The idea that long-term endurance exercise increases the risk for arrhythmia should no longer be considered counterintuitive. The list of published studies confirming this association is long, and this week, it got a little longer.
In a study published in the European Heart Journal,[1] researchers from Sweden report a cohort study of more than 52,000 cross-country skiers followed for decades. These were no ordinary weekend athletes; the analyzed group included finishers of the Vasaloppet,[2] a grueling 90-km (55-mile) cross-country ski race. Reliable sources tell me that cross-country skiing over that distance is the Nordic equivalent of an Ironman or double marathon. Yikes.
The hypothesis of the study held that both the number of races completed (exercise dosage) and finishing time (exercise intensity) would be associated with arrhythmia. (I would have bet my new mountain bike on that one.)
The Results
The average age of athletes at study entry was 38 years, while the average age at first arrhythmia was 57 years. Of the 52,000 athletes studied, there were 919 inpatient visits for any arrhythmia during a mean follow-up of 9.7 years.
The most common diagnosis was atrial fibrillation (n = 681), followed by bradyarrhythmia (n = 119), including 34 athletes with complete atrioventricular (AV) block. Typical supraventricular tachycardia (SVT) occurred in 105 athletes, and premature ventricular contractions (PVCs)/ventricular tachycardia (VT) in 90. Only patients with symptoms were counted.
Athletes who completed the highest number of races had the highest risk for arrhythmia. Arrhythmia risk increased on a continuum by races completed, up to 30% higher for 5-time finishers. Exercise intensity mattered too: Those who had the fastest finishing times had the higher risk for arrhythmia.