Lauren Eberly1,2,3, Lohit Garg1, Mahesh Vidula1, Nosheen Reza1, Sheela Krishnan1. 1. Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 2. Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, USA. 3. Penn Cardiovascular Center for Health Equity and Justice, University of Pennsylvania, Philadelphia, PA, USA.
Abstract
PURPOSE OF REVIEW: The purpose of this review is to summarize what is known about the relationship between exercise and arrhythmogenic right ventricular cardiomyopathy (ARVC) with regard to disease onset, diagnosis, progression, and clinical severity. This relationship forms the basis of the management recommendations for restricting physical activity in individuals with and at risk for ARVC. RECENT FINDINGS: While ARVC can be challenging to diagnose, there are several diagnostic testing and imaging modalities that may help distinguish athletic heart remodeling from ARVC. There is an increased risk of adverse clinical outcomes in ARVC from endurance and competitive sports participation, including a dose-dependent relationship between exercise intensity and risk of disease penetrance and progression. SUMMARY: High-intensity exercise can lead to earlier disease onset, increased penetrance, and clinical progression among individuals with and at risk for ARVC. Both amount and intensity of exercise are correlated with adverse outcomes, including ventricular arrhythmias and worsening biventricular function. All individuals with and at risk for ARVC should undergo detailed clinical phenotyping and risk stratification to reduce the risk of such outcomes, including sudden cardiac death. Consensus guidelines recommend against participation in competitive or high-intensity and endurance exercise for individuals with and at risk for ARVC.
PURPOSE OF REVIEW: The purpose of this review is to summarize what is known about the relationship between exercise and arrhythmogenic right ventricular cardiomyopathy (ARVC) with regard to disease onset, diagnosis, progression, and clinical severity. This relationship forms the basis of the management recommendations for restricting physical activity in individuals with and at risk for ARVC. RECENT FINDINGS: While ARVC can be challenging to diagnose, there are several diagnostic testing and imaging modalities that may help distinguish athletic heart remodeling from ARVC. There is an increased risk of adverse clinical outcomes in ARVC from endurance and competitive sports participation, including a dose-dependent relationship between exercise intensity and risk of disease penetrance and progression. SUMMARY: High-intensity exercise can lead to earlier disease onset, increased penetrance, and clinical progression among individuals with and at risk for ARVC. Both amount and intensity of exercise are correlated with adverse outcomes, including ventricular arrhythmias and worsening biventricular function. All individuals with and at risk for ARVC should undergo detailed clinical phenotyping and risk stratification to reduce the risk of such outcomes, including sudden cardiac death. Consensus guidelines recommend against participation in competitive or high-intensity and endurance exercise for individuals with and at risk for ARVC.
Entities:
Keywords:
Arrhythmia; Arrhythmogenic cardiomyopathy; Arrhythmogenic right ventricular cardiomyopathy; Exercise; Risk stratification; Sudden death
Authors: Aditya Bhonsale; Cynthia A James; Crystal Tichnell; Brittney Murray; Dmitri Gagarin; Binu Philips; Darshan Dalal; Ryan Tedford; Stuart D Russell; Theodore Abraham; Harikrishna Tandri; Daniel P Judge; Hugh Calkins Journal: J Am Coll Cardiol Date: 2011-09-27 Impact factor: 24.094
Authors: Christopher M Haggerty; Brittney Murray; Crystal Tichnell; Daniel P Judge; Harikrishna Tandri; Marci Schwartz; Amy C Sturm; Martin E Matsumura; Michael F Murray; Hugh Calkins; Brandon K Fornwalt; Cynthia A James Journal: Circ Genom Precis Med Date: 2018-07
Authors: Jonathan P Piccini; Darshan Dalal; Ariel Roguin; Chandra Bomma; Alan Cheng; Kalpana Prakasa; Jun Dong; Crystal Tichnell; Cynthia James; Stuart Russell; Jane Crosson; Ronald D Berger; Joseph E Marine; Gordon Tomaselli; Hugh Calkins Journal: Heart Rhythm Date: 2005-11 Impact factor: 6.343
Authors: Hein Heidbüchel; Jan Hoogsteen; Robert Fagard; L Vanhees; Hugo Ector; Rik Willems; Johan Van Lierde Journal: Eur Heart J Date: 2003-08 Impact factor: 29.983
Authors: F I Marcus; G H Fontaine; G Guiraudon; R Frank; J L Laurenceau; C Malergue; Y Grosgogeat Journal: Circulation Date: 1982-02 Impact factor: 29.690