Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter
Open accessAbstract
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.
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There is an association between endurance exercise and both bi-atrial and ventricular enlargement.
“Furthermore, there is an association between endurance exercise and both bi-atrial and ventricular enlargement [52].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [52]
The Arrhythmia substrate section reports larger atria in endurance athletes, and the Atrial flutter section suggests right atrial dilatation may result from volume overload. It also reports greater left ventricular mass in patients with atrial fibrillation, but does not establish ventricular enlargement associated with endurance exercise. Page numbers were not available in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAFL is seen in clinical conditions very much alike those seen in AF, including old age, hypertension, diabetes, chronic obstructive lung disease, excessive alcohol consumption, and high intensity sports practice.
“AFL is seen in clinical conditions very much alike those seen in AF, including old age, hypertension, diabetes, chronic obstructive lung disease, excessive alcohol consumption 172 and high intensity sports practice.173”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [173]
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“Furthermore, there is an association between endurance exercise and both bi-atrial and ventricular enlargement [52].”
Background
- Authors
- Mont, L., Elosua, R., & Brugada, J.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- Corresponding author
- Mont, L.
- ORCID
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-11-12
- Volume
- 11
- Issue
- 1
- Pages
- 11-17
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- PMC
- PMC2638655
- OpenAlex
- W2142530674
- Cited by
- 287
- References
- 54
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 15 · 2023: 28 · 2022: 17 · 2021: 15 · 2020: 13 · 2019: 12 · 2018: 12 · 2017: 19 · 2016: 20 · 2015: 17 · 2014: 12 · 2013: 16 · 2012: 27
- FWCI
- 2.22
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- EP Europace (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- 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
- endurance sports, atrial fibrillation, atrial flutter, athletes, atrial enlargement, atrial fibrosis, atrial ectopic beats, vagal tone, bradycardia, atrial refractory period, cardiovascular risk factors
- MeSH terms
- Atrial Fibrillation, Atrial Flutter, Female, Humans, Male, Physical Endurance, Physical Fitness, Risk Factors, Sports, Comorbidity, Incidence, Risk Assessment, Athletic Performance
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