Atrial fibrillation in endurance athletes.
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing mechanisms, animal studies, and observational literature without original data
PubMed 23610454 · doi:10.1177/2047487313476414
What was done
The authors conducted a narrative review synthesizing literature on the prevalence, pathophysiology, risk factors, and clinical management of atrial fibrillation (AF) and atrial flutter in endurance athletes, incorporating findings from animal models, observational cohorts, and prior meta-analyses.
What was found
The review highlights a cited 5-fold increased risk of AF among middle-aged endurance athletes with a substantial male predominance. In animal models, prolonged high-intensity training provoked bi-atrial fibrosis and heightened AF inducibility. Additional reported risk factors include lifetime training volume, height, absolute left atrial enlargement, higher resting and peak blood pressure, concentric left ventricular remodeling, and altered diastolic function. No original numerical data or confidence intervals were generated.
Why it matters
It emphasizes that extreme endurance exercise may provoke arrhythmogenic atrial remodeling, providing sports cardiologists with clinical context to consider tailored interventions, such as early catheter ablation, in symptomatic veteran athletes.
Limits
As a narrative review, it lacks a systematic search protocol and presents no new empirical data. The underlying evidence consists largely of observational associations and animal models, limiting causal inference and precision regarding safe exercise thresholds.
Cited by
- supports Competitive endurance athletes have an approximately fivefold increased risk of developing atrial fibrillation compared to non-athletes.