Return-to-play protocol safe for elite athletes with genetic heart diseases at risk for sudden cardiac death

The researchers found return-to-play (RTP) following shared decision-making (SDM) to be associated with low, nonfatal events rate at elite levels of sports after careful evaluation, risk stratification, and tailoring of their GHD therapy.

During cumulative follow-up of 200 athlete-years, Katherine A. Martinez, Mayo Clinic, Rochester, Minnesota, USA, and colleagues found no cardiac arrests or fatalities after the athletes returned to their sport upon approval by one of four U.S. sports cardiology centres using the protocol.

Ninety-five per cent of athletes with a diagnosed and treated GHD experienced no disease-triggered cardiac events, including cardiogenic fainting or seizures, sudden cardiac arrest, ICD shocks, or sudden cardiac death.

People with a diagnosis of genetic heart disease associated with sudden cardiac death have historically been restricted from competitive sports. Recent studies showing RTP experience following shared decision-making indicate that cardiac event rates for athletes with a GHD are lower than previously described, thereby suggesting an opportunity to reconsider this paradigm.

Martinez and the team aimed to evaluate clinical outcomes among National Collegiate Athletic Association Division I university and professional athletes diagnosed with genetic heart disease in a multicenter retrospective analysis.

The study included 50 National Collegiate Athletic Association Division I student-athletes and 26 professional athletes diagnosed with a GHD. The mean age at RTP was 19.9 years, and 28% of the cohort were women. The researchers examined clinical characteristics, demographics, RTP outcomes, and cardiac events among elite athletes with a GHD.

The most commonly represented conditions were long QT syndrome (26%) and hypertrophic cardiomyopathy (53%); the rest of the cases were a mix of dilated cardiomyopathy, arrhythmogenic cardiomyopathy, idiopathic ventricular fibrillation, and other cardiomyopathies in smaller numbers.

The study led to the following findings:

• Most athletes were asymptomatic (48 of 76, 63%) before diagnosis and had their GHD detected during routine preparticipation cardiovascular screening.
• Most athletes (55 of 76, 72%) were initially disqualified from their sport but subsequently opted for unrestricted RTP after comprehensive clinical evaluation and SDM.
• To date, (mean follow-up 7 ± 6 years), only 1 exercise-related (1.3%) and 2 nonexercise-related GHD-associated adverse cardiac events occurred.
• There have been no fatalities during follow-up.

According to the authors, these data suggest that sport after a GHD [genetic heart disease] diagnosis is both feasible and associated with low adverse event rates, even in elite-level athletes.

"For elite-level athletes diagnosed with genetic heart disease, the first available outcomes data on an RTP protocol favoured the approach, comprising shared decision-making with comprehensive diagnostic evaluation, risk stratification, and treatment," the researchers concluded.

Reference:

Source Reference: Martinez KA, et al "Return-to-play for elite athletes with genetic heart diseases predisposing to sudden cardiac death" J Am Coll Cardiol 2023; DOI: 10.1016/j.jacc.2023.05.059.