Atrial Fibrillation (AF) in Endurance Athletes: a Complicated Affair

Abstract

Purpose of review: A complex relationship exists between exercise and atrial fibrillation (AF). Moderate exercise reduces AF risk whereas intense strenuous exercise has been shown to increase AF burden. It remains unclear at which point exercise may become detrimental. Overall, endurance athletes remain at lower cardiovascular risk and experience fewer strokes. 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. This review aims to critically review the literature and advise on how best to manage athletes with AF.

Recent findings: Emerging evidence suggests that female athletes may exhibit lower risk of AF, but data is limited in female endurance athletes. AF is more prevalent in endurance athletes, particularly men and those who competed at a young age. Data is lacking in females and ethnic minorities. 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. Catheter ablation is effective and can allow return to full competition.

Keywords: Athletes; Atrial fibrillation; Endurance; Exercise.

Fig. 1

Schematic of AF risk in males and females according to levels of participation in endurance sports. Male and female athletes show different risk profiles for AF as levels of endurance exercise increase. High-intensity endurance training is associated with increased risk of AF in males. The reverse is seen in females, although less data is available in females (dashed line). Despite an increasing AF burden in male endurance athletes, weight, blood pressure (BP), cardiovascular (CVS) mortality, stroke, and CHA₂DS₂-VASc scores fall in this group. Figure modified from Mohanty et al [40].