Return-to-Play for Athletes With Genetic Heart Diseases
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- genetic heart disease
- hypertrophic cardiomyopathy
- long QT syndrome
- shared decision making
Until recently, expert guidelines such as the 2005 36th Bethesda Conference Guidelines1 and the 2005 European Society of Cardiology2 guidelines have recommended disqualification from most competitive sports for athletes with a variety of genetic heart diseases, aiming to prevent sudden cardiac death. However, recent studies have shown that carefully selected athletes with a variety of genetic heart diseases, including catecholaminergic polymorphic ventricular tachycardia and long QT syndrome, who elected to continue in competitive sports after a shared decision-making evaluation rarely experienced disease-triggered breakthrough cardiac events.3–5 These observations have prompted acknowledgment of the importance of shared decision making and consideration of an athlete’s desire to return-to-play in the recent 2015 American Heart Association/American College of Cardiology scientific statement.5 This document recognized that the foundational evidence to compel a recommendation for disqualification was disease-dependent and, in many instances, lacking.5 It updated the Bethesda guidelines by defining return-to-play as an approval from an expert who specializes in genetic heart diseases to participate in competitive sports after a thorough examination and a comprehensive treatment/management plan has been established. Additionally, the statement advised disclosure of the athlete’s medical condition to the athlete’s school/university with no guarantee that the host institution will uphold the return-to-play decision.5
After approval by the Mayo Clinic Institutional Review Board, a …