Long-Term Incidence of Atrial Fibrillation and Stroke Among Cross-Country Skiers: Cohort Study of Endurance-Trained Male and Female Athletes
Open accessAbstract
BACKGROUND: Studies have revealed a higher incidence of atrial fibrillation among well-trained athletes. We aim to investigate associations of endurance training with incidence of atrial fibrillation and stroke and to establish potential sex differences of such associations in a cohort of endurance trained athletes. METHODS: All Swedish skiers (208 654) completing 1 or more races in the 30 to 90 km cross-country skiing event Vasaloppet (1989-2011) and a matched sample (n=527 448) of nonskiers were followed until first event of atrial fibrillation or stroke. Cox regression was used to investigate associations of number of completed races and finishing time with incidence of atrial fibrillation and stroke. RESULTS: Female skiers in Vasaloppet had a lower incidence of atrial fibrillation than did female nonskiers (hazard ratio [HR], 0.55; 95% CI, 0.48-0.64), independent of finishing time and number of races. Male skiers had a similar incidence to that of nonskiers (HR, 0.98; 95% CI, 0.93-1.03). Skiers with the highest number of races or fastest finishing times had the highest incidence. Skiers of either sex had a lower incidence of stroke than did nonskiers (HR, 0.64; 95% CI, 0.60-0.67), independent of the number of races and finishing time. Skiers with atrial fibrillation had higher incidence of stroke than did skiers and nonskiers without atrial fibrillation (men: HR, 2.28; 95% CI, 1.93-2.70; women: HR, 3.51; 95% CI, 2.17-5.68; skiers with atrial fibrillation vs. skiers without atrial fibrillation). After diagnosis of atrial fibrillation, skiers with atrial fibrillation had a lower incidence of stroke (HR, 0.73; 95% CI, 0.50-0.91) and lower mortality compared with nonskiers with atrial fibrillation (HR, 0.57; 95% CI, 0.49-0.65). CONCLUSIONS: Female skiers in Vasaloppet had lower incidence of atrial fibrillation and stroke. Male skiers had similar incidence of atrial fibrillation and lower risk of stroke. Men with higher number of races and faster finishing times had the highest incidence of atrial fibrillation. After diagnosis of atrial fibrillation, skiers had lower incidence of stroke and death than did nonskiers with atrial fibrillation. This indicates that although on an individual level atrial fibrillation in well-trained individuals is associated with higher incidence of stroke, on population level, risk of stroke is low and that exercise should not be avoided.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
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?
In general, the risk of atrial fibrillation in female athletes appears to be lower than in male athletes.
“In general, risk of AF in female athletes appears to be lower than in male athletes.29 38”
From Risk of atrial fibrillation in athletes: a systematic review and meta-analysis (2021) · cites this paper as [38]
Although the prevalence of AF increases with age, the relative risk for athletes compared to nonathletes is higher in younger athletes.
“Moreover, although the prevalence of AF increases with age, the relative risk for athletes compared to nonathletes seems to be higher in younger athletes [22,23].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [23]
The Discussion says earlier reports found age important to AF development in male athletes, but it does not say whether younger athletes have a higher relative risk than older athletes compared with nonathletes. The Results compare skiers with nonskiers by sex, not by age; searches for younger skiers and age-dependent relative risk found no age-stratified comparison in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measuredPreliminary evidence suggests that the risk of atrial fibrillation-associated events such as stroke or mortality might be lower in athletes than in the general population.
“preliminary evidence suggests that the risk of AF-associated events (e.g.stroke, mortality) might be lower in athletes than in the general population.43,44”
From Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation (2023) · cites this paper as [44]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Atrial fibrillation as an independent risk factor for stroke: the Framingham study
Wolf, P. A., Abbott, R. D., & Kannel, W. B. (1991) · Stroke · doi:10.1161/01.str.22.8.983 · Cited by 7,388 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
External review and validation of the Swedish national inpatient register
Ludvigsson, J. F., Andersson, E., Ekbom, A., Feychting, M., Kim, J.-L., Reuterwall, C., Heurgren, M., & Olausson, P. O. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-450 · Cited by 5,055 · see citing works
The anti-inflammatory effect of exercise
Petersen, A. M. W., & Pedersen, B. K. (2005) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00164.2004 · Cited by 3,100 · see citing works
Robust causal inference using directed acyclic graphs: the R package ‘dagitty’
Textor, J., van der Zander, B., Gilthorpe, M. S., Liśkiewicz, M., & Ellison, G. T. H. (2017) · International Journal of Epidemiology · doi:10.1093/ije/dyw341 · Cited by 2,295 · see citing works
Arem, H., Moore, S. C., Patel, A., Hartge, P., Berrington de Gonzalez, A., Visvanathan, K., Campbell, P. T., Freedman, M., Weiderpass, E., Adami, H. O., et al. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.0533 · Cited by 1,498 · see citing works
Inflammation as a risk factor for atrial fibrillation
Aviles, R. J., Martin, D. O., Apperson-Hansen, C., Houghtaling, P. L., Rautaharju, P., Kronmal, R. A., Tracy, R. P., Van Wagoner, D. R., Psaty, B. M., Lauer, M. S., et al. (2003) · Circulation · doi:10.1161/01.cir.0000103131.70301.4f · Cited by 1,425 · see citing works
Samitz, G., Egger, M., & Zwahlen, M. (2011) · International Journal of Epidemiology · doi:10.1093/ije/dyr112 · Cited by 836 · see citing works
Role of Inactivity in Chronic Diseases: Evolutionary Insight and Pathophysiological Mechanisms
Booth, F. W., Roberts, C. K., Thyfault, J. P., Ruegsegger, G. N., & Toedebusch, R. G. (2017) · Physiological Reviews · doi:10.1152/physrev.00019.2016 · Cited by 696 · see citing works
Socioeconomic differences in attitudes and beliefs about healthy lifestyles
Wardle, J., & Steptoe, A. (2003) · Journal of Epidemiology & Community Health · doi:10.1136/jech.57.6.440 · Cited by 651 · see citing works
Effect of Endurance Exercise on Autonomic Control of Heart Rate
Carter, J. B., Banister, E. W., & Blaber, A. P. (2003) · Sports Medicine · doi:10.2165/00007256-200333010-00003 · Cited by 556 · see citing works
Mozaffarian, D., Furberg, C. D., Psaty, B. M., & Siscovick, D. (2008) · Circulation · doi:10.1161/circulationaha.108.785626 · Cited by 476 · see citing works
Role of Inflammation in Atrial Fibrillation Pathophysiology and Management
Harada, M., Wagoner, D. R. V., & Nattel, S. (2015) · Circulation Journal · doi:10.1253/circj.cj-15-0138 · Cited by 474 · see citing works
Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study
Andersen, K., Farahmand, B., Ahlbom, A., Held, C., Ljunghall, S., Michaëlsson, K., & Sundström, J. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht188 · Cited by 448 · see citing works
Merghani, A., Maestrini, V., Rosmini, S., Cox, A. T., Dhutia, H., Bastiaenan, R., David, S., Yeo, T. J., Narain, R., Malhotra, A., et al. (2017) · Circulation · doi:10.1161/circulationaha.116.026964 · Cited by 398 · see citing works
Relation of vigorous exercise to risk of atrial fibrillation
Aizer, A., Gaziano, J. M., Cook, N. R., Manson, J. E., Buring, J. E., & Albert, C. M. (2009) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2009.01.374 · Cited by 383 · see citing works
Cardiac Remodeling in Response to 1 Year of Intensive Endurance Training
Arbab‐Zadeh, A., Perhonen, M. A., Howden, E. J., Peshock, R. M., Zhang, R., Adams-Huet, B., Haykowsky, M. J., & Levine, B. D. (2014) · Circulation · doi:10.1161/circulationaha.114.010775 · Cited by 365 · see citing works
Molina, L., Mont, L., Marrugat, J., Berruezo, A., Brugada, J., Bruguera, J., Rebato, C., & Elosua, R. (2008) · EP Europace · doi:10.1093/europace/eun071 · Cited by 327 · see citing works
Lone atrial fibrillation in vigorously exercising middle aged men: case-control study
Karjalainen, J., Kujala, U. M., Kaprio, J., Sarna, S., & Viitasalo, M. (1998) · BMJ · doi:10.1136/bmj.316.7147.1784 · Cited by 326 · see citing works
Athlete's Heart and Cardiovascular Care of the Athlete
Baggish, A. L., & Wood, M. J. (2011) · Circulation · doi:10.1161/circulationaha.110.981571 · Cited by 294 · see citing works
Cornelissen, V. A., Verheyden, B., Aubert, A. E., & Fagard, R. H. (2010) · Journal of Human Hypertension · doi:10.1038/jhh.2009.51 · Cited by 252 · see citing works
Exercise Dose in Clinical Practice
Wasfy, M., & Baggish, A. (2016) · Circulation · doi:10.1161/circulationaha.116.018093 · Cited by 222 · see citing works
Atrial remodeling, autonomic tone, and lifetime training hours in nonelite athletes
Wilhelm, M., Roten, L., Tanner, H., Wilhelm, I., Schmid, J.-P., & Saner, H. (2011) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2011.03.086 · Cited by 192 · see citing works
Drca, N., Wolk, A., Jensen‐Urstad, M., & Larsson, S. C. (2014) · Heart · doi:10.1136/heartjnl-2013-305304 · Cited by 180 · see citing works
Calvo, N., Ramos, P., Montserrat, S., Guasch, E., Coll-Vinent, B., Domenech, M., Bisbal, F., Hevia, S., Vidorreta, S., Borras, R., et al. (2016) · Europace · doi:10.1093/europace/euv216 · Cited by 153 · see citing works
Held, C., Iqbal, R., Lear, S. A., Rosengren, A., Islam, S., Mathew, J., & Yusuf, S. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehr432 · Cited by 135 · see citing works
Diagnosis, pathophysiology, and management of exercise-induced arrhythmias
Guasch, E., & Mont, L. (2017) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2016.173 · Cited by 134 · see citing works
Thelle, D. S., Selmer, R., Gjesdal, K., Sakshaug, S., Jugessur, A., Graff-Iversen, S., Tverdal, A., & Nystad, W. (2013) · Heart · doi:10.1136/heartjnl-2013-303825 · Cited by 116 · see citing works
Physical Activity and the Risk of Incident Atrial Fibrillation in Women
Everett, B. M., Conen, D., Buring, J. E., Moorthy, M. V., Lee, I.-M., & Albert, C. M. (2011) · Circulation: Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.110.951442 · Cited by 116 · see citing works
Drca, N., Wolk, A., Jensen-Urstad, M., & Larsson, S. C. (2015) · Heart · doi:10.1136/heartjnl-2014-307145 · Cited by 111 · see citing works
Physical Activity in Primary Stroke Prevention
Howard, V. J., & McDonnell, M. N. (2015) · Stroke · doi:10.1161/strokeaha.115.006317 · Cited by 108 · see citing works
Andersen, K., Rasmussen, F. E., Held, C., Neovius, M., Tynelius, P., & Sundström, J. (2015) · BMJ · doi:10.1136/bmj.h4543 · Cited by 108 · see citing works
Mortality amongst participants in Vasaloppet: a classical long‐distance ski race in Sweden
Farahmand, B. Y., Ahlbom, A., Ekblom, Ö. B., Ekblom, B. T., Hållmarker, U., Aronson, D., & Brobert, G. (2003) · Journal of Internal Medicine · doi:10.1046/j.1365-2796.2003.01122.x · Cited by 88 · see citing works
Gender Differences of Atrial and Ventricular Remodeling and Autonomic Tone in Nonelite Athletes
Wilhelm, M., Roten, L., Tanner, H., Wilhelm, I., Schmid, J.-P., & Saner, H. (2011) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2011.06.073 · Cited by 77 · see citing works
Cardiorespiratory fitness and atrial fibrillation: A population-based follow-up study
Khan, H., Kella, D., Rauramaa, R., Savonen, K. P., Lloyd, M. S., & Laukkanen, J. A. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.03.024 · Cited by 69 · see citing works
Bapat, A. C., Zhang, Y., Post, W. S., Güallar, E., Soliman, E. Z., Heckbert, S. R., Lima, J. A. C., Bertoni, A. G., Alonso, Á., & Nazarian, S. (2015) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2015.06.013 · Cited by 47 · see citing works
Zhu, W., Wan, R., Din, Y., Xu, Z., Yang, X., & Hong, K. (2016) · Clinical Cardiology · doi:10.1002/clc.22531 · Cited by 34 · see citing works
Risk of Recurrent Stroke and Death After First Stroke in Long‐Distance Ski Race Participants
Hållmarker, U., Åsberg, S., Michaëlsson, K., Ärnlöv, J., Hellberg, D., Lindbäck, J., Wester, P. O., & James, S. K. (2015) · Journal of the American Heart Association · doi:10.1161/jaha.115.002469 · Cited by 26 · see citing works
Hållmarker, U., Lindbäck, J., Michaëlsson, K., Ärnlöv, J., Åsberg, S., Wester, P. O., Hellberg, D., Lagerqvist, B., & James, S. K. (2018) · European Heart Journal - Quality of Care and Clinical Outcomes · doi:10.1093/ehjqcco/qcy005 · Cited by 26 · see citing works
Hållmarker, U., Michaëlsson, K., Ärnlöv, J., Hellberg, D., Lagerqvist, B., Lindbäck, J., & James, S. K. (2015) · European Journal of Preventive Cardiology · doi:10.1177/2047487315578664 · Cited by 20 · see citing works
Physical Activity, Endurance Exercise, and Excess—Can One Overdose?
Kim, J. H., & Baggish, A. L. (2016) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-016-0490-6 · Cited by 15 · see citing works
Exercise, sex and atrial fibrillation: arrhythmogenesis beyond Y-chromosome?
Guasch, E., & Mont, L. (2015) · Heart · doi:10.1136/heartjnl-2015-308036 · Cited by 10 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Andrade, J. G., Aguilar, M., Atzema, C. L., Bell, A., Cairns, J. A., Cheung, C. C., Cox, J. L., Dorian, P., Gladstone, D. J., Healey, J. S., et al. (2020) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2020.09.001 · Cited by 568 · see citing works
Gluckman, T. J., Bhave, N. M., Allen, L. A., Chung, E. H., Spatz, E. S., Ammirati, E., Baggish, A. L., Bozkurt, B., Cornwell, W. K., Harmon, K. G., et al. (2022) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2022.02.003 · Cited by 419 · see citing works
Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation
Valenzuela, P. L., Ruilope, L. M., Santos-Lozano, A., Wilhelm, M., Kränkel, N., Fiuza-Luces, C., & Lucia, A. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad170 · Cited by 237 · see citing works
Coronavirus Disease 2019 and the Athletic Heart
Kim, J. H., Levine, B. D., Phelan, D. M. J., Emery, M. S., Martinez, M. W., Chung, E. H., Thompson, P. D., & Baggish, A. L. (2020) · JAMA Cardiology · doi:10.1001/jamacardio.2020.5890 · Cited by 182 · see citing works
Exercise and cardiovascular health: A state-of-the-art review
Isath, A., Koziol, K. J., Martinez, M. W., Garber, C. E., Martinez, M. N., Emery, M. S., Baggish, A. L., Naidu, S. S., Lavie, C. J., Arena, R., et al. (2023) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2023.04.008 · Cited by 176 · see citing works
Lampert, R., Chung, E. H., Ackerman, M. J., Arroyo, A. R., Darden, D., Deo, R., Dolan, J., Etheridge, S. P., Gray, B. R., Harmon, K. G., et al. (2024) · Heart Rhythm · doi:10.1016/j.hrthm.2024.05.018 · Cited by 167 · see citing works
Kim, J. H., Baggish, A. L., Levine, B. D., Ackerman, M. J., Day, S. M., Dineen, E. H., Guseh, J. S., Gerche, A. L., Lampert, R. J., Martinez, M. W., et al. (2025) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2024.12.025 · Cited by 147 · see citing works
Garnvik, L. E., Malmo, V., Janszky, I., Ellekjær, H., Wisløff, U., Loennechen, J. P., & Nes, B. M. (2020) · European Heart Journal · doi:10.1093/eurheartj/ehaa032 · Cited by 114 · see citing works
Franklin, B. A., Eijsvogels, T. M. H., Pandey, A., Quindry, J. C., & Toth, P. P. (2022) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2022.100424 · Cited by 127 · see citing works
Risk of atrial fibrillation in athletes: a systematic review and meta-analysis
Newman, W., Parry-Williams, G., Wiles, J., Edwards, J., Hulbert, S., Kipourou, K., Papadakis, M., Sharma, R., & O'Driscoll, J. (2021) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-103994 · Cited by 110 · see citing works
The effects of endurance exercise on the heart: panacea or poison?
Parry-Williams, G., & Sharma, S. (2020) · Nature Reviews Cardiology · doi:10.1038/s41569-020-0354-3 · Cited by 102 · see citing works
Atrial fibrillation: comorbidities, lifestyle, and patient factors
Shantsila, E., Choi, E., Lane, D. A., Joung, B., & Lip, G. Y. H. (2024) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2023.100784 · Cited by 104 · see citing works
Oja, P., Memon, A. R., Titze, S., Jurakić, D., Chen, S., Shrestha, N., Em, S., Matolić, T., Vasankari, T. J., Heinonen, A. O., et al. (2024) · Sports Medicine - Open · doi:10.1186/s40798-024-00692-x · Cited by 78 · see citing works
Kim, J. H., Baggish, A. L., Levine, B. D., Ackerman, M. J., Day, S. M., Dineen, E. H., Guseh, J. S., Gerche, A. L., Lampert, R. J., Martinez, M. W., et al. (2025) · Circulation · doi:10.1161/cir.0000000000001297 · Cited by 81 · see citing works
Ahn, H., Lee, S., Choi, E., Han, K., Jung, J., Lim, J., Yun, J. P., Kwon, S., Oh, S., & Lip, G. Y. H. (2021) · PLoS Medicine · doi:10.1371/journal.pmed.1003659 · Cited by 68 · see citing works
Rao, P., Belanger, M. J., & Robbins, J. (2021) · Cardiology in Review · doi:10.1097/crd.0000000000000416 · Cited by 57 · see citing works
High-intensity endurance training is associated with left atrial fibrosis
Peritz, D. C., Catino, A. B., Csécs, I., Kaur, G., Kheirkhahan, M., Loveless, B., Wasmund, S. L., Kholmovski, E. G., Morris, A. K., & MARROUCHE, N. F. (2020) · American Heart Journal · doi:10.1016/j.ahj.2020.05.015 · Cited by 44 · see citing works
Drca, N., Larsson, S. C., Grannas, D., & Jensen-Urstad, M. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2022-106035 · Cited by 41 · see citing works
Athlete’s Heart Revisited: Historical, Clinical, and Molecular Perspectives
Hsieh, P. N., Shen, S., Chukwurah, M. I., Churchill, T. W., Stewart, K. M., Chung, E. H., Weiner, R. B., Li, H., & Guseh, J. S. (2025) · Circulation Research · doi:10.1161/circresaha.125.325638 · Cited by 37 · see citing works
Impact of Exercise on Cerebrovascular Physiology and Risk of Stroke
Edward, J. A., & Cornwell, W. K. (2022) · Stroke · doi:10.1161/strokeaha.121.037343 · Cited by 36 · see citing works
Johansen, K. R., Ranhoff, A. H., Sørensen, E., Nes, B. M., Heitmann, K. A., Apelland, T., Bucher Sandbakk, S., Wilsgaard, T., Løchen, M.-L., Thelle, D. S., et al. (2022) · Open Heart · doi:10.1136/openhrt-2022-002154 · Cited by 32 · see citing works
Mehta, N. K., Strickling, J. E., Mark, E., Swinehart, S., Puthumana, J., Lavie, C. J., Haines, D. E., & Franklin, B. A. (2021) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2021.05.002 · Cited by 30 · see citing works
Elbasheir, Z., & Fouad, M. A. H. (2002) · PubMed · Cited by 29 · see citing works
Mehta, A., Kondamudi, N., Laukkanen, J. A., Wisløff, U., Franklin, B. A., Arena, R. A., Lavie, C. J., & Pandey, A. (2020) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2020.11.004 · Cited by 28 · see citing works
Beyond the medals: a cross-sectional study exploring retired elite female athletes’ health
Thornton, J. S., Rosen, C., Davenport, M. H., Mountjoy, M. L., Dorian, P., Gouttebarge, V., Breau, B., Pila, E., Reilly, K. C., Yuan, J., et al. (2023) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2022-001479 · Cited by 27 · see citing works
Atrial fibrillation in former world-class rowers: role of environmental and genetic factors
Flannery, D., Cánovas, R., Janssens, K., Mitchell, A. M., D’Ambrosio, P., Spencer, L. W., Rowe, S. J., Paratz, E. D., Claessen, G., Myrstad, M., et al. (2025) · European Heart Journal · doi:10.1093/eurheartj/ehaf369 · Cited by 26 · see citing works
Elliott, A. D., Ariyaratnam, J., Howden, E. J., Gerche, A. L., & Sanders, P. (2023) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00322.2023 · Cited by 25 · see citing works
Ahn, H., Choi, E., Rhee, T., Choi, J., Lee, K., Kwon, S., Lee, S., Oh, S., & Lip, G. Y. H. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-106862 · Cited by 24 · see citing works
Patel, R., Kemp, C. R., Hafejee, M., Peckham, N., Jain, V., McCann, G. P., & Pallikadavath, S. (2021) · Sports Medicine - Open · doi:10.1186/s40798-021-00320-y · Cited by 23 · see citing works
Rao, S. J., & Shah, A. B. (2021) · Clinical Therapeutics · doi:10.1016/j.clinthera.2021.11.018 · Cited by 19 · see citing works
Cornwell, W. K., Levine, B. D., Baptiste, D., Bhave, N. M., Desai, S., Dineen, E. H., Durstenfeld, M. S., Edward, J. A., Huang, M., Jacobsen, R. M., et al. (2025) · Circulation · doi:10.1161/cir.0000000000001348 · Cited by 17 · see citing works
The effects of daily dose of intense exercise on cardiac responses and atrial fibrillation
Gorman, R. A., Yakobov, S., Polidovitch, N., Debi, R., Sanfrancesco, V. C., Hood, D. A., Lakin, R., & Backx, P. H. (2024) · The Journal of Physiology · doi:10.1113/jp285697 · Cited by 18 · see citing works
Can the Heart Get an Overuse Sports Injury?
Thompson, P. D., Eijsvogels, T. M. H., & Kim, J. H. (2022) · NEJM Evidence · doi:10.1056/evidra2200175 · Cited by 15 · see citing works
Exercise and Experiments of Nature
Joyner, M. J., Wiggins, C. C., Baker, S. E., Klassen, S. A., & Senefeld, J. W. (2023) · Comprehensive physiology · doi:10.1002/cphy.c220027 · Cited by 16 · see citing works
Ageing, comorbidities, and the complex determinants of atrial fibrillation in athletes
Guasch, E., & Nattel, S. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab473 · Cited by 11 · see citing works
Eijsvogels, T. M. H., Kim, J. H., Aengevaeren, V. L., D’Ascenzi, F., Churchill, T., Dineen, E. H., la Garza, M. S., Gati, S., Hálasz, G., Haugaa, K. H., et al. (2026) · European Heart Journal · doi:10.1093/eurheartj/ehag040 · Cited by 11 · see citing works
The AFLETES Study: Atrial Fibrillation in Veteran Athletes and the Risk of Stroke
Pallikadavath, S., Richards, C. E., Bountziouka, V. P., Sandilands, A., Graham-Brown, M. P. M., Robinson, T. G., Singh, A., & McCann, G. P. (2023) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0000000000001115 · Cited by 10 · see citing works
Practical guidance for management of atrial fibrillation in sports cardiology
Palermi, A., Molinari, L. V., Ricci, F., Gallina, S., & Renda, G. (2025) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2025.102995 · Cited by 12 · see citing works
Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature
Kourek, C., Briasoulis, A., Tsougos, E., & Paraskevaidis, I. (2024) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd11100315 · Cited by 7 · see citing works
Verdicchio, C. V., Mahajan, R., Middeldorp, M. E., Gallagher, C., Mishima, R. S., Lau, D. H., Sanders, P., & Elliott, A. D. (2023) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwad242 · Cited by 7 · see citing works
Masters Athletes With Abnormal Cardiovascular Findings
Eijsvogels, T. M. H., Kim, J. H., Aengevaeren, V. L., D’Ascenzi, F., Churchill, T., Dineen, E. H., la Garza, M. S., Gati, S., Hálasz, G., Haugaa, K. H., et al. (2026) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2026.03.025 · Cited by 6 · see citing works
Strepp, T., Blumkaitis, J. C., Sareban, M., STÖGGL, T. L., & Haller, N. (2024) · Sports Medicine - Open · doi:10.1186/s40798-024-00761-1 · Cited by 7 · see citing works
Exercise and Experiments of Nature
Joyner, M. J., Wiggins, C. C., Baker, S. E., Klassen, S. A., & Senefeld, J. W. (2023) · Comprehensive physiology · doi:10.1002/j.2040-4603.2023.tb00274.x · Cited by 6 · see citing works
Exercise and Athletic Activity in Atrial Fibrillation
Kherlopian, A., Weinshel, S., Madias, C. A., & Estes, N. A. M. (2021) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2020.10.005 · Cited by 6 · see citing works
Kunutsor, S. K., Laukkanen, J. A., Kurl, S., Mäkikallio, T. H., & Khan, H. (2020) · European Journal of Preventive Cardiology · doi:10.1177/2047487319901040 · Cited by 6 · see citing works
Strenuous Endurance Exercise and the Heart: Physiological versus Pathological Adaptations
Valenzuela, P. L., Baggish, A. L., Castillo‐García, A., Santos‐Lozano, A., Boraíta, A., & Lucía, A. (2022) · Comprehensive physiology · doi:10.1002/cphy.c210045 · Cited by 8 · see citing works
Approach to atrial fibrillation
Bell, A., Andrade, J., Macle, L., Connelly, K., Labine, L., & Singer, A. (2023) · Canadian Family Physician Médecin de famille canadien · doi:10.46747/cfp.6904245 · Cited by 3 · see citing works
Exercise Testing in Elite Athletes
Rudofker, E. W., Ochten, N. A. V., Edward, J. A., Parker, H., Wulff, K., Suckow, E., Forbes, L. M., & Cornwell, W. K. (2024) · Heart Failure Clinics · doi:10.1016/j.hfc.2024.05.001 · Cited by 4 · see citing works
Reassuring News for Athletes With Atrial Fibrillation, But Perhaps Not All Athletes
Gerche, A. L. (2020) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2020.06.013 · Cited by 4 · see citing works
Vecchiarelli, E., Bentley, R. F., Connelly, K. A., Dorian, P., Yan, A. T.-K., Mak, S. S., Sasson, Z., & Goodman, J. M. (2024) · PLoS ONE · doi:10.1371/journal.pone.0294367 · Cited by 3 · see citing works
Javed, W., Botis, I., Tomoaia, R., Brown, B. D., Shabi, M., Chambers, B., Levelt, E., Dall’Armellina, E., Kellman, P., Greenwood, J. P., et al. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.125.042308 · Cited by 3 · see citing works
Dineen, E. H., Haigney, M., Levine, B. D., Ackerman, M., Baggish, A. L., Batts, T. C., Braverman, A. C., Chung, E. H., Cole, G. J., Cornwell, W. K., et al. (2026) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2026.07.003 · Cited by 1 · see citing works
Apelland, T., Sellevold, A. B., Letnes, J. M., Onarheim, S., Enger, S., Tveit, A., Delpire, B., Claessen, G., Gerche, A. L., Loennechen, J. P., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-093250 · Cited by 3 · see citing works
Endurance Exercise Induced Atrial Fibrillation (AF): Pathophysiology, Treatment and Prevention
Leowattana, W. (2020) · Biomedical Journal of Scientific & Technical Research · doi:10.26717/bjstr.2020.28.004640 · Cited by 3 · see citing works
Cross-country skiing and risk of atrial fibrillation: A meta-analysis of cohort studies
Guo, L., Huang, W., Dai, W., & Yang, J. (2022) · Science & Sports · doi:10.1016/j.scispo.2021.08.006 · Cited by 3 · see citing works
Glibbery, M., Banks, L., Altaha, M. A., Bentley, R. F., Konieczny, K. M., Yan, A. T.-K., Dorian, P., Deva, D. P., Goodman, J. M., & Connelly, K. A. (2021) · Clinical Cardiology · doi:10.1002/clc.23707 · Cited by 3 · see citing works
Strenuous Endurance Exercise and the Heart: Physiological versus Pathological Adaptations
Valenzuela, P. L., Baggish, A. L., Castillo‐García, A., Santos‐Lozano, A., Boraíta, A., & Lucía, A. (2022) · Comprehensive physiology · doi:10.1002/j.2040-4603.2022.tb00239.x · Cited by 3 · see citing works
Time Course of Cardiac Arrhythmia Following High‐Volume Exercise in Recreational Cyclists
Wundersitz, D. W. T., Collins, B. E. G., Gordon, B. A., Lavie, C. J., Orchard, J. J., Blair, N., Nadurata, V., & Kingsley, M. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.125.044378 · Cited by 2 · see citing works
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
Can too much exercise be dangerous: what can we learn from the athlete’s heart?
Goh, F. Q. (2021) · British Journal of Cardiology · doi:10.5837/bjc.2021.030 · Cited by 2 · see citing works
Mechanobiology of Exercise-Induced Cardiac Remodeling in Health and Disease
Cornwell, W. K., & Buttrick, P. M. (2023) · Cardiac and vascular biology · doi:10.1007/978-3-031-23965-6_9 · Cited by 2 · see citing works
Stroke in Athletes with Atrial Fibrillation: A Narrative Review
Pereira, J. C., Lima, M. R., Costa, F. M., Gomes, D. A., Maltês, S., Cunha, G., Dores, H., & Adragão, P. (2024) · Diagnostics · doi:10.3390/diagnostics15010009 · Cited by 1 · see citing works
Sanchis-Gomar, F., Pérez-Quilis, C., Eijsvogels, T., la Guía-Galipienso, F., Christle, J., Perez, M., & Lavie, C. (2023) · Heart and Mind · doi:10.4103/hm.hm-d-23-00005 · Cited by 2 · see citing works
Zhao, S., & Wehrens, X. H. T. (2024) · Clinical Science · doi:10.1042/cs20241421 · Cited by 1 · see citing works
Preserved Cardiorespiratory Fitness After Catheter Ablation in Athletes With Atrial Fibrillation
Hsieh, P. N., Czeisler, M. É., Chukwurah, M. I., Stewart, K. M., Gustus, S. K., Steinmetz, K., Volfson, A., Barrett, C. D., Churchill, T. W., Baggish, A. L., et al. (2026) · Journal of the American Heart Association · doi:10.1161/jaha.125.044421 · Cited by 1 · see citing works
High Physical Activity Level and the Long-Term Risk of Atrial Fibrillation in Two Swedish Cohorts
Wändell, P. E., Enarsson, M., Feldreich, T., Lind, L., Ärnlöv, J., & Carlsson, A. C. (2025) · Geriatrics · doi:10.3390/geriatrics10030080 · Cited by 1 · see citing works
Liao, M., Chen, C., Lin, T., Cheng, L.-Y., Ting, H.-W., & Lai, C. (2021) · PubMed Central · doi:10.6515/acs.202111_37(6).20210620a · Cited by 1 · see citing works
Adukauskaitė, A., & Stuehlinger, M. (2022) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-022-00913-4 · Cited by 2 · see citing works
Atrial fibrillation in athletes and non-athletes: evidence of different causative mechanisms
Sanchis‐Gomar, F., de la Guía-Galipienso, F., & Lavie, C. J. (2021) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jeab018 · Cited by 1 · see citing works
The Race to Improve Care for Athletes with Atrial Fibrillation
Elliott, A. D., & Lau, D. H. (2023) · Heart Lung and Circulation · doi:10.1016/j.hlc.2023.11.001 · Cited by 1 · see citing works
Lifestyle modification for the management of atrial fibrillation
Fanous, Y., & Dorian, P. (2020) · Canadian Medical Association Journal · doi:10.1503/cmaj.201084
Possibilities in the Prediction of Cardiac Arrhythmias and Conductivity Disorders in Former Athletes
Крысюк, О. Б., Обрезан, А. Г., Zadvorev, S. F., & Yakovlev, A. A. (2020) · Advances in Gerontology · doi:10.1134/s2079057020040104
Modification de l’hygiène de vie pour traiter la fibrillation auriculaire
Fanous, Y., & Dorian, P. (2021) · Canadian Medical Association Journal · doi:10.1503/cmaj.201084-f
Racial and Gender Differences in Cardiorespiratory Fitness and Atrial Fibrillation
Czulada, E., Shah, S. A., & Tsimploulis, A. (2024) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2507261
Myrstad, M., & Elliott, A. D. (2025) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2025.2476123
Electrophysiology in motion: The subspecialty of sports electrophysiology
Hsieh, P. N., & Chung, E. H. (2025) · HeartRhythm Case Reports · doi:10.1016/j.hrcr.2025.08.008
Letnes, J. M., Sellevold, A. B., Apelland, T., Brown, F. P., Byrkjeland, R., Flasnes, M., Loennechen, J. P., Nes, B. M., & Myrstad, M. (2025) · Heart Rhythm O2 · doi:10.1016/j.hroo.2025.12.002
Strepp, T., Blumkaitis, J. C., Sareban, M., STÖGGL, T. L., & Haller, N. (2024) · Figshare · doi:10.6084/m9.figshare.26952372
Strepp, T., Blumkaitis, J. C., Sareban, M., STÖGGL, T. L., & Haller, N. (2024) · Figshare · doi:10.6084/m9.figshare.26952366
Strepp, T., Blumkaitis, J. C., Sareban, M., STÖGGL, T. L., & Haller, N. (2024) · Figshare · doi:10.6084/m9.figshare.26952369
In Endurance Athletes at Risk for Arrhythmias, Screen Early and Gauge Often
Lewis, N. D. H., & Chung, E. H. (2026) · Journal of the American Heart Association · doi:10.1161/jaha.125.048048
Kłopotowski, M. M., Derejko, P., & Małek, Ł. A. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15062170
Sports and Exercise Cardiology: A New Frontier in Cardiovascular Disease Management
Cornwell, W. K., Dineen, E. H., Petek, B. J., Shafer, K. M., Davenport, E. D., Chung, E. H., Kim, J. H., & Levine, B. D. (2026) · Circulation Population Health and Outcomes · doi:10.1161/circoutcomes.126.013583
Exercise for Atrial Fibrillation: Unmasking Comorbidities and Improving Treatment
Dziano, J. K., Ariyaratnam, J., Middeldorp, M. E., Sanders, P., & Elliott, A. D. (2026) · Exercise and Sport Sciences Reviews · doi:10.1249/jes.0000000000000391
Atrial fibrillation in athletes: you can’t start a fire without a spark
Elliott, A. D., Gerche, A. L., & Myrstad, M. (2026) · European Heart Journal · doi:10.1093/eurheartj/ehag560
Suo, S., Zhou, X., Luo, Y., Zhang, Z., Pan, J., Sun, H., & Liu, H. (2026) · Frontiers in Physiology · doi:10.3389/fphys.2026.1878610
Dineen, E. H., Haigney, M. C., Levine, B. D., Ackerman, M. J., Baggish, A. L., Batts, T. C., Braverman, A. C., Chung, E. H., Cole, G. J., Cornwell, W. K., et al. (2026) · Circulation · doi:10.1161/cir.0000000000001476
Management of Anticoagulation in Athletes
Bavishi, P., & Raghavendran, P. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15187213
Davies, C. L., Pallikadavath, S., March, D. S., Lock, S., Puranik, A., Singh, A., Ng, G. A., & McCann, G. P. (2026) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwag535
Luvianto, J., & Suastika, L. (2026) · Cardiology in Review · doi:10.1097/crd.0000000000001503
Choi, E., Middeldorp, M. E., Ahn, H., Ariyaratnam, J., Elliott, A. D., Hung, C., Yu, H. T., Sharma, G., Wang, N., Yamaguchi, T., et al. (2026) · Journal of Arrhythmia · doi:10.1002/joa3.70490
- Authors
- Svedberg, N., Sundström, J., James, S., Hållmarker, U., Hambraeus, K., & Andersen, K.
- Affiliations
- Uppsala University (SE)
- Department of Medical Sciences, Uppsala University, Sweden (N..S., J.S., S.J., U.H., K.H., K.A.).
- Venue
- Circulation
- Published
- 2019-09-10
- Volume
- 140
- Issue
- 11
- Pages
- 910-920
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2972491210
- Cited by
- 92
- References
- 42
- Citations by year
- 2026: 16 · 2025: 13 · 2024: 16 · 2023: 13 · 2022: 9 · 2021: 13 · 2020: 11
- FWCI
- 5.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Regionala Forskningsrådet Uppsala/Örebro
- 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, stroke, cross-country skiing, endurance training, athletes, sex differences, Vasaloppet, finishing time, stroke mortality, long-term incidence, cardiovascular hospitalization, cardiovascular risk factors, cardiovascular risk reduction, cardiovascular risk prevention, cardiovascular risk screening
- MeSH terms
- Adult, Atrial Fibrillation, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Physical Endurance, Risk Factors, Skiing, Sweden, Time Factors, Cohort Studies, Incidence, Stroke, 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.
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 ›
Are you an author, or do you see a problem with this page? Request a review
