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Recommendations for exercise in individuals with arrhythmias and implantable cardiac devices Exercise recommendations in individuals with atrial fibrillation Regular physical activity is recommended to prevent AF. I A Evaluation and management of structural heart disease, thyroid dysfunction, alcohol or drug abuse, or other primary causes of AF is recommended before engaging in sports. I A AF ablation is recommended in exercising individuals with recurrent, symptomatic AF and/or in those who do not want drug therapy, given its impact on athletic performance. I B Sports with direct bodily contact or prone to trauma are not recommended in exercising individuals with AF who are anticoagulated. III C Recommendations for exercise and sports participation in individuals with paroxysmal supraventricular tachycardia and pre-excitation In individuals with palpitations, a comprehensive assessment to exclude (latent) pre-excitation, structural heart disease, and VAs is recommended. I B Ablation of the accessory pathway is recommended in competitive and recreational athletes with pre-excitation and documented arrhythmias. I C In competitive/professional athletes with asymptomatic pre-excitation, an EP study is recommended to evaluate the risk for sudden death. I B Exercise recommendations in individuals with premature ventricular contractions or non-sustained ventricular tachycardia In exercising individuals with >_2 PVCs on a baseline ECG (or >_1 PVC in case of high-endurance athletes) a thorough evaluation (including a detailed family history) to exclude underlying structural or arrhythmogenic conditions is recommended. I C Among individuals with frequent PVCs and non-sustained VT a thorough investigation with Holter monitoring, 12-lead ECG, exercise test, and suitable imaging is recommended. I C Exercise recommendations in long QT syndrome It is recommended that all exercising individuals with LQTS with prior symptoms or prolonged QTc be on therapy with beta-blockers at target dose. I B It is recommended that exercising individuals with LQTS should avoid QT-prolonging drugs (www.crediblemeds.org) and electrolyte imbalance such as hypokalaemia and hypomagnesaemia. I B Participation in high-intensity recreational and competitive sports, even when on beta-blockers, is not recommended in individuals with a QTc>500 ms or a genetically confirmed LQTS with a QTc>_470 ms in males or >_480 ms in females. III B Participation in competitive sports (with or without ICD) is not recommended in individuals with LQTS and prior cardiac arrest or arrhythmic syncope. III C Exercise recommendations in Brugada syndrome ICD implantation is recommended in patients with BrS with episodes of arrhythmic syncope and/or aborted SCD. I C Prescription of drugs that may aggravate BrS, electrolyte abnormalities, and sports practices that increase core temperature >39 C are not recommended in individuals with overt BrS or phenotypically negative mutation carriers. III C Exercise recommendations in individuals with implantable cardiac electronic devices It is recommended that individuals with implanted devices with/without resynchronization and underlying disease follow the recommendations pertaining to the underlying disease. I B An ICD is not recommended as a substitute for disease-related recommendations when these mandate sports restrictions. III C Recommendations for patients with congenital heart disease Participation in regular moderate exercise is recommended in all individuals with CHD. I B A discussion on exercise participation and provision of an individualized exercise prescription is recommended at every CHD patient encounter. I B Competitive sport is not recommended for individuals with CHD who are in NYHA class IIIIV or with potentially serious arrhythmias. III C Recommendations for exercise in pregnancy Among pregnant women without medical or obstetric contraindications, participation in at least 150 min/week of moderate-intensity aerobic exercise before, during, and after pregnancy is recommended. I B Re-evaluation before continuing exercise or training is recommended in pregnant woman if they experience excessive shortness of breath, severe chest pain, dizziness or syncope, regular painful contractions, vaginal bleeding, or amniotic fluid leakage. I A Among women with CVD who were habitually engaged in strength training or power sport disciplines before pregnancy, discussing the option with the medical team before continuing and avoiding the Valsalva manoeuvre is recommended. I A Exercise or sport involving forceful physical contact, risk of falling or abdominal trauma, heavy lifting, scuba diving, or exercising at high altitude when unacclimatized are not recommended. III C

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