Sport practice and the risk of lone atrial fibrillation: A case–control study

Elosúa, Roberto; Arquer, Andreu; Mont, Lluı́s; Sambola, Antonia; Molina, Lluís; García‐Morán, Emilio; Brugada, Josep; Marrugat, Jaume

doi:10.1016/j.ijcard.2005.05.020

Cited by 199 publications

(149 citation statements)

References 28 publications

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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

330

277

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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

330

277

View full text Add to dashboard Cite

show abstract

“…Aktywność fizyczna jest więc jedną z podstaw zapobiegania AF. Intensywne uprawianie sportu, zwłaszcza wytrzymałościowego (> 1500 h uprawiania sportów wytrzymałościowych) [899], zwiększa ryzyko AF w późniejszym okresie życia [900][901][902], co prawdopodobnie zależy od zmian napięcia układu autonomicznego, obciążenia objętościo-wego podczas wysiłku, przerostu przedsionka, a także jego powiększenia [903,904]. Prowadzi to do zależności między aktywnością fizyczną a zapadalnością na AF, która ma kształt krzywej U [214,898,902,905,906].…”

Section: Uprawianie Sportu a Migotanieunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,330

4,192

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“…Elousa et al 12 showed analogous results, with three times higher prevalence of lone AF and five times higher prevalence of vagal AF, indicating a threshold limit of 1,500 lifetime hours of intense endurance practice in order to attain this association. A following meta-analysis of six case-control studies including 655 athletes and 895 controls verified the aforementioned increased overall risk of AF for athletes compared with controls, demonstrating a high odds ratio of 5.29.…”

Section: Prevalence and Incidence Of Atrial Fibrillation In Endurancementioning

confidence: 78%

“…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%

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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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Sport practice and the risk of lone atrial fibrillation: A case–control study

Cited by 199 publications

References 28 publications

Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise

Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

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

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