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Brief Report
December 2018

Incidence of Atrial Fibrillation in Elite Athletes

Author Affiliations
  • 1Department of Cardiology, Sports Medicine Center, Spanish Sports Health Protection Agency, Madrid, Spain
  • 2i+HeALTH, Department of Health Sciences, European University Miguel de Cervantes, Valladolid, Spain
  • 3Research Institute of Hospital 12 de Octubre (“i+12”), Madrid, Spain
  • 4Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
  • 5Faculty of Sport Sciences, Universidad Europea, Madrid, Spain
JAMA Cardiol. 2018;3(12):1200-1205. doi:10.1001/jamacardio.2018.3482
Key Points

Question  What is the incidence of atrial fibrillation in a large cohort of elite athletes and its association with potential risk factors?

Findings  In this 20-year study of 6813 athletes (35.0% women), with most sports disciplines represented, only 21 athletes (1 woman) had atrial fibrillation. Increasing values of age, years of competition, and left atrial anteroposterior diameter were the main factors associated with higher atrial fibrillation risk.

Meaning  The incidence of atrial fibrillation is low among young elite athletes, but potential contributors (eg, atrial dimensions) need to be monitored.


Importance  Vigorous exercise (particularly endurance sports) might increase the risk of atrial fibrillation (AF), but there is variability in the reported frequency of this condition among elite athletes. The underlying pathophysiologic source remains unclear.

Objective  To determine AF incidence in a large cohort of elite athletes and its association with potential risk factors.

Design, Setting, and Participants  Retrospective observational cohort of all Spanish athletes (N = 6813) referred to a single center was used to determine AF incidence from January 1, 1997, to December 31, 2017, and cross-sectional analysis was conducted to compare athletes with and without reported AF. The cohort covered most sports disciplines, and the studied athletes were on national teams and competed in major international events. Cardiologists responsible for echocardiographic assessment were not blinded to the condition (AF or no AF) of the athletes.

Exposures  All participants underwent at least 1 cardiologic evaluation, including assessment at time of AF diagnosis in those with this condition.

Main Outcomes and Measures  Diagnosis of AF based on resting and/or exercise electrocardiogram, and/or 24-hour Holter monitoring and echocardiography-assessed atrial dimensions.

Results  A total of 6813 Spanish elite athletes (2385 [35.0%] women) were referred for cardiac evaluation during the study period. Mean (SD) age was 22 (7) years, and mean (SD) time of competition was 8 (5) years. Only 21 athletes (1 woman), participating in different types of sports, had AF (ie, paroxysmal [n = 18], persistent [n = 1], or long-standing persistent [n = 2]) during the 20-year study. In multivariate analysis, increasing values of age (odds ratio [OR], 1.07; 95% CI, 1.00-1.14), years of competition (OR, 1.14; 95% CI, 1.07-1.22), and left atrial anteroposterior diameter (OR, 1.21; 95% CI, 1.10-1.32) were associated with higher AF risk.

Conclusions and Relevance  The incidence of AF is low among young Spanish elite athletes, even when considering only endurance athletes. Yet, potential contributors (particularly atrial remodeling) need to be monitored.