Atrial fibrillation ablation in athletes: an Olympic challenge?

Abstract

Sports practice is very popular in our Western society as an epitome of a healthy life style, and endurance athletes have been our heroes since the days of the Greek in Olympia. However, aside from direct physical injury, there appear to be more indirect pathophysiological dangers that lurk around the corner. It has been established that individuals participating in regular intense physical exercise for several times a week have a two-fold risk of developing atrial fibrillation (AF). The Arrhythmia Unit of the Hospital Clinic in Barcelona, Spain, was among the first to make such observations in a population of AF patients with long-term sports activity.1 The Barcelona group extends their research by examining the results of ablation in athletes with AF.2 What is it that may distinguish athletes from other individuals? An increased physical demand may lead to structural adaptations of the heart, such as hypertrophy, dilatation, and fibrosis. Also, functional alterations in cellular ion channel expression and electrolyte handling may be evoked. In addition, an increased vagal tone and a lower resting heart rate can be found in well-trained athletes. Such changes may affect the electrophysiological properties of the atria and promote reentry and focal activity, which are established mechanisms for AF. The next question would be whether athletes with AF are any different … *Corresponding author. Tel: +31 30 609 9111, Fax: +31 30 609 2274, Email: l.boersma{at}Antonius.net