A little more than a decade ago, conventional cardiology councils would have prevented patients with QT Long (LQT) syndrome from participating in sports for the sake of potentially fatal arrhythmia. However, the montage of data, including those of a recent multinational prospective test, support a pivot away from these directives.
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The authors of this study, published In Trafficfound no appreciable difference in cardiac event rates among the participants in the study with phenotypic and / or genotypic LQTs which engaged in a weak or vigorous exercise.
Historical perspective
“Sports participation was really considered a risk for these patients about 15 years ago,” said Peter Aziz, MD, Director of the hereditary clinic of arrhythmia at the Cleveland Clinic and one of the co -authors of the study.
This approach without exposure was standard for decades until clinicians note that most treated patients did not know arrhythmias induced by activity. In the United States, two high volume centers have published retrospective studies around 2010 highlighting institutional experiences showing cardiac results associated with favorable LQs in the context of sports participation.
These results have contributed to inaugurating a new conscience of the discipline that, despite well -founded concerns, patients may be able to engage in complete safety in competition sports with the appropriate precautions. This evidence provided the basis of the potential and observational study known as the live study of the LQTS (lifestyle and exercise in the long study of QT syndrome).
A more in -depth look at the data
Live LQT researchers scored 1,413 patients from 2015 to 2019 in 37 high volume LQT centers in the United States, the United Kingdom, Canada, Australia and New Zealand. The ages varied from 8 to 60 with phenotypic and / or genotypic lqt. Study participants (or their parents) were administered surveys that captured physical activities and clinical events every six months for three years. They have established three activity cohorts with these data: sedentary exercise, moderate intensity and vigorous intensity exercise.
The authors found that 52% (n = 737) engaged in a vigorous exercise – and more than half (55%) were competition athletes. According to the researchers, the events triggered by LQTS were weak throughout the three -year follow -up. Only 2.6% of those who exercise vigorously and 2.7% of non -vigorously (sedentary and moderate) exercise experienced an event.
The risk report not adjusted for the experience of events for the vigorous group compared to the non -vigorous group was 0.97 (90%CI, 0.57–1.1.67), with an adjusted risk ratio of 1.17 (90%CI, 0.67–2.04), note the authors of the report.
A significant contribution to literature
Although it is not surprising, Dr. Aziz adds that the results were reassuring and add significant evidence to the literature, improving conversation with patients and families.
“We used to quote the data and say:” This is what we know, and these are the data we have. We believe that restricting children in sports participation is more harmful than beneficial. “But now we can comfort ourselves in the evidence of a large well -fueled study to feel confident to make this recommendation.”
Sports participation has many identity and social development training components for children. The cost of not engaging in physical activity can be high for certain children, with potential involuntary consequences, in particular low self -esteem and / or depression.
Screening and treatment improvements
Are the previous directives of the LQTS on sports participation too conservative? Not exactly. Said Dr. Aziz, “The event rates were much higher 30 years ago and are much lower because we better understand screening and treatment. We identify patients with LQT before becoming symptomatic, so the severity of the disease has decreased, even if nothing about the disease has really changed.”
It is now well established that there are three main LQTS subtypes, each caused by a different gene variant and with different symptoms and complications. “We now know that patients with LQT1 are more vulnerable to? “We also now know that beta-blockers, first-line therapy for LQTs, are incredibly effective in reducing arrhythmic events, especially in LQT1. Implantable devices and sympathetic denervation surgery can also be effective treatment strategies to prevent deadly arrhythmia in life in higher risk.”
Research that changes practice
Sports participation and vigorous activities are always a conversation for the patient, their parents or caregivers and the cardiologist. Many experts hope that this adds an ease of clinical decision -making which seems very different today from that ago, when the complete restriction would be the simplest and most avenged risk advice.
“One thing more difficult to do is say:” You can play, but let’s see how to make it sure for you. “It is our work to save lives, but it is also our work to defend our patients and to improve their quality of life, and that is what we aim to do in this study,” concludes Dr. Aziz.