Atrial fibrillation in middle-aged athletes: Impact on left atrial, ventricular and exercise performance

High volume endurance training may increase the risk of paroxysmal atrial fibrillation (AF) in middle-aged athletes. Limited data are available describing the cardiovascular phenotype of middle-aged endurance athletes, or the impact of AF on atrial function and exercise performance performed in sinus rhythm. The purpose of this study was to characterize LA phasic function at rest and during exercise in athletes with paroxysmal AF, and to determine its impact on exercise performance. Fifteen endurance trained males (EA) (56 +/- 5 years) without AF and 14 endurance trained males with paroxysmal AF (EA-AF) (55 +/- 8 years) underwent echocardiography during cycle-ergometry at light and moderate intensities. Resting LA maximal volumes were similar between EA and EA-AF (30 +/- 4 vs. 29 +/- 8 ml/m2, p = 0.50), and there were no differences in atrial electromechanical delay (AEMD). During moderate intensity exercise, EA-AF had reduced LA conduit (30 +/- 6 vs. 40 +/- 5 ml/m2, p = 0.002) LA booster volumes (17 +/- 5 vs. 21 +/- 4 ml/m2, p = 0.021), and reduced LV stroke volumes (100 +/- 12 vs. 117 +/- 16 ml, p = 0.007). These results demonstrate that exercise testing in athletes with AF unmasks evidence of adverse functional cardiac remodelling that may contribute to impaired exercise performance. It is unclear whether these functional alterations are the consequence of AF. Reductions in LA conduit volume, LA booster volume, and LV stroke volume during exercise may be helpful in clinical management and distinguishing pathologic from physiologic remodelling.