Exercise with high intensity is as a strong marker of life-threatening arrhythmias in arrhythmogenic cardiomyopathy but not in hypertrophic cardiomyopathy, according to Lars Andreas Dejgaard’s PhD thesis.


MAIN RESULTS:

  1. High-intensity exercise is not linked to ventricular arrhytmias in hypertrophic cardiomyopathy.
  2. High-intensity exercise is highly linked to ventricular arrhytmias in arrhythmogenic cardiomyopathy.
  3. Life-threatening arrhythmias are common in patients with mitral annulus disjunction.


THESIS DEFENCE:

Thesis: Cardiac diseases with risk of severe ventricular arrhythmias; risk stratification and impact of exercise
Candidate: Lars Andreas Dejgaard
Time: March 27, 2020 at 09:45
Place: Online-based solution, due to the covid-19 situation
Link to university website


SUMMARY:

(1) Regular vigorous exercise is associated with better diastolic heart function in patients with hypertrophic cardiomyopathy. High-intensity exercise is neither linked to increased myocardial hypertrophy nor previous arrhythmic events.

The study includes 187 genotype positive subjects, of which 121 also were phenotype positive with established left ventricular hypertrophy. Those who reported exercising vigorously for at least four days a week over at least six years had larger left ventricular end-diastolic volumes than those who exercised less. No difference in left ventricular systolic function was observed.

(2) Exerise with high intensity is a strong, independent marker of malignant cardiac arrhyhtmias in patients with arrhytmogenic cardiomyopathy. 173 patients were included in this study. Among the half who reported exercising vigorously, 74 % had a history of ventricular arrhythmias, compared to only 20 % among those who did not report high-intensity exercise. Long duration of exercise was also associated with more frequent arrhythmic events, but this association disappeared when adjusting for high-intensity exercise.

(3) 12 % of patients with a gap between the mitral ring and the ventricular myocardium had experienced aborted cardiac arrest or sustained ventricular tachycardia. A total of 116 patients with mitral annulus disjunction were included in the study. Previous life-threatening arrhythmias were more common in younger patients with lower ejection fraction and papillary muscle fibrosis. Mitral valve prolapse, on the other hand, was not associated with arrhythmic events.


REFERENCES:

(1) Dejgaard, L. A., Haland, T. F., Lie, O. H., Ribe, M., Bjune, T., Leren, I. S., Berge, K. E., Edvardsen, T., & Haugaa, K. H. (2018). Vigorous exercise in patients with hypertrophic cardiomyopathy. International journal of cardiology250, 157-163.

(2) Lie, Ø. H., Dejgaard, L. A., Saberniak, J., Rootwelt, C., Stokke, M. K., Edvardsen, T., & Haugaa, K. H. (2018). Harmful effects of exercise intensity and exercise duration in patients with arrhythmogenic cardiomyopathyJACC: Clinical Electrophysiology4(6), 744-753.

(3) Dejgaard, L. A., Skjølsvik, E. T., Lie, Ø. H., Ribe, M., Stokke, M. K., Hegbom, F., Scheirlynck, E. S., Gjertsen, E., Andresen, K., Helle-Valle, T. M., Hopp, E., Edvardsen, T., & Haugaa, K. H. (2018). The mitral annulus disjunction arrhythmic syndromeJournal of the American College of Cardiology72(14), 1600-1609.

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