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HRS 2021: Return to play possible for athletes with most genetic heart conditions

A study presented at the in-person Heart Rhythm 2021 (HRS 2021; 28–30 July, Boston, USA), and published in the Journal of the American College of Cardiology, indicates that — with the right management — many athletes with genetic heart conditions can safely return to playing sport after their diagnosis. Historically, the diagnosis of a genetic heart condition, such as long QT syndrome, meant that athletes would have to discontinue playing because of the risk of sudden cardiac death.

Kathryn E Tobert (Mayo Clinic, Minnesota, USA) and colleagues reviewed data for 672 patient athletes with genetic heart diseases that predisposed them to disease-triggered sudden cardiac arrest and who participated in organised, competitive sports between 2000 and 2020. A press release reports that each athlete's record was reviewed for clinical details, treatments, breakthrough cardiac events (such as fainting because of an arrythmia) and the sport or sports played. Additionally, the most physically active sport of each athlete was used to classify individual risk level. Of these athletes, 495 had long QT syndrome.

Tobert et al found that across more than 2,000 combined years of follow-up (over a 20-year period), no deaths were related to sports in the athletes diagnosed with genetic heart disease who decided to return to play. While there were breakthrough cardiac events, none of these events were fatal. Furthermore, most of the athletes in the study did not have an implantable cardioverter defibrillator (ICD) and of these, none required a rescue shock from an external automatic defibrillator (even though that equipment was part of every athlete's safety gear and emergency action plan). The press release states that these data show that athletes in the cohort had just over a 1% chance of having a non-lethal episode during sports each year.

According to the lead author Dr Michael J Ackerman (Mayo Clinic, Minnesota, USA), shared decision-making is important for a safe return to play. He explains that shared decision making begins with thorough testing, a customised treatment plan, discussion of risks and a review of current guidelines for sports participation. If the athlete and parents are unanimous in their decision ― when age-appropriate ― return to play is allowed. Then coaches and school officials are informed, and safety measures put in place, including having a personal automatic electronic defibrillator, avoiding QT-prolonging drugs in the case of long QT syndrome, maintaining proper hydration and electrolyte balance, and having annual follow-up consultations with their genetic cardiologist for risk re-evaluation and treatment review.

“The results of implementing shared decision-making have been incredibly satisfying and in fact have reshaped the global conversation for athletes with a wide variety of genetic heart diseases Young people with genetic heart disease can grow up and dream big. Such athletes will be able to reach for the highest level of Olympic and professional sports,” Dr Ackerman says.

However, he adds that shared decision making will not always result in an athlete returning to play as, for some, it will lead to the recommendation that the athlete does not return to play. This is the case for athletes who have a specific type of genetic heart disease that accelerates with sports activity. Ackerman states that 15–20% of his athletic patients come to a family-based decision of sports disqualification after evaluation.

For healthcare professionals
The Virtual Heart Rhythm Congress (launching 3rd October) will have session on both inherited conditions and on arrhythmias in athletes. For more programme information, and for information on how to register, visit: www.heartrhythmcongress.org

For patients
Visit our Patient Resources page for booklets and factsheets on living with arrhythmias, cardiac devices, and inherited arrhythmias and genetic testing. 

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