Differentiating right ventricular remodelling from cardiac pathology in athletes

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a leading cause of sudden cardiac death in young people and athletes. Prominent right ventricular remodelling can occur in highly trained endurance athletes, raising concern about underlying right ventricular pathology, such as ARVC. Distinguishing between physiological adaptation and cardiac pathology in athletes can be challenging, particularly in elite endurance athletes. This article describes a systematic approach used in sports cardiology to review the physiological adaptation of the right ventricle to exercise and the overlap with ARVC, focusing on the diagnostic investigations used to distinguish between athlete's heart and ARVC.