The occurrence of atrial fibrillation in former top-level handball players above the age of 50.
OBJECTIVE
Cardiac adaptation to sports activity in endurance athletes is considerably different from that in power athletes. The effects of a high-level team sport like handball, one of the most popular sports in the world, performed at a younger age, on cardiac rhythm in individuals above the age of 50 have not been investigated to date.


METHODS
Thirty-three former top-level handball players from the first German league (6 former world champions and numerous Olympians) (57.5 +/- 5.5 y) joined our screening programme for former athletes and underwent electrocardiography, echocardiography and spiroergometry. Data were compared to 24 sedentary healthy controls.


RESULTS
Ten of the 33 athletes suffered from atrial fibrillation (AF). Left ventricular diameter was 53.68 +/- 4.88 mm in the athletes group and 50.58 +/- 4.12 mm in the healthy controls. Analysing the subgroups of handball players ('AF group' and 'non-AF group'), spiroergometry showed oxygen consumption at the anaerobic threshold of 27.54 +/- 6.77 ml/kg/min in the AF group and 31.24 +/- 10.33 ml/kg/min in the non-AF group (P = 0.228). Absolute left atrial diameter was 44.34 +/- 4.41 mm in the AF group (non-AF group 38.94 +/- 3.77 mm, P < 0.001) (healthy controls 37.54 +/- 4.34 mm, compared with all athletes P = 0.015). In all individuals left ventricular wall thickness was within normal limits. However, myocardial walls were thicker in the AF group (11.28 +/- 1.83 mm) than in the non-AF group (9.44 +/- 1.26 mm, P = 0.002). Athletes in the AF group (187.6 +/- 6.42 cm) were significantly taller than in the non-AF group (180.91 +/- 7.31 cm, P = 0.018).


CONCLUSIONS
Not only endurance training, but also sports activity with a relevant static component, like team handball, might predispose for AF above the age of 50. LA size, height and myocardial wall thickness seem to affect the risk of developing AF. More data in non-endurance sports are mandatory to confirm this hypothesis.
Dept. of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Germany. fvbuuren@hdz-nrw.de
Frank
F
Van Buuren
Klaus P
KP
Mellwig
Lothar
L
Faber
Christian
C
Prinz
Andreas
A
Fruend
Johannes B
JB
Dahm
Tanja
T
Kottmann
Nikola
N
Bogunovic
Dieter
D
Horstkotte
Thomas
T
Butz
Christoph
C
Langer
D000465:Algorithms; D056352:Athletes; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D016022:Case-Control Studies; D004452:Echocardiography; D004562:Electrocardiography; D016552:Ergometry; D005858:Germany / Q000453:epidemiology; D006329:Heart Conduction System / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013147:Spirometry; D013177:Sports