Diagnosis and Prevention of Long QT Syndrome in Sports
DOI:
https://doi.org/10.56294/shp2024109Keywords:
Long QT syndrome (LQTS), arrhythmia, diagnosis, genetics, athletesAbstract
The relationship between sports and cardiovascular health, highlighting that, although exercise offered significant benefits, it could also trigger serious events in individuals with hereditary heart conditions, such as Long QT Syndrome (LQTS). This genetic channelopathy affected ventricular repolarisation, increasing the risk of arrhythmias and sudden cardiac death, especially in athletes. LQTS was caused by mutations in specific genes and could manifest as syncope, palpitations or sudden death during physical exertion. Diagnosis required a detailed electrocardiographic evaluation, complicated by physiological changes induced by training. The use of genetic testing and the importance of family screening were also mentioned. Finally, it was highlighted that international guidelines allowed for individualised assessment to determine sports eligibility, promoting personalised medicine that protected the lives of athletes.
References
1. Narayanan K, Chung EH, Gheorghiade M. Sudden cardiac death during sports activities in the general population. Card Electrophysiol Clin. 2017;9(4):559–67.
2. Agut-Busquey A, Galtés I. Sudden cardiac death and sport. Review and key trends. Rev Esp Med Legal. 2018;44(4):158–68.
3. Wang D, Shah KR, Um SY, Eng LS, Zhou B, Lin Y, et al. Cardiac channelopathy testing in 274 ethnically diverse sudden unexplained deaths. Forensic Sci Int. 2014;237:90–9.
4. Papadakis M, Sharma S. Sudden cardiac death. Medicine. 2010;38(9):502–9.
5. Jervell A, Lange-Nielsen F. Congenital deaf-mutism, functional heart disease with prolongation of the Q-T interval, and sudden death. Am Heart J. 1957;54(1):59–68.
6. Romano C, Gemme G, Pongiglione R. Syncopal attacks due to paroxysmal ventricular fibrillation. Clin Pediatr (Bologna). 1963;45:656–83.
7. Schwartz PJ, Stramba-Badiale M, Crotti L, Pedrazzini M, Besana A, Bosi G, et al. Prevalence of the congenital long-QT syndrome. Circulation. 2009;120(18):1761–7.
8. Zareba W, Moss AJ, Schwartz PJ, Vincent GM, Robinson JL, Priori SG, et al. Influence of the genotype on the clinical course of the long-QT syndrome. N Engl J Med. 1998;339(14):960–5.
9. Schwartz PJ. Idiopathic long QT syndrome: progress and questions. Am Heart J. 1985;109(2):399–411.
10. Wasfy MM, Weiner RB, Wang F, Berkstresser B, Lewis GD, DeLuca JR, et al. Endurance exercise-induced cardiac remodeling: not all sports are created equal. J Am Soc Echocardiogr. 2015;28(12):1434–40.
11. Baggish AL, Battle RW, Beaver TA, Border WL, Douglas PS, Kramer CM, et al. Recommendations on the use of multimodality cardiovascular imaging in young adult competitive athletes. J Am Soc Echocardiogr. 2020;33(5):523–49.
12. Goldenberg I, Zareba W. Long QT syndrome. Curr Probl Cardiol. 2008;33:629–94.
13. Schwartz PJ, Priori SG, Spazzolini C, Moss AJ, Vincent GM, Napolitano C, et al. Genotype-phenotype correlation in the long-QT syndrome: gene-specific triggers for life-threatening arrhythmias. Circulation. 2001;103(1):89–95.
14. Basavarajaiah S, Wilson M, Whyte G, Shah A, Behr E, Sharma S. Prevalence and significance of an isolated long QT interval in elite athletes. Eur Heart J. 2007;28(23):2944–9.
15. Ackerman MJ, Priori SG, Willems S, Berul C, Brugada R, Calkins H, et al. HRS/EHRA expert consensus statement on the state of genetic testing for channelopathies and cardiomyopathies. Heart Rhythm. 2011;8(8):1308–39.
16. Priori SG, Schwartz PJ, Napolitano C, Bloise R, Ronchetti E, Grillo M, et al. Risk stratification in the long-QT syndrome. N Engl J Med. 2003;348(19):1866–74.
17. Brugada J, Brugada R, Brugada P. Channelopathies: a new category of diseases causing sudden death. Herz. 2007;32(3):185–91.
18. Viskin S, Rosovski U, Sands AJ, Chen E, Kistler PM, Kalman JM, et al. Inaccurate electrocardiographic interpretation of long QT: the majority of physicians cannot recognize a long QT when they see one. Heart Rhythm. 2005;2(6):569–74.
19. Funck-Brentano C, Jaillon P. Rate-corrected QT interval: techniques and limitations. Am J Cardiol. 1993;72:17B–22B.
20. Malik M, Färbom P, Batchvarov V, Hnatkova K, Camm AJ. Relation between QT and RR intervals is highly individual among healthy subjects. Heart. 2002;87(3):220–8.
21. Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International recommendations for electrocardiographic interpretation in athletes. J Am Coll Cardiol. 2017;69(8):1057–75.
22. Petek BJ, Drezner JA, Churchill TW. The international criteria for electrocardiogram interpretation in athletes. Cardiol Clin. 2023;41(1):35–49.
23. Toivonen L. More light on QT interval measurement. Heart. 2002;87(3):193–4.
24. Malik M. Relation between QT and RR intervals is highly individual among healthy subjects. Heart. 2002;87(3):220–8.
25. Napolitano C, Bloise R, Priori SG. Long QT syndrome and short QT syndrome: how to make correct diagnosis and what about eligibility for sports activity. J Cardiovasc Med. 2006;7(4):250–6.
26. Funck-Brentano C, Jaillon P. Rate-corrected QT interval: techniques and limitations. Am J Cardiol. 1993;72(6):B17–22.
27. Johnson JN, Ackerman MJ. QTc: how long is too long? Br J Sports Med. 2009;43(9):657–62.
28. Taggart NW, Haglund CM, Tester DJ, Ackerman MJ. Diagnostic miscues in congenital long-QT syndrome. Circulation. 2007;115(20):2613–20.
29. Priori SG, Blomstrom-Lundqvist C, Mazzanti A, et al. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2015;36:2793–867.
30. Ernstene AC, Proudfit WL. Differentiation of the changes in the Q-T interval in hypocalcemia and hypopotassemia. Am Heart J. 1949;38:260–72.
31. Kapa S, Tester DJ, Salisbury BA, Harris-Kerr C, Pungliya MS, Alders M, et al. Genetic testing for long QT syndrome – distinguishing pathogenic mutations from benign variants. Circulation. 2009;120(18):1752–60.
32. Schnell F, Behar N, Carré F. Long-QT syndrome and competitive sports. Arrhythm Electrophysiol Rev. 2018;7(3):187.
33. Maron BJ, Zipes DP, Kovacs RJ. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: preamble, principles, and general considerations. Circulation. 2015;132(22).
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