Effect of Endurance Sport on the Right Heart

  • Antonis S. ManolisEmail author
  • Antonis A. Manolis


The right ventricle (RV) responds differently to prolonged exhaustive and competitive exercise, usually with enlargement, than does the left ventricle. Evidence has accumulated indicating that regular intense endurance exercise and sporting can promote electrical and structural remodeling of the RV, leading to fibrosis. This “exercise-induced cardiomyopathy” mimics features observed in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). In addition, exercise-induced impairment in atrial function (atrial remodeling), mostly in the right atrium related to RV systolic dysfunction, has also been suggested which favors the development of atrial arrhythmias. It should be noted that these adverse effects seem to be limited to extreme intensity levels of exercise and not related to recreational or moderate exercise levels. These deleterious effects of heavy endurance exercise on the right heart can be studied by several methods, including standard and newer echocardiographic techniques, stress testing methods, standard ECG, cardiac magnetic resonance imaging, biomarkers, electroanatomical mapping and/or an electrophysiology study, and in specific cases by genetic testing. All these issues are reviewed in this chapter.


Exercise Endurance sport Right heart Right ventricle Cardiac arrhythmias Sudden death Arrhythmogenic right ventricular cardiomyopathy/dysplasia Echocardiography Electrocardiography Cardiac magnetic resonance imaging 



Atrial fibrillation


Arrhythmogenic right ventricular dysplasia/cardiomyopathy


Cardiac magnetic resonance imaging




Right bundle branch block


Right ventric-le (-ular)


Conflict of Interest

None declared.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Third Department of CardiologyAthens University School of MedicineAthensGreece
  2. 2.Patras University School of MedicinePatrasGreece

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