Atrial remodeling, autonomic tone, and lifetime training hours in nonelite athletes
Open accessAbstract
Endurance athletes have an increased risk of developing atrial fibrillation (AF) at 40 to 50 years of age. Signal-averaged P-wave analysis has been used for identifying patients at risk for AF. We evaluated the impact of lifetime training hours on signal-averaged P-wave duration and modifying factors. Nonelite men athletes scheduled to participate in the 2010 Grand Prix of Bern, a 10-mile race, were invited. Four hundred ninety-two marathon and nonmarathon runners applied for participation, 70 were randomly selected, and 60 entered the final analysis. Subjects were stratified according to their lifetime training hours (average endurance and strength training hours per week × 52 × training years) in low (<1,500 hours), medium (1,500 to 4,500 hours), and high (>4,500 hours) training groups. Mean age was 42 ± 7 years. From low to high training groups signal-averaged P-wave duration increased from 131 ± 6 to 142 ± 13 ms (p = 0.026), and left atrial volume increased from 24.8 ± 4.6 to 33.1 ± 6.2 ml/m(2) (p = 0.001). Parasympathetic tone expressed as root of the mean squared differences of successive normal-to-normal intervals increased from 34 ± 13 to 47 ± 16 ms (p = 0.002), and premature atrial contractions increased from 6.1 ± 7.4 to 10.8 ± 7.7 per 24 hours (p = 0.026). Left ventricular mass increased from 100.7 ± 9.0 to 117.1 ± 18.2 g/m(2) (p = 0.002). Left ventricular systolic and diastolic function and blood pressure at rest were normal in all athletes and showed no differences among training groups. Four athletes (6.7%) had a history of paroxysmal AF, as did 1 athlete in the medium training group and 3 athletes in the high training group (p = 0.252). In conclusion, in nonelite men athletes lifetime training hours are associated with prolongation of signal-averaged P-wave duration and an increase in left atrial volume. The altered left atrial substrate may facilitate occurrence of AF. Increased vagal tone and atrial ectopy may serve as modifying and triggering factors.
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Regular exercise of low or moderate intensity serves as a preventive strategy for cardiovascular disease and AF, while higher-intensity endurance exercise may lead to AF.
“Regular exercise of either low or moderate intensity seems serve as a preventive strategy for cardiovascular disease and AF, while higher-intensity endurance exercise may lead to AF [6,7,8,12,13,14,15,16,17,18,19,20,21].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [6]
The Abstract and Discussion report increased AF risk among endurance athletes and AF episodes in the medium- and high-training groups. They do not say that low- or moderate-intensity exercise prevents cardiovascular disease or AF; the study groups are defined by lifetime training hours, not exercise intensity. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn an observational study of 492 marathon runners, hours of training correlated with LA enlargement, indicating a higher risk of AF in athletes with more hours of exercise training (24% in <1500 h, 40% 1500-4500 h, and 83% in >4500 h).
“An observational study involving 492 marathon runners reported a correlation between hours of training and LA enlargement, indicating a higher risk of AF in athletes with more hours of exercise training (24% in <1500 h, 40% 1500–4500 h and 83% in >4500 h) [6].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [6]
The Results report that left atrial enlargement increased across training groups: 24%, 40%, and 83%. But 492 runners applied; only 60 entered the analysis, and they included both marathon and nonmarathon runners. The percentages describe left atrial enlargement, not AF risk or incidence, although the Discussion links atrial remodeling to AF. (LLM, conf=0.91)
Experimental — accuracy not yet measuredA 2 to 10 times higher frequency of AF has been shown in high-intensity endurance athletes compared to individuals who do not exercise.
“Many retrospective observational studies and meta-analyses have estimated a 2 to 10 times higher frequency of AF in high-intensity endurance athletes compared to individuals who do not exercise [6,7,8,12,13,14,15,16,17].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [6]
The increased risk of AF from intensive sports practice is probably mediated by altered autonomic tone, volume load during exercise, atrial hypertrophy, and dilatation.
“probably mediated by altered autonomic tone, volume load during exercise, atrial hypertrophy, and dilatation.903,904”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [903]
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References 36 · Cited by 192
Research works printed but not linked: 2
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- Authors
- Wilhelm, M., Roten, L., Tanner, H., Wilhelm, I., Schmid, J.-P., & Saner, H.
- Affiliations
- University of Bern (CH)
- Corresponding author
- Wilhelm, Matthias
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2011-08
- Volume
- 108
- Issue
- 4
- Pages
- 580-585
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W1991363476
- Cited by
- 192
- References
- 36
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 15 · 2023: 12 · 2022: 12 · 2021: 10 · 2020: 13 · 2019: 16 · 2018: 23 · 2017: 13 · 2016: 18 · 2015: 12 · 2014: 14 · 2013: 9 · 2012: 8
- FWCI
- 7.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- BORIS (University Library Bern) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- atrial remodeling, atrial fibrillation, endurance athletes, left atrial volume, parasympathetic activity, autonomic tone, left ventricular mass, premature atrial contractions, marathon runners, left atrial substrate
- MeSH terms
- Adult, Atrial Fibrillation, Electrocardiography, Heart Atria, Humans, Male, Middle Aged, Risk Factors, Vagus Nerve, Athletes
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