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J Am Coll Cardiol, 2005; 46:690-696, doi:10.1016/j.jacc.2005.04.052 (Published online 27 July 2005).
© 2005 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: ATHLETICS AND CARDIAC FUNCTION

Prevalence and Clinical Significance of Left Atrial Remodeling in Competitive Athletes

Antonio Pelliccia, MD*,*, Barry J. Maron, MD{dagger}, Fernando M. Di Paolo, MD*, Alessandro Biffi, MD*, Filippo M. Quattrini, MD*, Cataldo Pisicchio, MD*, Alessandra Roselli, MD*, Stefano Caselli, MD* and Franco Culasso, PhD{ddagger}

* National Institute of Sports Medicine, Italian National Olympic Committee, Rome, Italy
{dagger} The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
{ddagger} Department of Experimental Medicine, University La Sapienza, Rome, Italy

Manuscript received January 20, 2005; revised manuscript received April 1, 2005, accepted April 25, 2005.

* Reprint requests and correspondence: Dr. Antonio Pelliccia, National Institute of Sports Medicine, Italian National Olympic Committee, Via dei Campi Sportivi, 46, 00197 Rome, Italy (Email: ant.pelliccia{at}libero.it).

OBJECTIVES: In the present study we assessed the distribution and clinical significance of left atrial (LA) size in the context of athlete's heart and the differential diagnosis from structural heart disease, as well as the proclivity to supraventricular arrhythmias.

BACKGROUND: The prevalence, clinical significance, and long-term arrhythmic consequences of LA enlargement in competitive athletes are unresolved.

METHODS: We assessed LA dimension and the prevalence of supraventricular tachyarrhythmias in 1,777 competitive athletes (71% of whom were males), free of structural cardiovascular disease, that were participating in 38 different sports.

RESULTS: The LA dimension was 23 to 50 mm (mean, 37 ± 4 mm) in men and 20 to 46 mm (mean, 32 ± 4 mm) in women and was enlarged (i.e., transverse dimension ≥40 mm) in 347 athletes (20%), including 38 (2%) with marked dilation (≥45 mm). Of the 1,777 athletes, only 14 (0.8%) had documented, symptomatic episodes of either paroxysmal atrial fibrillation (n = 5; 0.3%) or supraventricular tachycardia (n = 9; 0.5%), which together occurred in a similar proportion in athletes with (0.9%) or without (0.8%; p = NS) LA enlargement. Multivariate regression analysis showed LA enlargement in athletes was largely explained by left ventricular cavity enlargement (R2 = 0.53) and participation in dynamic sports (such as cycling, rowing/canoeing) but minimally by body size.

CONCLUSIONS: In a large population of highly trained athletes, enlarged LA dimension ≥40 mm was relatively common (20%), with the upper limits of 45 mm in women and 50 mm in men distinguishing physiologic cardiac remodeling ("athlete's heart") from pathologic cardiac conditions. Atrial fibrillation and other supraventricular tachyarrhythmias proved to be uncommon (prevalence <1%) and similar to that in the general population, despite the frequency of LA enlargement. Left atrial remodeling in competitive athletes may be regarded as a physiologic adaptation to exercise conditioning, largely without adverse clinical consequences.

Abbreviations and Acronyms
  ECG = electrocardiogram/electrocardiographic/electrocardiography
  LA = left atrial/atrium
  LV = left ventricular




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