Does High-Intensity Endurance Training Increase the Risk of Atrial Fibrillation? A Longitudinal Study of Left Atrial Structure and Function

Mildred A. Opondo, Norman Aiad, Matthew A. Cain, Satyam Sarma, Erin Howden, Douglas A. Stoller, Jason Ng, Pieter van Rijckevorsel, Michinari Hieda, Takashi Tarumi Ph.D., M. Dean Palmer, Benjamin D Levine

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: Exercise mitigates many cardiovascular risk factors associated with atrial fibrillation. Endurance training has been associated with atrial structural changes which can increase the risk for atrial fibrillation. The dose of exercise training required for these changes is uncertain. We sought to evaluate the impact of exercise on left atrial (LA) mechanical and electrical function in healthy, sedentary, middle-aged adults. METHODS: Sixty-one adults (52±5 years) were randomized to either 10 months of high-intensity exercise training or yoga. At baseline and post-training, all participants underwent maximal exercise stress testing to assess cardiorespiratory fitness, P-wave signal-averaged electrocardiography for filtered P-wave duration and atrial late potentials (root mean square voltage of the last 20 ms), and echocardiography for LA volume, left ventricular end-diastolic volume, and mitral inflow for assessment of LA active emptying. Post-training data were compared with 14 healthy age-matched Masters athletes. RESULTS: LA volume, Vo2 max, and left ventricular end-diastolic volume increased in the exercise group (15%, 17%, and 16%, respectively) with no change in control (P<0.0001). LA active emptying decreased post-exercise versus controls (5%; P=0.03). No significant changes in filtered P-wave duration or root mean square voltage of the last 20 ms occurred after exercise training. LA and left ventricular volumes remained below Masters athletes. The athletes had longer filtered P-wave duration but no difference in the frequency of atrial arrhythmia. CONCLUSIONS: Changes in LA structure, LA mechanical function, and left ventricular remodeling occurred after 10 months of exercise but without significant change in atrial electrical activity. A longer duration of training may be required to induce electrical changes thought to cause atrial fibrillation in middle-aged endurance athletes. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique Identifier: NCT02039154.

Original languageEnglish (US)
Pages (from-to)e005598
JournalCirculation. Arrhythmia and electrophysiology
Volume11
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Left Atrial Function
Atrial Fibrillation
Longitudinal Studies
Exercise
Athletes
Stroke Volume
Yoga
Ventricular Remodeling
Echocardiography
Cardiac Arrhythmias
Electrocardiography
Clinical Trials

Keywords

  • athletes
  • atrial fibrillation
  • atrial remodeling
  • echocardiography
  • exercise
  • yoga

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Does High-Intensity Endurance Training Increase the Risk of Atrial Fibrillation? A Longitudinal Study of Left Atrial Structure and Function. / Opondo, Mildred A.; Aiad, Norman; Cain, Matthew A.; Sarma, Satyam; Howden, Erin; Stoller, Douglas A.; Ng, Jason; van Rijckevorsel, Pieter; Hieda, Michinari; Tarumi Ph.D., Takashi; Palmer, M. Dean; Levine, Benjamin D.

In: Circulation. Arrhythmia and electrophysiology, Vol. 11, No. 5, 01.05.2018, p. e005598.

Research output: Contribution to journalArticle

Opondo, Mildred A. ; Aiad, Norman ; Cain, Matthew A. ; Sarma, Satyam ; Howden, Erin ; Stoller, Douglas A. ; Ng, Jason ; van Rijckevorsel, Pieter ; Hieda, Michinari ; Tarumi Ph.D., Takashi ; Palmer, M. Dean ; Levine, Benjamin D. / Does High-Intensity Endurance Training Increase the Risk of Atrial Fibrillation? A Longitudinal Study of Left Atrial Structure and Function. In: Circulation. Arrhythmia and electrophysiology. 2018 ; Vol. 11, No. 5. pp. e005598.
@article{89976e2f75b94160a1b3c631a308b191,
title = "Does High-Intensity Endurance Training Increase the Risk of Atrial Fibrillation? A Longitudinal Study of Left Atrial Structure and Function",
abstract = "BACKGROUND: Exercise mitigates many cardiovascular risk factors associated with atrial fibrillation. Endurance training has been associated with atrial structural changes which can increase the risk for atrial fibrillation. The dose of exercise training required for these changes is uncertain. We sought to evaluate the impact of exercise on left atrial (LA) mechanical and electrical function in healthy, sedentary, middle-aged adults. METHODS: Sixty-one adults (52±5 years) were randomized to either 10 months of high-intensity exercise training or yoga. At baseline and post-training, all participants underwent maximal exercise stress testing to assess cardiorespiratory fitness, P-wave signal-averaged electrocardiography for filtered P-wave duration and atrial late potentials (root mean square voltage of the last 20 ms), and echocardiography for LA volume, left ventricular end-diastolic volume, and mitral inflow for assessment of LA active emptying. Post-training data were compared with 14 healthy age-matched Masters athletes. RESULTS: LA volume, Vo2 max, and left ventricular end-diastolic volume increased in the exercise group (15{\%}, 17{\%}, and 16{\%}, respectively) with no change in control (P<0.0001). LA active emptying decreased post-exercise versus controls (5{\%}; P=0.03). No significant changes in filtered P-wave duration or root mean square voltage of the last 20 ms occurred after exercise training. LA and left ventricular volumes remained below Masters athletes. The athletes had longer filtered P-wave duration but no difference in the frequency of atrial arrhythmia. CONCLUSIONS: Changes in LA structure, LA mechanical function, and left ventricular remodeling occurred after 10 months of exercise but without significant change in atrial electrical activity. A longer duration of training may be required to induce electrical changes thought to cause atrial fibrillation in middle-aged endurance athletes. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique Identifier: NCT02039154.",
keywords = "athletes, atrial fibrillation, atrial remodeling, echocardiography, exercise, yoga",
author = "Opondo, {Mildred A.} and Norman Aiad and Cain, {Matthew A.} and Satyam Sarma and Erin Howden and Stoller, {Douglas A.} and Jason Ng and {van Rijckevorsel}, Pieter and Michinari Hieda and {Tarumi Ph.D.}, Takashi and Palmer, {M. Dean} and Levine, {Benjamin D}",
year = "2018",
month = "5",
day = "1",
doi = "10.1161/CIRCEP.117.005598",
language = "English (US)",
volume = "11",
pages = "e005598",
journal = "Circulation: Arrhythmia and Electrophysiology",
issn = "1941-3149",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Does High-Intensity Endurance Training Increase the Risk of Atrial Fibrillation? A Longitudinal Study of Left Atrial Structure and Function

AU - Opondo, Mildred A.

AU - Aiad, Norman

AU - Cain, Matthew A.

AU - Sarma, Satyam

AU - Howden, Erin

AU - Stoller, Douglas A.

AU - Ng, Jason

AU - van Rijckevorsel, Pieter

AU - Hieda, Michinari

AU - Tarumi Ph.D., Takashi

AU - Palmer, M. Dean

AU - Levine, Benjamin D

PY - 2018/5/1

Y1 - 2018/5/1

N2 - BACKGROUND: Exercise mitigates many cardiovascular risk factors associated with atrial fibrillation. Endurance training has been associated with atrial structural changes which can increase the risk for atrial fibrillation. The dose of exercise training required for these changes is uncertain. We sought to evaluate the impact of exercise on left atrial (LA) mechanical and electrical function in healthy, sedentary, middle-aged adults. METHODS: Sixty-one adults (52±5 years) were randomized to either 10 months of high-intensity exercise training or yoga. At baseline and post-training, all participants underwent maximal exercise stress testing to assess cardiorespiratory fitness, P-wave signal-averaged electrocardiography for filtered P-wave duration and atrial late potentials (root mean square voltage of the last 20 ms), and echocardiography for LA volume, left ventricular end-diastolic volume, and mitral inflow for assessment of LA active emptying. Post-training data were compared with 14 healthy age-matched Masters athletes. RESULTS: LA volume, Vo2 max, and left ventricular end-diastolic volume increased in the exercise group (15%, 17%, and 16%, respectively) with no change in control (P<0.0001). LA active emptying decreased post-exercise versus controls (5%; P=0.03). No significant changes in filtered P-wave duration or root mean square voltage of the last 20 ms occurred after exercise training. LA and left ventricular volumes remained below Masters athletes. The athletes had longer filtered P-wave duration but no difference in the frequency of atrial arrhythmia. CONCLUSIONS: Changes in LA structure, LA mechanical function, and left ventricular remodeling occurred after 10 months of exercise but without significant change in atrial electrical activity. A longer duration of training may be required to induce electrical changes thought to cause atrial fibrillation in middle-aged endurance athletes. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique Identifier: NCT02039154.

AB - BACKGROUND: Exercise mitigates many cardiovascular risk factors associated with atrial fibrillation. Endurance training has been associated with atrial structural changes which can increase the risk for atrial fibrillation. The dose of exercise training required for these changes is uncertain. We sought to evaluate the impact of exercise on left atrial (LA) mechanical and electrical function in healthy, sedentary, middle-aged adults. METHODS: Sixty-one adults (52±5 years) were randomized to either 10 months of high-intensity exercise training or yoga. At baseline and post-training, all participants underwent maximal exercise stress testing to assess cardiorespiratory fitness, P-wave signal-averaged electrocardiography for filtered P-wave duration and atrial late potentials (root mean square voltage of the last 20 ms), and echocardiography for LA volume, left ventricular end-diastolic volume, and mitral inflow for assessment of LA active emptying. Post-training data were compared with 14 healthy age-matched Masters athletes. RESULTS: LA volume, Vo2 max, and left ventricular end-diastolic volume increased in the exercise group (15%, 17%, and 16%, respectively) with no change in control (P<0.0001). LA active emptying decreased post-exercise versus controls (5%; P=0.03). No significant changes in filtered P-wave duration or root mean square voltage of the last 20 ms occurred after exercise training. LA and left ventricular volumes remained below Masters athletes. The athletes had longer filtered P-wave duration but no difference in the frequency of atrial arrhythmia. CONCLUSIONS: Changes in LA structure, LA mechanical function, and left ventricular remodeling occurred after 10 months of exercise but without significant change in atrial electrical activity. A longer duration of training may be required to induce electrical changes thought to cause atrial fibrillation in middle-aged endurance athletes. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique Identifier: NCT02039154.

KW - athletes

KW - atrial fibrillation

KW - atrial remodeling

KW - echocardiography

KW - exercise

KW - yoga

UR - http://www.scopus.com/inward/record.url?scp=85060773000&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060773000&partnerID=8YFLogxK

U2 - 10.1161/CIRCEP.117.005598

DO - 10.1161/CIRCEP.117.005598

M3 - Article

VL - 11

SP - e005598

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

SN - 1941-3149

IS - 5

ER -