Integrating Exercise Into Personalized Ventricular Arrhythmia Risk Prediction in Arrhythmogenic Right Ventricular Cardiomyopathy

Abstract

Background: Exercise is associated with sustained ventricular arrhythmias (VA) in Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) but is not included in the ARVC risk calculator ( arvcrisk.com ). The objective of this study is to quantify the influence of exercise at diagnosis on incident VA risk and evaluate whether the risk calculator needs adjustment for exercise. Methods: We interviewed ARVC patients without sustained VA at diagnosis about their exercise history. The relationship between exercise dose 3 years preceding diagnosis (average METh/wk) and incident VA during follow-up was analyzed with time-to-event analysis. The incremental prognostic value of exercise to the risk calculator was evaluated by Cox models. Results: We included 176 patients (male, 43.2%; age, 37.6±16.1 years) from 3 ARVC centers, of whom 53 (30.1%) developed sustained VA during 5.4 (2.7–9.7) years of follow-up. Exercise at diagnosis showed a dose-dependent nonlinear relationship with VA, with no significant risk increase <15 to 30 METh/wk. Athlete status, using 3 definitions from literature (>18, >24, and >36 METh/wk), was significantly associated with VA (hazard ratios, 2.53–2.91) but was also correlated with risk factors currently in the risk calculator model. Thus, adding athlete status to the model did not change the C index of 0.77 (0.71–0.84) and showed no significant improvement (Akaike information criterion change, <2). Conclusions: Exercise at diagnosis was dose dependently associated with risk of sustained VA in ARVC patients but only above 15 to 30 METh/wk. Exercise does not appear to have incremental prognostic value over the risk calculator. The ARVC risk calculator can be used accurately in athletic patients without modification.

Longitudinal Prediction of Ventricular Arrhythmic Risk in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy

“…Finally, our findings are consistent with the hypothesis that reduction in exercise and initiation of antiarrhythmic medications may help to reduce the likelihood of VA events. Although Bosman et al 28 examined the incremental value of adding exercise to the ARVC risk calculator and found no improvement in VA risk prediction, their analyses were restricted to risk prediction at the time of initial ARVC diagnosis. It is possible that reducing exercise and initiating antiarrhythmic medications may be important for improving individualized, longitudinal risk predictions.…”

“…Prior studies have shown that competitive sports activity is associated with as much as a 5-fold increase in risk for SCD in young adults 25,26 and that this association is dose-dependent. 27,28 Even recreational sports contribute significantly to risk of VA and SCD. 29 In this context, our results support decreasing exercise as a plausible mechanism for reducing risk for VA. We also found that patients in our cohort were more likely to be prescribed antiarrhythmic medications at 5-year follow-up compared with at the time of initial diagnosis (Figure 2G).…”

Physical exercise and arrhythmogenic right ventricular cardiomyopathy/dysplasia: An overview

“…The Medical Subject Headings (MeSH) terms used and combined were “Arrhythmogenic Right Ventricular Dysplasia” [Mesh] AND “Exercise” [Mesh], which resulted in 72 records. Seven animal or preclinical[ 15 16 17 18 19 20 21 ] and 18 clinical studies[ 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 ] were selected and discussed. [ Table 1 ] presents the definitions of terms used in the identified studies.…”

“…[ Table 1 ] presents the definitions of terms used in the identified studies. [ 22 23 25 26 27 28 29 30 32 33 36 ]…”

“…They found that exercise was associated with a sustained risk of arrhythmia when its intensity is above 15 to 30 MET-h/week. [ 36 ] Gasperetti et al . examined the consequences of detraining 25 athletes on ARVC/D progression after the initial diagnosis and evaluated the reliability of the Cadrin-Tourigny arrhythmic risk prediction algorithm.…”