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Atrial Fibrillation in Elite Athletes
Study Questions:
What is the incidence of atrial fibrillation (AF) among elite athletes?
Methods:
A retrospective, observational cohort study of all Spanish athletes (n = 6,813) referred to a single center was used to determine AF incidence from January 1997 through December 2017. Cross-sectional analysis was conducted to compare athletes with and without reported AF. The cohort covered most sports disciplines, and the studied athletes were on national teams and competed in major international events. All participants underwent at least 1 cardiologic evaluation, including assessment at the time of AF diagnosis. The diagnosis of AF was based on resting and/or exercise electrocardiogram and/or 24-hour Holter monitoring; atrial dimensions were based on echocardiography. Cardiologists responsible for echocardiographic assessment were not blinded to the condition (AF or no AF) of the athletes.
Results:
A total of 6,813 Spanish elite athletes (2,385 [35.0%] women) were referred for cardiac evaluation during the study period. Mean age was 22 ± 7 years, and mean time of competition was 8 ± 5 years. Including different types of sports, only 21 athletes (1 woman) had AF (paroxysmal [n = 18], persistent [n = 1], or long-standing persistent [n = 2]) during the 20-year study. In multivariate analysis, increasing values of age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.00-1.14), years of competition (OR, 1.14; 95% CI, 1.07-1.22), and left atrial anteroposterior diameter (OR, 1.21; 95% CI, 1.10-1.32) were associated with higher AF risk.
Conclusions:
The incidence of AF is low among young Spanish elite athletes, even when considering only endurance athletes. However, the authors concluded that potential contributors (particularly atrial remodeling) should be monitored.
Perspective:
Vigorous exercise, particularly endurance sports, might increase the risk of AF; however, there is variability in the reported frequency of AF among elite athletes (from 0.3-12.8%), and the underlying pathophysiologic source remains unclear. This large study suggests a low incidence of AF among elite athletes, albeit among a relatively young population, and the effect of life-time exercise on AF risk is not addressed. In addition, this study did not include prospective screening for AF, and the incidence of silent AF, therefore, might have been underestimated.
Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Noninvasive Imaging, Prevention, Sports and Exercise Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Echocardiography/Ultrasound, Exercise, Sports and Exercise and Imaging
Keywords: Arrhythmias, Cardiac, Athletes, Atrial Fibrillation, Atrial Remodeling, Echocardiography, Electrocardiography, Ambulatory, Exercise, Heart Atria, Primary Prevention, Risk, Sports
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