Atrial Electromechanical Function in Endurance Athletes With and Without Atrial Fibrillation

Study Overview
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Brief Summary
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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
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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.

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

Conditions
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Paroxysmal Atrial Fibrillation

Participation Criteria
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Eligibility Criteria
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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).

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Endurance Athlete with Atrial Fibrillation<br>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<br>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?
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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) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Athlete, Middle-aged, Endurance training, Cardiac Function, Atrial Fibrillation