Vigorous Exercise in Patients With Congenital Long QT Syndrome: Results of the Prospective, Observational, Multinational LIVE-LQTS Study-Reference-Cited by-同舟云学术

Vigorous Exercise in Patients With Congenital Long QT Syndrome: Results of the Prospective, Observational, Multinational LIVE-LQTS Study

Published:2024-08-13 Issue:7 Volume:150 Page:516-530
ISSN:0009-7322
Container-title:Circulation
language:en
Short-container-title:Circulation

Author:

Lampert Rachel¹^ORCID,Day Sharlene²³^ORCID,Ainsworth Barbara⁴⁵,Burg Matthew¹⁶^ORCID,Marino Bradley S.⁷⁸^ORCID,Salberg Lisa⁹^ORCID,Tome Esteban Maria Teresa¹⁰¹¹^ORCID,Abrams Dominic J.¹²^ORCID,Aziz Peter F.⁷^ORCID,Barth Cheryl¹^ORCID,Behr Elijah R.¹⁰¹¹^ORCID,Bell Cheyanne¹³^ORCID,Berul Charles I.¹⁴^ORCID,Bos Johan M.¹³^ORCID,Bradley David¹⁵,Cannom David S.¹⁶,Cannon Bryan C.¹³^ORCID,Concannon Maryann Anandi³,Cerrone Marina¹⁷^ORCID,Czosek Richard J.¹⁸^ORCID,Dubin Anne M.¹⁹^ORCID,Dziura James¹^ORCID,Erickson Christopher C.²⁰^ORCID,Estes N.A. Mark²¹²²^ORCID,Etheridge Susan P.²³^ORCID,Goldenberg Ilan²⁴^ORCID,Gray Belinda²⁵^ORCID,Haglund-Turnquist Carla¹³^ORCID,Harmon Kimberly²⁶^ORCID,James Cynthia A.²⁷^ORCID,Johnsrude Christopher²⁸^ORCID,Kannankeril Prince²⁹^ORCID,Lara Alice³⁰,Law Ian H.³¹^ORCID,Li Fangyong¹,Link Mark S.²¹³²^ORCID,Molossi Silvana M.³³^ORCID,Olshansky Brian³¹^ORCID,Noseworthy Peter A.³⁴^ORCID,Saarel Elizabeth V.³⁵^ORCID,Sanatani Shubhayan³⁶^ORCID,Shah Maully³⁷^ORCID,Simone Laura¹,Skinner Jonathan³⁸^ORCID,Tomaselli Gordon F.²⁷³⁹,Ware James Simon⁴⁰⁴¹^ORCID,Webster Gregory⁸^ORCID,Zareba Wojciech²⁴^ORCID,Zipes Douglas P.⁴²^ORCID,Ackerman Michael J.¹³^ORCID

Affiliation:

1. Yale School of Medicine, New Haven, CT (R.L., M.B., C. Barth, J.D., F.L, L.S.).

2. University of Pennsylvania, Philadelphia (S.D.).

3. University of Michigan Hospital, Ann Arbor (S.D., M.A.C.).

4. School of Exercise and Health, Shanghai University of Sport, China (B.A.).

5. College of Health Solutions/Arizona State University, Phoenix (B.A.).

6. VA Hospital, West Haven, CT (M.B.).

7. Cleveland Clinic, OH (B.S.M., P.F.A.).

8. Lurie Children’s Hospital, Chicago, IL (B.S.M., G.W.).

9. Hypertrophic Cardiomyopathy Association, Denville, NJ (L.S.).

10. Cardiology Section, Cardiovascular and Genomics Research Institute, St. George’s, University of London, UK (M.T.T.E., E.R.B.).

11. Cardiology Department, St. George’s University Hospitals NHS Foundation Trust, London, UK (M.T.T.E., E.R.B.).

12. Boston Children’s Hospital, MA (D.J.A.).

13. Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics; Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN (C. Bell, J.M.B., B.C.C., C.H.-T., M.J.A.).

14. Children’s National Hospital, Washington, DC (C.I.B.).

15. C.S. Mott Children’s Hospital, Ann Arbor, MI (D.B.).

16. Keck Medicine of USC, Los Angeles, CA (D.S.C.).

17. Leon H. Charney Division of Cardiology, NYU Grossman Sch of Medicine, New York (M.C.).

18. The Heart Institute, Cincinnati Children’s Hospital Med Center, OH (R.J.C.).

19. Stanford University School of Medicine, Palo Alto, CA (A.M.D.).

20. University of Nebraska Medical Center, Children’s Nebraska, Omaha (C.C.E.).

21. Tufts Medical Center, Boston, MA (N.A.M.E., M.S.L.).

22. UPMC, Pittsburgh, PA (N.A.M.E.).

23. University of Utah, Salt Lake City (S.P.E.).

24. Division of Cardiology, University of Rochester Medical Center, NY (I.G., W.Z.).

25. Faculty of Medicine and Health, University of Sydney/Royal Prince Alfred Hospital, Australia (B.G.).

26. Department of Family Medicine, University of Washington, Seattle (K.H.).

27. Johns Hopkins University, Baltimore, MD (C.A.J.,G.F.T.).

28. University of Louisville School of Medicine, KY (C.J.).

29. Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University, Nashville, TN (P.K.).

30. Sudden Arrhythmia Death Syndrome Foundation, Salt Lake City, UT (A.L.).

31. University of Iowa Carver College of Medicine, Iowa City (I.H.L., B.O.).

32. UT Southwestern Medical Center, Dallas, TX (M.S.L.).

33. Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston (S.M.M.).

34. Department of Medicine/Cardiology, Mayo Clinic, Rochester, MN (P.A.N.).

35. St. Lukes Medical Center/Primary Children’s Hospital, Boise, ID (E.V.S.).

36. Institution British Columbia Children’s Hospital, University of British Columbia, Vancouver, Canada (S.S.).

37. University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia (M.S.).

38. Cardiac Inherited Disease Group, Starship Children’s Hospital, Auckland, New Zealand (J.S.).

39. Albert Einstein College of Medine, Bronx, NY (G.F.T.).

40. National Heart & Lung Inst & MRC London Institute of Medical Sciences, Imperial College London, UK (J.S.W.).

41. Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK (J.S.W.).

42. Indiana University School of Medine, Carmel, IN (D.P.Z.).

Abstract

BACKGROUND: Whether vigorous exercise increases risk of ventricular arrhythmias for individuals diagnosed and treated for congenital long QT syndrome (LQTS) remains unknown. METHODS: The National Institutes of Health–funded LIVE-LQTS study (Lifestyle and Exercise in the Long QT Syndrome) prospectively enrolled individuals 8 to 60 years of age with phenotypic and/or genotypic LQTS from 37 sites in 5 countries from May 2015 to February 2019. Participants (or parents) answered physical activity and clinical events surveys every 6 months for 3 years with follow-up completed in February 2022. Vigorous exercise was defined as ≥6 metabolic equivalents for >60 hours per year. A blinded Clinical Events Committee adjudicated the composite end point of sudden death, sudden cardiac arrest, ventricular arrhythmia treated by an implantable cardioverter defibrillator, and likely arrhythmic syncope. A National Death Index search ascertained vital status for those with incomplete follow-up. A noninferiority hypothesis (boundary of 1.5) between vigorous exercisers and others was tested with multivariable Cox regression analysis. RESULTS: Among the 1413 participants (13% <18 years of age, 35% 18–25 years of age, 67% female, 25% with implantable cardioverter defibrillators, 90% genotype positive, 49% with LQT1, 91% were treated with beta-blockers, left cardiac sympathetic denervation, and/or implantable cardioverter defibrillator), 52% participated in vigorous exercise (55% of these competitively). Thirty-seven individuals experienced the composite end point (including one sudden cardiac arrest and one sudden death in the nonvigorous group, one sudden cardiac arrest in the vigorous group) with overall event rates at 3 years of 2.6% in the vigorous and 2.7% in the nonvigorous exercise groups. The unadjusted hazard ratio for experience of events for the vigorous group compared with the nonvigorous group was 0.97 (90% CI, 0.57–1.67), with an adjusted hazard ratio of 1.17 (90% CI, 0.67–2.04). The upper 95% one-sided confidence level extended beyond the 1.5 boundary. Neither vigorous or nonvigorous exercise was found to be superior in any group or subgroup. CONCLUSIONS: Among individuals diagnosed with phenotypic and/or genotypic LQTS who were risk assessed and treated in experienced centers, LQTS-associated cardiac event rates were low and similar between those exercising vigorously and those not exercising vigorously. Consistent with the low event rate, CIs are wide, and noninferiority was not demonstrated. These data further inform shared decision-making discussions between patient and physician about exercise and competitive sports participation. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02549664.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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