Log in to MyACC
Pacemaker Implantation Among Cross-Country Skiers
Quick Takes
- Male skiers, especially those performing at a higher level, exhibited a higher incidence of bradycardia and pacemaker implantations compared to nonskiers; however, this association was not observed in the female population.
- Comparing the indications for pacemaker implantation, sick sinus syndrome including associated atrial fibrillation was more common in high-intensity endurance training skiers compared to third-degree atrioventricular block in nonskiers.
- High performing skiers with pacemaker implantation did not have a long-term higher mortality risk compared to the general population.
Study Questions:
Does prolonged, high-intensity endurance training increase the risk of bradycardia requiring pacemaker implantation and ultimately the long-term mortality risk?
Methods:
Using the Swedish National Patient Register database, a retrospective analysis was performed on two groups: high-intensity endurance training cross-country skiers who completed >1 race between 1989 and 2011 (n = 209,108) and nonskiers in the general population (n = 532,290) to compare the incidence of their first event of bradycardia, pacemaker implantation, or death. Cox regression was used to analyze the association between the number of races, the finishing place, and sex with the long-term incidence of bradycardia, pacemaker implantation, and death between the groups.
Results:
At baseline, skiers were younger than nonskiers (median age, 37.4 vs. 41.7 years) and had fewer concomitant diseases. Skiers were younger than nonskiers at time of pacemaker implantation (mean age, 63.5 vs. 65.1 years, respectively). After adjusting for comorbidities between the groups, male skiers had a higher incidence of bradycardia (adjusted hazard ratio [aHR], 1.19 [95% CI, 1.05–1.34]) and pacemaker implantations (aHR, 1.17 [95% CI, 1.04–1.31]) compared with male nonskiers. Males completing more races and performing with better times exhibited the highest incidence of bradycardia. Female skiers did not have a significant incidence of bradycardia (aHR, 0.98 [95% CI, 0.75–1.30]) and pacemaker implantations (aHR, 0.98 [95% CI, 0.75–1.29]) compared to female nonskiers. Sick sinus syndrome, in association with atrial fibrillation, was the more common indication for pacemaker implantation in skiers compared to third-degree atrioventricular block in nonskiers. Long-term follow-up (median 8.8 years) revealed that skiers had an overall lower mortality rate than nonskiers (aHR, 0.16 [95% CI, 0.15–0.17]). There was no significant difference in mortality rates among skiers with or without pacemaker implantation.
Conclusions:
Overall, skiers had a lower mortality rate compared with nonskiers. Male endurance skiers, especially those completing the most races and performing at a higher level, had a higher incidence of bradycardia and pacemaker implantations compared with nonskiers; however, the mortality risk did not differ between the groups nor with skiers without pacemakers.
Perspective:
Although likely leading a healthier lifestyle, endurance athletes have a higher incidence of long-term bradyarrhythmias and atrial fibrillation in response to structural and electrical cardiac adaptations. Therefore, finishing first in a race or setting records is nice, but these athletes have a greater future need for pacemaker implantation without an improved mortality benefit compared to the general population or in lower performing athletes without a pacemaker. The findings of this study are also helpful when counseling a patient or providing a health screening for sports or exercise participation before initiating a program. Clinicians can assess the suitability and intensity of the exercise regimen while factoring in the patient’s comorbidities.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Sports and Exercise Cardiology, Implantable Devices, Exercise
Keywords: Bradycardia, Endurance Training, Pacemaker, Artificial
< Back to Listings
