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Europace Advance Access published online on November 6, 2008
Europace, doi:10.1093/europace/eun289
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions©oxfordjournals.org.

REVIEW

Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter

Lluís Mont1,*, Roberto Elosua2 and Josep Brugada1

1 Thorax Institute, Hospital Clínic, University of Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Villarroel 170, Barcelona 08036, Catalonia, Spain; 2 Lipids and Cardiovascular Epidemiology Unit, Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, Spain

Although the benefits of regular exercise in controlling cardiovascular risk factors have been extensively proven, little is known about the long-term cardiovascular effects of regular and extreme endurance sport practice, such as jogging, cycling, rowing, swimming, etc. Recent data from a small series suggest a relationship between regular, long-term endurance sport practice and atrial fibrillation (AF) and flutter. Reported case control studies included less than 300 athletes, with mean age between 40 and 50. Most series recruited only male patients, or more than 70% males, who had been involved in intense training for many years. Endurance sport practice increases between 2 and 10 times the probability of suffering AF, after adjusting for other risk factors. The possible mechanisms explaining the association remain speculative. Atrial ectopic beats, inflammatory changes, and atrial size have been suggested. Some of the published studies found that atrial size was larger in athletes than in controls, and this was a predictor for AF. It has also been shown that the left atrium may be enlarged in as many as 20% of competitive athletes. Other proposed mechanisms are increased vagal tone and bradycardia, affecting the atrial refractory period; however, this may facilitate rather than cause the arrhythmia. In summary, recent data suggest an association between endurance sport practice and atrial fibrillation and flutter. The underlying mechanism explaining this association is unclear, although structural atrial changes (dilatation and fibrosis) are probably present. Larger longitudinal studies and mechanistic studies are needed to further characterize the association to clarify whether a threshold limit for the intensity and duration of physical activity may prevent AF, without limiting the cardiovascular benefits of exercise.

Key Words: Athletes, Atrial fibrillation, Atrial flutter, Endurance sport practice

* Corresponding author. Tel: +34 932275551; fax: +34 934513045. E-mail address: lmont{at}clinic.ub.es

Manuscript submitted 10 June 2008. Accepted after revision 2 October 2008.


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Europace, September 1, 2009; 11(9): 1156 - 1159.
[Abstract] [Full Text] [PDF]


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