In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

The free consultation period for this content is over.

It is now only available year-round to EAPC Ivory (& above) Members, Fellows of the ESC and Young combined Members

Training-induced atrial morphological and electrical remodeling: a prospective, longitudinal study in top-level athletes

Session Poster Session V - Saturday 08:30 -12:30

Speaker Assistant Professor Flavio D'Ascenzi

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2015

  • Topic : preventive cardiology
  • Sub-topic : Sports Cardiology
  • Session type : Poster Session

Authors : F D'ascenzi (Siena,IT), M Solari (Siena,IT), M Biagi (Siena,IT), F Cassano (Siena,IT), M Focardi (Siena,IT), M Henein (Umea,SE), M Bonifazi (Siena,IT), S Mondillo (Siena,IT)

F D'ascenzi1 , M Solari1 , M Biagi1 , F Cassano1 , M Focardi1 , M Henein2 , M Bonifazi3 , S Mondillo1 , 1University of Siena, Department of Cardiovascular Diseases - Siena - Italy , 2Umea University Hospital, Department of Cardiology - Umea - Sweden , 3University of Siena, Department of Medicine, Surgery, and NeuroScience - Siena - Italy ,


Background. Biatrial enlargement is common in athletes and a further increase in biatrial size can occur in response to training. P-wave morphology seems to be unaffected by atrial size, however specific, longitudinal data are not available in top-athletes. Thus, the aim of this study was to investigate whether biatrial enlargement occurring in response to training is able to change the ECG pattern in athletes.
Methods. Fifty-five subjects were enrolled. 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. Athletes and controls were evaluated by ECG and both standard and 2D speckle tracking echocardiography.
Results. As expected, athletes had greater left atrial (LA) and right atrial (RA) size as compared with controls (p<.0001). After training, a further increase in LA and RA size was observed (p=.002 and p=.005, respectively). The increase in biatrial size was accompanied by an increase in both left and right ventricular size (p<.001 and p<.05, respectively). None of the participants fulfilled the criteria for RA enlargement. No significant differences existed between athletes and controls for criteria for LA enlargement, although 6% of athletes fulfilled these criteria. After training, despite an increase in LA size, the percentage of athletes fulfilling criteria for LA enlargement did not vary. Biatrial stiffness was normal both in athletes and in controls. Conclusions. Despite a greater biatrial size as compared with controls and despite a further training-induced increase in biatrial dimensions, in top-level athletes ECG criteria for biatrial enlargement do not significantly vary with training. The finding of a normal biatrial stiffness suggests that, in absence of intra-atrial delay and in presence of a physiological global remodelling, no pathological findings can be detected at 12-lead ECG.




P value

athletes vs. controls

P value

pre- 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






LA, left atrial; RA, right atrial.

Get your access to resources

Join now
  • 1ESC Professional Members – access all ESC Congress resources 
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s resources
  • 3Under 40 or in training - with a Combined Membership, access all resources
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are