Risk stratification is done with CHA2DS2-Vasc score, just like in the general population. Aside from the rate or rhythm control question, the other tenant of management of AF in athletes involves potential anticoagulation to reduce stroke risk. The need for anticoagulation should be assessed on a case by case basis. This would be an attractive option especially for those with low risk for stroke (CHA2DS2VASC of 1 or less). If an athlete has paroxysmal AF and remains asymptomatic, then he or she may not need to pursue a rate or rhythm control strategy and can continue participation in sports. We recognize that many athletes will be resistant to detraining and this may not be a realistic option. 5 Further treatment options can then be formulated in response to the degree of improvement that is experienced by the athlete.

2,12,11,10 The Study Group on Sports Cardiology of the European Association for Cardiovascular Prevention and Rehabilitation recommends that athletes in an early stage of paroxysmal AF should discontinue training for 2 months to stabilize sinus rhythm. For the patient not requiring chronic anticoagulation and/or determined to have a low CHA2DS2VASC score, oral anticoagulation is normally required after ablation, for at least 6 weeks post procedure and would increase the risk of major bleeding in contact sports such as football and would require temporary withdrawal from sport.įor all athletes diagnosed with AF, one initial approach could be to decrease training for a period of time as overtraining in athletes can be responsible for AF. The potential for femoral vein complications, for example, could be a particular concern for the active athlete. 14,15,16,17 Certainly, a thorough discussion about the risks and benefits of pharmacologic versus ablative therapy must be had. 14 Indeed, catheter ablation may be a reasonable initial approach in athletes with recurrent and symptomatic paroxysmal AF. The initial approach to both athletes and non-athletes with AF should include stroke risk assessment and rhythm control depending on symptoms. 10įor the purposes of this Expert Analysis, we are presuming the athletes in question are mostly those with paroxysmal AF and 'structurally normal' hearts. 10,2 Other changes associated with training including electrolyte abnormalities, autonomic changes, and even gastroesophageal reflux disease are also believed to contribute to the development of AF in this population. The pathophysiology of AF in athletes is complex and is believed to be multifactorial, with contributions from genetic predisposition, atrial ectopy, and sports supplements, combined with cardiac remodeling, fibrosis, inflammation, and fibrosis associated with exercise.

3,4,7 AF is an important topic in sports and exercise cardiology due to its prevalence and the development of resting and exertional symptoms.

The prevalence in athletes has been reported as occurring anywhere from 0.2% to 63%. 10 However, it has also been noted to occur in young athletes without traditional risk factors. Click here for the Pro article.Ītrial Fibrillation (AF) is the most common arrhythmia in the general population and in athletes, particularly in middle aged athletes participating in endurance sports. Editor's Note: This is the Con article of a two-part Pro/Con Expert Analysis.

Heart ablation for a flutter