Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study
Abstract
Aims We aimed to investigate the association of number of completed races and finishing time with risk of arrhythmias among participants of Vasaloppet, a 90 km cross-country skiing event. Methods and results All the participants without cardiovascular disease who completed Vasaloppet during 1989-98 were followed through national registries until December 2005. Primary outcome was hospitalization for any arrhythmia and secondary outcomes were atrial fibrillation/flutter (AF), bradyarrhythmias, other supraventricular tachycardias (SVT), and ventricular tachycardia/ventricular fibrillation/cardiac arrest (VT/VF/CA). Among 52 755 participants, 919 experienced arrhythmia during follow-up. Adjusting for age, education, and occupational status, those who completed the highest number of races during the period had higher risk of any arrhythmias [hazard ratio (HR)1.30; 95% CI 1.08-1.58; for ≥5 vs. 1 completed race], AF (HR 1.29; 95% CI 1.04-1.61), and bradyarrhythmias (HR 2.10; 95% CI 1.28-3.47). Those who had the fastest relative finishing time also had higher risk of any arrhythmias (HR 1.30; 95% CI 1.04-1.62; for 100-160% vs. >240% of winning time), AF (1.20; 95% CI 0.93-1.55), and bradyarrhythmias (HR 1.85; 95% CI 0.97-3.54). SVT or VT/VF/CA was not associated with finishing time or number of completed races. Conclusions Among male participants of a 90 km cross-country skiing event, a faster finishing time and a high number of completed races were associated with higher risk of ar…
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A U-shaped relationship exists between male elite athletes and AF, suggesting both type (endurance) and dose (hours of training) of physical activity relate to AF development.
“A U-shaped relationship between male elite athletes and AF is demonstrated through this finding, suggesting that both the type (endurance) and the dose (hours of training) of physical activity seem to relate to AF development [14,18,19,20,21].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [14]
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 [14]
A 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 [14]
The U-shaped relationship between physical activity and AF has not been confirmed in women.
“This U-shaped relationship has not been confirmed in women [14].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [14]
Cites
Multiple imputation using chained equations: Issues and guidance for practice
White, I. R., Royston, P., & Wood, A. M. (2011) · Statistics in Medicine · doi:10.1002/sim.4067 · Cited by 9,792 · see citing works
Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study
Heeringa, J., van der Kuip, D. A. M., Hofman, A., Kors, J. A., van Herpen, G., Stricker, B. H. C., Stijnen, T., Lip, G. Y. H., & Witteman, J. C. M. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehi825 · Cited by 1,939 · see citing works
Does sports activity enhance the risk of sudden death in adolescents and young adults?
Corrado, D., Basso, C., Rizzoli, G., Schiavon, M., & Thiene, G. (2003) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.03.002 · Cited by 1,311 · see citing works
Exercise and Physical Activity: Clinical Outcomes and Applications
Kokkinos, P., & Myers, J. (2010) · Circulation · doi:10.1161/circulationaha.110.948349 · Cited by 444 · see citing works
Relation of vigorous exercise to risk of atrial fibrillation
Aizer, A., Gaziano, J. M., Cook, N. R., Manson, J. E., Buring, J. E., & Albert, C. M. (2009) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2009.01.374 · Cited by 383 · cited 1× · see citing works
“The Physicians Health study among 1572 healthy physicians showed increased risk of atrial fibrillation by increasing days per week of exercise vigorous enough tobreaka sweat.(14) Althoughneither that studynor thepresent study had direct measurements of fitness level, the present study likely investigates individuals a…”
BackgroundMolina, L., Mont, L., Marrugat, J., Berruezo, A., Brugada, J., Bruguera, J., Rebato, C., & Elosua, R. (2008) · EP Europace · doi:10.1093/europace/eun071 · Cited by 327 · see citing works
Mont, L., Tamborero, D., Elosua, R., Molina, I., Coll-Vinent, B., Sitges, M., Vidal, B., Scalise, A., Tejeira, A., Berruezo, A., et al. (2008) · EP Europace · doi:10.1093/europace/eum263 · Cited by 270 · see citing works
Endurance sports is a risk factor for atrial fibrillation after ablation for atrial flutter
Heidbüchel, H., Anné, W., Willems, R., Adriaenssens, B., Van de Werf, F., & Ector, H. (2006) · International Journal of Cardiology · doi:10.1016/j.ijcard.2005.02.043 · Cited by 180 · see citing works
Grimsmo, J., Grundvold, I., Maehlum, S., & Arnesen, H. (2010) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/hjr.0b013e32833226be · Cited by 176 · see citing works
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease
Pelliccia, A., Sharma, S., Gati, S., Bäck, M., Börjesson, M., Caselli, S., Collet, J.-P., Corrado, D., Drezner, J. A., Halle, M., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehaa605 · Cited by 1,958 · see citing works
Arem, H., Moore, S. C., Patel, A., Hartge, P., Berrington de Gonzalez, A., Visvanathan, K., Campbell, P. T., Freedman, M., Weiderpass, E., Adami, H. O., et al. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.0533 · Cited by 1,498 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.017 · Cited by 933 · see citing works
Leisure-time running reduces all-cause and cardiovascular mortality risk.
Lee, D.-C., Pate, R. R., Lavie, C. J., Sui, X., Church, T. S., & Blair, S. N. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.04.058 · Cited by 819 · see citing works
Franklin, B. A., Thompson, P. D., Al-Zaiti, S. S., Albert, C. M., Hivert, M.-F., Levine, B. D., Lobelo, F., Madan, K., Sharrief, A. Z., Eijsvogels, T. M. H., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000749 · Cited by 410 · see citing works
Clinical neurocardiology defining the value of neuroscience-based cardiovascular therapeutics
Shivkumar, K., Ajijola, O. A., Anand, I., Armour, J. A., Chen, P., Esler, M., De Ferrari, G. M., Fishbein, M. C., Goldberger, J. J., Harper, R. M., et al. (2016) · The Journal of Physiology · doi:10.1113/jp271870 · Cited by 308 · see citing works
Malmo, V., Nes, B. M., Amundsen, B. H., Tjonna, A.-E., Stoylen, A., Rossvoll, O., Wisloff, U., & Loennechen, J. P. (2016) · Circulation · doi:10.1161/circulationaha.115.018220 · Cited by 263 · see citing works
Exercise can improve sleep quality: A systematic review and meta-analysis
Banno, M., Harada, Y., Taniguchi, M., Tobita, R., Tsujimoto, H., Tsujimoto, Y., Kataoka, Y., & Noda, A. (2018) · PeerJ · doi:10.7717/peerj.5172 · Cited by 246 · see citing works
Exercise and cardiovascular risk in patients with hypertension
Sharman, J. E., La Gerche, A., & Coombes, J. S. (2015) · American Journal of Hypertension · doi:10.1093/ajh/hpu191 · Cited by 224 · see citing works
Ten myths about work addiction
Griffiths, M. D., Demetrovics, Z., & Atroszko, P. A. (2018) · Journal of Behavioral Addictions · doi:10.1556/2006.7.2018.05 · Cited by 204 · see citing works
Aschar-Sobbi, R., Izaddoustdar, F., Korogyi, A. S., Wang, Q., Farman, G. P., Yang, F., Yang, W., Dorian, D., Simpson, J. A., Tuomi, J. M., et al. (2015) · Nature Communications · doi:10.1038/ncomms7018 · Cited by 185 · see citing works
Elite athletes live longer than the general population: a meta-analysis.
Garatachea, N., Santos-Lozano, A., Sanchis-Gomar, F., Fiuza-Luces, C., Pareja-Galeano, H., Emanuele, E., & Lucia, A. (2014) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2014.06.004 · Cited by 173 · see citing works
Lampert, R., Chung, E. H., Ackerman, M. J., Arroyo, A. R., Darden, D., Deo, R., Dolan, J., Etheridge, S. P., Gray, B. R., Harmon, K. G., et al. (2024) · Heart Rhythm · doi:10.1016/j.hrthm.2024.05.018 · Cited by 167 · see citing works
Diagnosis, pathophysiology, and management of exercise-induced arrhythmias
Guasch, E., & Mont, L. (2017) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2016.173 · Cited by 134 · see citing works
Risk of atrial fibrillation in athletes: a systematic review and meta-analysis
Newman, W., Parry-Williams, G., Wiles, J., Edwards, J., Hulbert, S., Kipourou, K., Papadakis, M., Sharma, R., & O'Driscoll, J. (2021) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-103994 · Cited by 110 · see citing works
The effects of endurance exercise on the heart: panacea or poison?
Parry-Williams, G., & Sharma, S. (2020) · Nature Reviews Cardiology · doi:10.1038/s41569-020-0354-3 · Cited by 102 · see citing works
Physical Activity and Risk of Atrial Fibrillation: A Nationwide Cohort Study in General Population
Jin, M.-N., Yang, P.-S., Song, C., Yu, H. T., Kim, T.-H., Uhm, J.-S., Sung, J.-H., Pak, H.-N., Lee, M.-H., & Joung, B. (2019) · Scientific Reports · doi:10.1038/s41598-019-49686-w · Cited by 99 · see citing works
Svedberg, N., Sundström, J., James, S., Hållmarker, U., Hambraeus, K., & Andersen, K. (2019) · Circulation · doi:10.1161/circulationaha.118.039461 · Cited by 92 · see citing works
Atrial fibrillation in athletes and the interplay between exercise and health
Gerche, A. L., & Schmied, C. M. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht265 · Cited by 78 · see citing works
Varma, N., Cygankiewicz, I., Turakhia, M. P., Heidbuchel, H., Hu, Y.-F., Chen, L. Y., Couderc, J.-P., Cronin, E. M., Estep, J. D., Grieten, L., et al. (2021) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.120.009204 · Cited by 74 · see citing works
Exercise genomics—a paradigm shift is needed: a commentary
Bouchard, C. (2015) · British Journal of Sports Medicine · doi:10.1136/bjsports-2015-095294 · Cited by 63 · see citing works
Atrial Fibrillation in Athletes
Estes, N. A. M., & Madias, C. (2017) · JACC: Clinical Electrophysiology · doi:10.1016/j.jacep.2017.03.019 · Cited by 56 · see citing works
Johansen, K. R., Ranhoff, A. H., Sørensen, E., Nes, B. M., Heitmann, K. A., Apelland, T., Bucher Sandbakk, S., Wilsgaard, T., Løchen, M.-L., Thelle, D. S., et al. (2022) · Open Heart · doi:10.1136/openhrt-2022-002154 · Cited by 32 · see citing works
Managing athletes with palpitations of unknown origin with an external loop recorder: A cohort study
SCIARRA, L., CAVARRETTA, E., SICILIANI, S., SETTE, A., SCARÀ, A., GRIECO, D., DE RUVO, E., PALAMÀ, Z., NESTI, M., ROMANO, S., et al. (2022) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.21.12831-2 · Cited by 15 · see citing works
Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature
Kourek, C., Briasoulis, A., Tsougos, E., & Paraskevaidis, I. (2024) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd11100315 · Cited by 7 · see citing works
- Authors
- Andersen, K., Farahmand, B., Ahlbom, A., Held, C., Ljunghall, S., Michaëlsson, K., & Sundström, J.
- Affiliations
- Uppsala University Hospital (SE)
- Karolinska Institutet (SE)
- Uppsala University (SE)
- Corresponding author
- Andersen, Kasper
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-06-11
- Volume
- 34
- Issue
- 47
- Pages
- 3624-3631
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2112107302
- Cited by
- 448
- References
- 9
- Citations by year
- 2026: 18 · 2025: 28 · 2024: 37 · 2023: 39 · 2022: 30 · 2021: 47 · 2020: 45 · 2019: 28 · 2018: 37 · 2017: 35 · 2016: 34 · 2015: 34 · 2014: 30 · 2013: 6
- FWCI
- 23.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (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 › Physiology › Physical Activity and Health
- Keywords
- cardiac arrhythmias, cross-country skiing, Vasaloppet, atrial fibrillation, bradycardia, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, cardiac arrest, finishing time, endurance exercise, male athletes
- MeSH terms
- Adolescent, Adult, Aged, Arrhythmias, Cardiac, Female, Humans, Male, Middle Aged, Risk Factors, Skiing, Sweden, Cohort Studies, Incidence, Young Adult, Out-of-Hospital Cardiac Arrest
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