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Arrhythmogenic Cardiomyopathy or "Athlete's Heart"?: A Systematic Approach to Differential Diagnosis

Tiziana Cristina Minopoli1, Kanesh Kanthagnani2, Iacopo Olivotto3

  • 1Cardiovascular and Genomics Research Institute, City St George's, University of London, London, United Kingdom; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.

JACC. Clinical Electrophysiology
|October 17, 2025
PubMed

Insights

Distinguishing arrhythmogenic cardiomyopathy (ACM) from athletic heart adaptations is crucial. This review aids clinicians in differentiating these conditions to ensure accurate diagnosis and management for athletes.

Area of Science:

  • Cardiology
  • Genetics
  • Sports Medicine

Background:

  • Arrhythmogenic cardiomyopathy (ACM) is a heritable heart condition linked to fatal arrhythmias, particularly with intense exercise.
  • Physiological cardiac adaptations in athletes can mimic ACM phenotypes, creating diagnostic challenges.
  • Misdiagnosis can lead to delayed treatment for ACM or unnecessary restrictions for athletes.

Purpose of the Study:

  • To provide a comprehensive analysis of the differential diagnosis between physiological cardiac adaptations and ACM.
  • To highlight key features that distinguish benign athletic remodeling from early arrhythmogenic cardiomyopathy.
  • To guide clinical management by identifying red flags and benign findings.

Main Methods:

  • Systematic review of literature on arrhythmogenic cardiomyopathy and athletic cardiac remodeling.
  • Analysis of clinical presentation, family history, and electrocardiogram findings.
  • Identification of distinguishing features for differential diagnosis.

Main Results:

  • Overlap exists between athletic adaptations and ACM phenotypes, complicating diagnosis.
  • Thorough patient history and ECG interpretation are essential.
  • Further investigations are needed when ACM is suspected.

Conclusions:

  • A systematic approach is vital for accurate diagnosis in athletes.
  • Differentiating ACM from athletic remodeling prevents misdiagnosis and ensures appropriate patient care.
  • This review offers a framework for rational clinical management.

Keywords:
arrhythmogenic cardiomyopathyathletecardiac imagingsudden cardiac death

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