Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Atrial fibrillation in athletes

Derek Crinion and Adrian Baranchuk
CMAJ January 13, 2020 192 (2) E40; DOI: https://doi.org/10.1503/cmaj.191209
Derek Crinion
Heart Rhythm Service, Kingston Health Sciences Centre, Queen’s University, Kingston, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Adrian Baranchuk
Heart Rhythm Service, Kingston Health Sciences Centre, Queen’s University, Kingston, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

Too much exercise can cause atrial fibrillation

Large observational studies have shown that a sedentary lifestyle increases the risk of atrial fibrillation fivefold.1,2 However, high-intensity aerobic exercise, especially for men, also increases the risk of atrial fibrillation at a threshold of more than 1500–2000 lifetime hours.3 Evidence is less clear for women.3 In the majority of athletes, atrial fibrillation is paroxysmal and symptomatic.2,3

The causes of atrial fibrillation in athletes are multifactorial

High-intensity aerobic exercise causes increased hemodynamic stress and generates free radicals.4 The atria appear to be particularly susceptible, with resultant dilatation, chronic inflammation and fibrosis.2–4 Autonomic modulation also plays a role, and athletes commonly describe triggers that are vagally (sleep, meals) or adrenergically (exercise) mediated.2,3

Other causes of atrial fibrillation should be considered and thromboembolic risk assessed

It is important not to miss conditions associated with atrial fibrillation, including cardiomyopathies, channelopathies, pre-excitation, hyperthyroidism and alcohol or drug misuse.2,3 Energy supplements and performance enhancers should also be considered.2,3 Data on stroke risk among athletes are limited, but the use of thromboembolic risk scores (CHADS-65) is recommended.2,3,5

Management of atrial fibrillation in athletes poses unique challenges

In nonrandomized studies, detraining has been shown to reduce atrial fibrillation, although athletes are often not willing to do this.2 Anti-arrhythmic medications are limited by bradycardia, impaired performance, long-term adverse effects and risk of ventricular arrhythmias during exercise.2,3 High-impact sports are a contraindication to anticoagulation.2,3

Ablation of atrial fibrillation is increasingly offered as first-line therapy

Data remain limited to small, nonrandomized studies, but ablation is often the preferred option for symptomatic athletes.2,3 Despite the distinct pathophysiology between symptomatic athletes and nonathletes, success rates appear similar to those of nonathletes: about 60% for the first procedure and > 80% for the second.2,3 Athletes not meeting CHADS-65 criteria must be informed of the need for anticoagulation for at least 2 months owing to the prothrombotic effect of catheter ablation.2,5

CMAJ invites submissions to “Five things to know about …” Submit manuscripts online at http://mc.manuscriptcentral.com/cmaj

Footnotes

  • CMAJ Podcasts: author interview at https://soundcloud.com/cmajpodcasts/191209-five

  • Competing interests: None declared.

  • This article has been peer reviewed.

References

  1. ↵
    1. Qureshi WT,
    2. Alirhayim Z,
    3. Blaha MJ,
    4. et al
    . Cardiorespiratory fitness and risk of incident atrial fibrillation: results from the Henry Ford Exercise Testing (FIT) Project. Circulation 2015;131:1827–34.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Calkins H,
    2. Hindricks G,
    3. Cappato R,
    4. et al
    . 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017;14:e445–94.
    OpenUrl
  3. ↵
    1. Estes NAM III.,
    2. Madias C
    . Atrial fibrillation in athletes: a lesson in the virtue of moderation. JACC Clin Electrophysiol 2017;3:921–8.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Guasch E,
    2. Benito B,
    3. Qi X,
    4. et al
    . Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model. J Am Coll Cardiol 2013;62:68–77.
    OpenUrlFREE Full Text
  5. ↵
    1. Andrade JG,
    2. Verma A,
    3. Mitchell LB,
    4. et al.
    CCS Atrial Fibrillation Guidelines Committee. 2018 focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation. Can J Cardiol 2018;34:1371–92.
    OpenUrl
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 192 (2)
CMAJ
Vol. 192, Issue 2
13 Jan 2020
  • Table of Contents
  • Index by author

Podcast

Subscribe to podcast
Download MP3

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Atrial fibrillation in athletes
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Atrial fibrillation in athletes
Derek Crinion, Adrian Baranchuk
CMAJ Jan 2020, 192 (2) E40; DOI: 10.1503/cmaj.191209

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Atrial fibrillation in athletes
Derek Crinion, Adrian Baranchuk
CMAJ Jan 2020, 192 (2) E40; DOI: 10.1503/cmaj.191209
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Too much exercise can cause atrial fibrillation
    • The causes of atrial fibrillation in athletes are multifactorial
    • Other causes of atrial fibrillation should be considered and thromboembolic risk assessed
    • Management of atrial fibrillation in athletes poses unique challenges
    • Ablation of atrial fibrillation is increasingly offered as first-line therapy
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Azathioprine-induced severe anemia potentiated by the concurrent use of allopurinol
  • Schwannoma of the tongue
  • “Superscan” in diffusion-weighted imaging with background body suppression magnetic resonance imaging
Show more Practice

Similar Articles

Collections

  • Sections
    • Five Things to Know About
  • Topics
    • Family medicine, general practice, primary care
    • Exercise & physical activity
    • Cardiovascular medicine

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire