When Christian Eriksen collapsed during Denmark’s Euro 2020 opener against Finland on 12 June 2021, his heart stopped for several minutes before medics restored circulation pitchside in Copenhagen. Eighteen months later, he was back in the Premier League with Brentford, fitted with an implantable cardioverter defibrillator (ICD) — a matchbox-sized device stitched beneath the skin near the collarbone. His return rewrote what was thought possible for elite athletes with serious cardiac conditions, and on Sunday’s friendly between Denmark and Ukraine in Aarhus, his second on-pitch scare reignited a debate that has never fully settled: should footballers with ICDs be playing at all?
How the device works — and why football poses a unique problem
An ICD continuously monitors the heart’s electrical rhythm. When it detects ventricular fibrillation or sustained ventricular tachycardia — the chaotic rhythms that cause sudden cardiac arrest — it delivers a shock of up to 40 joules to restore a normal beat. The shock takes roughly 10 to 15 seconds from detection to delivery. For most patients, the device is preventative insurance. For an elite footballer running at 32 km/h with a heart rate above 180 bpm, it is the difference between collapse and survival.
The European Society of Cardiology updated its guidelines in 2020, moving away from blanket bans on competitive sport for ICD recipients. Decisions are now made case-by-case, weighing the underlying diagnosis, ejection fraction, arrhythmia history, and the demands of the sport. Football presents specific challenges:
- Sustained high heart rates over 90 minutes increase the risk of inappropriate shocks triggered by sinus tachycardia rather than dangerous arrhythmia
- Contact with the chest wall — a stray elbow, a goalmouth scramble — risks dislodging the lead wires that connect the device to the heart
- The dehydration and electrolyte shifts of a competitive match alter the electrical threshold at which arrhythmias occur
- Heading the ball repeatedly subjects the device to mechanical stress not present in most other sports
FIFA’s medical committee still classifies ICD recipients as Category B — cleared to play only after individual cardiology sign-off, with the device’s shock zones programmed conservatively to avoid firing during normal match exertion.
What happens when one goes off
A shock from an ICD is, by every patient account, violent. Eriksen has compared it to “being kicked in the chest by a horse.” The athlete typically remains conscious — the shock arrives before loss of circulation — but is briefly incapacitated. Protocols developed by the English FA after the 2012 Fabrice Muamba arrest now require team doctors to be within 30 seconds of any player on the pitch, with an automated external defibrillator and trained responders at the touchline.
Modern devices store the electrocardiogram from the seconds before and after a shock, allowing cardiologists to confirm whether the discharge was appropriate. An inappropriate shock — triggered by exercise-induced tachycardia rather than a true arrhythmia — requires reprogramming rather than withdrawal from sport. An appropriate shock generally ends a player’s career, though Daniel Engelbrecht, the German striker who suffered cardiac arrest in 2013, played 31 matches with an ICD before retiring in 2017.
The trajectory of cardiac care in football
The numbers driving the conversation have shifted sharply. A 2017 study in the New England Journal of Medicine tracked 440 athletes with ICDs across 31 sports and found no deaths and no device failures attributable to play, though shocks occurred in 10 per cent of participants during competition. UEFA’s mandatory cardiac screening, introduced in 2006 and tightened in 2019, has identified an estimated 0.3 per cent of professional players carrying underlying cardiomyopathies — roughly one player per top-flight squad.
Eriksen’s case remains the reference point because it tested every protocol in real time and in front of 280 million television viewers. His successful return to Manchester United and then to Wolfsburg this season demonstrated the medical pathway works. Sunday’s incident in Aarhus, where he was substituted as a precaution after feeling unwell rather than collapsing, suggests the monitoring system is functioning as designed — flagging a concern before crisis.
The harder question facing football is not whether players with ICDs can compete, but whether the sport’s screening reaches the academy level rigorously enough to catch the next Muamba, the next Eriksen, before the collapse rather than after. UEFA’s next medical congress in Nyon on 18 September is expected to address exactly that.
Sports journalist and editor at SportsPortal.net. Covers cricket, football, Formula 1, tennis, and basketball with a focus on how global sports connect with Pakistani audiences. Follows the PSL, Pakistan national cricket team, Premier League, and major international tournaments. Has reported on sports for digital audiences since 2021.
160 articles published
