Return-to-Play May Be Possible for Athletes With Long QT Syndrome or Genetic Heart Diseases

The researchers examined the prevalence and outcomes of athletes with sudden cardiac death-predisposing genetic heart diseases, particularly LQTS, after return-to-play.

Through a shared decision-making approach, athletes —with genetic heart diseases (GHDs), such as long QT syndrome (LQTS), which predisposes them to sudden cardiac death, may be able to return to play, according to results of a 20-yearstudy published in Journal of the American College of Cardiology.

In the study, researchers from the Mayo Clinic assessed the outcomes of 672 athletes with GHDs that predisposed them to sudden cardiac arrest after they returned to play. Patient outcomes were retrospectively examined using electronic medical records, which were obtained from Mayo Clinic’s Windland Smith Rice Genetic Heart Rhythm Clinic. Only patient-athletes with GHDs who were treated at the clinic between 2000 and 2020 were included in the study.

Patients had returned to play after undergoing a comprehensive risk stratification consultation. Following this consultation, patients were placed on an optimized patient- and/or GHD-specific treatment plan. Patients, their parents, and treating physicians were all made to understand the risk of returning to sports, and sports officials were made aware of the underlying condition, risks, and final decision of the players.

A total of 494 athletes in the study had LQTS (mean age at diagnosis, 14.8±10.5 years; 46.8% women) and were allowed to return to play. The mean follow-up for these patients was 4.2±4.8 years.

Approximately 16% (n=79) of the 494 athletes with LQTS had symptoms prior to diagnosis, while 11.7% (n=58) received an implantable cardioverter-defibrillator. Patients had a total follow-up period of 2056.83 years, during which time there were no cases of GHD sports-associated mortality.

Most athletes (94.1%) had no LQTS-related breakthrough cardiac events (BCEs); however, 5.9% (n=29) had at least 1 event in the follow-up period. A total of 15 patients with at least 1 BCE experienced the event during the return-to-play period, while 3 (0.6%) experienced an event during exercise and 12 (2.4%) experienced an event during activities not related to sports. The overall event rate for athletes with LQTS was 1.16 nonlethal events per 100 athlete-years of follow-up.

Limitations of this study included its retrospective design and the inclusion of patients who received care at a tertiary specialty center. In addition, the findings may not be generalizable across all athletes with LQTS.

The researchers wrote that “the risk [for] cardiac events among patients with LQTS or other inherited arrhythmogenic channelopathies need not preclude participation in sports, providing patients follow a protocol that includes compliance with medication and treatment.”

The researchers suggested that return-to-play may be possible by “informing sports officials, trainers, or coaches” of the patient’s health status while making available “a personal automatic external defibrillator or implanted cardioverter-defibrillator” to the patient.

Disclosure: One author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Tobert KE, Bos M, Garmany R, Ackerman MJ. Return-to-play for athletes with long QT syndrome or genetic heart diseases predisposing to sudden death. J Am Coll Cardiol. Published online July 27, 2021. doi:10.1016/j.jacc.2021.04.026