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Evolving spectrum of arrhythmogenic cardiomyopathy: Implications for Sports Cardiology

Francesca Graziano1, Alberto Cipriani1, Dorottya Balla2

  • 1Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Italy.

Clinical Cardiology
|June 26, 2023
PubMed

Insights

Arrhythmogenic cardiomyopathy (ACM) is a genetic heart condition causing arrhythmias. Early screening in athletes is crucial, especially for left-dominant variants, as exercise can trigger dangerous heart events.

Area of Science:

  • Cardiology
  • Genetics
  • Sports Medicine

Background:

  • Arrhythmogenic cardiomyopathy (ACM) is a genetic heart muscle disease characterized by fibro-fatty myocardial replacement.
  • The disease spectrum includes right ventricular, biventricular, and left dominant phenotypes.
  • Athletic activity can exacerbate ACM, potentially leading to ventricular arrhythmias (VAs) and sudden cardiac death (SCD).

Purpose of the Study:

  • To review the literature on ACM in the context of Sport Cardiology.
  • To highlight the implications of ACM phenotypes in athletes.
  • To emphasize diagnostic strategies for ACM variants in sports preparticipation screening (PPS).

Main Methods:

  • Literature review focusing on ACM and its relationship with sports cardiology.
  • Analysis of diagnostic challenges, particularly for left-dominant ACM variants.
  • Evaluation of the role of exercise testing in athlete screening.

Main Results:

  • Cardiac magnetic resonance imaging has expanded the understanding of ACM phenotypes.
  • Left-dominant ACM variants may present with normal ECG and echocardiography, primarily manifesting as exercise-induced VAs.
  • Exercise testing can improve the diagnostic yield of PPS for identifying ACM in athletes.

Conclusions:

  • Early identification of ACM in athletes is vital for preventing adverse events.
  • Preparticipation screening protocols should consider exercise testing to detect subtle ACM variants.
  • While competitive sports are contraindicated, supervised low-to-moderate intensity physical activity may be permissible for ACM patients.

Keywords:
arrhythmogenic cardiomyopathyathletespreparticipation screeningsports cardiologysudden cardiac death

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