IJCS | Volume 32, Nº4, July/August 2019

394 1. Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Terradellas JB, et al. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Europace. 2017;19(1):139-63. 2. Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, et al. Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 Years of Age): a scientific statement from the American Heart Association and the American College of Cardiology. Circulation. 2014;130(15):1303-34. 3. Coris EE, Sahebzamani F, Curtis A, Jennings J, Walz SM, Nugent D, et al. Preparticipation cardiovascular screening among National Collegiate Athletic Association Division I institutions. Br J Sports Med. 2013;47(3):182-4. 4. Ackerman MJ, Priori SG, Willems S, Berul C, Brugada R, Calkins H, et al. HRS/EHRA expert consensus statement on the state of genetic References Lampert Sports participation for athletes with ICDs Int J Cardiovasc Sci. 2019;32(4):391-395 Review Article which violent contact was an intrinsic and purposeful part of the practice, such as American football or hockey. In the ICD Sports Registry, lead malfunction rates were similar to those reported in unselected populations, 31 but whether the risk of damage to the ICD system is higher during the practice of the more violent contact sports remains undetermined. Importance of shared decision-making Finally, the most important consideration is the athlete’s values and preferences, and often his or her family’s, and a shared decision-making approach is imperative. 32 Shared decision-making, termed the “pinnacle of patient-centered care”, 33 requires the physician to explain the risks and benefits of options and to help patients understand how to reconcile these options with their personal preferences and values. This means full discussion with the patients, and often with their families--What are the risks?What data do we have, and how does this patient compare to the patients in the studies? For instance, for a hockey player, it is important to explain that systemdamage may be greater. What data are lacking? For instance, as mentioned above, while we know that shocks occur during sports, whether shocks would be less likely with the discontinuation of sports is still unknown. Furthermore, while there has been no adverse events described in the 440 patients in the ICD Sports Registry over four years, this study is not large enough to declare that the risk is zero. What do the professional society guidelines recommend? What does this patient and family think about risk in general? For instance, some families allow their children to climb Mount Everest, while others would not allow them to play American football. This shared decision-making approach requires a combination of knowledge of the data, and willingness to engage the patients (and often their families) as partners in the decision-making process. Most importantly, we need to stress that we do not have all the answers, while providing a framework for decision-making. Author contributions Acquisition of data: Lampert R. Analysis and interpretation of the data: Lampert R. Obtaining financing: Lampert R. Writing of the manuscript: Lampert R. Critical revision of the manuscript for intellectual content: Lampert R. Potential Conflict of Interest There ispotential conflict of interest in relation to research grants from Medtronic, Boston Scientific, and Abbott/St Jude which supported much of the work described in the review. Honoraria/advisory board Medtronic. Sources of Funding This studywas funded byMedtronic, Boston Scientific and St. Jude Abbot. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Yale Human Investigation Committee under the protocol number 0608001736. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study.