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Prevalence and clinical significance of left atrial remodeling in competitive athletes

Antonio Pelliccia1, Barry J Maron, Fernando M Di Paolo

  • 1National Institute of Sports Medicine, Italian National Olympic Committee, Rome, Italy. ant.pelliccia@libero.it

Journal of the American College of Cardiology
|August 16, 2005
PubMed

Insights

In competitive athletes, enlarged left atrial (LA) size is common and often a normal adaptation, not typically leading to arrhythmias. Upper limits of 45mm in women and 50mm in men help differentiate this from disease.

Area of Science:

  • Cardiology
  • Sports Medicine
  • Physiology

Background:

  • The clinical significance and arrhythmic consequences of left atrial enlargement in athletes remain unclear.
  • Understanding the prevalence and impact of left atrial size is crucial for differentiating athlete's heart from structural heart disease.

Purpose of the Study:

  • To assess the distribution and clinical significance of left atrial size in athletes.
  • To differentiate physiological left atrial remodeling in athletes from pathological cardiac conditions.
  • To determine the prevalence of supraventricular arrhythmias in athletes with varying left atrial dimensions.

Main Methods:

  • Evaluated left atrial (LA) dimensions and supraventricular tachyarrhythmias in 1,777 competitive athletes across 38 sports.
  • Excluded athletes with known structural cardiovascular disease.
  • Utilized multivariate regression to identify factors associated with LA enlargement.

Main Results:

  • Left atrial enlargement (transverse dimension ≥ 40 mm) was observed in 20% of athletes, with marked dilation (≥ 45 mm) in 2%.
  • Supraventricular tachyarrhythmias, including atrial fibrillation, were uncommon (<1%) and occurred similarly in athletes with and without LA enlargement.
  • LA enlargement was primarily associated with left ventricular cavity enlargement and participation in dynamic sports, minimally influenced by body size.

Conclusions:

  • Enlarged left atrial dimension (≥ 40 mm) is relatively common in highly trained athletes and can be considered physiological remodeling ('athlete's heart') up to 45 mm in women and 50 mm in men.
  • Supraventricular tachyarrhythmias are infrequent in athletes, irrespective of left atrial size, and comparable to the general population.
  • Left atrial remodeling in athletes represents a physiological adaptation to training, generally without adverse clinical outcomes.
Abstract

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