What happened on June 12, 2021?
The European Championship match between Denmark and Finland, played in Copenhagen, is 42 minutes away when defender Joakim Maehle throws the ball in the direction of Christian Eriksen. He bounces the ball forward, but then remains motionless on the grass, suffering a cardiac arrest. Captain Simon Kjaer rushes in and prevents Eriksen from swallowing his tongue. Fellow players form a hedge around their teammate. There are glimpses of medical workers performing CPR. After ten minutes Eriksen is taken away on a stretcher. A photo appears showing that he has regained consciousness, his eyes are open. The match is played out. Three days later, the Dane announced on Instagram that he is doing well. Six days after his admission, an Implantable Cardioverter Defibrillator (ICD), a box that detects and corrects cardiac arrhythmias, is placed. A day later, he leaves the hospital and begins his rehabilitation.
What road has he traveled since then?
The messages have been scarce for a long time. At the beginning of August, he makes his appearance on the training field of his club Inter Milan. He said he is in ‘excellent physical and mental health’. But then it is already clear that if he wants to continue playing football, he will have to leave Italy. It is true that playing with an ICD is not specifically prohibited in the regulations, but top sport companies with heart problems are not allowed. In December, out of sight of the cameras, he makes his comeback on the training pitch at Odense Boldklub, where he played for three years in his youth before leaving for Ajax in 2008 at the age of 16. He also owns a town house on the island of Funen. According to his Dutch agent Martin Schoots, the interest of at least two football clubs also started around that time. In January, the footballer announced in an interview for Danish television that he would like to play football again, he hopes to be part of the national team again at the World Cup in Qatar. “It’s my goal, it’s my dream.” He is convinced that he can reach the same level again. Not long after, he once trained in Amsterdam with Jong Ajax at the De Toekomst complex; speculations about a return turn out to be unfounded. In the meantime, the number of clubs applying for a transfer has increased to ten, including PSV. Eriksen prefers a return to the Premier League. The choice will be made at the end of January on Brentford, the current number 14 in the highest British division. The coach Thomas Frank is a Dane. Two Danish players are under contract.
Is it safe to play with an ICD box?
‘About fifteen years ago, the answer would have been: no, you should advise against that in competitive sports. Today it is more nuanced: you have to look at it on a case-by-case basis, in close consultation with the athlete, his environment, the doctors involved and the club. The condition is that everyone agrees.’
Peter Peytchev is trained as a cardiologist and sports physician and is affiliated with the Onze Lieve Vrouw hospital in Aalst, Belgium. He specializes in the treatment of cardiac arrhythmias, including pacemakers and defibrillators. According to him, the cause of the cardiac arrest determines whether a follow-up is safe. ‘Was there an electrical disturbance, often genetically determined, in an otherwise healthy heart muscle? Is there something structurally wrong? Has a disease damaged the muscle? Did a virus infection lead to scar tissue formation? It is a broad spectrum on the basis of which you have to make the decision.’
He points out that a long process must be followed before it is decided whether sports are possible again. ‘Look how long it took between Eriksen’s placement of the ICD and his return. It starts with a little jogging until participating in a first competition. That entire process is closely monitored.’ What has helped is the quick assistance to Eriksen. “First it was his teammates, then the medical staff in the stadium, the specialists in the hospital – it all went exemplary. But, however responsible it may be, there are no guarantees that a repetition is excluded.’
An ICD is not uncommon in football. Ajax defender Daley Blind carries a locker; that he suddenly collapsed during a match in August 2020 was attributed to the intervention of a device after an arrhythmia. Former midfielder Evander Sno played with an internal defibrillator for several years. Trainer Mitchell van der Gaag has a device. In 2014, he was standing in front of the dugout of his then club Belenenses in Portugal when he felt his heart racing. The ICD delivered a shock to restore rhythm. In Belgium, Anthony Van Loo of KV Mechelen had the same thing happen twice.
Such a shock is not the first reaction to an abnormal rhythm of the ICD. The defibrillator consists of a flat box measuring five by three centimeters, placed under the skin at the level of the left chest muscle, and an electrode that is placed through a vein in the right ventricle or in the front of the chest. Cardiologist Peytchev: ‘Interrupting the disturbance often starts with overpacing, shortening the time between heartbeats. If that doesn’t work, a shock follows. It really is a huge blow. That can be traumatic. But usually the wearer is already unconscious or in the process of losing consciousness at that moment.’
This means that not every sport can be combined with an ICD. Cyclists or car and motorcycle racers cannot risk losing their knowledge for a moment. Sports that can damage the box or require extreme arm movements are also not recommended.
Can athletes with an ICD return to their previous level?
According to Peytchev, this is not self-evident. ‘The numbers are too few to draw any conclusions. Here too, each case stands on its own. But there’s a lot that goes into it. You usually have a long break on it. Heart damage may have occurred. Some have to take medication. Anthony Van Loo, for example, took beta-blockers before every match to suppress disorders. Don’t forget the psychological effects. If you have survived a cardiac arrest, it is not so obvious that you will start exercising again. Isn’t something going to happen again? Does the box work? Will it save my life? What does such a shock do to me? There are many questions.’
Eriksen himself is confident. In the interview for Danish TV he said: ‘I don’t feel like anything happened. I feel fine physically and I am in good shape. It was one time, it won’t happen to me again. I want to show that it’s over and that I can participate again.’
He has had his first hours on the field. Last week, he made his one-hour debut for Brentford in an exhibition game against Southend and contributed one assist to the 3-2 win. Last Monday he played 80 minutes against Rangers FC under coach Giovanni van Bronckhorst and was involved in both goals for his club with a free kick and a corner. The game ended 2-2.
On the website of his club he speaks about Saturday’s game against Newcastle. ‘It is becoming more and more real. I can’t imagine what it will feel like when I walk onto the field. But I’m looking forward to it.’