Exploring Exercise-induced Long QT: A Scoping Review of Reversibility Through Detraining and Distinction from Long QT Syndrome

Exercise-induced long QT may mimic congenital long QT syndrome (LQTS), risking misdiagnosis and unnecessary treatment. This scoping review explores its reversibility through detraining and differentiation from congenital LQTS. A systematic search of five databases identified six studies involving 196 subjects. Results showed that exercise-induced long QT is reversible, with QT intervals normalizing after detraining, typically over 1–6 months. Unlike congenital LQTS, affected athletes often lacked genetic mutations or family histories linked to the condition. The difference between congenital LQTS and exercise-induced long QT lies in the reversibility of QT interval prolongation. In those with exercise-induced long QT, the prolonged QT interval would return to normal levels with detraining, unlike in congenital LQTS. Further long-term follow-up is needed to assess the potential arrhythmic risk associated with re-exposure to intensive training. Additionally, negative genetic testing and absence of family history do not entirely exclude congenital LQTS nor indicate benignity, emphasizing the need for careful clinical assessment beyond these factors.