European Heart Journal Advance Access originally published online on October 18, 2007
European Heart Journal 2007 28(23):2944-2949; doi:10.1093/eurheartj/ehm404
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Prevalence and significance of an isolated long QT interval in elite athletes
1 University Hospital Lewisham/King's College Hospital, London SE5 9RS, UK
2 Olympic Medical Institute, London, UK
3 Liverpool John Moores University, Liverpool, England, UK
4 St. George's Hospital Medical School, London, UK
Received 9 July 2007; revised 15 August 2007; accepted 27 August 2007; online publish-ahead-of-print 18 October 2007.
* Corresponding author. Tel: +44 20 3299 8370; fax: +44 20 3299 3489. E-mail address: ssharma21{at}hotmail.com
See page 2825 for the editorial comment on this article (doi:10.1093/eurheartj/ehm491)
Aims: Identification of a prolonged, corrected QT (QTc) interval in athletes may be a recommendation for disqualification from competitive sports. However, the prevalence and diagnostic significance of an isolated prolonged QTc in asymptomatic athletes without familial disease is unknown.
Methods and results: Between 1996 and 2006, 2000 elite athletes (mean age, 20.2 years) underwent 12-lead ECG and 2-D echocardiography. The QT interval was corrected for heart rate (QTc). Athletes with QTc > 460 ms underwent 48 h Holter monitor and an exercise stress test. All athletes with a prolonged QTc interval were offered genetic testing and first-degree relatives were invited for ECG. The QTc was prolonged in seven (0.4%) athletes ranging from 460 to 570 ms. Three athletes had a QTc value of >500 ms and all exhibited one of: paradoxical prolongation of QTc during exercise, a confirmatory genetic mutation, or prolonged QTc in a first-degree relative. In contrast, none of the athletes with a QTc value of <500 ms had any other features to indicate long QT syndrome (LQTS).
Conclusion: The prevalence of prolonged QTc in elite athletes is 0.4%. A QTc of >500 ms is highly suggestive of LQTS. A QTc of <500 ms in the absence of symptoms or familial disease is unlikely to represent LQTS in elite athletes.
Key Words: Congenital long QT syndrome • Elite athletes • Polymorphic ventricular tachycardia • Competitive sports
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