Game changer? A sporting indication to implant a left atrial appendage closure device in a rugby player with atrial fibrillation: a case report. Issue 1 (29th January 2020)

• Record Type: Journal Article
• Authors: Briosa e Gala, Andre; Cox, Andrew; Pope, Michael; Betts, Timothy
• Editors: Gati, Sabiha; Niederseer, David; Behar, Jonathan M; Simovic, Stefan; Patel, Peysh A
• Is Part Of: European heart journal. Volume 4:Issue 1(2020)
• Page Start: 1
• Page End: 5
• Publication Date: 2020-01-29
• Subjects: Sports cardiology -- Atrial fibrillation -- Dilated cardiomyopathy -- Stroke -- Left atrial appendage occlusion -- Watchman device -- Case report; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytz242
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: Background: Caring for athletes with cardiac disease requires an approach that caters to the specific needs of the athlete. Case summary: A 27-year-old professional rugby player was admitted with decompensated heart failure and atrial fibrillation (AF). Transthoracic echocardiogram showed features in keeping with a dilated cardiomyopathy with severe left ventricular (LV) systolic impairment. He made good progress on evidence-based heart failure medication and his LV systolic function returned to normal. He failed to maintain sinus rhythm with cardioversion and remained in persistent AF. He then suffered a transient ischaemic attack despite appropriate anticoagulation. At 1-year follow-up, he was asymptomatic and against medical advice continued to play competitive rugby whilst taking rivaroxaban. He subsequently underwent implantation with a percutaneous left atrial appendage occlusion device, allowing him to discontinue anticoagulation, reduce his bleeding risk and resume his career, whilst simultaneously lowering the thromboembolic risk. Discussion: Counselling should include different management options aimed at minimizing the risks to athletes if they to return to competitive sports. Left atrial appendage occlusion devices are a suitable AF-related stroke prevention strategy in athletes competing in full-contact sports.