Hockey Player's Collapse Underscores the Importance of Early Intervention in Atrial Fibrillation

Data show improved survival rates and other outcomes are associated with rapid response when cardiac emergencies occur.

A cardiac emergency in the middle of a professional hockey game has generated an unexpected wave of publicity about the dangers of atrial fibrillation (AF) and the need for better treatment.

Dallas Stars forward Rich Peverley was waiting to go into a game against the Columbus Blue Jackets on the evening of March 10 when he felt his heart start racing before it stopped altogether and knocked him out. Teammates noticed immediately and medical personnel revived him less than 20 seconds later.

The dramatic scene on the bench, which spurred the postponement of the entire game, made news across the country.

Heart specialists popped up in local papers or on telecasts to explain how AF could have spurred Peverley’s collapse and why it could not be controlled, even in a young and otherwise healthy man with the best possible medical oversight.

Peverley, 31, was diagnosed with AF before the Dallas training camp last September. He was treated with a shock to the heart and medication and weighed the option of catheter ablation but ultimately declined because he was concerned about the surgery.

“It likely would keep him out for 2, 3 months, maybe longer depending,” said Robert Dimeff, MD, the director of medical services for the Stars. “And so he said, ‘I’m new to the team. It’s a new coach, a new general manager. I only have a 2-year contract. They’ve got to know that I can play this game,’ and that sort of thing. So we went back and forth.”

Even without the surgery, Peverley missed the entire preseason and the first game of the regular season but then played the next 60 games without incident while taking medication and undergoing regular checkups.

He first complained of feeling “odd” after playing one week before his eventual collapse, so team doctors held him out one game before letting him play the last 2 games before Dallas played Columbus.

Doctors who have spoken or written about Peverley’s experience have tried to combine explanations of the particular case with information of general value.

Some have stressed that the incident demonstrates the need for research into better treatment options than either the medication that failed Peverley or the catheter ablation that, according to a growing body of research, was no more likely to have worked.

Others have stressed that the incident illustrates the need for more people to get themselves tested.

But the most common teaching point seems to be the need for organizations, from offices to shops and restaurants, to prepare for cardiac emergencies.

Peverley lived because a fatal cardiac event several years ago inspired the NHL to implement a rapid response team that supplied help less than 30 seconds after the problem arose.

“If we could have 14 seconds on every person this happens to everywhere, it would be amazing,” said Dr. Sharon Reimold, a University of Texas Southwestern cardiologist. “If something lasted more than 10 minutes, it’s increasingly difficult to effectively resuscitate them.”

John Mandrola, MD, a cardiac electrophysiologist from Louisville reached the same conclusion on his blog.

“I can’t stress the point of early intervention enough,” he wrote. “This group of researchers from France found major regional disparities in survival from cardiac arrest. The authors concluded: ‘SCA [Sudden Cardiac Arrest] cases from regions with the highest levels of bystander resuscitation had the best survival rates to hospital admission and discharge.’”