Arrhythmias and Adaptations of the Cardiac Conduction System in Former National Football League Players

Philip Aagaard, Shishir Sharma, David A. McNamara, Parag Joshi, Colby R. Ayers, James A de Lemos, Andrew E. Lincoln, Bryan Baranowski, Kyle Mandsager, Elizabeth Hill, Lon Castle, James Gentry, Richard Lang, Reginald E. Dunn, Kezia Alexander, Andrew M. Tucker, Dermot Phelan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Habitual high-intensity endurance exercise is associated with increased atrial fibrillation (AF) risk and impaired cardiac conduction. It is unknown whether these observations extend to prior strength-type sports exposure. The primary aim of this study was to compare AF prevalence in former National Football League (NFL) athletes to population-based controls. The secondary aim was to characterize other conduction system parameters. Methods and Results This cross-sectional study compared former NFL athletes (n=460, age 56±12 years, black 47%) with population-based controls of similar age and racial composition from the cardiovascular cohort Dallas Heart Study-2 (n=925, age 54±9 years, black 53%). AF was present in 28 individuals (n=23 [5%] in the NFL group; n=5 [0.5%] in the control group). After controlling for other cardiovascular risk factors in multivariable regression analysis, former NFL participation remained associated with a 5.7 (95% CI: 2.1-15.9, P<0.001) higher odds ratio of AF. Older age, higher body mass index, and nonblack race were also independently associated with higher odds ratio of AF, while hypertension and diabetes mellitus were not. AF was previously undiagnosed in 15/23 of the former NFL players. Previously undiagnosed NFL players were rate controlled and asymptomatic, but 80% had a CHA2DS2-VASc score ≥1. Former NFL players also had an 8-fold higher prevalence of paced cardiac rhythms (2.0% versus 0.25%, P<0.01), compared with controls. Furthermore, former athletes had lower resting heart rates (62±11 versus 66±11 beats per minute, P<0.001), and a higher prevalence of first-degree atrioventricular block (18% versus 9%, P<0.001). Conclusions Former NFL participation was associated with an increased AF prevalence and slowed cardiac conduction when compared with a population-based control group. Former NFL athletes who screened positive for AF were generally rate controlled and asymptomatic, but 80% should have been considered for anticoagulation based on their stroke risk.

Original languageEnglish (US)
Pages (from-to)e010401
JournalJournal of the American Heart Association
Volume8
Issue number15
DOIs
StatePublished - Aug 6 2019

Fingerprint

Football
Cardiac Arrhythmias
Atrial Fibrillation
Athletes
Population Control
Odds Ratio
Control Groups
Atrioventricular Block
Sports
Diabetes Mellitus
Body Mass Index
Cross-Sectional Studies
Heart Rate
Stroke
Regression Analysis
Exercise
Hypertension

Keywords

  • athlete's heart
  • atrial fibrillation
  • conduction disease
  • National Football League

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Arrhythmias and Adaptations of the Cardiac Conduction System in Former National Football League Players. / Aagaard, Philip; Sharma, Shishir; McNamara, David A.; Joshi, Parag; Ayers, Colby R.; de Lemos, James A; Lincoln, Andrew E.; Baranowski, Bryan; Mandsager, Kyle; Hill, Elizabeth; Castle, Lon; Gentry, James; Lang, Richard; Dunn, Reginald E.; Alexander, Kezia; Tucker, Andrew M.; Phelan, Dermot.

In: Journal of the American Heart Association, Vol. 8, No. 15, 06.08.2019, p. e010401.

Research output: Contribution to journalArticle

Aagaard, P, Sharma, S, McNamara, DA, Joshi, P, Ayers, CR, de Lemos, JA, Lincoln, AE, Baranowski, B, Mandsager, K, Hill, E, Castle, L, Gentry, J, Lang, R, Dunn, RE, Alexander, K, Tucker, AM & Phelan, D 2019, 'Arrhythmias and Adaptations of the Cardiac Conduction System in Former National Football League Players', Journal of the American Heart Association, vol. 8, no. 15, pp. e010401. https://doi.org/10.1161/JAHA.118.010401
Aagaard, Philip ; Sharma, Shishir ; McNamara, David A. ; Joshi, Parag ; Ayers, Colby R. ; de Lemos, James A ; Lincoln, Andrew E. ; Baranowski, Bryan ; Mandsager, Kyle ; Hill, Elizabeth ; Castle, Lon ; Gentry, James ; Lang, Richard ; Dunn, Reginald E. ; Alexander, Kezia ; Tucker, Andrew M. ; Phelan, Dermot. / Arrhythmias and Adaptations of the Cardiac Conduction System in Former National Football League Players. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 15. pp. e010401.
@article{7f79207843bd4bed97e3c1a34a7ba5ca,
title = "Arrhythmias and Adaptations of the Cardiac Conduction System in Former National Football League Players",
abstract = "Background Habitual high-intensity endurance exercise is associated with increased atrial fibrillation (AF) risk and impaired cardiac conduction. It is unknown whether these observations extend to prior strength-type sports exposure. The primary aim of this study was to compare AF prevalence in former National Football League (NFL) athletes to population-based controls. The secondary aim was to characterize other conduction system parameters. Methods and Results This cross-sectional study compared former NFL athletes (n=460, age 56±12 years, black 47{\%}) with population-based controls of similar age and racial composition from the cardiovascular cohort Dallas Heart Study-2 (n=925, age 54±9 years, black 53{\%}). AF was present in 28 individuals (n=23 [5{\%}] in the NFL group; n=5 [0.5{\%}] in the control group). After controlling for other cardiovascular risk factors in multivariable regression analysis, former NFL participation remained associated with a 5.7 (95{\%} CI: 2.1-15.9, P<0.001) higher odds ratio of AF. Older age, higher body mass index, and nonblack race were also independently associated with higher odds ratio of AF, while hypertension and diabetes mellitus were not. AF was previously undiagnosed in 15/23 of the former NFL players. Previously undiagnosed NFL players were rate controlled and asymptomatic, but 80{\%} had a CHA2DS2-VASc score ≥1. Former NFL players also had an 8-fold higher prevalence of paced cardiac rhythms (2.0{\%} versus 0.25{\%}, P<0.01), compared with controls. Furthermore, former athletes had lower resting heart rates (62±11 versus 66±11 beats per minute, P<0.001), and a higher prevalence of first-degree atrioventricular block (18{\%} versus 9{\%}, P<0.001). Conclusions Former NFL participation was associated with an increased AF prevalence and slowed cardiac conduction when compared with a population-based control group. Former NFL athletes who screened positive for AF were generally rate controlled and asymptomatic, but 80{\%} should have been considered for anticoagulation based on their stroke risk.",
keywords = "athlete's heart, atrial fibrillation, conduction disease, National Football League",
author = "Philip Aagaard and Shishir Sharma and McNamara, {David A.} and Parag Joshi and Ayers, {Colby R.} and {de Lemos}, {James A} and Lincoln, {Andrew E.} and Bryan Baranowski and Kyle Mandsager and Elizabeth Hill and Lon Castle and James Gentry and Richard Lang and Dunn, {Reginald E.} and Kezia Alexander and Tucker, {Andrew M.} and Dermot Phelan",
year = "2019",
month = "8",
day = "6",
doi = "10.1161/JAHA.118.010401",
language = "English (US)",
volume = "8",
pages = "e010401",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "15",

}

TY - JOUR

T1 - Arrhythmias and Adaptations of the Cardiac Conduction System in Former National Football League Players

AU - Aagaard, Philip

AU - Sharma, Shishir

AU - McNamara, David A.

AU - Joshi, Parag

AU - Ayers, Colby R.

AU - de Lemos, James A

AU - Lincoln, Andrew E.

AU - Baranowski, Bryan

AU - Mandsager, Kyle

AU - Hill, Elizabeth

AU - Castle, Lon

AU - Gentry, James

AU - Lang, Richard

AU - Dunn, Reginald E.

AU - Alexander, Kezia

AU - Tucker, Andrew M.

AU - Phelan, Dermot

PY - 2019/8/6

Y1 - 2019/8/6

N2 - Background Habitual high-intensity endurance exercise is associated with increased atrial fibrillation (AF) risk and impaired cardiac conduction. It is unknown whether these observations extend to prior strength-type sports exposure. The primary aim of this study was to compare AF prevalence in former National Football League (NFL) athletes to population-based controls. The secondary aim was to characterize other conduction system parameters. Methods and Results This cross-sectional study compared former NFL athletes (n=460, age 56±12 years, black 47%) with population-based controls of similar age and racial composition from the cardiovascular cohort Dallas Heart Study-2 (n=925, age 54±9 years, black 53%). AF was present in 28 individuals (n=23 [5%] in the NFL group; n=5 [0.5%] in the control group). After controlling for other cardiovascular risk factors in multivariable regression analysis, former NFL participation remained associated with a 5.7 (95% CI: 2.1-15.9, P<0.001) higher odds ratio of AF. Older age, higher body mass index, and nonblack race were also independently associated with higher odds ratio of AF, while hypertension and diabetes mellitus were not. AF was previously undiagnosed in 15/23 of the former NFL players. Previously undiagnosed NFL players were rate controlled and asymptomatic, but 80% had a CHA2DS2-VASc score ≥1. Former NFL players also had an 8-fold higher prevalence of paced cardiac rhythms (2.0% versus 0.25%, P<0.01), compared with controls. Furthermore, former athletes had lower resting heart rates (62±11 versus 66±11 beats per minute, P<0.001), and a higher prevalence of first-degree atrioventricular block (18% versus 9%, P<0.001). Conclusions Former NFL participation was associated with an increased AF prevalence and slowed cardiac conduction when compared with a population-based control group. Former NFL athletes who screened positive for AF were generally rate controlled and asymptomatic, but 80% should have been considered for anticoagulation based on their stroke risk.

AB - Background Habitual high-intensity endurance exercise is associated with increased atrial fibrillation (AF) risk and impaired cardiac conduction. It is unknown whether these observations extend to prior strength-type sports exposure. The primary aim of this study was to compare AF prevalence in former National Football League (NFL) athletes to population-based controls. The secondary aim was to characterize other conduction system parameters. Methods and Results This cross-sectional study compared former NFL athletes (n=460, age 56±12 years, black 47%) with population-based controls of similar age and racial composition from the cardiovascular cohort Dallas Heart Study-2 (n=925, age 54±9 years, black 53%). AF was present in 28 individuals (n=23 [5%] in the NFL group; n=5 [0.5%] in the control group). After controlling for other cardiovascular risk factors in multivariable regression analysis, former NFL participation remained associated with a 5.7 (95% CI: 2.1-15.9, P<0.001) higher odds ratio of AF. Older age, higher body mass index, and nonblack race were also independently associated with higher odds ratio of AF, while hypertension and diabetes mellitus were not. AF was previously undiagnosed in 15/23 of the former NFL players. Previously undiagnosed NFL players were rate controlled and asymptomatic, but 80% had a CHA2DS2-VASc score ≥1. Former NFL players also had an 8-fold higher prevalence of paced cardiac rhythms (2.0% versus 0.25%, P<0.01), compared with controls. Furthermore, former athletes had lower resting heart rates (62±11 versus 66±11 beats per minute, P<0.001), and a higher prevalence of first-degree atrioventricular block (18% versus 9%, P<0.001). Conclusions Former NFL participation was associated with an increased AF prevalence and slowed cardiac conduction when compared with a population-based control group. Former NFL athletes who screened positive for AF were generally rate controlled and asymptomatic, but 80% should have been considered for anticoagulation based on their stroke risk.

KW - athlete's heart

KW - atrial fibrillation

KW - conduction disease

KW - National Football League

UR - http://www.scopus.com/inward/record.url?scp=85070472793&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070472793&partnerID=8YFLogxK

U2 - 10.1161/JAHA.118.010401

DO - 10.1161/JAHA.118.010401

M3 - Article

C2 - 31337251

AN - SCOPUS:85070472793

VL - 8

SP - e010401

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 15

ER -