Co-Author(s):
Nicholas Beccarino, MD
David Chang, MD
Eric Dulmovits, BS
Stuart Beldner, MD
Northwell Health
300 Community Drive, Manhasset, NY 11030
Introduction | Objectives: 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
these patients as those who have repeatedly competed in long distance
endurance events for a > 10 year period. Bipolar voltage
mappings were reviewed using CARTO (Biosense Webster, Diamond Bar, USA)
and LA scarring was defined as an area of less than 0.1mV. All patients
were monitored as outpatient for AF recurrence.
Results: Between January 2018 and January 2020, 14 patients (nine marathon
runners, four long distance cyclers, and one marathon swimmer) underwent
AF ablations. The patient demographics are shown in Table 1. All
patients in the cohort were male with an average
CHA2DS2-VASc score of 1.2 ± 0.9 and left
atrial volume of 34.4 cc/m2 ± 9.9. A total of seven
patients (50%) had persistent AF. One patient (7.1%) had LA scar on
the bipolar voltage mapping, whom also had a non-pulmonary vein trigger
of AF. Bidirectional blocks of the four pulmonary veins were achieved by
radiofrequency (RF) ablation in all patients. Freedom from documented
recurrence of AF up to 24 months was 92.9%. One patient (7.1%) had
recurrence of AF at 14 months and underwent successful cardioversion.
Conclusions: In our series of extreme master athletes with AF, the incidence of LA
scarring on the bipolar voltage mapping was low and the recurrence of AF
following PVI by RF ablation was minimal.