{
  "abstract": "Background: Arrhythmogenic cardiomyopathy (ACM) is a leading cause of sudden cardiac death in young adults and athletes. It is mostly genetically determined, with causal variants predominantly affecting desmosomal genes. Approximately one-third of patients remain gene-elusive despite extensive testing. Gene-elusive patients often report significantly higher lifetime exercise exposure than those with desmosomal ACM, suggesting a disproportionate role of exercise in this subgroup, also termed ‘exercise-induced ACM’. Yet, the effect of exercise history on the clinical characteristics and prognosis of this phenotype remains scarce.\n\nMethods: In this retrospective, single-centre cohort study, we included patients with definite or borderline ACM and negative genetic testing for ACM-associated genes. Exercise exposure was quantified with a standardised sports activity survey or from medical records. Competitive athletes were defined by an exercise exposure ≥24 metabolic equivalent of task-hour/week for ≥6 consecutive years and regular participation in competitive events. Life-threatening ventricular arrhythmias (LTVA) were defined as sustained ventricular tachycardia, ventricular fibrillation or appropriate implantable cardioverter-defibrillator therapies.\n\nResults: 46 patients (26 athletes, 20 non-athletes) were followed for a median of 7.5 years. At diagnosis, most athletes (77%) had definite right-ventricular ACM, compared with only 40% of non-athletes (p=0.025). Compared with non-athletes, athletes had a larger end-diastolic right-ventricular volume, while other imaging findings did not differ significantly. Athletes showed a distinct electrical phenotype with a shorter QTc (424 ms vs 449 ms, p<0.001), more T-wave inversions (4.0 vs 2.40, p=0.047) and a higher hazard of LTVA, death or heart transplantation during follow-up (HR 2.67, 95% CI 1.11 to 6.44, p=0.029).\n\nConclusion: In gene-elusive ACM, a history of competitive athletic participation was associated with more extensive repolarisation abnormalities, larger right ventricular volumes and a higher hazard of adverse outcomes during follow-up. These associations require validation in prospective multicentre cohorts, particularly regarding the relationship between exercise exposure and arrhythmic risk.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, University Hospital Zurich, Zürich, Switzerland",
    "Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zürich, Switzerland"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Lucas Tramèr",
      "orcid": "0009-0008-2372-2977"
    },
    {
      "affs": [
        0
      ],
      "name": "Deniz Akdis-Weidmann",
      "orcid": "0000-0003-4561-3540"
    },
    {
      "affs": [
        0
      ],
      "name": "Thierry G Donati"
    },
    {
      "affs": [
        0
      ],
      "name": "Andrea Agbariah"
    },
    {
      "affs": [
        0
      ],
      "name": "Fu Guan"
    },
    {
      "affs": [
        0
      ],
      "name": "Corinna Brunckhorst"
    },
    {
      "affs": [
        0
      ],
      "name": "Robert Manka"
    },
    {
      "affs": [
        0
      ],
      "name": "Felix C Tanner"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Ardan M Saguner"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Firat Duru"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c3evgtbhq83sn.bib",
  "cited_by": 0,
  "doi": "10.1136/openhrt-2026-004480",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13711553/",
  "id": "c3evgtbhq83sn",
  "issns": [
    "2053-3624"
  ],
  "landing_url": "https://doi.org/10.1136/openhrt-2026-004480",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "1506"
    ],
    [
      "heading",
      "Arrhythmias and Sudden Death"
    ],
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2705|Cardiovascular Effects of Exercise"
    ]
  ],
  "openalex": "W7223696042",
  "pdf_url": null,
  "pmcid": "PMC13711553",
  "pmid": "42933878",
  "published": "2026-10-26",
  "publisher": "BMJ Publishing Group",
  "ris": "https://research.draconitic.com/paper/c3evgtbhq83sn.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T12:22:18Z",
      "native_id": "PMC13711553",
      "source": "pmc",
      "url": "https://doi.org/10.1136/openhrt-2026-004480"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiovascular Effects of Exercise",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Association of exercise with phenotype and arrhythmic outcomes in gene-elusive arrhythmogenic cardiomyopathy",
  "title_text": "Association of exercise with phenotype and arrhythmic outcomes in gene-elusive arrhythmogenic cardiomyopathy",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:22:18Z",
  "url": "https://research.draconitic.com/paper/c3evgtbhq83sn",
  "venue": "Open Heart",
  "versions": []
}