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  • Associations between physical activity, left atrial size and incident atrial fibrillation: the Tromsø Study 1994–2016

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Cardiac risk factors and prevention
Original research
Associations between physical activity, left atrial size and incident atrial fibrillation: the Tromsø Study 1994–2016
  1. Kim Arne Heitmann1,2,
  2. Maja-Lisa Løchen3,
  3. Michael Stylidis3,
  4. Laila A Hopstock3,
  5. Henrik Schirmer4,5,6 and
  6. Bente Morseth1,2
  1. 1School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
  2. 2Centre for Research and Education, University Hospital of North Norway, Tromsø, Norway
  3. 3Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
  4. 4Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
  5. 5Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  6. 6Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
  1. Correspondence to Kim Arne Heitmann; kim.a.heitmann{at}uit.no

Abstract

Aims Left atrial (LA) enlargement is an independent risk factor for atrial fibrillation (AF). Interestingly, some athletes have increased risk of AF, which may be linked to LA enlargement; however, little is known about the relationship between LA enlargement and AF risk at moderate-level physical activity (PA). We aimed to explore the associations between PA, LA size and risk of incident AF, and if PA can attenuate the risk of AF with LA enlargement.

Methods This prospective study followed 2479 participants (52.4% female), free from known cardiac pathology, for median 20.2 years. Participants were followed up for hospital-diagnosed AF, confirmed by electrocardiography, from 1994-95 through 2016. At baseline, LA size was evaluated by anteroposterior LA diameter, and PA was self-reported by questionnaire.

Results We observed a U-shaped relationship between PA and AF, and moderately active had 32% lower AF risk than inactive (HRadjusted 0.68, 95% CI 0.50 to 0.93). Participants with LA enlargement had 38% higher AF risk compared with participants with normal LA size (HRadjusted 1.38, 95% CI 1.12 to 1.69). However, the increased AF risk with LA enlargement was attenuated by PA; compared with inactive participants with LA enlargement, the AF risk was 45% lower among active with LA enlargement (HRadjusted 0.55, 95% CI 0.39 to 0.79). AF risk in active participants with LA enlargement did not differ from active with normal LA size. These patterns were observed in both men and women, and in participants over/under 65 years.

Conclusion Moderate PA was associated with reduced AF risk, and PA attenuated the increased risk of AF with LA enlargement in both men and women and all age groups.

  • arrhythmias
  • cardiac
  • echocardiography
  • epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available. The legal restriction on data availability is set by the Tromsø Study Data and Publication Committee in order to control for data sharing, including publication of datasets with the potential of reverse identification of deidentified sensitive participant information. The data can, however, be made available from the Tromsø Study upon application to the Tromsø Study Data and Publication Committee. Contact information: The Tromsø Study, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway; e-mail: tromsous@uit.no.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/openhrt-2021-001823

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The legal restriction on data availability is set by the Tromsø Study Data and Publication Committee in order to control for data sharing, including publication of datasets with the potential of reverse identification of deidentified sensitive participant information. The data can, however, be made available from the Tromsø Study upon application to the Tromsø Study Data and Publication Committee. Contact information: The Tromsø Study, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway; e-mail: tromsous@uit.no.

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    Footnotes

    • Twitter @KimAHeitmann, @lailahopstock, @MorsethBente

    • Contributors All authors contributed to conception or design of the work. KAH, M-LL, HS, MS and BM contributed to acquisition, analysis or interpretation of the data. KAH drafted the manuscript. All authors critically revised the manuscript, gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy. KAH is responsible for the overall content as the guarantor.

    • Funding KAH was supported by the Northern Norway Regional Health Authority (grant number HNF1406-18).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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