Epidemiology, pathogenesis and management of atrial fibrillation in athletes - a narrative review

Background:Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting millions worldwide. While moderate physical activity is known to reduce AF risk, endurance athletes, particularly males, appear to have a higher prevalence of AF. The relationship between physical activity and AF f...

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Main Authors: Jan Zabierowski, Anna Tomasiewicz, Maciej Pachana, Piotr Kukuła, Marcin Piersiak, Hubert Sawczuk, Julia Marschollek, Maciej Ziomek
Format: Article
Language:English
Published: Nicolaus Copernicus University in Toruń 2025-07-01
Series:Quality in Sport
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Online Access:https://apcz.umk.pl/QS/article/view/62361
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author Jan Zabierowski
Anna Tomasiewicz
Maciej Pachana
Piotr Kukuła
Marcin Piersiak
Hubert Sawczuk
Julia Marschollek
Maciej Ziomek
author_facet Jan Zabierowski
Anna Tomasiewicz
Maciej Pachana
Piotr Kukuła
Marcin Piersiak
Hubert Sawczuk
Julia Marschollek
Maciej Ziomek
author_sort Jan Zabierowski
collection DOAJ
description Background:Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting millions worldwide. While moderate physical activity is known to reduce AF risk, endurance athletes, particularly males, appear to have a higher prevalence of AF. The relationship between physical activity and AF follows a U-shaped curve, where both sedentary lifestyles and extreme-levels of physical activity increase the risk. Understanding the pathophysiology, risk factors, and management of AF in athletes is crucial for optimizing both cardiovascular health and athletic performance. Aim of the work:This study aims to review current literature on AF in athletes, focusing on its prevalence, pathophysiology, risk factors, gender differences, clinical significance, and management strategies. It also seeks to identify gaps in research and suggest future directions for improving prevention and treatment in this population. Materials and methods: A thorough literature review was conducted using databases such as PubMed and Google Scholar, covering studies from the last 20 years. Keywords included "atrial fibrillation," "athletes," "endurance sports," and "exercise-induced AF." Studies were selected based on relevance, methodology, and sample size. Results: Findings suggest that AF prevalence is significantly higher in endurance athletes, particularly in middle-aged men with long-term high-intensity training. Key contributing factors include atrial remodeling, inflammation, fibrosis and autonomic nervous system imbalance. While male athletes appear to be at greater risk, evidence in female athletes remains limited and inconclusive. Management strategies emphasize risk factor modification, individualized treatment plans, careful use of medications and ablation therapy. Exercise reduction as a preventive strategy remains debated.
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publisher Nicolaus Copernicus University in Toruń
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spelling doaj-art-e0b74f922b2c43bbb74ebf906ddc80812025-08-20T03:50:53ZengNicolaus Copernicus University in ToruńQuality in Sport2450-31182025-07-014310.12775/QS.2025.43.62361Epidemiology, pathogenesis and management of atrial fibrillation in athletes - a narrative reviewJan Zabierowski0https://orcid.org/0000-0002-3909-2657Anna Tomasiewicz1https://orcid.org/0000-0002-0068-3898Maciej Pachana2https://orcid.org/0009-0001-5862-9755Piotr Kukuła3https://orcid.org/0009-0001-1474-1534Marcin Piersiak4https://orcid.org/0009-0004-2199-4670Hubert Sawczuk5https://orcid.org/0009-0003-2860-9002Julia Marschollek6https://orcid.org/0000-0002-7038-5431Maciej Ziomek7https://orcid.org/0009-0007-8027-89834th Military Clinical Hospital with Polyclinic in Wrocław Rudolfa Weigla 5, 50-981 Wrocław, Poland 4th Military Clinical Hospital with Polyclinic in Wrocław Rudolfa Weigla 5, 50-981 Wrocław, Poland 5th Military Clinical Hospital with Polyclinic in Krakow, Poland, 4th Military Clinical Hospital with Polyclinic in Wrocław Rudolfa Weigla 5, 50-981 Wrocław, Poland4th Military Clinical Hospital with Polyclinic in Wrocław Rudolfa Weigla 5, 50-981 Wrocław, PolandUniversity Clinical Hospital in Wrocław Borowska 213, 50-556 Wrocław, Poland,University Clinical Hospital in Wrocław Borowska 213, 50-556 Wrocław, Poland,Wrocław Medical University Ludwika Pasteura 1, 50-367 Wrocław, Poland, Background:Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting millions worldwide. While moderate physical activity is known to reduce AF risk, endurance athletes, particularly males, appear to have a higher prevalence of AF. The relationship between physical activity and AF follows a U-shaped curve, where both sedentary lifestyles and extreme-levels of physical activity increase the risk. Understanding the pathophysiology, risk factors, and management of AF in athletes is crucial for optimizing both cardiovascular health and athletic performance. Aim of the work:This study aims to review current literature on AF in athletes, focusing on its prevalence, pathophysiology, risk factors, gender differences, clinical significance, and management strategies. It also seeks to identify gaps in research and suggest future directions for improving prevention and treatment in this population. Materials and methods: A thorough literature review was conducted using databases such as PubMed and Google Scholar, covering studies from the last 20 years. Keywords included "atrial fibrillation," "athletes," "endurance sports," and "exercise-induced AF." Studies were selected based on relevance, methodology, and sample size. Results: Findings suggest that AF prevalence is significantly higher in endurance athletes, particularly in middle-aged men with long-term high-intensity training. Key contributing factors include atrial remodeling, inflammation, fibrosis and autonomic nervous system imbalance. While male athletes appear to be at greater risk, evidence in female athletes remains limited and inconclusive. Management strategies emphasize risk factor modification, individualized treatment plans, careful use of medications and ablation therapy. Exercise reduction as a preventive strategy remains debated. https://apcz.umk.pl/QS/article/view/62361atrial fibrillationathletesepidemiologypathophysiologymanagementexcercise-induced atrial fibrillation
spellingShingle Jan Zabierowski
Anna Tomasiewicz
Maciej Pachana
Piotr Kukuła
Marcin Piersiak
Hubert Sawczuk
Julia Marschollek
Maciej Ziomek
Epidemiology, pathogenesis and management of atrial fibrillation in athletes - a narrative review
Quality in Sport
atrial fibrillation
athletes
epidemiology
pathophysiology
management
excercise-induced atrial fibrillation
title Epidemiology, pathogenesis and management of atrial fibrillation in athletes - a narrative review
title_full Epidemiology, pathogenesis and management of atrial fibrillation in athletes - a narrative review
title_fullStr Epidemiology, pathogenesis and management of atrial fibrillation in athletes - a narrative review
title_full_unstemmed Epidemiology, pathogenesis and management of atrial fibrillation in athletes - a narrative review
title_short Epidemiology, pathogenesis and management of atrial fibrillation in athletes - a narrative review
title_sort epidemiology pathogenesis and management of atrial fibrillation in athletes a narrative review
topic atrial fibrillation
athletes
epidemiology
pathophysiology
management
excercise-induced atrial fibrillation
url https://apcz.umk.pl/QS/article/view/62361
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