Atrial fibrillation in highly trained endurance athletes — Description of a syndrome
Abstract
Atrial fibrillation (AF) is the most common heart arrhythmia, the risk of which typically increases with age. This condition is commonly associated with major cardiovascular diseases and structural heart damage, while it is rarely observed in healthy young people. However, increasing evidence indicates that paroxysmal AF can also onset in young or middle-aged and otherwise healthy endurance athletes (e.g., cyclists, runners and cross-country skiers). Here we review the topic of AF associated with strenuous endurance exercise (SEE), for example cycling, running and cross-country skiing, especially at a competitive level, and we propose the definition of a new syndrome based on the accumulating data in the literature: SEE-related AF under the acronym of 'PAFIYAMA' ('paroxysmal AF in young and middle-aged athletes'). Special emphasis is given to the proper differentiation of PAFIYAMA from 'classical AF' regarding pathophysiology, diagnosis and medical management.
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A 2 to 10 times higher frequency of AF has been shown in high-intensity endurance athletes compared to individuals who do not exercise.
“Many retrospective observational studies and meta-analyses have estimated a 2 to 10 times higher frequency of AF in high-intensity endurance athletes compared to individuals who do not exercise [6,7,8,12,13,14,15,16,17].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [13]
Regular exercise of low or moderate intensity serves as a preventive strategy for cardiovascular disease and AF, while higher-intensity endurance exercise may lead to AF.
“Regular exercise of either low or moderate intensity seems serve as a preventive strategy for cardiovascular disease and AF, while higher-intensity endurance exercise may lead to AF [6,7,8,12,13,14,15,16,17,18,19,20,21].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [13]
The prevalence of AF in competitive athletes ranges from 0.3% to approximately 13%, differing according to age and modality of exercise training.
“The prevalence of AF in competitive athletes ranges from 0.3% to approximately 13%, and differs according to the age and the modality of exercise training [13,25,26,27].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [13]
LA enlargement, both in size and volume, is associated with an increased risk of AF and is present in approximately 20% of young competitive athletes.
“Specifically, LA enlargement, both in size and volume, which is associated with an increased risk of AF, is present in approximately 20% of young competitive athletes [13,50].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [13]
Athletes present increased arterial blood pressure during exercise and, in combination with atrial wall stretching after long-term strenuous endurance training, may lead to the development of arrhythmogenic areas due to microtrauma, inflammation, and fibrosis.
“Athletes present increased arterial blood pressure during exercise and in combination with atrial wall stretching after long-term strenuous endurance training, which may lead to the development of arrhythmogenic areas due to microtrauma, inflammation, and fibrosis [13].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [13]
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Atrial Fibrillation in Athletes
Estes, N. A. M., & Madias, C. (2017) · JACC: Clinical Electrophysiology · doi:10.1016/j.jacep.2017.03.019 · Cited by 56 · see citing works
Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature
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“Athletes present increased arterial blood pressure during exercise and in combination with atrial wall stretching after long-term strenuous endurance training, which may lead to the development of arrhythmogenic areas due to microtrauma, inflammation, and fibrosis [13].”
Background
- Authors
- Sanchis-Gomar, F., Perez-Quilis, C., Lippi, G., Cervellin, G., Leischik, R., Löllgen, H., Serrano-Ostáriz, E., & Lucia, A.
- Affiliations
- University of Verona (IT)
- Ospedale di Parma (IT)
- Witten/Herdecke University (DE)
- Universidad de Zaragoza (ES)
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2017-01
- Volume
- 226
- Pages
- 11-20
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W2536564581
- Cited by
- 95
- References
- 29
- Citations by year
- 2026: 9 · 2025: 4 · 2024: 6 · 2023: 9 · 2022: 13 · 2021: 10 · 2020: 12 · 2019: 9 · 2018: 13 · 2017: 7 · 2016: 1 · 2012: 1
- FWCI
- 1.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- ABACUS. Repositorio de Producción Científica (Universidad Europea) (submittedVersion)
- Funders
- Spanish Ministry of Economy and Competitiveness (PI15/00558)
- Fondos Feder
- Cátedra Real Madrid-Universidad Europea (2015/02RM)
- Conselleria de Educación, Investigación, Cultura y Deporte de la Generalitat Valenciana (APOSTD/2016/140)
- 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 › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation, endurance athletes, paroxysmal atrial fibrillation, exercise-induced arrhythmia, pathophysiology, diagnosis, medical management, cycling, running, cross-country skiing
- MeSH terms
- Age Factors, Atrial Fibrillation, Female, Humans, Male, Physical Endurance, Risk Factors, Sex Factors, Syndrome, Ventricular Remodeling, Athletes
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