December 1, 2018Open Access

Atrial fibrillation in athletes and general population

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial fibrillation (n=8901). Intervention: Athletes (endurance exercise) vs. General population (non-athletes). Primary outcome: Risk of atrial fibrillation (OR 2.34, 95% CI 1.04-5.28).

Key Result

Athletes had a significantly higher risk of atrial fibrillation compared to the general population (OR 2.34).

Study Design

Type

Meta-Analysis (n=8,901)

PICO

Population

Atrial fibrillation (n=8,901)

Intervention / Comparator

Athletes (endurance exercise) vs General population (non-athletes)

Primary Outcome

Risk of atrial fibrillation — OR 2.34 (1.04-5.28)

Main Result

Effect estimate: OR 2.34 (95% CI 1.04-5.28)

Limitations

The included studies in the athletic populations were of small size and not randomized controlled in nature.
The studies demonstrated significant heterogeneity.
Few studies had AF determined by self-reported questionnaires, which might lead to an underestimation of the events.

Abstract

BACKGROUND: Atrial fibrillation (AF) is the most common type of heart arrhythmia, but the impact of long-term, high-intensity endurance exercise on the risk of AF remains uncertain. METHODS: PubMed, EMBASE, and Cochrane library databases were searched till Nov 2017 to retrieve the articles. The included studies were summarized, pooled odds ratio (OR) and its 95% confidence interval (CI) were calculated. Both fixed and random effects models were used to combine the data. Stratified and logistic meta-regression analyses were performed to explore the sources of heterogeneity across studies. RESULTS: Nine studies including 2308 athletes and 6593 controls were eligible. Our results showed that the risk of AF was significantly higher in athletes than in general population (OR = 2.34, 95% CI = 1.04-5.28, Pheterogeneity<.001, I = 92.3%). Subgroup analysis based on gender and mean age demonstrated a significantly increased risk in men (OR = 4.03, 95% CI = 1.73-9.42, Pheterogeneity<.001, I = 82.7%) and participants with mean age <60 (OR = 3.24, 95% CI = 1.23-8.55, Pheterogeneity<.001, I = 84.3%). Furthermore, subgroup analysis based on type of athletes demonstrated a significantly increased risk of AF in participants with single type of sport (OR = 3.97, 95% CI = 1.16-13.62, Pheterogeneity = .018, I = 70.4%). Results remained unchanged after performing sensitivity analysis. Meta-regression showed that gender, age, type of study, sample size, and sports mode were unrelated to heterogeneity. CONCLUSION: Our study confirmed that the risk of AF was significantly higher in athletes than in general population, especially among men and participants aged <60.

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