Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 21;1(1):30.
doi: 10.1038/s44325-024-00032-8.

Atrial cardiomyopathy in endurance athletes

L W Spencer  1   2 , P D'Ambrosio  1   2   3 , M Ohanian  4 , S J Rowe  1   2   5 , K Janssens  1   6 , G Claessen  7 , D Fatkin  4   8   9 , A La Gerche  10   11   12
Affiliations

Atrial cardiomyopathy in endurance athletes

L W Spencer et al. NPJ Cardiovasc Health. .

Abstract

Atrial cardiomyopathy is characterized by electrical and structural remodeling of the atria, which can predispose to arrhythmias and thromboembolic stroke. Changes in atrial size and function are frequently observed in athletes engaged in endurance sports, a phenomenon known as "athlete's heart." Common left atrial observations in athletes may include larger left atrial volumes but lower left atrioventricular volume ratios, mildly reduced left atrial strain, possible mild left atrial fibrosis, longer P-wave duration, and greater atrial ectopic activity. However, it remains unclear whether these changes represent physiological adaptations to endurance exercise or disease-promoting pathology. While the athlete's heart is considered a benign physiological phenomenon, endurance athletes have an established risk of atrial fibrillation. Therefore, atrial cardiomyopathy represents a significant consideration in disease prognostication and the development of management strategies for athletes. This review examines current literature with respect to the clinical features, causes, and consequences of atrial cardiomyopathy in athletes.

PubMed Disclaimer

Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Atrial-specific physiological and functional considerations.
Analysis of left atrial cardiomyopathy includes any complex of structural, functional or electrophysiological remodeling that may be clinically relevant. Created with BioRender.com.
Fig. 2
Fig. 2. Multimodality assessment of left atrial cardiomyopathy.
The assessment of left atrial cardiomyopathy necessitates the utilization of multiple assessment modalities, including cardiac magnetic resonance, electrocardiogram, echocardiography, genome sequencing and blood biomarkers. Created with BioRender.com.
Fig. 3
Fig. 3. Proposed structural overlap in four categories of patients.
Yellow = atrial dilation, green = normal heart, blue = ventricular dilation, red = athletes’ heart (bi-atrial and bi-ventricular dilation). Figure reproduced from Malaescu et al. with permission from Elsevier. The figure was created using BioRender.com.
Fig. 4
Fig. 4. Interpretation of left atrial cardiomyopathy features in athletes.
Green = normal athletic findings, amber = potential markers of risk, red = abnormal LA features that require further examination. Created with BioRender.com.
See this image and copyright information in PMC

References

    1. Goette, A. et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace18, 1455–1490 (2016). - DOI - PMC - PubMed
    1. Kamel, H. et al. The atrial cardiopathy and antithrombotic drugs in prevention after cryptogenic stroke randomized trial: rationale and methods. Int. J. Stroke14, 207–214 (2019). - DOI - PMC - PubMed
    1. Goette, A. et al. Atrial cardiomyopathy revisited—evolution of a concept: a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Association (APHRS), and the Latin American Heart Rhythm Society (LAHRS). Europace26, euae204 (2024). - PMC - PubMed
    1. Henry, W. L. et al. Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation53, 273–279 (1976). - DOI - PubMed
    1. Vaziri, S. M., Larson, M. G., Benjamin, E. J. & Levy, D. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation89, 724–730 (1994). - DOI - PubMed

LinkOut - more resources