D'Ambrosio Paolo, De Paepe Jarne, Janssens Kristel, Mitchell Amy M, Rowe Stephanie J, Spencer Luke W, Van Puyvelde Tim, Bogaert Jan, Ghekiere Olivier, Pauwels Rik, Herbots Lieven, Robyns Tomas, Kistler Peter M, Kalman Jonathan M, Heidbuchel Hein, Willems Rik, Claessen Guido, La Gerche André
Department of Medicine, The University of Melbourne, Parkville, VIC 3010, Australia; Heart, Exercise & Research Trials (HEART) lab, St Vincent's Institute, Fitzroy, VIC 3065, Australia; Department of Cardiology, The Royal Melbourne Hospital, Parkville, VIC 3010, Australia.
Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven 3000, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven 3000, Belgium.
J Sport Health Sci. 2025 Apr 22;14:101043. doi: 10.1016/j.jshs.2025.101043.
A greater prevalence of arrhythmias has been described in endurance athletes, but it remains unclear whether this risk persists after detraining. We aimed to evaluate the prevalence of arrhythmias and their relationship with cardiac remodeling in lifelong and retired master endurance athletes compared to non-athletic controls.
We performed a cross-sectional analysis of observational studies that used echocardiography and cardiac magnetic resonance to detail cardiac structure and function, and Holter monitors to identify atrial and ventricular arrhythmias in 185 endurance athletes and 81 non-athletic controls aged ≥40 years. Athletes were categorized as active lifelong (n = 144) or retired (n = 41) based on hours per week of high-intensity endurance exercise within 5 years of enrollment and validated by percentage of predicted maximal oxygen consumption (VO). Athletes with overt cardiomyopathies, channelopathies, pre-excitation, and/or myocardial infarction were excluded.
Lifelong athletes (median age = 55 years (interquartile range (IQR): 46-62), 79% male) were significantly fitter than retired athletes (median age = 66 years (IQR: 58-71), 95% male) and controls (median age = 53 years (IQR: 48-60), 96% male), respectively (predicted VO: 131% ± 18% vs. 99% ± 14% vs. 98% ± 15%, p < 0.001). Compared to controls, athletes in our cohort had a higher prevalence of atrial fibrillation ((AF): 32% vs. 0%, p < 0.001) and non-sustained ventricular tachycardia ((NSVT): 9% vs. 1%, p = 0.007). There was no difference in prevalence of any arrhythmia between lifelong and retired athletes. Lifelong athletes had larger ventricular volumes than retired athletes, who had ventricular volumes similar to controls (left ventricular end-diastolic volume indexed to body surface area (LVEDVi): 101 ± 20 mL/mvs. 86 ± 16 mL/mvs. 94 ± 18 mL/m, p < 0.001; right ventricular end-diastolic volume indexed to body surface area (RVEDVi): 117 ± 23 mL/mvs. 101 ± 19 mL/mvs. 100 ± 19 mL/m, p < 0.001). Athletes had more scar (40% vs. 18%, p = 0.002) and larger left atria (median volume = 45 mL/m (IQR: 38-52) vs. 31 mL/m (IQR: 25-38), p < 0.001) than controls, with no difference in atrial volumes and non-ischaemic scar between the athlete groups.
Master endurance athletes have a higher prevalence of AF and NSVT than non-athletic controls. Whereas ventricular remodeling tends to reverse with detraining, the propensity to arrhythmias persists regardless of whether they are actively exercising or retired.
耐力运动员中心律失常的患病率较高，但停训后这种风险是否持续尚不清楚。我们旨在评估终身和退役的中老年耐力运动员与非运动员对照组相比心律失常的患病率及其与心脏重塑的关系。
我们对观察性研究进行了横断面分析，这些研究使用超声心动图和心脏磁共振来详细了解心脏结构和功能，并使用动态心电图监测仪来识别185名年龄≥40岁的耐力运动员和81名非运动员对照组中的房性和室性心律失常。根据入组后5年内每周高强度耐力运动的时长，并通过预测最大耗氧量（VO）百分比进行验证，将运动员分为活跃的终身运动员（n = 144）或退役运动员（n = 41）。排除患有明显心肌病、通道病、预激综合征和/或心肌梗死的运动员。
终身运动员（中位年龄 = 55岁（四分位间距（IQR）：46 - 62岁），79%为男性）分别比退役运动员（中位年龄 = 66岁（IQR：58 - 71岁），95%为男性）和对照组（中位年龄 = 53岁（IQR：48 - 60岁），96%为男性）身体状况显著更好（预测VO：131% ± 18% vs. 99% ± 14% vs. 98% ± 15%，p < 0.001）。与对照组相比，我们队列中的运动员房颤（（AF）：32% vs. 0%，p < 0.001）和非持续性室性心动过速（（NSVT）：9% vs. 1%，p = 0.007）的患病率更高。终身运动员和退役运动员之间任何心律失常的患病率没有差异。终身运动员的心室容积大于退役运动员，退役运动员的心室容积与对照组相似（体表面积指数左心室舒张末期容积（LVEDVi）：101 ± 20 mL/m² vs. 86 ± 16 mL/m² vs. 94 ± 18 mL/m²，p < 0.001；体表面积指数右心室舒张末期容积（RVEDVi）：117 ± 23 mL/m² vs. 101 ± 19 mL/m² vs. 100 ± 19 mL/m²，p < 0.001）。与对照组相比，运动员有更多的瘢痕（40% vs. 18%，p = 0.002）和更大的左心房（中位容积 = 45 mL/m²（IQR：38 - 52）vs. 31 mL/m²（IQR：25 - 38），p < 0.001），运动员组之间心房容积和非缺血性瘢痕没有差异。
中老年耐力运动员房颤和NSVT的患病率高于非运动员对照组。虽然心室重塑倾向于随着停训而逆转，但无论他们是在积极运动还是已退役，心律失常的倾向都持续存在。
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