The risk of atrial fibrillation in athletes: A systematic review and meta-analysis

Journal article


Newman, W, Parry-Williams, G, Wiles, J., Edwards, J, Hulbert, S., Kipourou, K, Papadakis, M, Sharma, R and O'Driscoll, J. 2021. The risk of atrial fibrillation in athletes: A systematic review and meta-analysis. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2021-103994
AuthorsNewman, W, Parry-Williams, G, Wiles, J., Edwards, J, Hulbert, S., Kipourou, K, Papadakis, M, Sharma, R and O'Driscoll, J.
Abstract

Objective: A systematic review, meta-analysis and meta-regression were performed on selected studies to investigate the incidence of atrial fibrillation (AF) amongst athletes compared to 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 2nd 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 odds ratios (OR).

Results: The risk of developing AF was significantly higher in athletes than in non-athlete controls (OR: 2.46; 95% CI 1.73-3.51; 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 yrs) athletes were significantly more likely to develop AF compared to older (55 yrs) athletes (B =-0.02293, p<0.001).

Conclusion: Athletes have a significantly greater likelihood of developing AF compared to 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.

KeywordsAthletes; Atrial Fibrillation; Exercise; Sport
Year2021
JournalBritish Journal of Sports Medicine
PublisherBMJ Publishing Group
ISSN0306-3674
1473-0480
Digital Object Identifier (DOI)https://doi.org/10.1136/bjsports-2021-103994
Official URLhttps://bjsm.bmj.com/content/early/2021/06/30/bjsports-2021-103994
Publication dates
Print12 Jul 2021
Publication process dates
Accepted11 Jun 2021
Deposited14 Jul 2021
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Open
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The implementation of problem based learning styles to teach the Coach-Athlete relationship to undergraduate Sport and Exercise Science students
Rossato, C. and O'Driscoll, J. 2013. The implementation of problem based learning styles to teach the Coach-Athlete relationship to undergraduate Sport and Exercise Science students. International Journal of Sport Studies. 3, pp. 859-864.
A retrospective observational study of the effectiveness of paliperidone palmitate on acute inpatient hospitalization rates
Bressington, D., Stock, J., Hulbert, S. and MacInnes, D. 2015. A retrospective observational study of the effectiveness of paliperidone palmitate on acute inpatient hospitalization rates. International Clinical Psychopharmacology. 30 (4), pp. 230-236. https://doi.org/10.1097/YIC.0000000000000077
Viewing art on a tablet computer: a wellbeing intervention for people with dementia and their caregivers
Tyack, C., Camic, P., Herron, A. and Hulbert, S. 2015. Viewing art on a tablet computer: a wellbeing intervention for people with dementia and their caregivers. Journal of Applied Gerontology. https://doi.org/10.1177/0733464815617287
Museum activities in dementia care: using visual analog scales to measure subjective wellbeing
Johnson, J., Culverwell, A., Hulbert, S., Roberton, M. and Camic, P. 2015. Museum activities in dementia care: using visual analog scales to measure subjective wellbeing. Dementia: The International Journal for Social Research and Practice. https://doi.org/10.1177/1471301215611763
The impact of viewing and making art on verbal fluency and memory in people with dementia in an art gallery setting
Young, R., Tischler, V., Hulbert, S. and Camic, P. 2015. The impact of viewing and making art on verbal fluency and memory in people with dementia in an art gallery setting. Psychology of Aesthetics, Creativity, and the Arts. https://doi.org/10.1037/aca0000030
The unitary ability of IQ and indexes in WAIS-IV
Orsini, A., Pezzuti, L. and Hulbert, S. 2015. The unitary ability of IQ and indexes in WAIS-IV. European Journal of Psychological Assessment. https://doi.org/10.1027/1015-5759/a000306
Group singing and young people’s psychological well-being
Hinshaw, T., Clift, S., Hulbert, S. and Camic, P. 2015. Group singing and young people’s psychological well-being. International Journal of Mental Health Promotion. https://doi.org/10.1080/14623730.2014.999454
Resting blood pressure reductions following isometric leg exercise training are associated with improved flow-mediated vasodilatation
Howland, L., Wiles, J. and Coleman, D. 2014. Resting blood pressure reductions following isometric leg exercise training are associated with improved flow-mediated vasodilatation.
Improved gross efficiency during long duration submaximal cycling following a short-term high carbohydrate diet
Cole, M., Coleman, D., Hopker, J. and Wiles, J. 2014. Improved gross efficiency during long duration submaximal cycling following a short-term high carbohydrate diet. International Journal of Sports Medicine. 35 (3), pp. 265-269. https://doi.org/10.1055/s-0033-1348254
Examining the effectiveness of the Theory of Planned Behaviour in predicting exercise intention and behaviour during pregnancy: Preliminary findings from a random effects meta-analysis
De Vivo, M., Hulbert, S., Mills, H. and Uphill, M. 2014. Examining the effectiveness of the Theory of Planned Behaviour in predicting exercise intention and behaviour during pregnancy: Preliminary findings from a random effects meta-analysis.
The unitary ability of IQ in the WISC-IV and its computation
Orsini, A., Pezzuti, L., Hulbert, S., Sapienza University of Rome and Canterbury Christ Church University 2014. The unitary ability of IQ in the WISC-IV and its computation. Personality and Individual Differences. 69, pp. 173-175. https://doi.org/10.1016/j.paid.2014.05.023
Enhanced physical health screening for people with severe mental illness in Hong Kong: results from a one-year prospective case series study
Bressington, D., Mui, J., Hulbert, S., Cheung, E., Bradford, S. and Gray, Richard 2014. Enhanced physical health screening for people with severe mental illness in Hong Kong: results from a one-year prospective case series study. BMC Psychiatry. 14 (57). https://doi.org/10.1186/1471-244X-14-57
The influence of ageing and training status on exercise efficiency and cycling performance
Hopker, J., Coleman, D., Jobson, S., Von der Haar, T., Wiles, J. and Passfield, L. 2013. The influence of ageing and training status on exercise efficiency and cycling performance.
Reductions in resting blood pressure after isometric exercise training are not related to shear stress
Smith, J., Wiles, J., Swaine, I. and Coleman, D. 2013. Reductions in resting blood pressure after isometric exercise training are not related to shear stress.
Effect of acute isometric bilateral leg extension exercise on brachial and common femoral artery flow-mediated dilatation
Howland, L., Wiles, J., Coleman, D. and Swaine, I. 2013. Effect of acute isometric bilateral leg extension exercise on brachial and common femoral artery flow-mediated dilatation.
The effect of exercise-induced hypohydration upon treadmill running performance
Baker, D., Coleman, D. and Wiles, J. 2013. The effect of exercise-induced hypohydration upon treadmill running performance.
Carbohydrate ingestion improves gross cycling efficiency and subsequent time-trial performance
Cole, M., Hopker, J., Wiles, J. and Coleman, D. 2013. Carbohydrate ingestion improves gross cycling efficiency and subsequent time-trial performance.
The effects of isometric wall squat exercise on heart rate and blood pressure in a normotensive population
Goldring, N., Wiles, J. and Coleman, D. 2013. The effects of isometric wall squat exercise on heart rate and blood pressure in a normotensive population. Journal of Sports Sciences. https://doi.org/10.1080/02640414.2013.809471
The influence of training status, age, and muscle fibre type on cycling efficiency and endurance performance
Hopker, J., Coleman, D., Gregson, H., Jobson, S., Von der Haar, T., Wiles, J. and Passfield, L. 2013. The influence of training status, age, and muscle fibre type on cycling efficiency and endurance performance. Journal of Applied Physiology. https://doi.org/10.1152/japplphysiol.00361.2013
The influence of parents' education in the Italian standardization sample of the WISC-III
Cianci, L., Orsini, A., Hulbert, S. and Pezzuti, L. 2013. The influence of parents' education in the Italian standardization sample of the WISC-III. Learning and Individual Differences. 28, pp. 47-53. https://doi.org/10.1016/j.lindif.2013.09.009
The reliability of responses to repeated laboratory assessment: the evaluation of a preload-performance protocol in runners
Baker, D., Coleman, D. and Wiles, J. 2011. The reliability of responses to repeated laboratory assessment: the evaluation of a preload-performance protocol in runners.
Change in lactate accumulation after isometric exercise training and its relationship with reduced resting blood pressure
Swaine, I., Devereux, G., Wiles, J. and Coleman, D. 2011. Change in lactate accumulation after isometric exercise training and its relationship with reduced resting blood pressure.
Rapid loss of isometric training-induced reductions in resting blood pressure
Wiles, J., Devereux, G., Coleman, D. and Swaine, I. 2011. Rapid loss of isometric training-induced reductions in resting blood pressure.
Change in the immediate post-exercise blood pressure response after isometric exercise training and its relationship with reduced resting blood pressure
Wiles, J., Swaine, I., Howden, R., McCartney, N. and Coleman, D. 2011. Change in the immediate post-exercise blood pressure response after isometric exercise training and its relationship with reduced resting blood pressure.
Change in shear rate in the common femoral upon cessation of leg isometric exercise at increasing intensities
Swaine, I., Smith, J. and Wiles, J. 2012. Change in shear rate in the common femoral upon cessation of leg isometric exercise at increasing intensities.
Cardio-pulmonary responses to whole-body simulated swimming using a novel swimming training machine
Swaine, I., Wiles, J., Coleman, D., Hunter, A. and Carlton, K. 2010. Cardio-pulmonary responses to whole-body simulated swimming using a novel swimming training machine.
Effects of the intensity of leg isometric training on the vasculature of trained and untrained limbs and resting blood pressure in middle-aged men
Baross, A., Wiles, J. and Swaine, I. 2012. Effects of the intensity of leg isometric training on the vasculature of trained and untrained limbs and resting blood pressure in middle-aged men. International Journal of Vascular Medicine. 2012. https://doi.org/10.1155/2012/964697
Lactate accumulation following isometric exercise training and its relationship with reduced resting blood pressure
Devereux, G., Coleman, D., Wiles, J. and Swaine, I. 2012. Lactate accumulation following isometric exercise training and its relationship with reduced resting blood pressure. Journal of Sports Sciences. 30 (11), pp. 1141-1148. https://doi.org/10.1080/02640414.2012.692482
Markers of isometric training intensity and their relationship with training-induced reductions in resting blood pressure
Devereux, G., Wiles, J. and Swaine, I. 2011. Markers of isometric training intensity and their relationship with training-induced reductions in resting blood pressure. Journal of Sports Sciences. 29 (7), pp. 715-724. https://doi.org/10.1080/02640414.2011.552113
The relationship between indices of fatigue and femoral artery post exercise hyperaemia after double-leg isometric exercise at increasing intensities
Smith, J., Wiles, J., Swaine, I. and Coleman, D. 2012. The relationship between indices of fatigue and femoral artery post exercise hyperaemia after double-leg isometric exercise at increasing intensities.
The effects of four weeks home-based isometric exercise training on resting blood pressure
Goldring, N., Wiles, J. and Coleman, D. 2012. The effects of four weeks home-based isometric exercise training on resting blood pressure.
The effects of isometric wall squat exercise on heart rate and blood pressure in a normotensive population
Goldring, N., Wiles, J. and Coleman, D. 2010. The effects of isometric wall squat exercise on heart rate and blood pressure in a normotensive population.
The influence of nutritional interventions on the measurement of gross efficiency during cycling
Cole, M., Coleman, D. and Wiles, J. 2012. The influence of nutritional interventions on the measurement of gross efficiency during cycling.
The effect of short-term dietary manipulation on gross efficiency during cycling
Cole, M., Coleman, D. and Wiles, J. 2011. The effect of short-term dietary manipulation on gross efficiency during cycling.
The relationship between EMG and either heart rate or blood pressure during a single-leg incremental isometric exercise test
Swaine, I., Baross, T., Kay, T. and Wiles, J. 2009. The relationship between EMG and either heart rate or blood pressure during a single-leg incremental isometric exercise test.
Can 4 weeks of isometric exercise lower resting blood pressure in young, healthy, active men?
Swaine, I., Devereux, G. and Wiles, J. 2009. Can 4 weeks of isometric exercise lower resting blood pressure in young, healthy, active men?
Effect of isometric exercise training on resting blood pressure: A meta-analysis of controlled trials
Swaine, I., Owen, A. and Wiles, J. 2009. Effect of isometric exercise training on resting blood pressure: A meta-analysis of controlled trials.
Effects of physical activity, performed in accordance with the current recommendations, on CVD risk factors in 40-65 year old men
Perkins, G., Owen, A., Kearney, E., Wiles, J. and Swaine, I. 2007. Effects of physical activity, performed in accordance with the current recommendations, on CVD risk factors in 40-65 year old men.
Differing autonomic responses to dobutamine stress in the presence and absence of myocardial ischaemia
Sharma, R., O'Driscoll, J., Bromley, P., Sritharan, M. and Rosen, S. 2008. Differing autonomic responses to dobutamine stress in the presence and absence of myocardial ischaemia.
Dobutamine stress echocardiography accurately detects significant coronary artery disease in Indian Asians living in the United Kingdom
Itam, S., O'Driscoll, J., Milad, E. and Sharma, R. 2008. Dobutamine stress echocardiography accurately detects significant coronary artery disease in Indian Asians living in the United Kingdom.
The effects of a high-protein, paleolithic-type diet on body composition and exercise performance in amateur mixed martial artists
Slee, A., O'Driscoll, J., Burnet, S., Hughes, G. and Chen, M. 2009. The effects of a high-protein, paleolithic-type diet on body composition and exercise performance in amateur mixed martial artists.
Subjective global assessment is an independent predictor of cardiac ischaemia in patients with mild chronic kidney disease
Aldous, G., Sharma, R., O'Driscoll, J., Ashby, D., Tarn, F. and Choi, P. 2010. Subjective global assessment is an independent predictor of cardiac ischaemia in patients with mild chronic kidney disease.
A National Health Service hospital's cardiac rehabilitation programme: a qualitative analysis of provision
O'Driscoll, J., Shave, R. and Cushion, C. 2007. A National Health Service hospital's cardiac rehabilitation programme: a qualitative analysis of provision. Journal of Clinical Nursing. 16 (10), pp. 1908-1918. https://doi.org/10.1111/j.1365-2702.2007.01815.x
Inequalities in the training and implementation of cardiac rehabilitation in the United Kingdom
O'Driscoll, J. and Sharma, R. 2009. Inequalities in the training and implementation of cardiac rehabilitation in the United Kingdom. in: Bennington, E. (ed.) Horizons in World Cardiovascular Research Hauppauge, New York Nova Science Publishers.
Effect of caffeinated coffee on running speed, respiratory factors, blood lactate and perceived exertion during 1500-m treadmill running
Wiles, J., Bird, S., Hopkins, J. and Riley, M. 1992. Effect of caffeinated coffee on running speed, respiratory factors, blood lactate and perceived exertion during 1500-m treadmill running. British Journal of Sports Medicine. 26 (2), pp. 116-120. https://doi.org/10.1136/bjsm.26.2.116
Effect of pre-exercise protein ingestion upon VO2, R and perceived exertion during treadmill running
Wiles, J., Woodward, R. and Bird, S. 1991. Effect of pre-exercise protein ingestion upon VO2, R and perceived exertion during treadmill running. British Journal of Sports Medicine. 25 (1), pp. 26-30. https://doi.org/10.1136/bjsm.25.1.26
Effectiveness of two glycerol ingestion strategies on 40-km cycling time trial performance
Brickell, L., Balmer, J., Theakston, S., Wiles, J. and Bird, S. 2001. Effectiveness of two glycerol ingestion strategies on 40-km cycling time trial performance. Journal of Sports Sciences. 20 (1), pp. 46-47. https://doi.org/10.1080/026404102317126164
We can work it out
Morrissey, M. and Wiles, J. 2001. We can work it out. Nursing Times. 97 (47), pp. 34-36.
Effects of isometric exercise training intensity upon reductions in resting systolic blood pressure
Wiles, J., Coleman, D. and Swaine, I. 2008. Effects of isometric exercise training intensity upon reductions in resting systolic blood pressure.
A novel method for the performance of isometric exercise in the home
Wiles, J., Coleman, D., Dunford, M. and Swaine, I. 2004. A novel method for the performance of isometric exercise in the home.
The precision with which isometric exercise training can be performed according to a given heart rate
Swaine, I., Wiles, J. and Coleman, D. 2008. The precision with which isometric exercise training can be performed according to a given heart rate.
Effects of three types of isometric leg exercise at the same relative exercise intensities on blood pressure
Swaine, I., Wiles, J., Dunford, M. and Coleman, D. 2004. Effects of three types of isometric leg exercise at the same relative exercise intensities on blood pressure.
The freely chosen contribution of the leg kick to the total power during simulated front crawl swimming on a onland ergometer
Swaine, I., Dunford, M., Wiles, J., Coleman, D., Hunter, A. and Carlton, K. 2006. The freely chosen contribution of the leg kick to the total power during simulated front crawl swimming on a onland ergometer.
The relationship between selected cardiovascular variables and exercise intensity during continuous and discontinuous incremental exercise tests
Allum, S., Wiles, J., Coleman, D. and Swaine, I. 2006. The relationship between selected cardiovascular variables and exercise intensity during continuous and discontinuous incremental exercise tests.
Familiarisation and reliability of sprint test indices during laboratory and field assessment
Hopker, J., Coleman, D., Wiles, J. and Galbraith, A. 2009. Familiarisation and reliability of sprint test indices during laboratory and field assessment. Journal of Sports Science and Medicine. 8 (4), pp. 528-532.
Occurrence of injury during officer safety training at Kent Police
Andrew, J., Henry, T., Coleman, D. and Wiles, J. 2009. Occurrence of injury during officer safety training at Kent Police. The Police Journal. 82 (3), pp. 265-274. https://doi.org/10.1350/pojo.2009.82.3.455
The effects of performing isometric training at two exercise intensities in healthy young males
Wiles, J., Coleman, D. and Swaine, I. 2010. The effects of performing isometric training at two exercise intensities in healthy young males. European Journal of Applied Physiology. 108 (3), pp. 419-428. https://doi.org/10.1007/s00421-009-1025-6
The effect of training volume and intensity on competitive cyclists’ efficiency
Hopker, J., Coleman, D., Passfield, L. and Wiles, J. 2010. The effect of training volume and intensity on competitive cyclists’ efficiency. Applied Physiology, Nutrition and Metabolism. 35 (1), pp. 17-22. https://doi.org/10.1139/H09-124
Reductions in resting blood pressure after 4 weeks of isometric exercise training
Devereux, G., Wiles, J. and Swaine, I. 2010. Reductions in resting blood pressure after 4 weeks of isometric exercise training. European Journal of Applied Physiology. 109 (4), pp. 601-606. https://doi.org/10.1007/s00421-010-1394-x
Effect of isometric exercise on resting blood pressure: a meta analysis
Owen, A., Wiles, J. and Swaine, I. 2010. Effect of isometric exercise on resting blood pressure: a meta analysis. Journal of Human Hypertension. 24 (12), pp. 796-800. https://doi.org/10.1038/jhh.2010.13
Reproducibility of limb power outputs and cardiopulmonary responses to exercise using a novel swimming training machine
Swaine, I., Hunter, A., Carlton, K., Wiles, J. and Coleman, D. 2010. Reproducibility of limb power outputs and cardiopulmonary responses to exercise using a novel swimming training machine. International Journal of Sports Medicine. 31 (12), pp. 854-859. https://doi.org/10.1055/s-0030-1265175
The effect of sodium bicarbonate ingestion on 1500-m racing time
Bird, S., Wiles, J. and Robbins, J. 1995. The effect of sodium bicarbonate ingestion on 1500-m racing time. Journal of Sports Sciences. 13 (5), pp. 399-403. https://doi.org/10.1080/02640419508732255
Validity and reliability of the Ergomopro Powermeter
Kirkland, A., Coleman, D., Wiles, J. and Hopker, J. 2008. Validity and reliability of the Ergomopro Powermeter. International Journal of Sports Medicine. 29 (11), pp. 913-916. https://doi.org/10.1055/s-2008-1038621
The relationships between exercise intensity, heart rate, and blood pressure during an incremental isometric exercise test
Wiles, J., Allum, S., Coleman, D. and Swaine, I. 2007. The relationships between exercise intensity, heart rate, and blood pressure during an incremental isometric exercise test. Journal of Sports Sciences. 26 (2), pp. 155-162. https://doi.org/10.1080/02640410701370655
A novel method for the performance of isometric exercise in the home
Wiles, J., Coleman, D., Dunford, M. and Swaine, I. 2005. A novel method for the performance of isometric exercise in the home. Journal of Sports Sciences. 23 (8), pp. 795-803. https://doi.org/10.1080/02640410400021658
The effects of caffeine ingestion on performance time, speed and power during a laboratory-based 1 km cycling time-trial
Wiles, J., Coleman, D., Tegerdine, M. and Swaine, I. 2006. The effects of caffeine ingestion on performance time, speed and power during a laboratory-based 1 km cycling time-trial. Journal of Sports Sciences. 24 (11), pp. 1165-1171. https://doi.org/10.1080/02640410500457687
Validity and reliability of a new isometric hand dynamometer
Wiles, J., Boyson, H., Balmer, J. and Bird, S. 2001. Validity and reliability of a new isometric hand dynamometer. Sports Engineering. 4 (3), pp. 147-152. https://doi.org/10.1046/j.1460-2687.2001.00080.x
Relationships between pulse wave velocity and heart rate variability in healthy men with a range of moderate-to-vigorous physical activity levels
Perkins, G., Owen, A., Swaine, I. and Wiles, J. 2006. Relationships between pulse wave velocity and heart rate variability in healthy men with a range of moderate-to-vigorous physical activity levels. European Journal of Applied Physiology. 98 (5), pp. 516-523. https://doi.org/10.1007/s00421-006-0303-9
Differences in efficiency between trained and recreational cyclists
Hopker, J., Coleman, D. and Wiles, J. 2007. Differences in efficiency between trained and recreational cyclists. Applied Physiology, Nutrition and Metabolism. 32 (6), pp. 1036-1042. https://doi.org/10.1139/H07-070
Reliability of sprint test indices in well-trained cyclists
Coleman, D., Wiles, J., Nunn, M. and Smith, M. 2005. Reliability of sprint test indices in well-trained cyclists. International Journal of Sports Medicine. 26 (5), pp. 383-387. https://doi.org/10.1055/s-2004-821226
Power output measurement during treadmill cycling
Coleman, D., Wiles, J., Davison, R., Smith, M. and Swaine, I. 2007. Power output measurement during treadmill cycling. International Journal of Sports Medicine. 28 (6), pp. 525-530. https://doi.org/10.1055/s-2006-955888