Key result
Paroxysmal AF in endurance athletes is linked to ~25% lower LA conduit volume during moderate exercise.
Why the study?
Limited data exist describing the cardiovascular phenotype of middle-aged endurance athletes or the impact of paroxysmal AF on atrial function and exercise performance in sinus rhythm.
Does paroxysmal atrial fibrillation impair left atrial function and exercise performance in middle-aged endurance athletes?
Cross-Sectional (n=29)
Does paroxysmal atrial fibrillation impair left atrial function and exercise performance in middle-aged endurance athletes?
Absolute Event Rate: 30% vs 40%
p-value: p=0.002
Exercise echocardiography in middle-aged endurance athletes with paroxysmal AF unmasks adverse functional cardiac remodeling, including reduced LA and LV volumes during exercise, which may contribute to impaired performance.
May impair exercise performance in endurance athletes with paroxysmal AF; hypothesis-generating and requires prospective validation.
High volume endurance training may increase the risk of paroxsysmal atrial fibrillation (AF) in middle-aged athletes. Limited data are available describing the cardiovascular phenotype of middle-aged endurance athletes, or the impact of AF on atrial function and exercise performance performed in sinus rhythm. The purpose of this study was to characterize LA phasic function at rest and during exercise in athletes with paroxysmal AF, and to determine its impact on exercise performance. Fifteen endurance trained males (EA) (56 ± 5 years) without AF and 14 endurance trained males with paroxysmal AF (EA-AF) (55 ± 8 years) underwent echocardiography during cycle-ergometry at light and moderate intensities. Resting LA maximal volumes were similar between EA and EA-AF (30 ± 4 vs. 29 ± 8 ml/m 2 , p=0.50), and there were no differences in AEMD. During moderate intensity exercise, EA-AF had reduced LA conduit (30 ± 6 vs. 40 ± 5 ml/m 2 , p=0.002) LA booster volumes (17 ± 5 vs. 21 ± 4 ml/m 2 , p=0.021), and reduced LV stroke volumes (100 ± 12 vs. 117 ± 16 ml, p=0.007). These results demonstrate that exercise testing in athletes with AF unmasks evidence of adverse functional cardiac remodelling that may contribute to impaired exercise performance. It is unclear whether these functional alterations are the consequence of AF. Reductions in LA conduit volume, LA booster volume, and LV stroke volume during exercise may be helpful in clinical management and distinguishing pathologic from physiologic remodelling.
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Vecchiarelli et al. (2023) conducted a cross-sectional in Paroxysmal Atrial Fibrillation (n=29). Paroxysmal Atrial Fibrillation (EA-AF) vs. Healthy endurance athletes (EA) was evaluated on Left atrial conduit volume during moderate intensity exercise (ml/m2) (p=0.002). During moderate intensity exercise, endurance athletes with paroxysmal atrial fibrillation had significantly reduced left atrial conduit volume (30 vs 40 ml/m2) and left ventricular stroke volume (100 vs 117 ml) compared to healthy endurance athletes.
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