Exercise and Atrial Fibrillation: Prevention or Causation?

Elliott, Adrian D.; Linz, Dominik; Verdicchio, Christian V.; Sanders, Prashanthan

doi:10.1016/j.hlc.2018.04.296

Cited by 46 publications

(48 citation statements)

References 59 publications

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“…43 It is proposed that human athletes undertaking higher volumes and intensity of exercise are predisposed to development of AF. 23,24,44 In rodents, myocardial inflammation and fibrosis after exercise training is considered to be a substrate for arrhythmia. [20][21][22] Several studies have reported inflammatory and fibrotic changes in the myocardium of racehorses involving the atria, conduction system and ventricles 3,[45][46][47][48][49] Age is a risk factor for AF in racehorses, 10,12 supporting the effect of volume of training and cardiac remodeling in the promotion of AF in this species.…”

Section: Discussionmentioning

confidence: 99%

“…Atrioventricular regurgitation occurs concurrently 43 . It is proposed that human athletes undertaking higher volumes and intensity of exercise are predisposed to development of AF 23,24,44 . In rodents, myocardial inflammation and fibrosis after exercise training is considered to be a substrate for arrhythmia.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22] In human athletes, the risk for AF is related to cumulative volume of exercise training. 23,24 Although not yet evaluated in horses, it is evident that cardiac remodeling in athletes is not entirely benign and could parallel pathological heart disease, increasing risk for arrhythmias and SCD. 23,25 Persistent AF can be converted to sinus rhythm using either transvenous electrocardioversion or pharmacologic intervention, most commonly using quinidine sulfate, and generally carries an excellent prognosis for future athleticism.…”

Section: Introductionmentioning

confidence: 99%

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Incidence, recurrence, and outcome of postrace atrial fibrillation in Thoroughbred horses

Nath

Elliott

Weir

et al. 2021

Veterinary Internal Medicne

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Background: Atrial fibrillation (AF) impacts performance and horse and jockey safety. Understanding the outcomes of AF identified postrace will better inform regulatory policy. Hypothesis/Objectives: To investigate the outcomes after episodes of AF identified postrace and determine whether affected horses are at increased risk of additional episodes compared to the general racing population. Animals: Total of 4684 Thoroughbred racehorses. Methods: Race records for Thoroughbred horses racing in Hong Kong from 2007 to 2017 were reviewed. Horses that performed below expectation were examined by cardiac auscultation and ECG. Incidence and recurrence of AF were compared between horses with and without a history of AF and between horses with paroxysmal and persistent episodes using Fisher's exact test. Results: There were 96 135 race starts during the study. Atrial fibrillation was identified in 4.9% of horses, with an overall incidence of 2.7 episodes per 1000 starts. The incidence of AF in horses after any previous episode (12.8 per 1000 starts) was higher than for horses with no previous episode (2.4 per 1000 starts; odds ratio [OR], 5.3; 95% confidence interval [CI], 3.8-7.6). Recurrence was seen in 64% of horses previously treated for persistent AF, which was higher than recurrence in horses with paroxysmal AF (23%; OR, 5.9; 95% CI, 1.6-21.2). Median duration between episodes was 343 days (range, 34-1065). Conclusions and Clinical Importance: Thoroughbreds are at increased risk of recurrent AF after both paroxysmal and persistent episodes, but the duration of time between episodes varies widely. These findings support a substantial burden of AF among individual Thoroughbred racehorses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence, recurrence, and outcome of postrace atrial fibrillation in Thoroughbred horses

Nath

Elliott

Weir

et al. 2021

Veterinary Internal Medicne

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“…However, the results of this review may be considered preliminary given the relatively small number of studies available for the analysis of LA structure. Atrial morphology in older endurance athletes, relative to normal controls, requires further study and is of clinical interest given the ongoing debate concerning the potential interaction between atrial structural remodelling and the known larger incidence of atrial fibrillation in endurance athletes [65].…”

Section: Discussionmentioning

confidence: 99%

Aerobic Training Protects Cardiac Function During Advancing Age: A Meta-Analysis of Four Decades of Controlled Studies

et al. 2018

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Background In contrast to younger athletes, there is comparatively less literature examining cardiac structure and function in older athletes. However, a progressive accumulation of studies during the past four decades offers a body of literature worthy of systematic scrutiny. Objectives We conducted a systematic review, meta-analysis and meta-regression of controlled echocardiography studies comparing left ventricular (LV) structure and function in aerobically trained older athletes (> 45 years) with age-matched untrained controls, in addition to investigating the influence of chronological age. Methods Electronic databases were searched from inception to January 2018 before conducting a random-effects meta-analysis to calculate pooled differences in means, effect size and 95% confidence intervals (CIs). Study heterogeneity was reported using Cochran’s Q and I 2 statistic. Results Overall, 32 studies (644 athletes; 582 controls) were included. Athletes had greater LV end-diastolic diameter (3.65 mm, 95% CI 2.66–4.64), interventricular septal thickness (1.23 mm, 95% CI 0.85–1.60), posterior wall thickness (1.20 mm, 95% CI 0.83–1.56), LV mass (72 g, 95% CI 46–98), LV mass index (28.17 g·m 2 , 95% CI 19.84–36.49) and stroke volume (13.59 mL, 95% CI 7.20–19.98) (all p < 0.01). Athletes had superior global diastolic function [ratio of early ( E ) to late ( A ) mitral inflow velocity ( E / A ) 0.18, 95% CI 0.13–0.24, p < 0.01; ratio of early ( e ′) to late ( a ′) diastolic annular tissue velocity ( e ′/ a ′) 0.23, 95% CI 0.06–0.40, p = 0.01], lower A (−8.20 cm·s −1 , 95% CI −11.90 to −4.51, p < 0.01) and a ′ (−0.72 cm·s −1 , 95% CI −1.31 to −0.12, p = 0.02), and more rapid e ′ (0.96 cm·s −1 , 95% CI 0.05–1.86, p = 0.04). Meta-regression for chronological age identified that athlete–control differences, in the main, are maintained during advancing age. Conclusions Athletic older men have larger cardiac dimensions and enjoy more favourable cardiac function than healthy, non-athletic counterparts. Notably, the athlete groups maintain these effects during chronological ageing. Electronic supplementary material The online version of this article (10.1007/s40279-018-1004-3) contains supplementary material, which is available to authorized use...

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“…These results are potentially consistent with previous studies, which demonstrate that extreme levels of PA increase the risk of AF. 10…”

Section: Mandeep R Mehra MDmentioning

confidence: 99%

Is There an “Asymptote of Gain” Beyond Which Further Increases in Cardiorespiratory Fitness Convey No Additional Benefits on Mortality and Atrial Fibrillation?

Jae

Kurl

Kim

et al. 2019

Mayo Clinic Proceedings

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Exercise and Atrial Fibrillation: Prevention or Causation?

Cited by 46 publications

References 59 publications

Incidence, recurrence, and outcome of postrace atrial fibrillation in Thoroughbred horses

Incidence, recurrence, and outcome of postrace atrial fibrillation in Thoroughbred horses

Aerobic Training Protects Cardiac Function During Advancing Age: A Meta-Analysis of Four Decades of Controlled Studies

Is There an “Asymptote of Gain” Beyond Which Further Increases in Cardiorespiratory Fitness Convey No Additional Benefits on Mortality and Atrial Fibrillation?

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