![]() Arrhythmia event rates were recorded from national inpatient databases. Fifty-two thousand seven hundred fifty-five Swedish long-distance cross-country skiers who completed a 90-km race between 19 were studied and followed up till 2005. The authors identify a reduction in AF risk in non-sedentary individuals who complete less than 2000 h of cumulative high-intensity exercise (OR 0.38) and increased risk in those with greater than 2000 h (OR 3.88).Ī number of centers have completed studies on highly selected groups of endurance athletes. Once again, a U-shaped relationship was identified. Care was taken to extend the study into levels of exertion that would include endurance training. have specifically looked at the dose-response relationship between physical activity and lone atrial fibrillation in a case-control study of 157 patients. Importantly, few patients within these populations exercised enough to be described as endurance athletes. Those with the greatest fitness demonstrate an increased incidence of AF. In keeping with this, further studies suggest that improved cardiorespiratory fitness as measured in METS achieved during exercise testing and VO2 max during cardiopulmonary exercise testing is associated with lower risk of AF at moderate levels. ![]() The Cardiovascular Health Study and the Norwegian Tromso survey both demonstrate in a large population that there is a reduction in AF prevalence in those who undertake moderate exercise, but more intense exercise may be associated with increased risk. The reference lists of the retrieved articles and the review articles published on the subject were also screened for eligible manuscripts. The following keywords were used: atrial fibrillation, athlete, exercise, sport, ablation, stroke, CHA 2DS 2-VASc. Finally, the authors will review treatment options for atrial fibrillation in athletic individuals.Īn extensive literature search was conducted using the PubMed database up until 2018. This review aims to evaluate the current literature, in an attempt to assess at what point does exercise increase the risk of atrial fibrillation and represent too much of a good thing, and whether the negative impact of AF ever outweighs the clear benefits of exercise. Hence, the relationship between exercise and AF is complicated. The 2016 European Society of Cardiology (ESC) guidelines for the management of AF state that “moderate regular physical activity is recommended to prevent AF, while athletes should be counselled that long-lasting intense sports participation can promote AF” (Class of recommendation 1, Level of evidence A). These data are now supported by a recent randomized controlled trial demonstrating a reduction in AF burden in an overweight population through moderate exercise. Notably, although sustained endurance training is associated with an increased AF burden, moderate exercise is associated with a reduction in AF risk in prospective epidemiological studies. However, data are not conclusive, controversy continues, and many questions remain unanswered. Ī growing list of publications have identified an association between AF and exercise, in particular endurance exercise. Atrial fibrillation is a leading cause of morbidity and mortality worldwide, with complications including thromboembolic stroke, cardiac failure, cognitive impairment, and a 1.5–1.9-fold increased risk of death independent of cardiovascular disease. Catheter ablation is effective and can allow return to full competition.Ītrial fibrillation (AF) is the most common sustained arrhythmia, affecting at least 1% of the general population. Current evidence suggests that treatment options for AF in athletes are similar to those used in the general population however, medical therapy may be poorly tolerated. Data is lacking in females and ethnic minorities. SummaryĪF is more prevalent in endurance athletes, particularly men and those who competed at a young age. Recent findingsĮmerging evidence suggests that female athletes may exhibit lower risk of AF, but data is limited in female endurance athletes. This review aims to critically review the literature and advise on how best to manage athletes with AF. The questions that arise therefore are whether AF is an acceptable byproduct of strenuous exercise, whether athletes who experience AF should be told to reduce exercise volume and how should they be managed. ![]() Overall, endurance athletes remain at lower cardiovascular risk and experience fewer strokes. ![]() It remains unclear at which point exercise may become detrimental. Moderate exercise reduces AF risk whereas intense strenuous exercise has been shown to increase AF burden. A complex relationship exists between exercise and atrial fibrillation (AF). ![]()
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