Impact of dynamic physical exercise on high‐risk definite arrhythmogenic right ventricular cardiomyopathy

Ruíz-Salas, Amalio; Cordero, Alberto; Navarro‐Arce, Isabel; Navarro, Manuel Jiménez; Pinilla, José Manuel García; Bueno, Fernando Cabrera; Abdeselam-Mohamed, Nasiba; Morcillo‐Hidalgo, Luis; Doblas, Juan José Gómez; Teresa, Eduardo de; Alzueta, Javier

doi:10.1111/jce.13704

Cited by 16 publications

(25 citation statements)

References 24 publications

(30 reference statements)

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“…Others have assessed the effect of exercise restriction to find out an improvement in outcomes (43,44) regardless of the previous level of training (45). Although more exercise causes more electrical and/or structural progression (41,43,(46)(47)(48), the intensity rather than the duration of the exercise performed seems to play a more determinant role. Indeed, intensity rather than duration is strongly linked to adverse prognosis (49,50) and, furthermore, its reduction more effectively improves the arrhythmic burden (44).…”

Section: Clinical Series Analyzing the Effect Of Exercise On Acmmentioning

confidence: 99%

“…Thus, current guidelines on sports recommendations (11) do not make any distinction between genetic and suspected exerciseinduced ACM in terms of exercise restriction once an overt ACM phenotype is present. Among the clinical series reviewed on the topic "ACM and sports/exercise, " two of them specifically focused on outcomes in gene elusive individuals (41,46). As previously commented, this group might include both genetic ACM with negative genetic results and sports-induced ACM.…”

Section: Strenuous Exercise As Stand-alone Cause Of Acmmentioning

confidence: 99%

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Facts and Gaps in Exercise Influence on Arrhythmogenic Cardiomyopathy: New Insights From a Meta-Analysis Approach

Martínez-Solé

Sabater-Molina

Braza-Boïls

et al. 2021

Front. Cardiovasc. Med.

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Arrhythmogenic cardiomyopathy (ACM) is a genetic cardiac condition characterized by fibrofatty myocardial replacement, either at the right ventricle, at the left ventricle, or with biventricular involvement. Ventricular arrhythmias and heart failure represent its main clinical features. Exercise benefits on mental and physical health are worldwide recognized. However, patients with ACM appear to be an exception. A thorough review of the literature was performed in PubMed searching for original papers with the terms “ARVC AND sports/exercise” and “sudden cardiac death AND sports/exercise.” Additional papers were then identified through other sources and incorporated to the list. All of them had to be based on animal models or clinical series. Information was structured in a regular format, although some data were not available in some papers. A total of 34 papers were selected and processed regarding sports-related sudden cardiac death, pre-clinical models of ACM and sport, and clinical series of ACM patients engaged in sports activities. Eligible papers were identified to obtain pooled data in order to build representative figures showing the global incidence of the most important causes of sudden cardiac death in sports and the global estimates of life-threatening arrhythmic events in ACM patients engaged in sports. Tables and figures illustrate their major characteristics. The scarce points of controversy were discussed in the text. Fundamental concepts were summarized in three main issues: sports may accelerate ACM phenotype with either structural and/or arrhythmic features, restriction may soften the progression, and these rules also apply to phenotype-negative mutation carriers. Additionally, remaining gaps in the current knowledge were also highlighted, namely, the applicability of those fundamental concepts to non-classical ACM phenotypes since left dominant ACM or non-plakophillin-2 genotypes were absent or very poorly represented in the available studies. Hopefully, future research endeavors will provide solid evidence about the safest exercise dose for each patient from a personalized medicine perspective, taking into account a big batch of genetic, epigenetic, and epidemiological variables, for instance, in order to assist clinicians to provide a final tailored recommendation.

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Section: Clinical Series Analyzing the Effect Of Exercise On Acmmentioning

confidence: 99%

Section: Strenuous Exercise As Stand-alone Cause Of Acmmentioning

confidence: 99%

Facts and Gaps in Exercise Influence on Arrhythmogenic Cardiomyopathy: New Insights From a Meta-Analysis Approach

Martínez-Solé

Sabater-Molina

Braza-Boïls

et al. 2021

Front. Cardiovasc. Med.

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“…The diagnosis is difficult, especially in an athlete with mild RV damage or documented VA (differentiating potential malignant arrhythmias from benign RV outflow tract arrhythmias), 67,68 typically requiring an expert electrophysiological knowledge (Table 1). A complete evaluation is mandatory 16 to identify pathological features of a disease at potential risk of SCD during sport, 69 or to avoid false diagnosis of ARVC 70 . Finally, the controversial hypothesis of an “exercise‐induced" cardiomyopathy is questionable, and its distinction from potential ARVC variants in which mutations have not yet been identified is difficult to evaluate, due to similar clinical course.…”

Section: Discussionmentioning

confidence: 99%

The arrhythmogenic right ventricular cardiomyopathy in comparison to the athletic heart

Mascia

Arbelo

Porto

et al. 2020

Cardiovasc electrophysiol

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Intense exercise‐induced right ventricular remodeling is a potential adaptation of cardiac function and structure. The features of the remodeling may overlap with those of a very early form of arrhythmogenic right ventricular cardiomyopathy (ARVC): at this early stage, it could be difficult to discriminate ARVC, from exercise‐induced cardiac adaptation that may develop in normal individuals. The purpose of this paper is to discuss which exercise‐induced remodeling may be a pathological or a physiological finding. A complete evaluation may be required to identify the pathological features of ARVC that would include potential risk of sudden cardiac death during sport or, to avoid the false diagnosis of ARVC. The most recent expert assessment of arrhythmogenic cardiomyopathy focuses on endurance athletes presenting with clinical features indistinguishable from ARVC.

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“…Low intensity exercise, even for long durations, was associated with a milder phenotype and can be advised for patients with ACM Salas AR et al J Cardiovasc Electrophysiol. 2018 [ 21 ] Aim: To discover the impact of dynamic physical activity on 36 patients with high-risk definite ACM. Study type: Observational retrospective cohort study Study population: 36 high-risk ACM Definitions: According to the guidelines on sports participation for patients with cardiovascular disease the following were considered high dynamic sports: badminton, long or middle-distance running (marathon), cross-country skiing, squash, basketball, ice hockey, hockey, rugby, football, swimming, singles tennis, handball, boxing, kayaking, cycling, decathlon, rowing, speed skating, and triathlon.…”

Section: Role Of Sports Activity In Promoting Disease Penetrance and Progressionmentioning

confidence: 99%

Role of Exercise as a Modulating Factor in Arrhythmogenic Cardiomyopathy

et al. 2021

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Purpose of Review The review addresses the role of exercise in triggering ventricular arrhythmias and promoting disease progression in arrhythmogenic cardiomyopathy (AC) patients and gene-mutation carriers, the differential diagnosis between AC and athlete’s heart and current recommendations on exercise activity in AC. Recent Findings AC is an inherited heart muscle disease caused by genetically defective cell-to-cell adhesion structures (mainly desmosomes). The pathophysiological hallmark of the disease is progressive myocyte loss and replacement by fibro-fatty tissue, which creates the substrates for ventricular arrhythmias. Animal and human studies demonstrated that intense exercise, but not moderate physical activity, may increase disease penetrance, worsen the phenotype, and favor life-threatening ventricular arrhythmias. It has been proposed that in some individuals prolonged endurance sports activity may in itself cause AC (so-called exercise-induced AC). Summary The studies agree that intense physical activity should be avoided in patients with AC and healthy gene-mutation carriers. However, low-to-moderate intensity exercise does not appear detrimental and these patients should not be entirely deprived from the many health benefits of physical activity.

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Impact of dynamic physical exercise on high‐risk definite arrhythmogenic right ventricular cardiomyopathy

Abstract: Dynamic exercise could be directly associated with the severity of the phenotype in relation to the precocity of major ventricular arrhythmic events and right ventricular systolic dysfunction in patients with high-risk definite ARVC/D.

Cited by 16 publications

References 24 publications

Facts and Gaps in Exercise Influence on Arrhythmogenic Cardiomyopathy: New Insights From a Meta-Analysis Approach

Facts and Gaps in Exercise Influence on Arrhythmogenic Cardiomyopathy: New Insights From a Meta-Analysis Approach

The arrhythmogenic right ventricular cardiomyopathy in comparison to the athletic heart

Role of Exercise as a Modulating Factor in Arrhythmogenic Cardiomyopathy

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