The DOI matches its Crossref record; 51 of the 52 references it cites were found in a registry or an index; 11 of the 24 sources its claims cite were checked for support.
Risk of atrial fibrillation in athletes: a systematic review and meta-analysis
Open accessAbstract
OBJECTIVE: A systematic review, meta-analysis and meta-regression were performed on selected studies to investigate the incidence of atrial fibrillation (AF) among athletes compared with non-athlete controls. DESIGN: Meta-analysis with heterogeneity analysis and subsequent meta-regression to model covariates were performed. The mode of exercise (endurance and mixed sports) and age were the a priori determined covariates. DATA SOURCES: PubMed, MEDLINE, Science Direct, SPORTDiscus and the Cochrane library were searched. ELIGIBILITY CRITERIA: Research articles published after 1990 and before 2 December 2020 were included if they reported the number of AF cases in athletes with non-athlete (physically active or inactive) control groups, were case-control or cohort studies and if data allowed calculation of OR. RESULTS: The risk of developing AF was significantly higher in athletes than in non-athlete controls (OR: 2.46; 95% CI 1.73 to 3.51; p<0.001, Z=4.97). Mode of exercise and risk of AF were moderately correlated (B=0.1259, p=0.0193), with mixed sport conferring a greater risk of AF than endurance sport (B=-0.5476, p=0.0204). Younger (<55 years) athletes were significantly more likely to develop AF compared with older (≥55 years) athletes (B=-0.02293, p<0.001). CONCLUSION: Athletes have a significantly greater likelihood of developing AF compared with non-athlete controls, with those participating in mixed sport and younger athletes at the greatest risk. Future studies of AF prevalence in athletes according to specific exercise dose parameters, including training and competition history, may aid further in delineating those at risk.
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Claims the paper makes
20 Own result · 9 No full text of the sources · 6 Own method · 6 Own interpretation · 5 Partly supported · 5 No basis given · 2 Supported · 1 Supported so far · 1 Sources not found · 1 Not checked yet · accuracy not yet measured
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“In general, risk of AF in female athletes appears to be lower than in male athletes.29 38”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Study limitations
What the sources say
- Not checked — no full text of the sourcecites [29] source
- Supportedcites [38] Svedberg, 2019, Long-Term incidence of atrial fibrillation and stroke among Cross-Country skiers, Circulation source
The Clinical Perspective explicitly states that female endurance athletes appear less susceptible to atrial fibrillation than male endurance athletes. The Discussion also reports a lower incidence among female skiers relative to female nonskiers, while male skiers with the highest exercise load had a higher incidence. (LLM, conf=0.94)
hedgedstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Younger athletes (OR: 3.60; 95% CI 2.09 to 6.29, p<0.001,Z=4.603) had a significantly higher relative risk of AF than older athletes (OR: 1.76; 95% CI 0.97 to 3.21, p=0.065,Z=1.845) (figure 3)”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Subgroup analysis
plainstates an association- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, in athletes and non-athletes without CVD risk factors, athletes had a significantly greater relative risk of AF (OR: 3.66; 95% CI 2.28 to 5.88, p<0.001,Z=5.355).”
- Also stated in: § Review · plain
“When CVD was excluded from analyses, the risk of AF in athletes was significantly greater compared with non-athletes (OR: 3.66).”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Subgroup analysis
plainstates an association- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Review · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was a significant relationship between the mode of exercise and risk of AF (B=0.1259,p=0.0193), with mixed sport conferring a greater risk of AF compared with endurance sport (B=-0.5476,p=0.0204).”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Moderator analysis
plainstates an association- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The initial random effects pooled analysis demonstrated that the risk of AF was significantly higher in athletes than nonathletes (OR: 2.46; 95% CI 1.73 to 3.51, p<0.001,Z=4.97) (figure 2).”
- Also stated in: § DISCUSSION · hedged
“The results of the analysis indicate that the relative risk of AF is higher in athletes than in those not exercising or performing regular, non-competitive physical activity.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Primary analysis
boostedstates an association- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The prevalence of atrial fibrillation among athletes is relatively low.
- Rests on an assumption: Atrial flutter is a precursor to atrial fibrillation.
- Also stated in: § DISCUSSION · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and good quality studies (OR: 2.32; 95% CI 1.62 to 3.32, p<0.001,Z=4.610) reported lower overall OR for AF in athletes than poor quality studies (OR: 4.80; 95% CI 1.22 to 18.88, p=0.025,Z=2.244) (online supplemental figure S2).”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Subgroup analysis
plainstates an association- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was significant heterogeneity among the studies (p<0.001,I 2 =84%).”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Primary analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Case-control studies (OR: 4.91; 95% CI 3.48 to 6.93, p<0.001,Z=9.03) produced a greater relative risk of AF in athletes than cohort-design studies (OR: 1.26; 95% CI 1.02 to 1.56, p=0.035,Z=2.11).”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Subgroup analysis
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When dichotomising studies into those with and without CVD risk factors (type 2 diabetes mellitus and hypertension), there was no significant difference in the relative risk of AF in athletes with CVD risk factors versus non-athletes with CVD risk factors (OR: 1.51; 95% CI 0.90 to 2.54, p=0.116,Z=1.572).”
- Also stated in: § Review · plain
“however, there was no statistically significant difference in the risk of AF in athletes and non-athletes with CVD risk factors.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Subgroup analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Review · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, it was not possible in these analyses to discern a specific duration and frequency threshold or type of exercise at which AF risk increased.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Review
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 18
- Probably not a substantial claim. 16
- The quote only partly states this claim. 1
Every source the paper cites for this claim was checked and supports it.
In the paper
“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”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > INTRODUCTION
What the sources say
- Supportedcites [14] source
The Results of the analyses report an odds ratio of 5.29 (95% CI 3.57–7.85) for atrial fibrillation in athletes versus controls. In the citing sentence, this paper is cited for the 5.29 estimate; the 1.64 estimate is assigned to a different citation. (LLM, conf=0.93)
- Supportedcites [15] Ayinde, 2018, Age modifies the risk of atrial fibrillation among athletes: a systematic literature review and meta-analysis, Int J Cardiol Heart Vasc source
The Results report this meta-analysis’s pooled odds ratio of 1.64 for atrial fibrillation in athletes versus the general population. The Discussion also identifies the earlier meta-analysis reporting 5.29 and notes that its effect size was much larger, supporting the comparison of differing estimates. (LLM, conf=0.92)
boostedstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“It has been reported that male endurance athletes performing high-intensity and high-volume exercise training are at an increased risk, 9”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > INTRODUCTION
What the sources say
- Partly supportedcites [9] sourceExperimental — accuracy not yet measured
The Abstract reports a higher risk of symptomatic lone atrial fibrillation in male marathon runners than in sedentary men. The Discussion (Figure 2 section; page unavailable) indicates substantial lifetime sport practice among the runners, but the paper does not establish that high training intensity specifically increases risk; its finding is also narrower than atrial fibrillation generally. (LLM, conf=0.83)
hedgedstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“with studies suggesting a U-shaped curve, with lack of physical activity and long-term vigourous exercise both increasing the risk of developing AF. 10 11”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > INTRODUCTION
What the sources say
- Supportedcites [10] source
The discussion and Figure 2 caption (p. 3624) describe a U-shaped relationship: AF risk falls with regular mild-to-moderate activity, then rises with more sustained vigorous exercise. The paper presents this as a suggested pattern drawn from studies, matching the claim's qualification. (LLM, conf=0.92)
- Partly supportedcites [11] sourceExperimental — accuracy not yet measured
The Introduction reports reduced AF risk with moderate activity and increased risk with high-intensity or endurance exercise in younger athletes and middle-aged men, supporting the suggested curve for those groups. The Results (Physical activity and AF) found that activity above 1,000 MET-minutes/week was not associated with higher risk than inactivity, so this paper does not establish increased risk at both extremes in the general population. Page numbers were not supplied in our copy. (LLM, conf=0.86)
hedgedstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Interestingly, Ayinde et al 15 identified age as a significant determinant of AF risk, with younger athletes (below 40 years old) at greater relative risk than athletes >54 years of age.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > INTRODUCTION
What the sources say
- Partly supportedcites [15] Ayinde, 2018, Age modifies the risk of atrial fibrillation among athletes: a systematic literature review and meta-analysis, Int J Cardiol Heart Vasc sourceExperimental — accuracy not yet measured
The Results (Stratified analysis > Age) identify age as an effect modifier: athletes under 54 had significantly higher odds of AF than similarly aged controls, while the increase was not significant among athletes 54 or older. The paper uses a cutoff of 54, not 40, and compares each athlete age group with controls rather than directly comparing younger and older athletes. (LLM, conf=0.90)
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Investigating the mechanistic underpinning of this age-dependant risk, Hoogsteen et al 24 discuss AF being triggered by adrenergic surges occurring during exercise in younger athletes, 25 whereas older athletes typically experience vagally induced AF after exercise, normally from secondary autonomic dysfunction.26”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > DISCUSSION
What the sources say
- Partly supportedcites [24] Hoogsteen, 2004, Recommendations and cardiological evaluation of athletes with arrhythmias: Part 1, Neth Heart JExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Partly supportedcites [25] sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
- Not checked — no full text of the sourcecites [26] source
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Mechanistically, Wilhelm 13 indicates biatrial remodelling, dilation and fibrosis as crucial substrates to developing this pathology.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > DISCUSSION
What the sources say
- Partly supportedcites [13] sourceExperimental — accuracy not yet measured
In “The substrate: atrial remodelling in athletes” (page unavailable), Wilhelm reports enlargement of both atria in endurance athletes and says enlargement accompanied by fibrosis in aging athletes may create a substrate for atrial fibrillation. Calling remodelling, dilation and fibrosis unqualified “crucial substrates” overstates that tentative, age-dependent account; the section also notes that enlarged atria in young athletes did not necessarily increase AF risk. (LLM, conf=0.86)
hedgedstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“This analysis may also be limited by the possibility of sparse data bias in the pooled OR estimates, as indicated by the unconventional ORs and wide confidence limits produced by some studies.This is problematic as such bias can inflate the estimate of effect measures, which should be taken into account when interpreting the findings of the present analysis.37”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Study limitations
What the sources say
- Supportedcites [37] Greenland S , Mansournia MA , Altman DG . Sparse data bias: a problem hiding in plain sight. BMJ;2016:i1981. doi:10.1136/bmj.i1981 source
The paper’s Abstract explains that sparse data bias can inflate estimated effect ratios, including odds ratios. Its “Preliminary checks for sparse data bias” passage illustrates unusually large odds ratios with wide confidence intervals. The citing authors frame its possible relevance to their pooled analysis as their own interpretation. (LLM, conf=0.90)
hedgedstates a possible cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Only two studies provided data on volume or average duration of exercise and both defined this by lifetime exercise hours and could therefore not be used to quantify weekly exposure.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Study and participant characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the endurance sports, cycling conferred the highest risk of AF and Nordic skiing conferred the lowest risk (see online supplemental figure S3 for the lowest to highest risk of AF in endurance sports).”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Moderator analysis
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Crucially, our research identifies a significant relationship between mode of exercise and risk of developing AF, with mixed sport conferring a greater risk than endurance sport.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > DISCUSSION
boostedstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Five studies included athletes with the CVD risk factors diabetes and/or hypertension.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Study and participant characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The meta-analysis included 13 studies (7 cohort and 6 case-control) with a pooled sample size of 70 478 participants, which included 63 662 controls and 6816 athletes (online supplemental file).”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Study and participant characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Atrial flutter is a precursor to atrial fibrillation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, it was not possible to appropriately analyse the association of exercise intensity and AF risk due to insufficient data.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Subgroup analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The post hoc Egger's test (1997) was statistically significant (p<0.001),suggesting publication bias.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Primary analysis
hedgedstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the studies included in the analysis, three involved Nordic skiing, with these studies representing 36% of the total weighting in the overall effect size.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Study data was extracted and a risk of bias analysis performed, which were systematically screened by a second reviewer.When disputes were detected in coding or quality analyses, the reviewers met to discuss any conflicts, which were then resolved and evaluated further.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Review
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
In the paper
“This systematic review and meta-analysis was fully compliant with and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 16 including use of the described PICOS method for the systematic review process.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Search strategy
What the sources say
- Not checked — no full text of the sourcecites [16] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Qualitative risk of bias assessment was carried out utilising the tool from CLARITY at McMaster University (Evidence Partners, 2019) to ascertain the risk of bias in the cohort and case-control studies independently.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Review
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Additionally, the inclusion of studies involving athlete cohorts with common health conditions offers a more 'real world' estimation.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > DISCUSSION
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
In the paper
“Indeed, the observation that endurance sports correlate with AF is generally accepted.21”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > DISCUSSION
What the sources say
- Not checked — no full text of the sourcecites [21] source
boostedstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, the OR in older athletes was still 1.76 and much higher compared with non-athletes and thus must not be ignored.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > DISCUSSION
boostedstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“With this, it cannot be excluded that the remaining endurance sports included were comparatively underestimated in the analysis with Nordic skiing over-represented due to a greater quantity of published studies.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > DISCUSSION
hedgedstates a possible cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Prior research suggests there is a threshold beyond which exposure to increasing levels of exercise is associated with an increased risk of cardiovascular disease, including arrhythmias (U-shaped relationship).”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Additional information
hedgedstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“First, our OR, considering all primary studies, of 2.46 is much closer to the 'true' value as we included studies examining athletes, physically active individuals and sedentary populations, unlike other analyses.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > DISCUSSION
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Indeed, 84% is well above an expected I 2 value for a meta-analysis, probably owing to the differences in methodological parameters in the included studies.20”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Study limitations
What the sources say
- Not checked — no full text of the sourcecites [20] source
hedgedstates a possible cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“With this, the lower association of AF in older athletes compared with younger athletes has been previously linked to the higher rates of AF in older individuals, independent from physical activity levels.27”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Review
What the sources say
- Not checked — no full text of the sourcecites [27] source
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Additionally, Furlanello et al 23 examined the relationship between AF risk and sport participation in elite and Olympic athletes, finding a significant prevalence among young (average age 24 years old), male athletes.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > DISCUSSION
What the sources say
- Not checked yetcites [23] Furlanello, 1998, Atrial fibrillation in elite athletes, J Cardiovasc Electrophysiol
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“As detailed in Greenland and O'Rourke, 32 the present analysis would have benefited from adjustment using external estimates in those studies which do not apply sufficient adjustment.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Study limitations
What the sources say
- Not matchedcites [32] Greenland S , O’Rourke K . Meta-analysis. In: Rothman KJ , Greenland S , Lash T , eds. Modern epidemiology. 3rd edn. Philadelphia, PA: Lippincott Williams & Wilkins, 2008.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Indeed, it is possible that studies with a null hypotheses of a significant relationship between AF and athletes were not published, alongside bias in study methodologies.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Study limitations
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Finally, due to the lack of available data, we were unable to provide information regarding training volume and the risk of AF.”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Study limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
The prevalence of atrial fibrillation among athletes is relatively low.
“As the prevalence is relatively low, this paper aimed to perform a meta-analysis and pool multiple study data to draw a more conclusive overall prevalence among athletes.”
The paper relies on this without support.
Atrial flutter is a precursor to atrial fibrillation.
“Furthermore, studies reporting atrial flutter were included due to it being a precursor to AF.”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“A large meta-analysis of 13 studies, including approximately 64,000 athletes, showed that athletes were 2.46 times more likely to have prevalent AF (95% CI 1.73 to 3.51). This odds ratio increased to 3.6 for athletes aged <55 years of age [25].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [25]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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 [25]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Athletes participating in mixed sports (such as football, basketball, and American football) have increased AF burden compared to those engaged in endurance sports (such as Nordic skiing, orienteering, and rowing; B = −0.5476, p = 0.0204) [25].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [25]
In the citing paper
“Although sports participation seems associated with incident AF, 37”
From Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation (2023) · cites this paper as [37]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > Data extraction, coding and study quality
“Karjalainen et al 1998 Finland 440 46 Orienteering Cohort 1”
§ Risk of atrial fibrillation in athletes: a systematic review and meta-analysis > References
“Lone atrial fibrillation in vigorously exercising middle aged men: case-control study.”
Citations
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859
Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & the PRISMA Group* (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-4-200908180-00135 · Cited by 37,554
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009) · doi:10.1002/9780470743386 · Cited by 14,225
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2021) · doi:10.1002/9781119558378 · Cited by 9,799
Exercise and Physical Activity for Older Adults
Chodzko-Zajko, W. J., Proctor, D. N., Fiatarone Singh, M. A., Minson, C. T., Nigg, C. R., Salem, G. J., & Skinner, J. S. (2009) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181a0c95c · Cited by 5,153
Assessing heterogeneity in meta-analysis: Q statistic or I² index?
Huedo-Medina, T. B., Sánchez-Meca, J., Marín-Martínez, F., & Botella, J. (2006) · Psychological Methods · doi:10.1037/1082-989x.11.2.193 · Cited by 4,256
Benjamin, E. J. (1994) · JAMA · doi:10.1001/jama.1994.03510350050036 · Cited by 2,613
Research works printed but not linked: 1
- Greenland S , O’Rourke K . Meta-analysis. In: Rothman KJ , Greenland S , Lash T , eds. Modern epidemiology. 3rd edn. Philadelphia, PA: Lippincott Williams & Wilkins, 2008.
Cited by
Sorted by citations
Gelder, I. C. V., Rienstra, M., Bunting, K. V., Casado-Arroyo, R., Caso, V., Crijns, H. J. G. M., Potter, T. J. R. D., Dwight, J., Guasti, L., Hanke, T., et al. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae176 · Cited by 3,594
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A. M., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001193 · Cited by 3,145
Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001168 · Cited by 1,598
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.017 · Cited by 933
Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., et al. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.04.003 · Cited by 596
Metadata
- Authors
- Newman, W., Parry-Williams, G., Wiles, J., Edwards, J., Hulbert, S., Kipourou, K., Papadakis, M., Sharma, R., & O'Driscoll, J.
- Affiliations
- Canterbury Christ Church University (GB)
- Cardiology Clinical Academic Group, St George's University of London, London, UK
- St George’s University Hospitals NHS Foundation Trust (GB)
- St George's, University of London (GB)
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
- ORCID
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2021-07-12
- Volume
- 55
- Issue
- 21
- Pages
- 1233-1238
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W3180889449
- Semantic Scholar
- 83072963f4ff855873e9eee679f2ad84dca30cc2
- Cited by
- 110
- References
- 45
- Citations by year
- 2026: 14 · 2025: 28 · 2024: 34 · 2023: 23 · 2022: 9 · 2021: 2
- FWCI
- 4.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- Kent Academic Repository (University of Kent) (submittedVersion)
- UEL Research Repository (University of East London) (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 › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- atrial fibrillation, athletes, sports participation, endurance sports, exercise mode, age, incidence, risk factors
- MeSH terms
- Adult, Aged, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Sports, Exercise, Incidence, Risk Assessment, 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.
A language model drew the claims from the paper on 2026-10-12, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-12 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
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 ›
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