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:

  1. 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.
  2. 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.
  3. Some data indicate a threshold requirement of 1,500-2,000 lifetime training hours before the risk of AF rises.
  4. 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.
  5. 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.
  6. 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.
  7. Other possible mechanisms include intermittent and intense sympathetic activation, pulmonary vein triggers, genetic factors, and performance-enhancing agents.
  8. 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.
  9. If a reduction in exercise intensity is ineffective, a rate- or rhythm-control strategy should be selected on an individualized basis.
  10. A recommendation regarding anticoagulation should be individualized, taking into account the same risk factors as in nonathletes.
  11. Catheter ablation is a reasonable option in athletes who do not respond to or chose not to pursue antiarrhythmic drug therapy.
  12. It is acceptable for athletes with AF that is well-tolerated to continue to compete without any therapy.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Prevention, Sports and Exercise Cardiology, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Exercise

Keywords: Anti-Arrhythmia Agents, Anticoagulants, Arrhythmias, Cardiac, Athletes, Atrial Fibrillation, Catheter Ablation, Exercise, Fibrosis, Inflammation, Jogging, Pulmonary Veins, Primary Prevention, Risk Factors

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