These studies were underpowered to detect a small difference in outcomes or to identify subgroups of athletes who might have had more limited success. They observed an intriguing trend that favored greater recurrence among athletes that was similar to that observed by Decrooq et al. AF recurrence was similar to that of a nonathletic cohort matched for age, sex, and AF characteristics. ( 6) validated these findings in a cohort of 144 predominantly middle-aged athletes and documented post−single-procedure PVI recurrence rates of 25%, 32%, and 67% for paroxysmal, persistent, and long-standing persistent AF in athletic cases, respectively. In the largest study to date, Mandsager et al. Several modest-sized studies demonstrated that PVI was similarly efficacious in athletes with that of the general population ( 7–10). For the athlete, exercise performance is an important determinant of quality of life and should be discussed in shared decision-making. In the athlete with troublesome symptoms, there is often clear motivation for PVI, whereas for those with less frequent or milder symptoms, the decision for PVI is uncommon, but the serious risks are balanced against potential improvements in quality of life. Profound baseline bradycardia and impairment of exercise capacity may limit the use of beta-blockers, whereas flecainide presents the risk of flutter with rapid atrioventricular node conduction, particularly in young athletes.
There are reasons why PVI may be considered early in the management of athletes. Pulmonary vein isolation (PVI) is the most effective means of reducing symptoms associated with AF in patients with paroxysmal or persistent AF. ( 6) provide important advances in answering these questions. In this issue of JACC: Clinical Electrophysiology, Mandsager et al. In addition to questions regarding the potential complications of AF, athletes are often desperate to know how treatments will affect performance, whether they can return to the track, and when. Recent studies have documented that the increased risk of stroke with AF also applies to athletes, although possibly at a slightly lower relative risk ( 4). Thus, the management of athletes with arrhythmias is not a public health issue however, athletes who develop AF can have debilitating symptoms and unique management issues ( 2). Although the assertion that you can have “too much of a good thing“ has been popularized among the lay media, the overall health outcomes and longevity among even the most intensively trained athletes are significantly better that of the general population ( 4, 5). It is always important to contextualize the increased risk of AF in endurance athletes against the pleomorphic benefits of exercise. A well-documented interaction between exercise and atrial fibrillation (AF) exists in which moderate amounts of exercise are protective, but both too little and too much exercise are associated with increased risk ( 1–3).
0 kommentar(er)
