Those most likely to derive benefit are those with paroxysmal AF, no underlying cardiac disease and a non-dilated left atrium. In this general population, the likelihood of procedural success is more directly related to patient characteristics than to the specific technique. As such, catheter ablation has emerged as an attractive therapeutic option in athletes with AF.Īs is true for most treatments of the athlete, most of the data on catheter ablation is from a more general population of individuals, who are largely non-athletes. In addition both short term side effects and long term toxicities limit their use in a younger healthier population. However, these agents are not without their risk, including proarrhythmia and sudden cardiac death. 10 Antiarrhythmic agents for a rhythm control strategy may be an alternative. Additionally, beta-blockers are banned from some competitive sports. Both drug classes can have limiting side effect profiles in athletes and non-athletes alike. However, titrating AV nodal blockade to allow for high-performance activities at high heart rates, while preventing AF with a rapid ventricular response can prove difficult, if not impossible in many athletes. 10,11 Traditional rate-controlling methods focus on beta-adrenergic and/or calcium-channel blocking agents. Both United States and European guidelines suggests athletes with both symptomatic and asymptomatic AF without structural heart disease with appropriate rate responsiveness may continue to play sports. Initial recommendations for athletes' participation in competitive sports were driven largely by the ventricular rate during exertion.
In the athlete, aggressive rhythm control may allow the patient to continue to train and compete with minimal interruption. 9 When present in the highly trained athlete, these symptoms are of particular concern and may result in a decrease in performance or even render the athlete ineligible for further competition. However, the optimal treatment algorithm for managing athletes with AF has not been well elucidated.ĪF is known to cause a variety of symptoms in the general population including palpitations, dyspnea, and generalized fatigue. In addition, the effects of AF on quality of life, in particular for the athlete, can be extreme. Regardless of the mechanism, non-valvular AF is associated with increased rates of morbidity and mortality in both athletes and the general population. Vagal-mediated AF may be one of the mechanism by which athletes develop higher rates of AF. 7 With deconditioning, episodes of AF may be diminished. Highly trained athletes develop increased parasympathetic tone, some have attributed to high vagal tone. The autonomic nervous system also plays an important role in both the initiation and maintenance of AF. The increase in atrial wall stretch/strain may play a mechanistic role in the development of AF. 5 Prior studies have demonstrated the left atrial dimensions are increased in athletes when compared to the general population. In fact, one of the greatest independent predictors of AF risk is left atrial size. It is theorized that some of these adaptive mechanisms to recurrent atrial pressure overload may lead to higher rates of AF. Physiologic adaptations to intense exercise serve to increase oxygenation of skeletal muscle during rigorous activity. 4Ĭurrent theories suggest the etiology of AF in athletes is multifactorial and may include different mechanisms than in the general population. Studies suggest atrial fibrillation (AF) and atrial flutter may be more common in aerobically-trained athletes than non-aerobically trained athletes. 3 Even the type of physical activity may also play a role. Recent meta-analysis suggested the rate of AF in athletes is higher than controls, though the data were of poor quality.
This potentially puts athletes at increased risk of developing atrial fibrillation. 2 In fact, vigorous exercise may increase the risk of cardiac arrhythmias. Regular exercise is recommended by the American College of Cardiology and the American Heart Association as it improves cardiovascular fitness and reduces mortality. AF is not limited to those with underlying heart disease and other conditions, but is also observed in quite healthy athletes. 1 AF is responsible for considerable morbidity and may dramatically affect quality of life. Click here for the Con article.Ītrial fibrillation (AF) is widely recognized as the most common arrhythmia in clinic practice and its prevalence is expected to increase over the next decade.
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Editor's Note: This is the Pro article of a two-part Pro/Con Expert Analysis.
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