Atrial Fibrillation in Endurance Athletes

A growing number of publications describes a relation between intensive endurance exercise and the prevalence of atrial fibrillation. Existing data focus on the influence of endurance training in older male athletes. There is no evidence for an enhanced prevalence of atrial fibrillation in younger male athletes and in female athletes of any age. The prevalence of atrial fibrillation seems to have an U-shaped dose dependency in relation to athletic activity No athletic activity and intensive athletic activity are associated with the incidence of atrial fibrillation, whereas light to moderate exercise seems to have a protective influence. Atrial fibrillation is caused by alterations in the complex interactions between arrhythmogenic triggers in the pulmonary veins, the substrate of the left atrium and influences of the autonomic nervous system. There is no evidence for an enhanced activity of arrhythogenic triggers in the pulmonary veins in athletes. Therefore, changes of the left atrial substrate are the most likely reason. Histological changes and increase of left-atrial size have to be considered. Also, the pronounced amplitude of the autonomic nervous system can contribute to the development of atrial fibrillation. If atrial fibrillation affects the mortality in athletes, is not studied yet. Therefore, the positive effect of regular exercise on health is indisputable and not restricted by the existing data. For athletes with highly symptomatic atrial fibrillation and unsuccessful drug therapy, ablation should be considered.