Association of exercise with phenotype and arrhythmic outcomes in gene-elusive arrhythmogenic cardiomyopathy

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.