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NCT Number: NCT06844656

Understanding the Increased Risk of Atrial Fibrillation in Athletes: a Case-control Study

Exercise is beneficial to heart health, however, there appears to be a 'U' shaped relationship where too much exercise may increase the risk of an irregular heart rhythm, called atrial fibrillation. Endurance athletes may have up to a 2.5-fold higher risk of developing atrial fibrillation than non-athletic controls.

The mechanisms behind this increased risk of atrial fibrillation are not the well understood. It is thought to be a mixture of enlarged heart chambers, low resting heart rate, genetic predisposition and possibly scarring in the heart. In this study, the investigators will investigate the electrical activity changes in the heart, using a high-quality electrocardiogram (ECG) and relate this to changes in the heart size measured by ultrasound and MRI. Cardiopulmonary exercise testing will determine fitness (V̇O2 max) and assess the heart's electrical activity during exercise.

This will be a case-control study where athletes with and without atrial fibrillation will be recruited. The investigators hope the results of this study can improve our understanding of atrial fibrillation in athletes by associating atrial fibrillation with structural and electrical differences which may aid the prediction of future atrial fibrillation development and help guide more athlete-specific treatment pathways.

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Key information

Conditions

Atrial Fibrillation (AF) Arrhythmias, Cardiac Atrial Fibrillation Behavior Cardiovascular Diseases Heart Diseases Motor Activity Pathologic Processes Pathological Conditions, Signs and Symptoms

Age range

18 year and older

Sex eligibility

All sexes

Study type

Observational

Primary location

Department of Cardiovascular Sciences. University of Leicester. Glenfield Hospital.

Leicester, LE3 9QP, United Kingdom

Location contact

Andre Ng, Professor

PRINCIPAL_INVESTIGATOR

Cai L Davies

CONTACT

[email protected]

+447765791818

Gerry McCann, Professor

PRINCIPAL_INVESTIGATOR

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • ≥18 years of age at the time of enrolment, male and female.
  • History of atrial fibrillation confirmed on ECG - either paroxysmal or persistent.
  • Competitive athlete. Defined as:
  • Competed in endurance sports with a total cumulative moderate to high intensity of > 1500 hours.
  • Have participated in at least one competitive event in the last 10 years.

Exclusion criteria

  • Permanent atrial fibrillation.
  • History of pre-existing cardiovascular disease :
  • Atherosclerotic disease: previous myocardial infarction, symptomatic coronary artery disease or Peripheral peripheral arterial disease
  • Left ventricular systolic dysfunction (EF < 45%)
  • Heart muscle disease: cardiomyopathies, Infiltrative diseases of the heart
  • Complex Congenital heart disease
  • Moderate or severe valvular disease
  • Uncontrolled hypertension (>180/100mmHg)

Treatment and study plan

Primary outcomes

  1. High-resolution ECG

    Time frame: At study visit

    Using high quality ECG, assess whether subtle differences can be detected in athletes with AF, compared to athletes without AF, and whether machine learning could predict new-onset AF.

    Detection of subtle differences in p wave parameters (duration, amplitude, dispersion, PTFV1) in athletes with AF compared to athletes without AF. AUC, specificity and sensitivity.

Secondary outcomes

  1. AI classification and prediction

    Time frame: At study visit

    Assess the accuracy of using machine learning to identify athletes with AF using ECG data.

    AUC, specificity and sensitivity of machine learning identification of AF.

  2. 72hr heart rate monitoring

    Time frame: At study visit

    Compare autonomic tone via heart rate variability from 72-hour continuous ECG monitoring in athletes with and without AF.

    Analysis of RR intervals from heart rate variability.

  3. Electronic stethoscope recording

    Time frame: At study visit

    Compare the heart sounds using electronic stethoscope in athletes with and without AF.

    S1 and S2 sounds of heart valves.

  4. Cardiac imaging

    Time frame: At study visit

    Left ventricular mass

  5. Cardiac imaging

    Time frame: At study visit

    Left ventricular volume

  6. Cardiac imaging

    Time frame: At study visit

    Strain rate

  7. Cardiac imaging

    Time frame: At study visit

    Myocardial perfusion reserve

  8. Cardiac imaging

    Time frame: At study visit

    Myocardial interstitial fibrosis

  9. Cardiac imaging

    Time frame: At study visit

    Left atrial mass

  10. Cardiac imaging

    Time frame: At study visit

    Left atrial volume

  11. Cardiac imaging

    Time frame: At study visit

    Vascular stiffness

  12. Cardiac imaging

    Time frame: At study visit

    Left ventricular filling pressure

  13. Cardiac imaging

    Time frame: At study visit

    Tissue Doppler velocity

  14. Cardiopulmonary exercise testing

    Time frame: At study visit

    Peak VO2

  15. Cardiopulmonary exercise testing

    Time frame: At study visit

    Exercising p wave duration

  16. Cardiopulmonary exercise testing

    Time frame: At study visit

    Exercising p wave amplitude

  17. Cardiopulmonary exercise testing

    Time frame: At study visit

    Exercising p wave dispersion

  18. Cardiopulmonary exercise testing

    Time frame: At study visit

    Exercising p wave PTFV1

  19. Cardiac motion recording

    Time frame: At study visit

    Cardiac angular velocity

Study contacts

Contact information is provided by the study sponsor or research team.

Cai L Davies

CONTACT

[email protected]

+447765791818

Sponsors and collaborators

Lead sponsor

University of Leicester

Other

Registry information

Acronym: AFLETES-ECG

Important dates

Study start
2025
Primary completion
2026
Study completion
2026
First posted
Feb 25, 2025
Registry last updated
Feb 25, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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