Atrial fibrillation in endurance athletes
Abstract
There is a growing population of veteran endurance athletes, regularly participating in training and competition. Although the graded benefit of exercise on cardiovascular health and mortality is well established, recent studies have raised concern that prolonged and strenuous endurance exercise may predispose to atrial and ventricular arrhythmias. Atrial fibrillation (AF) and atrial flutter are facilitated by atrial remodelling, atrial ectopy, and an imbalance of the autonomic nervous system. Endurance sports practice has an impact on all of these factors and may therefore act as a promoter of these arrhythmias. In an animal model, long-term intensive exercise training induced fibrosis in both atria and increased susceptibility to AF. While the prevalence of AF is low in young competitive athletes, it increases substantially in the aging athlete, which is possibly associated with an accumulation of lifetime training hours and participation in competitions. A recent meta-analysis revealed a 5-fold increased risk of AF in middle-aged endurance athletes with a striking male predominance. Beside physical activity, height and absolute left atrial size are independent risk factors for lone AF and the stature of men per se may explain part of their higher risk of AF. Furthermore, for a comparable amount of training volume and performance, male non-elite athletes exhibit a higher blood pressure at rest and peak exercise, a more concentric type of left ventricular remodelling, and an altered diastolic function, possibly contributing to a more pronounced atrial remodelling. The sports cardiologist should be aware of the distinctive features of AF in athletes. Therapeutic recommendations should be given in close cooperation with an electrophysiologist. Reduction of training volume is often not desired and drug therapy not well tolerated. An early ablation strategy may be appropriate for some athletes with an impaired physical performance, especially when continuation of competitive activity is intended. This review focuses on the prevalence, risk factors, and mechanisms of AF in endurance athletes, and possible therapeutic options.
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Wilhelm indicates biatrial remodelling, dilation and fibrosis as crucial substrates to developing atrial fibrillation.
“Mechanistically, Wilhelm 13 indicates biatrial remodelling, dilation and fibrosis as crucial substrates to developing this pathology.”
From Risk of atrial fibrillation in athletes: a systematic review and meta-analysis (2021) · cites this paper as [13]
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)
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Cites
Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.
Haïssaguerre, M., Jaïs, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., Garrigue, S., Mouroux, A. L., Métayer, P. L., & Clémenty, J. (1998) · New England Journal of Medicine · doi:10.1056/nejm199809033391003 · Cited by 8,040 · see citing works
Guidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq278 · Cited by 5,875 · see citing works
Benjamin, E. J. (1994) · JAMA · doi:10.1001/jama.1994.03510350050036 · Cited by 2,613 · see citing works
Feinberg, W. M. (1995) · Archives of Internal Medicine · doi:10.1001/archinte.155.5.469 · Cited by 2,282 · see citing works
Atrial Remodeling and Atrial Fibrillation: Mechanisms and Implications
Nattel, S., Burstein, B., & Dobrev, D. (2008) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.107.754564 · Cited by 1,124 · see citing works
Heart Rate Variability in Athletes
AUBERT, A. E., Seps, B., & Beckers, F. (2003) · Sports Medicine · doi:10.2165/00007256-200333120-00003 · Cited by 922 · see citing works
Physical activity and all-cause mortality: what is the dose–response relation?
LEE, I.-M., & SKERRETT, P. J. (2001) · Medicine and Science in Sports and Exercise · doi:10.1097/00005768-200106001-00016 · Cited by 786 · see citing works
Cardiac arrest during long-distance running races
Kim, J. H., Malhotra, R., Chiampas, G., d'Hemecourt, P., Troyanos, C., Cianca, J., Smith, R. N., Wang, T. J., Roberts, W. O., Thompson, P. D., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1106468 · Cited by 597 · see citing works
Exercise characteristics and the blood pressure response to dynamic physical training
FAGARD, R. H. (2001) · Medicine and Science in Sports and Exercise · doi:10.1097/00005768-200106001-00018 · Cited by 561 · see citing works
Autonomic tone variations before the onset of paroxysmal atrial fibrillation
Bettoni, M., & Zimmermann, M. (2002) · Circulation · doi:10.1161/01.cir.0000018443.44005.d8 · Cited by 534 · see citing works
Neilan, T. G., Januzzi, J. L., Lee-Lewandrowski, E., Ton-Nu, T.-T., Yoerger, D. M., Jassal, D. S., Lewandrowski, K. B., Siegel, A. J., Marshall, J. E., Douglas, P. S., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.647461 · Cited by 519 · see citing works
Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training
Benito, B., Gay-Jordi, G., Serrano-Mollar, A., Guasch, E., Shi, Y., Tardif, J.-C., Brugada, J., Nattel, S., & Mont, L. (2011) · Circulation · doi:10.1161/circulationaha.110.938282 · Cited by 478 · see citing works
Prevalence and Clinical Significance of Left Atrial Remodeling in Competitive Athletes
Pelliccia, A., Maron, B. J., Di Paolo, F. M., Biffi, A., Quattrini, F. M., Pisicchio, C., Roselli, A., Caselli, S., & Culasso, F. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.04.052 · Cited by 443 · see citing works
Paroxysmal Atrial Fibrillation: A Disorder of Autonomic Tone?
Coumel, P. (1994) · European Heart Journal · doi:10.1093/eurheartj/15.suppl_a.9 · Cited by 422 · see citing works
Abdulla, J., & Nielsen, J. R. (2009) · Europace · doi:10.1093/europace/eup197 · Cited by 420 · see citing works
Inflammation in the genesis and perpetuation of atrial fibrillation
Engelmann, M. D. M., & Svendsen, J. H. (2005) · European Heart Journal · doi:10.1093/eurheartj/ehi350 · Cited by 419 · see citing works
Heidbüchel, H. (2003) · European Heart Journal · doi:10.1016/s0195-668x(03)00282-3 · Cited by 395 · 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 · cited 1× · see citing works
“In the Physicians Health Study, the relative risk of AF increased in joggers practising more than 3 or 4 days a week.(60) Thus, limiting endurance training is the most important recommendation in athletes with AF.”
BackgroundFukunami, M., Yamada, T., Ohmori, M., Kumagai, K., Umemoto, K., Sakai, A., Kondoh, N., Minamino, T., & Hoki, N. (1991) · Circulation · doi:10.1161/01.cir.83.1.162 · Cited by 353 · see citing works
Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists
Baldesberger, S., Bauersfeld, U., CANDINAS, R., Seifert, B., Zuber, M., Ritter, M., Jenni, R., Oechslin, E. N., Luthi, P., Scharf, C., et al. (2007) · European Heart Journal · doi:10.1093/eurheartj/ehm555 · Cited by 343 · see citing works
Long-lasting sport practice and lone atrial fibrillation
Mont, L. (2002) · European Heart Journal · doi:10.1053/euhj.2001.2802 · Cited by 331 · 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
Iellamo, F., Legramante, J. M., Pigozzi, F., Spataro, A., Norbiato, G., Lucini, D., & Pagani, M. (2002) · Circulation · doi:10.1161/01.cir.0000018124.01299.ae · Cited by 309 · see citing works
Mont, L., Tamborero, D., Elosua, R., Molina, I., Coll-Vinent, B., Sitges, M., Vidal, B., Scalise, A., Tejeira, A., Berruezo, A., et al. (2008) · EP Europace · doi:10.1093/europace/eum263 · Cited by 270 · see citing works
Sport practice and the risk of lone atrial fibrillation: a case-control study
Elosua, R., Arquer, A., Mont, L., Sambola, A., Molina, L., García-Morán, E., Brugada, J., & Marrugat, J. (2006) · International Journal of Cardiology · doi:10.1016/j.ijcard.2005.05.020 · Cited by 250 · see citing works
Autonomic nerve activity and atrial fibrillation
Chen, P., & Tan, A. Y. (2006) · Heart Rhythm · doi:10.1016/j.hrthm.2006.12.006 · Cited by 233 · see citing works
Acute cardiac effects of marathon running
Trivax, J. E., Franklin, B. A., Goldstein, J. A., Chinnaiyan, K. M., Gallagher, M. J., deJong, A. T., Colar, J. M., Haines, D. E., & McCullough, P. A. (2010) · Journal of Applied Physiology · doi:10.1152/japplphysiol.01151.2009 · Cited by 229 · 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
Self-citationAngiotensin II-antagonist in paroxysmal atrial fibrillation (ANTIPAF) trial
Goette, A., Schön, N., Kirchhof, P., Breithardt, G., Fetsch, T., Häusler, K. G., Klein, H. U., Steinbeck, G., Wegscheider, K., & Meinertz, T. (2012) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.111.965178 · Cited by 187 · see citing works
Endurance sports is a risk factor for atrial fibrillation after ablation for atrial flutter
Heidbüchel, H., Anné, W., Willems, R., Adriaenssens, B., Van de Werf, F., & Ector, H. (2006) · International Journal of Cardiology · doi:10.1016/j.ijcard.2005.02.043 · Cited by 180 · see citing works
Grimsmo, J., Grundvold, I., Maehlum, S., & Arnesen, H. (2010) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/hjr.0b013e32833226be · Cited by 176 · see citing works
Exercise-Associated Increases in Cardiac Biomarkers
Scharhag, J., George, K., Shave, R., Urhausen, A. J. P., & Kindermann, W. (2008) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318172cf22 · Cited by 163 · see citing works
Long-Term Clinical Consequences of Intense, Uninterrupted Endurance Training in Olympic Athletes
Pelliccia, A., Kinoshita, N., Pisicchio, C., Quattrini, F., DiPaolo, F. M., Ciardo, R., Di Giacinto, B., Guerra, E., De Blasiis, E., Casasco, M., et al. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.10.068 · Cited by 159 · see citing works
(1998) · PubMed · Cited by 152 · see citing works
Arterial Stiffness and Wave Reflections in Marathon Runners
Vlachopoulos, C. V., Kardara, D. F., Anastasakis, A., Baou, K., Terentes-Printzios, D. G., Tousoulis, D., & Stefanadis, C. (2010) · American Journal of Hypertension · doi:10.1038/ajh.2010.99 · Cited by 138 · see citing works
Paroxysmal atrial fibrillation in male endurance athletes. A 9-year follow up
Hoogsteen, J. (2004) · Europace · doi:10.1016/j.eupc.2004.01.004 · Cited by 134 · see citing works
Hein, H., Panhuyzen-Goedkoop, N., Corrado, D., Hoffmann, E., Biffi, A., Delise, P., Blomstrom-Lundqvist, C., Vanhees, L., IvarHoff, P., Dorwarth, U., et al. (2006) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000216543.54066.72 · Cited by 134 · see citing works
Efficacy of circumferential pulmonary vein ablation of atrial fibrillation in endurance athletes
Calvo, N., Mont, L., Tamborero, D., Berruezo, A., Viola, G., Guasch, E., Nadal, M., Andreu, D., Vidal, B., Sitges, M., et al. (2010) · Europace · doi:10.1093/europace/eup320 · Cited by 121 · see citing works
Abe, Y., Fukunami, M., Yamada, T., Ohmori, M., Shimonagata, T., Kumagai, K., Kim, J., Sanada, S., Hori, M., & Hoki, N. (1997) · Circulation · doi:10.1161/01.cir.96.8.2612 · Cited by 117 · see citing works
Furlanello, F., Lupo, P., Pittalis, M., FORESTI, S., Serdoz, L. V., Francia, P., Ambroggi, G. D., Ferrero, P., Nardi, S., Inama, G., et al. (2008) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2007.01077.x · Cited by 112 · see citing works
Ambulatory Electrocardiographic Findings in Top Athletes, Athletic Students and Control Subjects
Bjørnstad, H., Storstein, L., Meen, H. D., & Hals, O. (2008) · Cardiology · doi:10.1159/000176327 · Cited by 110 · see citing works
Efficacy of radiofrequency catheter ablation in athletes with atrial fibrillation
Koopman, P., Nuyens, D., Garweg, C., La Gerche, A., De Buck, S., Van Casteren, L., Alzand, B., Willems, R., & Heidbuchel, H. (2011) · Europace · doi:10.1093/europace/eur142 · Cited by 102 · see citing works
Atrial fibrillation and anabolic steroids
Sullivan, M. L., Martinez, C., & Gallagher, E. J. (1999) · Journal of Emergency Medicine · doi:10.1016/s0736-4679(99)00095-5 · Cited by 97 · see citing works
Biochemical evidence of myocardial fibrosis in veteran endurance athletes
Lindsay, M. M., & Dunn, F. G. (2007) · British Journal of Sports Medicine · doi:10.1136/bjsm.2006.031534 · Cited by 96 · see citing works
Scharf, M., Brem, M. H., Wilhelm, M., Schoepf, U. J., Uder, M., & Lell, M. (2010) · Radiology · doi:10.1148/radiol.10092377 · Cited by 86 · see citing works
Self-citationSwanson, D. R. (2006) · Medical Hypotheses · doi:10.1016/j.mehy.2006.01.006 · Cited by 81 · see citing works
Atrial fibrillation and anabolic steroid abuse
Lau, D. H., Stiles, M. K., John, B., Shashidhar, Young, G. D., & Sanders, P. (2007) · International Journal of Cardiology · doi:10.1016/j.ijcard.2006.11.199 · Cited by 79 · see citing works
P Wave Signal‐Averaged Electrocardiography to Identify Risk for Atrial Fibrillation
Darbar, D., Jahangir, A., Hammill, S. C., & Gersh, B. J. (2002) · Pacing and Clinical Electrophysiology · doi:10.1046/j.1460-9592.2002.01447.x · Cited by 78 · 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
Self-citationFogari, R., Derosa, G., Ferrari, I., Corradi, L., Zoppi, A., Lazzari, P., Santoro, T., Preti, P. S., & Mugellini, A. (2008) · American Journal of Hypertension · doi:10.1038/ajh.2008.217 · Cited by 76 · see citing works
Inflammation and atrial remodeling after a mountain marathon
Wilhelm, M., Züger, T., Marchi, S. D., Rimoldi, S. F., Brugger, N., Steiner, R., Stettler, C., Nuoffer, J., Seiler, C. A., & Ith, M. (2012) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.12030 · Cited by 53 · see citing works
Self-citationLong-term endurance sport is a risk factor for development of lone atrial flutter
Claessen, G., Colyn, E., Gerche, A. L., Koopman, P., Alzand, B. S. N., Garweg, C., Willems, R., Nuyens, D., & Heidbüchel, H. (2011) · Heart · doi:10.1136/hrt.2010.216150 · Cited by 46 · see citing works
Long-Term Cardiac Remodeling and Arrhythmias in Nonelite Marathon Runners
Wilhelm, M., Roten, L., Tanner, H., Schmid, J., Wilhelm, I., & Saner, H. E. (2012) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2012.02.058 · Cited by 40 · see citing works
Self-citationReverse atrial electrical remodeling: A systematic review
Pang, H., Ronderos, R., Pérez‐Riera, A. R., Femenía, F., & Baranchuk, A. M. (2011) · Cardiology Journal · doi:10.5603/cj.2011.0025 · Cited by 40 · see citing works
Wilhelm, M., Brem, M. H., Rost, C., Klinghammer, L., Hennig, F. F., Daniel, W. G., & Flachskampf, F. A. (2010) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2010.03.072 · Cited by 37 · see citing works
Self-citationCardiovascular Risk and Clinical Factors in Athletes
de Matos, L. D. N. J., CALDEIRA, N. D. A. O., Perlingeiro, P. D. S., SANTOS, I. L. G. D., Negrão, C. E., & AZEVEDO, L. F. (2010) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318203d5cb · Cited by 36 · see citing works
Wilhelm, M., Nuoffer, J., Schmid, J., Wilhelm, I., & Saner, H. E. (2012) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2011.11.039 · Cited by 35 · see citing works
Self-citationBjörnstad, H. H., Bjørnstad, T. H., Urheim, S., Hoff, P. I., Smith, G., & Maron, B. J. (2008) · Cardiology · doi:10.1159/000151435 · Cited by 29 · see citing works
Fogari, R., Zoppi, A., Maffioli, P., Mugellini, A., Preti, P. S., Perrone, T., & Derosa, G. (2012) · Clinical Cardiology · doi:10.1002/clc.21994 · Cited by 29 · see citing works
Lawless, C. E., & Briner, W. W. (2008) · Sports Medicine · doi:10.2165/00007256-200838080-00006 · Cited by 25 · see citing works
Delise, P., Sitta, N., & Berton, G. S. (2012) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0b013e3283522485 · Cited by 20 · see citing works
Association of Physical Activity and Atrial Fibrillation
Müller‐Riemenschneider, F., Andersohn, F., Ernst, S., & Willich, S. N. (2012) · Journal of Physical Activity and Health · doi:10.1123/jpah.9.5.605 · Cited by 18 · see citing works
Run, Pheidippides, Run! The story of the Battle of Marathon.
Grogan, R. (1981) · British Journal of Sports Medicine · doi:10.1136/bjsm.15.3.186 · Cited by 17 · see citing works
Walter, J. F. (1984) · Archives of Dermatology · doi:10.1001/archderm.1984.01650480053017 · Cited by 16 · see citing works
Fowler, N. O. (1971) · New England Journal of Medicine · doi:10.1056/nejm197111042851917 · Cited by 10 · see citing works
Atrial fibrillation ablation in athletes: an Olympic challenge?
Boersma, L. V. A. (2009) · EP Europace · doi:10.1093/europace/eup399 · Cited by 3 · see citing works
Benito, B., Cardin, S., Guasch, E., Shi, Y., Lawler, P., Maguy, A., Tardif, J., Oliveras, A., Mont, L., & Nattel, S. (2009) · Circulation · Cited by 1 · see citing works
Flagged first, then by citations
1 of the 69 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Epidemiology of Atrial Fibrillation in the 21st Century
Kornej, J., Börschel, C. S., Benjamin, E. J., & Schnabel, R. B. (2020) · Circulation Research · doi:10.1161/circresaha.120.316340 · Cited by 1,550 · see citing works
Clinical neurocardiology defining the value of neuroscience-based cardiovascular therapeutics
Shivkumar, K., Ajijola, O. A., Anand, I., Armour, J. A., Chen, P., Esler, M., De Ferrari, G. M., Fishbein, M. C., Goldberger, J. J., Harper, R. M., et al. (2016) · The Journal of Physiology · doi:10.1113/jp271870 · Cited by 308 · see citing works
The autonomic nervous system and cardiac arrhythmias: current concepts and emerging therapies
Herring, N., Kalla, M., & Paterson, D. J. (2019) · Nature Reviews Cardiology · doi:10.1038/s41569-019-0221-2 · Cited by 254 · see citing works
Ozemek, C., Laddu, D., Lavie, C. J., Claeys, H., Kaminsky, L. A., Ross, R., Wisløff, U., Arena, R. A., & Blair, S. N. (2018) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2018.11.005 · Cited by 208 · see citing works
Physical activity, resting heart rate, and atrial fibrillation: the Tromsø Study
Morseth, B., Graff-Iversen, S., Jacobsen, B. K., Jørgensen, L., Nyrnes, A., Thelle, D. S., Vestergaard, P., & Løchen, M.-L. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw059 · Cited by 204 · see citing works
Myrstad, M., Løchen, M., Graff‐Iversen, S., Gulsvik, A. K., Thelle, D. S., Stigum, H., & Ranhoff, A. H. (2013) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.12150 · Cited by 114 · 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
Atrial fibrillation in highly trained endurance athletes — Description of a syndrome
Sanchis-Gomar, F., Perez-Quilis, C., Lippi, G., Cervellin, G., Leischik, R., Löllgen, H., Serrano-Ostáriz, E., & Lucia, A. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.10.047 · Cited by 95 · see citing works
Rowing Injuries: An Updated Review
Thornton, J. S., Vinther, A., Wilson, F., Lebrun, C. M., Wilkinson, M., Ciacca, S. R. D., Orlando, K., & Smoljanović, T. (2016) · Sports Medicine · doi:10.1007/s40279-016-0613-y · Cited by 85 · see citing works
Caffeine delays autonomic recovery following acute exercise
Bunsawat, K., White, D. W., Kappus, R. M., & Baynard, T. (2015) · European Journal of Preventive Cardiology · doi:10.1177/2047487314554867 · Cited by 61 · see citing works
Lisi, M., Cameli, M., Mandoli, G. E., Pastore, M. C., Righini, F. M., D’Ascenzi, F., Focardi, M., Rubboli, A., Mondillo, S., & Henein, M. Y. (2022) · Heart Failure Reviews · doi:10.1007/s10741-022-10214-0 · Cited by 68 · see citing works
Skielboe, A. K., Bandholm, T., Hakmann, S., Mourier, M., Kallemose, T., & Dixen, U. (2017) · PLoS ONE · doi:10.1371/journal.pone.0170060 · Cited by 65 · see citing works
Elliott, A. D., Maatman, B. T., Emery, M. S., & Sanders, P. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.07.001 · Cited by 62 · see citing works
Age as a Critical Determinant of Atrial Fibrillation: A Two-sided Relationship
Laredo, M., Waldmann, V., Khairy, P., & Nattel, S. (2018) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2018.08.007 · Cited by 63 · see citing works
Zorzi, A., Mastella, G., Cipriani, A., Berton, G., Monte, A. D., Gusella, B., Nese, A., Portolan, L., Sciacca, F., Tikvina, S., et al. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318797396 · Cited by 62 · see citing works
Atrial Fibrillation in Athletes
Estes, N. A. M., & Madias, C. (2017) · JACC: Clinical Electrophysiology · doi:10.1016/j.jacep.2017.03.019 · Cited by 56 · see citing works
D’Ascenzi, F., Pelliccia, A., Natali, B. M., Cameli, M., Andrei, V., Incampo, E., Alvino, F., Lisi, M., Padeletti, M., Focardi, M., et al. (2015) · International journal of cardiac imaging · doi:10.1007/s10554-015-0600-7 · Cited by 52 · see citing works
Skielboe, A. K., Marott, J. L., Dixen, U., Friberg, J., & Jensen, G. B. (2016) · European Journal of Preventive Cardiology · doi:10.1177/2047487316655464 · Cited by 49 · see citing works
Does endurance exercise cause atrial fibrillation in women?
Myrstad, M., Aarønæs, M., Graff-Iversen, S., Nystad, W., & Ranhoff, A. H. (2015) · International Journal of Cardiology · doi:10.1016/j.ijcard.2015.03.018 · Cited by 44 · 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 43 · see citing works
Masked hypertension and cardiac remodeling in middle-aged endurance athletes
Trachsel, L. D., Carlen, F., Brugger, N., Seiler, C. A., & Wilhelm, M. (2015) · Journal of Hypertension · doi:10.1097/hjh.0000000000000558 · Cited by 37 · see citing works
Self-citationExercise‐related severe cardiac events
Vicent, L., Ariza‐Solé, A., González‐Juanatey, J. R., Uribarri, A., Ortiz, J., de Sá, E. L., Sans‐Roselló, J., Querol, C. T., Codina, P., Sousa-Casasnovas, I., et al. (2017) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.13037 · Cited by 35 · see citing works
Association of sex, age and education level with patient reported outcomes in atrial fibrillation
Gleason, K. T., Himmelfarb, C. D., Ford, D. E., Lehmann, H. P., Samuel, L. J., Han, H., Jain, S. K., Naccarelli, G. V., Aggarwal, V., & Nazarian, S. (2019) · BMC Cardiovascular Disorders · doi:10.1186/s12872-019-1059-6 · Cited by 34 · see citing works
Myrstad, M., Aarønæs, M., Graff‐Iversen, S., Ariansen, I., Nystad, W., & Ranhoff, A. H. (2015) · Clinical Research in Cardiology · doi:10.1007/s00392-015-0898-0 · Cited by 32 · see citing works
Atrial Fibrillation in Endurance Athletes
Elliott, A. D., Mahajan, R., Lau, D. H., & Sanders, P. (2016) · Cardiology Clinics · doi:10.1016/j.ccl.2016.06.006 · Cited by 30 · 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
Shi, S., Shi, J., Jia, Q., Shi, S., Yuan, G., & Hu, Y. (2020) · Frontiers in Physiology · doi:10.3389/fphys.2020.00740 · Cited by 25 · see citing works
Trohman, R. G., Huang, H. D., & Sharma, P. S. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1060030 · Cited by 28 · see citing works
Cavigli, L., Zorzi, A., Spadotto, V., Mandoli, G. E., Melani, A., Fusi, C., D’Andrea, A., Focardi, M., Valente, S., Cameli, M., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11030528 · Cited by 25 · see citing works
Atrial fibrillation and physical activity: Should we exercise caution?
Bosomworth, N. J. (2015) · PubMed Central · Cited by 19 · see citing works
Excess of exercise increases the risk of atrial fibrillation
Müssigbrodt, A., Weber, A., Mandrola, J. M., Belle, Y. V., Richter, S., Döring, M., Arya, A., Sommer, P., Bollmann, A., & Hindricks, G. (2017) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.12830 · Cited by 19 · see citing works
Atrial Fibrillation in the Young: A Neurologist’s Nightmare
Aggarwal, N., Selvendran, S. S., Raphael, C. E., & Vassiliou, V. S. (2015) · Neurology Research International · doi:10.1155/2015/374352 · Cited by 19 · see citing works
Excessive Exercise Habits in Marathoners as Novel Indicators of Masked Hypertension
Kim, Y., Park, Y., Kang, D.-H., & Kim, C. (2017) · BioMed Research International · doi:10.1155/2017/1342842 · Cited by 19 · see citing works
Subclinical Atrial Fibrillation: A Silent Threat with Uncertain Implications
Kashou, A. H., Adedinsewo, D. A., & Noseworthy, P. A. (2021) · Annual Review of Medicine · doi:10.1146/annurev-med-042420-105906 · Cited by 18 · see citing works
Atrial fibrillation in athletes: From epidemiology to treatment in the novel oral anticoagulants era
Sanna, G. D., Gabrielli, E., Vito, E. D., Nusdeo, G., Prisco, D., & Parodi, G. (2018) · Journal of Cardiology · doi:10.1016/j.jjcc.2018.04.011 · Cited by 17 · see citing works
Balta, A., Ceasovschih, A., Șorodoc, V., Dimitriadis, K. S., Güzel, S., Lionte, C., Stătescu, C., Sascău, R. A., Mantzouranis, E., Sakalidis, A., et al. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12111754 · Cited by 16 · see citing works
Echocardiography in the Assessment of Heart Failure Patients
Dini, F. L., Cameli, M., Stefanini, A., Soliman-Aboumarie, H., Lisi, M., Lindqvist, P., & Henein, M. Y. (2024) · Diagnostics · doi:10.3390/diagnostics14232730 · Cited by 20 · see citing works
Long-Term, Competitive Swimming and the Association with Atrial Fibrillation
Schreiner, A. D., Keith, B. A., Abernathy, K. E., Zhang, J., & Brzezinski, W. A. (2016) · Sports Medicine - Open · doi:10.1186/s40798-016-0066-8 · Cited by 15 · see citing works
Excessive exercise habits of runners as new signs of hypertension and arrhythmia
Kim, Y., Kim, C., & Park, K. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.05.001 · Cited by 15 · see citing works
Diastolic function and dysfunction in athletes
Dalen, H., Letnes, J. M., Høydal, M. A., & Wisløff, U. (2024) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jeae155 · Cited by 14 · see citing works
Iop, L., Iliceto, S., Civieri, G., & Tona, F. (2021) · Cells · doi:10.3390/cells10113175 · Cited by 14 · see citing works
Zimmermann, P., Moser, O., Edelmann, F., Schöffl, V., Eckstein, M. L., & BRAUN, M. U. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2022.739753 · Cited by 14 · see citing works
Kim, Y., & Park, K. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13082184 · Cited by 11 · see citing works
Advances in Atrial Fibrillation Management: A Guide for General Internists
Pham, H. N., Ibrahim, R., Hieu, T. H., Sainbayar, E., Tran, V. N., Abdelnabi, M. H., Kanaan, C. N., & Sridharan, A. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13247846 · Cited by 12 · see citing works
Geschlechterspezifische Aspekte kardiovaskulärer Erkrankungen
Baessler, A., Bauer, P., Becker, M., Berrisch-Rahmel, S., Goldmann, B. U., Grünig, E., Hamm, C., Meder, B., Kindermann, I., Ong, P., et al. (2024) · Die Kardiologie · doi:10.1007/s12181-024-00694-9 · Cited by 10 · see citing works
Kunimatsu, N., Tsukamoto, H., & Ogoh, S. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13195975 · Cited by 10 · 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
Effects of Excessive Endurance Activity on the Heart
Seidl, J., & Asplund, C. A. (2014) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000097 · Cited by 10 · see citing works
van den Broek, J. L. P. M., Gottlieb, L. A., Vermeer, J. R., Overeem, S., & Dekker, L. (2024) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2024.05.035 · Cited by 9 · see citing works
Zimmermann, P., Moser, O., Eckstein, M. L., Wüstenfeld, J. C., Schöffl, V., Zimmermann, L., BRAUN, M. U., & Schöffl, I. (2021) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd9010008 · Cited by 9 · see citing works
Keithler, A. N., Wilson, A. S., Yuan, A., Sosa, J. M., & Bush, K. N. V. (2021) · BMJ Military Health · doi:10.1136/bmjmilitary-2020-001665 · Cited by 8 · see citing works
Kim, Y., Lee, S., & Park, K. (2021) · Journal of Clinical Hypertension · doi:10.1111/jch.14359 · Cited by 8 · see citing works
Choi, Y. W., Park, M., Lim, Y., Myung, J., Kim, B. S., Lee, Y., Shin, J., Park, H.-C., Shin, J., Kim, C. K., et al. (2019) · Scientific Reports · doi:10.1038/s41598-019-47748-7 · Cited by 8 · see citing works
Ahmadi, M. N., Mundell, H. D., Sutherland, G. T., Hamer, M., Sillanpää, E., Blodgett, J. M., Cruz, B. D. P., & Stamatakis, E. A. (2025) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2025.101055 · Cited by 5 · see citing works
Exercise and Atrial Fibrillation: Current Evidence, Knowledge Gaps, and Future Directions
Pham, H. N., Abdelnabi, M. H., Ibrahim, R., Sainbayar, E., Truong, H. H., Habib, E., Pathangey, G., Bcharah, G., Singh, A., Arsanjani, R., et al. (2025) · Reviews in Cardiovascular Medicine · doi:10.31083/rcm39200 · Cited by 5 · see citing works
Impact of atrial fibrillation and atrial fibrillation therapies on sports performance in athletes
Khan, A. K., Lee, H. J., Hills, M. T., Moss, M., Lara, B., Baumann, R. P., Brandt, C., & Lampert, R. J. (2024) · Heart Rhythm · doi:10.1016/j.hrthm.2024.11.020 · Cited by 6 · see citing works
Thacker, M. (2025) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2025.06.003 · Cited by 4 · see citing works
Román, P. Á. L., Latorre-Sevilla, C., & Sánchez, J. S. (2022) · Retos · doi:10.47197/retos.v47.95252 · Cited by 4 · see citing works
Aker, A., Saliba, W., & Zafrir, B. (2022) · Hellenic Journal of Cardiology · doi:10.1016/j.hjc.2022.12.005 · Cited by 4 · see citing works
Zimmermann, P., & Lutter, C. (2019) · BMJ Case Reports · doi:10.1136/bcr-2019-231659 · Cited by 4 · see citing works
Endurance sport and atrial fibrillation: a mini-review of a complex relationship
Costantini, M., Elizari, M. V., Previtali, M., Sciarra, L., Luzza, F., Costantini, L., Carbone, V., & Maffia, M. (2025) · Exploration of Cardiology · doi:10.37349/ec.2025.101267 · 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
Anti-arrhythmic therapy in athletes
Zorzi, A., Cipriani, A., & Corrado, D. (2019) · Pharmacological Research · doi:10.1016/j.phrs.2019.04.027 · Cited by 3 · see citing works
Keithler, A. N., Wilson, A. S., Yuan, A., Sosa, J. M., & Bush, K. N. V. (2022) · BMC Cardiovascular Disorders · doi:10.1186/s12872-022-02542-8 · Cited by 3 · see citing works
Zimmermann, P., & Lutter, C. (2020) · BMJ Case Reports · doi:10.1136/bcr-2020-238674 · Cited by 2 · see citing works
Read, M. J., Koschinski, A., Bose, S. J., & Burton, R. A. B. (2025) · American Journal of Physiology-Cell Physiology · doi:10.1152/ajpcell.00782.2024 · Cited by 2 · see citing works
Mid-term development of the right ventricle in competitive athletes
Krumm, P., Krauß, S., Mangold, S., Zitzelsberger, T., Klumpp, B. D., Nikolaou, K., Niess, A. M., Krämer, U., & Burgstahler, C. (2018) · Acta Radiologica · doi:10.1177/0284185118764203 · Cited by 2 · see citing works
The mystery further deepens: How much exercise is harmful for atrial fibrillation?
Baba, R. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318769412 · Cited by 1 · see citing works
Gioia, G. D., Vespasiano, F., Maestrini, V., Monosilio, S., Segreti, A., Lemme, E., Squeo, M. R., Serdoz, A., & Pelliccia, A. (2024) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0000000000001657 · Cited by 1 · see citing works
Endurance swimming and increased risk of atrial fibrillation
Schreiner, A. D., Keith, B. A., & Brzezinski, W. A. (2015) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2015.03.004 · Cited by 1 · see citing works
Endurance Exercise and Atrial Fibrillation
Sareban, M., Guasch, E., & Mont, L. (2020) · Springer eBooks · doi:10.1007/978-3-030-35374-2_33 · Cited by 1 · see citing works
Román, P. Á. L., MONTILLA, J. A. P., García‐Pinillos, F., & Sánchez, J. S. (2021) · Cultura Ciencia y Deporte · doi:10.12800/ccd.v16i49.1641 · Cited by 1 · see citing works
Pizzamiglio, F., Dessanai, M. A., Tondo, C., Sicuso, R., Fassini, G. M., Bonomi, A., Russo, A. D., Andreini, D., Zeppilli, P., & Riva, S. I. (2021) · doi:10.22541/au.161979813.31268532/v1 · Cited by 1 · see citing works
Reisen und Sport nach Schlaganfall
Schröder, K., & Maschke, M. (2014) · Nervenheilkunde · doi:10.1055/s-0038-1627666
Fibrillation auriculaire et activité physique Faut-il être prudent?
Bosomworth, N. J. (2015) · PubMed Central
Das Herz beim Seniorensportler: Benefit und Risiken.
Trachsel, L. D., & Wilhelm, M. (2014) · doi:10.7892/boris.64466
Self-citationMyrstad, M. (2015) · NORA - Norwegian Open Research Archives
Cardiovascular Adaptation and Side Effects in Middle-Aged Marathoners
Kim, Y. (2016) · The Korean Journal of Sports Medicine · doi:10.5763/kjsm.2016.34.1.10
The Resilience of Women: Atrial Fibrillation Resistance
McKinney, J., & Krahn, A. D. (2016) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.13039
Fibrillation auriculaire et activité physique
Bosomworth, N. J. (2015) · Canadian Family Physician
Cardiovascular effects and alterations from endurance sports. A systematic review
Ojeda, Á. H., Navarrete-Peña, R., Valenzuela-Fernández, N., & Maliqueo, S. G. (2017) · Apunts Sports Medicine · doi:10.1016/j.apunts.2016.12.001
Nursing considerations of physical activity in AF
Ting, F. F. (2018) · British Journal of Cardiac Nursing · doi:10.12968/bjca.2018.13.2.70
Sport bei Herzpatienten: Was soll man empfehlen?
Rossi, V. A., Schmied, C. M., & Niederseer, D. (2018) · Praxis · doi:10.1024/1661-8157/a002993
Cardiorespiratory Fitness, Physical Activity, and Incidence of Atrial Fibrillation
Tsimploulis, A., Pittaras, A. E., & Faselis, C. J. (2019) · Springer eBooks · doi:10.1007/978-3-030-04816-7_20
Study of aetiology and Clinical Profile in Patients with Atrial Fibrillation
Yadav, D. R. (2020) · Journal of Medical Science And clinical Research · doi:10.18535/jmscr/v8i2.65
Exercise in Specific Diseases: Atrial Fibrillation
Laszlo, R., & Wilhelm, M. (2020) · Springer eBooks · doi:10.1007/978-3-030-35374-2_49
Self-citationPrevention of Atrial Fibrillation
Kornej, J., & Benjamin, E. J. (2020) · Contemporary cardiology · doi:10.1007/978-3-030-56279-3_23
Post Paddle Boarding Atrial Fibrillation in an Aging Athlete
Faris, M., Goebel, J., & Sherertz, R. (2022) · Cureus · doi:10.7759/cureus.22577
Reply to Lemaître and Costalat
Mulder, E., Pernett, F., & Schagatay, E. K. A. (2023) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00483.2023
Elderly/Masters Athlete (Overview)
Piedade, S. R., Teixeira, R. C., Beck, L. A. D. S., & Ferreira, D. M. (2023) · Springer eBooks · doi:10.1007/978-3-031-33867-0_2
Catheter Ablation for Typical Atrial Flutter in Tactical Athletes
Tunzi, M. A., Calaquian, L. L., & Bush, K. N. V. (2025) · Military Medicine · doi:10.1093/milmed/usaf242
Left atrial stiffness index in sprinters
Poyraz, E., & Can, F. (2026) · Sport Sciences for Health · doi:10.1007/s11332-026-01761-2
Friedman, D. J., Hughes, D. C., Thornton, J. S., Saw, R., Girdwood, M., Wells, K. R., Bruder, A. M., Adler, S. J., Pila, E., & Crossley, K. M. (2026) · Journal of Sport Rehabilitation · doi:10.1123/jsr.2026-0031
- Authors
- Wilhelm, M.
- Affiliations
- University Hospital of Bern (CH)
- Corresponding author
- Wilhelm, Matthias
- ORCID
- Wilhelm, Matthias
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-01-30
- Volume
- 21
- Issue
- 8
- Pages
- 1040-1048
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- OpenAlex
- W2142858838
- Cited by
- 95
- References
- 69
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 9 · 2023: 5 · 2022: 8 · 2021: 8 · 2020: 9 · 2019: 6 · 2018: 8 · 2017: 7 · 2016: 10 · 2015: 10 · 2014: 4 · 2013: 1
- FWCI
- 1.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Preventive Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (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, endurance athletes, atrial remodeling, atrial flutter, atrial ectopy, autonomic imbalance, atrial fibrosis, left atrial size, sex differences, training volume, left ventricular remodeling, diastolic dysfunction, atrial fibrillation ablation, risk factors
- MeSH terms
- Atrial Fibrillation, Humans, Physical Endurance, Athletes
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