Risk of arrhythmia in endurance racers

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  • Risk of arrhythmia in endurance racers
  • legolam
    Member

    I know there’s a few people on here who’ve suffered from AF or who have an interest in it, so I thought I’d share an interesting study I read today.

    The authors studied over 52,000 cross country skiers taking part in a long distance ski race in Sweden and showed that those who took part several times, or who had a faster finishing time, had a higher incidence of AF than other racers (or the general population). The conclusion is that being a trained endurance athlete may confer some risk of AF.

    Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study
    Published in the European Heart Journal, 2013

    Aims
    We aimed to investigate the association of number of completed races and finishing time with risk of arrhythmias among participants of Vasaloppet, a 90 km cross-country skiing event.

    Methods and results
    All the participants without cardiovascular disease who completed Vasaloppet during 1989–98 were followed through national registries until December 2005. Primary outcome was hospitalization for any arrhythmia and secondary outcomes were atrial fibrillation/flutter (AF), bradyarrhythmias, other supraventricular tachycardias (SVT), and ventricular tachycardia/ventricular fibrillation/cardiac arrest (VT/VF/CA). Among 52 755 participants, 919 experienced arrhythmia during follow-up. Adjusting for age, education, and occupational status, those who completed the highest number of races during the period had higher risk of any arrhythmias [hazard ratio (HR)1.30; 95% CI 1.08–1.58; for ?5 vs. 1 completed race], AF (HR 1.29; 95% CI 1.04–1.61), and bradyarrhythmias (HR 2.10; 95% CI 1.28–3.47). Those who had the fastest relative finishing time also had higher risk of any arrhythmias (HR 1.30; 95% CI 1.04–1.62; for 100–160% vs. >240% of winning time), AF (1.20; 95% CI 0.93–1.55), and bradyarrhythmias (HR 1.85; 95% CI 0.97–3.54). SVT or VT/VF/CA was not associated with finishing time or number of completed races.

    Conclusions
    Among male participants of a 90 km cross-country skiing event, a faster finishing time and a high number of completed races were associated with higher risk of arrhythmias. This was mainly driven by a higher incidence of AF and bradyarrhythmias. No association with SVT or VT/VF/CA was found.

    cynic-al
    Member

    30% higher risk? NOt huge?

    Premier Icon Drac
    Subscriber

    Interesting stuff but then again putting increased strain on your heart is likely to have some effect, wether that’s through being a fat lazy lazy slob or pushing yourself to the extreme.

    Fortunately something I never need to worry about.

    This is very similar to what my cardiologist told me. I’m 36, have been fit and healthy all my life, but I have also participated in endurance activities at high intensity for 20 years. I occasionally get arrhythmias now when pushing it hard on the bike, which are probably made worse by caffeine, tiredness, illness or alcohol consumption.

    Basically – he said it’s wise to do things in moderation – including the intensity and duration of any exercise, otherwise I run the risk of developing heart problems (permanent AF) in mid- to later life.

    I’m inclined to believe him. And his is a mantra I’m trying to stick to..

    TiRed
    Member

    Hardly compelling given the very large sample size. A 30% increase in hazard based on a 2% risk very small. Since the lower 95% CL’s are so close to unity, I wonder if they adjusted for multiplicty – make 20 comparisons and one tends to be “signiicant” just by chance.

    For reference, the odds ratio for lung cancer in Richard Doll’s first seminal smoking study was 3-fold and 9-fold in the second not 1.3. Now THAT’S an effect.

    Premier Icon ton
    Subscriber

    i would love to say i am a highly trained endurance athlete……sadly i am not, but i have cycled all my working life, also played rugby and done the odd triathlon and half marathon.
    my cardiologist told me that folk who did a load of endurance type sport were more open to AF than other folks.

    i reckon my perm AF is just down to being a superfit endurance god…………. 😀

    Premier Icon Drac
    Subscriber

    Yup that’ll be it Ton

    legolam
    Member

    It’s actually quite an interesting edition of the European Heart Journal this month (can’t believe I actually typed that!). Other highlights:

    Exercise related cardiac arrest has an incidence of 2.1 per 100,000 person-years (0.3/100,000 person-years in those <35) and has a significantly better survival rate than non-exercise related cardiac arrest (46 vs 17%)

    Mean age of cardiac arrest during exercise is 46, with a ratio of 20 males:1 female

    There are significant regional differences in the rate of bystander CPR after cardiac arrest during sport (ranged from 15-81%) with patients from the regions with high rates of bystander CPR having significantly better survival

    asterix
    Member

    oh great, as I am sitting here off the bike this week with chest pain that comes on while climbing fast and an odd fluttering feeling across my chest between rides. Had an ECG day before yesterday and more tests to come in next two weeks:-( Any (sensible) advice on whether I should be riding at all (e.g., zones 1-2) / drinking coffee at all over xmas?

    crazy legs suggested I read this but my athletic status is roughly “enthusiastic lazy bastard”. I can certainly speak in favour of “bystander CPR” (otherwise I’d be very dead) 🙂

    brakes
    Member

    is this skewed statistics – the doctors of endurance skiers claiming their patients have arrhythmia so they can legitimately give them EPO?

    Premier Icon paul4stones
    Subscriber

    We were talking about this the other night after a run (we being me, dentist; friend 1, GP; friend 2, medically and dentally qualified working in the local cardiac unit). Might it be that a number of people are in AF without realising because they are inactive and for whom it is normal to be out of breath walking up the stairs or down the road? Just easier to pick up in those who exercise.

    legolam
    Member

    The study linked above did mention that as a possible limitation of the study – athletes are more likely to be aware of their body and therefore more likely to seek medical attention when symptoms occur, therefore there may be some under-reporting in the general population.

    I’m not sure there is any benefit to being diagnosed with an arrhythmia with respect to EPO or other doping – the mainstay of treatment for the majority of arrhythmias is beta blockers, which are much more likely to slow you down and give you LESS energy.

    Asterix – it’s tricky to give advice over the Internet. Take the advice of your doctor (but I suspect they would say to take it easy on all fronts until you know what you’re dealing with)

    Premier Icon ton
    Subscriber

    one nice bit of news for anyone in perm AF on here,
    once you are in AF, it is nigh on impossible for the quacks to get you back in proper rythm.

    chin up eh….. 😀

    milky1980
    Member

    Got diagnosed with permanent AF back in the summer, was told to take it easy on the bike.

    48 hours later I was in the Alps making copious use of the charlifts 😆

    Premier Icon ton
    Subscriber

    milky…..how are you when riding up tho?

    milky1980
    Member

    It hurts less to push hard up them than to bimble up spinning slowly bizarrely!!

    Premier Icon ton
    Subscriber

    any procedures planned?

    milky1980
    Member

    Err nope. You’ve got me worried now though 😕

    granny
    Member

    I had a couple of hospital stays in September with persistent AF. Few years back I was pretty fit and doing a lot of rock climbing, which I consider caused the problem, so it’s interesting reading this post. I know that triggers include food and excercise, but I can’t work out any consistency in precise triggers. My cardiologist didn’t seem over-concerned at me continuing excercise. To be honest, there’s no danger of me overdoing it as my muscles burn out, and I struggle to get a heart rate above 100 BPM during excercise. The consultant seems optimistic that drugs and procedures will get it back under control. We’ll see.

    butcher
    Member

    This concerns me a bit if I’m honest. Started having palpitations and flutters in recent years having never experienced them before. I even found a correlation between them and strenuous exercise. Cutting down alcohol ( particularly red wine and whisky 🙁 ) has helped a lot. But then my dad has also been recently diagnosed with occasional arrhythmia, having had the same as me for years. So I guess that is what’s coming to me.

    I’m no endurance ‘athlete’ by any means. But I do like to keep fit, and I like a good long ride. I like to test my endurance. And I don’t really want to stop doing that.

    So I’m hoping that medical science will have advanced a bit by the time it catches up with me 😐

    I’m late forties and had an ablation to fix AF earlier this year. I mentioned that I’d started doing a lot of high intensity intervals but my physiologist (who’s incidentally a keen roadie) didn’t think this was necessarily linked and if I recall correctly thought that there are many reasons why you can develop AF so you couldn’t rule out any other cause, though it did get to the stage that moderate exertion (on my bike) would set it off.

    Premier Icon ton
    Subscriber

    tasteslikeburning, did the ablation sort you out?

    I have had 2 failed ablations, now waiting for the chest opening for something else trying.

    hh45
    Member

    I find interval type activities, xc races and hill climb trials make my chest / heart really hurt and I do wonder whether its really as good for me as it used to be. Family history of heart problems on M’s side and i am now mid nearly 46 – the mean age! Enduros and sportives don’t hurt nearly as much. Neck pain, stiffness and so on yes, but heart / chest not so.

    This article is not comparing slobs to active people, rather they are effectively comparing moderately-active people to extremely active ones.

    Adjusting for age, education, and occupational status, those who completed the highest number of races during the period had higher risk of any arrhythmias

    The athletic heart is a fairly well-established phenomenon, and in fact the relative risk of AF in athletes is much higher than 1.3, ranging from [googles] 2.87 – 8.8*. In this study they are essentially suggesting that athleticism is a dose-related risk factor for arrhythmia.

    Exercise can also act as a trigger for an exacerbation of AF which is a bit of a different phenomenon.

    Thanks for posting, interesting 🙂

    *Calvo et al., “Atrial Fibrillation and Atrial Flutter in Athletes.”

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