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Athletics and Risk in Arrhythmogenic RV Cardiomyopathy | Journal Scan
Study Questions:
What is the effect of sports participation on the onset and risk of cardiac events in arrhythmogenic right ventricular cardiomyopathy (ARVC)?
Methods:
Subjects were obtained from the multicenter prospective North American ARVC registry – a database of 322 ARVC probands or family members. Registry patients must be >12 years old. The primary combined endpoint was ventricular tachyarrhythmias (VTAs) or death. Patient participation in exercise or sports was queried at time of entry into the registry.
Results:
The subjects were 108 ARVC probands: 18% were inactive, 44% were involved in recreational sport, and 38% in competitive sport prior to ARVC diagnosis. Competitive athletes demonstrated increased risk compared with the other activity levels for multiple parameters: onset of symptoms (30 years vs. 38-40 years, p = 0.005); age at diagnosis (34 years vs. 41-43 years, p = 0.04); age at first VTA (33 years vs. 40-43 years, p = 0.02); and inducible VTA at electrophysiology study (71% vs. 32-44%, p = 0.006). Competitive athletes more often had negative T waves in leads V1-V3 and larger RV and left ventricular volumes, without a difference in RV ejection fraction. Overall, 76.9% of subjects experienced a VTA event. Stratified risk of VTA at 40 years of age was 61% for competitive, 33% for recreational, and 22% for inactive. Competitive athletes were at significantly higher risk of VTA or death, even if only high dynamic competitive or recreational sports were considered (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.21-3.28), while there was no difference between inactive or recreational athletes (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.07-3.91). Inactive or recreational athletes tended not to change their activity level after diagnosis. Most (82%) competitive athletes decreased their exercise level after diagnosis, which subsequently dampened their risk of VTA to the level of inactive or recreational athletes.
Conclusions:
The authors concluded that competitive athletics increases the risk of VTA and death in ARVC compared to recreational sport or inactivity. Recreational sport was not associated with increased risk compared to inactivity.
Perspective:
The influence of athletic participation on arrhythmogenic risk in various diseases (e.g., long QT syndrome, ARVC) and whether competitive and recreational athletics impose different risks are common and practical clinical questions, especially in the adolescent and young adult populations. This study finds a significant difference in arrhythmia risk in ARVC patients based on level of athletic activity, suggesting there is a difference in arrhythmogenesis related to competition. Notably, the risk of events was high in all activity levels, re-emphasizing the severity of risk imposed by ARVC. Discontinuation of competitive athletics attenuated risk to lower levels.
Keywords: Adolescent, Arrhythmias, Cardiac, Arrhythmogenic Right Ventricular Dysplasia, Athletes, Cardiomyopathies, Electrophysiology, Heart Conduction System, Heart Failure, Long QT Syndrome, Patient Participation, Prospective Studies, Recreation, Registries, Risk, Sports, Tachycardia
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