Sportkardiologie

Abstract

Recently, there is evidence that atrial fibrillation (AF) is associated with endurance sports. Training-induced left atrial enlargement, vagotonic increase and left atrial volume strain during exercise may act proarrhythmogenic in terms of a facilitated induction and maintenance of AF in endurance athletes. Nevertheless, there is currently no evidence of an increased AF prevalence in young endurance athletes. However, longstanding endurance exercise increases AF risk. An exercise-induced atrial remodeling as a potential pathophysiological mechanism is being discussed. However, respective definitive evidence of the latter in human beings is still missing. Two equivalent recommendationsconcerning sports participation (European Society of Cardiology/ American Heart Association and American College of Cardiology) are available for evaluation of competitive athletes with AF. Both exhibit blurs and points of criticism which lower practicability in clinical practice. However, they can act as a decision support for evaluation and guidance of most of the competitive athletes with AF. In competitive athletes, a rather individualized or sports-specific approach is necessary also under consideration of pathophysiological aspects and current knowledge concerning the association of AF and endurance sports. The rather brief American recommendations are moving in this direction. At least in cases concerning professional athletes, interdisciplinary collaboration between experts in cardiology, rhythmology and sports medicine if needed should be considered, not only as public pressure (including social environment of the athlete) on decision-making physicians may sometimes be high.KEY WORDS: Atrial Fibrillation, Competitive Sports, Sports Participation, Endurance Exercise