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Review
Risk of atrial fibrillation in athletes: a systematic review and meta-analysis
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  1. William Newman1,
  2. Gemma Parry-Williams2,
  3. Jonathan Wiles1,
  4. Jamie Edwards1,
  5. Sabina Hulbert3,
  6. Konstantina Kipourou4,
  7. Michael Papadakis2,
  8. Rajan Sharma4,
  9. Jamie O'Driscoll1,4
  1. 1 School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
  2. 2 Cardiology Clinical Academic Group, St George's University of London, London, UK
  3. 3 School of Psychology, Politics and Sociology, Canterbury Christ Church University, Canterbury, Kent, UK
  4. 4 Depertment of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Jamie O'Driscoll, School of Human and Life Sciences, Canterbury Christ Church University, Canterbury CT1 1QU, UK; jamie.odriscoll{at}canterbury.ac.uk

Abstract

Objective A systematic review, meta-analysis and meta-regression were performed on selected studies to investigate the incidence of atrial fibrillation (AF) among athletes compared with non-athlete controls.

Design Meta-analysis with heterogeneity analysis and subsequent meta-regression to model covariates were performed. The mode of exercise (endurance and mixed sports) and age were the a priori determined covariates.

Data sources PubMed, MEDLINE, Science Direct, SPORTDiscus and the Cochrane library were searched.

Eligibility criteria Research articles published after 1990 and before 2 December 2020 were included if they reported the number of AF cases in athletes with non-athlete (physically active or inactive) control groups, were case–control or cohort studies and if data allowed calculation of OR.

Results The risk of developing AF was significantly higher in athletes than in non-athlete controls (OR: 2.46; 95% CI 1.73 to 3.51; p<0.001, Z=4.97). Mode of exercise and risk of AF were moderately correlated (B=0.1259, p=0.0193), with mixed sport conferring a greater risk of AF than endurance sport (B=−0.5476, p=0.0204). Younger (<55 years) athletes were significantly more likely to develop AF compared with older (≥55 years) athletes (B=−0.02293, p<0.001).

Conclusion Athletes have a significantly greater likelihood of developing AF compared with non-athlete controls, with those participating in mixed sport and younger athletes at the greatest risk. Future studies of AF prevalence in athletes according to specific exercise dose parameters, including training and competition history, may aid further in delineating those at risk.

  • athletes
  • exercise
  • sport

https://doi.org/10.1136/bjsports-2021-103994

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    Footnotes

    • Twitter @willwillnewman, @JODriscoll9

    • Contributors WN and JO’D contributed to the conception and design of the study. WN, GP-W, JW, JE, SH, KK, MP, RS and JO’D contributed to the development of the search strategy. WN, JE, SH and JO’D conducted the systematic review. WN, GP-W, JE and JO’D completed the acquisition of data. WN, JE, SH and JO’D performed the data analysis. All authors assisted with the interpretation. WN, GP-W, JE and JO’D were the principal writers of the manuscript. All authors contributed to the drafting and revision of the final article. All authors approved the final submitted version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.