Is the risk of atrial fibrillation higher in athletes than in the general population? a systematic review and meta-analysis.
Open accessAbstract
AIMS: The aim of this study was to examine by a systematic literature review and meta-analysis whether the risk of atrial fibrillation (AF) is higher in athletes compared with not athletes. METHODS AND RESULTS: A comprehensive systematic search was conducted for case-control studies that examined cases of AF or atrial flutter in athletes vs. controls. Extracted data from the eligible studies were meta-analysed using fixed effects model. Six case-control studies were eligible for meta-analysis. A total of 655 athletes and 895 controls were compared. Mean age was 51+/-9 years and 93% were men. There were 147 (23%) vs. 116 (12.5%) cases of AF among athletes compared with controls. The overall risk of AF was significantly higher in athletes than in controls with odds ratio (95% confidence interval)=5.29 (3.57-7.85), P=0.0001, and Z-score=8.08. For heterogeneity, the calculated chi2=2.92, P=0.633, and I2=0% were not significant. CONCLUSION: The risk of AF is significantly higher in athletes compared with not athletes. However, this finding should be confirmed further in large-scale prospective longitudinal studies.
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Endurance athletes may have increased AF risk.
“Endurance athletes may may have increased AF risk (Abdulla 2009, Anderson 2013).”
From 2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society (2021) · cites this paper as Abdulla 2009
Two prior meta-analyses investigating the possible increased risk of atrial fibrillation in athletes demonstrated equivocal findings, with odds ratios of 1.64 and 5.29.
“Two prior meta-analyses investigating the possible increased risk of AF in athletes have demonstrated equivocal findings, with ORs of 1.64 14 and 5.29.15”
From Risk of atrial fibrillation in athletes: a systematic review and meta-analysis (2021) · cites this paper as [14]
Newer evidence has suggested associations between habitual vigorous exercise and potentially pathologic cardiovascular findings, including atrial fibrillation, coronary artery calcification, myocardial fibrosis, and aortic dilation.
“newer evidence has suggested associations between habitual vigorous exercise and potentially pathologic cardiovascular findings, including atrial fibrillation,19 coronary artery calcification,20 myocardial fibrosis,21 and aortic dilation.22”
From Association of Cardiorespiratory Fitness with Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing (2018) · cites this paper as [19]
Recent observational studies have described adverse cardiovascular findings associated with habitual vigorous exercise and have raised new questions regarding the benefits of exercise and fitness.
“However, recent observational studies19,20,21,22 have described adverse cardiovascular findings associated with habitual vigorous exercise and have raised new questions regarding the benefits of exercise and fitness.”
From Association of Cardiorespiratory Fitness with Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing (2018) · cites this paper as [19]
Intensive sports practice, especially endurance sports (> 1500 h of endurance sports practice), increases the risk of AF later in life.
“Intensive sports practice, especially endurance sports (> 1500 h of endurance sports practice), 899 increases the risk of AF later in life, [900][901][902]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [901]
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“Our findings are similar to a meta-analysis published in 2009 by Abdulla and Nielsen [6].”
ResultCardiorespiratory fitness and the incidence of chronic disease
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- Authors
- Abdulla, J., & Nielsen, J. R.
- Affiliations
- Glostrup Hospital (DK)
- Corresponding author
- Abdulla, J.
- ORCID
- Abdulla, J.
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-07-24
- Volume
- 11
- Issue
- 9
- Pages
- 1156-1159
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2075883866
- Cited by
- 420
- References
- 21
- Citations by year
- 2026: 19 · 2025: 25 · 2024: 28 · 2023: 25 · 2022: 25 · 2021: 43 · 2020: 37 · 2019: 18 · 2018: 41 · 2017: 25 · 2016: 34 · 2015: 30 · 2014: 18 · 2013: 23 · 2012: 14
- FWCI
- 1.40
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- 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, athletes, atrial flutter, sports participation, cardiovascular risk, case-control study, odds ratio
- MeSH terms
- Atrial Fibrillation, Female, Humans, Male, Risk Factors, Sports, Incidence, Risk Assessment
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