Abstract
Tobert et al (J Am Coll Cardiol 2021;78:594, PMID 34330632) reported outcomes of athletes with genetic heart disease (GHD) at risk for sudden death after return to play (RTP). The study used shared medical decision making and an evaluation protocol including education for patients/families to decide on RTP. This retrospective study included 672 athletes, of whom 494 had long QT syndrome (LQTS) (mean age 14.8 ± 10.5 years; mean follow-up 4.2 ± 4.8 years: 50% LQTS type 1; 16% symptomatic before diagnosis; and 11.7% with an implantable cardioverter-defibrillator). The LQTS group had a breakthrough cardiac event in 15 (3%) during the RTP period, with only 3 (0.6%) occurring during exercise. The rate of breakthrough cardiac event was 1.16 per 100 athlete-years. The group of 178 athletes with non-LQTS GHD (mean follow-up 4.8 ± 3.7 years) had 14 subjects with ≥1 breakthrough cardiac event during the RTP period (8%) with a rate of 3.3 per 100 athlete-years. There was no significant difference in the event rate on the basis of LQTS genotype (P = .45) or on the basis of sports classification. In 2056 combined years of follow-up, there were no deaths related to GHD in this study. The authors conclude that after thorough evaluation and shared medical decision making with patients and families, athletes with GHD can safely return to play.
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