Atrial Electromechanical Function in Endurance Athletes With and Without Atrial Fibrillation

Paroxysmal Atrial Fibrillation Clinical Trial

Official title:

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

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03305744
• Other study ID #: AthletesHeartUofT
• Status: Active, not recruiting
• Start date: January 30, 2018
• Est. completion date: August 2021

Study information

• Verified date: November 2020
• Source: University of Toronto
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 34
• Est. completion date: August 2021
• Est. primary completion date: August 2021
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Male
• Age group: 45 Years to 65 Years

Eligibility

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).

Related Conditions & MeSH terms

• Atrial Fibrillation
• Paroxysmal Atrial Fibrillation

Locations

Country	Name	City	State
Canada	Goldring Center for High Performance	Toronto	Ontario

Sponsors (2)

Lead Sponsor	Collaborator
University of Toronto	St. Michael's Hospital, Toronto

Country where clinical trial is conducted

Canada, 

References & Publications (3)

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. Review. — View 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. — View 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. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Lifetime hours of Physical Activity (# of hours)	Total lifetime hours of physical activity will be assessed using the Lifetime Physical Activity Questionnaire (LTPAQ).	baseline (day 1: at first visit, one time measure)
Other	Maximal oxygen consumption (VO2 max)	Maximal oxygen consumption (VO2 max) will be determined using a maximal treadmill test, in which a calibrated metabolic cart and indirect calorimetry will be used. VO2 max will be expressed as ml/kg/min.	baseline (day 1: at first visit, one time measure)
Primary	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	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)
Secondary	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)