1
|
Di Gioia G, Vespasiano F, Maestrini V, Monosilio S, Segreti A, Lemme E, Squeo MR, Serdoz A, Pelliccia A. Determinants of supraventricular extra beats in elite athletes practicing different sporting disciplines. J Cardiovasc Med (Hagerstown) 2024; 25:731-739. [PMID: 39225077 DOI: 10.2459/jcm.0000000000001657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Supraventricular extra beats (SVEB) are frequently observed in athletes but data on significance, prognostic role and correlation with cardiac remodeling are contrasting. It is uncertain whether SVEB may indicate the development of more complex arrhythmias and the need for closer monitoring is undetermined. The aim was to assess the prevalence and clinical significance of BESV in Olympic athletes of different sporting disciplines, evaluating potential correlations with cardiac remodeling and clinical features. METHODS We enrolled athletes who participated at 2012-2022 Olympic Games, submitted to physical examination, blood tests, echocardiography and exercise tests, categorized into power, skills, endurance and mixed disciplines. RESULTS We studied 1492 elite athletes: 56% male individuals, mean age 25.8 ± 5.1 years; 29.5% practiced power, 12.3% skills, 21% endurance and 37.2% mixed disciplines. At exercise-stress tests, 6.2% had SVEB, mostly single beats. SVEB were not influenced by anthropometrics or blood test results. They were more common in male individuals (77.4 vs. 54.6%, P < 0.0001) and older athletes (27.1 ± 5.7 vs. 25.7 ± 5.1, P = 0.01). In male athletes with SVEB, higher left atrial volumes were observed (24.2 ± 7.3 vs. 22.2 ± 7.1 ml/m2, P = 0.03). No differences were found in terms of sporting discipline: despite larger left atrial dimensions in aerobic disciplines, SVEB rates were similar in different sporting disciplines (6.1% endurance, 6.3% mixed, 5.2% power and 8.7% skills; P = 0.435). CONCLUSION SVEB were more common in older, male athletes and associated with higher left atrial volume (especially in male individuals) regardless of sport practiced. Athletes with greater left atrial volume and SVEB are supposed to have higher risk, in middle age, of developing more complex arrhythmias.
Collapse
Affiliation(s)
- Giuseppe Di Gioia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli
- Department of Movement, Human and Health Sciences, University of Rome 'Foro Italico', Piazza Lauro De Bosis
| | - Francesca Vespasiano
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo
| | - Viviana Maestrini
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro, Rome, Italy
| | - Sara Monosilio
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro, Rome, Italy
| | - Andrea Segreti
- Department of Movement, Human and Health Sciences, University of Rome 'Foro Italico', Piazza Lauro De Bosis
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo
| | - Erika Lemme
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli
| | - Maria Rosaria Squeo
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli
| | - Andrea Serdoz
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli
| | - Antonio Pelliccia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli
| |
Collapse
|
2
|
Akkad G, Meller L, Allen M, Wilson K, Vitale K. Golf Swing-Induced Pacemaker Atrial Noise and Extraction: A Case Report and Literature Review. Cureus 2024; 16:e63409. [PMID: 39070418 PMCID: PMC11283872 DOI: 10.7759/cureus.63409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Implantable medical devices, such as pacemakers, have significantly improved the quality of life for patients with cardiac conditions, allowing them to maintain active lifestyles. Nonetheless, these devices can present unique challenges when interacting with the wearer's physical activities, potentially leading to unforeseen complications. Here, we present a case of an 81-year-old male golfer, with a history of atrial fibrillation, congestive heart failure, and sick sinus syndrome, who experienced atrial lead noise from his pacemaker, exclusively triggered by his golf swing. This incident, which led to multiple interventions including lead extraction, reimplantation, and eventually a switch to a unipolar lead configuration, represents the first documented case of its kind. It underscores the intricate relationship between the biomechanical forces of certain sports and the functionality of implanted cardiac devices. Through detailed electrophysiology testing, this case demonstrates how specific movements inherent to the patient's golf swing could induce micro-damage to the pacemaker leads, causing noise and malfunction. The findings from this case emphasize the need for healthcare providers to perform sport-specific biomechanical evaluations and create tailored rehabilitation strategies that consider the unique physical demands placed on patients with implanted devices. This approach is important not only for diagnosing and managing similar cases but also for advancing our understanding of how to best support the active lifestyles of patients with implanted cardiac devices, ensuring their safety and longevity.
Collapse
Affiliation(s)
- Ghassan Akkad
- Department of Orthopedic Surgery, Division of Sports Medicine, University of California San Diego School of Medicine, La Jolla, USA
| | - Leo Meller
- Department of Orthopedic Surgery, Division of Sports Medicine, University of California San Diego School of Medicine, La Jolla, USA
| | - Matthew Allen
- Department of Orthopedic Surgery, Division of Sports Medicine, University of California San Diego School of Medicine, La Jolla, USA
| | - Katherine Wilson
- Department of Orthopedic Surgery, Division of Sports Medicine, University of California San Diego School of Medicine, La Jolla, USA
| | - Kenneth Vitale
- Department of Orthopedic Surgery, Division of Sports Medicine, University of California San Diego School of Medicine, La Jolla, USA
| |
Collapse
|
3
|
Lampert R, Chung EH, Ackerman MJ, Arroyo AR, Darden D, Deo R, Dolan J, Etheridge SP, Gray BR, Harmon KG, James CA, Kim JH, Krahn AD, La Gerche A, Link MS, MacIntyre C, Mont L, Salerno JC, Shah MJ. 2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play. Heart Rhythm 2024:S1547-5271(24)02560-8. [PMID: 38763377 DOI: 10.1016/j.hrthm.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.
Collapse
Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut
| | - Eugene H Chung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Rajat Deo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joe Dolan
- University of Utah, Salt Lake City, Utah
| | | | - Belinda R Gray
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jack C Salerno
- University of Washington School of Medicine, Seattle, Washington
| | - Maully J Shah
- Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
4
|
Abstract
Exercise stress testing (EST) is indicated for diagnostic and prognostic purposes in the general population. In athletes, stress tests can also be useful to inform the risk of high-intensity training and competition, to assess athletic conditioning, and to refine training regimens. Many specific indications for EST are unique to athletes. Treadmill and cycle ergometer protocols each have their strengths and disadvantages; extensive protocol customization may be necessary to answer the clinical question at hand. A comprehensive understanding of the available tools for exercise testing, their strengths, and their limitations is crucial to providing cardiovascular care to athletic individuals.
Collapse
Affiliation(s)
- Gary Parizher
- Sports Cardiology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael S Emery
- Sports Cardiology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
5
|
Sciarra L, Cavarretta E, Siciliani S, Sette A, Scarà A, Grieco D, DE Ruvo E, Palamà Z, Nesti M, Romano S, Penco M, Pelliccia A, Calò L. Managing athletes with palpitations of unknown origin with an external loop recorder: a cohort study. J Sports Med Phys Fitness 2021; 62:554-559. [PMID: 34498825 DOI: 10.23736/s0022-4707.21.12831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Palpitations in athletes are usually benign, but the presence of major cardiac arrhythmias should be ruled out despite the infrequent appraisal of symptoms. External loop recorders (ELR) are promising to identify arrhythmias in these circumstances, but experiences in athletes are lacking. We aimed to investigate the feasibility and diagnostic yield of an ELR in athletes with unexplained palpitations in a cohort study. METHODS 122 consecutive subjects (61 athletes and 61 sedentary controls) with sporadic palpitations and inconclusive diagnosis were enrolled and equipped with an ELR. Findings were categorized as major and minor arrhythmic findings, non-arrhythmic findings or negative monitoring. RESULTS Long-term ELR monitoring was feasible in all subjects, with median duration of 12 (11; 15) days. Major arrhythmic events during palpitations were found in 9 (14.8%) athletes: 7 experienced sustained paroxysmal supraventricular tachycardia, and 2 had non sustained ventricular tachycardia. Minor arrhythmic events (premature supraventricular or ventricular beats) were observed in 13 athletes (21.3%). Non-arrhythmic findings (i.e., sinus rhythm or sinus tachycardia) were recorded in 28 athletes (45.9%), whereas 11 (18%) had negative monitoring. In the sedentary group, arrhythmic events were similar for types and frequency to athletes. The diagnostic yield of loop monitoring was 82.8% in the overall population and 82.0% in the athlete's group. CONCLUSIONS In the management of an athlete symptomatic with unexplained palpitations after 24-hour ECG monitoring and stress test, ELR is an efficient tool to identify major arrhythmic events, which can be present in up to 10% of symptomatic athletes during practice and competition.
Collapse
Affiliation(s)
- Luigi Sciarra
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and iotechnologies, Sapienza University of Rome, Latina, Italy - .,Mediterranea Cardiocentro, Napoli, Italy
| | | | | | - Antonio Scarà
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | | | | | | | | | - Silvio Romano
- Department of Cardiology, L'Aquila University, L'Aquila, Italy
| | - Maria Penco
- Department of Cardiology, L'Aquila University, L'Aquila, Italy
| | | | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| |
Collapse
|
6
|
Lee SH, Ryu S, Lee JY, Seo DC, Kim BJ, Sung KC. Association between self-reported physical activity and incident atrial fibrillation in a young Korean population. Sci Rep 2019; 9:4222. [PMID: 30862894 PMCID: PMC6414613 DOI: 10.1038/s41598-019-40744-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/19/2019] [Indexed: 11/16/2022] Open
Abstract
The association between physical activity (PA) and atrial fibrillation (AF) remains unclear. We thus investigated association of PA with the development of AF. Type and duration data for PA were acquired from 211,992 AF-free individuals using the validated Korean version of the International Physical Activity Questionnaire Short From between March 2002 and December 2014. Individuals were divided into four groups according to self-reported PA level and previous international PA guidelines: no PA with a sedentary lifestyle, insufficient PA, sufficient PA, and health-enhancing PA. AF was diagnosed by annual 12-lead electrocardiogram. During a median follow-up of 5.6 years, AF occurred in 304 participants (annual AF incidence rate 2.5/10,000 person-years). After adjusting for age and sex, PA level was not associated with AF incidence (P for trend = 0.26). The multivariable-adjusted hazard ratios (95% confidence interval) for incidental AF was 1.00 (0.74–1.37) for the insufficient PA group, 1.34 (0.91–1.97) for the sufficient PA group, and 1.27 (0.72–2.23) for the health-enhancing PA group compared with the no PA group (P for trend = 0.18). Thus, our study does not support an association between the risk of AF and PA level in a young Korean population.
Collapse
Affiliation(s)
- Sung Ho Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seungho Ryu
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae Chul Seo
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung Jin Kim
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
7
|
Albrecht M, Koolhaas CM, Schoufour JD, van Rooij FJA, Kavousi M, Ikram MA, Franco OH. Physical activity types and atrial fibrillation risk in the middle-aged and elderly: The Rotterdam Study. Eur J Prev Cardiol 2018; 25:1316-1323. [PMID: 29863405 PMCID: PMC6097116 DOI: 10.1177/2047487318780031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background The association between physical activity and atrial fibrillation remains
controversial. Physical activity has been associated with a higher and lower
atrial fibrillation risk. These inconsistent results might be related to the
type of physical activity. We aimed to investigate the association of total
and types of physical activity, including walking, cycling, domestic work,
gardening and sports, with atrial fibrillation. Design Prospective cohort study. Methods Our study was performed in the Rotterdam Study, a prospective
population-based cohort. We included 7018 participants aged 55 years and
older with information on physical activity between 1997–2001. Cox
proportional hazards models were used to examine the association of physical
activity with atrial fibrillation risk. Models were adjusted for biological
and behavioural risk factors and the remaining physical activity types.
Physical activity was categorised in tertiles and the low group was used as
reference. Results During 16.8 years of follow-up (median: 12.3 years, interquartile range:
8.7–15.9 years), 800 atrial fibrillation events occurred (11.4% of the study
population). We observed no association between total physical activity and
atrial fibrillation risk in any model. After adjustment for confounders, the
hazard ratio and 95% confidence interval for the high physical activity
category compared to the low physical activity category was: 0.71
(0.80–1.14) for total physical activity. We did not observe a significant
association between any of the physical activity types with atrial
fibrillation risk. Conclusion Our results suggest that physical activity is not associated with higher or
lower risk of atrial fibrillation in older adults. Neither total physical
activity nor any of the included physical activity types was associated with
atrial fibrillation risk.
Collapse
Affiliation(s)
- Marijn Albrecht
- Department of Epidemiology, Erasmus MC –
University Medical Center Rotterdam, The Netherlands
| | - Chantal M Koolhaas
- Department of Epidemiology, Erasmus MC –
University Medical Center Rotterdam, The Netherlands
- Chantal M Koolhaas, Department of
Epidemiology – Erasmus University Medical Center, PO Box 2040, 3000 CA
Rotterdam, The Netherlands.
| | - Josje D Schoufour
- Department of Epidemiology, Erasmus MC –
University Medical Center Rotterdam, The Netherlands
| | - Frank JA van Rooij
- Department of Epidemiology, Erasmus MC –
University Medical Center Rotterdam, The Netherlands
| | - M Kavousi
- Department of Epidemiology, Erasmus MC –
University Medical Center Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC –
University Medical Center Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC –
University Medical Center Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC –
University Medical Center Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC –
University Medical Center Rotterdam, The Netherlands
| |
Collapse
|
8
|
Magalhães-Ribeiro C, Freitas J. Syncope in the young athlete: Assessment of prognosis in subjects with hypertrophic cardiomyopathy. Rev Port Cardiol 2016; 35:433-40. [DOI: 10.1016/j.repc.2016.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/14/2016] [Accepted: 04/20/2016] [Indexed: 12/13/2022] Open
|
9
|
Magalhães-Ribeiro C, Freitas J. Syncope in the young athlete: Assessment of prognosis in subjects with hypertrophic cardiomyopathy. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
10
|
Navas de Solis C. Exercising arrhythmias and sudden cardiac death in horses: Review of the literature and comparative aspects. Equine Vet J 2016; 48:406-13. [DOI: 10.1111/evj.12580] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 03/28/2016] [Indexed: 12/25/2022]
Affiliation(s)
- C. Navas de Solis
- Swiss Institute of Equine Medicine; Faculty of Veterinary Science (Vetsuisse); University of Bern and Agroscope; Bern Switzerland
- Texas Veterinary Medical Center; Texas A&M University; College Station USA
| |
Collapse
|
11
|
D'Ascenzi F, Zorzi A, Alvino F, Bonifazi M, Corrado D, Mondillo S. The prevalence and clinical significance of premature ventricular beats in the athlete. Scand J Med Sci Sports 2016; 27:140-151. [DOI: 10.1111/sms.12679] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- F. D'Ascenzi
- Department of Medical Biotechnologies; Division of Cardiology; University of Siena; Siena Italy
| | - A. Zorzi
- Department of Cardiac, Thoracic, and Vascular Sciences; University of Padova; Padova Italy
| | - F. Alvino
- Department of Medical Biotechnologies; Division of Cardiology; University of Siena; Siena Italy
| | - M. Bonifazi
- Department of Medicine, Surgery, and NeuroScience; University of Siena; Siena Italy
| | - D. Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences; University of Padova; Padova Italy
| | - S. Mondillo
- Department of Medical Biotechnologies; Division of Cardiology; University of Siena; Siena Italy
| |
Collapse
|
12
|
Schilling JM, Horikawa YT, Zemljic-Harpf AE, Vincent KP, Tyan L, Yu JK, McCulloch AD, Balijepalli RC, Patel HH, Roth DM. Electrophysiology and metabolism of caveolin-3-overexpressing mice. Basic Res Cardiol 2016; 111:28. [PMID: 27023865 DOI: 10.1007/s00395-016-0542-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
Abstract
Caveolin-3 (Cav-3) plays a critical role in organizing signaling molecules and ion channels involved in cardiac conduction and metabolism. Mutations in Cav-3 are implicated in cardiac conduction abnormalities and myopathies. Additionally, cardiac-specific overexpression of Cav-3 (Cav-3 OE) is protective against ischemic and hypertensive injury, suggesting a potential role for Cav-3 in basal cardiac electrophysiology and metabolism involved in stress adaptation. We hypothesized that overexpression of Cav-3 may alter baseline cardiac conduction and metabolism. We examined: (1) ECG telemetry recordings at baseline and during pharmacological interventions, (2) ion channels involved in cardiac conduction with immunoblotting and computational modeling, and (3) baseline metabolism in Cav-3 OE and transgene-negative littermate control mice. Cav-3 OE mice had decreased heart rates, prolonged PR intervals, and shortened QTc intervals with no difference in activity compared to control mice. Dobutamine or propranolol did not cause significant changes between experimental groups in maximal (dobutamine) or minimal (propranolol) heart rate. Cav-3 OE mice had an overall lower chronotropic response to atropine. The expression of Kv1.4 and Kv4.3 channels, Nav1.5 channels, and connexin 43 were increased in Cav-3 OE mice. A computational model integrating the immunoblotting results indicated shortened action potential duration in Cav-3 OE mice linking the change in channel expression to the observed electrophysiology phenotype. Metabolic profiling showed no gross differences in VO2, VCO2, respiratory exchange ratio, heat generation, and feeding or drinking. In conclusion, Cav-3 OE mice have changes in ECG intervals, heart rates, and cardiac ion channel expression. These findings give novel mechanistic insights into previously reported Cav-3 dependent cardioprotection.
Collapse
Affiliation(s)
- Jan M Schilling
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Yousuke T Horikawa
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Department of Pediatrics, Sharp Rees-Stealy Medical Group, San Diego, CA, USA
| | - Alice E Zemljic-Harpf
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Kevin P Vincent
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Leonid Tyan
- Department of Medicine, Cellular and Molecular Arrhythmia Research Program, University of Wisconsin, Madison, WI, USA
| | - Judith K Yu
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.,Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ravi C Balijepalli
- Department of Medicine, Cellular and Molecular Arrhythmia Research Program, University of Wisconsin, Madison, WI, USA
| | - Hemal H Patel
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - David M Roth
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA. .,Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.
| |
Collapse
|
13
|
Jansen MJ, Burke FW. Athletes and Arrhythmias. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2015.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
14
|
Zipes DP, Link MS, Ackerman MJ, Kovacs RJ, Myerburg RJ, Estes NM. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 9: Arrhythmias and Conduction Defects. Circulation 2015; 132:e315-25. [DOI: 10.1161/cir.0000000000000245] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
15
|
Zipes DP, Link MS, Ackerman MJ, Kovacs RJ, Myerburg RJ, Estes NM. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 9: Arrhythmias and Conduction Defects. J Am Coll Cardiol 2015; 66:2412-2423. [DOI: 10.1016/j.jacc.2015.09.041] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
16
|
Iskandar A, Mujtaba MT, Thompson PD. Left Atrium Size in Elite Athletes. JACC Cardiovasc Imaging 2015; 8:753-62. [PMID: 26093921 DOI: 10.1016/j.jcmg.2014.12.032] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/04/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The goal of this study was to perform a meta-analysis of the published literature to investigate the relationship of high levels of exercise training to left atrial (LA) size. BACKGROUND The "athlete's heart" is a series of cardiac adaptations to systematic exercise training and may include LA enlargement. METHODS We conducted a systematic review of English-language studies in MEDLINE and Scopus from inception through April 29, 2014, that reported LA size in elite athletes. RESULTS A total of 54 studies comprising 7,189 elite athletes and 1,375 controls were included. Forty-eight of the 54 studies reported absolute LA diameter in 7,018 athletes and 1,044 controls. Nine of the 54 studies (including 992 athletes and 426 controls) presented LA volume corrected for body surface area. The adjusted weighted mean LA diameter was 4.1 mm greater in athletes overall compared with sedentary controls (p < 0.0001), and LA volume index was 7.0 ml/m(2) greater in athletes than controls (p < 0.01). Compared with controls, LA diameter was 4.6 mm greater in endurance-trained athletes (p < 0.0001), 2.9 mm greater in strength-trained athletes (p < 0.03), 3.5 mm greater in combined strength- and endurance-trained athletes (p < 0.0001), and 4.2 mm greater in athletes with unspecified training (p < 0.02). CONCLUSIONS To our knowledge, this is the largest compilation of studies documenting that elite athletes have larger LA dimensions compared with controls when evaluated by either LA diameter or LA volume corrected for body surface area. The largest average LA diameters were reported in endurance athletes. Physicians evaluating athletes should be aware that the LA is increased in both strength- and endurance-trained elite athletes.
Collapse
Affiliation(s)
- Aline Iskandar
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Paul D Thompson
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut; Division of Cardiology, Hartford Hospital, Hartford, Connecticut.
| |
Collapse
|
17
|
Wernhart S, Halle M. Atrial fibrillation and long-term sports practice: epidemiology and mechanisms. Clin Res Cardiol 2014; 104:369-79. [DOI: 10.1007/s00392-014-0805-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 12/16/2014] [Indexed: 12/19/2022]
|
18
|
Mitchell JR, Wang JJ. Expanding application of the Wiggers diagram to teach cardiovascular physiology. ADVANCES IN PHYSIOLOGY EDUCATION 2014; 38:170-175. [PMID: 24913453 PMCID: PMC4056172 DOI: 10.1152/advan.00123.2013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/13/2014] [Indexed: 06/03/2023]
Abstract
Dr. Carl Wiggers' careful observations have provided a meaningful resource for students to learn how the heart works. Throughout the many years from his initial reports, the Wiggers diagram has been used, in various degrees of complexity, as a fundamental tool for cardiovascular instruction. Often, the various electrical and mechanical plots are the novice learner's first exposure to simulated data. As the various temporal relationships throughout a heartbeat could simply be memorized, the challenge for the cardiovascular instructor is to engage the learner so the underlying mechanisms governing the changing electrical and mechanical events are truly understood. Based on experience, we suggest some additions to the Wiggers diagram that are not commonly used to enhance cardiovascular pedagogy. For example, these additions could be, but are not limited to, introducing the concept of energy waves and their role in influencing pressure and flow in health and disease. Also, integrating concepts of exercise physiology, and the differences in cardiac function and hemodynamics between an elite athlete and normal subject, can have a profound impact on student engagement. In describing the relationship between electrical and mechanical events, the instructor may find the introduction of premature ventricular contractions as a useful tool to further understanding of this important principle. It is our hope that these examples can aid cardiovascular instructors to engage their learners and promote fundamental understanding at the expense of simple memorization.
Collapse
Affiliation(s)
- Jamie R Mitchell
- Faculty of Medicine and Dentistry, Department of Physiology, University of Alberta, Edmonton, Alberta, Canada; and
| | - Jiun-Jr Wang
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| |
Collapse
|
19
|
Drca N, Wolk A, Jensen-Urstad M, Larsson SC. Atrial fibrillation is associated with different levels of physical activity levels at different ages in men. Heart 2014; 100:1037-42. [PMID: 24829373 DOI: 10.1136/heartjnl-2013-305304] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study examines the influence of physical activity at different ages and of different types, on the risk of developing atrial fibrillation (AF) in a large cohort of Swedish men. METHODS Information about physical activity was obtained from 44 410 AF-free men, aged 45-79 years (mean age=60), who had completed a self-administered questionnaire at baseline in 1997. Participants reported retrospectively their time spent on leisure-time exercise and on walking or bicycling throughout their lifetime (at 15, 30 and 50 years of age, and at baseline (mean age=60)). Participants were followed-up in the Swedish National Inpatient Register for ascertainment of AF. Cox proportional hazards regression models were used to estimate relative risks (RR) with 95% CIs, adjusted for potential confounders. RESULTS During a median follow-up of 12 years, 4568 cases of AF were diagnosed. We observed a RR of 1.19 (95% CI 1.05 to 1.36) of developing AF in men who at the age of 30 years had exercised for >5 h/week compared with <1 h/week. The risk was even higher (RR 1.49, 95% CI 1.14 to 1.95) among the men who exercised >5 h/week at age 30 and quit exercising later in life (<1 h/week at baseline). Walking/bicycling at baseline was inversely associated with risk of AF (RR 0.87, 95% CI 0.77 to 0.97 for >1 h/day vs almost never) and the association was similar after excluding men with previous coronary heart disease or heart failure at baseline (corresponding RR 0.88, 95% CI 0.77 to 0.998). CONCLUSIONS Leisure-time exercise at younger age is associated with an increased risk of AF, whereas walking/bicycling at older age is associated with a decreased risk.
Collapse
Affiliation(s)
- Nikola Drca
- Department of Cardiology at the Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Alicja Wolk
- Division of Nutritional Epidemiology, The National Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology at the Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Susanna C Larsson
- Division of Nutritional Epidemiology, The National Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
20
|
Current World Literature. Curr Opin Cardiol 2013; 28:369-79. [DOI: 10.1097/hco.0b013e328360f5be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Wang Y, Pan L, Fan W, Zhou Z, Zhu L, Wang Y, Hu R. Influence of vagal injury on acute traumatic reaction after blast injury. Eur J Trauma Emerg Surg 2013; 39:385-92. [PMID: 26815399 DOI: 10.1007/s00068-013-0277-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
|
22
|
Apor P. [Atrial fibrillation and physical activity]. Orv Hetil 2013; 154:503-9. [PMID: 23524234 DOI: 10.1556/oh.2013.29554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Atrial fibrillation is the most frequent arrhythmia. Its "lone" form (when underlying pathology is not discovered) can be detected in a small percentage of endurance sports participants, and in growing numbers among veterans, probably as a result of some cardiac or other irregularities. Enhanced vagal tone and sudden sympathetic impulse, repetitive oxidative stress, inflammatory processes, enlarged atria, electric instabilization can explain the higher occurrence. Treatment of atrial fibrillation enables the affected persons to participate in regular medium-intensity exercise, 3-5 hours a week, which offers a protective role against cardiovascular, metabolic and mental illnesses.
Collapse
Affiliation(s)
- Péter Apor
- Semmelweis Egyetem, Testnevelési és Sporttudományi Kar Budapest Oxygén Wellness Budapest Apor-Med Bt. Budapest.
| |
Collapse
|
23
|
Current world literature. Curr Opin Cardiol 2012. [PMID: 23207493 DOI: 10.1097/hco.0b013e32835c1388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|