Arrhythmogenic Right Ventricular Cardiomyopathy in Athletes
Key result
Genotype-informed shared decision-making personalizes exercise recommendations for athletes with ARVC.
- n=2
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Why the study?
Exercise recommendations in athletes with arrhythmogenic cardiomyopathy are shifting toward an individualized, genotype-informed approach, but applying consensus guideline recommendations into real-world practice involves clinical complexities.
Key Points
- To examine the implementation of genotype-informed risk stratification and shared decision-making regarding athletic participation in individuals with arrhythmogenic right ventricular cardiomyopathy.
- Evaluated 2 illustrative clinical cases of athletes diagnosed with arrhythmogenic right ventricular cardiomyopathy undergoing sports participation counseling.
- Applied guidance from the 2024 Heart Rhythm Society consensus statement and the 2025 American College of Cardiology/American Heart Association guidelines integrating genotype, phenotype, and exercise volume.
- Unrestricted high-intensity endurance exercise promotes disease progression and elevates ventricular arrhythmia risks, particularly in athletes harboring PKP2 mutations or displaying severe structural phenotypes.
- Shared decision-making resulted in a transition to restricted exercise for an athlete with high-risk features and allowed a tailored 1-year competitive participation plan for an athlete with a mild phenotype.
- Contemporary guidelines indicate that implantable cardioverter-defibrillator placement should not be performed solely to facilitate sports eligibility, emphasizing mandatory personalized emergency action plans for athletes who continue vigorous activity.
Study Design
Type
Case Report (n=2)
Structured PICO
P
Population
2 male athletes (ages 17 and 53) with arrhythmogenic right ventricular cardiomyopathy undergoing shared decision-making for exercise recommendations.
I
Intervention
Shared decision-making (SDM) approach for exercise recommendations, incorporating genotype, phenotype, and sport type, along with multidisciplinary care and emergency action planning.
A shared decision-making and genotype-informed approach is essential for individualizing exercise recommendations and managing risk in athletes with arrhythmogenic right ventricular cardiomyopathy.
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Implication
Supports individualized counseling in ARVC athletes; extends guideline application via cases but leaves open need for prospective validation.
Abstract
Exercise recommendations in athletes with arrhythmogenic cardiomyopathy are shifting toward an individualized and genotype-informed approach. Specifically, athletes with arrhythmogenic right ventricular cardiomyopathy represent a subgroup in whom the risk of disease progression and sudden cardiac death with continued high-intensity endurance exercise is considered higher. Contemporary practice, guided by consensus statements, emphasizes multidisciplinary care and shared decision-making to inform sports participation advice and overall disease management. We highlight these principles and the clinical complexities faced when applying guideline recommendations into real-world practice through 2 illustrative cases.
JACC Case Reports. Genotype-informed shared decisions personalize exercise advice for athletes with ARVC. Arrhythmogenic Right Ventricular Cardiomyopathy in Athletes 2 athletes: Two athletes living with ARVC. Different genotypes, different sports: Runner, 53, gene-elusive vs Basketball player, 17, PKP2. Shared decision-making weighs each factor: Genotype → Phenotype → Sport type → Shared exercise plan. Individualized outcomes for each athlete: Reduced endurance training, ICD placed, Final competitive year, Recreational activity. Bottom line: Counsel ARVC athletes individually, guided by genotype; prospective validation still needed.
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Cite This Study
Aljohar et al. (2026) conducted a case report in Arrhythmogenic right ventricular cardiomyopathy (ARVC) (n=2). Shared decision-making and genotype-informed exercise recommendations was evaluated. Shared decision-making and genotype-informed individualized risk assessment are essential for managing exercise recommendations in athletes with arrhythmogenic right ventricular cardiomyopathy.