title: 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: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Heart Research Follow-up Program, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420653, Rochester, NY 14642, USA Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark annechristinehuth@hotmail.com acruwald@gmail.com.
authors.forename: Anne-Christine
authors.initials: AC
authors.lastname: Ruwald
authors.affiliation: University of Arizona Health Science Center, Tucson, AZ, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Marcus
authors.affiliation: Tufts Medical Center, Cardiac Arrhythmia Center, Boston, MA, USA.
authors.forename: N A Mark
authors.initials: NA
authors.lastname: Estes
authors.affiliation: Tufts Medical Center, Cardiac Arrhythmia Center, Boston, MA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Link
authors.affiliation: Heart Research Follow-up Program, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420653, Rochester, NY 14642, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.affiliation: Heart Research Follow-up Program, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420653, Rochester, NY 14642, USA.
authors.forename: Bronislava
authors.initials: B
authors.lastname: Polonsky
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.affiliation: Pediatric Cardiology Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Towbin
authors.affiliation: Heart Research Follow-up Program, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420653, Rochester, NY 14642, USA.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.affiliation: Heart Research Follow-up Program, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420653, Rochester, NY 14642, USA.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D011998:Recreation / Q000502:physiology; D012307:Risk Factors; D013177:Sports / Q000502:physiology*; D017180:Tachycardia, Ventricular / Q000209:etiology*; D055815:Young Adult
keywords: ARVC; Arrhythmogenic right ventricular cardiomyopathy; Exercise; Presentation; Sport; Ventricular arrhythmia