Competitive Sports Participation in Athletes With Congenital Long QT Syndrome

To the Editor: Competitive sports participation for athletes with long QT syndrome (LQTS) is guided by the 36th Bethesda Conference, which recommends that patients with either (1) symptoms, (2) a corrected QT interval (QTc) greater than 470 milliseconds (males) or 480 milliseconds (females), or (3) an implantable cardioverter-defibrillator (ICD) not participate in most sports. 1 The European Society of Cardiology guidelines are more restrictive, disqualifying athletes from all sports based solely on a stringent QTc cutoff (Ͼ440 milliseconds in males, Ͼ460 milliseconds in females). 2We sought to determine the outcomes of patients with LQTS who chose to remain athletes against guideline recommendations.Methods.In this institutional review board-approved study (with waiver of consent), we reviewed records for patients with LQT1-3 genotypes, aged 6 to 40 years, who were first evaluated in the Mayo Clinic LQTS Clinic between July 2000 and November 2010.Records were reviewed for athletic participation after LQTS diagnosis and LQTS-related events during a mean (SD) follow-up of 5.1 (2.9) years.No patients were lost to follow-up.All were reevaluated or contacted by phone after July 1, 2011.A "competitive athlete" was defined as one participating in organized competitive sports at the little league, middle or high school, collegiate, or professional level.The approach in the Mayo Clinic LQTS Clinic is to provide the athlete and their family with sufficient information to enable an informed decision regarding sports continuation.All patients received a comprehensive 2-to 3-day clinical and genetic evaluation, including a 1-to 2-hour consultation with an LQTS specialist (M.J.A.) and additional consultations as needed. 3-5Extensive counseling was provided to discuss individual prognosis and athletic participation guidelines.If a minor, the athlete and both parents had to agree to sports continuation.Tailored therapy included ␤-blockers, left cardiac sympathetic denervation, an ICD, or a combination.QT drug avoidance, electrolyte and hydration replenishment, and minimization of core body temperature elevations were advised.Each athlete obtained an automatic external defibrillator as part of the sports gear, and relevant school officials and coaches were informed.Statistical analysis was performed using JMP version 8.0 (SAS Institute).A 2-tailed PϽ.05 was considered significant.Results.Of 353 LQT1-3 patients (199 females; mean SD age, 17 11 years; mean SD QTc, 472 42 milliseconds), the majority (223, 63%) either were not