Using Atrial Cardiomyopathy Metrics to Characterize Atrial Fibrillation in Endurance Athletes

Area of Science:

• Cardiology
• Sports Medicine
• Genetics

Background:

• Atrial fibrillation (AF) is more common in endurance athletes (EAs) than the general population.
• Identifying EAs at highest risk for AF remains a clinical challenge.

Purpose of the Study:

• To develop a risk assessment tool for AF in EAs.
• To identify associations between AF and markers of atrial cardiomyopathy in EAs.

Main Methods:

• Comprehensive phenotyping of EAs and nonathletic controls (NAs) including exercise testing, echocardiography, ECG, Holter monitoring for premature atrial contractions (PACs), and genetic analysis.
• Development of an AF probability model using logistic regression based on atrial cardiomyopathy markers.

Main Results:

• EAs exhibited larger left atrial (LA) volumes compared to NAs.
• EAs with AF showed significantly larger LA volumes, reduced LA strain, prolonged P-wave duration, abnormal P-wave terminal force, and increased PACs compared to EAs without AF.
• The developed risk model demonstrated excellent discrimination (AUC = 0.84), with AF prevalence increasing from 4% to 86% across risk categories.

Conclusions:

• Atrial cardiomyopathy markers are associated with high AF prevalence in EAs.
• A quantitative AF risk identification tool shows promise for targeted interventions in EAs.
• This tool may help prevent AF and thromboembolic complications in this population.