Age modifies the risk of atrial fibrillation among athletes: A systematic literature review and meta-analysis

BACKGROUND: The relationship between competitive sports and atrial fibrillation (AF) is controversial. We aimed to systematically evaluate and summarize all published observational data on the association between competitive sports and AF. METHODS AND RESULTS: We searched PubMed, EMBASE, Scopus and SportDiskus for all observational studies that assessed the risk of AF among athletes involved in competitive sports. Data were extracted and pooled odds ratios (OR) were calculated using random effects models. Six cohort studies and 2 case-control studies with a total of 9113 subjects were included in our meta-analysis. Pooled analyses showed an increased risk of incident and prevalent AF among athletes compared to the general population (OR = 1.64 [95% confidence interval (CI): 1.10-2.43]). Age-stratified analysis revealed an effect modification with age. Studies enrolling younger adults (<54 years) had an increased risk of AF among athletes compared to controls (OR = 1.96 [95% CI: 1.06-3.65]), but this association was not seen among older adults ≥54 years (OR = 1.41 [95% CI: 0.81-2.44], p = 0.23). CONCLUSION: Athletes have an increased risk of AF compared to the general population. Age appears to modify the risk of AF in athletes.