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Atrial fibrillation in Long distance runners:

Can athletes with atrial fibrillation stay active (e.g. jogging)? Are endurance sports a risk factor for people with heart rhythm disorders? What should be done when atrial fibrillation occurs?

In a recently published study it was shown that endurance athletes, especially marathon / cross-country skiers, have an unusually high risk of atrial fibrillation at a relatively early age. A prominent example is the well-known internet journalist Tim Cole, who documented his heart rhythm disorder and ensuing treatment (laser catheter ablation) via blogs and social media on the internet. Today, Tim Cole is running once again, however, there are clear indications that extreme stress is a contributing factor for a premature occurrence of atrial fibrillation. While atrial fibrillation is widespread among the population, a recently published study from the European Society of Cardiology (ESC) indicates that young athletes, compared with the general population, have a significantly higher risk of developing atrial fibrillation. 
In the study, based on data accumulated over the past thirty years, the incidence of atrial fibrillation among athletes was 12.8 percent. In comparison, among the general population the incidence is 0.5 percent, and only increases to about 15 percent from the age of 75 years or older. These results are from cross-country skiers who regularly participate in a ski marathon.

Is it possible to predict the probability of an occurrence of atrial fibrillation in an individual athlete?

So-called indicators of atrial fibrillation in this study were a slow heart rate and an enlarged left atrium. Preventive screening by means of a long term-ECG and echocardiography can reveal these symptoms. Both of these findings are characteristically found in other endurance athletes. The enlargement of the left atrium in an otherwise healthy heart constitutes an adaptation to endurance training, and along with the slow heart rate at rest resulting from regular training is apparently a risk indicator for atrial fibrillation in marathon cross-country skiers. Tim Cole and many other endurance athletes should neither be discouraged nor scared off by these facts. As demonstrated by the case of Mr. Cole, atrial fibrillation does not have to mean an end to endurance sports.
 
Aside from extreme examples such as marathon running, endurance sports have a significant role in prevention.  Atrial fibrillation can limit an athlete’s duration so much that not even short workouts are possible. Endurance athletes should be aware that arrhythmia leads not only to a lackluster performance, but also brings with it a significant risk of stroke. Once again, the internet journalist is a good example; shortly before a scheduled catheter intervention he experienced a mild stroke. This can also happen to quite younger athletes. Regular check-ups (e.g. with echocardiography or a long term-ECG) are called for if an athlete starts to notice a decrease in performance, or even arrhythmia itself.
 

Can and should an athlete with atrial fibrillation continue to carry on with his sport?

Atrial fibrillation often occurs in combination with other diseases (a concomitant disease). This means there is an underlying treatable cause. For instance, if the atrial fibrillation is caused by inadequately regulated or unregulated blood pressure, coronary heart disease with a significant narrowing of the blood vessels, or valvular disease, any continuation of athletic training could be dangerous. Therefore, any new occurrences of heart rhythm disorder, especially of the most widespread form of arrhythmia, atrial fibrillation, should be assessed as quickly as possible. 
 
Your primary care physician and / or a specialist (e.g. cardiologist) can best clarify major causes quickly and treat them appropriately. Once the cause has been treated or rectified, sports and athletic activity may again be resumed. But it is important for an athlete in regard to continuing any sport or athletic exertion that accompanying diseases (comorbidities) are correctly identified and dealt with. This applies especially to regulating hypertension because there are certain combinations of medication that are less suitable for athletes. In such situations your general practitioner and referring cardiologist play a vitally important role. Performance and stress-tests are important tools in estimating the risk as to whether any further physical activity is allowed.
 

As an athlete, how do I recognize atrial fibrillation? Are there any warning signs?

Individual "skips of the heartbeat" (premature beats) during exercise are perfectly normal and occur even in healthy individuals. If there is an inexplicable increase of heartbeats, or an irregular pulse, these can be a cause for concern: For example, an athlete might notice in the context of ergometer training an irregular heart rate on the pulse monitor or personal heart rate monitoring device.  It may also be the case that due to the arrhythmic pulse, the pulse measurement or heart rate monitor may not even register. If the pulse is measured by placing two fingers on the wrist, the arrhythmic and changing pulse intensity will be noticeable. 
 
Many athletes also notice a decrease in performance when there is an occurrence of atrial fibrillation. If there is shortness of breath at what would be otherwise a normal performance level, a specialist should be consulted.  Especially after a first event, the clarification of possible causes (coronary heart disease, for example) is important for the athlete.
Untreated, the underlying diseases may be more dangerous than the actual atrial fibrillation. 
 
Aside from a decrease in performance, there is a significantly increased risk of stroke, and therefore a comprehensive diagnosis in each patient should be done with the onset of atrial fibrillation. In addition to ECG, the main tools for assessing the condition are long term ECG-monitoring and ultrasound imaging diagnostics.
 
For patients with a high risk of stroke or already stattgehabtem insult the TEE examination can be an additional tool. One of the first athletes who has benefited from the new method of laser ablation for atrial fibrillation is Tim Cole, mentioned above. In numerous online features this athlete has reported about the course of his disease and resumption of training following ablation.
 
 
 
 

 

 

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