How can athletes play with ICDs, and what happens when one goes off?

Key developments are emerging from the global stage. How can athletes play with ICDs, and what happens when one goes off? Image source, Getty ImagesImage caption, Christian Eriksen is Denmark's record appearance-makerByDaniel AustinBBC Sport senior journalistPublished1 hour agoWhen Christian Eriksen collapsed during Denmark's 2-1 friendly victory over Ukraine on Sunday, he was assisted by a device which was fitted to support his heart after he suffered a cardiac arrest during a Euro 2020 match. The implantable cardioverter defibrillator (ICD) sits in Eriksen's chest, with wires connecting it to his heart.

It provides a shock to either restart the heart if it stops beating, or to jolt it back into a regular rhythm if abnormalities are detected. "The pacemaker responded as it should," said Denmark's national team doctor Morten Boesen on Sunday. The sight of Eriksen dropping to the turf, before being surrounded by visibly upset team-mates while being treated by medical staff behind a makeshift curtain, was frighteningly reminiscent of his previous collapse, which shocked football fans around the world.

The Details

So, how can athletes return to elite-level sport after having an ICD fitted, what are the risks, and what happens when the device goes off? 'Athletes will never say stop' Figure caption, What is an ICD and how does it work? The need for an ICD - which is around half the size of a mobile phone - to be fitted can be caused by a variety of different health conditions, including heart failure, coronary heart disease, and arrhythmias.

Depending on the exact illness an athlete is suffering from, a return to competition is possible. "All cases are individual," says Dr Amanda Lahti, a doctor and researcher in sports medicine. "It is a shared decision model – you take opinions from the club, the player, their agent, and medical experts, looking at the risks and the potential benefits.

You then take a collective decision about whether a player can continue with their career or if they should stop. "The difficulty with that is the athlete themselves has the final word, and they will never say 'stop'. They are willing to take risks that perhaps you or I would not.

What Experts Say

"When Eriksen suffered his cardiac arrest in June 2021, he was playing his club football for Inter Milan in Italy's Serie A, one of a minority of leagues which prohibits players fitted with an ICD from competing. Eriksen made his return first with Brentford and then Manchester United in the Premier League, where there is no blanket rule, and players must undergo individual testing to assess whether they are healthy enough to play. "I don't see any risk, no," he told Sport in 2022.

"I have an ICD, if anything would happen then I am safe.

The story has become one of the most prominent items on the global agenda.