrest&#58; the role of the automated external defibrillator"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;P&#46; Marenco"
                            1 => "P&#46;J&#46; Wang"
                            2 => "M&#46;S&#46; Link"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2001"
                        "volumen" => "285"
                        "paginaInicial" => "1193"
                        "paginaFinal" => "1200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11231750"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673610607465"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46;D&#46; Valenzuela"
                            1 => "D&#46;J&#46; Roe"
                            2 => "G&#46; Nichol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM200010263431701"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2000"
                        "volumen" => "343"
                        "paginaInicial" => "1206"
                        "paginaFinal" => "1209"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11071670"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673612614226"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implantable cardioverter-defibrillators&#58; expanding indications and technologies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Z&#46; Goldberger"
                            1 => "R&#46; Lampert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.295.7.809"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2006"
                        "volumen" => "295"
                        "paginaInicial" => "809"
                        "paginaFinal" => "818"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16478904"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Update of the guidelines on sudden cardiac death of the European Society of Cardiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;G&#46; Priori"
                            1 => "E&#46; Aliot"
                            2 => "C&#46; Blomstrom-Lundqvist"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "13"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12559931"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implantable cardioverter defibrillator therapy in athletes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; Heidb&#252;chel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ccl.2007.07.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiol Clin"
                        "fecha" => "2007"
                        "volumen" => "25"
                        "paginaInicial" => "467"
                        "paginaFinal" => "482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17961801"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of sympathetic activation on ventricular ectopic beats in subjects with and without evidence of organic heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Lombardi"
                            1 => "G&#46; Malfatto"
                            2 => "A&#46; Belloni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "1987"
                        "volumen" => "8"
                        "paginaInicial" => "1065"
                        "paginaFinal" => "1074"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2445568"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcome and risk stratification in dilated cardiolaminopathies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Pasotti"
                            1 => "C&#46; Klersy"
                            2 => "A&#46; Pilotto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.06.044"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "1250"
                        "paginaFinal" => "1260"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18926329"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exercise increases age-related penetrance and arrhythmic risk in arrhythmogenic right ventricular dysplasia&#47;cardiomyopathy-associated desmosomal mutation carriers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;A&#46; James"
                            1 => "A&#46; Bhonsale"
                            2 => "C&#46; Tichnell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2013.06.033"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2013"
                        "volumen" => "62"
                        "paginaInicial" => "1290"
                        "paginaFinal" => "1297"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23871885"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recommendations for competitive sports participation in athletes with cardiovascular disease&#58; a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Pelliccia"
                            1 => "R&#46; Fagard"
                            2 => "H&#46;H&#46; Bjornstad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehi325"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "1422"
                        "paginaFinal" => "1445"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15923204"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety of sports for athletes with implantable cardioverter-defibrillators&#58; results of a prospective&#44; multinational registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Lampert"
                            1 => "B&#46; Olshansky"
                            2 => "H&#46; Heidbuchel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.112.000447"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2013"
                        "volumen" => "127"
                        "paginaInicial" => "2021"
                        "paginaFinal" => "2030"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23690453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcome after ICD and CRT implantation and influence of remote device follow-up&#58; the ALTITUDE survival study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46;A&#46; Saxon"
                            1 => "D&#46;L&#46; Hayes"
                            2 => "F&#46;R&#46; Gilliam"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.110.960633"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2010"
                        "volumen" => "122"
                        "paginaInicial" => "2359"
                        "paginaFinal" => "2367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21098452"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results of a multicenter retrospective implantable cardioverter-defibrillator registry of pediatric and congenital heart disease patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;I&#46; Berul"
                            1 => "G&#46;F&#46; Van Hare"
                            2 => "N&#46;J&#46; Kertesz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.01.033"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2008"
                        "volumen" => "51"
                        "paginaInicial" => "1685"
                        "paginaFinal" => "1691"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18436121"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development and validation of a risk score to predict early mortality in recipients of implantable cardioverter-defibrillators"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;B&#46; Kramer"
                            1 => "P&#46;A&#46; Friedman"
                            2 => "L&#46;M&#46; Kallinen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hrthm.2011.08.031"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Rhythm"
                        "fecha" => "2012"
                        "volumen" => "9"
                        "paginaInicial" => "42"
                        "paginaFinal" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21893137"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Forced retirement from elite football in Australia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "V&#46; Fortunato"
                            1 => "D&#46; Marchant"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pers Interpers Loss"
                        "fecha" => "1999"
                        "volumen" => "4"
                        "paginaInicial" => "269"
                        "paginaFinal" => "280"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sports for young patients with implantable cardioverter-defibrillators&#58; refining the risk"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46; Saarel"
                            1 => "T&#46; Pilcher"
                            2 => "D&#46; Gamboa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2014"
                        "volumen" => "6"
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673606694208"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient empowerment&#58; myths and misconceptions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;M&#46; Anderson"
                            1 => "M&#46;M&#46; Funnell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pec.2009.07.025"
                      "Revista" => array:7 [
                        "tituloSerie" => "Patient Educ Couns"
                        "fecha" => "2010"
                        "volumen" => "79"
                        "paginaInicial" => "277"
                        "paginaFinal" => "282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19682830"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S2213858714700579"
                          "estado" => "S300"
                          "issn" => "22138587"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Shared decision making &#8211; pinnacle of patient-centered care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;J&#46; Barry"
                            1 => "S&#46; Edgman-Levitan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMp1109283"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2012"
                        "volumen" => "366"
                        "paginaInicial" => "780"
                        "paginaFinal" => "781"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22375967"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Doctor&#8211;patient relationship&#58; from medical paternalism to enhanced autonomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;J&#46; Chin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Singapore Med J"
                        "fecha" => "2002"
                        "volumen" => "43"
                        "paginaInicial" => "152"
                        "paginaFinal" => "155"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12005343"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sports participation for athletes with implantable cardioverter-defibrillators should be an individualized risk-benefit decision"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Lampert"
                            1 => "D&#46; Cannom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hrthm.2008.01.024"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Rhythm"
                        "fecha" => "2008"
                        "volumen" => "5"
                        "paginaInicial" => "861"
                        "paginaFinal" => "863"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18534371"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality of life in the antiarrhythmics versus implantable defibrillators trial&#58; impact of therapy and influence of adverse symptoms and defibrillator shocks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;B&#46; Schron"
                            1 => "D&#46;V&#46; Exner"
                            2 => "Q&#46; Yao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2002"
                        "volumen" => "105"
                        "paginaInicial" => "589"
                        "paginaFinal" => "594"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11827924"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European guidelines on cardiovascular disease prevention in clinical practice&#58; executive summary&#46; Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice &#40;constituted by representatives of nine societies and by invited experts&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I&#46; Graham"
                            1 => "D&#46; Atar"
                            2 => "K&#46; Borch-Johnsen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.hjr.0000277984.31558.c4"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur J Cardiovasc Prev Rehabil"
                        "fecha" => "2007"
                        "volumen" => "14"
                        "numero" => "Suppl&#46; 2"
                        "paginaInicial" => "E1"
                        "paginaFinal" => "E40"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17726406"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003400000006/v1_201506200223/S2174204915001166/v1_201506200223/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9924"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Review Article"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003400000006/v1_201506200223/S2174204915001166/v1_201506200223/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001166?idApp=UINPBA00004E"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Review article
Use of implantable cardioverter-defibrillators in athletes: A systematic review
Utilização de cardioversores desfibrilhadores implantáveis em desportistas: revisão sistemática
Ricardo Liz Almeidaa, Rui Providênciaa,b,
Corresponding author
rui_providencia@yahoo.com

Corresponding author.
, Lino Gonçalvesa,b
a Universidade de Coimbra, Faculdade de Medicina, Coimbra, Portugal
b Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Read
8119
Times
was read the article
2278
Total PDF
5841
Total HTML
Share statistics
 array:25 [
  "pii" => "S2174204915001166"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2015.05.004"
  "estado" => "S300"
  "fechaPublicacion" => "2015-06-01"
  "aid" => "608"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "ssu"
  "cita" => "Rev Port Cardiol. 2015;34:411-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4240
    "formatos" => array:3 [
      "EPUB" => 198
      "HTML" => 3150
      "PDF" => 892
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:20 [
      "pii" => "S0870255115000438"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2014.11.007"
      "estado" => "S300"
      "fechaPublicacion" => "2015-06-01"
      "aid" => "608"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "ssu"
      "cita" => "Rev Port Cardiol. 2015;34:411-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4680
        "formatos" => array:3 [
          "EPUB" => 185
          "HTML" => 3627
          "PDF" => 868
        ]
      ]
      "pt" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Artigo de Revis&#227;o</span>"
        "titulo" => "Utiliza&#231;&#227;o de cardioversores desfibrilhadores implant&#225;veis em desportistas&#58; revis&#227;o sistem&#225;tica"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "tieneResumen" => array:2 [
          0 => "pt"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "411"
            "paginaFinal" => "419"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Use of implantable cardioverter&#8208;defibrillators in athletes&#58; A systematic review"
          ]
        ]
        "contieneResumen" => array:2 [
          "pt" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 2479
                "Ancho" => 2623
                "Tamanyo" => 345268
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Diagrama ilustrando a sele&#231;&#227;o dos estudos&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Ricardo Liz Almeida, Rui Provid&#234;ncia, Lino Gon&#231;alves"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Ricardo"
                "apellidos" => "Liz Almeida"
              ]
              1 => array:2 [
                "nombre" => "Rui"
                "apellidos" => "Provid&#234;ncia"
              ]
              2 => array:2 [
                "nombre" => "Lino"
                "apellidos" => "Gon&#231;alves"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204915001166"
          "doi" => "10.1016/j.repce.2015.05.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001166?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115000438?idApp=UINPBA00004E"
      "url" => "/08702551/0000003400000006/v1_201506170141/S0870255115000438/v1_201506170141/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2174204915001129"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2014.11.007"
    "estado" => "S300"
    "fechaPublicacion" => "2015-06-01"
    "aid" => "610"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Rev Port Cardiol. 2015;34:421&#46;e1-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4228
      "formatos" => array:3 [
        "EPUB" => 160
        "HTML" => 3219
        "PDF" => 849
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Recurrent constrictive pericarditis&#58; A diagnostic and therapeutic challenge"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "421&#46;e1"
          "paginaFinal" => "421&#46;e5"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Pericardite constritiva recorrente &#8211; um desafio diagn&#243;stico e terap&#234;utico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 649
              "Ancho" => 1950
              "Tamanyo" => 133985
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Coronary angiography showing no coronary artery disease and marked calcification of the cardiac silhouette&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Raquel Ferreira, Anabela Gonzaga, Lu&#237;s Santos, Jos&#233; Ant&#243;nio Santos"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Raquel"
              "apellidos" => "Ferreira"
            ]
            1 => array:2 [
              "nombre" => "Anabela"
              "apellidos" => "Gonzaga"
            ]
            2 => array:2 [
              "nombre" => "Lu&#237;s"
              "apellidos" => "Santos"
            ]
            3 => array:2 [
              "nombre" => "Jos&#233; Ant&#243;nio"
              "apellidos" => "Santos"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255115000451"
        "doi" => "10.1016/j.repc.2014.11.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115000451?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001129?idApp=UINPBA00004E"
    "url" => "/21742049/0000003400000006/v1_201506200223/S2174204915001129/v1_201506200223/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2174204915001348"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2015.01.006"
    "estado" => "S300"
    "fechaPublicacion" => "2015-06-01"
    "aid" => "639"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2015;34:403-10"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2722
      "formatos" => array:3 [
        "EPUB" => 180
        "HTML" => 1894
        "PDF" => 648
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Impact of atrial fibrillation type during acute coronary syndromes&#58; Clinical features and prognosis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "403"
          "paginaFinal" => "410"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Impacto do tipo de fibrilha&#231;&#227;o auricular no contexto das s&#237;ndromes coron&#225;rias agudas &#8211; caracter&#237;sticas cl&#237;nicas e progn&#243;stico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1181
              "Ancho" => 1646
              "Tamanyo" => 119342
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier survival curves for patients with new-onset AF&#44; pre-existing AF and without AF&#46; AF&#58; atrial fibrillation&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Carlos Galv&#227;o Braga, V&#237;tor Ramos, Juliana Martins, Carina Arantes, Gl&#243;ria Abreu, Catarina Vieira, Alberto Salgado, Ant&#243;nio Gaspar, Pedro Azevedo, Miguel &#193;lvares Pereira, S&#243;nia Magalh&#227;es, Jorge Marques"
          "autores" => array:12 [
            0 => array:2 [
              "nombre" => "Carlos Galv&#227;o"
              "apellidos" => "Braga"
            ]
            1 => array:2 [
              "nombre" => "V&#237;tor"
              "apellidos" => "Ramos"
            ]
            2 => array:2 [
              "nombre" => "Juliana"
              "apellidos" => "Martins"
            ]
            3 => array:2 [
              "nombre" => "Carina"
              "apellidos" => "Arantes"
            ]
            4 => array:2 [
              "nombre" => "Gl&#243;ria"
              "apellidos" => "Abreu"
            ]
            5 => array:2 [
              "nombre" => "Catarina"
              "apellidos" => "Vieira"
            ]
            6 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Salgado"
            ]
            7 => array:2 [
              "nombre" => "Ant&#243;nio"
              "apellidos" => "Gaspar"
            ]
            8 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Azevedo"
            ]
            9 => array:2 [
              "nombre" => "Miguel"
              "apellidos" => "&#193;lvares Pereira"
            ]
            10 => array:2 [
              "nombre" => "S&#243;nia"
              "apellidos" => "Magalh&#227;es"
            ]
            11 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Marques"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0870255115001225"
        "doi" => "10.1016/j.repc.2015.01.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001225?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001348?idApp=UINPBA00004E"
    "url" => "/21742049/0000003400000006/v1_201506200223/S2174204915001348/v1_201506200223/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>"
    "titulo" => "Use of implantable cardioverter-defibrillators in athletes&#58; A systematic review"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "411"
        "paginaFinal" => "419"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Ricardo Liz Almeida, Rui Provid&#234;ncia, Lino Gon&#231;alves"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "Ricardo"
            "apellidos" => "Liz Almeida"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "Rui"
            "apellidos" => "Provid&#234;ncia"
            "email" => array:1 [
              0 => "rui&#95;providencia&#64;yahoo&#46;com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Lino"
            "apellidos" => "Gon&#231;alves"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Universidade de Coimbra&#44; Faculdade de Medicina&#44; Coimbra&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servi&#231;o de Cardiologia&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#44; Coimbra&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Utiliza&#231;&#227;o de cardioversores desfibrilhadores implant&#225;veis em desportistas&#58; revis&#227;o sistem&#225;tica"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2479
            "Ancho" => 2625
            "Tamanyo" => 362531
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Diagram illustrating the study selection process&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0045" class="elsevierStylePara elsevierViewall">Sudden cardiac death &#40;SCD&#41; in athletes&#44; its prevention by means of implantable cardioverter-defibrillators &#40;ICDs&#41;&#44; and whether athletes with ICDs should be disqualified from participating in competitive sport&#44; are currently the subject of intense controversy&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The recommendations of the 36th Bethesda Conference &#40;BC&#35;36&#41;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> and the European Society of Cardiology &#40;ESC&#41;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">25</span></a> exclude athletes with ICDs from all but low-intensity sports &#40;category IA of the BC&#35;36 classification<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a>&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; These recommendations are based on the perceived risks&#44; including failure of the device to deliver appropriate therapies&#44; injury resulting from loss of consciousness or control caused by an ICD shock or the arrhythmia itself&#44; and damage to the device or leads&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> The guidelines were developed on the basis of expert consensus rather than on the results of studies&#44; and there is as yet no solid evidence concerning the actual risks to ICD patients arising from participation in competitive sports&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Implantation of ICDs has grown exponentially in recent decades&#44; often in individuals with normal myocardial function but with genetic mutations that could lead to fatal arrhythmias&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> The result is an increasing number of young individuals with ICDs&#44; many of whom are athletes and&#44; according to the guidelines&#44; should be disqualified from participating in competitive sports&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">2&#44;25</span></a> The problem is even more serious for professional athletes who are thereby prevented from exercising their profession and suffer the inevitable consequences&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Despite the existence of the guidelines&#44; according to a 2006 survey&#44; many clinicians do not follow them and opt to make their decisions based on the individual athlete&#44; medical condition and sport concerned&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a> In recent years&#44; the subject has been explored by some centers&#59; their findings may support evidence-based decision-making and lead to changes in the management of these patients&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The aim of the present study is to systematically review the state of the art in this area&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Methods</span><p id="par0070" class="elsevierStylePara elsevierViewall">The review was based on information in articles indexed in MEDLINE &#40;via PubMed&#41; using the following search string&#58; &#8220;&#40;&#40;sudden cardiac death&#41; AND &#40;sport OR physical exercise&#41;&#41; AND defibrillator&#8221;&#46; Filters were defined to restrict searches to articles in English&#44; Portuguese or Spanish&#44; with available abstracts&#44; published between 1985 and 2014&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Articles were selected on the basis of their abstract&#44; which was used to assess their relevance and whether they were likely to meet the inclusion and exclusion criteria defined below&#46; The full text of each relevant article was read to determine whether it was to be included&#46; The inclusion criteria were&#58; &#40;1&#41; research on individuals with ICDs who participate in sports&#44; whether &#40;a&#41; only athletes with ICDs&#44; &#40;b&#41; athletes and non-athletes with ICDs&#44; or &#40;c&#41; athletes with and without ICDs&#59; &#40;2&#41; registries characterizing epidemiological aspects of SCD in athletes&#59; &#40;3&#41; consensus documents and international guidelines on the subject&#46; Letters to the Editor&#44; case reports&#44; and review articles that did not provide new observational data were excluded&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Additional searches were performed with alternative search strings in different search engines&#44; including Sci-Hub and B-on&#44; and the reference lists of the selected articles were consulted to identify other potentially relevant material&#44; which was analyzed using the same inclusion and exclusion criteria&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">The search string produced a total of 378 results&#44; of which 340 were excluded after a reading of the abstract indicated they were not relevant to the current review&#46; The remaining 38 manuscripts&#44; together with others identified from other sources&#44; were analyzed using the same inclusion and exclusion criteria and a total of 36 were selected for the review&#58; 35 articles<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">3&#8211;30&#44;32&#8211;36</span></a> and a poster presented at a congress&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a> The selection process is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Definition and epidemiology of sudden cardiac death</span><p id="par0090" class="elsevierStylePara elsevierViewall">SCD&#44; mainly caused by malignant ventricular arrhythmias&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a> is one of the leading causes &#40;&#62;50&#37;&#41; of cardiovascular death worldwide&#46; It is defined as unexpected natural death from a cardiac cause within a short time period&#44; generally &#8804;1 hour from the onset of symptoms&#44; in a person without any prior condition that would appear fatal&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a> Although rare in the young&#44; participation in competitive sports increases the risk of SCD<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a>&#59; the annual incidence of SCD in athletes aged &#60;35 years is reported as 1&#58;100<span class="elsevierStyleHsp" style=""></span>000&#8211;300<span class="elsevierStyleHsp" style=""></span>000&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a> although recent studies have suggested that this is an underestimate and that 1&#58;50<span class="elsevierStyleHsp" style=""></span>000 is more realistic&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a> It is more common in males&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Causes of sudden cardiac death</span><p id="par0095" class="elsevierStylePara elsevierViewall">The fatal event is usually caused by rhythm disturbances&#44; particularly tachyarrhythmias such as ventricular fibrillation&#46; The arrhythmia may have various causes &#40;ischemia&#44; primary arrhythmia&#44; rapid atrioventricular conduction&#41;&#44; but the common denominator is electrical instability<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The most common cause of SCD in young athletes is hypertrophic cardiomyopathy &#40;HCM&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a> although in a study in the region of Veneto&#44; Italy&#44; the leading cause was arrhythmogenic right ventricular dysplasia &#40;ARVD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a> This may be explained by regional differences between Europe and the USA and by the different screening methods used in Italy&#44; where all competitive athletes aged under 35 undergo testing consisting of a thorough clinical and family history&#44; physical examination and 12-lead ECG&#46; Such screening is more likely to detect HCM &#40;in which over 95&#37; of cases present a pathological ECG&#41; than ARVD&#44; most cases of which are only diagnosed on autopsy and which contribute significantly to mortality in young athletes&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> In athletes aged over 35&#44; the leading cause of SCD is atherosclerotic coronary disease&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Definition of sports and of athletes</span><p id="par0105" class="elsevierStylePara elsevierViewall">According to the BC&#35;36&#44; a competitive athlete is defined as one who participates in a team or individual sport&#44; competes regularly&#44; and undergoes systematic training &#40;usually intense&#41; to achieve excellence&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> A sport is an organized&#44; competitive&#44; entertaining&#44; and skillful activity requiring commitment&#44; strategy&#44; and fair play&#44; in which a winner can be defined by objective means&#46; It is governed by a set of rules or customs&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a> This definition does not include recreational or leisure activities&#44; since they are not competitive&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a> and according to the BC&#35;36 and ESC guidelines&#44; sport is considered more demanding than other recreational activities&#44; placing the individual at higher risk of a fatal arrhythmia&#46; However&#44; it should be borne in mind that some competitive sports may incur less risk than certain leisure activities&#59; for example&#44; competitive shooting is less likely to lead to SCD than amateur weightlifting&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> The BC&#35;36 recommendations accordingly classify sports by the intensity of their static and dynamic components &#40;low&#44; moderate or high&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; On this basis&#44; weightlifting has a large static component and running has a large dynamic component&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Use of implantable cardioverter-defibrillators in athletes</span><p id="par0110" class="elsevierStylePara elsevierViewall">The sooner defibrillation is performed&#44; the more effectively ventricular fibrillation can be terminated&#46; If the shock is delivered within 30 s&#44; there is a 90&#37; probability that it will be successful&#44; but this falls by 7&#37;&#8211;10&#37; for every minute that passes&#44; and if defibrillation is begun 10 min after the event the likelihood of resuscitation is only 10&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The location of an ICD means that it can interpret the cardiac rhythm and apply a shock almost immediately&#44; which leads to success rates of 95&#37;&#8211;99&#37;&#46; As a result&#44; in the last 20 years ICDs have become the gold standard treatment for ventricular arrhythmias&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The indications for ICD implantation in athletes in the ESC<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6&#44;20</span></a> and American College of Cardiology&#47;American Heart Association &#40;ACC&#47;AHA&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a> guidelines are similar to those for the general population&#46; The main complications are lead dislodgment or fracture&#44; inappropriate shocks&#44; and generator migration or pocket erosion&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The number of individuals with ICDs for primary prevention has risen sharply in recent years&#44; due to more widespread screening of families with a history of inherited arrhythmia syndromes&#44; channelopathies and cardiomyopathies&#44; as well as improved identification of silent mutation carriers&#46; As a consequence&#44; there are increasing numbers of apparently healthy and highly active individuals who&#44; due to their increased risk of suffering an arrhythmic event &#40;or to prevent recurrence&#41;&#44; have an ICD to prevent SCD&#44; which can be the first manifestation of disease&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Specific risks associated with implantable cardioverter-defibrillators in athletes</span><p id="par0130" class="elsevierStylePara elsevierViewall">There are various considerations specific to athletes that can affect the safety and efficacy of ICDs in this population and thus influence the decision whether they can resume their sporting activity after implantation &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> A major concern is that the ICD may not reliably defibrillate under athletic conditions&#44; because of physiological alterations such as increased circulating catecholamine levels&#44; leading to dehydration&#44; acidosis&#44; electrolyte disturbances and volume depletion&#44; which in turn make the occurrence and perpetuation of arrhythmias more likely&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a> There is little evidence on the efficacy of ICD shocks under the metabolic conditions of intense exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Furthermore&#44; strenuous exercise worsens certain conditions such as ARVD and dilated cardiomyopathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Another potential problem is that inappropriate shocks may be more frequent during exercise&#44; due to sinus or supraventricular tachycardia or atrial fibrillation&#46; Moreover&#44; an athlete &#40;and&#44; in the case of motor sports&#44; spectators&#41; may be injured as a result of transient loss of consciousness and&#47;or control due to arrhythmia or ICD shock&#46; In addition&#44; the ICD or leads may be damaged&#44; particularly due to repeated energetic arm movements&#44; as found in sports such as golf and boxing&#44; or to direct impacts on the ICD itself or the subclavian region &#40;&#8220;subclavian crush&#8221;&#41;&#44; as may occur in any contact sport&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> Finally&#44; those who argue that athletes with ICDs should be excluded from competition point out that inappropriate shocks can have a negative psychological effect on these individuals&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In light of the above&#44; current guidelines recommend that athletes with ICDs should be disqualified from all competitive sports except those with low static and dynamic components&#44; such as golf&#44; billiards or bowling &#40;category IA of the BC&#35;36 classification&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">New studies and controversy</span><p id="par0150" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> summarizes the main results of studies assessing the use of ICDs in athletes&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">A 2006 survey<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a> of physician members of the Heart Rhythm Society designed to assess the decisions being made regarding sports participation in patients with ICDs painted a very different picture from that to be expected from the guidelines&#58; of the 614 physicians who responded&#44; only 62 &#40;10&#37;&#41; followed the BC&#35;36 and ESC guidelines strictly by excluding patients from all sports except those in category IA&#44; while most &#40;n&#61;464&#59; 76&#37;&#41; only recommended avoidance of contact&#44; 273 &#40;45&#37;&#41; recommended avoidance of competitive sports&#44; and 71&#37; reported caring for patients who participated in sports&#44; including vigorous&#44; competitive sports&#46; More than two-thirds based restrictions on patients&#8217; underlying heart disease and not solely on the guidelines&#46; It is worth noting that 40&#37; of responders had over 10 years&#8217; experience with ICD patients&#46; Although a high proportion of patients participated in sports&#44; and shocks were common&#44; adverse events were rare&#46; Most complications were due to device failure such as lead fracture or migration attributed to repetitive arm movements &#40;n&#61;28&#41;&#44; most commonly weightlifting &#40;n&#61;16&#41;&#44; tennis &#40;n&#61;2&#41; and golf &#40;n&#61;5&#41;&#46; Interestingly&#44; the latter is classified as IA and thus not excluded by the guidelines&#46; While there was agreement that heart failure and ischemic heart disease should limit sports participation&#44; physicians disagree concerning long QT syndrome and Brugada syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In view of the observation that despite the guidelines&#44; ICD patients continue to take part in competitive sports&#44; Lampert et al&#46; established a multicenter international registry&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a> Participants were recruited via mailings to physicians and by direct communication with patients via patient group Internet sites and mailing lists&#46; Data were collected through telephone contact every six months and medical records were obtained from 41 sites in North America and 18 in Europe&#46; Patients were queried about shocks received&#44; sequelae&#44; preshock activity and any change in sports participation&#44; health or ICD status&#46; Of the 372 participants&#44; 328 were participating in organized sports and 44 were participating in high-risk sports&#46; Median age was 33 years and 33&#37; were female&#46; The most frequent diagnoses were long QT syndrome &#40;n&#61;73&#41;&#44; HCM &#40;n&#61;63&#41;&#44; and ARVD &#40;n&#61;55&#41;&#59; the most common sports were running &#40;n&#61;106&#41;&#44; soccer &#40;n&#61;69&#41; and basketball &#40;n&#61;56&#41;&#44; while the most common high-risk sport was skiing&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">During a median follow-up of 31 months&#44; there were no tachyarrhythmic deaths&#44; resuscitated cardiac arrests&#44; or injuries related to arrhythmias or shocks during sports participation&#46; There were 49 shocks in 37 participants &#40;10&#37; of the study population&#41; during competition&#47;practice&#44; 39 shocks in 29 participants &#40;8&#37;&#41; during other physical activity&#44; and 33 shocks in 24 participants &#40;6&#37;&#41; at rest&#46; More individuals received shocks during either competition&#47;practice or physical activity than during rest &#40;16&#37; vs&#46; 6&#37;&#59; p&#60;0&#46;0001&#41;&#44; but there was no significant difference between the proportion receiving a shock during competition&#47;practice and those receiving a shock during other physical activity &#40;10&#37; vs&#46; 8&#37;&#59; p&#61;0&#46;34&#41;&#46; Similarly&#44; the proportion receiving appropriate shocks during either competition&#47;practice or other physical activity was greater than the proportion receiving appropriate shocks during rest &#40;8&#37; vs&#46; 3&#37;&#59; p&#61;0&#46;006&#41;&#44; but there was no difference between competition&#47;practice and other physical activity &#40;6&#37; vs&#46; 4&#37;&#59; p&#61;0&#46;18&#41;&#46; Of a subgroup of 60 highly competitive athletes&#44; all &#8804;21 years of age&#44; 17 &#40;28&#37;&#41; experienced a total of 25 shocks&#46; In this subgroup there was no significant difference between the number of shocks in this subgroup during competition&#47;practice &#40;1&#37;&#41; and at rest &#40;4&#37;&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">There were no reported ICD malfunctions in 97&#37; of the participants at five years and in 90&#37; at 10 years&#46; Most &#40;70&#37;&#41; of athletes who received shocks during sports chose to continue playing&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">These findings suggest that many athletes can safely participate in various contact or high-intensity sports without risk of injury&#44; device damage&#44; or ineffective defibrillation&#46; Shock rates in the study population were generally similar to those in ICD patients who do not play sports or are less active&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">27&#44;28</span></a> The rate of lead failure or fracture was also similar to five-year rates seen in other populations &#40;85&#37;&#8211;98&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Disqualifying athletes with ICDs from sports can significantly affect their quality of life&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> particularly younger individuals&#44; who describe feelings of exclusion and being considered &#8216;not normal&#8217; as the main problem with having an ICD&#46; The fact that most athletes in the study continued to play even after receiving shocks suggests that the benefits of sport outweigh the negative impact that shocks may have&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Following publication of the above studies&#44; other researchers have set out to investigate further&#46; Saarel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a> recently presented preliminary results of a registry of 21 young patients with ICDs who choose to play competitive or dangerous sports greater than IA in both static and dynamic components&#46; Ten had congenital heart disease&#44; six had inherited arrhythmia syndromes and five had cardiomyopathy&#46; Mean follow-up was five years&#59; the most common sports were basketball and baseball&#46; There were no cardiac deaths and no increase in morbidity after four years&#46; One participant received two appropriate shocks for supraventricular tachycardia during a basketball game and subsequently retired from competitive sports&#59; no other participant suffered more frequent shocks&#44; appropriate or inappropriate&#44; during sports&#44; and no increase in device malfunction was reported&#46; All participants were under beta-blocker therapy to prevent inappropriate shocks due to sinus or ventricular tachycardia&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Discussion</span><p id="par0190" class="elsevierStylePara elsevierViewall">Recent studies<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">5&#44;26&#44;31</span></a> appear to show that participation in sports by ICD patients is not as harmful as previously thought&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The decision whether to disqualify athletes with ICDs should be taken on an individual basis&#46; In recent years&#44; there has been a growing trend in medicine towards patient-centered decision-making&#44; in which patients&#8217; motivations and preferences are taken more into account&#44; increasing their empowerment and role in decisions&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a> However&#44; it is important to avoid the opposite extreme&#44; in which the physician acts merely as a provider of information and the patient is given complete autonomy to take decisions&#44; irrespective of the physician&#39;s opinion&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">33&#44;34</span></a> The guidelines are still based largely on input from cardiologists as the main decision-makers&#44; and the question of the degree of empowerment that athletes with ICDs do or should have with regard to disqualification or retirement from sports is still an open one&#46; These patients require counseling&#44; taking the time to provide them with careful and clear explanations of the known risks of participation in sports&#44; and the benefits and risks of ICDs&#44; as well as aspects for which there is insufficient evidence&#44; and to answer any questions they may have&#44; in order to give them a greater sense of control and to enable joint and informed decisions&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">There is consensus among physicians that heart failure&#44; HCM and ischemic heart disease should limit participation in sports&#44; but this is not the case with long QT syndrome and Brugada syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> In HCM&#44; different sports&#44; such as football or boxing&#44; can be associated with different levels of risk&#46; In certain cases the decision is not likely to be difficult&#44; such as in left ventricular dysfunction with exercise-induced arrhythmia&#44; but in ICD patients without left ventricular dysfunction other factors need to be taken into consideration&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">Although ICD shocks can have a negative impact on quality of life&#44; exclusion from playing sports can have a similar or even worse effect&#46; Physical activity considerably reduces cardiovascular morbidity and mortality through a variety of mechanisms&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a> It should be stressed that in many cases the athlete will be forced to abandon their professional or recreational sports activity&#44; which can have severe personal repercussions&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Limitations</span><p id="par0210" class="elsevierStylePara elsevierViewall">This review has certain limitations&#46; Firstly&#44; there are few studies assessing the use of ICDs in athletes&#46; Secondly&#44; follow-up times for athletes with ICDs are short and there are no data on long-term efficacy and safety in this population&#46; Thirdly&#44; the use of automated external defibrillators was not examined&#44; since there is extensive evidence and consensus in the medical community on this subject&#46; Finally&#44; most of the results relate to devices with intravascular leads&#59; data on subcutaneous ICDs are still scarce&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0215" class="elsevierStylePara elsevierViewall">Management of athletes with ICDs should be individualized to the patient&#44; according to the heart disease and sport in question&#46; Disqualifying almost all ICD patients from participating in sports&#44; without taking into consideration their individual needs and characteristics&#44; may be prejudicial to a considerable number of patients by preventing them from exercising their profession or engaging in recreational sport&#44; for which their risk of sudden cardiac death may be low&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The BC&#35;36 guidelines are now 10 years old and based solely on expert consensus and the evidence available at the time&#46; Recent studies may lead to a revision of the guidelines&#59; however&#44; there is still little evidence and further studies will be needed to provide solid data and clear answers to the many questions in this area&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical disclosures</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Protection of human and animal subjects</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Confidentiality of data</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Right to privacy and informed consent</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres525249"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec545486"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres525248"
          "titulo" => "Resumo"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec545487"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Results"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Definition and epidemiology of sudden cardiac death"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Causes of sudden cardiac death"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Definition of sports and of athletes"
            ]
            3 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Use of implantable cardioverter-defibrillators in athletes"
            ]
            4 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Specific risks associated with implantable cardioverter-defibrillators in athletes"
            ]
            5 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "New studies and controversy"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Limitations"
        ]
        9 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conclusions"
        ]
        10 => array:3 [
          "identificador" => "sec0065"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        11 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Conflicts of interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-10-15"
    "fechaAceptado" => "2014-11-15"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec545486"
          "palabras" => array:6 [
            0 => "Implantable cardioverter-defibrillator"
            1 => "Sudden cardiac death"
            2 => "Arrhythmia"
            3 => "Athlete"
            4 => "Sports"
            5 => "Disqualification"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec545487"
          "palabras" => array:6 [
            0 => "Cardioversor desfibrilhador implant&#225;vel"
            1 => "Morte s&#250;bita card&#237;aca"
            2 => "Arritmia"
            3 => "Atletas"
            4 => "Desporto"
            5 => "Desqualifica&#231;&#227;o"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">International guidelines exclude athletes with implantable cardioverter-defibrillators &#40;ICDs&#41; from participating in sports&#44; except those of low intensity &#40;category IA&#44; such as golf&#44; billiards or bowling&#41;&#46; However&#44; these guidelines are based on expert consensus&#44; and thus the safety and risks of participating in sports in this population are still largely unknown in the medical community&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a systematic review of the literature in PubMed using the following search string&#58; &#8220;&#40;&#40;sudden cardiac death&#41; AND &#40;sport OR physical exercise&#41;&#41; AND defibrillator&#8221;&#46; After the application of pre-defined inclusion and exclusion criteria&#44; 36 results were selected&#44; which are explored in this paper&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Preliminary results on ICD use in this population appear to demonstrate the safety and efficacy of the device in this context&#46; Further studies&#44; with longer follow-up and with larger samples&#44; may provide stronger evidence to support these findings&#46; In the meantime&#44; disqualifying almost all ICD patients from participating in sports&#44; without taking into consideration their individual needs and characteristics&#44; may be prejudicial to a considerable number of patients by preventing them from exercising their profession or engaging in recreational sport&#44; for which their risk of sudden cardiac death may be low&#46;</p></span>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">As recomenda&#231;&#245;es internacionais excluem todos os atletas possuidores de um cardioversor desfibrilhador implant&#225;vel &#40;CDI&#41; da pr&#225;tica de todos os desportos exceto os de baixa intensidade&#44; inseridos na categoria IA &#40;golfe&#44; bilhar&#44; <span class="elsevierStyleItalic">bowling</span>&#41;&#46; No entanto&#44; estas recomenda&#231;&#245;es s&#227;o baseadas em consensos de peritos e a seguran&#231;a ou riscos resultantes da pr&#225;tica desportiva nesta popula&#231;&#227;o ainda s&#227;o largamente desconhecidos da comunidade m&#233;dica&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Foi realizada uma revis&#227;o sistem&#225;tica da literatura existente na PubMed utilizando a seguinte express&#227;o&#58; &#171;&#40;<span class="elsevierStyleItalic">sudden cardiac death</span>&#41; AND &#40;<span class="elsevierStyleItalic">sport OR physical exercise</span>&#41; AND <span class="elsevierStyleItalic">defibrillator</span>&#187;&#46; Ap&#243;s a avalia&#231;&#227;o de crit&#233;rios de inclus&#227;o e exclus&#227;o pr&#233;-definidos&#44; foram selecionados 36 resultados que s&#227;o explorados neste manuscrito&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Aesultados preliminares da utiliza&#231;&#227;o de CDI nesta popula&#231;&#227;o parecem atestar a sua seguran&#231;a e efic&#225;cia&#46; Estudos futuros&#44; permitindo o seguimento de um maior n&#250;mero de desportistas por um per&#237;odo mais duradouro&#44; poder&#227;o fornecer mais robustez e evid&#234;ncia mais forte a suportar estes achados&#46; Entretanto&#44; a abordagem ao desportista portador de CDI deve ser personalizada e adequada ao paciente&#44; de acordo com a cardiopatia e tipo de desporto em quest&#227;o&#46; Uma abordagem generalista com desqualifica&#231;&#227;o de quase todos os desportistas sem atender &#224;s suas especificidades pode prejudicar uma quantidade consider&#225;vel de doentes aos quais ser&#225; vedada a possibilidade de manter a sua profiss&#227;o ou pr&#225;tica&#44; para a qual poderiam eventualmente apresentar um risco baixo de morte s&#250;bita card&#237;aca&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Liz Almeida R&#44; Provid&#234;ncia R&#44; Gon&#231;alves L&#46; Utiliza&#231;&#227;o de cardioversores desfibrilhadores implant&#225;veis em desportistas&#58; revis&#227;o sistem&#225;tica&#46; Rev Port Cardiol&#46; 2015&#59;34&#58;411&#8211;419&#46;</p>"
      ]
    ]
    "nomenclatura" => array:1 [
      0 => array:3 [
        "identificador" => "nom0005"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0025">List of abbreviations</span>"
        "listaDefinicion" => array:1 [
          0 => array:1 [
            "definicion" => array:8 [
              0 => array:2 [
                "termino" => "ARVD"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">arrhythmogenic right ventricular dysplasia</p>"
              ]
              1 => array:2 [
                "termino" => "BC&#35;36"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">36th Bethesda Conference</p>"
              ]
              2 => array:2 [
                "termino" => "DCM"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">dilated cardiomyopathy</p>"
              ]
              3 => array:2 [
                "termino" => "ESC"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">European Society of Cardiology</p>"
              ]
              4 => array:2 [
                "termino" => "ICD"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">implantable cardioverter-defibrillator</p>"
              ]
              5 => array:2 [
                "termino" => "HCM"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">hypertrophic cardiomyopathy</p>"
              ]
              6 => array:2 [
                "termino" => "SCD"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">sudden cardiac death</p>"
              ]
              7 => array:2 [
                "termino" => "ACC&#47;AHA"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">American College of Cardiology&#47;American Heart Association</p>"
              ]
            ]
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2479
            "Ancho" => 2625
            "Tamanyo" => 362531
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Diagram illustrating the study selection process&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tablaImagen" => array:1 [
                0 => array:4 [
                  "imagenFichero" => "fx1.jpeg"
                  "imagenAlto" => 1673
                  "imagenAncho" => 2778
                  "imagenTamanyo" => 393113
                ]
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Classification of sports &#40;adapted from Maron et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a>&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ARVD&#58; arrhythmogenic right ventricular dysplasia&#59; HCM&#58; hypertrophic cardiomyopathy&#59; LVH&#58; left ventricular hypertrophy&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of athletes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HCM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Commotio cordis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Coronary artery anomalies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LVH of indeterminate causation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Myocarditis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ruptured aortic aneurysm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ARVD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Myocardial bridging&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Aortic valve stenosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Atherosclerotic coronary artery disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Dilated cardiomyopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Myxomatous mitral valve degeneration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Asthma &#40;or other pulmonary condition&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Heat stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Drug abuse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Other cardiovascular cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Long QT syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Cardiac sarcoidosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Trauma involving structural cardiac injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ruptured cerebral artery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab847216.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Causes of sudden death in 387 young athletes &#40;adapted from Maron et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a>&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ARVD&#58; arrhythmogenic right ventricular dysplasia&#59; DCM&#58; dilated cardiomyopathy&#59; ICD&#58; implantable cardioverter-defibrillator&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Increased exercise-induced ventricular arrhythmias</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Fear of ICD failure to defibrillate under athletic conditions</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Worsening of ARVD and DCM</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Increased inappropriate shocks due to sinus or supraventricular tachycardia or atrial fibrillation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Injury due to momentary loss of consciousness and&#47;or control due to arrhythmia or ICD shock</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Damage to ICD mechanism&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#46; Lead fracture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#46; Generator migration or pocket erosion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#46; Traumatic damage to or destruction of generator or reset&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Lack of evidence of ICD effectiveness under conditions of intense exercise</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab847217.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Factors affecting the use of implantable cardioverter-defibrillators in athletes &#40;adapted from Lawless et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a>&#41;&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">ICD&#58; implantable cardioverter-defibrillator&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main findings and conclusions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Limitations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lampert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">614 physicians involved in assessing athletes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">- Only 10&#37; followed the guidelines strictly- More than two-thirds based restrictions on patients&#8217; underlying heart disease- Many patients with ICDs continue to participate in vigorous and even competitive sports&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">- A survey&#44; not a prospective study- Participants were self-selected- Responses may not reflect the opinions of all physician members of the Heart Rhythm Society- Recollection of events may have been selective- Factors potentially predisposing to shocks were not determined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lampert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">372 athletes with ICDs&#44; 137 highly competitive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Many athletes with ICDs can engage in vigorous competitive sports without increased risk of arrhythmia or of damage to the ICD system&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">- Study participants were self-selected- Most subjects had excellent ejection fractions- Not all shocks were reported immediately&#44; some only at six-monthly follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Saarel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 competitive athletes with ICDs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sports-related complications &#40;n&#61;0&#44; 0&#37;&#41;&#44; appropriate shocks &#40;n&#61;7&#44; 33&#37;&#41; and inappropriate shocks &#40;n&#61;1&#44; 5&#37;&#41; were rare- Patients chose to continue to participate because it appeared to be safe to do so&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">- Small sample&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab847215.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Main studies assessing the use of implantable cardioverter-defibrillators in athletes&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:37 [
            0 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exercise and competitive sports in patients with an implantable cardioverter-defibrillator"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Heidbuchel"
                            1 => "F&#46; Carre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehu130"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2014"
                        "volumen" => "35"
                        "numero" => "44"
                        "paginaInicial" => "3097"
                        "paginaFinal" => "3102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24713647"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "36th Bethesda Conference&#58; eligibility recommendations for competitive athletes with cardiovascular abnormalities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;J&#46; Maron"
                            1 => "D&#46;P&#46; Zipes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2005"
                        "volumen" => "45"
                        "paginaInicial" => "1313"
                        "paginaFinal" => "1375"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implantable cardioverter defibrillators in athletes&#58; rationale for use and issues surrounding return to play"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46;E&#46; Lawless"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Sports Med Rep"
                        "fecha" => "2008"
                        "volumen" => "7"
                        "paginaInicial" => "86"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22908402"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators&#58; calendar year 2009 &#8211; a World Society of Arrhythmia&#39;s project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46;G&#46; Mond"
                            1 => "A&#46; Proclemer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1540-8159.2011.03150.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pacing Clin Electrophysiol"
                        "fecha" => "2011"
                        "volumen" => "34"
                        "paginaInicial" => "1013"
                        "paginaFinal" => "1027"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21707667"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety of sports participation in patients with implantable cardioverter defibrillators&#58; a survey of heart rhythm society members"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Lampert"
                            1 => "D&#46; Cannom"
                            2 => "B&#46; Olshansky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1540-8167.2005.00331.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cardiovasc Electrophysiol"
                        "fecha" => "2006"
                        "volumen" => "17"
                        "paginaInicial" => "11"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16426392"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACC&#47;AHA&#47;ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death&#58; a report of the American College of Cardiology&#47;American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines &#40;Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death&#41;&#58; developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;P&#46; Zipes"
                            1 => "A&#46;J&#46; Camm"
                            2 => "M&#46; Borggrefe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.106.178233"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2006"
                        "volumen" => "114"
                        "paginaInicial" => "e385"
                        "paginaFinal" => "e484"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16935995"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sudden cardiac death"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;P&#46; Zipes"
                            1 => "H&#46;J&#46;J&#46; Wellens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1998"
                        "volumen" => "98"
                        "paginaInicial" => "2334"
                        "paginaFinal" => "2351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9826323"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does sports activity enhance the risk of sudden death in adolescents and young adults&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Corrado"
                            1 => "C&#46; Basso"
                            2 => "G&#46; Rizzoli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2003"
                        "volumen" => "42"
                        "paginaInicial" => "1959"
                        "paginaFinal" => "1963"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14662259"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002914912022850"
                          "estado" => "S300"
                          "issn" => "00029149"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of sudden cardiac death in athletes&#58; a state-of-the-art review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46;G&#46; Harmon"
                            1 => "J&#46;A&#46; Drezner"
                            2 => "M&#46;G&#46; Wilson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Heart"
                        "fecha" => "2014"
                        "paginaInicial" => "1227"
                        "paginaFinal" => "1234"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long- and short-term risk of sudden coronary death"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;A&#46; Cupples"
                            1 => "D&#46;R&#46; Gagnon"
                            2 => "W&#46;B&#46; Kannel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1992"
                        "volumen" => "85"
                        "numero" => "1 Suppl&#46;"
                        "paginaInicial" => "I11"
                        "paginaFinal" => "I18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1370216"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sudden death in young athletes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;J&#46; Maron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMra022783"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2003"
                        "volumen" => "349"
                        "paginaInicial" => "1064"
                        "paginaFinal" => "1075"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12968091"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Corrado"
                            1 => "C&#46; Basso"
                            2 => "A&#46; Pavei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.296.13.1593"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2006"
                        "volumen" => "296"
                        "paginaInicial" => "1593"
                        "paginaFinal" => "1601"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17018804"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and clinical meaning of isolated increase of QRS voltages in hypertrophic cardiomyopathy versus athlete&#39;s heart&#58; relevance to athletic screening"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Calore"
                            1 => "P&#46; Melacini"
                            2 => "A&#46; Pelliccia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2013.06.123"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2013"
                        "volumen" => "168"
                        "paginaInicial" => "4494"
                        "paginaFinal" => "4497"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23928341"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The editor&#39;s roundtable&#58; sudden cardiac death in athletes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46;E&#46; Friedewald"
                            1 => "B&#46;J&#46; Maron"
                            2 => "W&#46;C&#46; Roberts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2007.07.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2007"
                        "volumen" => "100"
                        "paginaInicial" => "1451"
                        "paginaFinal" => "1459"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17950807"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bethesda Conference &#35;36 and the European Society of Cardiology Consensus Recommendations revisited a comparison of U&#46;S&#46; and European criteria for eligibility and disqualification of competitive athletes with cardiovascular abnormalities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Pelliccia"
                            1 => "D&#46;P&#46; Zipes"
                            2 => "B&#46;J&#46; Maron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.08.055"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "1990"
                        "paginaFinal" => "1996"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19055990"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Task Force 8&#58; classification of sports"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;H&#46; Mitchell"
                            1 => "W&#46; Haskell"
                            2 => "P&#46; Snell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2005.02.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2005"
                        "volumen" => "45"
                        "paginaInicial" => "1364"
                        "paginaFinal" => "1367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15837288"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improving survival from sudden cardiac arrest&#58; the role of the automated external defibrillator"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;P&#46; Marenco"
                            1 => "P&#46;J&#46; Wang"
                            2 => "M&#46;S&#46; Link"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2001"
                        "volumen" => "285"
                        "paginaInicial" => "1193"
                        "paginaFinal" => "1200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11231750"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673610607465"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46;D&#46; Valenzuela"
                            1 => "D&#46;J&#46; Roe"
                            2 => "G&#46; Nichol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM200010263431701"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2000"
                        "volumen" => "343"
                        "paginaInicial" => "1206"
                        "paginaFinal" => "1209"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11071670"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673612614226"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implantable cardioverter-defibrillators&#58; expanding indications and technologies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Z&#46; Goldberger"
                            1 => "R&#46; Lampert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.295.7.809"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2006"
                        "volumen" => "295"
                        "paginaInicial" => "809"
                        "paginaFinal" => "818"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16478904"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Update of the guidelines on sudden cardiac death of the European Society of Cardiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;G&#46; Priori"
                            1 => "E&#46; Aliot"
                            2 => "C&#46; Blomstrom-Lundqvist"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "13"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12559931"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implantable cardioverter defibrillator therapy in athletes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; Heidb&#252;chel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ccl.2007.07.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiol Clin"
                        "fecha" => "2007"
                        "volumen" => "25"
                        "paginaInicial" => "467"
                        "paginaFinal" => "482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17961801"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of sympathetic activation on ventricular ectopic beats in subjects with and without evidence of organic heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Lombardi"
                            1 => "G&#46; Malfatto"
                            2 => "A&#46; Belloni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "1987"
                        "volumen" => "8"
                        "paginaInicial" => "1065"
                        "paginaFinal" => "1074"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2445568"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcome and risk stratification in dilated cardiolaminopathies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Pasotti"
                            1 => "C&#46; Klersy"
                            2 => "A&#46; Pilotto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.06.044"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "1250"
                        "paginaFinal" => "1260"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18926329"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exercise increases age-related penetrance and arrhythmic risk in arrhythmogenic right ventricular dysplasia&#47;cardiomyopathy-associated desmosomal mutation carriers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;A&#46; James"
                            1 => "A&#46; Bhonsale"
                            2 => "C&#46; Tichnell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2013.06.033"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2013"
                        "volumen" => "62"
                        "paginaInicial" => "1290"
                        "paginaFinal" => "1297"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23871885"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recommendations for competitive sports participation in athletes with cardiovascular disease&#58; a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Pelliccia"
                            1 => "R&#46; Fagard"
                            2 => "H&#46;H&#46; Bjornstad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehi325"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "1422"
                        "paginaFinal" => "1445"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15923204"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety of sports for athletes with implantable cardioverter-defibrillators&#58; results of a prospective&#44; multinational registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Lampert"
                            1 => "B&#46; Olshansky"
                            2 => "H&#46; Heidbuchel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.112.000447"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2013"
                        "volumen" => "127"
                        "paginaInicial" => "2021"
                        "paginaFinal" => "2030"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23690453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcome after ICD and CRT implantation and influence of remote device follow-up&#58; the ALTITUDE survival study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46;A&#46; Saxon"
                            1 => "D&#46;L&#46; Hayes"
                            2 => "F&#46;R&#46; Gilliam"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.110.960633"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2010"
                        "volumen" => "122"
                        "paginaInicial" => "2359"
                        "paginaFinal" => "2367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21098452"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results of a multicenter retrospective implantable cardioverter-defibrillator registry of pediatric and congenital heart disease patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;I&#46; Berul"
                            1 => "G&#46;F&#46; Van Hare"
                            2 => "N&#46;J&#46; Kertesz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.01.033"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2008"
                        "volumen" => "51"
                        "paginaInicial" => "1685"
                        "paginaFinal" => "1691"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18436121"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development and validation of a risk score to predict early mortality in recipients of implantable cardioverter-defibrillators"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;B&#46; Kramer"
                            1 => "P&#46;A&#46; Friedman"
                            2 => "L&#46;M&#46; Kallinen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hrthm.2011.08.031"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Rhythm"
                        "fecha" => "2012"
                        "volumen" => "9"
                        "paginaInicial" => "42"
                        "paginaFinal" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21893137"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Forced retirement from elite football in Australia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "V&#46; Fortunato"
                            1 => "D&#46; Marchant"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pers Interpers Loss"
                        "fecha" => "1999"
                        "volumen" => "4"
                        "paginaInicial" => "269"
                        "paginaFinal" => "280"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sports for young patients with implantable cardioverter-defibrillators&#58; refining the risk"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46; Saarel"
                            1 => "T&#46; Pilcher"
                            2 => "D&#46; Gamboa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2014"
                        "volumen" => "6"
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673606694208"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient empowerment&#58; myths and misconceptions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;M&#46; Anderson"
                            1 => "M&#46;M&#46; Funnell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pec.2009.07.025"
                      "Revista" => array:7 [
                        "tituloSerie" => "Patient Educ Couns"
                        "fecha" => "2010"
                        "volumen" => "79"
                        "paginaInicial" => "277"
                        "paginaFinal" => "282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19682830"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S2213858714700579"
                          "estado" => "S300"
                          "issn" => "22138587"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Shared decision making &#8211; pinnacle of patient-centered care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;J&#46; Barry"
                            1 => "S&#46; Edgman-Levitan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMp1109283"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2012"
                        "volumen" => "366"
                        "paginaInicial" => "780"
                        "paginaFinal" => "781"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22375967"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Doctor&#8211;patient relationship&#58; from medical paternalism to enhanced autonomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;J&#46; Chin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Singapore Med J"
                        "fecha" => "2002"
                        "volumen" => "43"
                        "paginaInicial" => "152"
                        "paginaFinal" => "155"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12005343"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sports participation for athletes with implantable cardioverter-defibrillators should be an individualized risk-benefit decision"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Lampert"
                            1 => "D&#46; Cannom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hrthm.2008.01.024"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Rhythm"
                        "fecha" => "2008"
                        "volumen" => "5"
                        "paginaInicial" => "861"
                        "paginaFinal" => "863"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18534371"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality of life in the antiarrhythmics versus implantable defibrillators trial&#58; impact of therapy and influence of adverse symptoms and defibrillator shocks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;B&#46; Schron"
                            1 => "D&#46;V&#46; Exner"
                            2 => "Q&#46; Yao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2002"
                        "volumen" => "105"
                        "paginaInicial" => "589"
                        "paginaFinal" => "594"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11827924"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European guidelines on cardiovascular disease prevention in clinical practice&#58; executive summary&#46; Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice &#40;constituted by representatives of nine societies and by invited experts&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I&#46; Graham"
                            1 => "D&#46; Atar"
                            2 => "K&#46; Borch-Johnsen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.hjr.0000277984.31558.c4"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur J Cardiovasc Prev Rehabil"
                        "fecha" => "2007"
                        "volumen" => "14"
                        "numero" => "Suppl&#46; 2"
                        "paginaInicial" => "E1"
                        "paginaFinal" => "E40"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17726406"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003400000006/v1_201506200223/S2174204915001166/v1_201506200223/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9924"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Review Article"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003400000006/v1_201506200223/S2174204915001166/v1_201506200223/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001166?idApp=UINPBA00004E"
]
Article information
ISSN: 21742049
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 10 3 13
2024 October 56 43 99
2024 September 82 29 111
2024 August 76 40 116
2024 July 60 44 104
2024 June 57 32 89
2024 May 64 31 95
2024 April 62 27 89
2024 March 82 16 98
2024 February 60 23 83
2024 January 40 30 70
2023 December 33 22 55
2023 November 58 26 84
2023 October 33 17 50
2023 September 39 21 60
2023 August 51 20 71
2023 July 56 14 70
2023 June 131 19 150
2023 May 54 33 87
2023 April 30 3 33
2023 March 66 28 94
2023 February 50 26 76
2023 January 21 18 39
2022 December 54 26 80
2022 November 94 32 126
2022 October 58 22 80
2022 September 39 52 91
2022 August 49 36 85
2022 July 47 38 85
2022 June 26 19 45
2022 May 37 42 79
2022 April 54 28 82
2022 March 24 37 61
2022 February 27 24 51
2022 January 32 28 60
2021 December 22 20 42
2021 November 33 29 62
2021 October 41 44 85
2021 September 31 43 74
2021 August 38 32 70
2021 July 24 28 52
2021 June 21 16 37
2021 May 25 33 58
2021 April 54 38 92
2021 March 52 18 70
2021 February 60 9 69
2021 January 21 16 37
2020 December 36 10 46
2020 November 29 11 40
2020 October 27 11 38
2020 September 78 14 92
2020 August 20 5 25
2020 July 59 9 68
2020 June 53 17 70
2020 May 58 10 68
2020 April 38 8 46
2020 March 46 7 53
2020 February 122 30 152
2020 January 44 7 51
2019 December 27 10 37
2019 November 31 9 40
2019 October 44 3 47
2019 September 22 16 38
2019 August 31 4 35
2019 July 32 16 48
2019 June 23 14 37
2019 May 42 16 58
2019 April 22 18 40
2019 March 18 23 41
2019 February 42 10 52
2019 January 25 16 41
2018 December 57 20 77
2018 November 100 9 109
2018 October 248 10 258
2018 September 42 13 55
2018 August 91 9 100
2018 July 27 9 36
2018 June 55 7 62
2018 May 53 12 65
2018 April 83 11 94
2018 March 86 9 95
2018 February 67 5 72
2018 January 105 3 108
2017 December 130 7 137
2017 November 47 13 60
2017 October 39 9 48
2017 September 53 15 68
2017 August 50 18 68
2017 July 35 17 52
2017 June 59 22 81
2017 May 48 16 64
2017 April 45 8 53
2017 March 56 68 124
2017 February 29 12 41
2017 January 34 6 40
2016 December 41 13 54
2016 November 27 5 32
2016 October 36 4 40
2016 September 34 9 43
2016 August 10 1 11
2016 July 25 7 32
2016 June 11 2 13
2016 May 21 12 33
2016 April 57 15 72
2016 March 43 25 68
2016 February 75 26 101
2016 January 54 20 74
2015 December 40 15 55
2015 November 54 16 70
2015 October 52 20 72
2015 September 63 31 94
2015 August 104 45 149
2015 July 177 84 261
2015 June 75 31 106
Show all

Follow this link to access the full text of the article

Idiomas
Revista Portuguesa de Cardiologia (English edition)
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.