Author + information
- Received March 13, 2013
- Revision received June 2, 2013
- Accepted June 18, 2013
- Published online October 1, 2013.
- Cynthia A. James, ScM, PhD∗ (, )
- Aditya Bhonsale, MD,
- Crystal Tichnell, MGC,
- Brittney Murray, MS,
- Stuart D. Russell, MD,
- Harikrishna Tandri, MD,
- Ryan J. Tedford, MD,
- Daniel P. Judge, MD and
- Hugh Calkins, MD
- ↵∗Reprint requests and correspondence:
Dr. Cynthia A. James, Johns Hopkins ARVD Program, Blalock 545, 600 North Wolfe Street, Baltimore, Maryland 21287.
Objectives This study sought to determine how exercise influences penetrance of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) among patients with desmosomal mutations.
Background Although animal models and anecdotal evidence suggest that exercise is a risk factor for ARVD/C, there have been no systematic human studies.
Methods Eighty-seven carriers (46 male; mean age, 44 ± 18 years) were interviewed about regular physical activity from 10 years of age. The relationship of exercise with sustained ventricular arrhythmia (ventricular tachycardia/ventricular fibrillation [VT/VF]), stage C heart failure (HF), and meeting diagnostic criteria for ARVD/C (2010 Revised Task Force Criteria [TFC]) was studied.
Results Symptoms developed in endurance athletes (N = 56) at a younger age (30.1 ± 13.0 years vs. 40.6 ± 21.1 years, p = 0.05); they were more likely to meet TFC at last follow-up (82% vs. 35%, p < 0.001) and have a lower lifetime survival free of VT/VF (p = 0.013) and HF (p = 0.004). Compared with those who did the least exercise per year (lowest quartile) before presentation, those in the second (odds ratio [OR]: 6.64, p = 0.013), third (OR: 16.7, p = 0.001), and top (OR: 25.3, p < 0.0001) quartiles were increasingly likely to meet TFC. Among 61 individuals who did not present with VT/VF, the 13 subjects experiencing a first VT/VF event over a mean follow-up of 8.4 ± 6.7 years were all endurance athletes (p = 0.002). Survival from a first VT/VF event was lowest among those who exercised most (top quartile) both before (p = 0.036) and after (p = 0.005) clinical presentation. Among individuals in the top quartile, a reduction in exercise decreased VT/VF risk (p = 0.04).
Conclusions Endurance exercise and frequent exercise increase the risk of VT/VF, HF, and ARVD/C in desmosomal mutation carriers. These findings support exercise restriction for these patients.
- arrhythmogenic right ventricular dysplasia
- heart failure
- ventricular arrhythmias
The Johns Hopkins ARVD/C Program is supported by the Bogle Foundation, the Healing Hearts Foundation, the Campanella family, Wilmerding Endowments, and the Dr. Francis P. Chiaramonte Private Foundation. Dr. Tandri received grant K23HL093350 from the National Heart, Lung, and Blood Institute. Dr. Calkins receives research support from Medtronic and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 13, 2013.
- Revision received June 2, 2013.
- Accepted June 18, 2013.
- 2013 American College of Cardiology Foundation