Sports Activity and Arrhythmic Risk in Cardiomyopathies and Channelopathies: A Critical Review of European Guidelines on Sports Cardiology in Patients with Cardiovascular Diseases

Abstract

The prediction and prevention of sudden cardiac death is the philosopher’s stone of clinical cardiac electrophysiology. Sports can act as triggers of fatal arrhythmias and therefore it is essential to promptly frame the athlete at risk and to carefully evaluate the suitability for both competitive and recreational sports activity. A history of syncope or palpitations, the presence of premature ventricular complexes or more complex arrhythmias, a reduced left ventricular systolic function, or the presence of known or familiar heart disease should prompt a thorough evaluation with second level examinations. In this regard, cardiac magnetic resonance and electrophysiological study play important roles in the diagnostic work-up. The role of genetics is increasing both in cardiomyopathies and in channelopathies, and a careful evaluation must be focused on genotype positive/phenotype negative subjects. In addition to being a trigger for fatal arrhythmias in certain cardiomyopathies, sports also play a role in the progression of the disease itself, especially in the case arrhythmogenic right ventricular cardiomyopathy. In this paper, we review the latest European guidelines on sport cardiology in patients with cardiovascular diseases, focusing on arrhythmic risk stratification and the management of cardiomyopathies and channelopathies.

Arrhythmogenic Cardiomyopathy: Exercise Pitfalls, Role of Connexin-43, and Moving beyond Antiarrhythmics

“…High-intensity exercise impacts not only ACM progression but also other cardiovascular diseases considered that present with a high risk of SCD and fatal arrhythmias [ 108 ]. In studies of trained HCM mice, treadmill running demonstrated an overall improved response to the enhanced hemodynamic load, while forced swimming protocols revealed a concerning increase in fibrotic levels [ 109 ].…”

The safety of sports in children with inherited arrhythmia substrates

“…Smith et al found that desmoplakin associated cardiomyopathy showed no correlation between exercise and risk of ventricular arrhythmias or LV/RV dysfunction, indicating that risk of arrhythmias may be specific to genotype ( 57 ). Risk and outcomes in ACM can change over time, therefore, it is imperative that ACM patients engaged in low or moderate activity be assessed yearly ( 12 , 58 ).…”

Analysis of digitalized ECG signals based on artificial intelligence and spectral analysis methods specialized in ARVC

“…Moreover, the association between ARVC and sport activities is well‐known, as a significant percentage of SCDs concerning athletes have been attributed to this heart muscle disease. To lend more support, intense physical exercise can lead to disease progression 8 …”

“…To lend more support, intense physical exercise can lead to disease progression. 8 One of the most widely used tools for ARVC diagnosis are cardiovascular magnetic resonance (CMRI) and echocardiography. During the last decade, CMRI represents a useful medical tool for the efficient diagnosis of ARVC, permitting non-invasive morphological and functional evaluation accompanied by tissue characterization.…”