Sports Participation in Genotype Positive Children with Long QT Syndrome

Aziz, Peter F.; Sweeten, Tammy L.; Vogel, R. Lee; Bonney, William J.; Henderson, Jacqueline; Patel, Akash R.; Shah, Maully J.

doi:10.1016/j.jacep.2015.02.003

Cited by 10 publications

(15 citation statements)

References 11 publications

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“…A prospective study from Italy found a 73% mortality reduction in athletes from early detection of hypertrophic cardiomyopathy compared to unscreened non-athletes 51. In addition, individualised management and indepth counseling of children diagnosed with long QT syndrome have shown low cardiac event rates and no deaths in two separate cohorts of young recreational and competitive athletes 99 100. Expert consensus guidelines for risk stratification and management of asymptomatic athletes identified with a Wolff-Parkinson-White pattern also were developed in partnership between the Pediatric and Congenital Electrophysiology Society and the Heart Rhythm Society 101 102.…”

Section: Outcomes For Early Detection Of Cardiovascular Diseasementioning

confidence: 99%

AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions

et al. 2016

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Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the centre of the controversy is the addition of a resting ECG to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcome-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs and resources. The decision to implement a cardiovascular screening programme, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes. BACKGROUND

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Section: Outcomes For Early Detection Of Cardiovascular Diseasementioning

confidence: 99%

AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions

et al. 2016

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“…Even though the new American scientific statement [14] is more liberal regarding channelopathies and supports participation under certain conditions, on the bases of recent findings [15,16], the 2005 ESC recommendations [9] advise that these individuals should not be involved in competitive sports or should be excluded from most competitive sports, with the possibility of those of low intensity sports (Classification of sports is based on Mitchell et al [17]). …”

Section: To Disqualify or Not To Disqualify?mentioning

confidence: 99%

Empowerment of athletes with cardiac disorders: a new paradigm

et al. 2017

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Athletes with cardiac disorders frequently pose an ethical and medical dilemma to physicians assessing their eligibility to participate in sport. In recent decades, patient empowerment has been gaining increasing recognition in clinical decision-making. Empowerment is a process through which people are involved over the decisions and actions that affect their own lives. In the context of a cardiac disorder, empowerment means giving an athlete the chance to participate in the decision about whether or not to remain active in competition. Three models of treatment decision-making are described in this paper, with progressive levels of empowerment: the paternalistic model (the athlete has a passive role), the shared-decision making model (both athlete and physician participate in the decision) and the informeddecision making (the decision is made by the athlete while the role of the physician is solely to provide information). This paper critically discusses the issues involved in disqualification of athletes with cardiovascular disorders and suggests possible ways of incorporating patient empowerment in potentially career-ending decisions. The authors propose a model of empowerment, which gives patients the opportunity to choose how much, and if, they would like to be involved in the decision-making process.

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“…For example, large cohort studies using current therapeutic measures have demonstrated improved survival and low mortality rates in children and young adults with hypertrophic cardiomyopathy 16 17. For children diagnosed with long QT syndrome, individualised management and in-depth counselling were associated with low cardiac event rates and no deaths in two independent cohorts of young athletes 18 19. For asymptomatic athletes identified with ventricular pre-excitation (Wolff-Parkinson-White pattern), expert consensus guidelines define risk stratification and management strategies to reduce risk 20 21.…”

Section: Disease-oriented Outcomes Evidencementioning

confidence: 99%

Why cardiovascular screening in young athletes can save lives: a critical review

et al. 2016

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Cardiovascular (CV) screening in young athletes remains challenging and a topic of considerable debate. Recent criticisms of ECG screening have perpetuated arguments that ECG screening is neither indicated nor effective by applying outdated incidence data and flawed methodology. In response, this article provides a critical review of the arguments in favour of ECG screening in athletes and the early detection of CV disorders at elevated risk of sudden cardiac death (SCD). Importantly, no study to date has demonstrated that screening by history and physical examination alone is effective in detecting athletes at risk or in preventing SCD. ECG screening using current athlete-specific interpretation standards provides a low false-positive rate and improves detection of potentially lethal CV conditions. Further, risk reduction in athletes identified with CV disorders can be effectively achieved through modern strategies for risk stratification and disease-specific management. By every definition of the purpose of CV screening, ECG-inclusive programmes will better meet the stated objective of early detection when proper ECG interpretation and adequate cardiology resources are available. Less debate on screening protocols and more emphasis on advancing physician skills and infrastructure in sports cardiology is needed to more effectively screen targeted athlete populations.

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Sports Participation in Genotype Positive Children with Long QT Syndrome

Cited by 10 publications

References 11 publications

AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions

AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions

Empowerment of athletes with cardiac disorders: a new paradigm

Why cardiovascular screening in young athletes can save lives: a critical review

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