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Vandenberk B, Haemers P, Morillo C. The autonomic nervous system in atrial fibrillation-pathophysiology and non-invasive assessment. Front Cardiovasc Med 2024; 10:1327387. [PMID: 38239878 PMCID: PMC10794613 DOI: 10.3389/fcvm.2023.1327387] [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] [Received: 10/24/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open
Abstract
The autonomic nervous system plays a crucial role in atrial fibrillation pathophysiology. Parasympathetic hyperactivity result in a shortening of the action potential duration, a reduction of the conduction wavelength, and as such facilitates reentry in the presence of triggers. Further, autonomic remodeling of atrial myocytes in AF includes progressive sympathetic hyperinnervation by increased atrial sympathetic nerve density and sympathetic atrial nerve sprouting. Knowledge on the pathophysiological process in AF, including the contribution of the autonomic nervous system, may in the near future guide personalized AF management. This review focuses on the role of the autonomic nervous system in atrial fibrillation pathophysiology and non-invasive assessment of the autonomic nervous system.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Peter Haemers
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Carlos Morillo
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
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Lobo HM, Naves ÍG, Marçal SB, Canzi CC, Rodrigues ABS, Menezes Jr AS. Atrial Fibrillation in Endurance Training Athletes: Scoping Review. Rev Cardiovasc Med 2023; 24:155. [PMID: 39077536 PMCID: PMC11264108 DOI: 10.31083/j.rcm2406155] [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] [Received: 12/12/2022] [Revised: 02/11/2023] [Accepted: 02/28/2023] [Indexed: 07/31/2024] Open
Abstract
Background Moderate regular physical activity is indicated to avoid atrial fibrillation (AF), whereas athletes should be counseled that long-lasting vigorous sports engagement may cause AF, according to the 2016 European Society of Cardiology (ESC) recommendations for AF treatment. Exercise and AF are complex. Objectives To evaluate the relationship between Endurance training and AF, in addition to the starting point/trigger by which Endurance Training causes impairment of cardiac function and AF, considering the time and intensity of Endurance training. Materials and Methods We synthesized evidence from articles published in the PubMed, EMBASE, and SciELO databases using their respective Boolean operators. A total of 112 original articles related to AF and endurance athletes published up to the year 2023 were reviewed. Results Our study verified multiples aspects of the genesis of AF in athletes, such as cardiac adaptations to exercise, disturbances in cardiac injury biomarkers, sex differences in cardiac adaptations and their role in AF risk, and the relationship between body composition (height, weight, and physical fitness) and AF pathogenesis. Conclusions Variations in cardiac structure (increased atrial thickness and size in addition to myocardial fibrosis) and significant increases in vagal tone (sinus bradycardia and imbalances in sympathetic and parasympathetic activation) shorten the refractory period shortening in athletes, induce the onset of re-entrance mechanisms, and serve as ectopic triggers that can lead to AF.
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Affiliation(s)
- Henrique M. Lobo
- Medical and Life Sciences School, Pontifical Catholic University of Goiás, 74175-120 Goiânia, Goiás, Brazil
| | - Ícaro G. Naves
- Medical and Life Sciences School, Pontifical Catholic University of Goiás, 74175-120 Goiânia, Goiás, Brazil
| | - Silvia Botelho Marçal
- Internal Medicine Department, Medicine Faculty, Federal University of Goiás, 74690-900 Goiânia, Goiás, Brazil
| | - Camila Cassia Canzi
- Medical and Life Sciences School, Pontifical Catholic University of Goiás, 74175-120 Goiânia, Goiás, Brazil
| | | | - Antonio S. Menezes Jr
- Medical and Life Sciences School, Pontifical Catholic University of Goiás, 74175-120 Goiânia, Goiás, Brazil
- Internal Medicine Department, Medicine Faculty, Federal University of Goiás, 74690-900 Goiânia, Goiás, Brazil
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Petek BJ, Hayes DM, Wasfy MM. Right Heart Resilience and Atrial Fibrillation Risk in Long-Term Endurance Athletes. J Am Soc Echocardiogr 2022; 35:1269-1272. [PMID: 36471518 DOI: 10.1016/j.echo.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
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Lee HC, Chen CY, Lee SJ, Lee MC, Tsai CY, Chen ST, Li YJ. Exploiting exercise electrocardiography to improve early diagnosis of atrial fibrillation with deep learning neural networks. Comput Biol Med 2022; 146:105584. [PMID: 35551013 DOI: 10.1016/j.compbiomed.2022.105584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/01/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) is the most common type of sustained arrhythmia. It results from abnormal irregularities in the electrical performance of the atria, and may cause heart thrombosis, stroke, arterial disease, thromboembolism, and heart failure. Prior to the onset of atrial fibrillation, most people experience atrial cardiomyopathy which, if effectively managed, can be prevented from progressing to atrial fibrillation. Electrocardiogram (ECG) can show changes in the heartbeats, and is a common and painless tool to detect heart problems. P-waves in exercise ECGs change more drastically than those in regular ECG, and are more effective in the detection of atrial myocardial diseases. In this paper, we propose a deep learning system to help clinicians to early detect if a patient has atrial enlargement or fibrillation. Firstly, a Convolutional Recurrent Neural Network is employed to locate the P-waves in the patient's exercise ECGs taken in the exercise ECG test process. Relevant parameters are then calculated from the located P-waves. Then a Parallel Bi-directional Long Short-Term Memory Network is applied to analyze the obtained parameters and make a diagnosis for the patient. With our proposed deep learning system, the changes of P-waves collected in different phases in the exercise ECG test can be analyzed simultaneously to get more stable and accurate results. The system can take data of different length as input, and is also applicable to any number of ECG collections. We conduct various experiments to show the effectiveness of our proposed system. We also show that the more ECG data collected in the exercise phase are involved, the more effective our system is in diagnosis of the diseases.
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Affiliation(s)
- Hsiang-Chun Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Chun-Yen Chen
- Department of Electrical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan.
| | - Shie-Jue Lee
- Department of Electrical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan; Intelligent Electronic Commerce Research Center, National Sun Yat-Sen University, Kaohsiung, Taiwan.
| | - Ming-Chuan Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Ching-Yi Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Su-Te Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Yu-Ju Li
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Zimmermann P, Moser O, Edelmann F, Schöffl V, Eckstein ML, Braun M. Electrical and Structural Adaption of Athlete’s Heart and the Impact on Training and Recovery Management in Professional Basketball Players: A Retrospective Observational Study. Front Physiol 2022; 13:739753. [PMID: 35222069 PMCID: PMC8874328 DOI: 10.3389/fphys.2022.739753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/18/2022] [Indexed: 12/31/2022] Open
Abstract
IntroductionWe analyzed data of 27 professional basketball players to prove cardiac remodeling referring echocardiographic parameters, cardiopulmonary exercise testing (CPET), and 12-lead electrocardiogram (ECG) analyses. The aim of our study was to present different characteristics in the athletes, on the one hand signs of a high vagal tone in the 12-lead ECG as criteria of early repolarization (ER), furthermore echocardiographic remodeling parameters and finally the performance in CPET. Therefore, we divided the cohort into a group with signs of ER pattern in the 12-lead ECG and without these criteria and presented the differences in detail.Materials and MethodsThis was a single-center, retrospective study performed in 27 professional basketball players (age: 26.5 ± 7.5 years, male: 27, height: 197.2 ± 12 cm, weight: 100 ± 17 kg, BMI: 25.7 ± 3.4 kg/m2). All participants underwent a sports medicine checkup, ECG analysis, transthoracic echocardiographic examination, and a CPET on a cycle ergometer between 2015 and 2019 during their pre-season preparation time. All individuals were healthy people without cardiological advance anamnesis. After assessment, two groups were built based on electrocardiographic criteria of ER pattern and a group without these criteria and compared against each other for parameters of echocardiographic assessment, CPET, and 12-lead ECG analysis. Data were analyzed with Minitab statistic program (Minitab Inc., State College, PA, United States) and Graph Pad Prism 8.2.1 (279; Graph Pad Software, San Diego, CA, United States) using ANOVA testing with post-hoc testing and unpaired t-testing (p ≤ 0.05).Retrospectively additional information was collected referring to the management of training sessions, recovery time, and nutrition by interviewing the athletic training staff in order to understand the principles for individual athlete’s training management and physiological and cardiopulmonary interactions.ResultsComparing professional basketball players with ER pattern to those with no ER pattern, significant differences were found for CPET, echocardiographic, and ECG analysis (p < 0.05). Absolute and relativized peak oxygen uptake (VO2 peak; ER 4120 ± 750 ml/min (39 ± 5.4 ml/kg/min) vs. non-ER 3556 ± 393 ml/min (37.2 ± 5.3 ml/kg/min), p = 0.018) and maximum workload during CPET (ER 310 ± 51.5 Watt (2.94 ± 0.35 W/kg) vs. non-ER 271 ± 32 Watt (2.85 ± 0.49 W/kg), p = 0.026) was higher in athletes with an ER pattern. Furthermore, ER pattern athletes showed a higher enddiastolic left ventricular diameter (LVedd; ER 58.3 ± 7.9 mm vs. non-ER 53.6 ± 3.6 mm, p = 0.048) and a significantly enlarged left atrial (LA) endsystolic diameter (ER 23.33 ± 2.71 mm vs. non-ER 20.47 ± 2.29 mm, p = 0.006) as well as a significantly enlarged right atrial (RA) endsystolic diameter (ER 23.42 ± 2.15 mm vs. non-ER 20.93 ± 3.28 mm, p = 0.033). Significant differences between the two compared groups could be revealed for left ventricular mass Index (LVMI gr/m2; LVMI ER 113 gr/m2 ± 17.5 vs. LVMI non-ER 91.3 gr/m2 ± 15.1, p = 0.002), but no significant differences for the relative wall thickness were found (RWT; RWT ER 0.49 ± 0.11 vs. RWT non-ER 0.38 ± 0.06, p = 0.614).ConclusionProfessional basketball players with criteria of ER pattern showed different results in CPET and cardiac remodeling as athletes with no ER pattern. These findings should encourage the athletic training staff to emphasize the quality of an individual training schedule for each athlete based on the cardiopulmonary pre-season sport medicine checkup. Nevertheless, echocardiographic findings, ER pattern, and performance in CPET have to be interpreted referring the sport-specific and athlete’s ethnical background.
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Affiliation(s)
- Paul Zimmermann
- Department of Cardiology, Klinikum Bamberg, Bamberg, Germany
- Interdisciplinary Center of Sportsmedicine Bamberg, Klinikum Bamberg, Bamberg, Germany
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
- *Correspondence: Paul Zimmermann,
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
- Interdisciplinary Metabolic Medicine Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, CVK, Charité University Medicine Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Volker Schöffl
- Interdisciplinary Center of Sportsmedicine Bamberg, Klinikum Bamberg, Bamberg, Germany
- Department of Traumatology and Orthopaedics, Klinikum Bamberg, Bamberg, Germany
| | - Max L. Eckstein
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
| | - Martin Braun
- Department of Cardiology, Klinikum Bamberg, Bamberg, Germany
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Zimmermann P, Lutter C. Establishing stable sinus rhythm in an endurance athlete with paroxysmal supraventricular tachycardia improves haemodynamical performance during exercise testing. BMJ Case Rep 2020; 13:13/9/e238674. [DOI: 10.1136/bcr-2020-238674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Drum SN, Donath L, Dehlin C, Kashou A, Noseworthy PA, Zacher J. Atrial Fibrillation: Should Lifelong Athletes Be Worried? Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zimmermann P, Lutter C. Haemodynamic effects of paroxysmal supraventricular tachycardia in an endurance athlete during exercise testing. BMJ Case Rep 2019; 12:12/10/e231659. [PMID: 31645406 DOI: 10.1136/bcr-2019-231659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
| | - Christoph Lutter
- Department of Orthopedics, University Medical Center, Rostock, Germany
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Abstract
PURPOSE OF REVIEW A complex relationship exists between exercise and atrial fibrillation (AF). Moderate exercise reduces AF risk whereas intense strenuous exercise has been shown to increase AF burden. It remains unclear at which point exercise may become detrimental. Overall, endurance athletes remain at lower cardiovascular risk and experience fewer strokes. The questions that arise therefore are whether AF is an acceptable byproduct of strenuous exercise, whether athletes who experience AF should be told to reduce exercise volume and how should they be managed. This review aims to critically review the literature and advise on how best to manage athletes with AF. RECENT FINDINGS Emerging evidence suggests that female athletes may exhibit lower risk of AF, but data is limited in female endurance athletes. AF is more prevalent in endurance athletes, particularly men and those who competed at a young age. Data is lacking in females and ethnic minorities. Current evidence suggests that treatment options for AF in athletes are similar to those used in the general population; however, medical therapy may be poorly tolerated. Catheter ablation is effective and can allow return to full competition.
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Affiliation(s)
- Dimitrios Stergiou
- MSc Sports Cardiology, Cardiology Clinical Academic Group, St George's, University of London, London, UK
| | - Edward Duncan
- MSc Sports Cardiology, Cardiology Clinical Academic Group, St George's, University of London, London, UK.
- Department of Cardiology, The Bristol Heart Institute, Bristol, UK.
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Estes NM, Madias C. Atrial Fibrillation in Athletes. JACC Clin Electrophysiol 2017; 3:921-928. [DOI: 10.1016/j.jacep.2017.03.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/20/2017] [Accepted: 03/23/2017] [Indexed: 01/02/2023]
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