Low fitness levels were associated with elevated risk for atrial arrhythmias.
Older age is a major risk factor for atrial and ventricular arrhythmias, low fitness level appears to raise high atrial topic burden, according to findings presented at the European Society of Cardiology Congress.
“These findings are a powerful reminder that the heart often whispers before it shouts,” Amit Moses, MD, internal medicine resident at the Chaim Sheba Medical Center Ramat Gan, Israel, said in a press release. “Subtle signs, such as frequent irregular heartbeats and complex arrhythmias, give us an early warning of future risk before symptoms occur. This could allow early intervention to alter the trajectory of disease, allowing us to move to a new era of anticipatory heart medicine.”
Moses and colleagues screened 1,151 age 40 65 years with no evidence of CV symptoms or structural heart disease. All participants underwent 24-hour Holter monitoring and exercise stress testing. The analysis included 1,010 individuals (mean age, 52 years; 12% women).
The outcome of interest was atrial and ventricular ectopic burden; anyone above the median in either was considered at high burden, as well as anyone confirmed to have a complex arrhythmia such as atrial fibrillation, supraventricular tachycardia and nonsustained ventricular tachycardia.
Among the cohort, 32% had supraventricular tachycardia, 6% had nonsustained ventricular tachycardia and 4% had AF.
In a univariate analysis, high atrial ectopic burden was associated with older age, male sex, lower fitness levels as determined by metabolic equivalents of task, hypertension and reduced estimated glomerular filtration rate, high ventricular ectopic burden was associated with older age and reduced eGFR.
In a multivariate analysis, older age (OR = 1.08; 95% CI, 1.06-1.11; P < .001) and lower fitness levels (OR = 1.52; 95% CI, 1.11-2.04; P = .008) were independent risk factors for high atrial ectopic burden, older age was an independent risk factor for high ventricular ectopic burden (OR = 1.04; 95% CI, 1.02-1.06; P < .001).
"We were particularly struck by the strength of the association between lower aerobic fitness levels and higher risk of frequent atrial ectopy and complex arrhythmias," Moses said in the release. "This is further evidence that maintaining good physical fitness should be a priority for everyone to improve their heart health and prevent the development of arrhythmias later in life. Exercise should be tailored to one's age and capacity, and can involve simple and cheap activities such as walking, running, cycling or other aerobic activities performed consistently."
In addition, the researchers found, low eGFR was linked high atrial ectopic burden (OR = 0.98; 95% CI, 0.97-0.99; P = .046) and high ventricular ectopic burden (OR = 0.98; 95% CI, 0.97-0.99; P = .034).
"Our findings suggest that risk of arrhythmia begins to increase well before typical retirement age," Moses said in the release. "They strongly support the need to screen older adults for arrhythmias, beginning at around age 50, to allow for timely intervention and improved long-term outcomes."
He said limitations of the study include its observational nature and the lack of diversity in the patient population.
"Future research will be needed to tell us whether it is possible to intervene early to reduce the risk of arrhythmias using lifestyle changes, exercise programs or pharmacological treatments," he said.
Older age and low fitness levels are associated with heartbeat abnormalities that increase future cardiovascular risk. https://www.escardio.org/The-ESC/Press-Office/Press-releases/Older-age-and-low-fitness-levels-are-associated-with-heartbeat-abnormalities-that-increase-future-cardiovascular-risk. Published Aug 27, 2025. Accessed Aug 29, 2025.
