MEDICAL AREA   

Medicina dello Sport 2017 December;70(4):457-79

DOI: 10.23736/S0025-7826.17.03155-6

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English, Italian

Atrial fibrillation and flutter in sportsmen: pathophysiological mechanisms, diagnostic-therapeutic process and judgement of eligibility

Stefano CAMELIO ^{1, 2} ✉, Ugo LUCIANI ^{1, 3}, Fabio FAIOLA ^{1, 3}, Antonella COTUGNO ^{1, 3}, Giovanni VINETTI ^{1, 2}, Matteo D'ELIA ^{1, 2}, Maurizio CASASCO ^{1, 3}, Gaetano BIANCHI ^{1, 3}

¹ Federazione Medico Sportiva Italiana (FMSI), Rome, Italy; ² School of Sports Medicine, University of Brescia, Brescia, Italy; ³ Panathleticon, Brescia, Italy

BACKGROUND: A body of evidence in the literature points to an increased risk of developing atrial fibrillation and flutter in athletes practicing endurance sports; this association, however, continues to be debated and the pathophysiological mechanisms underlying it are not entirely clear. The aim of this study is to carry out a critical review of case series of sportsmen with atrial fibrillation or flutter attending our Sports Medicine Center, investigating the role possibly played by sports participation in the genesis of these arrhythmias.
METHODS: We took into consideration the entire adult sports population aged ≥21 years that, from January 2006 to February 2017, underwent the pre-participation screening at our Sports Medicine Center, identifying all subjects in whom atrial fibrillation or flutter was diagnosed. We subsequently reviewed the clinical documentation, excluding from the investigation those who were found to have a triggering condition. In the remaining cases, we identified characteristics that allow us to hypothesize a possible association between arrhythmia and the sporting activity.
RESULTS: Over a period of 10 years and 2 months, out of a total of 21,191 sportsmen and sportswomen (average age: 28.3±9.4 years; 21-30 years: 65.7%; 31-40 years: 20.1%; ≥41 years: 14.2%), sports medical fitness examinations found 7 subjects with paroxysmal or persistent episodes of atrial fibrillation or atrial fibrillo-flutter (prevalence: 0.33‰); of these, no triggering condition was identified in 6 cases.
CONCLUSIONS: In the population examined in our survey, the prevalence of atrial fibrillation and flutter is very low and, considering the characteristics of the sample, it is not comparable with other reported prevalence data. The possible pathophysiological mechanisms found are probably related to various combinations of vagal and adrenergic hypertonus, sudden reduction of vagal tone, adrenergic activation and increased atrial automaticity. In the cases described, strenuous, continuous sporting activity may have predisposed the athlete to the onset of such arrhythmias.

KEY WORDS: Atrial fibrillation - Atrial flutter - Sports medicine - Athletes