Frequency of exercise-induced ST-T-segment deviations and cardiac arrhythmias in recreational endurance athletes during a marathon race: results of the prospective observational Berlin Beat of Running study

Juliane Herm, Agnieszka Töpper, Alexander Wutzler, Claudia Kunze, Matthias Krüll, Lars Brechtel, Jürgen Lock, Jochen B Fiebach, Peter U Heuschmann, Wilhelm Haverkamp, Matthias Endres, Gerhard Jan Jungehulsing, Karl Georg Haeusler, Juliane Herm, Agnieszka Töpper, Alexander Wutzler, Claudia Kunze, Matthias Krüll, Lars Brechtel, Jürgen Lock, Jochen B Fiebach, Peter U Heuschmann, Wilhelm Haverkamp, Matthias Endres, Gerhard Jan Jungehulsing, Karl Georg Haeusler

Abstract

Objectives: While regular physical exercise has many health benefits, strenuous physical exercise may have a negative impact on cardiac function. The 'Berlin Beat of Running' study focused on feasibility and diagnostic value of continuous ECG monitoring in recreational endurance athletes during a marathon race. We hypothesised that cardiac arrhythmias and especially atrial fibrillation are frequently found in a cohort of recreational endurance athletes. The main secondary hypothesis was that pathological laboratory findings in these athletes are (in part) associated with cardiac arrhythmias.

Design: Prospective observational cohort study including healthy volunteers.

Setting and participants: One hundred and nine experienced marathon runners wore a portable ECG recorder during a marathon race in Berlin, Germany. Athletes underwent blood tests 2-3 days prior, directly after and 1-2 days after the race.

Results: Overall, 108 athletes (median 48 years (IQR 45-53), 24% women) completed the marathon in 249±43 min. Blinded ECG analysis revealed abnormal findings during the marathon in 18 (16.8%) athletes. Ten (9.3%) athletes had at least one episode of non-sustained ventricular tachycardia, one of whom had atrial fibrillation; eight (7.5%) individuals showed transient ST-T-segment deviations. Abnormal ECG findings were associated with advanced age (OR 1.11 per year, 95% CI 1.01 to 1.23), while sex and cardiovascular risk profile had no impact. Directly after the race, high-sensitive troponin T was elevated in 18 (16.7%) athletes and associated with ST-T-segment deviation (OR 9.9, 95% CI 1.9 to 51.5), while age, sex and cardiovascular risk profile had no impact.

Conclusions: ECG monitoring during a marathon is feasible. Abnormal ECG findings were present in every sixth athlete. Exercise-induced transient ST-T-segment deviations were associated with elevated high-sensitive troponin T (hsTnT) values.

Trial registration: ClinicalTrials.gov NCT01428778; Results.

Keywords: ECG; Marathon; arrhythmia; magnetic resonance imaging; troponin.

Conflict of interest statement

Competing interests: JH reports no conflict of interest. AT reports lecture fees from the Circle Institute. MK received consulting, lecture and advisory board fees from ALK, Berlin Chemie, Novartis, Mundipharma and Teva. LB reports research support from the German Ministry of Research and Education. JBF reports the following board memberships, consultancies and/or payments for lectures including service on speaker's bureaus: Boehringer Ingelheim, Lundbeck, BioClinica and Parexel. PUH reports research grants from the German Ministry of Research and Education, EU, Charité, Berlin Chamber of Physicians, German Parkinson Society, University Hospital Würzburg, Robert Koch Institute, Charité—Universitätsmedizin Berlin (within MonDAFIS; MonDAFIS is supported by an unrestricted research grant to the Charité from Bayer Healthcare), University Göttingen (within FINDAF randomized; FINDAF randomized is supported by an unrestricted research grant to the University Göttingen from Boehringer Ingelheim) and University Hospital Heidelberg (within RASUNOAprime; RASUNOAprime is supported by an unrestricted research grant to the University Hospital Heidelberg from Bayer Healthcare, BMS and Boehringer Ingelheim), outside submitted work. GJJ has received funding from the German Ministry for Education and Research. He has served on the Critical Event committees of the SourceXT registry and the ProTAVIC study (Edwards Lifesciences, USA). He serves as a consultant for Cipio Partners (Munich, Germany and Elron, Tel Aviv, Israel). He has received speakers’ honoraria from Genzyme and Pfizer (20102013). ME and KGH report lecture fees and study grants from Sanofi-Aventis and Bayer Healthcare.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Non-sustained ventricular tachycardia in a well-trained 48-year-old male endurance runner without cardiovascular risk factors despite smoking.
Figure 2
Figure 2
ECG at rest (A) and exercise-induced ST-segment deviations (B) in a 60-year-old male endurance runner without cardiovascular risk.

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Source: PubMed

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