Atrial Fibrillation in Athletes
Open accessAbstract
Although the cardiovascular benefits of moderate exercise are well established, there is growing epidemiological support for the notion that high-intensity endurance athletics increases the risk of atrial fibrillation (AF). There are many gaps in evidence related to epidemiology and mechanisms of AF in endurance athletes. The proposed pathophysiological mechanisms include alterations of autonomic tone, electrical remodeling, anatomical remodeling, fibrosis, and inflammation. Clinical management of the athlete with AF often includes a period of decreased frequency, intensity, and duration of exercise with assessment for improvement in AF recurrence. Based on symptoms, a strategy of rate or rhythm control should be selected; however, due to side effects and intolerance of medications, ablation may be a preferred approach. The risks and benefits of anticoagulation for stroke prevention must be carefully assessed in the athlete with AF. All patients should be encouraged to be physically active with moderation; however, men should be advised of the higher risk of AF with long-term, high-intensity endurance training.
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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 [12]
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 [12]
Theories suggest that complex mechanisms may contribute to AF, including alterations in autonomic tone, systemic inflammation, electrical remodeling, and LA enlargement and fibrosis.
“Theories suggest that complex mechanisms may contribute to AF, including alterations in autonomic tone, systemic inflammation, electrical remodeling, and LA enlargement and fibrosis [12,44,45,46,47,48,49,50].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [12]
The combination of increased basal vagal activity and adrenergic activation may serve as a predisposing factor for AF.
“In general, the combination of increased basal vagal activity and adrenergic activation may serve as a predisposing factor for AF [12].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [12]
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Practical guidance for management of atrial fibrillation in sports cardiology
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Sex as a main determinant of bi-atrial acute and chronic adaptation to exercise
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Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature
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“In general, the combination of increased basal vagal activity and adrenergic activation may serve as a predisposing factor for AF [12].”
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Endurance Sports and Atrial Fibrillation: A Puzzling Conundrum
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Exercising immune cells: The immunomodulatory role of exercise on atrial fibrillation
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Exercise and Athletic Activity in Atrial Fibrillation
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Self-citationAtrial fibrillation in the athlete: Case report and a contemporary appraisal
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Endurance sport and atrial fibrillation: a mini-review of a complex relationship
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Atrial Fibrillation in Athletes
Alameh, I. A., Fout, G. A., Ezekowitz, M. D., & Kamareddine, M. H. (2026) · JACC Case Reports · doi:10.1016/j.jaccas.2026.107061 · Cited by 3 · see citing works
Atrial Fibrillation and Exercise: Exercise Recommendations
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Right Heart Resilience and Atrial Fibrillation Risk in Long-Term Endurance Athletes
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Modifiable Lifestyle Factors, Left Atrial Indices, and Atrial Fibrillation
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An Assessment of Training Characteristics Associated with Atrial Fibrillation in Masters Runners
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Competitive Endurance Activities of Middle-aged Athletes as a Risk Factor for Atrial Fibrillation
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Comparison of P wave indices between ultramarathon athletes and general population
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Self-citationAtrial Fibrillation: Should Lifelong Athletes Be Worried?
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Atrial fibrillation in athletes
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Supraventricular Tachyarrhythmia Management in Elite Athletes
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Arrhythmias due to athletic training
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The super healthy atrial fibrillation conundrum
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Cardiac Response to Stress and Injury
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How much exercise is too much? Understanding the impact on atrial remodelling
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Exercise and Atrial Fibrillation: Friends or Foes?
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ATRIAL FIBRILLATION IN AN ATHLETE: A CLINICAL CASE
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Emerging roles of micropeptides in calcium cycling dysregulation and atrial fibrillation: A review
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Cardiac Morbidities in Elite Endurance Athletes: Rare but Potentially Serious
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Atrial Fibrillation in Athletes: Evaluation, Management and Prognostic Considerations
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- Authors
- Estes, N. A. M., & Madias, C.
- Affiliations
- Tufts University (US)
- Corresponding author
- Estes, N.A. Mark
- Venue
- JACC: Clinical Electrophysiology
- Publisher
- Elsevier BV
- Published
- 2017-09
- Volume
- 3
- Issue
- 9
- Pages
- 921-928
- ISSN
- 2405-500X (ISSN-L)
- OpenAlex
- W2752819522
- Cited by
- 56
- References
- 64
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 8 · 2023: 5 · 2022: 4 · 2021: 8 · 2020: 9 · 2019: 8 · 2018: 3
- FWCI
- 0.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC. Clinical electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- 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 Arrhythmias and Treatments
- Keywords
- atrial fibrillation, endurance athletes, high-intensity exercise, autonomic tone, electrical remodeling, atrial fibrosis, inflammation, atrial remodeling, rate control, rhythm control, anticoagulation, stroke prevention, exercise training
- MeSH terms
- Anti-Arrhythmia Agents, Anticoagulants, Atrial Fibrillation, Autonomic Nervous System, Female, Fibrosis, Humans, Inflammation, Male, Physical Endurance, Risk Factors, Exercise, Incidence, Catheter Ablation, Stroke, Athletes, Atrial Remodeling
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