Paroxysmal atrial fibrillation in young and middle-aged athletes (PAFIYAMA) syndrome in the real world: a paradigmatic case report

Atrial Fibrillation in Endurance Training Athletes: Scoping Review

Background

Moderate regular physical activity is indicated to avoid atrial fibrillation (AF), whereas athletes should be counseled that long-lasting vigorous sports engagement may cause AF, according to the 2016 European Society of Cardiology (ESC) recommendations for AF treatment. Exercise and AF are complex.

Objectives

To evaluate the relationship between Endurance training and AF, in addition to the starting point/trigger by which Endurance Training causes impairment of cardiac function and AF, considering the time and intensity of Endurance training.

Materials and Methods

We synthesized evidence from articles published in the PubMed, EMBASE, and SciELO databases using their respective Boolean operators. A total of 112 original articles related to AF and endurance athletes published up to the year 2023 were reviewed.

Results

Our study verified multiples aspects of the genesis of AF in athletes, such as cardiac adaptations to exercise, disturbances in cardiac injury biomarkers, sex differences in cardiac adaptations and their role in AF risk, and the relationship between body composition (height, weight, and physical fitness) and AF pathogenesis.

Conclusions

Variations in cardiac structure (increased atrial thickness and size in addition to myocardial fibrosis) and significant increases in vagal tone (sinus bradycardia and imbalances in sympathetic and parasympathetic activation) shorten the refractory period shortening in athletes, induce the onset of re-entrance mechanisms, and serve as ectopic triggers that can lead to AF.

The impact of a violent community on mental health and the benefits of a sport program for social development

The aim of the present study was to evaluate the impact of a violent environment on mental health and the impact of a sport for social development (SSD) program on quality of life, mental distress symptoms, and heart rate variability (HRV). HRV and psychometric data were measured from 20 men professional athletes assisted by the SSD and 20 men living in the same violent community. The comparison of groups revealed greater sympathetic parameters of HRV, positive affect, and quality of life in the SSD group. Multiple regression analysis showed that the quality of life in the SSD group was positively predicted by positive affect, while in the control group the quality of life was negatively predicted by their history of traumatic events. Both groups reported high levels of exposure to traumatic events and posttraumatic stress symptoms. However, this study demonstrates the benefits of SSD programs in mental health.

Atrial fibrillation and sport: need for monitoring

Historically, regular exercise contributed to reduce the arrhythmic burden and improve cardiovascular outcomes in the general population. However, a heightened risk of Atrial Fibrillation (AF) seems to occur mainly amongst endurance athletes. The exact mechanisms are not fully elucidated, but dynamic interactions between electroanatomical changes induced by exercise, the autonomic system, variable triggers, along individual genetic predisposition are the main contributors to AF development in athletes. The type and training load of sports are also crucial in determining the arrhythmogenic milieu predisposing to AF insurgence and perpetuation. Moreover, a sex difference seems to influence an increased risk of AF only in men undergoing strenuous exercise, whereas women appear protected even during more vigorous training. In the absence of solid evidence, the advent of modern technologies could help to monitor and deep investigate the peculiar aspects of AF in these athletes. This review aims to describe the pathophysiology, diagnosis, and management of AF in athletes, shedding light on possible future strategies to face AF in this population.

Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review

It is well established that physical activity reduces all-cause mortality and can prolong life. Ultra-endurance running (UER) is an extreme sport that is becoming increasingly popular, and comprises running races above marathon distance, exceeding 6 h, and/or running fixed distances on multiple days. Serious acute adverse events are rare, but there is mounting evidence that UER may lead to long-term health problems. The purpose of this review is to present the current state of knowledge regarding the potential long-term health problems derived from UER, specifically potential maladaptation in key organ systems, including cardiovascular, respiratory, musculoskeletal, renal, immunological, gastrointestinal, neurological, and integumentary systems. Special consideration is given to youth, masters, and female athletes, all of whom may be more susceptible to certain long-term health issues. We present directions for future research into the pathophysiological mechanisms that underpin athlete susceptibility to long-term issues. Although all body systems can be affected by UER, one of the clearest effects of endurance exercise is on the cardiovascular system, including right ventricular dysfunction and potential increased risk of arrhythmias and hypertension. There is also evidence that rare cases of acute renal injury in UER could lead to progressive renal scarring and chronic kidney disease. There are limited data specific to female athletes, who may be at greater risk of certain UER-related health issues due to interactions between energy availability and sex-hormone concentrations. Indeed, failure to consider sex differences in the design of female-specific UER training programs may have a negative impact on athlete longevity. It is hoped that this review will inform risk stratification and stimulate further research about UER and the implications for long-term health.

Insights into the genetic basis of HMGB1 in atrial fibrillation in a Chinese Han population

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia. High mobility group box 1 (HMGB1) has been demonstrated to be involved in AF, but the genetic relationship between them is not clear yet. Here, we investigated the genetic association between functional variants in HMGB1 and AF in a Chinese Han population.

Methods

Two common variants (the promoter one rs1045411^T/C and the 3'UTR one rs1412125^C/T) in HMGB1 were selected and genotyped in 576 AF patients and 869 control subjects. Traditional risk factors, such as age, gender, the history of smoking, hypertension and diabetes mellitus, were adjusted as covariates using a logistic regression analysis (SPSS, v.21.0). The haplotypic analysis was performed using SPSS (v.21.0, Inc., Chicago, IL, USA).

Results

Under the allelic association analysis, neither rs1045411^T/C nor rs1412125^C/T was associated with AF with all P values >0.05; under the genotypic association analysis, the 3'UTR variant rs1045411^T showed a marginally significant association with AF under the recessive model (P_adj=0.056, OR =0.42; 95% CI: 0.17-1.02). When divided the studied population by gender, we still found no significant association results between the selected variants and AF with P values more than 0.05; however, when divided the population into subgroups by the age onset of AF, we found that the 3'UTR variant rs1045411^T was significantly associated with AF in the late-onset subgroup (P_adj=0.009, OR =11.1; 95% CI: 1.82-50.0).

Conclusions

The 3'UTR variant rs1045411^T/C of HMGB1 might influence the risk of late-onset AF in the Chinese Han population, which provides an important target factor for the prevention and treatment study of AF.