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Atrial fibrillation in athletes and the interplay between exercise and health

Andre La Gerche, Christian Marc Schmied
DOI: http://dx.doi.org/10.1093/eurheartj/eht265 eht265 First published online: 24 July 2013

Exercise is one of the most powerful lifestyle intervention strategies for the primary and secondary prevention of cardiovascular disease. There is a wealth of evidence regarding the lower ranges of the exercise dose–response relationship providing concrete evidence for the current recommendations of at least 30 min of moderate intensity exercise on most days as a means of reducing cardiovascular events.1 However, there is an increasing proportion of today's society engaging in sports practices which vastly exceed these guidelines, and there has been very limited study of the upper ranges of the exercise dose–response relationship.2 On the one hand are studies suggesting that long-term health and life expectancy of well-trained athletes is superior to that of the general population,35 while, on the other, there is evidence suggesting an increased prevalence of arrhythmias and chronic structural remodelling of the athletic heart.69

Atrial fibrillation (AF) may therefore represent the most intriguing and best evidenced example of the interplay between exercise and cardiac health. AF can be diagnosed in ∼1% of the population by age 60 and in >10% when older than 80 years,10 making it the most prevalent sustained arrhythmia in adults. In cohorts of young or middle-aged subjects, AF is relatively uncommon, thus implying that large cohorts would be required to provide sufficient power to identify any excess in prevalence due to sports practice. In this context, it is not surprising that Pelliccia et al. found only very few cases of AF despite significant left atrial enlargement in a fairly large (n = 1777) athletic cohort aged 24 ± 6 years.11 In contrast, Baldesberger et al. were able to identify an excess of AF when comparing a small cohort of 62 former professional cyclists with 62 ex-golfers aged 66 ± …

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