B-PO05-190 ATHLETES WITH SUDDEN CARDIAC DEATH-PREDISPOSING GENETIC HEART DISEASE: WINNING THE ‘RETURN-TO-PLAY’ GAME

Abstract

Within the last five years, international cardiac society guidelines have begun to acknowledge shared decision making (SDM) for the athlete with sudden cardiac death (SCD)-predisposing genetic heart diseases (GHDs) and the possibility for that athlete’s return-to-play (RTP). Previously, these guidelines embraced a de facto disqualification for all such athletes including athletes with solely a positive genetic test in Europe. To examine the prevalence and outcomes of athletes with SCD-predisposing GHDs after their RTP. We performed a retrospective review of the electronic medical record on all athletes with GHD who were evaluated, risk stratified, and treated in Mayo Clinic’s Windland Smith Rice Genetic Heart Rhythm Clinic by a single genetic cardiologist between July 2000 and July 2020 and analyzed SCD-associated breakthrough cardiac events (BCEs). The cohort included 672 athletes (292 females [43.5%]; mean age at diagnosis 15.7 ± 10.7 years; mean follow-up 3.16 ± 3.83 years) who were given RTP approval. The majority of athletes (N = 494 [73.5%]) had long QT syndrome (LQTS). Overall, 166 (24.7%) were symptomatic before diagnosis, and 139 (20.7%) had an implantable cardioverter defibrillator (ICD). In 2,126 combined years of follow-up, there was no GHD-sports associated mortality. Instead, 48 (7.1%) patients had > 1 non-lethal, GHD-associated BCE. Of those, 29 (4.3%) were athletes at the time of the BCE, with 15 (2.2%) experiencing a sports-related BCE, and 14 (2.1%) non-sports-related. Overall, the event rate was calculated to be 1.69 events per 100 athlete-years of follow-up. The BCE rate for LQTS athletes was 1.16 events per 100 athlete-years. This 20-year single center experience challenges the prior status quo of disqualification for all athletes with GHD and provides additional observational evidence, albeit from a single center, in support of the more contemporary SDM approaches to this complex issue.