Voltage mapping and pulmonary vein isolation in master athletes with atrial fibrillation.
ablation
athlete
atrial fibrillation
recurrence
scarring
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
Nov 2022
Nov 2022
Historique:
revised:
19
09
2022
received:
07
05
2022
accepted:
27
09
2022
pubmed:
6
10
2022
medline:
16
11
2022
entrez:
5
10
2022
Statut:
ppublish
Résumé
Master athletes encompass a wide range of exercise enthusiasts. At the extreme, there is an increased risk of atrial fibrillation (AF). Therapies aimed at rate or rhythm control are often limited given unfavorable side effects. Although studies suggest an increase in left atrial (LA) fibrosis in this population, minimal electrophysiologic data exist regarding the LA voltage mapping and the efficacy of AF ablation with pulmonary vein isolation (PVI). In a retrospective single-center study, we reviewed AF ablations (pulmonary vein isolation and assessment/ablation of non-pulmonary vein triggers) performed in extreme master athletes with AF. We define "extreme" as those who have repeatedly competed in long distance endurance events for a > 10-year period. Bipolar voltage mappings obtained through PENTARAY Catheter (Biosense Webster) were reviewed using CARTO. LA scarring was defined as an area of less than 0.1 mV. All patients were monitored as outpatients for AF recurrence. Between January 2018 and February 2022, 16 patients (11 marathon runners, four long distance cyclers, and one marathon swimmer) underwent AF ablations. All patients in the cohort were male with an average CHA2DS2-VASc score of 1.2 ± 0.8 and left atrial volume of 34.4 cc/m In our series of extreme master athletes with AF, the incidence of LA scarring on bipolar voltage mapping was low and the recurrence of AF following PVI by RF ablation was minimal.
Sections du résumé
BACKGROUND
Master athletes encompass a wide range of exercise enthusiasts. At the extreme, there is an increased risk of atrial fibrillation (AF). Therapies aimed at rate or rhythm control are often limited given unfavorable side effects. Although studies suggest an increase in left atrial (LA) fibrosis in this population, minimal electrophysiologic data exist regarding the LA voltage mapping and the efficacy of AF ablation with pulmonary vein isolation (PVI).
METHODS
In a retrospective single-center study, we reviewed AF ablations (pulmonary vein isolation and assessment/ablation of non-pulmonary vein triggers) performed in extreme master athletes with AF. We define "extreme" as those who have repeatedly competed in long distance endurance events for a > 10-year period. Bipolar voltage mappings obtained through PENTARAY Catheter (Biosense Webster) were reviewed using CARTO. LA scarring was defined as an area of less than 0.1 mV. All patients were monitored as outpatients for AF recurrence.
RESULTS
Between January 2018 and February 2022, 16 patients (11 marathon runners, four long distance cyclers, and one marathon swimmer) underwent AF ablations. All patients in the cohort were male with an average CHA2DS2-VASc score of 1.2 ± 0.8 and left atrial volume of 34.4 cc/m
CONCLUSION
In our series of extreme master athletes with AF, the incidence of LA scarring on bipolar voltage mapping was low and the recurrence of AF following PVI by RF ablation was minimal.
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1338-1342Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Tian D, Meng J. Exercise for prevention and relief of cardiovascular disease: prognoses, mechanisms, and approaches. Oxid Med Cell Longev. 2019;4:1-11.
Pathak RK, Elliott A, Middeldorp ME, et al. Impact of CARDIOrespiratory FITness on arrhythmia recurrence in obese individuals with atrial fibrillation: the CARDIO-FIT study. J Am Coll Cardiol. 2015;66:985-996.
Baldesberger S, Bauersfeld U, Candinas R, et al. Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists. Eur Heart J. 2008;29:71-78.
Claessen G, Colyn E, La Gerche A, et al. Long-term endurance sport is a risk factor for development of lone atrial flutter. Heart. 2011;97:918-922.
Grimsmo J, Grundvold I, Maehlum S, Arnesen H. High prevalence of atrial fibrillation in long-term endurance cross-country skiers: echocardiographic findings and possible predictors-a 28-30 years follow-up study. Eur J Cardiovasc Prev Rehabil. 2010;17:100-105.
Molina L, Mont L, Marrugat J, et al. Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study. Europace. 2008;10:618-623.
Maron BJ, Pelliccia A. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation. 2006;114:1633-1644.
Flannery MD, Kalman JM, Sanders P, La Gerche A. State of the art review: atrial fibrillation in athletes. Heart Lung Circ. 2017;26:983-989.
Marrouche NF, Wilber D, Hindricks G, et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF Study. JAMA. 2014;311:498-506.
Dzeshka MS, Lip GY, Snezhitskiy V, Shantsila E. Cardiac fibrosis in patients with atrial fibrillation: mechanisms and clinical implications. J Am Coll Cardiol. 2015;66:943-959.
Guasch E, Benito B, Qi X, et al. Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model. J Am Coll Cardiol. 2013;62:68-77.
Peritz DC, Catino AB, Csecs I, et al. High-intensity endurance training is associated with left atrial fibrosis. Am Heart J. 2020;226:206-213.
Aschar-Sobbi R, Izaddoustdar F, Korogyi AS, et al. Increased atrial arrhythmia susceptibility induced by intense endurance exercise in mice requires TNFα. Nat Commun. 2015. https://doi.org/10.1038/ncomms7018
Guasch E, Mont L, Sitges M. Mechanisms of atrial fibrillation in athletes: what we know and what we do not know. Neth Heart J. 2018;26:133-145.
Sanchis L, Sanz-de La Garza M, Bijnens B, et al. Gender influence on the adaptation of atrial performance to training. Eur J Sport Sci. 2017;17:720-726.
Brugger N, Krause R, Carlen F, et al. Effect of lifetime endurance training on left atrial mechanical function and on the risk of atrial fibrillation. Int J Cardiol. 2014;170:419-425.
Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation. 1994;89:724-730.
Neuberger HR, Schotten U, Blaauw Y, et al. Chronic atrial dilation, electrical remodeling, and atrial fibrillation in the goat. J Am Coll Cardiol. 2006;47:644-653.
Spach MS, Heidlage JF, Dolber PC, Barr RC. Electrophysiological effects of remodeling cardiac gap junctions and cell size: experimental and model studies of normal cardiac growth. Circ Res. 2000;86:302-311.
Gabrielli L, Enríquez A, Córdova S, Yáñez F, Godoy I, Corbalán R. Assessment of left atrial function in hypertrophic cardiomyopathy and athlete's heart: a left atrial myocardial deformation study. Echocardiography. 2012;29:943-949.
Gibson DN, Di Biase L, Mohanty P, et al. Stiff left atrial syndrome after catheter ablation for atrial fibrillation: clinical characterization, prevalence, and predictors. Heart Rhythm. 2011; 8:1364-1371.