Association of competitive and recreational sport participation with cardiac events in patients with arrhythmogenic right ventricular cardiomyopathy: results from the North American multidisciplinary study of arrhythmogenic right ventricular cardiomyopathy

Abstract

Aims: It has been proposed that competitive sport increases the risk of ventricular tachyarrhythmias (VTA) and death in patients with arrhythmogenic right-ventricular cardiomyopathy (ARVC). However, it is unknown whether this only applies to competitive sport or if recreational sports activity also increases the risk of VTA/death.

Methods and results: Probands diagnosed with ARVC according to the 2010 task force criteria for ARVC (n = 108) were included in the current analysis. At the time of enrolment, study participants were questioned about exercise level prior to and after ARVC diagnosis, within three categories of sports participation: competitive (n = 41), recreational (n = 48), and inactive (n = 19). Competitive sport was associated with a significantly higher risk of VTA/death when compared with both recreational sport [HR = 1.99 (1.21-3.28), P = 0.007] and inactive patients [HR = 2.05 (1.07-3.91), P = 0.030]. No increased risk of VTA/death was associated with recreational sport when compared with patients who were inactive [HR = 1.03 (0.54-1.97), P = 0.930]. Symptoms developed at an earlier age in patients who participated in competitive sport (30 ± 12 years), when compared with patients who participated in recreational sport (38 ± 17 years) (P = 0.015) and inactive patients (41 ± 11 years) (P = 0.002). No difference in age at first symptom was seen between patients who participated in recreational sport and inactive patients (P = 0.651).

Conclusion: Competitive sport was associated with a two-fold increased risk of VTA/death, and earlier presentation of symptoms, when compared with inactive patients, and to patients who participated in recreational sport. When compared with inactive patients, recreational sport was not associated with earlier onset of symptoms or increased risk of VTA/death. ClinicalTrials.gov Identifier: NCT00024505.

Keywords: ARVC; Arrhythmogenic right ventricular cardiomyopathy; Exercise; Presentation; Sport; Ventricular arrhythmia.

Figure 1

Kaplan–Meier graph showing the cumulative probability of VTA/death from birth in ARVC probands by sports level (A) and by sports type and level (B) before diagnosis. Sports level defined as competitive (black), recreational (red), or inactive (blue). The x-axis shows years from birth. (A) Probability of VTA/death from birth by sports level. (B) Probability of VTA/death from birth by sports level in patients who participated specifically in high-dynamic sports or were inactive. VTA, ventricular tachyarrhythmia; ARVC, arrhythmogenic right-ventricular cardiomyopathy.

Figure 2

Kaplan–Meier graph showing the time relationship between first sport initiation and the time of first ARVC symptom in probands who participated in sports on a competitive (black) or recreational (red) level. The x-axis shows years from first sport initiation, and the y-axis shows the cumulative probability of earliest ARVC symptom. ARVC, arrhythmogenic right-ventricular cardiomyopathy.

Figure 3

Kaplan–Meier graph showing the cumulative probability of VTA/death from the time of ARVC diagnosis in probands who participated in sports on a competitive level, both before and after diagnosis (black), who participated in sports on a competitive level before diagnosis and changed sport level to either inactive or recreational after diagnosis (red), or who were inactive or participated in sports on a recreational level both before and after diagnosis (blue). The x-axis shows years from diagnosis. VTA, ventricular tachyarrhythmia; ARVC, arrhythmogenic right-ventricular cardiomyopathy.