Skip to main content
SpringerLink
Log in

Endurance Exercise and Atrial Fibrillation

  • Chapter
  • First Online:
Textbook of Sports and Exercise Cardiology

Abstract

Atrial fibrillation (AF) is the most frequent sustained arrhythmia and a major cause of morbidity and mortality. Increasing physical activity has convincingly shown to reduce the risk of AF. However, repetitive bouts of prolonged and vigorous endurance exercise have recently emerged as a risk factor for AF in middle-aged male athletes. Thus, a growing body of literature supports a U-shaped relation between lifetime-accumulated high-intensity endurance training and AF in men. The pathophysiology underlying this relation poses a puzzling question with multiple hypothesized mechanisms, which probably in combination create the necessary substrate and trigger for AF onset. Presumably adaptive atrial changes secondary to long-standing endurance training as part of the “athlete’s heart” add special considerations as they build up a grey zone of diagnostic uncertainty with atrial changes seen in individuals with AF. Evolving functional diagnostic modalities may re-shape this diagnostic grey zone and facilitate diagnostic workup. Initiating management of AF requires documentation of an AF episode, which can be challenging in athletes as it usually occurs intermittent. New wearable devices hold promise to facilitate early documentation and follow-up, but their reliability still has to be established, especially during exercise. When counseling competitive athletes and highly active people regarding treatment options of AF, special considerations should be taken into account to reduce risk associated with AF but also sustain the numerous health benefits of regular exercise and the lifestyle of being a competitive endurance athlete.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893–962.

    PubMed  Google Scholar 

  2. Mozaffarian D, Furberg CD, Psaty BM, Siscovick D. Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation. 2008;118:800–7.

    PubMed  PubMed Central  Google Scholar 

  3. Qureshi WT, Alirhayim Z, Blaha MJ, Juraschek SP, Keteyian SJ, Brawner CA, et al. Cardiorespiratory fitness and risk of incident atrial fibrillation: results from the Henry Ford Exercise Testing (FIT) Project. Circulation. 2015;131:1827–34.

    PubMed  Google Scholar 

  4. Morseth B, Graff-Iversen S, Jacobsen BK, Jørgensen L, Nyrnes A, Thelle DS, et al. Physical activity, resting heart rate, and atrial fibrillation: the Tromsø Study. Eur Heart J. 2016;37:2307–13.

    PubMed  PubMed Central  Google Scholar 

  5. Abdulla J, Nielsen JR. Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis. Europace. 2009;11:1156–9.

    PubMed  Google Scholar 

  6. Calvo N, Ramos P, Montserrat S, Guasch E, Coll-Vinent B, Domenech M, et al. Emerging risk factors and the dose-response relationship between physical activity and lone atrial fibrillation: a prospective case-control study. Europace. 2016;18:57–63.

    PubMed  Google Scholar 

  7. Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol. 2014;6:213–20.

    PubMed  PubMed Central  Google Scholar 

  8. Krijthe BP, Kunst A, Benjamin EJ, Lip GYH, Franco OH, Hofman A, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34:2746–51.

    PubMed  PubMed Central  Google Scholar 

  9. Baldesberger S, Bauersfeld U, Candinas R, Seifert B, Zuber M, Ritter M, et al. Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists. Eur Heart J. 2008;29:71–8.

    PubMed  Google Scholar 

  10. da Fonseca-Engelhardt K, Knechtle B, Rüst CA, Knechtle P, Lepers R, Rosemann T. Participation and performance trends in ultra-endurance running races under extreme conditions - “Spartathlon” versus “Badwater”. Extrem Physiol Med. 2013;2:15.

    PubMed  PubMed Central  Google Scholar 

  11. Mohanty S, Mohanty P, Tamaki M, Natale V, Gianni C, Trivedi C, et al. Differential association of exercise intensity with risk of atrial fibrillation in men and women: evidence from a meta-analysis. J Cardiovasc Electrophysiol. 2016;27:1021–9.

    PubMed  Google Scholar 

  12. Fleischmann P, Kellermann JJ. Persistent irregular tachycardia in a successful athlete without impairment of performance. Isr J Med Sci. 1969;5:950–2.

    CAS  PubMed  Google Scholar 

  13. Karjalainen J, Kujala UM, Kaprio J, Sarna S, Viitasalo M. Lone atrial fibrillation in vigorously exercising middle aged men: case-control study. BMJ. 1998;316:1784–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Molina L, Mont L, Marrugat J, Berruezo A, Brugada J, Bruguera J, et al. Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study. Europace. 2008;10:618–23.

    PubMed  Google Scholar 

  15. Elosua R, Arquer A, Mont L, Sambola A, Molina L, García-Morán E, et al. Sport practice and the risk of lone atrial fibrillation: a case-control study. Int J Cardiol. 2006;108:332–7.

    PubMed  Google Scholar 

  16. Andersen K, Farahmand B, Ahlbom A, Held C, Ljunghall S, Michaëlsson K, et al. Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study. Eur Heart J. 2013;34:3624–31.

    PubMed  Google Scholar 

  17. Myrstad M, Aarønæs M, Graff-Iversen S, Nystad W, Ranhoff AH. Does endurance exercise cause atrial fibrillation in women? Int J Cardiol. 2015;184:431–2.

    PubMed  Google Scholar 

  18. Drca N, Wolk A, Jensen-Urstad M, Larsson SC. Atrial fibrillation is associated with different levels of physical activity levels at different ages in men. Heart. 2014;100:1037–42.

    PubMed  Google Scholar 

  19. Marijon E, Tafflet M, Antero-Jacquemin J, El Helou N, Berthelot G, Celermajer DS, et al. Mortality of French participants in the Tour de France (1947–2012). Eur Heart J. 2013;662833848:1–6.

    Google Scholar 

  20. Mont L, Tamborero D, Elosua R, Molina I, Coll-Vinent B, Sitges M, et al. Physical activity, height, and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals. Europace. 2008;10:15–20.

    PubMed  Google Scholar 

  21. Arriagada G, Berruezo A, Mont L, Tamborero D, Molina I, Coll-Vinent B, et al. Predictors of arrhythmia recurrence in patients with lone atrial fibrillation. Europace. 2008;10:9–14.

    PubMed  Google Scholar 

  22. Baggish AL, Wood MJ. Athlete’s heart and cardiovascular care of the athlete: scientific and clinical update. Circulation. 2011;123:2723–35.

    PubMed  Google Scholar 

  23. Iskandar A, Mujtaba MT, Thompson PD. Left atrium size in elite athletes. JACC Cardiovasc Imaging. 2015;8:753–62.

    PubMed  Google Scholar 

  24. Sareban M, Winkert K, Sperlich B, Berger MM, Niebauer J, Steinacker JM, et al. Speckle tracking-derived bi-atrial strain before and after eleven weeks of training in elite rowers. Sci Rep. 2018;8:14300.

    PubMed  PubMed Central  Google Scholar 

  25. Leischik R, Spelsberg N, Niggemann H, Dworrak B, Tiroch K. Exercise-induced arterial hypertension – an independent factor for hypertrophy and a ticking clock for cardiac fatigue or atrial fibrillation in athletes? F1000Research. 2014;3:105.

    PubMed  PubMed Central  Google Scholar 

  26. Zou R, Kneller J, Leon LJ, Nattel S. Substrate size as a determinant of fibrillatory activity maintenance in a mathematical model of canine atrium. Am J Physiol Heart Circ Physiol. 2005;289:H1002–12.

    CAS  PubMed  Google Scholar 

  27. Neuberger H-R, Schotten U, Blaauw Y, Vollmann D, Eijsbouts S, van Hunnik A, et al. Chronic atrial dilation, electrical remodeling, and atrial fibrillation in the goat. J Am Coll Cardiol. 2006;47:644–53.

    PubMed  Google Scholar 

  28. Rosenberg MA, Patton KK, Sotoodehnia N, Karas MG, Kizer JR, Zimetbaum PJ, et al. The impact of height on the risk of atrial fibrillation: the cardiovascular health study. Eur Heart J. 2012;33:2709–17.

    PubMed  PubMed Central  Google Scholar 

  29. Neubauer O, König D, Wagner K-H. Recovery after an Ironman triathlon: sustained inflammatory responses and muscular stress. Eur J Appl Physiol. 2008;104:417–26.

    PubMed  Google Scholar 

  30. Scharhag J, George K, Shave R, Urhausen A, Kindermann W. Exercise-associated increases in cardiac biomarkers. Med Sci Sports Exerc. 2008;40:1408–15.

    PubMed  Google Scholar 

  31. Wilhelm M, Zueger T, De Marchi S, Rimoldi SF, Brugger N, Steiner R, et al. Inflammation and atrial remodeling after a mountain marathon. Scand J Med Sci Sports. 2014;24:519–25.

    CAS  PubMed  Google Scholar 

  32. Guasch E, Mont L. Diagnosis, pathophysiology, and management of exercise-induced arrhythmias. Nat Rev Cardiol. 2017;14:88–101.

    CAS  PubMed  Google Scholar 

  33. Aschar-Sobbi R, Izaddoustdar F, Korogyi AS, Wang Q, Farman GP, Yang F, et al. Increased atrial arrhythmia susceptibility induced by intense endurance exercise in mice requires TNFα. Nat Commun. 2015;6:6018.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Guasch E, Benito B, Qi X, Cifelli C, Naud P, Shi Y, et al. Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model. J Am Coll Cardiol. 2013;62:68–77.

    PubMed  Google Scholar 

  35. Burstein B, Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol. 2008;51:802–9.

    CAS  PubMed  Google Scholar 

  36. Lindsay MM, Dunn FG. Biochemical evidence of myocardial fibrosis in veteran endurance athletes. Br J Sports Med. 2007;41:447–52.

    PubMed  PubMed Central  Google Scholar 

  37. Blume GG, Mcleod CJ, Barnes ME, Seward JB, Pellikka PA, Bastiansen PM, et al. Left atrial function: physiology, assessment, and clinical implications. Eur J Echocardiogr. 2011;12:421–30.

    PubMed  Google Scholar 

  38. Mondillo S, Galderisi M, Mele D, Cameli M, Lomoriello VS, Zacà V, et al. Speckle-tracking echocardiography: a new technique for assessing myocardial function. J Ultrasound Med. 2011;30:71–83.

    PubMed  Google Scholar 

  39. Saraiva RM, Demirkol S, Buakhamsri A, Greenberg N, Popović ZB, Thomas JD, et al. Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr. 2010;23:172–80.

    PubMed  Google Scholar 

  40. Wright S, Sasson Z, Gray T, Chelvanathan A, Esfandiari S, Dimitry J, et al. Left atrial phasic function interacts to support left ventricular filling during exercise in healthy athletes. J Appl Physiol. 2015;119:328–33.

    CAS  PubMed  Google Scholar 

  41. Gabrielli L, Bijnens BH, Brambila C, Duchateau N, Marin J, Sitges-Serra I, et al. Differential atrial performance at rest and exercise in athletes: potential trigger for developing atrial dysfunction? Scand J Med Sci Sports. 2016;26:1444–54.

    CAS  PubMed  Google Scholar 

  42. Sareban M, Zügel D, Hartveg P, Zügel M, Gary T, Niebauer J, et al. Preserved left atrial mechanics following a 5-h laboratory triathlon in euhydrated athletes. Int J Sports Med. 2019;40:88–94.

    PubMed  Google Scholar 

  43. Hubert A, Galand V, Donal E, Pavin D, Galli E, Martins RP, et al. Atrial function is altered in lone paroxysmal atrial fibrillation in male endurance veteran athletes. Eur Heart J Cardiovasc Imaging. 2018;19:145–53.

    PubMed  Google Scholar 

  44. Vaseghi M, Salavatian S, Rajendran PS, Yagishita D, Woodward WR, Hamon D, et al. Parasympathetic dysfunction and antiarrhythmic effect of vagal nerve stimulation following myocardial infarction. JCI Insight. 2017;2:pii: 86715.

    Google Scholar 

  45. Michael S, Graham KS, Oam GMD. Cardiac autonomic responses during exercise and post-exercise recovery using heart rate variability and systolic time intervals-a review. Front Physiol. 2017;8:1–19.

    Google Scholar 

  46. D’Souza A, Bucchi A, Johnsen AB, Logantha SJRJ, Monfredi O, Yanni J, et al. Exercise training reduces resting heart rate via downregulation of the funny channel HCN4. Nat Commun. 2014;5:3775.

    PubMed  PubMed Central  Google Scholar 

  47. Stein R, Medeiros CM, Rosito GA, Zimerman LI, Ribeiro JP. Intrinsic sinus and atrioventricular node electrophysiologic adaptations in endurance athletes. J Am Coll Cardiol. 2002;39:1033–8.

    PubMed  Google Scholar 

  48. Nattel S. New ideas about atrial fibrillation 50 years on. Nature. 2002;415:219–26.

    CAS  PubMed  Google Scholar 

  49. Liu L, Nattel S. Differing sympathetic and vagal effects on atrial fibrillation in dogs: role of refractoriness heterogeneity. Am J Physiol. 1997;273:H805–16.

    CAS  PubMed  Google Scholar 

  50. Chen P-S, Chen LS, Fishbein MC, Lin S-F, Nattel S. Role of the autonomic nervous system in atrial fibrillation: pathophysiology and therapy. Circ Res. 2014;114:1500–15.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Burashnikov A, Antzelevitch C. Reinduction of atrial fibrillation immediately after termination of the arrhythmia is mediated by late phase 3 early afterdepolarization-induced triggered activity. Circulation. 2003;107:2355–60.

    PubMed  Google Scholar 

  52. Patterson E, Po SS, Scherlag BJ, Lazzara R. Triggered firing in pulmonary veins initiated by in vitro autonomic nerve stimulation. Heart Rhythm. 2005;2:624–31.

    PubMed  Google Scholar 

  53. Grundvold I, Skretteberg PT, Liestl K, Erikssen G, Engeseth K, Gjesdal K, et al. Low heart rates predict incident atrial fibrillation in healthy middle-aged men. Circ Arrhythm Electrophysiol. 2013;6:726–31.

    PubMed  Google Scholar 

  54. Mont L, Sambola A, Brugada J, Vacca M, Marrugat J, Elosua R, et al. Long-lasting sport practice and lone atrial fibrillation. Eur Heart J. 2002;23:477–82.

    CAS  PubMed  Google Scholar 

  55. Hoogsteen J, Schep G, Van Hemel NM, Van Der Wall EE. Paroxysmal atrial fibrillation in male endurance athletes. A 9-year follow up. Europace. 2004;6:222–8.

    PubMed  Google Scholar 

  56. Wilhelm M, Roten L, Tanner H, Wilhelm I, Schmid J-P, Saner H. Atrial remodeling, autonomic tone, and lifetime training hours in nonelite athletes. Am J Cardiol. 2011;108:580–5.

    PubMed  Google Scholar 

  57. Yamaguchi T, Tsuchiya T, Nagamoto Y, Miyamoto K, Takahashi N. Characterization of atrial fibrillation and the effect of pulmonary vein antrum isolation in endurance athletes. J Arrhythmia. 2012;28:175–81.

    Google Scholar 

  58. Haïssaguerre M, Shah DC, Jaïs P, Hocini M, Yamane T, Deisenhofer I, et al. Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation. 2000;102:2463–5.

    PubMed  Google Scholar 

  59. Ehrlich JR, Cha T, Zhang L, Chartier D, Melnyk P, Hohnloser SH, et al. Cellular electrophysiology of canine pulmonary vein cardiomyocytes: action potential and ionic current properties. J Physiol. 2003;551:801–13.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Chen YJ, Chen SA, Chen YC, Yeh H-II, Chan P, Chang M-SS, et al. Effects of rapid atrial pacing on the arrhythmogenic activity of single cardiomyocytes from pulmonary veins: implication in initiation of atrial fibrillation. Circulation. 2001;104:2849–54.

    CAS  PubMed  Google Scholar 

  61. Hocini M, Ho SY, Kawara T, Linnenbank AC, Potse M, Shah D, et al. Electrical conduction in canine pulmonary veins: electrophysiological and anatomic correlation. Circulation. 2002;105:2442–8.

    PubMed  Google Scholar 

  62. Arora R, Verheule S, Scott L, Navarrete A, Katari V, Wilson E, et al. Arrhythmogenic substrate of the pulmonary veins assessed by high-resolution optical mapping. Circulation. 2003;107:1816–21.

    PubMed  PubMed Central  Google Scholar 

  63. Calvo N, Mont L, Tamborero D, Berruezo A, Viola G, Guasch E, et al. Efficacy of circumferential pulmonary vein ablation of atrial fibrillation in endurance athletes. Europace. 2010;12:30–6.

    PubMed  Google Scholar 

  64. Koopman P, Nuyens D, Garweg C, La Gerche A, De Buck S, Van Casteren L, et al. Efficacy of radiofrequency catheter ablation in athletes with atrial fibrillation. Europace. 2011;13:1386–93.

    PubMed  Google Scholar 

  65. Oyen N, Ranthe MF, Carstensen L, Boyd HA, Olesen MS, Olesen S-P, et al. Familial aggregation of lone atrial fibrillation in young persons. J Am Coll Cardiol. 2012;60:917–21.

    PubMed  Google Scholar 

  66. Otway R, Vandenberg JI, Guo G, Varghese A, Castro ML, Liu J, et al. Stretch-sensitive KCNQ1 mutation. A link between genetic and environmental factors in the pathogenesis of atrial fibrillation? J Am Coll Cardiol. 2007;49:578–86.

    CAS  PubMed  Google Scholar 

  67. San Antonio R, Guasch E, Tolosana JM, Mont L. Determining the best approach to reduce the impact of exercise-induced atrial fibrillation: prevention, screening, or symptom-based treatment? Expert Rev Cardiovasc Ther. 2018;17:14779072.2019.1550720.

    Google Scholar 

  68. Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Terradellas JB, et al. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Europace. 2017;19:139–63.

    PubMed  Google Scholar 

  69. Sejr MH, Nielsen JC, Damgaard D, Sandal BF, May O. Atrial fibrillation detected by external loop recording for seven days or two-day simultaneous Holter recording: a comparison in patients with ischemic stroke or transient ischemic attack. J Electrocardiol. 2017;50:287–93.

    PubMed  Google Scholar 

  70. Fabregat-Andres O, Munoz-Macho A, Adell-Beltran G, Ibanez-Catala X, Macia A, Facila L. Evaluation of a new shirt-based electrocardiogram device for cardiac screening in soccer players: comparative study with treadmill ergospirometry. Cardiol Res. 2014;5:101–7.

    PubMed  PubMed Central  Google Scholar 

  71. Müssigbrodt A, Richter S, Wetzel U, Van Belle Y, Bollmann A, Hindricks G. Diagnosis of arrhythmias in athletes using leadless, ambulatory HR monitors. Med Sci Sports Exerc. 2013;45:1431–5.

    PubMed  Google Scholar 

  72. Bumgarner JM, Lambert CT, Hussein AA, Cantillon DJ, Baranowski B, Wolski K, et al. Smartwatch algorithm for automated detection of atrial fibrillation. J Am Coll Cardiol. 2018;71:2381–8.

    PubMed  Google Scholar 

  73. Chan P-H, Wong C-K, Poh YC, Pun L, Leung WW-C, Wong Y-F, et al. Diagnostic performance of a smartphone-based photoplethysmographic application for atrial fibrillation screening in a primary care setting. J Am Heart Assoc. 2016;5:pii: e003428.

    Google Scholar 

  74. Rozen G, Vaid J, Hosseini SM, Kaadan MI, Rafael A, Roka A, et al. Diagnostic accuracy of a novel mobile phone application for the detection and monitoring of atrial fibrillation. Am J Cardiol. 2018;121:1187–91.

    PubMed  Google Scholar 

  75. Perez de Isla L, Lennie V, Quezada M, Guinea J, Arce C, Abad P, et al. New generation dynamic, wireless and remote cardiac monitorization platform: a feasibility study. Int J Cardiol. 2011;153:83–5.

    PubMed  Google Scholar 

  76. Despang HG, Netz S, Heinig A, Holland HJ, Fischer WJ. Wireless long-term ECG integrated into clothing. Biomed Technol (Berl). 2008;53:270–8.

    Google Scholar 

  77. Myrstad M, Aarønæs M, Graff-Iversen S, Ariansen I, Nystad W, Ranhoff AH. Physical activity, symptoms, medication and subjective health among veteran endurance athletes with atrial fibrillation. Clin Res Cardiol. 2016;105:154–61.

    PubMed  Google Scholar 

  78. Furlanello F, Bertoldi A, Dallago M, Galassi A, Fernando F, Biffi A, et al. Atrial fibrillation in elite athletes. J Cardiovasc Electrophysiol. 1998;9:S63–8.

    CAS  PubMed  Google Scholar 

  79. Stefanadis C, Dernellis J, Toutouzas P. A clinical appraisal of left atrial function. Eur Heart J. 2001;22:22–36.

    CAS  PubMed  Google Scholar 

  80. Channer KS, Jones JV. The contribution of atrial systole to mitral diastolic blood flow increases during exercise in humans. J Physiol. 1989;411:53–61.

    CAS  PubMed  PubMed Central  Google Scholar 

  81. Nishikawa Y, Roberts JP, Tan P, Klopfenstein CE, Klopfenstein HS. Effect of dynamic exercise on left atrial function in conscious dogs. J Physiol. 1994;481(Pt 2):457–68.

    CAS  PubMed  PubMed Central  Google Scholar 

  82. Hijazi Z, Lindbäck J, Alexander JH, Hanna M, Held C, Hylek EM, et al. The ABC (age, biomarkers, clinical history) stroke risk score: a biomarker-based risk score for predicting stroke in atrial fibrillation. Eur Heart J. 2016;37:1582–90.

    PubMed  PubMed Central  Google Scholar 

  83. Bisbal F, Gomez-Pulido F, Cabanas-GrandÍo P, Akoum N, Calvo M, Andreu D, et al. Left atrial geometry improves risk prediction of thromboembolic events in patients with atrial fibrillation. J Cardiovasc Electrophysiol. 2016;27:804–10.

    PubMed  Google Scholar 

  84. King JB, Azadani PN, Suksaranjit P, Bress AP, Witt DM, Han FT, et al. Left atrial fibrosis and risk of cerebrovascular and cardiovascular events in patients with atrial fibrillation. J Am Coll Cardiol. 2017;70:1311–21.

    PubMed  Google Scholar 

  85. Hållmarker U, Åsberg S, Michaëlsson K, Ärnlöv J, Hellberg D, Lindbäck J, et al. Risk of recurrent stroke and death after first stroke in long-distance ski race participants. J Am Heart Assoc. 2015;4:e002469.

    PubMed  PubMed Central  Google Scholar 

  86. Stewart S, Hart CL, Hole DJ, McMurray JJV. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the renfrew/Paisley study. Am J Med. 2002;113:359–64.

    PubMed  Google Scholar 

  87. Santhanakrishnan R, Wang N, Larson MG, Magnani JW, McManus DD, Lubitz SA, et al. Atrial fibrillation begets heart failure and vice versa: temporal associations and differences in preserved versus reduced ejection fraction. Circulation. 2016;133:484–92.

    PubMed  PubMed Central  Google Scholar 

  88. Wijesurendra RS, Liu A, Eichhorn C, Ariga R, Levelt E, Clarke WT, et al. Lone atrial fibrillation is associated with impaired left ventricular energetics that persists despite successful catheter ablation. Circulation. 2016;134:1068–81.

    PubMed  PubMed Central  Google Scholar 

  89. Li D, Fareh S, Leung TK, Nattel S. Promotion of atrial fibrillation by heart failure in dogs: atrial remodeling of a different sort. Circulation. 1999;100:87–95.

    CAS  PubMed  Google Scholar 

  90. De Potter T, Berruezo A, Mont L, Matiello M, Tamborero D, Santibanez C, et al. Left ventricular systolic dysfunction by itself does not influence outcome of atrial fibrillation ablation. Europace. 2010;12:24–9.

    PubMed  Google Scholar 

  91. Calvo N, Bisbal F, Guiu E, Ramos P, Nadal M, Maria Tolosana J, et al. Impact of atrial fibrillation-induced tachycardiomyopathy in patients undergoing pulmonary vein isolation. Int J Cardiol. 2013;168:4093–7.

    PubMed  Google Scholar 

  92. Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378:417–27.

    PubMed  Google Scholar 

  93. Zipes DP, Link MS, Ackerman MJ, Kovacs RJ, Myerburg RJ, Estes NAM. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 9: arrhythmias and conduction defects: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66:2412–23.

    PubMed  Google Scholar 

  94. Berkowitz JN, Moll S. Athletes and blood clots: individualized, intermittent anticoagulation management. J Thromb Haemost. 2017;15:1051–4.

    CAS  PubMed  Google Scholar 

  95. Berruezo A, Tamborero D, Mont L, Benito B, Tolosana JM, Sitges M, et al. Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. Eur Heart J. 2007;28:836–41.

    PubMed  Google Scholar 

  96. Marrouche NF, Wilber D, Hindricks G, Jais P, Akoum N, Marchlinski F, et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study. JAMA. 2014;311:498–506.

    CAS  PubMed  Google Scholar 

  97. de Vos CB, Nieuwlaat R, Crijns HJGM, Camm AJ, LeHeuzey J-Y, Kirchhof CJ, et al. Autonomic trigger patterns and anti-arrhythmic treatment of paroxysmal atrial fibrillation: data from the Euro Heart Survey. Eur Heart J. 2008;29:632–9.

    PubMed  Google Scholar 

  98. Moore SC, Lee I-M, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, et al. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med. 2016;176:816–25.

    PubMed  PubMed Central  Google Scholar 

  99. Lafuente-Lafuente C, Mouly S. L-TMAB. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atral fibrillation. Cochrane Database Syst Rev. 2015;3:CD005049.

    Google Scholar 

  100. Alboni P, Botto GL, Baldi N, Luzi M, Russo V, Gianfranchi L, et al. Outpatient treatment of recent-onset atrial fibrillation with the “pill-in-the-pocket” approach. N Engl J Med. 2004;351:2384–91.

    CAS  PubMed  Google Scholar 

  101. Holmes B, Heel RC. Flecainide. A preliminary review of its pharmacodynamic properties and therapeutic efficacy. Drugs. 1985;29:1–33.

    CAS  PubMed  Google Scholar 

  102. Furlanello F, Lupo P, Pittalis M, Foresti S, Vitali-Serdoz L, Francia P, et al. Radiofrequency catheter ablation of atrial fibrillation in athletes referred for disabling symptoms preventing usual training schedule and sport competition. J Cardiovasc Electrophysiol. 2008;19:457–62.

    PubMed  Google Scholar 

  103. Heidbüchel H, Anné W, Willems R, Adriaenssens B, Van de Werf F, Ector H. Endurance sports is a risk factor for atrial fibrillation after ablation for atrial flutter. Int J Cardiol. 2006;107:67–72.

    PubMed  Google Scholar 

  104. Van Gelder IC, Groenveld HF, Crijns HJGM, Tuininga YS, Tijssen JGP, Alings AM, et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med. 2010;362:1363–73.

    PubMed  Google Scholar 

  105. Ulimoen SR, Enger S, Carlson J, Platonov PG, Pripp AH, Abdelnoor M, et al. Comparison of four single-drug regimens on ventricular rate and arrhythmia-related symptoms in patients with permanent atrial fibrillation. Am J Cardiol. 2013;111:225–30.

    CAS  PubMed  Google Scholar 

  106. Ulimoen SR, Enger S, Pripp AH, Abdelnoor M, Arnesen H, Gjesdal K, et al. Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation. Eur Heart J. 2014;35:517–24.

    CAS  PubMed  Google Scholar 

  107. Farshi R, Kistner D, Sarma JSM, Longmate JA, Singh BN. Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens. J Am Coll Cardiol. 1999;33:304–10.

    CAS  PubMed  Google Scholar 

  108. Matsuda M, Matsuda Y, Yamagishi T, Takahashi T, Haraguchi M, Tada T, et al. Effects of digoxin, propranolol, and verapamil on exercise in patients with chronic isolated atrial fibrillation. Cardiovasc Res. 1991;25:453–7.

    CAS  PubMed  Google Scholar 

  109. Aizer A, Gaziano JM, Cook NR, Manson JE, Buring JE, Albert CM. Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol. 2009;103:1572–7.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria

    Mahdi Sareban

  2. Arrhythmia Unit, Cardiology Department, Hospital Clínic/IDIBAPS, Barcelona, Spain

    Eduard Guasch & Lluis Mont

Authors
  1. Mahdi Sareban
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eduard Guasch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lluis Mont
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lluis Mont .

Editor information

Editors and Affiliations

  1. Private Center for Sports and Exercise Cardiology, München, Bayern, Germany

    Axel Pressler

  2. University Institute of Sports Medicine Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

Review

Review

1.1 Questions

  1. 1.

    Regarding the prevalence and relative risk of AF in endurance athletes, which of the following statements is true?

    1. (a)

      The prevalence of AF is decreasing in the general population and is projected to further decrease in the next decades.

    2. (b)

      The prevalence of AF is higher within a middle-aged cohort of male individuals practicing long-term and vigorous endurance activities compared to the general population.

    3. (c)

      Even endurance activities with moderate intensity increase the risk for AF.

    4. (d)

      Increased AF risk with increasing number of vigorous endurance activities applies similarly in women and men.

    5. (e)

      There is a well-established cutoff where the risk for AF in endurance athletes increases.

  2. 2.

    Regarding the mechanisms of AF in endurance athletes, which of the following statements is true?

    1. (a)

      Functional assessment of the LA holds promise to identify endurance athletes at risk of developing AF.

    2. (b)

      There is no link between atrial inflammation and atrial fibrosis.

    3. (c)

      Regular endurance activities do not promote resting cardiac autonomic activity changes.

    4. (d)

      There is no evidence for a genetic component of AF.

    5. (e)

      LA dilatation has the same prognostic implications among endurance athletes and non-athletes.

  3. 3.

    Regarding the therapeutic approach to patients with AF, which of the following statements is not true?

    1. (a)

      Athletes willing to remain competitive may opt for a rhythm control approach to preserve their physical performance.

    2. (b)

      In athletes less than 65 years old who have no other comorbidities, planned cardioversion can be safely performed without anticoagulation.

    3. (c)

      The pill-in-the-pocket approach should be considered in those athletes with infrequent AF recurrences.

    4. (d)

      Although plausible, clinical evidence for a deconditioning benefit on AF burden is scarce.

    5. (e)

      Amiodarone should be considered a second-line option because of its systemic side effects.

1.2 Answers

  1. 1.

    Answer b is correct: There is mounting evidence that middle-aged male endurance athletes are at increased risk for AF compared to sedentary individuals.

  2. 2.

    Answer a is correct: New imaging technologies as speckle tracking echocardiography give detailed insights in phasic atrial function and hold promise to identify endurance athletes at risk of developing AF.

  3. 3.

    Answer b is not correct: Although athletes with AF usually are at a low thromboembolic risk (i.e., low CHA2DS2VASc score), peri-procedural anticoagulation should be administered when undergoing cardioversion or AF ablation.

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sareban, M., Guasch, E., Mont, L. (2020). Endurance Exercise and Atrial Fibrillation. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_33

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-35374-2_33

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-35373-5

  • Online ISBN: 978-3-030-35374-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation