Exercise blood pressure response does not differentiate endurance athletes with paroxysmal atrial fibrillation

Atrial fibrillation (AF) is more prevalent among endurance athletes than in the general population. An exaggerated blood pressure (BP) response to exercise may contribute to atrial pressure excess and AF risk. We hypothesized that higher exercise BP would be associated with left atrial enlargement and AF prevalence in endurance athletes.

One hundred seventy-eight endurance-trained athletes, 89 with paroxysmal AF [median age 55 (IQR: 46-62 years), 92% male] and 89 age- and sex-matched athletes without AF, underwent resting echocardiography and cardiopulmonary exercise testing with automated BP measurements. Athletes with hypertension were excluded. Absolute BP responses [maximal systolic (SBPmax) and diastolic (DBPmax)] and BP responses relative to exercise workload (W) (SBP/W-slope, DBP/W-slope, and the SBPmax/W-ratio) were compared between groups. Both groups had similar years of training (P = 0.83) and peak oxygen uptake (P = 0.34). Athletes with AF had significantly larger left atrial volumes (LAVi; 48 mL/m2 vs. 42 mL/m2, P < 0.001), higher mean resting SBP (132 ± 13 mmHg vs. 127 ± 14 mmHg, P = 0.018), and DBP (76 ± 10 mmHg vs. 73 ± 11 mmHg, P = 0.090) compared with athletes without AF. There were no differences in SBPmax (221 ± 23 mmHg vs. 219 ± 26 mmHg, P = 0.54) or DBPmax (P = 0.84) in athletes with and without AF, respectively. In athletes with AF, SBP/W-slope was lower, whilst DBP/W-slope and SBPmax/W-ratio were similar to athletes without AF (P = 0.022, P = 0.63, and P = 0.82, respectively). Furthermore, there was no difference in exercise BP responses in those athletes with and without severely dilated LAVi.

In endurance athletes, neither AF nor left atrial dilation was associated with higher exercise BP responses.