Department of Medical Sciences, Uppsala University, Sweden (N.S., J.S., S.J., U.H., K.H., K.A.).
Department of Cardiology, Falun Hospital, Sweden (N.S., K.H.).
Circulation. 2024 Oct 8;150(15):1161-1170. doi: 10.1161/CIRCULATIONAHA.123.068280. Epub 2024 Aug 5.
Bradycardia is more common among well-trained athletes than in the general population, but the association with pacemaker implantations is less known. We investigated associations of endurance training with incidence of bradycardia and pacemaker implantations, including sex differences and long-term outcome, in a cohort of endurance trained individuals.
All Swedish skiers who completed >1 race in the cross-country skiing event Vasaloppet between 1989 and 2011 (n=209 108) and a sample of 532 290 nonskiers were followed until first event of bradycardia, pacemaker implantation, or death, depending on end point. The Swedish National Patient Register was used to obtain diagnoses. Cox regression was used to investigate associations of number of completed races and finishing time in Vasaloppet with incidence of bradycardia and pacemaker implantations. In addition, Cox regression was used to investigate associations of pacemaker implantations with death in skiers and nonskiers.
Male skiers had a higher incidence of bradycardia (adjusted hazard ratio [aHR], 1.19 [95% CI, 1.05-1.34]) and pacemaker implantations (aHR, 1.17 [95% CI, 1.04-1.31]) compared with male nonskiers. Those who completed the most races and had the best performances exhibited the highest incidence. For female skiers in Vasaloppet, the incidence of bradycardia (aHR, 0.98 [95% CI, 0.75-1.30]) and pacemaker implantations (aHR, 0.98 [95% CI, 0.75-1.29]) was not different from that of female nonskiers. The indication for pacemaker differed between skiers and nonskiers, with sick sinus syndrome more common in the former and third-degree atrioventricular block in the latter. Skiers had lower overall mortality rates than nonskiers (aHR, 0.16 [95% CI, 0.15-0.17]). There were no differences in mortality rates by pacemaker status among skiers.
In this study, male endurance skiers had a higher incidence of bradycardia and pacemaker implantations compared with nonskiers, a pattern not seen in women. Among male skiers, those who completed the most races and had the fastest finishing times had the highest incidence of bradycardia and pacemaker implantations. Within each group, mortality rates did not differ in relation to pacemaker status. These findings suggest that bradycardia associated with training leads to a higher risk for pacemaker implantation without a detrimental effect on mortality risk.
在训练有素的运动员中，心动过缓比一般人群更为常见，但与起搏器植入的关联知之甚少。我们研究了耐力训练与心动过缓和起搏器植入的发生率之间的关联，包括性别差异和长期结果，在一组耐力训练个体中。
所有在 1989 年至 2011 年间完成过瑞典瓦萨滑雪节越野滑雪项目超过 1 次的瑞典滑雪者（n=209108 人）和 532290 名非滑雪者都被随访，直到出现心动过缓、起搏器植入或死亡的首次事件，具体取决于终点。瑞典国家患者登记处用于获取诊断。使用 Cox 回归研究完成的瓦萨滑雪比赛次数和完成时间与心动过缓和起搏器植入发生率之间的关联。此外，Cox 回归还用于研究起搏器植入与滑雪者和非滑雪者死亡之间的关联。
与男性非滑雪者相比，男性滑雪者心动过缓（调整后的危险比 [aHR]，1.19 [95%CI，1.05-1.34]）和起搏器植入（aHR，1.17 [95%CI，1.04-1.31]）的发生率更高。那些完成比赛最多和表现最好的人发病率最高。对于瓦萨滑雪节的女性滑雪者，心动过缓（aHR，0.98 [95%CI，0.75-1.30]）和起搏器植入（aHR，0.98 [95%CI，0.75-1.29]）的发生率与女性非滑雪者无差异。滑雪者和非滑雪者的起搏器植入指征不同，病窦综合征在前者中更为常见，三度房室传导阻滞在后者中更为常见。与非滑雪者相比，滑雪者的总死亡率较低（aHR，0.16 [95%CI，0.15-0.17]）。在滑雪者中，起搏器状态与死亡率之间没有差异。
在这项研究中，与非滑雪者相比，男性耐力滑雪者心动过缓和起搏器植入的发生率更高，而女性则没有这种情况。在男性滑雪者中，完成比赛最多和完成时间最快的人，心动过缓和起搏器植入的发生率最高。在每组中，起搏器状态与死亡率之间没有差异。这些发现表明，与训练相关的心动过缓会导致更高的起搏器植入风险，但不会对死亡率产生不利影响。
