Athletes with channelopathy may be eligible to play.

N M Panhuyzen-Goedkoop,A A M Wilde

doi:10.1007/s12471-018-1077-5

Abstract

The European and Bethesda recommendations roughly state that any athlete with channelopathy is not eligible to participate in sports on a presumed risk of potentially life-threatening ventricular tachycardia or fibrillation. However, eligibility decision-making on a presumed risk of ventricular tachycardia or fibrillation is debatable. Channelopathies are primary electrical cardiac disorders and are usually transmitted as an autosomal dominant trait. Some of the channelopathies are potentially fatal in relation to exercise and predispose to life-threatening cardiac arrhythmias including ventricular tachycardia or fibrillation. Exercise, swimming, body heating and electrolyte depletion can all act as a trigger of ventricular tachycardia or fibrillation in channelopathy. However, new research mentioned a very low incidence of ventricular tachycardia or fibrillation in athletes with channelopathy challenging the decision of disqualification. Recently, the American recommendations for sports participation in athletes with a cardiovascular disorder have updated their eligibility decision-making.In this manuscript we describe the signature features of the electrocardiogram changes in channelopathies and we argue that new research data should allow for the introduction of more liberal eligibility decision-making for sports participation in athletes with channelopathy, not only in the United States but also in European countries.

Highlights

Channelopathies are inherited primary electrical disorders without structural abnormalities
There are certain specific triggers provoking VT/VF, such as exercise (LQTS, short QT syndrome (SQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT)), increased vagal tone (SQTS, Brugada syndrome (BrS)), immersion in cold water (LQTS), hyperthermia/fever (LQTS, BrS), and electrolyte disturbances [4,5,6,7]. In this issue of the Netherlands Heart Journal, Zorzi et al describe the eligibility in cardiomyopathies—hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy—that are inherited cardiac disorders with structural abnormalities predisposing to fatal cardiac arrhythmia during exercise [8]
In this manuscript we describe the signature features of the ECG changes in channelopathies and we argue that new research data should allow for the introduction of more liberal eligibility decision-making for sports participation in athletes with channelopathy, in the United States and in European countries

Summary

Introduction

Channelopathies are inherited primary electrical disorders without structural abnormalities. There are certain specific triggers provoking VT/VF, such as exercise (LQTS, SQTS, CPVT), increased vagal tone (SQTS, BrS), immersion in cold water (LQTS), hyperthermia/fever (LQTS, BrS), and electrolyte disturbances [4,5,6,7] In this issue of the Netherlands Heart Journal, Zorzi et al describe the eligibility in cardiomyopathies—hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy—that are inherited cardiac disorders with structural abnormalities predisposing to fatal cardiac arrhythmia during exercise [8]. The American recommendations published in 2015 are more liberal in their eligibility decision-making in inherited cardiovascular disorders (CVD) [17,18,19] In this manuscript we describe the signature features of the ECG changes in channelopathies and we argue that new research data should allow for the introduction of more liberal eligibility decision-making for sports participation in athletes with channelopathy, in the United States and in European countries. Triathlon and cycling for instance are high dynamic high static sports, and golf, billiards and riflery are low dynamic low static sports [20]

Electrocardiography in eligibility screening

Cardiac evaluation

Genetic counselling and family screening

Brugada Syndrome All sports All sports

Findings

Conclusion