Abstract：
UNASSIGNED: Bradycardia is more common among well-trained athletes than in the general population, but the association with pacemaker implantations is less known. We investigated associations of endurance training with incidence of bradycardia and pacemaker implantations, including sex differences and long-term outcome, in a cohort of endurance trained individuals.
UNASSIGNED: All Swedish skiers who completed >1 race in the cross-country skiing event Vasaloppet between 1989 and 2011 (n=209 108) and a sample of 532 290 nonskiers were followed until first event of bradycardia, pacemaker implantation, or death, depending on end point. The Swedish National Patient Register was used to obtain diagnoses. Cox regression was used to investigate associations of number of completed races and finishing time in Vasaloppet with incidence of bradycardia and pacemaker implantations. In addition, Cox regression was used to investigate associations of pacemaker implantations with death in skiers and nonskiers.
UNASSIGNED: 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. Those who completed the most races and had the best performances exhibited the highest incidence. For female skiers in Vasaloppet, the incidence of bradycardia (aHR, 0.98 [95% CI, 0.75-1.30]) and pacemaker implantations (aHR, 0.98 [95% CI, 0.75-1.29]) was not different from that of female nonskiers. The indication for pacemaker differed between skiers and nonskiers, with sick sinus syndrome more common in the former and third-degree atrioventricular block in the latter. Skiers had lower overall mortality rates than nonskiers (aHR, 0.16 [95% CI, 0.15-0.17]). There were no differences in mortality rates by pacemaker status among skiers.
UNASSIGNED: In this study, male endurance skiers had a higher incidence of bradycardia and pacemaker implantations compared with nonskiers, a pattern not seen in women. Among male skiers, those who completed the most races and had the fastest finishing times had the highest incidence of bradycardia and pacemaker implantations. Within each group, mortality rates did not differ in relation to pacemaker status. These findings suggest that bradycardia associated with training leads to a higher risk for pacemaker implantation without a detrimental effect on mortality risk.
UNASSIGNED: All Swedish skiers who completed >1 race in the cross-country skiing event Vasaloppet between 1989 and 2011 (n=209 108) and a sample of 532 290 nonskiers were followed until first event of bradycardia, pacemaker implantation, or death, depending on end point. The Swedish National Patient Register was used to obtain diagnoses. Cox regression was used to investigate associations of number of completed races and finishing time in Vasaloppet with incidence of bradycardia and pacemaker implantations. In addition, Cox regression was used to investigate associations of pacemaker implantations with death in skiers and nonskiers.
UNASSIGNED: 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. Those who completed the most races and had the best performances exhibited the highest incidence. For female skiers in Vasaloppet, the incidence of bradycardia (aHR, 0.98 [95% CI, 0.75-1.30]) and pacemaker implantations (aHR, 0.98 [95% CI, 0.75-1.29]) was not different from that of female nonskiers. The indication for pacemaker differed between skiers and nonskiers, with sick sinus syndrome more common in the former and third-degree atrioventricular block in the latter. Skiers had lower overall mortality rates than nonskiers (aHR, 0.16 [95% CI, 0.15-0.17]). There were no differences in mortality rates by pacemaker status among skiers.
UNASSIGNED: In this study, male endurance skiers had a higher incidence of bradycardia and pacemaker implantations compared with nonskiers, a pattern not seen in women. Among male skiers, those who completed the most races and had the fastest finishing times had the highest incidence of bradycardia and pacemaker implantations. Within each group, mortality rates did not differ in relation to pacemaker status. These findings suggest that bradycardia associated with training leads to a higher risk for pacemaker implantation without a detrimental effect on mortality risk.
摘要：
■心动过缓在训练有素的运动员中比在普通人群中更常见，但与起搏器植入的关联鲜为人知。我们调查了耐力训练与心动过缓和起搏器植入发生率的关系，包括性别差异和长期结果，在一群耐力训练过的人中。
■所有在1989年至2011年之间在越野滑雪比赛Vasaloppet中完成1场比赛的瑞典滑雪者（n=209108）和532290名非滑雪者的样本被跟踪，直到第一场心动过缓，起搏器植入,或死亡，取决于终点。瑞典国家患者登记册用于获得诊断。Cox回归用于调查Vasaloppet的完成比赛次数和完成时间与心动过缓和起搏器植入发生率的关系。此外,Cox回归用于研究起搏器植入与滑雪者和非滑雪者死亡的关系。
■男性滑雪者的心动过缓发生率较高（调整后的危险比[aHR]，1.19[95%CI，1.05-1.34])和起搏器植入(AHR，1.17[95%CI，1.04-1.31]）与男性非滑雪者相比。完成比赛最多，表现最好的人的发病率最高。对于Vasaloppet的女性滑雪者来说，心动过缓的发生率(AHR，0.98[95%CI，0.75-1.30])和起搏器植入(AHR，0.98[95％CI，0.75-1.29]）与女性非滑雪者没有差异。滑雪者和非滑雪者的起搏器适应症不同，病态窦房结综合征多见于前者，三度房室传导阻滞多见于后者。滑雪者的总死亡率低于非滑雪者(AHR，0.16[95%CI，0.15-0.17]）。滑雪者之间起搏器状态的死亡率没有差异。
■在这项研究中，与非滑雪者相比，男性耐力滑雪者的心动过缓和起搏器植入发生率更高，一种在女性身上看不到的模式。在男性滑雪者中，那些完成最多比赛和完成时间最快的人，心动过缓和起搏器植入的发生率最高。在每一组中,死亡率与起搏器状态没有差异.这些发现表明，与训练相关的心动过缓会导致起搏器植入的风险更高，而不会对死亡风险产生不利影响。
■所有在1989年至2011年之间在越野滑雪比赛Vasaloppet中完成1场比赛的瑞典滑雪者（n=209108）和532290名非滑雪者的样本被跟踪，直到第一场心动过缓，起搏器植入,或死亡，取决于终点。瑞典国家患者登记册用于获得诊断。Cox回归用于调查Vasaloppet的完成比赛次数和完成时间与心动过缓和起搏器植入发生率的关系。此外,Cox回归用于研究起搏器植入与滑雪者和非滑雪者死亡的关系。
■男性滑雪者的心动过缓发生率较高（调整后的危险比[aHR]，1.19[95%CI，1.05-1.34])和起搏器植入(AHR，1.17[95%CI，1.04-1.31]）与男性非滑雪者相比。完成比赛最多，表现最好的人的发病率最高。对于Vasaloppet的女性滑雪者来说，心动过缓的发生率(AHR，0.98[95%CI，0.75-1.30])和起搏器植入(AHR，0.98[95％CI，0.75-1.29]）与女性非滑雪者没有差异。滑雪者和非滑雪者的起搏器适应症不同，病态窦房结综合征多见于前者，三度房室传导阻滞多见于后者。滑雪者的总死亡率低于非滑雪者(AHR，0.16[95%CI，0.15-0.17]）。滑雪者之间起搏器状态的死亡率没有差异。
■在这项研究中，与非滑雪者相比，男性耐力滑雪者的心动过缓和起搏器植入发生率更高，一种在女性身上看不到的模式。在男性滑雪者中，那些完成最多比赛和完成时间最快的人，心动过缓和起搏器植入的发生率最高。在每一组中,死亡率与起搏器状态没有差异.这些发现表明，与训练相关的心动过缓会导致起搏器植入的风险更高，而不会对死亡风险产生不利影响。
