Effects of Exercise Intensity and Duration in Arrhythmogenic Cardiomyopathy

Study Questions:

What are the relationships between exercise duration and intensity and life-threatening ventricular arrhythmias (VAs) in patients with arrhythmogenic cardiomyopathy (AC)?

Methods:

The exercise habits of 173 patients (mean age 41 years) with AC were recorded at the time of diagnosis. High-intensity exercise was defined as >6 metabolic equivalents and long exercise duration was defined as weekly exercise duration greater than the median of 2.5 hours. A life-threatening VA was defined as a history of cardiac arrest, sustained ventricular tachycardia or fibrillation, or appropriate implantable cardioverter-defibrillator therapy. Upon diagnosis, all patients were advised to abstain from competitive sports.

Results:

High-intensity exercise was reported by 52% of patients; 48% of patients had experienced a life-threatening VA. A life-threatening VA was more prevalent among patients who reported high-intensity exercise than low-intensity exercise (74% vs. 20%), and also more prevalent with long-duration than short-duration exercise (65% vs. 31%). High-intensity exercise was independently associated with a history of life-threatening VA (odds ratio, 3.8), but long-duration exercise was not.

Conclusions:

High-intensity exercise is strongly associated with a history of life-threatening VAs in AC patients, independent of long exercise duration.

Perspective:

Prior studies have demonstrated an association between exercise and negative outcomes in AC patients, but the present study is the first to analyze exercise intensity and duration as independent correlates of a life-threatening VA. The results allow more specific recommendations for exercise than simply advising abstention from competitive sports. High-intensity exercise such as running, aerobics, soccer, or fast swimming should be avoided even when performed in a noncompetitive setting, whereas low-intensity exercise, even when performed for long duration, does not appear to be harmful. This may be because high-intensity exercise has a more marked effect on right ventricular wall stress than does low-intensity exercise, independent of exercise duration.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Sports and Exercise Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Exercise

Keywords: Arrhythmias, Cardiac, Cardiomyopathies, Defibrillators, Implantable, Exercise, Exercise Tolerance, Heart Arrest, Heart Failure, Metabolic Equivalent, Secondary Prevention, Sports, Tachycardia, Ventricular, Ventricular Fibrillation


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