Atrial Electromechanical Function in Endurance Athletes With and Without Atrial Fibrillation

Atrial Electromechanical Function in Middle-aged Endurance Athletes With and Without Atrial Fibrillation

This study evaluates cardiac structure and function differences between healthy endurance trained athletes with atrial fibrillation and healthy age matched endurance trained athletes without atrial fibrillation. It is hypothesized that despite having similar structural adaptations of the heart (due to endurance training), athletes with atrial fibrillation display will impaired heart functional measures compared to endurance athletes without atrial fibrillation.

Study Overview

• Status: Unknown
• Conditions: Paroxysmal Atrial Fibrillation

Detailed Description

Regular physical activity, including vigorous exercise, lowers cardiovascular risk factors, including the risk of developing Atrial Fibrillation (AF), one of the most commonly diagnosed types of arrhythmias. Paradoxically, despite the cardioprotective effects of exercise, middle aged endurance athletes are at 5 fold risk of developing AF compared to active individuals. Long standing endurance training induces significant changes to the heart- collectively known as the 'athlete's heart.' While these changes may be beneficial for performance, they may be conducive in promoting the risk of AF in this cohort. The aim of this study is to compare cardiac structure and function in endurance athletes diagnosed with AF (n=17) and in healthy aged matched endurance athletes (n=17). Male subjects between ages 45 and 65 years old with a long-standing history of endurance training and competition will be recruited. Heart structure and function will be compared at rest and during submaximal exercise. Participants will also complete fitness assessments and questionnaires that characterize their lifetime involvement in exercise training. This study will address the gap in the literature regarding the interaction of endurance training and AF risk.

• Study Type: Observational
• Enrollment (Anticipated): 34

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M5S 2C9
      • Goldring Center for High Performance

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 45 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Male

• Sampling Method: Non-Probability Sample

Study Population

Community sample from, but not limited to, various running, cycling, and rowing clubs for middle-aged athletes. Healthy endurance athletes will be selected from an existing study for convenience (non-probability sample). Endurance athletes with AF will be selected from the community (probability sample).

Description

Inclusion Criteria:

ALL participants:

• endurance athlete (cyclist, runner, triathlete or other) who participate in vigorous year-round training of 4-6 hours per week for a minimum of 20 years
• participation in atleast one major competition per year (marathon/triathlon/endurance competition)
• sinus rhythm during all assessments

Inclusion criteria specific to endurance athletes with AF:

• diagnosed with lone paroxysmal AF in the last 4 years
• able to verify diagnosis (ECG or Holter verification/proof of diagnosis),
• can be on any type of medication.

Inclusion criteria specific to healthy endurance athletes without AF:

• previous participation in Athlete's Heart Study
• has completed resting cardiac magnetic resonance imaging and resting electrocardiogram

Exclusion Criteria:

• females
• no more than >1 hour per week of resistance training
• treatment or prior diagnosis of cardiovascular disease, valvular disease, hypertension, heart failure, diabetes, thyroid disorder, sleep apnea, current/recent viral disease, chronic inflammatory disease
• previous (within 10 years) or current smoking
• recreational drug use or alcohol consumption in excess of accepted standards
• inability to provide informed consent
• inability to verify AF diagnosis (if AF athlete).

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Endurance Athlete with Atrial Fibrillation; These are middle-aged athletes who are diagnosed with paroxysmal Atrial Fibrillation in the last 4 years, but are otherwise free of disease.
Endurance Athlete without Atrial Fibrillation; These are middle-aged athletes who will serve as our control group- they have not been diagnosed with AF or any other disease.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Left intra-atrial electromechanical delay (ms)	Left intra-atrial electromechanical delay will be measured using cardiac echocardiography at rest and during submaximal cycling. Left intra-atrial electromechanical delay will be measured as the time interval between the initiation of the P wave (on an electrocardiogram) to the beginning of the late diastolic wave (Am wave) on echocardiography.	baseline (day 1: at first visit, one time measure)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Left atrial reservoir function	Left atrial reservoir function will be measured by Speckle Tracking echocardiography, at 60-80 frames per second. Left atrial reservoir function will be measured by assessing left atrial reservoir strain (%), measured during ventricular systole on echocardiography.	baseline (day 1: at first visit, one time measure)
Left atrial volume (mL)	Left atrial volume (mL) will be measured using echocardiography at the end of ventricular systole, prior to the opening of the mitral valve. Imaging will be acquired using two and four chamber views.	baseline (day 1: at first visit, one time measure)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lifetime hours of Physical Activity (# of hours)	Total lifetime hours of physical activity will be assessed using the Lifetime Physical Activity Questionnaire (LTPAQ).	baseline (day 1: at first visit, one time measure)
Maximal oxygen consumption (VO2 max)	Maximal oxygen consumption (VO2 max) will be determined using a maximal treadmill test, in which a calibrated metabolic cart and indirect calorimetry will be used. VO2 max will be expressed as ml/kg/min.	baseline (day 1: at first visit, one time measure)

Collaborators and Investigators

• Sponsor: University of Toronto
• Collaborators: Unity Health Toronto
• Investigators: Principal Investigator: Paul Dorian, MD, Unity Health Toronto; Principal Investigator: Emily Vecchiarelli, BKin, University of Toronto

Publications and helpful links

General Publications

• Molina L, Mont L, Marrugat J, Berruezo A, Brugada J, Bruguera J, Rebato C, Elosua R. Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study. Europace. 2008 May;10(5):618-23. doi: 10.1093/europace/eun071. Epub 2008 Apr 4.
• Grimsmo J, Grundvold I, Maehlum S, Arnesen H. High prevalence of atrial fibrillation in long-term endurance cross-country skiers: echocardiographic findings and possible predictors--a 28-30 years follow-up study. Eur J Cardiovasc Prev Rehabil. 2010 Feb;17(1):100-5. doi: 10.1097/HJR.0b013e32833226be.
• Calvo N, Brugada J, Sitges M, Mont L. Atrial fibrillation and atrial flutter in athletes. Br J Sports Med. 2012 Nov;46 Suppl 1:i37-43. doi: 10.1136/bjsports-2012-091171.

Study record dates

Study Major Dates

• Study Start (Actual): January 30, 2018
• Primary Completion (Anticipated): August 1, 2021
• Study Completion (Anticipated): August 1, 2021

Study Registration Dates

• First Submitted: September 29, 2017
• First Submitted That Met QC Criteria: October 4, 2017
• First Posted (Actual): October 10, 2017

Study Record Updates

• Last Update Posted (Actual): November 3, 2020
• Last Update Submitted That Met QC Criteria: November 2, 2020
• Last Verified: November 1, 2020

More Information

Terms related to this study

• Keywords: Atrial Fibrillation; Athlete; Endurance training; Cardiac Function; Middle-aged
• Additional Relevant MeSH Terms: Pathologic Processes; Heart Diseases; Cardiovascular Diseases; Arrhythmias, Cardiac; Atrial Fibrillation
• Other Study ID Numbers: AthletesHeartUofT

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Participant data may be used for future study upon participant consent for their de-identified data to be used in the event that a related study is conducted. Only principal investigators will have access to records and will have the ability to share data with approved researchers.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No