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P-wave morphology is unaffected by training-induced biatrial dilatation: a prospective, longitudinal study in healthy athletes
1University of Siena, Department of Medical Biotechnologies, Division of Cardiology - Siena - Italy
2University of Padova, Department of Cardiac, Thoracic, and Vascular Sciences - Padua - Italy
3University of Siena, Department of Medicine, Surgery, and NeuroScience - Siena - Italy
4Umea University Hospital, Department of Cardiology - Umea - Sweden
Purpose: Biatrial enlargement is common in athletes and a further increase in biatrial size can occur in response to training during the season. Although P-wave mophology seems to be unaffected by atrial size, data based on in-seasonal repeated measures are not available in top-athletes. Thus, the aim of this study was to investigate whether training-induced biatrial enlargement is able to change the ECG pattern in athletes.
Methods: Thirty-three professional, top-level athletes were evaluated at the beginning of the competitive season and after 6 months of training. Twenty-two sedentary subjects were used as controls. ECG and both standard and 2D speckle tracking echocardiography were used.
Results: Athletes had greater left atrial (LA) and right atrial (RA) size as compared with controls (p<.0001). A further increase in left and right atrial size was observed after training (p=.002 and p=.005, respectively). Neither athletes nor controls fulfilled the criteria for RA enlargement. No significant differences exist between athletes and controls for criteria for LA enlargement, although 6% of athletes fullfilled the ECG criteria for LA enlargement. After training, despite an increase in LA size, the percentage of athletes fulfilling these criteria did not vary. Of note, biatrial stiffness was normal both in athletes and in controls.
Conclusions: Despite a greater biatrial size and a further training-induced increase in biatrial dimensions, in top-level athletes ECG criteria for biatrial enlargement do not significantly vary during the season, suggesting that P-wave morphology is unaffected by atrial size. The finding of a normal biatrial stiffness suggests that, in absence of intra-atrial delay and in presence of a physiological remodelling, no pathological findings can be detected at 12-lead ECG.
athletes vs. controls
pre-training vs. post-training
LA volume index, mL/m2
20.7 ± 4.7
27.1 ± 6.6
31.1 ± 8.2
RA volume index, mL/m2
17.3 ± 3.8
23.4 ± 6.3
26.4 ± 6.4
LA enlargement criteria
RA enlargement criteria
Biatrial volumes and ECG criteria for biatrial enlargement in athletes and in controls.
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