Tobert KE, Bos JM, Garmany R, et al. - The status quo of disqualification for all athletes with long QT syndrome (LQTS) is challenged by this 20-year single center experience. Furthermore, this study offers additional observational evidence, albeit from a single center, favoring the more contemporary shared decision making approaches to this complex issue.

• This is a retrospective review of 672 athletes with genetic heart disease (GHD) overall including 494 athletes with LQTS who were given return-to-play approval.

• Prior to diagnosis, symptoms were present in 79 of 494 athletes with LQTS (16.0%), and an implantable cardioverter-defibrillator was received by 58 (11.7%).

• No GHD–sports associated mortality was revealed in 2,056 combined years of follow-up.

• Instead, ≥1 nonlethal, LQTS-related breakthrough cardiac event occurred in 29 patients (5.9%), of those, 15 (3.0%) were athletes when breakthrough cardiac event occurred, with 3 (0.6%) encountering a sports-associated breakthrough cardiac event, and 12 (2.4%) a non–sports-related event.

• Per 100 athlete-years of follow-up, the event rate was 1.16 nonlethal events.