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Vorhofflimmern und körperliche Aktivität

Eine Übersicht

Atrial fibrillation and physical activity

An overview

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Zusammenfassung

Ein trainingsbedingt erhöhter Vagotonus sowie die Vergrößerung bzw. Volumenbelastung des linken Vorhofs können theoretisch die Induktion und Aufrechterhaltung von Vorhofflimmern (VHF) beim (Ausdauer-)Athleten begünstigen. Trotzdem gibt es bis dato keinen Hinweis auf ein häufigeres Auftreten von VHF beim jungen Athleten im Vergleich zur altersgleichen Normalbevölkerung. Im Rattenmodell führt das Korrelat einer langjährigen Ausdauerbelastung zu einem proarrhythmogenen atrialen Remodelling, auch beim Menschen gibt es hierfür erste Hinweise. Möglicherweise aufgrund dessen tritt beim Veteranenathleten VHF vergleichsweise gehäufter auf, wobei das relative Risiko im Vergleich zur Normalbevölkerung aufgrund methodischer Probleme, u. a. die nicht hinreichende Berücksichtigung von „neuen“ Risikofaktoren für VHF, bis dato möglicherweise überschätzt wurde. Aktuell gibt es keinen Hinweis auf eine Erhöhung des Vorhofflimmerrisikos durch normale körperliche Aktivität/Gesundheitssport; moderate körperliche Aktivität scheint das Risiko sogar senken zu können. Wichtige Aspekte bei der individuellen Beurteilung der Sporttauglichkeit von Patienten mit VHF sind neben der kardialen Gesamtsituation die atrioventrikuläre Leitung unter Belastung, eine möglicherweise vorhandene orale Antikoagulation sowie die ausgeübte Sportart und -intensität. Individuell angepasstes körperliches Training bei VHF bei fehlenden Kontraindikationen ist jedoch sicher und effektiv im Sinne der allgemein positiven Effekte von körperlicher Aktivität bei kardiovaskulären Patienten, beispielsweise durch eine günstige Beeinflussung kardiovaskulärer Risikofaktoren.

Abstract

A training-induced increase in vagal tone, left atrial enlargement and high atrial volume load due to exercise can theoretically favor induction and continuation of atrial fibrillation (AF) in (endurance) athletes. However, there is currently no evidence for a higher occurrence of AF in young endurance athletes in comparison to an age-matched normal population. The correlate of long-term endurance training results in proarrhythmogenic atrial remodeling in a rat model. The results of some studies also suggest that there may be atrial remodeling in humans, which might be an explanation for the comparatively higher incidence of AF in veteran athletes, whereby the relative risk might have been overestimated due to methodological problems, e.g. due to insufficient consideration of “new” AF risk factors. To date, there are no indications for an increased risk of AF due to normal physical activity: on the contrary, moderate physical activity seems to decrease the risk for AF. For an individual evaluation of sports participation of patients with AF, the overall cardiac situation, atrioventricular conduction during exercise, a possible oral anticoagulation as well as the sport and training intensity practiced are important. Well-adapted training for patients with AF has to be considered as safe and effective in terms of the overall positive effects of physical activity in patients with cardiovascular problems, for example due to a positive influence on cardiovascular risk factors.

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  1. Sektion Sport- und Rehabilitationsmedizin, Universitätsklinik Ulm, Leimgrubenweg 14, 89070, Ulm, Deutschland

    R. Laszlo & J.M. Steinacker

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Laszlo, R., Steinacker, J. Vorhofflimmern und körperliche Aktivität. Herz 41, 131–137 (2016). https://doi.org/10.1007/s00059-015-4352-x

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