Arrhythmias & electrophysiology
Exercise-induced ventricular arrhythmias: a marker of risk in arrhythmogenic cardiomyopathy
Authors' conclusion
EIVAs occurred in nearly 40% of patients with ACM and were associated with adverse arrhythmic outcomes, alongside MF. These findings support the integration of exercise testing into routine risk stratification.
Study context
- Population
- Patients with a definitive diagnosis of arrhythmogenic cardiomyopathy (ACM) and individuals harbouring a P/LP gene variant associated with ACM with a negative or borderline phenotypeunderwent exercise tolerance test (ETT) or cardiopulmonary exercise test (CPET) at baseline, of 202 patients followed at our centre
- Participants
- 157 patients
- Comparison
- Patients demonstrating EIVA vs counterparts
- EIVAn = 61
- Outcome
- Composite of:
- Sustained ventricular tachycardia/fibrillation
- Appropriate implantable cardioverter-defibrillator therapy
- Sudden cardiac arrest
- Sudden death
Main finding
As reported in the abstract
- Myocardial fibrosis (MF) independently associated with the primary arrhythmic endpoint, HR 6.05
- p=0.005 (95% CI 1.70 to 21.54)
- EIVA independently associated with the primary arrhythmic endpoint, HR 2.8
- p=0.03 (95% CI 1.1 to 7.3)
- Combination of EIVA and MF (score 2) significantly stratified prognosis in comparison to none or one risk factor (score 0-1)
- p<0.001
Further findings
Myocardial fibrosis (MF) on cardiac magnetic resonance · numerically higher with EIVA
P = 0.071
| Outcome | EIVA | No EIVA | P value |
|---|---|---|---|
| Peak VO 2Lower peak VO 2 with EIVA | 38.2 ± 10.2 mL/kg/min | 43.0 ± 10.4 mL/kg/min | P = 0.019 |
- Prevalence of EIVA by exercise group: lower-exercise 31%
- Prevalence of EIVA by exercise group: higher-exercise 30%
Prevalence of EIVA
- Exercise-induced ventricular arrhythmias (EIVAs) observed
- 61 (39%)
- Among 65 patients with a baseline normal ECG, exhibited EIVA
- 9 (14%)
- Among 29 genotype-positive individuals with a negative or borderline phenotype, showed EIVA
- 6 (20%)
Mean peak VO 2
- Mean peak VO 2
- 41.4±10.6 mL/kg/min
Prevalence of EIVA by exercise group
- Comparable
Original publication
Exercise-induced ventricular arrhythmias: a marker of risk in arrhythmogenic cardiomyopathy. Heart. Published 7 August 2026. doi:10.
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