Let kids with heart condition play sports

April 30, 2015

Children with long QT syndrome need not miss out on the fun and health benefits of recreational and competitive sports, according to a new study that recommends loosening restrictions on participation.

Children with long QT syndrome (LQTS) need not miss out on the fun and health benefits of recreational and competitive sports, according to a new study that recommends loosening restrictions on participation.

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Researchers assessed the prevalence of cardiac events or deaths among 103 children aged between 4 and 21 years who were referred to the Children’s Hospital of Philadelphia for evaluation and management of LQTS between 1998 and 2013. They examined the children’s medical records over an average of 7 years for documented LQTS events. All the children played sports-26 competitively, 77 recreationally-and all received treatment with β-blockers (1 child couldn’t tolerate the medication and 1 was noncompliant).

None of the patients experienced LQTS symptoms during sports participation in 755 patient-years of follow-up. Two patients received a total of 5 appropriate shocks from implantable cardioverter-defibrillators, none of them related to playing sports.

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The 2005 Bethesda Conference report recommends allowing all children with LQTS to participate in billiards, bowling, cricket, curling, golf, and riflery-the so-called “safe six” sports. The recommendations don’t specifically permit children to play more strenuous sports, even if they’re receiving medication for LQTS. The researchers conclude that the results of their study suggest that children who are adequately treated for LQTS can safely participate in more recreational and competitive sports than currently recommended.

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The researchers acknowledge that the study is limited by being confined to 1 institution, including mostly patients participating in recreational sports and less physically demanding competitive sports, and following only active sports participants, perhaps reflecting survival or selection bias. Although the study population was skewed toward asymptomatic patients, they note, it may more accurately reflect the general population, in which many children are diagnosed with LQTS based not on symptoms but rather on electrocardiograms and genetic testing.

An editorial accompanying the study advocates basing decisions about sports participation on consultation between an expert in LQTS and the athlete and family to promote well-informed decision making that weighs all the risks. “The question has never been whether aerobic activity for this group of patients is a potential risk but whether the risk can be minimized in other ways besides eliminating sports,” the editorial states. “We have concluded that the answer is yes.”