Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study

Molina, Lluís; Mont, Lluı́s; Marrugat, Jaume; Berruezo, Antonio; Brugada, Josep; Bruguera, Jordi; Rebato, Carolina; Elosúa, Roberto

doi:10.1093/europace/eun071

Cited by 286 publications

(198 citation statements)

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“…29,31,54 Indeed, long-term sustained vigorous aerobic ET such as marathon or ultramarathon running or professional cycling has been associated with as much as a 5-fold increase in the prevalence of atrial fibrillation. 19,30,31,37,[55][56][57][58][59][60][61][62][63] Potential mechanisms underlying the association of long-term excessive exercise and atrial fibrillation are speculative but may include increased vagal and sympathetic tone, bradycardia, inflammatory changes, atrial wall fibrosis, and increased atrial size. 59 Some data indicate that atrial size may be larger in veteran endurance athletes than in age-matched sedentary controls.…”

Section: Proarrhythmic Effects Of Excessive Endurance Etmentioning

confidence: 99%

Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise

O’Keefe

Patil

Lavie

et al. 2012

Mayo Clinic Proceedings

335

305

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A routine of regular exercise is highly effective for prevention and treatment of many common chronic diseases and improves cardiovascular (CV) health and longevity. However, long-term excessive endurance exercise may induce pathologic structural remodeling of the heart and large arteries. Emerging data suggest that chronic training for and competing in extreme endurance events such as marathons, ultramarathons, ironman distance triathlons, and very long distance bicycle races, can cause transient acute volume overload of the atria and right ventricle, with transient reductions in right ventricular ejection fraction and elevations of cardiac biomarkers, all of which return to normal within 1 week. Over months to years of repetitive injury, this process, in some individuals, may lead to patchy myocardial fibrosis, particularly in the atria, interventricular septum, and right ventricle, creating a substrate for atrial and ventricular arrhythmias. Additionally, long-term excessive sustained exercise may be associated with coronary artery calcification, diastolic dysfunction, and large-artery wall stiffening. However, this concept is still hypothetical and there is some inconsistency in the reported findings. Furthermore, lifelong vigorous exercisers generally have low mortality rates and excellent functional capacity. Notwithstanding, the hypothesis that long-term excessive endurance exercise may induce adverse CV remodeling warrants further investigation to identify at-risk individuals and formulate physical fitness regimens for conferring optimal CV health and longevity.

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Section: Proarrhythmic Effects Of Excessive Endurance Etmentioning

confidence: 99%

Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise

O’Keefe

Patil

Lavie

et al. 2012

Mayo Clinic Proceedings

335

305

View full text Add to dashboard Cite

show abstract

“…Low-level vagal stimulation prevents AF by decreasing sympathetic and parasympathetic cardiac responsiveness in animal models susceptible to AF 74 . High-intensity endurance training is an evolving risk factor underlying AF in middle-aged Europeans without overt structural heart disease 75,76 , which can be mediated by an elevated parasympathetic tone, structural changes, or by changes in ion-channel expression 14,73,77 . Similarly, AF in patients with obstructive sleep apnoea can be provoked by autonomic imbalance 14,78 .…”

Section: Autonomic Dysfunctionmentioning

confidence: 99%

Defining the major health modifiers causing atrial fibrillation: a roadmap to underpin personalized prevention and treatment

et al. 2015

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Despite the important advances that have enabled better stroke prevention in atrial fibrillation (AF) and more effective maintenance of sinus rhythm over the past decades, a large unmet need to improve the prevention and treatment of AF remains. Mortality for AF remains at 3.5% per year, and death is often experienced as sudden death or as a result of heart failure 1,2 . Each year, approximately 20% of patients with AF need to be hospitalized 3,4 , and stroke occurs in 1.5% of patients with AF who are receiving anticoagulant drugs 5 . Furthermore, more than half of the patients with AF are symptomatic despite adequate anticoagulation and rate control 4,6 . In view of the projected increase in the incidence and prevalence of AF 7-9 , as well as the substantial burden of death and dis ability that is still associated with this condition 10 , the status quo is unacceptable.Current management of patients with AF comprises treatment of the accompanying cardiovascular conditions, oral anticoagulation, rate control -with medications that slow atrioventricular nodal recovery or, rarely, with atrioventricular nodal ablation -and rhythm-control therapy with antiarrhythmic drugs, electrical cardioversion, catheter ablation or, at times, AF surgery 11,12 . Unfortunately, most of these current approaches are disconnected from our understanding of the major mechanisms that cause AF 1,13,14 1,2,7,19,20 Abstract | Despite remarkable advances in antiarrhythmic drugs, ablation procedures, and stroke-prevention strategies, atrial fibrillation (AF) remains an important cause of death and disability in middle-aged and elderly individuals. Unstructured management of patients with AF sharply contrasts with our detailed, although incomplete, knowledge of the mechanisms that cause AF and its complications. Altered calcium homeostasis, atrial fibrosis and ageing, ion-channel dysfunction, autonomic imbalance, fat-cell infiltration, and oxidative stress, in addition to a susceptible genetic background, contribute to the promotion, maintenance, and progression of AF. However, clinical management of patients with AF is currently guided by stroke risk parameters, AF pattern, and symptoms. In response to this apparent disconnect between the known pathophysiology of AF and clinical management, we propose a roadmap to develop a set of clinical markers that reflect the major causes of AF in patients. Thereby, the insights into the mechanisms causing AF will be transformed into a format that can underpin future personalized strategies to prevent and treat AF, ultimately informing better patient care.230 | APRIL 2016 | VOLUME 13 www.nature.com/nrcardio CONSENSUS STATEMENT © 2 0 1 6 M a c m i l l a n P u b l i s h e r s L i m i t e d . A l l r i g h t s r e s e r v e d .

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“…6,[8][9][10][11][12][13][14][15] Furlanello et al 16 and Pelliccia et al 17 reported a low rate of AF (0.2 % and 0.3 %, respectively), no different from that observed in the general population. However, both studies included exclusively young athletes with relatively fewer years of training.…”

Section: Prevalence and Incidence Of Atrial Fibrillation In Endurancementioning

confidence: 91%

Endurance Sport Activity and Risk of Atrial Fibrillation – Epidemiology, Proposed Mechanisms and Management

Fragakis

Vicedomini

Pappone

2011

Arrhythmia &Amp; Electrophysiology Review

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Although atrial fibrillation (AF) is considered the most common arrhythmia in clinical practice, its prevalence is relatively low in the young and middle-aged, ranging from 0.5 % in men below 40 years to 1 % by 60 years.1,2 Regular exercise is proposed as a powerful tool for the primary and secondary prevention of cardiovascular disease, reducing most of the risk factors that predispose to AF, such as hypertension, diabetes mellitus, coronary artery disease and obesity.3,4 However, there is growing evidence that long-term endurance exercise may increase the risk of developing AF, with a reported 2-10 times greater prevalence in athletes and those who are involved in long-term sport participation. 5Why athletes should be susceptible to AF is an issue of ongoing debate. Several mechanisms underlying the association between exercise and AF have been proposed but they remain speculative.It is of interest that adaptations such as sinus bradycardia and atrioventricular node disturbances, which are generally considered benign and reversible after a short period of detraining, have been considered by some investigators as a reason for AF development in elderly athletes. 6 It is clear that AF in athletes has some differences in cause, clinical presentation and treatment strategies compared with the general population. The aim of this short review is to present the existing data about the epidemiology of AF in athletes and those engaged in long-term endurance sport practice, to analyse the pathophysiological mechanisms that connect AF with exercise, and finally to discuss the existing treatment options. Prevalence and Incidence of Atrial Fibrillation in Endurance Sport Practice and in Vigorous Physical ActivityThe prevalence of AF in the athletic community varies considerably dependent on the age and the number of years of training of the subjects. It is essential to make a distinction between studies including young athletes with only a few years of training and those with middle-aged or older individuals practising sports for many years.Whereas the incidence of AF in young athletes appears similar to that observed in the general population, in older athletes an increased incidence of AF is reported. 6,[8][9][10][11][12][13][14][15] Furlanello et al. 16 and Pelliccia et al. 17 reported a low rate of AF (0.2 % and 0.3 %, respectively), no different from that observed in the general population. However, both studies included exclusively young athletes with relatively fewer years of training. In contrast, several other studies of middle-aged athletes, who were engaged in sport training for many years, demonstrated an increased prevalence of AF compared with the rest of the population (see Table 1). A common characteristic among all these studies was that the participating athletes were predominately male and they were involved in endurance sports. The prevailing pattern of AF was the so-called vagal lone AF, as it was usually encountered in relatively young individuals (<60 years old) without clinical or echocardiographic e...

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Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study

Abstract: Long-term endurance sport practice is associated with a higher risk of symptomatic LAF in men. This risk is associated with a larger left atrial inferosuperior diameter and volume in physically active subjects.

Cited by 286 publications

References 28 publications

Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise

Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise

Defining the major health modifiers causing atrial fibrillation: a roadmap to underpin personalized prevention and treatment

Endurance Sport Activity and Risk of Atrial Fibrillation – Epidemiology, Proposed Mechanisms and Management

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