Long-Term Sports Practice and Atrial Fibrillation: An Updated Review of a Complex Relationship

Exploring the Causal Effects of Physical Activity, Sedentary Behaviour, and Diet on Atrial Fibrillation and Heart Failure: A Multivariable Mendelian Randomisation Analysis

AIMS

This study aimed to investigate the causal effects of physical activity, sedentary behaviour, and diet on atrial fibrillation (AF) and heart failure (HF) using multivariate Mendelian randomization (MR) analysis and genetic variants as instrumental variables.

METHODS

The study employed multivariate MR analysis with physical activity, sedentary behaviour, and diet as exposures and AF and HF as outcomes. Data were obtained from the UK Biobank (over 500,000 participants) and the FinnGen project (218,792 participants of European ancestry). Genetic variants associated with physical activity, diet, and sedentary behaviour were used as instrumental variables. The main analysis methods included the inverse variance weighted (IVW) method, MR-Egger, and weighted median methods. Heterogeneity was assessed using Cochran's Q test.

RESULTS

The analyses generally did not demonstrate significant causal relationships between physical activity or sedentary behaviour and AF. Diet showed a potential protective effect on AF in some analyses but was not consistently significant across methods. For HF, physical activity and sedentary behaviour did not show significant causal relationships. Diet showed a significant protective effect against HF in the IVW method but was not consistent across all methods.

CONCLUSIONS

This study suggests that while there may be some protective effects of these lifestyle factors on cardiovascular disease, most analyses did not show significant causality, and results were inconsistent. Further research is needed to validate these findings.

Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature

Although the benefits of exercise training have been shown repeatedly in many studies, its relationship with the occurrence of atrial fibrillation (AF) in competitive athletes still remains controversial. In the present review, we sought to demonstrate a comprehensive report of the incidence, pathophysiology, and therapeutic approaches to AF in elite athletes. A 2 to 10 times higher frequency of AF has been shown in many studies in high-intensity endurance athletes compared to individuals who do not exercise. Moreover, a U-shaped relationship between male elite athletes and AF is demonstrated through this finding, while the type and the years of physical activity seem to relate to AF development. A strong correlation seems to exist among the type of exercise (endurance sports), age (>55 years), gender (males), and the time of exercise training, all contributing to an increased risk of AF. The pathophysiology of AF still remains unclear; however, several theories suggest that complex mechanisms are involved, such as bi-atrial dilatation, pulmonary vein stretching, cardiac inflammation, fibrosis, and increased vagal tone. Elite athletes with AF require a comprehensive clinical evaluation and risk factor optimization, similar to the approach taken for nonathletes. Although anticoagulation and rate or rhythm control are cornerstones of AF management, there are still no specific guidelines for elite athletes.

Thromboembolic prevention in athletes: management of anticoagulation in sports players affected by atrial fibrillation

Atrial fibrillation (AF) is a common cardiac arrhythmia that poses a significant risk of stroke and thromboembolic events. Anticoagulation therapy is essential for preventing stroke in patients with AF. An increasing number of people of all ages, including cardiac patients, approach physical activity as both a leisure-time exercise and a competitive sport. Therefore, patients at risk of AF are increasingly allowed to practice sports activities. Management of oral anticoagulant therapy (OAT) in these patients is extremely challenging because of the need to balance the risks and benefits of medications, considering both hemorrhagic (in case of trauma) and ischemic complications when the drugs are avoided. Official recommendations are limited for these patients and forbid sports that increase the risk of trauma and consequent bleeding in most cases. These recommendations are strongly influenced by the "traditional" management of OAT, which mainly involves coumarin derivatives. Non-vitamin K antagonist direct oral anticoagulants (DOACs), with their more favorable pharmacokinetic-pharmacodynamic profile than that of coumarin derivatives, may represent an opportunity to modify the approach to sports activity in patients with AF and indications for OAT. This study aimed to review the use of anticoagulants in athletes with AF, highlight their efficacy and safety, and provide practical considerations regarding their management.

Associations of Dietary and Lifestyle Components with Atrial Fibrillation

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia that still remains a significant health concern, especially due to its consequences, including stroke and heart failure. This review explores the intricate interplay between AF, lifestyle choices, and dietary habits. It is particularly focused on findings from diverse studies about non-pharmacological methods of managing AF. Moreover, its purpose is to elucidate the implementation of lifestyle changes such as physical activity or proper diet choices in the integrated treatment strategy of patients with AF.

Study of Morpho-Functional Characteristics of the Cardiovascular System According to Electrocardiography, Phonocardiography, Echocardiography in Masters Athletics

Background

Many authors have noted the lack of knowledge on the causal relationship between the degree of physical activity, the dynamics, and outcomes of diseases, as well as the influence of sports history on the rehabilitation potential of former athletes.

Purpose

Assessment of the functional state of the cardiovascular system according to the indicators of electrocardiography, polycardiography, echocardiography and the level of physical performance in masters athletes.

Patients and Methods

The study included a main group consisting of 100 athletes, who had undergone electrocardiography, poly-electrocardiography, ultrasound echocardiography, heart rate and blood pressure measurement to determine their level of physical performance. The subjects were then divided into 2 groups. The first group included 75 people who continue to be active in regular sports activities. The second group consisted of 25 people who completely stopped training or had only occasional, unsystematic physical activities. A control group of 31 people, consisting of people of the same age who had not been involved in sports earlier, was examined according to the same program.

Results

The data obtained by us show that sports activities do contribute to the increasing stability of the body and maximize the deployment of the capabilities of the circulatory system, including their long-term preservation in masters athletic. Athletes who have stopped training have signs of age-related changes in the heart and blood vessels, which seem to be more frequent and earlier than those who continue training. A higher degree of myocardial contractility (in 90.67% of cases) can also be seen in the main group.

Conclusion

Masters athletes and those who stopped training after completing their sports career, should have notably thorough medical supervision and undergo regular annual in-depth examination.

An Overview of Sport Participation and Exercise Prescription in Mitral Valve Disease

The incidence of heart valve disease (HVD) has been rising over the last few decades, mainly due to the increasing average age of the general population, and mitral valve (MV) disease is the second most prevalent HVD after calcific aortic stenosis, but MV disease is a heterogeneous group of different pathophysiological diseases. It is widely proven that regular physical activity reduces all-cause mortality rates, and exercise prescription is part of the medical recommendations for patients affected by cardiovascular diseases. However, changes in hemodynamic balance during physical exercise (including the increase in heart rate, preload, or afterload) could favor the progression of the MV disease and potentially trigger major cardiac events. In young patients with HVD, it is therefore important to define criteria for allowing competitive sport or exercise prescription, balancing the positive effects as well as the potential risks. This review focuses on mitral valve disease pathophysiology, diagnosis, risk stratification, exercise prescription, and competitive sport participation selection, and offers an overview of the principal mitral valve diseases with the aim of encouraging physicians to embody exercise in their daily practice when appropriate.