Physical exercise accelerates ARVC phenotypic expression and arrhythmia risk, while exercise-induced physiological remodeling can mimic ARVC features and complicate diagnosis in athletes.
How does physical exercise impact disease progression and arrhythmia risk in patients with ARVC, and how can ARVC be differentiated from athlete's heart?
Physical exercise is a strong determinant of ARVC phenotypic expression and arrhythmia risk, making the differentiation between ARVC and exercise-induced athlete's heart crucial to avoid misdiagnosis and inappropriate management.
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease associated with a high risk of sudden cardiac death. Among other factors, physical exercise has been clearly identified as a strong determinant of phenotypic expression of the disease, arrhythmia risk, and disease progression. Because of this, current guidelines advise that individuals with ARVC should not participate in competitive or frequent high-intensity endurance exercise. Exercise-induced electrical and morphological para-physiological remodelling (the so-called 'athlete's heart') may mimic several of the classic features of ARVC. Therefore, the current International Task Force Criteria for disease diagnosis may not perform as well in athletes. Clear adjudication between the two conditions is often a real challenge, with false positives, that may lead to unnecessary treatments, and false negatives, which may leave patients unprotected, both of which are equally inacceptable. This review aims to summarize the molecular interactions caused by physical activity in inducing cardiac structural alterations, and the impact of sports on arrhythmia occurrence and other clinical consequences in patients with ARVC, and help the physicians in setting the two conditions apart.
Gasperetti et al. (Thu,) conducted a review in Arrhythmogenic right ventricular cardiomyopathy (ARVC). Physical exercise was evaluated. Physical exercise accelerates ARVC phenotypic expression and arrhythmia risk, while exercise-induced physiological remodeling can mimic ARVC features and complicate diagnosis in athletes.
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