Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited cardiomyopathy characterised by frequent ventricular arrhythmias and slowly progressive predominant RV dysfunction. Up to two-thirds of ARVD/C patients have mutations in genes encoding the cardiac desmosome. Mutations in other genes are increasingly recognised. Inheritance of ARVD/C is generally autosomal dominant with reduced age-related penetrance and significant variable expressivity. While the full explanation for this phenotypic heterogeneity remains unclear, there is increasing evidence that exercise plays a major role in disease penetrance and arrhythmic risk. The disproportionate representation of athletes among ARVD/C patients has long been noted. Recently, the association of exercise with earlier onset and more severe arrhythmic and structural disease has been documented. This article reviews current evidence regarding the association of genotype, exercise and clinical outcomes and discusses the emerging paradigm in which genetic predisposition and environmental factors (exercise) interact around a threshold for phenotypic expression of ARVD/C.
Cynthia A James - Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, US
Cynthia A James holds grants sponsored by the National Society of Genetic Counselors and the Barth Syndrome Foundation. The Johns Hopkins ARVD/C Program is supported by the Dr Francis P Chiaramonte Private Foundation, the Leyla Erkan Family Fund for ARVD Research, the Dr Satish Rupal and Robin Shah ARVD Fund at Johns Hopkins, the Bogle Foundation, the Healing Hearts Foundation, the Campanella family, the Patrick J Harrison Family, the Peter French Memorial Foundation and the Wilmerding Endowments.
