Endurance exercise and atrial fibrillation – a state of the art review

Abstract

Increasing physical activity has convincingly shown to reduce the risk of atrial fibrillation (AF). However, decades of repetitive bouts of prolonged and vigorous endurance exercise have recently emerged as a risk factor for AF in middle-aged male athletes. › The pathophysiology underlying this relation poses a puzzling question with multiple hypothesized mechanisms, which proba-bly in combination create the necessary substrate and trigger for AF onset. Adaptive atrial changes secondary to long-standing endurance training as part of the “athlete’s heart” add special considerations as they build a grey zone of diagnostic uncer-tainty 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 diagnostic 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 narrative, state of the art review aims to describe the association between AF and endurance athletes including current findings and mechanistic concepts and thereby giving an update on a highly relevant clinical topic in sports medicine.