{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:56:49Z","timestamp":1790211409224,"version":"4.1.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2021,10,12]],"date-time":"2021-10-12T00:00:00Z","timestamp":1633996800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background\u2003<\/jats:title><jats:p>Arrhythmogenic right ventricular cardiomyopathy (ARVC)\/dysplasia is a genetic disease characterized by fibro-adipose degeneration of ventricular myocardium. Initial clinical presentation is variable and ranges from asymptomatic cases to chronic heart failure and sudden cardiac death due to malignant arrhythmias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case summary\u2003<\/jats:title><jats:p>Here, a 67-year-old male patient who started extensive physical training upon retirement and presented with ventricular tachycardia and progressive heart failure as a first sign of his disease. Arrhythmogenic right ventricular cardiomyopathy diagnosis was established according to the 2010 modified Task Force Criteria and supported by HRS\/EHRA consensus-based genotyping. After initial discharge on optimal medical therapy and prophylactic implantable cardioverter-defibrillator implantation according to his individual ARVC risk score, the patient reported rapid decline in physical capacity on a regular follow-up 4 months later. To better understand the aetiology of his clinical deterioration, we performed stress echocardiography, coronary angiogram, and exercise right heart catheterization, which conclusively suggest impaired left ventricular filling secondary to right ventricular failure as a main cause of global circulatory failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion\u2003<\/jats:title><jats:p>The present case report focuses on relation of physical activity to disease onset and the concomitant advent of symptoms during exercise as well as a structured and guideline-aided diagnostic workup in ARVC and staged treatment options. Continuous ARVC centre-oriented re-assessment and treatment planning including lifestyle intervention, psychological support, medical, surgical, and interventional options are key elements of sustained long-term care for ARVC patients.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab417","type":"journal-article","created":{"date-parts":[[2021,10,17]],"date-time":"2021-10-17T20:22:42Z","timestamp":1634502162000},"source":"Crossref","is-referenced-by-count":4,"title":["How exercise can deteriorate the clinical course of an ARVC patient: a case report"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3214-5672","authenticated-orcid":false,"given":"Enzo","family":"L\u00fcsebrink","sequence":"first","affiliation":[{"name":"Department of Medicine I, University Hospital, Ludwig-Maximilians University Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonhard","family":"Binzenh\u00f6fer","sequence":"additional","affiliation":[{"name":"Department of Medicine I, University Hospital, Ludwig-Maximilians University Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Brunner","sequence":"additional","affiliation":[{"name":"Department of Medicine I, University Hospital, Ludwig-Maximilians University Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Hausleiter","sequence":"additional","affiliation":[{"name":"Department of Medicine I, University Hospital, Ludwig-Maximilians University Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7387-3986","authenticated-orcid":false,"given":"Steffen","family":"Massberg","sequence":"additional","affiliation":[{"name":"Department of Medicine I, University Hospital, Ludwig-Maximilians University Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Orban","sequence":"additional","affiliation":[{"name":"Department of Medicine I, University Hospital, Ludwig-Maximilians University Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8824-3581","authenticated-orcid":false,"given":"Stefan","family":"K\u00e4\u00e4b","sequence":"additional","affiliation":[{"name":"Department of Medicine I, University Hospital, Ludwig-Maximilians University Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,10,12]]},"reference":[{"key":"2021110408074365900_ytab417-B1","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1016\/S0140-6736(09)60256-7","article-title":"Arrhythmogenic right ventricular cardiomyopathy","volume":"373","author":"Basso","year":"2009","journal-title":"Lancet"},{"key":"2021110408074365900_ytab417-B2","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1056\/NEJM198801213180301","article-title":"Right ventricular cardiomyopathy and sudden death in young people","volume":"318","author":"Thiene","year":"1988","journal-title":"N Engl J Med"},{"key":"2021110408074365900_ytab417-B3","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1056\/NEJMra1509267","article-title":"Arrhythmogenic right ventricular cardiomyopathy","volume":"376","author":"Corrado","year":"2017","journal-title":"N Engl J Med"},{"key":"2021110408074365900_ytab417-B4","first-page":"1601","article-title":"2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)","volume":"17","author":"Priori","year":"2015","journal-title":"Europace"},{"key":"2021110408074365900_ytab417-B5","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1016\/j.jacc.2016.02.062","article-title":"Etiology of sudden death in sports: insights from a United Kingdom Regional Registry","volume":"67","author":"Finocchiaro","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2021110408074365900_ytab417-B6","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1016\/j.jacc.2013.06.033","article-title":"Exercise increases age-related penetrance and arrhythmic risk in arrhythmogenic right ventricular dysplasia\/cardiomyopathy-associated desmosomal mutation carriers","volume":"62","author":"James","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2021110408074365900_ytab417-B7","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1093\/eurheartj\/ehv110","article-title":"Association of competitive and recreational sport participation with cardiac events in patients with arrhythmogenic right ventricular cardiomyopathy: results from the North American multidisciplinary study of arrhythmogenic right ventricular cardiomyopathy","volume":"36","author":"Ruwald","year":"2015","journal-title":"Eur Heart J"},{"key":"2021110408074365900_ytab417-B8","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1093\/eurheartj\/ehq025","article-title":"Diagnosis of arrhythmogenic right ventricular cardiomyopathy\/dysplasia: proposed modification of the Task Force Criteria","volume":"31","author":"Marcus","year":"2010","journal-title":"Eur Heart J"},{"key":"2021110408074365900_ytab417-B9","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1093\/eurheartj\/ehz669","article-title":"Arrhythmogenic right ventricular cardiomyopathy: evaluation of the current diagnostic criteria and differential diagnosis","volume":"41","author":"Corrado","year":"2020","journal-title":"Eur Heart J"},{"key":"2021110408074365900_ytab417-B10","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1161\/CIRCGENETICS.114.001003","article-title":"Clinical presentation, long-term follow-up, and outcomes of 1001 arrhythmogenic right ventricular dysplasia\/cardiomyopathy patients and family members","volume":"8","author":"Groeneweg","year":"2015","journal-title":"Circ Cardiovasc Genet"},{"key":"2021110408074365900_ytab417-B11","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1001\/jama.296.13.1593","article-title":"Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program","volume":"296","author":"Corrado","year":"2006","journal-title":"JAMA"},{"key":"2021110408074365900_ytab417-B12","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1002\/ejhf.181","article-title":"Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members","volume":"16","author":"Saberniak","year":"2014","journal-title":"Eur J Heart Fail"},{"key":"2021110408074365900_ytab417-B13","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1161\/CIRCEP.111.968677","article-title":"Outcomes of catheter ablation of ventricular tachycardia in arrhythmogenic right ventricular dysplasia\/cardiomyopathy","volume":"5","author":"Philips","year":"2012","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2021110408074365900_ytab417-B14","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1093\/europace\/eur245","article-title":"HRS\/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies: this document was developed as a partnership between the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA)","volume":"13","author":"Ackerman","year":"2011","journal-title":"Europace"},{"key":"2021110408074365900_ytab417-B15","doi-asserted-by":"crossref","first-page":"e301","DOI":"10.1016\/j.hrthm.2019.05.007","article-title":"2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy","volume":"16","author":"Towbin","year":"2019","journal-title":"Heart Rhythm"},{"key":"2021110408074365900_ytab417-B16","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.1093\/eurheartj\/ehz103","article-title":"A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy","volume":"40","author":"Cadrin-Tourigny","year":"2019","journal-title":"Eur Heart J"},{"key":"2021110408074365900_ytab417-B17","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.3390\/jcm9051317","article-title":"Right ventricular free wall strain and congestive hepatopathy in patients with acute worsening of chronic heart failure: a CATSTAT-HF echo substudy","volume":"9","author":"Borovac","year":"2020","journal-title":"J Clin Med"},{"key":"2021110408074365900_ytab417-B18","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1001\/jama.295.2.165","article-title":"Comparison of beta-blockers, amiodarone plus beta-blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators: the OPTIC Study: a randomized trial","volume":"295","author":"Connolly","year":"2006","journal-title":"JAMA"},{"key":"2021110408074365900_ytab417-B19","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1016\/S0140-6736(00)02379-5","article-title":"Identification of a deletion in plakoglobin in arrhythmogenic right ventricular cardiomyopathy with palmoplantar keratoderma and woolly hair (Naxos disease)","volume":"355","author":"McKoy","year":"2000","journal-title":"Lancet"},{"key":"2021110408074365900_ytab417-B20","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.jacc.2018.05.065","article-title":"Clinical diagnosis, imaging, and genetics of arrhythmogenic right ventricular cardiomyopathy\/dysplasia: JACC state-of-the-art review","volume":"72","author":"Gandjbakhch","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2021110408074365900_ytab417-B21","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1161\/CIRCEP.113.000392","article-title":"Implantable cardioverter defibrillators in arrhythmogenic right ventricular dysplasia\/cardiomyopathy: patient outcomes, incidence of appropriate and inappropriate interventions, and complications","volume":"6","author":"Schinkel","year":"2013","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2021110408074365900_ytab417-B22","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.hrcr.2016.01.007","article-title":"Congenital heart disease confounding the diagnosis of arrhythmogenic right ventricular cardiomyopathy","volume":"2","author":"Kiamanesh","year":"2016","journal-title":"HeartRhythm Case Rep"},{"key":"2021110408074365900_ytab417-B23","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1093\/europace\/euv340","article-title":"Arrhythmogenic right ventricular cardiomyopathy, clinical manifestations, and diagnosis","volume":"18","author":"Haugaa","year":"2016","journal-title":"Europace"},{"key":"2021110408074365900_ytab417-B24","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.ijcard.2020.07.010","article-title":"Tricuspid regurgitation and right ventricular dysfunction after cardiac device implantation\u2014is it time for intra-procedural TEE-guided lead implantation?","volume":"321","author":"Orban","year":"2020","journal-title":"Int J Cardiol"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytab417\/40572205\/ytab417.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/11\/ytab417\/41074745\/ytab417.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/11\/ytab417\/41074745\/ytab417.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T15:56:27Z","timestamp":1673538987000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytab417\/6390813"}},"subtitle":[],"editor":[{"given":"Erik","family":"Holy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Christoph","family":"Sinning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Josip Andelo","family":"Borovac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Daniel","family":"Tardo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Nida","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,10,12]]},"references-count":24,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytab417","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,11,1]]},"published":{"date-parts":[[2021,10,12]]},"article-number":"ytab417"}}