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Arrhythmias & electrophysiologyResearch article

Exercise-induced ventricular arrhythmias: a marker of risk in arrhythmogenic cardiomyopathy

HeartPublished

  • retrospectively analysed
Read the original article ↗

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

OutcomeEIVAno EIVAP value
Peak VO 2 · lower peak VO 2 with EIVA38.2 ± 10.2 mL/kg/min43.0 ± 10.4 mL/kg/minP = 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:10.1136/heartjnl-2026-328138
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Summarised from the published abstract; every number is checked against it