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Exercise and β-blocker therapy recommendations for inherited arrhythmogenic conditions

Published online by Cambridge University Press:  23 September 2015

Susan Christian ,
Martin Somerville ,
Sherry Taylor  and
Joseph Atallah
Susan Christian*
Affiliation:
Department of Medical Genetic, University of Alberta, Edmonton, Alberta, Canada
Martin Somerville
Affiliation:
Department of Medical Genetic, University of Alberta, Edmonton, Alberta, Canada
Sherry Taylor
Affiliation:
Department of Medical Genetic, University of Alberta, Edmonton, Alberta, Canada
Joseph Atallah
Affiliation:
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
*
Correspondence to: S. Christian, MSc CGC, Department of Medical Genetic, University of Alberta, 826 Medical Sciences Building, Edmonton, Alberta T6G 2H7, Canada. Tel: +1 780 407 1015; Fax: +1 780 407 1761; E-mail: Susan.Christian@albertahealthservices.ca
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Abstract

Background

Management of individuals with long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy may involve exercise restriction and/or β-blocker therapy.

Objective

This study assessed the practices of a group of paediatric electrophysiologists regarding the management of genotype-positive/phenotype-positive and genotype-positive/phenotype-negative individuals with these conditions.

Method

An online survey was circulated to members of the Pediatric and Congenital Electrophysiology Society in May, 2014. The survey included questions addressing the respondents’ approach regarding exercise recommendations and prescription of β-blocker therapy.

Results

A total of 45 cardiologists completed the survey. The majority of respondents restricted symptomatic patients from competitive sports; however, only approximately half restricted phenotype-negative mutation carriers from this level of activity. Recommendations were less consistent regarding other types of activities. A trend was identified regarding physician physical activity and exercise recommendations for phenotype-negative mutation carriers. Less-active physicians were more likely to restrict exercise. β-blocker therapy was discussed by the majority of respondents for symptomatic patients and a significant number of asymptomatic patients.

Conclusion

Exercise restriction for patients with long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy varies based on several factors including phenotype, type of exercise, guidelines referred to, and physicians’ own level of activity.

Keywords

Arrhythmiacardiomyopathyexercise restrictionβ-blocker therapy
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 6 , August 2016 , pp. 1123 - 1129
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Copyright
© Cambridge University Press 2015 

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References

1. Vaseghi, M, Ackerman, MJ, Mandapati, R. Restricting sports for athletes with heart disease: are we saving lives, avoiding lawsuits, or just promoting obesity and sedentary living? Pediatr Cardiol 2012; 33: 407–416.CrossRefGoogle ScholarPubMed
2. Priori, SG, Wilde, AA, Horie, M, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm 2013; 10: 1932–1963.Google Scholar
3. Pelliccia, A, Fagard, R, Bjornstad, HH, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the study group of sports cardiology of the working group of cardiac rehabilitation and exercise physiology and the working group of myocardial and pericardial diseases of the European Society of Cardiology. Eur Heart J 2005; 26: 1422–1445.CrossRefGoogle Scholar
4. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American Society of Echocardiography, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. J Thorac Cardiovasc Surg 2011; 142: 1303–1338.Google Scholar
5. Maron, BJ, Ackerman, MJ, Nishimura, RA, Pyeritz, RE, Towbin, JA, Udelson, JE. Task force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and marfan syndrome. J Am Coll Cardiol 2005; 45: 1340–1345.Google Scholar
6. Postma, AV, Denjoy, I, Kamblock, J, et al. Catecholaminergic polymorphic ventricular tachycardia: RYR2 mutations, bradycardia, and follow up of the patients. J Med Genet 2005; 42: 863–870.Google Scholar
7. Ostman-Smith, I, Wettrell, G, Riesenfeld, T. A cohort study of childhood hypertrophic cardiomyopathy: improved survival following high-dose beta-adrenoceptor antagonist treatment. J Am Coll Cardiol 1999; 34: 1813–1822.Google Scholar
8. Villain, E, Denjoy, I, Lupoglazoff, JM, et al. Low incidence of cardiac events with beta-blocking therapy in children with long QT syndrome. Eur Heart J 2004; 25: 1405–1411.Google Scholar
9. Iyer, VR, Chin, AJ Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). Am J Med Genet C Semin Med Genet 2013; 163C: 185–197.CrossRefGoogle ScholarPubMed
10. Godin, G, Jobin, J, Bouillon, J. Assessment of leisure time exercise behavior by self-report: a concurrent validity study. Can J Public Health 1986; 77: 359–362.Google ScholarPubMed
11. Roston, TM, De Souza, AM, Sandor, GG, Sanatani, S, Potts, JE. Physical activity recommendations for patients with electrophysiologic and structural congenital heart disease: a survey of Canadian health care providers. Pediatr Cardiol 2013; 34: 1374–1381.Google Scholar
12. Schwartz, PJ, Priori, SG, Spazzolini, C, et al. Genotype-phenotype correlation in the long-QT syndrome: gene-specific triggers for life-threatening arrhythmias. Circulation 2001; 103: 89–95.CrossRefGoogle ScholarPubMed
13. James, CA, Bhonsale, A, Tichnell, C, et al. Exercise increases age-related penetrance and arrhythmic risk in arrhythmogenic right ventricular dysplasia/cardiomyopathy-associated desmosomal mutation carriers. J Am Coll Cardiol 2013; 62: 1290–1297.CrossRefGoogle ScholarPubMed
14. Saberniak, J, Hasselberg, NE, Borgquist, R, et al. Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members. Eur J Heart Fail 2014; 16: 1337–1344.Google Scholar
15. Harris-Lewis v. Mudge. 2004; 60 Mass. App. Ct.:480.CrossRefGoogle Scholar
16. Bisognano, M, Schummers, D. Flipping healthcare: an essay by Maureen Bisognano and Dan Schummers. BMJ 2014; 349: g5852.CrossRefGoogle ScholarPubMed
17. Howe, M, Leidel, A, Krishnan, SM, Weber, A, Rubenfire, M, Jackson, EA. Patient-related diet and exercise counseling: do providers’ own lifestyle habits matter? Prev Cardiol 2010; 13: 180–185.CrossRefGoogle ScholarPubMed
18. Abramson, S, Stein, J, Schaufele, M, Frates, E, Rogan, S. Personal exercise habits and counseling practices of primary care physicians: a national survey. Clin J Sport Med 2000; 10: 40–48.CrossRefGoogle ScholarPubMed
19. Smith, W, Members of CSANZ Cardiovascular Genetics Working Group. Guidelines for the diagnosis and management of arrhythmogenic right ventricular cardiomyopathy. Heart Lung Circ 2011; 20: 757–760.CrossRefGoogle ScholarPubMed
20. VanGeest, JB, Johnson, TP, Welch, VL. Methodologies for improving response rates in surveys of physicians: a systematic review. Eval Health Prof 2007; 30: 303–321.CrossRefGoogle ScholarPubMed