Long-term efficacy and impact on quality of life of atrial fibrillation catheter ablation in competitive athletes

Elisabetta Toso; Marco Gagliardi; Mattia Peyracchia; Filippo Angelini; Matteo Anselmino; Federico Ferraris; Carla Giustetto; Marco Scaglione; Fiorenzo Gaïta

doi:10.23736/s0022-4707.21.13257-8

December 21, 2021The Journal of Sports Medicine and Physical Fitness

Long-term efficacy and impact on quality of life of atrial fibrillation catheter ablation in competitive athletes

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Why the study?

Data are limited regarding the long-term efficacy of catheter ablation for sport-associated AF, and its impact on quality of life and training capabilities in competitive athletes remains unknown.

Does catheter ablation improve quality of life and prevent atrial fibrillation recurrence in competitive athletes?

Structured PICO

Does catheter ablation improve quality of life and prevent atrial fibrillation recurrence in competitive athletes?

P

Population

133 competitive athletes with atrial fibrillation (defined as performing ≥5 h/week of vigorous sports, achieving a total of ≥1500 h lifetime sport activity, for at least one year before AF first symptomatic episode) out of 1215 screened AF patients.

I

Intervention

Catheter ablation

O

Outcome

Atrial fibrillation recurrence, Quality of Life (SF36 score), and training capabilities at 10-year follow-up

Catheter ablation is highly effective for maintaining sinus rhythm and improving quality of life and training capabilities in competitive athletes with atrial fibrillation over a 10-year follow-up.

Implication

Supports ablation for AF in athletes; extends long-term observational data but leaves open need for RCTs.

Abstract

BACKGROUND: Limited data are available on the efficacy of catheter ablation (CA) for sport-associated atrial fibrillation (AF), in particular at long term follow-up. Moreover, the impact of AF CA on Quality of Life (QoL) in this population remains unknown. We aimed to determine AF CA efficacy in athletes, to assess the impact on athletes' QoL (with SF36 score) and on training capabilities in a long-term follow-up (FU). METHODS: A total of 1215 AF patients' candidates to CA between January 2007 and December 2012, were retrospectively screened. Athletes were defined as patients performing ≥5 h/week of vigorous sports, achieving a total of ≥1500 h lifetime sport activity, for at least one year before AF first symptomatic episode. RESULTS: Out of 1215 AF patients, 133 were considered competitive athletes and underwent CA. Overall, 43% of our cohort showed typical or atypical atrial flutter, which required a more extensive ablation procedure. Before AF, athletes used to practice for a mean of 8.5±2.7 h/week, while after the first AF episode the mean practice duration decreased to 2.8±2.5 h/week. At 10-year follow-up, 83% of athletes did not present any recurrent event, and training capabilities increased up to 5.6±3.6 h/week after the procedure. Moreover, intense physical activity before AF CA was related to long-term AF recurrence rates (P=0.05). QoL scores significantly improved in each single domain (P<0.05). CONCLUSIONS: AF CA represents an effective procedure to maintain sinus rhythm in athletes, with a significant improvement in QoL.