Sudden cardiac arrest during sex in patients with either catecholaminergic polymorphic ventricular tachycardia or long-qt syndrome: A rare but shocking experience

Sudden Cardiac Arrest During Sex in Cardiac Channelopathies Background Patients with catecholaminergic polymorphic ventricular tachycardia (CPVT) and long-QT syndrome (LQTS) are susceptible to cardiac events during sympathetic nervous system activation. Herein, we sought to determine the risk of cardiac events associated with sex in CPVT and LQTS patients. Methods and Results We reviewed the electronic medical record of patients seen in the Genetic Heart Rhythm Clinic. There were 445 patients ≥18 years diagnosed with LQTS (N = 402, age at diagnosis 30 ± 16 years) or CPVT (N = 43, age at diagnosis 25 ± 15 years). No sex-induced cardiac events occurred in the LQTS population, and 2 occurred in the CPVT population. Sex-induced events were more likely in CPVT (2/43, 4.7%) than LQTS (0/402, 0%, P = 0.008). One case involved a 22-year-old CPVT1 female with prior cardiac arrest, who experienced several appropriate implantable cardioverter defibrillator shocks during intercourse while taking β-blockers. The second case was a 52-year-old CPVT1 male with history of recurrent exercise-triggered syncope, who had syncope during sex in the setting of β-blocker noncompliance. Extrapolating from published estimates of intercourse frequency by age, the overall event rate was only 0.0004%, and 0.005% among the CPVT cohort. Conclusions Potentially life-threatening cardiac events during sex in patients with CPVT are rare and even rarer in LQTS. Overall, the cardiac event per intercourse rate is extremely low. Patients and their partners should be reassured that sex is a low-risk activity from a cardiac standpoint.