Prevalence, mechanism and management of atrial fibrillation in athletes

Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice with an estimated prevalence of 0.4% to 1% in the general population [1], increasing with age to 8% in those older than 80 years [2]. The recognised risk factors for developing AF include age, structural heart disease, hypertension, diabetes mellitus and hyperthyroidism [3]. However, the mechanisms underlying the onset and maintenance of AF in patients younger than 60 years in whom no cardiovascular disease or any other known causal factor is present are yet to be clarified. This condition is termed lone AF [4], and may be responsible for as many as 30% of patients with paroxysmal AF seeking medical attention [5, 6]. It is well known that regular exercise is beneficial to health and reduces the risks of cardiovascular diseases [7, 8]. However, recent studies suggest that longterm endurance exercise may increase the incidence of AF [9–16]. This review article is intended to analyse the possible links between AF and endurance sport practice, the pathophysiological mechanisms responsible for this association and the recommended therapeutic options.