Clinical trial NCT03305744: Atrial Electromechanical Function in Endurance Athletes With and Without Atrial Fibrillation
Official title: Atrial Electromechanical Function in Middle-aged Endurance Athletes With and Without Atrial Fibrillation
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Paroxysmal Atrial Fibrillation
Keywords: Athlete
Middle-aged
Endurance training
Cardiac Function
Atrial Fibrillation
Lead sponsor: University of Toronto
Sponsor class: OTHER
Collaborators: name: Unity Health Toronto
First posted: 2017-10-10
Enrollment: 34
Sex: MALE
Minimum age (years): 45
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: CASE_CONTROL
Time perspective: CROSS_SECTIONAL
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Community sample from, but not limited to, various running, cycling, and rowing clubs for middle-aged athletes. Healthy endurance athletes will be selected from an existing study for convenience (non-probability sample). Endurance athletes with AF will be selected from the community (probability sample).

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.

Eligibility criteria: 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).

Primary outcomes:
measure: Left intra-atrial electromechanical delay (ms)
timeFrame: baseline (day 1: at first visit, one time measure)
Secondary outcomes:
measure: Left atrial reservoir function
timeFrame: baseline (day 1: at first visit, one time measure)
measure: Left atrial volume (mL)
timeFrame: baseline (day 1: at first visit, one time measure)
Other outcomes:
measure: Lifetime hours of Physical Activity (# of hours)
timeFrame: baseline (day 1: at first visit, one time measure)
measure: Maximal oxygen consumption (VO2 max)
timeFrame: baseline (day 1: at first visit, one time measure)
Locations:
city: Toronto
country: Canada
facility: Goldring Center for High Performance
state: Ontario
Study officials:
affiliation: University of Toronto
name: Emily Vecchiarelli, BKin
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Toronto
name: Jack Goodman, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Unity Health Toronto
name: Paul Dorian, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Molina L, Mont L, Marrugat J, Berruezo A, Brugada J, Bruguera J, Rebato C, Elosua R. Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study. Europace. 2008 May;10(5):618-23. doi: 10.1093/europace/eun071. Epub 2008 Apr 4.
citation: Grimsmo J, Grundvold I, Maehlum S, Arnesen H. High prevalence of atrial fibrillation in long-term endurance cross-country skiers: echocardiographic findings and possible predictors--a 28-30 years follow-up study. Eur J Cardiovasc Prev Rehabil. 2010 Feb;17(1):100-5. doi: 10.1097/HJR.0b013e32833226be.
citation: Calvo N, Brugada J, Sitges M, Mont L. Atrial fibrillation and atrial flutter in athletes. Br J Sports Med. 2012 Nov;46 Suppl 1:i37-43. doi: 10.1136/bjsports-2012-091171.