Incidence of Atrial Fibrillation in Elite Athletes
Open accessAbstract
Importance: Vigorous exercise (particularly endurance sports) might increase the risk of atrial fibrillation (AF), but there is variability in the reported frequency of this condition among elite athletes. The underlying pathophysiologic source remains unclear. Objective: To determine AF incidence in a large cohort of elite athletes and its association with potential risk factors. Design, Setting, and Participants: Retrospective observational cohort of all Spanish athletes (N = 6813) referred to a single center was used to determine AF incidence from January 1, 1997, to December 31, 2017, and cross-sectional analysis was conducted to compare athletes with and without reported AF. The cohort covered most sports disciplines, and the studied athletes were on national teams and competed in major international events. Cardiologists responsible for echocardiographic assessment were not blinded to the condition (AF or no AF) of the athletes. Exposures: All participants underwent at least 1 cardiologic evaluation, including assessment at time of AF diagnosis in those with this condition. Main Outcomes and Measures: Diagnosis of AF based on resting and/or exercise electrocardiogram, and/or 24-hour Holter monitoring and echocardiography-assessed atrial dimensions. Results: A total of 6813 Spanish elite athletes (2385 [35.0%] women) were referred for cardiac evaluation during the study period. Mean (SD) age was 22 (7) years, and mean (SD) time of competition was 8 (5) years. Only 21 athletes (1 woman), participating in different types of sports, had AF (ie, paroxysmal [n = 18], persistent [n = 1], or long-standing persistent [n = 2]) during the 20-year study. In multivariate analysis, increasing values of age (odds ratio [OR], 1.07; 95% CI, 1.00-1.14), years of competition (OR, 1.14; 95% CI, 1.07-1.22), and left atrial anteroposterior diameter (OR, 1.21; 95% CI, 1.10-1.32) were associated with higher AF risk. Conclusions and Relevance: The incidence of AF is low among young Spanish elite athletes, even when considering only endurance athletes. Yet, potential contributors (particularly atrial remodeling) need to be monitored.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
An association among endurance sports, age >55 years, male gender, and duration of exercise training with increased AF risk has been proven through studies.
“An association among the type of exercise (endurance sports), age (>55 years), gender (males), and the duration of exercise training with increased AF risk has been proven through studies [24].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [24]
Table 2 (page not provided) associates increasing age and years of competition with AF in multivariate analysis; male sex and endurance sport are associated only in univariate analysis and are nonsignificant in the multivariate model. The table gives an age cutoff of 27 years, not >55 years. The observational findings do not establish that these factors have been proven to increase risk. (LLM, conf=0.89)
Experimental — accuracy not yet measuredIn the same cohort, increased AF risk was associated with years of exercise training, age, and left atrial anteroposterior diameter.
“In the same study, there was an association between increased AF risk and years of exercise training, age, and left atrial (LA) anteroposterior diameter [24].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [24]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 12 · Cited by 35
Research works printed but not linked: 10
- Thijssen DHJ, Redington A, George KP, Hopman MTE, Jones H. Association of exercise preconditioning with immediate cardioprotection: a review. JAMA Cardiol. 2018;3(2):169-176. doi:10 .1001/jamacardio.2017.4495
- Fiuza-Luces C, Santos-Lozano A, Joyner M, et al. Exercise benefits in cardiovascular disease: beyond attenuation of traditional risk factors [published online August 16, 2018]. Nat Rev Cardiol. doi:10 .1038/s41569-018-0065-1 · DOI · Paper page
- Thompson PD. Physical fitness, physical activity, exercise training, and atrial fibrillation: first the good news, then the bad. J Am Coll Cardiol. 2015;66 (9):997-999. doi:10.1016/j.jacc.2015.07.003 · DOI
- Du X, Dong J, Ma C. Is atrial fibrillation a preventable disease? J Am Coll Cardiol. 2017;69(15): 1968-1982. doi:10.1016/j.jacc.2017.02.020 · DOI
- Sanchis-Gomar F, Perez-Quilis C, Lippi G, et al. Atrial fibrillation in highly trained endurance athletes-description of a syndrome. Int J Cardiol. 2017;226:11-20. doi:10.1016/j.ijcard.2016.10.047 · DOI · Paper page
- World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-2194.
- Pelliccia A, Maron BJ, Di Paolo FM, et al. Prevalence and clinical significance of left atrial remodeling in competitive athletes. J Am Coll Cardiol. 2005;46(4):690-696. doi:10.1016/j.jacc.2005.04 .052 · DOI · Paper page
- Wernhart S, Halle M. Atrial fibrillation and long-term sports practice: epidemiology and mechanisms. Clin Res Cardiol. 2015;104(5):369-379. doi:10.1007/s00392-014-0805-0 · DOI · Paper page
- Bisbal F, Alarcón F, Ferrero-de-Loma-Osorio A, et al. Left atrial geometry and outcome of atrial fibrillation ablation: results from the multicentre LAGO-AF study. Eur Heart J Cardiovasc Imaging. 2018;19(9):1002-1009. doi:10.1093/ehjci/jey060 · DOI
- Passman R, Piccini J. Electrocardiography screening for atrial fibrillation: we can do better [published online August 7, 2018]. JAMA Cardiol. doi:10.1001/jamacardio.2018.220010 · DOI
- Authors
- Boraita, A., Santos-Lozano, A., Heras, M. E., González-Amigo, F., López-Ortiz, S., Villacastín, J. P., & Lucia, A.
- Affiliations
- Department of Cardiology, Sports Medicine Center, Spanish Sports Health Protection Agency, Madrid, Spain
- i+HeALTH, Department of Health Sciences, European University Miguel de Cervantes, Valladolid, Spain
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
- Research Institute of Hospital 12 de Octubre (“i+12”), Madrid, Spain
- Venue
- JAMA Cardiology
- Publisher
- American Medical Association (AMA)
- Published
- 2018-12-01
- Volume
- 3
- Issue
- 12
- Pages
- 1200
- ISSN
- 2380-6583 (ISSN-L)
- PMC
- PMC6583086
- OpenAlex
- W2899249384
- Cited by
- 35
- References
- 12
- Citations by year
- 2026: 6 · 2025: 2 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 5 · 2020: 6 · 2019: 5
- FWCI
- 3.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Cardiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ABACUS. Repositorio de Producción Científica (Universidad Europea) (submittedVersion, other-oa)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- atrial fibrillation, elite athletes, incidence, endurance sports, atrial remodeling, left atrial diameter, risk factors, youth athletes
- MeSH terms
- Adult, Atrial Fibrillation, Cross-Sectional Studies, Echocardiography, Female, Heart Atria, Humans, Male, Physical Endurance, Retrospective Studies, Spain, Incidence, Athletes
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
