Atrial remodeling and ectopic burden in recreational athletes: Implications for risk of atrial fibrillation

Background: Atrial remodeling, vagal tone, and atrial ectopic triggers are suggested to contribute to increased incidence of atrial fibrillation (AF) in endurance athletes. How these parameters change with increased lifetime training hours is debated. Hypothesis.: Atrial remodeling occurs in proportion to total training history, thus contributing to elevated risk of AF. Methods: We recruited 99 recreational endurance athletes, subsequently grouped according to lifetime training hours, to undergo evaluation of atrial size, autonomic modulation, and atrial ectopy. Athletes were grouped by self-reported lifetime training hours: low (6000 h). Left atrial (LA) volume, left ventricular (LV) dimensions, and LV systolic and diastolic function were assessed by echocardiography. We used 48-hour ambulatory electrocardiographic monitoring to determine heart rate, heart rate variability, premature atrial contractions, and premature ventricular contractions. Results: LA volume was significantly greater in the high (+5.1 mL/m2, 95% CI: 1.3–8.9) and medium (+4.2 mL/m2, 95% CI: 0.2–8.1) groups, compared with the low group. LA dilation was observed in 19.4%, 12.9%, and 0% of the high, medium, and low groups, respectively (P = 0.05). No differences were observed between groups for measures of LV dimensions or function. Minimum heart rate, parasympathetic tone expressed using heart rate variability indices, and premature atrial contraction and premature ventricular contraction frequencies did not differ between groups. Conclusions: In recreational endurance athletes, increased lifetime training is associated with LA dilation in the absence of increased vagal parameters or atrial ectopy, which may promote incidence of AF in this cohort.Adrian D. Elliott, Rajiv Mahajan, Dominik Linz, Michael Stokes, Christian V. Verdicchio, Melissa E. Middeldorp, Andre La Gerche, Dennis H. Lau, Prashanthan Sander