Myocarditis

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Return to Play

Bethesda Guidelines

• Before returning to competitive sports, athletes should undergo a
  • resting echocardiogram
  • 24-hour Holter monitoring
  • an exercise ECG
• no less than 3 to 6 months after the initial illness (Class I; Level of Evidence C}.
• It is reasonable that athletes resume training and competition if all of the following criteria are met
  • Ventricular systolic function has returned to the normal range.
  • Serum markers of myocardial injury, inflammation, and heart failure have normalized.
  • Clinically relevant arrhythmias such as frequent or complex repetitive forms of ventricular or supraventricular ectopic activity are absent on Holter monitor and graded exercise ECGs.
• At present, it is unresolved whether resolution of myocarditis-related LGE should be required to permit return to competitive sports.
• Athletes with probable or definite myocarditis should not participate in competitive sports while active inflammation is present.
• This recommendation is independent of age, gender, and LV function (Class III; Level of Evidence C).

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