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Editorial
To play or not to play? sports participation and shared decision-making in athletes with inherited heart rhythm disorders
  1. Christopher OY Li,
  2. Thomas M Roston,
  3. Claire MacEwing,
  4. Shubhayan Sanatani
  1. The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Shubhayan Sanatani, The University of British Columbia, Vancouver, BC V6H 3N1, Canada; ssanatani{at}cw.bc.ca

https://doi.org/10.1136/bjsports-2019-101236

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    Sudden cardiac death (SCD) is a leading cause of death in sport. Inherited heart rhythm disorders that cause SCD in young individuals include, but are not limited to, long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), Brugada syndrome, arrhythmogenic cardiomyopathy and hypertrophic cardiomyopathy (HCM). The 2005 American College of Cardiology and the European Society of Cardiology consensus statements recommended uniform and mandatory disqualification of athletes with inherited heart rhythm disorders from competitive sports due to the potential risk of fatal arrhythmias precipitated by adrenergic stress.1 2 This broad, universal mandate for exclusion is an antiquated practice from a time where risk was mostly unpredictable and risk reduction strategies poorly defined. The discovery of many evidence-based markers of risk can facilitate a precision medicine approach to exercise prescription in patients with inherited heart rhythm disorders.

    Primary electrical diseases versus cardiomyopathies: do they need different recommendations for sports participation?

    The risk of recurrent cardiac events is lower than previously thought for primary electrical diseases such as LQTS and CPVT. Young athletes, those aged 21 years or younger, receiving the recommended treatment for LQTS and CPVT (eg, beta blockers and avoidance of QT prolonging medications at a minimum) are not at an increased risk for SCD during competitive sports.3 4 For the other major channelopathy, Brugada syndrome, …

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    Footnotes

    • Contributors COYL, TMR and SS have substantially contributed and are primarily responsible for drafting the work and revising the manuscript. CW supported the drafting of the work and revising it for patient perspective.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.