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SYNTAX Score and Revascularisation — EECC MCQ

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HardCoronary Artery DiseaseSYNTAX Score and RevascularisationEECC

A 24-year-old carrying a pathogenic plakophilin-2 variant has subtle right-ventricular regional akinesia but no sustained arrhythmia. She trains for long-distance triathlon and asks which change most alters future penetrance and ventricular-arrhythmic risk. What should be recommended?

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Correct answer: E — Stop competitive endurance training and restrict high-intensity exercise exposure

In genotype-positive arrhythmogenic cardiomyopathy, cumulative high-intensity endurance exposure accelerates phenotypic expression, ventricular dysfunction and arrhythmia. Restricting competitive endurance activity is therefore disease modifying. Resistance-only restriction misses the principal exposure; stable annual imaging does not guarantee safety, beta-blockade does not neutralise exercise-related progression, and waiting for sustained VT forfeits preventive benefit.

Reference: 2022 ESC Guidelines for ventricular arrhythmias and sudden cardiac death. https://academic.oup.com/eurheartj/article/43/40/3997/6675633