Journal
JOURNAL OF THE AMERICAN HEART ASSOCIATION
Volume 7, Issue 12, Pages -Publisher
WILEY
DOI: 10.1161/JAHA.118.008843
Keywords
arrhythmogenic right ventricular cardiomyopathy; exercise; implantable cardioverter-defibrillator; ventricular tachycardia
Categories
Funding
- 2017 Clinical Research Award in Honor of Mark Josephson from the Heart Rhythm Society
- Hein Wellens Scholarship from the Heart Rhythm Society
- Dr. Francis P. Chiaramonte Private Foundation
- Boston Scientific Corp.
- Foundation Leducq [16 CVD 02]
- Leyla Erkan Family Fund for ARVD Research
- Dr. Satish, Rupal, and Robin Shah ARVD Fund at Johns Hopkins
- Bogle Foundation
- Healing Hearts Foundation
- Campanella Family
- Patrick J. Harrison Family
- Peter French Memorial Foundation
- Wilmerding Endowments
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Background-Prior studies have shown a close link between exercise and development of arrhythmogenic right ventricular cardiomyopathy. How much exercise restriction reduces ventricular arrhythmia (VA), how genotype modifies its benefit, and whether it reduces risk sufficiently to defer implantable cardioverter-defibrillator (ICD) placement in arrhythmogenic right ventricular cardiomyopathy are unknown. Methods and Results-We interviewed 129 arrhythmogenic right ventricular cardiomyopathy patients (age: 34.0 +/- 14.8 years; male: 60%) with ICDs (36% primary prevention) about exercise participation. Exercise change was defined as annual exercise duration and dose in the 3 years before clinical presentation minus that after presentation. The primary outcome was appropriate ICD therapy for VA. During the 5.1 years (interquartile range: 2.7-10.8 years) after presentation, 74% (95/129) patients reduced exercise dose and 85 (66%) patients experienced the primary outcome. In multivariate analyses, top tertile reduction in exercise duration and dose were both associated with less VA (duration: hazard ratio: 0.23 [95% confidence interval, 0.07-0.81]; dose: hazard ratio: 0.14 [95% confidence interval, 0.04-0.44]). Greater reduction in exercise dose conferred greater reduction in VA (P=0.01 for trend). Patients without desmosomal mutations and those with primary-prevention ICDs benefited more from exercise reduction (P=0.16 and P=0.06 for interaction); however, 58% (18/31) of athletes who reduced exercise dose by >80% still experienced VA. Conclusions-Exercise restriction should be recommended to all arrhythmogenic right ventricular cardiomyopathy patients with ICDs. Patients who are gene-elusive and those with primary-prevention devices may particularly benefit. Exercise reduction is unlikely to reduce arrhythmia sufficiently in high-risk patients to alter decision-making regarding ICD implantation.
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