Methods:

Clinical data were extracted from medical records at four tertiary sports cardiology expertise centers to identify all elite (NCAA Division I, Olympic, or professional) athletes diagnosed with a SCD-predisposing-GHD (arrhythmogenic right ventricular cardiomyopathy [ARVC], catecholamine polymorphic ventricular tachycardia [VT], dilated cardiomyopathy [DCM], hypertrophic cardiomyopathy [HCM], idiopathic ventricular fibrillation [VF], long QT syndrome [LQTS], or left ventricular noncompaction associated cardiomyopathy). The RTP process at each institution utilized a process of shared decision making (SDM) albeit without standardized methodology. The primary clinical outcome was breakthrough cardiac events (BCEs) defined as arrhythmic syncope or seizures, symptomatic nonsustained VT, appropriate VT and/or VF-terminating therapy from an implantable cardioverter-defibrillator (ICD), sudden cardiac arrest with external defibrillator rescue, sustained VT, or SCD after diagnosis and initiation of treatment. BCEs were further categorized in terms of occurrence before RTP, after RTP at an elite level, or after the conclusion of the elite athlete career; and patient activity (athletic or nonathletic) at the time of BCE.