Characterization of atrial fibrillation and the effect of pulmonary vein antrum isolation in endurance athletes

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=22). Intervention: Pulmonary vein antrum isolation (PVAI). Primary outcome: Elimination of atrial fibrillation without antiarrhythmic drugs.

Q: What does this research mean for the field?

Pulmonary vein antrum isolation is an effective non-pharmacological therapy that eliminates atrial fibrillation without antiarrhythmic drugs in 82% of endurance athletes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Takanori Yamaguchi; Takeshi Tsuchiya; Yasutsugu Nagamoto; Koji Miyamoto; Naohiko Takahashi

doi:10.1016/j.joa.2011.12.002

April 24, 2012Journal of ArrhythmiaOpen Access

Characterization of atrial fibrillation and the effect of pulmonary vein antrum isolation in endurance athletes

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Key result

PVAI linked to AF elimination without antiarrhythmic drugs in ~82% of endurance athletes.

n=22

Why the study?

Endurance sports have recently been recognized as a risk factor for atrial fibrillation, but characterization of AF and efficacy of pulmonary vein antrum isolation in this population remain unclear.

Does pulmonary vein antrum isolation (PVAI) eliminate atrial fibrillation in endurance athletes?

Study Design

Type

Observational (n=22)

Structured PICO

Does pulmonary vein antrum isolation (PVAI) eliminate atrial fibrillation in endurance athletes?

P

Population

22 male endurance athletes (mean age 46) with atrial fibrillation and no other risk factors, with a subset followed for an average of 21 months after pulmonary vein antrum isolation.

E

Exposure

Pulmonary vein antrum isolation (PVAI) (performed in 11 patients)

O

Outcome

Elimination of atrial fibrillation

Pulmonary vein antrum isolation appears to be an effective non-pharmacologic therapy for eliminating atrial fibrillation in endurance athletes, who frequently present with reduced exercise tolerance despite being asymptomatic at rest.

Implication

May support PVAI consideration in endurance athletes with AF; hypothesis-generating and requires confirmation in larger trials.

Abstract

Introduction Endurance sports have recently been recognized as a risk factor for atrial fibrillation (AF). This study aimed to characterize AF in endurance athletes and to examine the efficacy of pulmonary vein antrum isolation (PVAI) in an attempt to clarify the mechanism. Methods and results Twenty‐two men (46±8 years old) with AF, who had no risk factors other than participation in long‐term endurance sports, were examined; 12 patients had paroxysmal AF, 9 had persistent AF, and 1 had long‐standing AF. Twelve patients (55%) were asymptomatic at rest. Nineteen patients (86%) experienced less exercise tolerance during AF than during sinus rhythm; exercise‐induced paroxysmal AF was noted in 14 of these patients (64%). Antiarrhythmic drugs (AADs) were used in 18 patients, but were effective in only 3 patients (16%). Eleven patients underwent PVAI; in these patients, AF was eliminated without AADs in 9 patients (82%) and with AADs in 2 patients over an average follow‐up period of 21±9 months. Conclusion AF in endurance athletes is frequently asymptomatic at rest, but manifests as reduced exercise tolerance. AF originates from the pulmonary veins; PVAI could be an effective non‐pharmacologic therapy.

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Cite This Study

Yamaguchi et al. (2012) conducted an observational in Atrial fibrillation (n=22). Pulmonary vein antrum isolation (PVAI) was evaluated on Elimination of atrial fibrillation without antiarrhythmic drugs. Pulmonary vein antrum isolation eliminated atrial fibrillation without antiarrhythmic drugs in 82% (9 of 11) of endurance athletes over an average follow-up of 21 months.

synapsesocial.com/papers/6aaa0bf278e2697aa3f6aea2 https://doi.org/10.1016/j.joa.2011.12.002