Key result
Endurance athletics linked to pacemaker implantation ~8 years earlier than power or mixed sports.
Why the study?
Athletic bradycardia and AV block are considered adaptive and reversible, but evidence suggests they may persist after detraining and become pathological, prompting investigation into former professional athletes requiring PM implantation.
Does former professional sports activity affect the age of onset and need for pacemaker implantation for intrinsic sinus node dysfunction or AV block in patients without underlying heart disease?
Observational (n=381)
No
Does former professional sports activity affect the age of onset and need for pacemaker implantation for intrinsic sinus node dysfunction or AV block in patients without underlying heart disease?
Absolute Event Rate: 65% vs 73%
p-value: p=<0.05
Prolonged endurance sports activity may accelerate the onset of clinically significant sinus node or AV node dysfunction requiring pacemaker implantation later in life.
May prompt earlier monitoring in former endurance athletes; challenges reversibility consensus yet leaves open causality.
BACKGROUND: Sinus bradycardia and first degree or second degree Mobitz type I atrioventricular (AV) block in an athlete are considered adaptive and reversible phenomena; however, some evidence suggests that they may persist after detraining and become pathological. The aim of the study was to investigate the characteristics of a group of former professional athletes who required pacemaker (PM) implantation for intrinsic (idiopathic) sinus node (SN) dysfunction or AV block in comparison to control groups of sedentary individuals. METHODS: We included all patients who underwent PM implantation during 2022. Three groups were compared: group 1 including 18 former professional athletes who received a PM for SN dysfunction/AV block in the absence of heart disease; group 2 including the first 20 sedentary individuals without heart disease who underwent PM implantation; and group 3 including all other 323 patients who received PM, the majority with underlying heart diseases. RESULTS: Compared to the non-athlete control group 2, the mean age at diagnosis and at the time of PM implantation of former professional athletes did not show statistically significant differences. However, subgroup analysis revealed significant differences depending on the type of sports discipline: the age at diagnosis and at PM implantation was significantly lower in former endurance athletes than former strength/mixed athletes, control non-athletes, and all other patients. Moreover, former endurance professional athletes exhibited a higher prevalence of second or third degree AV block (78%) as the reason for PM implantation compared to power/mixed athletes (44%). The other clinical characteristics, including echocardiographic parameters, did not differ between former athletes and non-athletes. CONCLUSIONS: Former professional endurance athletes with idiopathic SN dysfunction/AV block manifested the disease earlier in the life course compared to former power/mixed athletes and non-athletes. This suggests that bradycardia/AV block caused by intense and prolonged endurance sports may not always be benign and adaptive phenomena.
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Bondarev et al. (2023) conducted an observational in Intrinsic sinus node dysfunction or atrioventricular block (n=381). Former professional endurance sport activity vs. Former power/mixed sport activity and sedentary non-athletes was evaluated on Age at pacemaker implantation (p=<0.05). Former professional endurance athletes with idiopathic sinus node dysfunction or atrioventricular block required pacemaker implantation at a significantly younger age (65.0 years) compared to former power/mixed athletes (73.0 years) and non-athletes.
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