In long QT syndrome, vigorous exercise appears OK regardless of age, sex, genotype
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Key takeaways:
- In long QT syndrome, patients doing vigorous exercise did not have more events than those doing nonvigorous exercise, regardless of age, sex or genotype.
- Very few events occurred during vigorous exercise.
In patients with long QT syndrome, vigorous exercise did not appear to increase CV event risk vs. nonvigorous exercise regardless of age, sex or genotype, according to new data from the LIVE-LQTS study presented at Heart Rhythm 2024.
As Healio previously reported, in the main results of LIVE-LQTS, vigorous exercise did not raise risk for death or arrhythmias compared with nonvigorous exercise in patients with long QT syndrome (LQTS).
“We had a couple of questions we wanted to delve into more deeply that led us to this subanalysis,” Rachel Lampert, MD, FACC, FHRS, Robert W. Berliner Professor of Medicine (Cardiology) at Yale School of Medicine, told Healio. “First, we wanted to look at different subgroups based on long QT genotype — long QT1 and long QT2 being the most common — as well as age and sex. We know from prior work that, in general, arrhythmia susceptibilities vary based on these factors. We wanted to understand whether exercise would impact individuals differently based on these factors. The second question we had was ... what were the patients doing at the time that they had their arrhythmic events, and did that differ by these same factors?””
The trial included 1,413 people (mean age, 28 years; 67% women; 94% white) from 42 sites in five countries with a diagnosis of manifest or concealed LQTS who were able to complete a questionnaire and did not have any conditions precluding exercise. All patients were followed for 3 years. For the present analysis, participants were stratified by age ( 13 years or < 13 years), sex (male or female) and genotype (LQT1 or LQT2).
Breakdown by age, sex, genotype
In those with LQT1 younger than 13 years, there were no events in females and three events in males, one in the vigorous exercise group and two in the nonvigorous exercise group, Lampert said during a presentation, noting that all events were implantable cardioverter defibrillator shocks for ventricular fibrillation or ventricular tachycardia and occurred during mild physical activity such as playing tag.
In those with LQT1 aged 13 years or older, there were three events in males — one patient from the vigorous group cardiac arrest during physical activity and two ICD shocks for VF/VT in one patient from the nonvigorous group while playing sports — and 14 events (one death and 13 ICD shocks) in eight female patients, half of whom had their events during physical activity and the other half of whom had theirs during activities of daily living or while at rest, representing 1.7% of the vigorous group and 2.4% in the nonvigorous group, according to the researchers.
In patients with LQT2 younger than 13 years, there were no events in males, whereas one female patient had cardiac arrest while getting up from a table, Lampert said.
In patients with LQT2 aged 13 years or older, there were no events in males and 13 ICD shocks in 10 female patients, all of whom had their events during activities of daily living or while at rest, representing 4.6% of the vigorous group and 3.6% of the nonvigorous group, she said.
Appropriate treatment key
“Almost none of the events in the exercisers or the non-exercisers in any of these subgroups were actually occurring during vigorous exercise,” Lampert told Healio. “There were no subgroups in which we were seeing anything different from the main analysis. This reinforces the findings of the main analysis that in these patients with long QT syndrome who are appropriately treated, we are not seeing increases in events overall. We also are not seeing competition as a frequent trigger.”
She said the findings show that “being seen by an expert and being appropriately treated is key. If you are appropriately treated and counseled by an expert, with individualized discussions and decision-making, many individuals can return to vigorous exercise.”
For more information:
Rachel Lampert, MD, FACC, FHRS, can be reached at rachel.lampert@yale.edu.
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Lampert R, et al. Late-breaking clinical trials and science – CIEDs. Presented at: Heart Rhythm 2024; May 16-19, 2024; Boston.
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