Can CPVT Patients Compete in Sports?

Patients with catecholaminergic polymorphic ventricular tachycardia (CPVT), who are usually disqualified from participating in most sports due to a risk of sudden cardiac death, may be able to safely participate in athletics as long as they are well treated and well informed, according to a study published June 20 in JACC: Clinical Electrophysiology.

In the study, Michael J. Ackerman, MD, PhD, et al., retrospectively analyzed records of 63 patients ages six and older with CPVT treated at Mayo Clinic’s Genetic Heart Rhythm Clinic to determine the impact of continued sports participation. Patients in the study were diagnosed at an average age of 16, and 31 participants said they were athletes at some point before diagnosis.

Of the 24 patients in the study who identified as athletes at the time of diagnosis, 21 continued to compete in sports. They also found that 76 percent of the athletes had cardiac events prior to diagnosis compared to 43 percent in the non-athlete group. Of the 63 patients, nine patients experienced a CPVT-related event during follow-up despite ongoing treatment. However, there was no difference in events or event rates between the athletes and non-athletes — three athletes experienced one event each while seven events total were reported among six non-athletes. There were no deaths in either group.

According to the researchers, the decision for these patients to compete in sports is complex and must involve all relevant family members and coaches, especially if the patient is a minor. There must be a discussion of the risks and benefits of associated with sports, the diagnosis, as well as the impact of any side-effects associated with treatment before a decision is made. The authors add that moving forward, larger studies will be needed to fully understand the impact and outcomes of sports participation for patients with CPVT. They explain that their results may not be generalizable to patients evaluated and treated elsewhere, especially centers with a lack of experience in treating this specific genetic heart rhythm disorder.

In an accompanying editorial, Andrew D. Krahn, MD, and Shubhayan Sanatani, MD, say the study is good news for patients with CPVT. "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 potentially encouraging participation in physical activity, including competitive sports," they explain. "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 towards health promotion and athletic participation."

Clinical Topics: Arrhythmias and Clinical EP, Sports and Exercise Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Arrhythmias, Cardiac, Athletes, Death, Sudden, Cardiac, Decision Making, Electrophysiology, Health Promotion, Heart Conduction System, Retrospective Studies, Risk Assessment, Sports, Tachycardia, Ventricular

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