{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:03:21Z","timestamp":1781629401719,"version":"3.54.5"},"reference-count":39,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>The prediction and prevention of sudden cardiac death is the philosopher\u2019s stone of clinical cardiac electrophysiology. Sports can act as triggers of fatal arrhythmias and therefore it is essential to promptly frame the athlete at risk and to carefully evaluate the suitability for both competitive and recreational sports activity. A history of syncope or palpitations, the presence of premature ventricular complexes or more complex arrhythmias, a reduced left ventricular systolic function, or the presence of known or familiar heart disease should prompt a thorough evaluation with second level examinations. In this regard, cardiac magnetic resonance and electrophysiological study play important roles in the diagnostic work-up. The role of genetics is increasing both in cardiomyopathies and in channelopathies, and a careful evaluation must be focused on genotype positive\/phenotype negative subjects. In addition to being a trigger for fatal arrhythmias in certain cardiomyopathies, sports also play a role in the progression of the disease itself, especially in the case arrhythmogenic right ventricular cardiomyopathy. In this paper, we review the latest European guidelines on sport cardiology in patients with cardiovascular diseases, focusing on arrhythmic risk stratification and the management of cardiomyopathies and channelopathies.<\/jats:p>","DOI":"10.3390\/medicina57040308","type":"journal-article","created":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T14:51:12Z","timestamp":1616683872000},"page":"308","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Sports Activity and Arrhythmic Risk in Cardiomyopathies and Channelopathies: A Critical Review of European Guidelines on Sports Cardiology in Patients with Cardiovascular Diseases"],"prefix":"10.3390","volume":"57","author":[{"given":"Giovanni","family":"Volpato","sequence":"first","affiliation":[{"name":"Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Falanga","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7570-4278","authenticated-orcid":false,"given":"Laura","family":"Cipolletta","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel Antonio","family":"Conti","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gino","family":"Grifoni","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8698-5848","authenticated-orcid":false,"given":"Giuseppe","family":"Ciliberti","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9824-2398","authenticated-orcid":false,"given":"Alessia","family":"Urbinati","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Barbarossa","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7095-5732","authenticated-orcid":false,"given":"Giulia","family":"Stronati","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2993-5718","authenticated-orcid":false,"given":"Marco","family":"Fogante","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9864-1938","authenticated-orcid":false,"given":"Marco","family":"Bergonti","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milan, 20100 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Catto","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, 20100 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5394-1312","authenticated-orcid":false,"given":"Federico","family":"Guerra","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Giovagnoni","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Dello Russo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5322-1742","authenticated-orcid":false,"given":"Michela","family":"Casella","sequence":"additional","affiliation":[{"name":"Department of Clinical, Special and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1924-6548","authenticated-orcid":false,"given":"Paolo","family":"Compagnucci","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital \u201cOspedali Riuniti Umberto I-Lancisi-Salesi\u201d, Marche Polytechnic University, 60100 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1056\/NEJMra022783","article-title":"Sudden Death in Young Athletes","volume":"349","author":"Maron","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/eurheartj\/ehaa605","article-title":"2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease","volume":"42","author":"Pelliccia","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.jacep.2018.11.004","article-title":"Sudden death can be the first manifestation of hypertrophic cardiomyopathy: Data from a United Kingdom Pathology Registry","volume":"5","author":"Finocchiaro","year":"2019","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.jacc.2004.11.043","article-title":"Spectrum and prognostic significance of arrhythmias on ambulatory Holter electrocardio-gram in hypertrophic cardiomyopathy","volume":"45","author":"Adabag","year":"2005","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1161\/CIRCULATIONAHA.113.007094","article-title":"Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evalua-tion of sudden death risk in patients with hypertrophic cardiomyopathy","volume":"130","author":"Chan","year":"2014","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.jacc.2018.05.060","article-title":"Late gadolinium enhancement in patients with hypertrophic cardiomyopathy and pre-served systolic function","volume":"72","author":"Mentias","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1136\/heartjnl-2013-305471","article-title":"Role of late gadolinium enhancement cardiovascular magnetic resonance in the risk stratifica-tion of hypertrophic cardiomyopathy","volume":"100","author":"Ismail","year":"2014","journal-title":"Heart"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s10741-019-09775-4","article-title":"Hypertrophic cardiomyopathy: An updated review on diagnosis, prognosis, and treatment","volume":"24","author":"Makavos","year":"2019","journal-title":"Heart Fail. Rev."},{"key":"ref_9","first-page":"2010","article-title":"A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM Risk-SCD)","volume":"35","author":"Jichi","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.jacep.2018.01.010","article-title":"Harmful Effects of Exercise Intensity and Exercise Duration in Patients with Arrhythmogenic Cardiomyopathy","volume":"4","author":"Lie","year":"2018","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2175","DOI":"10.1016\/j.jacc.2008.09.019","article-title":"Left-dominant arrhythmogenic cardiomyopathy: An underrecognized clinical entity","volume":"52","author":"Syrris","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"009005","DOI":"10.1161\/CIRCEP.120.009005","article-title":"Characteristics of Patients with Arrhythmogenic Left Ventricular Cardiomyopathy: Combining Genetic and Histopathologic Findings","volume":"13","author":"Casella","year":"2020","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1161\/CIRCULATIONAHA.117.030792","article-title":"Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy","volume":"136","author":"Calkins","year":"2017","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Towbin, J.A., McKenna, W.J., Abrams, D.J., Ackerman, M.J., Calkins, H., Darrieux, F.C., Daubert, J.P., Chillou, C., de Pasquale, E.C., and Desai, M.Y. (2019). 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy. Heart Rhythm, 16.","DOI":"10.1016\/j.hrthm.2019.09.019"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1093\/ehjci\/jeu323","article-title":"The multi-modality cardiac imaging approach to the Athlete\u2019s heart: An expert consensus of the European Association of Cardiovascular Imaging","volume":"16","author":"Galderisi","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1161\/CIRCULATIONAHA.116.027134","article-title":"Personalizing risk stratification for sudden death in dilated cardiomyopathy: The past, present, and future","volume":"136","author":"Halliday","year":"2017","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.ahj.2005.03.037","article-title":"Survival in biopsy-proven myocarditis: A long-term retrospective analysis of the histo-pathologic, clinical, and hemodynamic predictors","volume":"151","author":"Magnani","year":"2006","journal-title":"Am. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1016\/j.jacc.2012.01.007","article-title":"Long-term follow up of biopsy-proven viral myocarditis: Predictors of mortality and incomplete recovery","volume":"59","author":"Schumm","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1007\/s00380-013-0455-6","article-title":"Ventricular arrhythmias induced by long-term use of ephedrine in two competitive athletes","volume":"30","author":"Casella","year":"2014","journal-title":"Heart Vessel."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.jacc.2020.01.036","article-title":"Ventricular Arrhythmias in Myocarditis: Characterization and Relationships with Myocardial Inflammation","volume":"75","author":"Peretto","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1161\/CIRCEP.111.965012","article-title":"Drug-refractory ventricular tachycardias after myocarditis: Endocardial and epicardial radiofrequency catheter ablation","volume":"5","author":"Russo","year":"2012","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1161\/CIRCULATIONAHA.120.046900","article-title":"Diagnostic Yield of Electroanatomic Voltage Mapping in Guiding Endomyocardial Biopsies","volume":"142","author":"Casella","year":"2020","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1038\/s41569-020-00435-x","article-title":"Myocarditis and inflammatory cardiomyopathy: Current evidence and future directions","volume":"18","author":"Ammirati","year":"2021","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Casella, M., Bergonti, M., Narducci, M.L., Persampieri, S., Gasperetti, A., Conte, E., Catto, V., Carbucicchio, C., Guerra, F., and Pontone, G. (2020). Prior myocarditis and ventricular arrhythmias: The importance of scar pattern. Heart Rhythm, 1547\u20135271.","DOI":"10.1016\/j.hrthm.2020.12.016"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Compagnucci, P., Volpato, G., Falanga, U., Cipolletta, L., Conti, M., Grifoni, G., Verticelli, L., Schicchi, N., Giovagnoni, A., and Casella, M. (2020). Recent advances in three-dimensional electroanatomical mapping guidance for the ablation of complex atrial and ventricular arrhythmias. J. Interv. Card. Electrophysiol., 1\u20137.","DOI":"10.1007\/s10840-020-00781-3"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.jacep.2019.12.010","article-title":"Long-Term Arrhythmic Risk Assessment in Biopsy-Proven Myocarditis","volume":"6","author":"Pelargonio","year":"2020","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1161\/CIRCULATIONAHA.120.052573","article-title":"COVID-19 Myocardial Pathology Evaluation in Athletes with Cardiac Magnetic Resonance (COMPETE CMR)","volume":"143","author":"Clark","year":"2021","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Coromilas, E.J., Kochav, S., Goldenthal, I., Biviano, A., Garan, H., Goldbarg, S., Kim, J.-H., Yeo, I., Tracy, C., and Ayanian, S. (2021). Worldwide Survey of COVID-19 Associated Arrhythmias. Circ. Arrhythmia Electrophysiol.","DOI":"10.1161\/CIRCEP.120.009458"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"129","DOI":"10.3389\/fcvm.2020.00129","article-title":"The Dual Role of Echocardiography in the Diagnosis of Acute Cardiac Complications and Treatment Monitoring for Coronavirus Disease 2019 (COVID-19)","volume":"7","author":"Vrettou","year":"2020","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1001\/jamacardio.2020.2136","article-title":"A Game Plan for the Resumption of Sport and Exercise after Coronavirus Disease 2019 (COVID-19) Infection","volume":"5","author":"Phelan","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e008774","DOI":"10.1161\/CIRCEP.120.008774","article-title":"Impact of the COVID-19 Pandemic on a Tertiary-Level Electrophysiology Laboratory in Italy","volume":"13","author":"Compagnucci","year":"2020","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2308","DOI":"10.1161\/CIRCULATIONAHA.111.055350","article-title":"Risk of arrhythmia and sudden death in patients with asymptomatic preexcitation: A meta-analysis","volume":"125","author":"Obeyesekere","year":"2012","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/0002-9149(89)90426-8","article-title":"Stress and pharmacologic tests as methods to identify patients with Wolff-Parkinson-White syn-drome at risk of sudden death","volume":"64","author":"Gaita","year":"1989","journal-title":"Am. J. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.jacep.2019.10.015","article-title":"Risk Stratification of Patients with Apparently Idiopathic Premature Ventricular Contractions: A Multicenter International CMR Registry","volume":"6","author":"Muser","year":"2020","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/s11936-018-0693-0","article-title":"Interpreting the Athlete\u2019s ECG: Current State and Future Perspectives","volume":"20","author":"Basu","year":"2018","journal-title":"Curr. Treat. Options Cardiovasc. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/S0735-1097(02)01977-0","article-title":"Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes","volume":"40","author":"Biffi","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1161\/01.CIR.88.2.782","article-title":"Diagnostic criteria for the long QT syndrome. An update","volume":"88","author":"Schwartz","year":"1993","journal-title":"Circulation"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1056\/NEJMoa022147","article-title":"Risk Stratification in the Long-QT Syndrome","volume":"348","author":"Priori","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1161\/CIR.0b013e318293688f","article-title":"Promotion of physical activity for children and adults with congenital heart disease: A scientific statement from the American Heart Association","volume":"127","author":"Longmuir","year":"2013","journal-title":"Circulation"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/4\/308\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:40:50Z","timestamp":1760161250000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/4\/308"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,25]]},"references-count":39,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["medicina57040308"],"URL":"https:\/\/doi.org\/10.3390\/medicina57040308","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,25]]}}}