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Athletic participation risk appears acceptable in properly managed CPVT
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Athletes with catecholaminergic polymorphic ventricular tachycardia, or CPVT, may safely compete if shared decision making and effective treatment are utilized, according to data published in JACC: Clinical Electrophysiology.
“While breakthrough events can and do occur even among CPVT patients receiving the best care at dedicated CPVT centers of excellence, there are also the known risks of a sedentary lifestyle as well as a decreased quality of life that may come with quitting physical activity and/or athletics,” Michael J. Ackerman, MD, PhD, director of the Long QT Syndrome/Genetic Heart Rhythm Clinic and the Windland Smith Rice Sudden Death Genomics Laboratory at Mayo Clinic, said in a press release.
Michael J. Ackerman
Ackerman and colleagues performed a retrospective analysis of 63 patients (46% male; mean age, 26 years) who were seen at Mayo Clinic’s Long QT Syndrome/Genetic Heart Rhythm Clinic after 1995 with a diagnosis of CPVT, a genetic condition. Of those, 24 identified as current athletes at time of diagnosis and 21 of them continued competition after diagnosis.
The researchers collected information on treatment, sports played before and after diagnosis, and cardiac events before and after initiation of treatment. Patients and their families were informed about the risks and benefits associated with competitive sports and CPVT and the side effects of treatment before a shared decision was made.
Athlete vs. n onathlete
According to the results, nine patients (14%) experienced a CPVT-associated cardiac event during follow-up. At the time of the event, three of the patients were athletes and six were nonathletes; no difference in event rate was observed between the two groups (P = .7). An 86% event-free survival rate in 583 combined years of follow-up was observed regardless if the patient was athletic. Three of the 21 athletes (14%) who continued to compete experienced three events compared with the seven events experienced by six of the nonathletes (14%; P = 1). No deaths occurred, and all patients who experienced an event received adjustment to their therapy.
The researchers wrote their data suggest that “after correct diagnosis and implementation of a robust CPVT-directed program, the likelihood of a nonlethal cardiac event was the same among our CPVT patients whether currently an athlete or not.”
Shared decision making
In an accompanying editorial, Andrew D. Krahn, MD, head of the division of cardiology at the University of British Columbia in Vancouver, British Columbia, Canada, and Shubhayan Sanatani, MD, of the BC Children’s Hospital, department of pediatrics, University of British Columbia, wrote that, “Shared decision making supported by evidence-guided medical therapy and incremental interventions lays the foundation for a more permissive approach to not only allowing but also potentially encouraging participation in physical activity, including competitive sports.
“Although highly publicized, sudden death in the young, particularly during athletic competition, is rare, even in CPVT. None of the events in this series would be prevented by activity restriction, and our bias should be toward health promotion and athletic participation,” Krahn and Sanatani wrote. – by Tracey Romero
Disclosure: Ackerman reports consulting for Boston Scientific, Gilead Sciences, Medtronic and St. Jude Medical. Ackerman and Mayo Clinic report receiving sales-based royalties from Transgenomic for two genetic tests. Please see the full study for a list of all other researchers’ relevant financial disclosures. Krahn and Sanatani report no relevant financial disclosures.
Perspective
Back to TopBrian Olshansky, MD
This is a single-center early experience. The data are definitely not definitive. Also, because this is a study of children, the data may not translate to adults. The “shared decision making approach” passes the buck, but it may be the most acceptable for the patient and the family. My experience with this, however, is less than ideal, especially in children who cannot make the decision. The parents do. The patient’s family may think they are informed, but they may be blind-sighted by the risks and if a patient dies, they may deny knowing or ever being told the risks.
Other concerns include that beta-blockers can blunt sports performance and may not be taken despite drug prescription, and that while activity level was not related to events in this trial, in CPVT, activity level can trigger events.
The data do not say what you might think they say. They do not say that it is safe for a CPVT patient to participate in competitive sports.
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