Endurance sports is a risk factor for atrial fibrillation after ablation for atrial flutter
Introduction
Foregoing studies have reported a higher incidence of AF in competitive athletes and in recreational athletes compared to the general population [1], [2], [3], [4]. In patients < 65 years with lone AF, 63% is regularly engaged in sports activity (i.e. > 3 h/week) whereas only 15% of the general population within the same age group is performing similar sports (p < 0.05) [2]. Arrhythmias in athletes are often attributed to underlying heart disease, with sports acting as the trigger, and to the increased vagal tone at rest or the increased sympathetic tone during strenuous exercise [5]. The observed association between AF and sports activity was present despite a lower incidence of other risk factors for AF (like hypertension) and AF is mainly seen in those performing dynamic sports (running, cycling, swimming). This has led to the suggestion that cardiac adaptations like atrial dilatation and hypertrophy, secondary to sports activity, may also contribute to AF development [2].
Ablation for atrial flutter has evolved into a very effective intervention, with a high procedural success rate (90–98%) and low recurrence rate (3–11%) [6], [7], [8], [9]. However, the success of the intervention is often offset by the development of atrial fibrillation (AF), which is observed in as many as 17–60% of the patients during follow-up [6], [10], [11], [12]. There are many recognized risk factors for AF development after flutter ablation, like history of foregoing AF, electrical cardioversion, induction of AF during the ablation procedure, the number of antiarrhythmic drugs used before, left atrial size, mitral regurgitation, left ventricular ejection fraction, structural heart disease and the use of ACE inhibitors, angiotension II receptor antagonists and/or diuretics [6], [10], [12], [13].
We wanted to evaluate whether a history of endurance sports and/or its continuation after flutter ablation is an independent risk factor for AF development. Endurance sports activity has so far not been investigated as a risk factor for AF in this particular patient population.
Section snippets
Patient cohort
We report on 219 consecutive patients who underwent ablation for atrial flutter at the University of Leuven between 1999 and 2002. Sixty-five patients were excluded from analysis because they had concomitant ablation of post-surgical intra-atrial reentrant tachycardia or pulmonary vein isolation for focally-induced atrial fibrillation, leaving a population of 154 patients.
Sports activity was evaluated by detailed questionnaires in which the types of sports, number of years of participation and
Patients and ablation success
One hundred fourteen of the 137 patients were men (83%) with an age of 58 ± 10 years. Of the 50 patients performing regular sports activity before ablation, 31 (62%; 23% of the whole population) were mainly engaged in endurance activities (18 cycling, 11 running, 2 swimming). Clinical characteristics of these 31 patients performing regular endurance sports activity and those who did not are summarized in Table 1. Patients performing endurance sports were significantly more often men, they were
Atrial fibrillation after flutter ablation
Ablation for atrial flutter is a highly effective intervention to prevent its recurrence but many authors have pointed to the development of atrial fibrillation during follow-up [6], [10], [11], [12]. This is not surprising given the fact that both arrhythmias are due to similar structural and electrical modifications in the atrium. Despite effective ablation of atrial flutter (which could lead to some degree of reversed atrial electrical and structrual remodeling) [15], the underlying disease
Acknowledgements
H. Heidbüchel is a Fundamental Clinical Investigator of the Fund for Scientific Research-Flanders.
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2022, Cardiac Electrophysiology ClinicsCitation Excerpt :The management of AFl in athletes is complicated by the fact that the high sympathetic tone during exercise often prevents an adequate rate control, and very high ventricular rates (especially in case of 1:1 atrioventricular conduction) pose the athlete at risk of major injuries. Therefore, catheter ablation of the cavotricuspid isthmus is a first-line therapeutic strategy for leisure-time and competitive athletes and is very effective in preventing AFl recurrences, with more than 90% effectiveness over long-term follow-up.76 Cavotricuspid isthmus ablation should also be performed in athletes with both AFl and AF (either as a stand-alone procedure or together with pulmonary vein isolation for AF), especially if treatment with class I antiarrhythmic drugs is anticipated, to reduce the risk of 1:1 atrioventricular conduction.15,77,78
2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease
2021, Revista Espanola de CardiologiaThe 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation
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