Exercise Volume and the Risk of Atrial Fibrillation in Athletes: A Literature Review
DOI:
https://doi.org/10.12775/QS.2026.76.75267Keywords
atrial fibrillation; athletes; endurance exercise; physical activity; sports cardiology; exercise volume; cardiac remodelingAbstract
Background. Despite the proven positive effects of physical activity on the cardiovascular system, an increasing number of veteran athletes are being diagnosed with atrial fibrillation (AF). Over the past few decades, a growing body of evidence suggests that prolonged endurance training may contribute to the development of AF in certain groups of athletes. The recognition of this link has sparked a debate among researchers regarding the determination of the amount of training at which the risk of AF significantly increases. However, current research findings are inconsistent regarding this relationship; therefore, the relationship between training volume, the type of sport practiced, and the risk of arrhythmia remains not fully understood.
Aim. This literature review aims to review the mechanisms involved in the development of atrial fibrillation in athletes and to evaluate the association between exercise volume and the risk of atrial fibrillation.
Material and methods. A literature review was conducted using PubMed and Google Scholar. Meta-analyses, systematic reviews, randomized control trials, systematic and literature reviews from past 20 years were analyzed.
Results. The strongest available evidence suggests that athletes have approximately 2.5 times the risk of AF compared to the general population. The available data suggest a U-shaped or J-shaped relationship between exercise and the risk of AF. Moderate physical activity still remains cardioprotective. Studies involving the population of female athletes remain limited.
Conclusions. The relationship between the risk of AF and physical activity is complex and seems paradoxical. Moderate physical activity has a protective effect, while excessive training increases the risk of AF.
References
Newman W, Parry-Williams G, Wiles J, et al. Risk of atrial fibrillation in athletes: a systematic review and meta-analysis. Br J Sports Med. 2021;55(21):1233-1238. https://doi.org/ 10.1136/bjsports-2021-103994
Kourek C, Briasoulis A, Tsougos E, Paraskevaidis I. Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature. J Cardiovasc Dev Dis. 2024;11(10):315. Published 2024 Oct 9. https://doi.org/10.3390/jcdd11100315
Opondo MA, Aiad N, Cain MA, et al. Does High-Intensity Endurance Training Increase the Risk of Atrial Fibrillation? A Longitudinal Study of Left Atrial Structure and Function. Circ Arrhythm Electrophysiol. 2018;11(5):e005598. https://doi.org/10.1161/CIRCEP.117.005598
Buckley BJR, Lip GYH, Thijssen DHJ. The counterintuitive role of exercise in the prevention and cause of atrial fibrillation. Am J Physiol Heart Circ Physiol. 2020;319(5):H1051-H1058. https://doi.org/10.1152/ajpheart.00509.2020
Apelland T, Janssens K, Loennechen JP, et al. Effects of training adaption in endurance athletes with atrial fibrillation: protocol for a multicentre randomised controlled trial. BMJ Open Sport Exerc Med. 2023;9(2):e001541. Published 2023 Apr 11. https://doi.org/10.1136/bmjsem-2023-001541
Hopman LHGA, Smedema JP, Swart J, et al. Left atrial function and fibrosis in lifelong endurance athletes: a cardiac magnetic resonance imaging study. Int J Cardiovasc Imaging. 2025;41(7):1321-1330. https://doi.org/10.1007/s10554-025-03416-8
Wilhelm M, Roten L, Tanner H, Wilhelm I, Schmid JP, Saner H. Atrial remodeling, autonomic tone, and lifetime training hours in nonelite athletes. Am J Cardiol. 2011;108(4):580-585. https://doi.org/10.1016/j.amjcard.2011.03.086
Aaroee M, Tischer SG, Christensen R, et al. Long-term left atrial adaptations to reduced training load in former elite athletes: a long-term follow-up longitudinal observational study. BMJ Open Sport Exerc Med. 2025;11(2):e002379. Published 2025 Apr 3. https://doi.org/10.1136/bmjsem-2024-002379
M Aaroe, S G Tischer, C H D Christian Have Dall, J J T Jens Jacob Thune, H R Hanne Kruuse Rasmusen, Chronic adaptations to exercise in thin-walled chambers of the heart: a longitudinal study echocardiographic study of elite athletes, European Journal of Preventive Cardiology, Volume 31, Issue Supplement_1, June 2024, zwae175.258, https://doi.org/10.1093/eurjpc/zwae175.258
Trivedi SJ, Claessen G, Stefani L, et al. Differing mechanisms of atrial fibrillation in athletes and non-athletes: alterations in atrial structure and function. Eur Heart J Cardiovasc Imaging. 2020;21(12):1374-1383. https://doi.org/10.1093/ehjci/jeaa183
Waśkiewicz Z, Bezuglov E, Talibov O, Gajda R, Mukhambetov Z, Azerbaev D, Bondarev S. Divergent Cardiac Adaptations in Endurance Sport: Atrial Fibrillation Markers in Marathon Versus Ultramarathon Athletes. Journal of Cardiovascular Development and Disease. 2025; 12(7):260. https://doi.org/10.3390/jcdd12070260
L. Spencer, K. Janssens, A. Mitchell, M. Ohanian, R. Johnson, M. Soka, P. Young, E. Giannoulatou, P. Lacaze, P. D'Ambrosio, S. Rowe, T. Van Puyvelde, G. Claessens, D. Fatkin, A. La Gerche. Genetic and clinical determinants of AF in athletes.
Heart, Lung and Circulation, Volume 33, Supplement 4, 2024, Page S129, ISSN 1443-9506, https://doi.org/10.1016/j.hlc.2024.06.018.
Janik M, Blachut D, Czogalik Ł, Tomasik AR, Wojciechowska C, Kukulski T. Adaptive Changes in Endurance Athletes: A Review of Molecular, Echocardiographic and Electrocardiographic Findings. Int J Mol Sci. 2025;26(17):8329. Published 2025 Aug 28. https://doi.org/10.3390/ijms26178329
Aaroee M, Tischer SG, Christensen R, Dall CH, Thune JJ, Rasmusen H. Atrial remodelling associated with sporting discipline, sex and duration in elite sports: a cross-sectional echocardiographic study among Danish elite athletes. BMJ Open Sport Exerc Med. 2024;10(2):e001880. Published 2024 May 15. https://doi.org/10.1136/bmjsem-2023-001880
Aaroee M, Tischer SG, Christensen R, Sajadieh A, Dall CH, Thune JJ, et al. Long-term left atrial adaptations to reduced training load in former elite athletes: a long-term follow-up longitudinal observational study. BMJ Open Sport & Exercise Medicine. 2025;11:e002379. https://doi.org/10.1136/bmjsem-2024-002379
Abdulla J, Nielsen JR. Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis. Europace. 2009;11(9):1156-1159. https://doi.org/10.1093/europace/eup197
Elliott AD, Linz D, Verdicchio CV, Sanders P. Exercise and Atrial Fibrillation: Prevention or Causation?. Heart Lung Circ. 2018;27(9):1078-1085. https://doi.org/10.1016/j.hlc.2018.04.296
Guasch E, Mont L. Diagnosis, pathophysiology, and management of exercise-induced arrhythmias. Nat Rev Cardiol. 2017;14(2):88-101. https://doi.org/10.1038/nrcardio.2016.173
Wilhelm M. Atrial fibrillation in endurance athletes. Eur J Prev Cardiol. 2014;21(8):1040-1048. https://doi.org/10.1177/2047487313476414
Afaghi S, Rahimi FS, Soltani P, Kiani A, Abedini A. Sex-Specific Differences in Cardiovascular Adaptations and Risks in Elite Athletes: Bridging the Gap in Sports Cardiology. Clin Cardiol. 2024;47(9):e70006. https://doi.org/10.1002/clc.70006
Mont L, Tamborero D, Elosua R, et al. Physical activity, height, and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals. Europace. 2008;10(1):15-20. https://doi.org/10.1093/europace/eum263
Chung MK, Eckhardt LL, Chen LY, et al. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement from the American Hearth Association. Circulation. 2020;141(16):e750-e772. https://doi.org/10.1161/CIR.0000000000000748
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Kamil Marchlik, Julia Tesyna, Melania Czapla, Karolina Kubala, Aleksandra Obszańska, Jakub Tomczyszyn
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 43
Number of citations: 0
