Cover Image

Exercise and Atrial Fibrillation: Some Good News and Some Bad News

Alireza Sepehri Shamloo, Arash Arya, Nikolas Dagres, Gerhard Hindricks

Atrial fibrillation (AF) is considered as the most common sustained arrhythmia in adults, whose incidence rate is on the rise due to the increase in the mean age of the global population. In recent years, many efforts have been made to identify effective factors in the incidence of AF to prevent them and thereby reduce the consequences of AF. Physical activity is one of the topics that attracted much attention in the last two decades. According to some findings, extreme and prolonged exercise itself can be considered as a risk factor for the onset of AF; however, other studies have shown that exercise can be regarded a protective factor against AF in the general population. The present study reviews the findings of studies on the relationship between AF and exercise and discusses possible mechanisms for this relationship. Additionally, we present some recommendations for researchers and physicians about exercise management in association with AF prevention. [GMJ.2018;7:e1401] 

Atrial fibrillation; Exercise; Primary Prevention; Aging

Kirchhof P, Breithardt G, Bax J, Benninger G, Blomstrom-Lundqvist C, Boriani G, et al. A roadmap to improve the quality of atrial fibrillation management: proceedings from the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference. Europace. 2016 Jan;18(1):37-50. https://doi.org/10.1093/europace/euv304 PMid:26481149

Mairesse GH, Moran P, Van Gelder IC, Elsner C, Rosenqvist M, Mant J, et al. Screening for atrial fibrillation: a European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLAECE). Europace. 2017;19(10):1589-623. https://doi.org/10.1093/europace/eux177 PMid:29048522

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609-78. https://doi.org/10.1093/europace/euw295 PMid:27567465

Stewart S, Murphy N, Walker A, McGuire A, McMurray J. Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK. Heart. 2004;90(3):286-92. https://doi.org/10.1136/hrt.2002.008748 PMid:14966048 PMCid:PMC1768125

Seccia TM, Calo LA. Is exercise becoming a danger for our health? The complex relationship between exercise and atrial fibrillation. Eur J Prev Cardiol. 2018;25(6):621-3. https://doi.org/10.1177/2047487318762445 PMid:29488811

Calvo N, Ramos P, Montserrat S, Guasch E, Coll-Vinent B, Domenech M, et al. Emerging risk factors and the dose-response relationship between physical activity and lone atrial fibrillation: a prospective case-control study. Europace. 2016;18(1):57-63. https://doi.org/10.1093/europace/euv216 PMid:26333377 PMCid:PMC4739323

Elliott AD, Linz D, Verdicchio CV, Sanders P. Exercise and Atrial Fibrillation: Prevention or Causation? Heart Lung Circ. 2018;27(9):1078-1085 . https://doi.org/10.1016/j.hlc.2018.04.296 PMid:29891251

Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Terradellas JB, et al. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Europace. 2017;19(1):139-63.PMid:27815371

Brandes A, Smit MD, Nguyen BO, Rienstra M, Van Gelder IC. Risk factor management in atrial fibrillation. Arrhythm Electrophysiol Rev. 2018;7(2):118. https://doi.org/10.15420/aer.2018.18.2 PMid:29967684 PMCid:PMC6020195

Elliott AD, Maatman B, Emery MS, Sanders P. The role of exercise in atrial fibrillation prevention and promotion: finding optimal ranges for health. Heart Rhythm. 2017;14(11):1713-20. https://doi.org/10.1016/j.hrthm.2017.07.001 PMid:28694186

Buring JE, Albert CM. Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol. 2009;103(11):1572-7. https://doi.org/10.1016/j.amjcard.2009.01.374 PMid:19463518 PMCid:PMC2687527

Thelle DS, Selmer R, Gjesdal K, Sakshaug S, Jugessur A, Graff-Iversen S, et al. Resting heart rate and physical activity as risk factors for lone atrial fibrillation: a prospective study of 309,540 men and women. Heart. 2013;99(23):1755-60. https://doi.org/10.1136/heartjnl-2013-303825 PMid:23749790

Drca N, Wolk A, Jensen-Urstad M, Larsson SC. Atrial fibrillation is associated with different levels of physical activity levels at different ages in men. Heart. 2014;100(13):1037-42. https://doi.org/10.1136/heartjnl-2013-305304 PMid:24829373

Khan H, Kunutsor SK, Rauramaa R, Merchant FM, Laukkanen JA. Long-Term Change in Cardiorespiratory Fitness in Relation to Atrial Fibrillation and Heart Failure (from the Kuopio Ischemic Heart Disease Risk Factor Study). Am J Cardiol. 2018;121(8):956-60. https://doi.org/10.1016/j.amjcard.2018.01.003 PMid:29472009

Eijsvogels TMH, Thompson PD, Franklin BA. The "Extreme Exercise Hypothesis": Recent Findings and Cardiovascular Health Implications. Curr Treat Options Cardiovasc Med. 2018;20(10):84. https://doi.org/10.1007/s11936-018-0674-3 PMid:30155804 PMCid:PMC6132728

Drca N, Wolk A, Jensen-Urstad M, Larsson SC. Physical activity is associated with a reduced risk of atrial fibrillation in middle-aged and elderly women. Heart. 2015;101(20):1627-30. https://doi.org/10.1136/heartjnl-2014-307145 PMid:26019224

Mittal S. Physical Activity and Incidence of Atrial Fibrillation in Older Adults: The Cardiovascular Health Study. J Atr Fibrillation. 2008;1(3). https://doi.org/10.4022/jafib.v1i1.391 PMid:28496592 PMCid:PMC4956377

Yang Y, Han X, Chen Y, Gao L, Yin X, Li H, et al. Association between modifiable lifestyle and the prevalence of atrial fibrillation in a Chinese population: Based on the cardiovascular health score. Clin Cardiol. 2017;40(11):1061-7. https://doi.org/10.1002/clc.22771 PMid:28833291

Park J, Kyoung AK. 136-75: Gender difference of life style patterns including smoking, alcohol, and physical activity related to new onset atrial fibrillation: A nationwide cohort study in Korea. Europace. 2016;18(suppl_1):i109-i.

Faselis C, Kokkinos P, Tsimploulis A, Pittaras A, Myers J, Lavie CJ, et al. Mayo Clin Proc. 2016;91(5):558-66. https://doi.org/10.1016/j.mayocp.2016.03.002 PMid:27068670

Qureshi WT, Alirhayim Z, Blaha MJ, Juraschek SP, Keteyian SJ, Brawner CA, et al. Cardiorespiratory fitness and risk of incident atrial fibrillation: results from the Henry Ford ExercIse Tesing (FIT) project. Circulation. 2015;131(21):1827-34. https://doi.org/10.1161/CIRCULATIONAHA.114.014833

Ricci C, Gervasi F, Gaeta M, Smuts CM, Schutte AE, Leitzmann MF. Physical activity volume in relation to risk of atrial fibrillation. A non-linear meta-regression analysis. Eur J Prev Cardiol. 2018;25(8):857-66. https://doi.org/10.1177/2047487318768026

Providencia R, Teixeira C, Segal OR, Ullstein A, Mueser K, Lambiase PD. Empowerment of athletes with cardiac disorders: a new paradigm. Europace. 2018;20(8):1243-51. https://doi.org/10.1093/europace/eux268

Karjalainen J, Kujala UM, Kaprio J, Sarna S, Viitasalo M. Lone atrial fibrillation in vigorously exercising middle aged men: case-control study. BMJ (Clinical research ed). 1998;316(7147):1784-5. https://doi.org/10.1136/bmj.316.7147.1784

Morseth B, Graff-Iversen S, Jacobsen BK, Jorgensen L, Nyrnes A, Thelle DS, et al. Physical activity, resting heart rate, and atrial fibrillation: the Tromso Study. Eur Heart J. 2016;37(29):2307-13. https://doi.org/10.1093/eurheartj/ehw059

Mont L, Sambola A, Brugada J, Vacca M, Marrugat J, Elosua R, et al. Long-lasting sport practice and lone atrial fibrillation. Eur Heart J. 2002;23(6):477-82. https://doi.org/10.1053/euhj.2001.2802

Elosua R, Arquer A, Mont L, Sambola A, Molina L, García-Morán E, et al. Sport practice and the risk of lone atrial fibrillation: a case–control study. Int J Cardiol. 2006;108(3):332-7. https://doi.org/10.1016/j.ijcard.2005.05.020

Myrstad M, Løchen ML, Graff-Iversen S, Gulsvik AK, Thelle DS, Stigum H, et al. Increased risk of atrial fibrillation among elderly N orwegian men with a history of long-term endurance sport practice. Scand J Med Sci Sports. 2014;24(4):e238-44. https://doi.org/10.1111/sms.12150

Myrstad M, Lochen ML, Graff-Iversen S, Gulsvik AK, Thelle DS, Stigum H, et al. Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice. Scand J Med Sci Sports. 2014 Aug;24(4):e238-44. https://doi.org/10.1111/sms.12150

Mont L, Tamborero D, Elosua R, Molina I, Coll-Vinent B, Sitges M, et al. Physical activity, height, and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals. Europace. 2008;10(1):15-20. https://doi.org/10.1093/europace/eum263

Andersen K, Farahmand B, Ahlbom A, Held C, Ljunghall S, Michaelsson K, et al. Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study. Eur Heart J. 2013;34(47):3624-31. https://doi.org/10.1093/eurheartj/eht188 PMid:23756332

Abdulla J, Nielsen JR. Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis. Europace. 2009;11(9):1156-9. https://doi.org/10.1093/europace/eup197 PMid:19633305

O'Hanlon R, Wilson M, Wage R, Smith G, Alpendurada FD, Wong J, et al. Troponin release following endurance exercise: is inflammation the cause? a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2010;12:38. https://doi.org/10.1186/1532-429X-12-38 PMid:20598139 PMCid:PMC2908607

Bohm P, Schneider G, Linneweber L, Rentzsch A, Kramer N, Abdul-Khaliq H, et al. Right and Left Ventricular Function and Mass in Male Elite Master Athletes: A Controlled Contrast-Enhanced Cardiovascular Magnetic Resonance Study. Circulation. 2016;133(20):1927-35. https://doi.org/10.1161/CIRCULATIONAHA.115.020975 PMid:27073129

Raatikainen MJP, Arnar DO, Merkely B, Nielsen JC, Hindricks G, Heidbuchel H, Camm J. A Decade of Information on the Use of Cardiac Implantable Electronic Devices and Interventional Electrophysiological Procedures in the European Society of Cardiology Countries: 2017 Report from the European Heart Rhythm Association. Europace. 2017 Aug 1;19(suppl_2): ii1-ii90.

Wilhelm M, Roten L, Tanner H, Wilhelm I, Schmid J-P, Saner H. Atrial remodeling, autonomic tone, and lifetime training hours in nonelite athletes. Am J Cardiol. 2011;108(4):580-5. https://doi.org/10.1016/j.amjcard.2011.03.086 PMid:21658663

Guasch E, Calvo N, Ramos P, Montserrat S, Domenech M, Arbelo E, et al. P296Exercise-induced atrial fibrillation is associated with a pro-inflammatory status. Europace. 2017;19(suppl_3):iii45-iii.

De With RR, Marcos EG, Van Gelder IC, Rienstra M. Atrial fibrillation progression and outcome in patients with young-onset atrial fibrillation. Europace. 2018. https://doi.org/10.1093/europace/euy028

Vidal A, Agorrody V, Abreu R, Viana P, Dodera A, Vidal L. Vagal third-degree atrioventricular block in a highly trained endurance athlete. Europace. 2017;19(11):1863-. https://doi.org/10.1093/europace/eux045 PMid:28430941

Linz D, Hohl M, Vollmar J, Ukena C, Mahfoud F, Böhm M. Atrial fibrillation and gastroesophageal reflux disease: the cardiogastric interaction. Europace. 2017;19(1):16-20. PMid:27247004

El-Battrawy I, Lang S, Zhou X, Borggrefe M, Akin I. The link between atrial fibrillation and hereditary channelopathies. Europace. 2018: euy109-euy. https://doi.org/10.1093/europace/euy109

Hong KL, Glover BM. The impact of lifestyle intervention on atrial fibrillation. Curr Opin Cardiol. 2018;33(1):14-9. https://doi.org/10.1097/HCO.0000000000000470

Middeldorp ME, Pathak RK, Meredith M, Mehta AB, Elliott AD, Mahajan R, et al. PREVEntion and regReSsive Effect of weight-loss and risk factor modification on Atrial Fibrillation: the REVERSE-AF study. Europace. 2018. https://doi.org/10.1093/europace/euy117

Mohammad AT, Asghar MA, Asadollah M, Jalal A, Javad S, Alireza SS, et al. The evaluation of right atrial temporary pacing for preventing postoperative atrial fibrillation following coronary artery bypass grafting surgery: prospective observational study. Life Sci J. 2012;9(3):2233-7.

Kwon Y, Misialek JR, Duprez D, Alonso A, Jacobs JDR, Heckbert SR, et al. Association between sleep disordered breathing and electrocardiographic markers of atrial abnormalities: the MESA study. Europace. 2017;19(11):1759-66. https://doi.org/10.1093/europace/euw328

Mazza A, Bendini MG, De Cristofaro R, Lovecchio M, Valsecchi S, Boriani G. Pacemaker-detected severe sleep apnea predicts new-onset atrial fibrillation. Europace. 2017 Dec 1;19(12):1937-1943. https://doi.org/10.1093/europace/euw371

Senturk T, Xu H, Puppala K, Krishnan B, Sakaguchi S, Chen LY, Karim R, Dickinson O, Benditt DG. Cardiac pauses in competitive athletes: a systematic review examining the basis of current practice recommendations. Europace. 2016 Dec;18(12):1873-1879.

Refbacks

  • There are currently no refbacks.