Exercise and Arrhythmogenic Right Ventricular Cardiomyopathy
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Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a group of cardiomyopathies associated with ventricular arrhythmias predominantly arising from the right ventricle, sudden cardiac death, and right ventricular failure, caused largely due to inherited mutations in proteins of the desmosomal complex. Whilst long recognized as a cause of sudden cardiac death (SCD) during exercise, it has recently been recognized that intense and prolonged exercise can worsen the disease resulting in earlier and more severe phenotypic expression. Changes in cardiac structure and function as a result of exercise training also pose challenges with diagnosis as enlargement of the right ventricle is commonly seen in endurance athletes. Advice regarding restriction of exercise is an important part of patient management, not only of those with an established disease but also in individuals known to carry gene mutations associated with the development of ARVC.

Arrhythmogenic right ventricular cardiomyopathy interacts with exercise in multiple ways which are all of clinical importance. It is an important cause of SCD during exercise in the young. Phenotypic expression and severity of ARVC are worsened by exercise, particularly endurance exercise. Extreme endurance exercise has been implicated in the development of and exercise-induced ARVC syndrome, even in the absence of gene mutations recognized to cause ARVC. For these reasons, advice regarding exercise restriction forms a major component of the management of this condition.

Source: https://www.sciencedirect.com/science/article/pii/S1443950619315574