Atrial Electromechanical Function in Endurance Athletes With and Without Atrial Fibrillation

• Conditions: Paroxysmal Atrial Fibrillation

• Registration Number: NCT03305744
• Lead Sponsor: University of Toronto

Brief Summary

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.

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 Timeline

• Study First Submitted: 2017-09-29
• Study First Submitted QC: 2017-10-04
• Study First Posted: 2017-10-10
• Study Start: 2018-01-30
• Status Verified: 2020-11
• Last Update Submitted: 2020-11-02
• Last Update Posted: 2020-11-03
• Primary Completion: 2021-08
• Study Completion: 2021-08

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: Male
• Target Recruitment: 34

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 & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Left intra-atrial electromechanical delay (ms)	baseline (day 1: at first visit, one time measure)	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.

Secondary Outcome Measures

Name	Time	Method
Left atrial volume (mL)	baseline (day 1: at first visit, one time measure)	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.
Left atrial reservoir function	baseline (day 1: at first visit, one time measure)	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.

Trial Locations

Locations (1)

Goldring Center for High Performance; 🇨🇦 Toronto, Ontario, Canada