What lies ahead for Christian Eriksen and the Premier League?
According to reliable reports in the media, Christian Eriksen is assessing his career options in bid to make a competitive comeback to England. The Premier League will need to take adequate precautions before registering the player based on individual medical examinations since Eriksen will have an implanted cardioverter defibrillator (ICD) attached to his chest after suffering a cardiac arrest during Denmark’s game against Finland in Euro 2020.
As per Athletic UK’s Jay Harris, Brentford have offered a six-month deal to Christian Eriksen with an option to extend a further year. Eriksen became a free agent after mutually terminating his contract with Inter in December 2021 as Serie A rules prohibited Italian medical authority from awarding clearance certificates to players having implanted electronic devices such as an ICD in their body.
The former Tottenham Hotspur attacking midfielder told Danish channel DR1 about his future where he stated that being a part of Denmark’s squad in the Qatar World Cup was his main aim. He indicated that his individual preparations have already started in order to get physically ready for the major tournament. Eriksen’s agent Martin Schoots revealed that a return to England would “feel like coming home”.
In England, the Football Association(FA) would allow Eriksen’s registration as medical clearance is ratified on “individual basis” through fitness examinations and blood tests. Eriksen will be assessed by a member from the FA’s Cardiac Consensus Panel and an abnormal cardiac screening will take place before making a final decision.
As it stands, Premier League records show that Eriksen will be the first player to feature in the league with an ICD attached, subject to clearance from the FA. In 2012, Bolton’s Fabrice Muamba suffered a fatal attack. Despite fitting an ICD, he retired from the game. Former Manchester United defender Daley Blind is currently playing in Eredivisie with an ICD after undergoing a heart surgery. He has regularly featured for Ajax since the arrhythmic incident on the pitch. It seems to be a recurring theme in sports and the Premier League will need to be prepared for eventualities especially when a player could be playing with an artificial device which is battery driven.
To understand the potential risks that Eriksen may face, let’s understand how an ICD works. It’s a cookie-sized device which works electronically to detect and stop irregular heartbeats. In Eriksen’s case, the main intention of this battery powered device will be pacing, which generally means that corrective electric shocks are administered to the heart if anything goes wrong. A small incision is created on the chest to insert the device. It can be turned on/off manually depending on the player’s heart rhythm but it should be switched on while playing football since it involves exercises that require higher heart-rate.
The Premier League is known for the physicality required to thrive in a highly competitive environment filled with constant and rough physical contact. Along with that, ICDs are susceptible to magnetic fields. As a result, Eriksen should be exempted from security checks involving metal detector scans before entering into an arena. The ICD might set off alarms if the playmaker is exposed to large amount of electromagnetic interference1 beyond a certain amount of time.
The league will need to conduct weekly cardiac sessions which could help in monitoring the Danish playmaker’s heart and it’s connectivity with his ICD. Since the onset of COVID19 pandemic, match schedules have been finalised in such a way that there is hardly ever time for prolonged rest and recovery. Club and League officials will have to chart the number of minutes Eriksen could play using the professional help of cardiologists from the FA, since fatigue can cause complications to the heart, as electric shocks of higher mV will need to be applied.
Pitch side biomedical technicians would be beneficial in future league games to prevent major malfunctioning of the ICD. Utmost care should be provided to Eriksen while applying external resuscitation over the chest if the ICD fails. Paramedic support would be necessary to avoid such fatal scenarios. External Defibrillators can be applied for revitalising circulation but according to an electrophysiologist from British Heart Foundation, an automated external defibrillator (AED) is safer to use as it’s external pads analyze heart rhythms before applying responsive shocks needed for regular heart-rate. It’s application on the human body is relatively easier compared to other defibrillators and affordable to maintain as well.
In my opinion, if a transfer happens, Eriksen’s teammates should undergo special training, which would teach them to revive a person who collapses on the pitch due to a cardiac arrest and sufficient workshops would be necessary to give them a glimpse of the manner in which CPR is conducted on a human body.
Continuous research is being conducted to find out some of the numerous reasons behind a large number of cardiac arrests happening in world football. From a clinical perspective, it occurs due to inconsistent rhythm while cardiomyopathy- a disease that affects the dimensions of the heart muscles leading to inflammation cannot be dismissed.
In certain findings, image modalities cannot be taken as the only source of analyzing cardiovascular diseases. Based on the outcomes of cardiac screening from the New England Journal of Medicine, it was found that, in a sample size of 11,168 adolescent football athletes, around 8 players suffered sudden death due to cardiac diseases, out of which 6 players initially showed normal results in the screening process. Even more frightening was that 7 deaths out of the 8 were concluded as sudden attacks due to cardiomyopathy.
Although the study mentions a death rate of one in 14,700 players over a 20 year period, there are valid concerns in the eyes of people who look more into the data points. These tragic incidents are being recorded from a very young age and numbers show that the rates are significantly higher than what it was earlier, which was previously estimated as one in 50,000 to 200,000.
From various academic discussions, it is understood that preventive screening strategies could be planned to ensure a player’s cardiac health. By standard tests such as ECG and echocardiography, players with abnormal T-wave inversion(usually symmetric in shape) and Wollf-Parkinson-White syndrome could be provided with follow-up consultation from both internal and external levels. This standard must be followed after a player’s retirement from sports as well to ensure that there aren’t any major fluctuations over a shorter period.
Recently, the availability of trained medical responders have helped in achieving a higher success rate. In Eriksen’s ICD case, early chest compressions and immediate implementation of defibrillation saved his life. Players will need to remember the 3Rs(Recognition, Response, Resuscitate) to ensure safety in future events.
With growing awareness, the scope of treatment will evolve. Moreover, experts from the field of sports cardiology and professionals from the medical community learn spontaneously through awful real-life events which come to the point of questioning some of the theories written in publications. Priority should be given to the identification of structural and electrical properties of the athlete’s heart conditions which could lead to sudden cardiac deaths. More investment in sports medicine and it’s research will enable medical professionals to simulate such deadly scenarios and take proper action at the time of need.
1. Implanted cardioverter defibrillator’s are sensitive to radiations from heavy-duty devices especially the ones connected directly to the power supply while in use
ICD to heart GIF: istockphotos
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Written by Alan Bince | Photo by Stuart Franklin/Getty Images
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