Endurance Sport Activity and Risk of Atrial Fibrillation – Epidemiology, Proposed Mechanisms and Management

Q: What is the clinical evidence from this study?

Study design: Review. Population: Atrial fibrillation in athletes. Intervention: Long-term endurance sports training vs. General population or sedentary controls. Primary outcome: Prevalence and risk of atrial fibrillation.

Nikolaos Fragakis; Gabriele Vicedomini; Carlo Pappone

doi:10.15420/aer.2011.3.1.15

April 30, 2014Arrhythmia & Electrophysiology ReviewOpen Access

Endurance Sport Activity and Risk of Atrial Fibrillation – Epidemiology, Proposed Mechanisms and Management

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Key result

Long-term endurance training linked to up to ~10-fold higher AF prevalence vs non-athletes.

Why the study?

Does long-term endurance sport activity increase the risk of atrial fibrillation compared to the general population, and what are the optimal management strategies?

Key Points

Review the epidemiology of atrial fibrillation in endurance athletes, examine potential underlying pathophysiological mechanisms, and evaluate current clinical management strategies.
Narrative review evaluating epidemiological studies, pathophysiological concepts, and therapeutic interventions for atrial fibrillation in athletic cohorts.
Examined clinical data comparing incidence rates between young athletes and middle-aged or older endurance participants.
Athletes engaged in long-term endurance training show a 2- to 10-fold higher prevalence of atrial fibrillation than the general population, including a reported odds ratio of 5.5 in middle-aged cross-country runners.
Studies in young athletes with few training years observed low atrial fibrillation rates (0.2% and 0.3%), mirroring the general population rate of 0.5% in men under 40 years.
Catheter ablation achieves outcomes similar to those in non-athletes, whereas antiarrhythmic medications remain limited due to adverse effects on exercise tolerance and sports eligibility rules.

Structured PICO

Does long-term endurance sport activity increase the risk of atrial fibrillation compared to the general population, and what are the optimal management strategies?

P

Population

Athletes, predominantly middle-aged men, engaged in long-term endurance sports training evaluated for the prevalence, mechanisms, and management of atrial fibrillation.

E

Exposure

Long-term endurance sports training (for epidemiology/risk) and management strategies including detraining, pharmacological therapy ('pill in the pocket' with class IC agents), and catheter ablation (pulmonary vein isolation, cavotricuspid isthmus ablation)

C

Comparator

General population or non-athlete controls

O

Outcome

Prevalence and incidence of atrial fibrillation, and maintenance of sinus rhythm following treatmenthard clinical

This narrative review highlights that while mild-to-moderate exercise protects against cardiovascular disease, long-term vigorous endurance training increases the risk of atrial fibrillation 2- to 10-fold, with catheter ablation serving as a valid therapeutic option to avoid the limitations of medical therapy in athletes.

Limitations

Lack of prospective studies where exercise dose was accurately measured over many years
Proposed pathophysiological mechanisms (atrial adaptation, autonomic alterations, inflammation, fibrosis) remain speculative
Lack of randomized studies to produce clear treatment guidelines for athletes with AF
Studies evaluating pulmonary vein isolation in athletes have small sample sizes and relatively limited follow-up periods
Lack of prospective studies where the exercise dose was accurately measured and athletes were followed over many years
Proposed pathophysiological mechanisms connecting exercise and AF remain speculative and unproven in human clinical studies
Lack of randomized clinical trials for AF treatment in athletes to guide clear recommendations
Studies on catheter ablation in athletes are limited by small numbers of subjects and relatively short follow-up periods

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May inform AF risk counseling in endurance athletes; leaves open causal mechanisms and preventive strategies.

Abstract

There is evidence for a higher prevalence of atrial fibrillation (AF) in athletes engaged in long-term endurance sports training compared with the general population. Although atrial anatomic adaptations, alterations in autonomic nervous system, chronic systemic inflammation and fibrosis have been proposed as potential mechanisms, they remain speculative. Medical therapy with long-term antiarrhythmic agents or 'pill in the pocket' medications is hampered by limitations, such as sports eligibility and interference with exercise tolerance. AF ablation represents a valid therapeutic option with results similar to these achieved in other patients. Nevertheless, further clinical trials are needed to confirm whether endurance sport practice affects the maintenance of sinus rhythm following catheter ablation of AF.

Discussion

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Cite This Study

Fragakis et al. (2014) conducted a review in Atrial fibrillation in athletes. Long-term endurance sports training vs. General population or sedentary controls was evaluated on Prevalence and risk of atrial fibrillation. Long-term endurance sports training is associated with a 2- to 10-fold higher prevalence of atrial fibrillation compared with the general population, with catheter ablation offering outcomes similar to non-athletes.

synapsesocial.com/papers/6a7b275ffb5b6b43000e3362 https://doi.org/10.15420/aer.2011.3.1.15

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Endurance Sport Activity and Risk of Atrial Fibrillation – Epidemiology, Proposed Mechanisms and Management

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Endurance Sport Activity and Risk of Atrial Fibrillation – Epidemiology, Proposed Mechanisms and Management

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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