Atrial Remodeling, Autonomic Tone, and Lifetime Training Hours in Nonelite Athletes

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Aktywność fizyczna jest więc jedną z podstaw zapobiegania AF. Intensywne uprawianie sportu, zwłaszcza wytrzymałościowego (> 1500 h uprawiania sportów wytrzymałościowych) [899], zwiększa ryzyko AF w późniejszym okresie życia [900][901][902], co prawdopodobnie zależy od zmian napięcia układu autonomicznego, obciążenia objętościo-wego podczas wysiłku, przerostu przedsionka, a także jego powiększenia [903,904]. Prowadzi to do zależności między aktywnością fizyczną a zapadalnością na AF, która ma kształt krzywej U [214,898,902,905,906].…”

Can Intensive Exercise Harm the Heart?

“…Andersen et al 33 provided further valuable insights into the dose-response relationship by demonstrating that the risk of AF among cross-country skiers increased progressively with shorter race completion time and with the number of races completed, surrogates of training volume and duration, respectively. Potential mechanisms underpinning the excess in AF in athletes were elegantly investigated by Wilhelm et al 48 In a cohort of 70 randomly selected athletes entering a 10-mile running race, they demonstrated an increase in left atrial volume and P-wave prolongation as evidence of altered atrial substrate, as well as increased vagal tone and atrial ectopy as potential modulators and triggers of arrhythmias, respectively. These data concur nicely with preclinical data from the "marathon rat" model of Nattel, Mont et al showing promotion of AF in relation to an altered atrial substrate in the form of fibrosis, dilation, and vagal modulation.…”

Atrial remodelling is less pronounced in female endurance-trained athletes compared with that in male athletes

“…Cut off values for normal atrial remodeling are often presented normalized for body surface area (BSA) (8)(9)(10)(11)(12). This form of scaling may be useful in a normal population where atrial volumes vary with BSA (11).…”