Atrial Fibrillation in Athletes: Virtue of Moderation
- Estes NA III, Madias C.
- Atrial Fibrillation in Athletes: A Lesson in the Virtue of Moderation. JACC Clin Electrophysiol 2017;3:921-928.
The following are key points to remember from this review of atrial fibrillation (AF) in athletes:
- Based on retrospective and observational studies, high-intensity endurance athletes have been estimated to have a 2- to 10-fold higher risk of developing AF compared with sedentary individuals.
- The Physicians’ Health Study, a large-scale observational study in 16,921 healthy men, reported that jogging 5-7 times/week was associated with a 53% higher odds of developing AF compared with men who did not exercise vigorously.
- Some data indicate a threshold requirement of 1,500-2,000 lifetime training hours before the risk of AF rises.
- More recent studies have indicated that vigorous exercise and the lack of exercise both are associated with a higher risk of AF and that mild-moderate exercise lowers the risk of AF.
- A recent meta-analysis suggests that whereas moderate exercise reduces the risk of AF in men and women, intense exercise increases the risk in men but lowers the risk in women.
- Based on available evidence, the mechanisms by which intense exercise predisposes to AF are most likely to include atrial fibrosis, inflammation, atrial enlargement, and increased vagal tone.
- Other possible mechanisms include intermittent and intense sympathetic activation, pulmonary vein triggers, genetic factors, and performance-enhancing agents.
- Some studies have reported a marked reduction in AF burden after abstinence from exercise, lending support to a treatment strategy of reducing the intensity and duration of exercise in athletes with symptomatic AF.
- If a reduction in exercise intensity is ineffective, a rate- or rhythm-control strategy should be selected on an individualized basis.
- A recommendation regarding anticoagulation should be individualized, taking into account the same risk factors as in nonathletes.
- Catheter ablation is a reasonable option in athletes who do not respond to or chose not to pursue antiarrhythmic drug therapy.
- It is acceptable for athletes with AF that is well-tolerated to continue to compete without any therapy.
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