IMR Press / RCM / Volume 24 / Issue 6 / DOI: 10.31083/j.rcm2406155
Open Access Review
Atrial Fibrillation in Endurance Training Athletes: Scoping Review
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1 Medical and Life Sciences School, Pontifical Catholic University of Goiás, 74175-120 Goiânia, Goiás, Brazil
2 Internal Medicine Department, Medicine Faculty, Federal University of Goiás, 74690-900 Goiânia, Goiás, Brazil
*Correspondence: (Antonio S. Menezes Jr)
These authors contributed equally.
Rev. Cardiovasc. Med. 2023, 24(6), 155;
Submitted: 12 December 2022 | Revised: 11 February 2023 | Accepted: 28 February 2023 | Published: 26 May 2023
(This article belongs to the Special Issue Cardiovascular Diseases in Athletes)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Moderate regular physical activity is indicated to avoid atrial fibrillation (AF), whereas athletes should be counseled that long-lasting vigorous sports engagement may cause AF, according to the 2016 European Society of Cardiology (ESC) recommendations for AF treatment. Exercise and AF are complex. Objectives: To evaluate the relationship between Endurance training and AF, in addition to the starting point/trigger by which Endurance Training causes impairment of cardiac function and AF, considering the time and intensity of Endurance training. Materials and Methods: We synthesized evidence from articles published in the PubMed, EMBASE, and SciELO databases using their respective Boolean operators. A total of 112 original articles related to AF and endurance athletes published up to the year 2023 were reviewed. Results: Our study verified multiples aspects of the genesis of AF in athletes, such as cardiac adaptations to exercise, disturbances in cardiac injury biomarkers, sex differences in cardiac adaptations and their role in AF risk, and the relationship between body composition (height, weight, and physical fitness) and AF pathogenesis. Conclusions: Variations in cardiac structure (increased atrial thickness and size in addition to myocardial fibrosis) and significant increases in vagal tone (sinus bradycardia and imbalances in sympathetic and parasympathetic activation) shorten the refractory period shortening in athletes, induce the onset of re-entrance mechanisms, and serve as ectopic triggers that can lead to AF.

atrial fibrillation
cardiac remodeling
endurance exercise
high-performance athlete
sudden cardiac death
Graphical Abstract
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Fig. 1.
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