Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of case-control studies
PubMed 19633305 · doi:10.1093/europace/eup197
What was done
A systematic review and meta-analysis was conducted to evaluate whether the risk of atrial fibrillation (AF) or atrial flutter is higher in athletes compared with non-athletes. Investigators searched for case-control studies comparing athletes to controls. Data from 6 eligible case-control studies including 655 athletes and 895 controls (mean age 51 ± 9 years, 93% men) were meta-analyzed using a fixed-effects model.
What was found
AF occurred in 147 of 655 athletes (23%) compared with 116 of 895 controls (12.5%). Athletes had a significantly higher risk of AF than controls, with an odds ratio of 5.29 (95% CI 3.57 to 7.85; P = 0.0001; Z-score = 8.08). Heterogeneity between studies was low and not statistically significant (chi-squared = 2.92, P = 0.633; I² = 0%).
Why it matters
This review provides pooled evidence that athletic participation is associated with a greater than five-fold increase in atrial fibrillation risk, supporting the association between long-term athletic training and atrial arrhythmias.
Limits
The analysis relied exclusively on case-control studies, which are vulnerable to recall and selection biases and cannot establish a temporal or causal relationship. The total sample was relatively small (1,550 individuals) and overwhelmingly male (93%), limiting generalizability to female athletes. Exercise type, intensity, and duration were not detailed in the abstract.
Cited by
- supports Competitive endurance athletes have an approximately fivefold increased risk of developing atrial fibrillation compared to non-athletes.