Management of atrial fibrillation in the athlete

Hariharan Raju, Jonathan M. Kalman

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Atrial fibrillation (AF) is a recognised arrhythmic risk of endurance sports participation, predominantly affecting middle-aged men who are lifelong athletes. Affected athletes were historically included in the category of lone AF, although specific pathophysiological processes apply to this condition, referred to as exercise-related AF. Younger non-endurance athletes may also present with AF, particularly when associated with co-existing cardiomyopathy or arrhythmia syndrome. Management of exercise-related AF is largely based on evidence from randomised trials in non-athletes. Cornerstones of treatment are, thus, thromboembolic risk reduction and risk factor modification. Rhythm control is generally preferred over rate control due to frequent presentation with symptomatic AF during the paroxysmal phase. Many therapies specific to athletes are based on expert consensus alongside observational data in athletic populations. These include: recommendations to detrain; treatment of symptomatic oesophageal reflux; and preferential use of anticholinergic antidysrhythmic agents to address the predominance of “vagal” AF in athletes. Ongoing research involving cardiac ion channel remodelling and systemic inflammation as mediators of AF genesis may provide future novel therapeutic targets for exercise-related AF. Ablative therapy shows promise in the athletic population with AF, although evidence remains limited. International consensus guidance for disqualification from competitive sports exists to guide medical management alongside athletes’ preferences to continue to participate. This review focusses on isolated exercise-related AF and reviews the evidence supporting postulated management recommendations of this unique patient population.

LanguageEnglish
Pages1086-1092
Number of pages7
JournalHeart Lung and Circulation
Volume27
Issue number9
DOIs
Publication statusPublished - 1 Sep 2018

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Athletes
Atrial Fibrillation
Sports
Exercise
Consensus
Population
Therapeutics
Inflammation Mediators
Cholinergic Antagonists
Risk Reduction Behavior
Gastroesophageal Reflux
Cardiomyopathies
Ion Channels
Cardiac Arrhythmias

Keywords

  • Athlete
  • Atrial fibrillation
  • Endurance sport

Cite this

Raju, Hariharan ; Kalman, Jonathan M. / Management of atrial fibrillation in the athlete. In: Heart Lung and Circulation. 2018 ; Vol. 27, No. 9. pp. 1086-1092.
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Management of atrial fibrillation in the athlete. / Raju, Hariharan; Kalman, Jonathan M.

In: Heart Lung and Circulation, Vol. 27, No. 9, 01.09.2018, p. 1086-1092.

Research output: Contribution to journalReview articleResearchpeer-review

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