“Lone” Atrial Fibrillation in Athletes: A Consequence 0f Long- Term Intensive Sport Practice

  • F. Naccarella
  • F. Furlanello
  • A. Bertoldi
  • S. Sdringola Maranga
  • G. Lepera
  • R. Cappato
Conference paper


Atrial fibrillation (AF) in both the paroxysmal and persistent atrial forms has been documented both in normal hearts without signs of demonstrable cardiac disease [1–67] and, since 1990, also in some professional and competitive athletes, by Furlanello et al. [4–17, 68–73], Maron and Mitchell [11], Fenici et al. [41] Zeppilli [42], and Naccarella and Brachetti [20, 67]. A useful classification from the diagnostic and therapeutic points of view is the following:
  1. 1.

    Lone vagal AF associated with severe sinus bradycardia and cardiac pauses [19,20,29,30,33–38]

  2. 2.

    Lone sympathetic AF induced only by strenuous physical activity or exercise test or psychological stress. [24,36–38]

  3. 3.

    A mixture of 1 and 2 [19,20,24]

  4. 4.

    AF associated with supraventricular tachycardia (RSVT) [20–27]

  5. 5.

    AF associated with Wolff-Parkinson-Write (WPW) syndrome or cardiac pre-excitation syndromes [21–27,32]

  6. 6.

    “Familial ”lone AF [29–31,43–49]



Atrial Fibrillation Pulmonary Vein Catheter Ablation Elite Athlete Supraventricular Tachycardia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Haïssaguerre M, Jais P, Shah DC et al (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666PubMedCrossRefGoogle Scholar
  2. 2.
    Hwang C, Wu T-J, Doshi RN, Peter CT, Chen P-S (2000) Vein of Marshall cannulation for the analysis of electrical activity in patients with focal atrial fibrillation. Circulation 101:1503–1505PubMedCrossRefGoogle Scholar
  3. 3.
    Hindricks G, Kottkamp H (2001) Simultaneous noncontact mapping of left atrium in patients with paroxysmal atrial fibrillation. Circulation 104:297–303PubMedCrossRefGoogle Scholar
  4. 4.
    McGovern BA, Liberthson R (1996) Arrhythmias induced by exercise in athletes and others. S Afr Med J 86(Suppl sn2):C78–C82PubMedGoogle Scholar
  5. 5.
    Zehender M, Meinertz T, Keul J et al (1990) ECG variants and cardiac arrhythmias in athletes: clinical relevance and prognostic importance. Am Heart J 119:1378–1394PubMedCrossRefGoogle Scholar
  6. 6.
    Biffi A, Piovano G, Verdile L et al (1997) Prognostic evaluation on supraventricular arrhythmias in athletes. In: Pelliccia A, Caselli G, Bellotti P (eds) Advances in sport cardiology. Springer, Berlin New York Milan, pp 40–44Google Scholar
  7. 7.
    Delise P, Bonso A, Cor L et al (1992) Electrophysiologic substrates of idiopathic atrial fibrillation in the general population and in athletes. New Trends Arrhyth 8:719–724Google Scholar
  8. 8.
    Coelho A, Palieo E, Ashley W et al (1990) Tachyarrhythmias in young athletes. J Ambul Monit 3/4:269–281Google Scholar
  9. 9.
    Bertoldi A, Furlanello F, Fernando F et al (1993) Cardioarrhythmologic evaluation of symptoms and arrhythmic manifestations in 110 top level consecutive professional athletes. New Trends Arrhythm 9:199–209Google Scholar
  10. 10.
    Furlanello F, Bettini R, Bertoldi A et al (1991) Competitive sports and cardiac arrhythmias. In: Luderitz B, Saksena S (eds) International electrophysiology. Futura, Mount Kisco, NY, pp 41–47Google Scholar
  11. 11.
    Maron BJ, Mitchell J (1994) 26th Bethesda Conference. Recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. J Am Cardiol 24:848–899CrossRefGoogle Scholar
  12. 12.
    Murgatroyd FD, O’Farrel D, Ward DE et al (1993) Who gets paroxymal atrial fibrillation? Clinical features in 222 patients from the Craft multi-centre registry. (Abstract) In: Olson SB, Allessie MA, Campbell RWF (eds) Atrial fibrillation mechanisms and novel therapeutic strategies. Abstracts book. Lund p 7Google Scholar
  13. 13.
    Epstein AE, Mile WM, Bendin DG et al (1996) Personal and public safety issues related to arrhythmias that may affect consciousness: implications for regulation and physician recommendations. Circulation 94:1147–1166PubMedCrossRefGoogle Scholar
  14. 14.
    Coumel PR (1994) Autonomic arrhythmogenic factors in paroxysmal atrial fibrillation. In: Ollson SB, Allessie MA, Campbell RWF (eds) Atrial fibrillation mechanisms and therapeutic strategies. Futura, Armonk, NY, pp 171–185Google Scholar
  15. 15.
    Furlanello F, Bertoldi A, Bettini R et al (1992) Life-threatening tachyarrhythmias in athletes. Pacing Clin Electrophysiol 15:1403–1411PubMedGoogle Scholar
  16. 16.
    Furlanello F, Bertoldi A, Dallago M et al (1998) Atrial fibrillation in athletes. J Cardiovasc Electrophysiol 9:563–568CrossRefGoogle Scholar
  17. 17.
    Bertoldi A, Furlanello F, Fernando F et al (2002) Risk stratification in elite athletes with arrhythmias. G Ital Aritmol Cardiostim 5:218–219Google Scholar
  18. 18.
    Cappato R, Negroni S, Furlanello F et al (2002) Efficacy of a probabilistic approach, step-wise RF catheter ablation approach for the curative treatment of atrial fibrillaion. G Ital Aritmol Cardiostim 5:281–228Google Scholar
  19. 19.
    Wijffels MC, Kirchhof CJ, Dorland R, Alessie MA (1995) Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 92:1954–1968PubMedCrossRefGoogle Scholar
  20. 20.
    Bracchetti D, Naccarella F (2002) Cuore e sport. Linee guida per l’idoneità alPattività sportiva agonistica. Centro ScientificoGoogle Scholar
  21. 21.
    Brembilla-Perrot B, Marçon F, Bosser G et al (2001) Paroxysmal tachycardia in children and teenagers with normal sinus rhythm and without heart disease. Pacing Clin Electrophysiol 24:41–45PubMedCrossRefGoogle Scholar
  22. 22.
    Benson DW, Dunningan A, Benditt DG et al (1983) Transesophageal study of infant with supraventricular tachycardia. Electrophysiologic characteristics. Am J Cardiol 52:1002–1006PubMedCrossRefGoogle Scholar
  23. 23.
    Brembilla-Perrot B, Spatz F, Khaaldi E et al (1990) Value of esophageal pacing in the evaluation of supraventricular tachycardia. Am J Cardiol 65:322–330PubMedCrossRefGoogle Scholar
  24. 24.
    Brembilla-Perrot B, Terrier De La Chaise A, Pichenè M et al (1989) Isoprenaline as an aid to the induction of catecholamine-dependent supraventricular tachycardia. Br Heart J 61:322–330CrossRefGoogle Scholar
  25. 25.
    Slama R, Coumel Ph, Motté G et al (1975) Tachycardies paroxystiques liées à un syndrome de Wolff Parkinson White inapparent. Nouv Press Med 45:169–172Google Scholar
  26. 26.
    Garson A, Gillette PC (1981) Electrophysiologic studies of supraventricular tachycardia in children. Prediction of specific mechanism by noninvasive features. Am Heart J 102:383–388PubMedCrossRefGoogle Scholar
  27. 27.
    Biffi A, Ammirati F, Caselli G et al (1993) Usefulness of transesophageal pacing during exercise for evaluation of palpitations in top-level athletes. Am J Cardiol 72:922–926PubMedCrossRefGoogle Scholar
  28. 28.
    Pongiglione G, Saul P, Dunningan A et al (1988) Role of transesophageal pacing in evaluation of palpitations in children and adolescents. Am I Cardiol 66:566–570CrossRefGoogle Scholar
  29. 29.
    Driscoll DJ, Jacobsen SJ, Porter CNJ et al (1997) Syncope in children and adolescents. Am J Cardiol 29:1039–1045CrossRefGoogle Scholar
  30. 30.
    Beder SD, Cohen MH, Riewenschneider TA (1985) Occult arrhythmias as the etiology of unexplained syncope in children with structurally normal hearts. Am Heart J 109:309–313PubMedCrossRefGoogle Scholar
  31. 31.
    Leitch JW, Klein GT, Yee R et al (1992) Syncope associated with supraventricular tachycardia. An expression of tachycardia rate or vasomotor response. Circulation 85:1064–1071PubMedCrossRefGoogle Scholar
  32. 32.
    Bayés de Luna A, Furlanello F, Maron BJ, Zipes DP (2000) Arrhythmias and sudden death in athletes. Dev Card Med 1–126Google Scholar
  33. 33.
    Lin P-H, Huang J-L, Ting C-T, Chen S-A (2001) Respiration and initiation of atrial fibrillation. J Cardiovasc Electrophysiol 12:979PubMedCrossRefGoogle Scholar
  34. 34.
    Chou H-H, Lin K-H, Luqman N, Kuo C-T (2003) Prolonged ventricular asystole, sinus arrest, and paroxysmal atrial flutter-fibrillation: an uncommon presentation of vasovagal syncope. Pacing Clin Electrophysiol 26:914–917PubMedCrossRefGoogle Scholar
  35. 35.
    Miyamoto K-J, Tsuchihasashi K, Uno K et al (2001) Studies on the prevalence of complicated atrial arrhythmias, flutter and fibrillation in patients with reciprocating supraventricular tachycardia before and after successful catheter ablation. Pacing Clin Electrophysiol 24:969–978PubMedCrossRefGoogle Scholar
  36. 36.
    Taneja T, Windhagen Mahnert B, Passman R, Goldberger J, Kadish A (2001) Effects of sex and age on electrocardiographic and cardiac electrophysiological properties in adults. Pacing Clin Electrophysiol 24:16–21PubMedCrossRefGoogle Scholar
  37. 37.
    Report of the American College of Cardiology (2002) Management of patients with atrial fibrillation. In ACC/AHA/ESC Pocket Guidelines, pp 1–75Google Scholar
  38. 38.
    Report of the American College of Cardiology (2001) ACC/AHA/ESC Guidelines for the management of patients with atrial fibrillation: executive summary. ACC/AHA/ESC Guidelines Executive Summary 38:4.1–19Google Scholar
  39. 39.
    Comitato organizzativo cardiologico per l’idoneità allo sport (ANCE-ANMCO-FMSI-SIC-SIC SPORT) (1995) Protocolli cardiologici per il giudizio di idoneità allo sport agonistico. Casa Editrice Internazionale, pp 1–75Google Scholar
  40. 40.
    Comitato organizzativo cardiologico per l’idoneità allo sport (ANCE-ANMCO-FMSI-SIC-SIC SPORT) (2003) Protocolli cardiologici per il giudizio di idoneità allo sport agonistico. Casa Editrice Internazionale, pp 430–437Google Scholar
  41. 41.
    Fenici RR, Brisinda D, Fenici P, Zinzi D, Delise P (2201) La sindrome da preeccitazio-ne cardiaca e l’ablazione transcatetere delle aritmie. In: Cardiologia dello sport. Casa Editrice Scientifica InternazionaleGoogle Scholar
  42. 42.
    Zeppilli P (2003) Cardiologia dello sport. Casa Editrice Scientifica Internazionale, pp 1–590Google Scholar
  43. 43.
    Brugada R, Roberts E (2000) Familial atrial fibrillation. In: Molecular genetics of cardiac electrophysiology, vol 7. Kluwer Academic, Dordrecht, pp 90–98Google Scholar
  44. 44.
    Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG (1995) Prevalence, age distribution, and gender of patients with atrial fibrillation. Arch Intern Med 155:469–473PubMedCrossRefGoogle Scholar
  45. 45.
    Wolff L (1943) Familial auricular fibrillation. N Engl J Med 229:396–397CrossRefGoogle Scholar
  46. 46.
    Poret P, Mabo P, Deplace C et al (1996) Isolated atrial fibrillation genetically determined? A propos of a familial history. Arch Mal Coeur Vaiss 89:1197–1203PubMedGoogle Scholar
  47. 47.
    Beyer F, Luhmer PT, Bertram H, Kallfeltz HC (1993) Familial idiopathic atrial fibrillation with bradyarrhythmia. Z Kardiol 82:674–677PubMedGoogle Scholar
  48. 48.
    Brugada R, Bachinski LL, Hill R, Roberts R (1998) Familial atrial fibrillation is a gene-tically heterogeneous disease. J Am Coll Cardiol 31:349 ACrossRefGoogle Scholar
  49. 49.
    Berul CI, Towbin JA (2000) Molecular genetics of cardiac electrophysiology. Kluwer Academic, Dordrecht, pp 1–201CrossRefGoogle Scholar
  50. 50.
    Mark estes III NA, Salem DN, Wang PJ (1999) Sudden cardiac death in the athlete. Futura, Armonk, NY, pp 1–350Google Scholar
  51. 51.
    Palmieri M, Bracchetti D (2002) II paziente con fibrillazione atriale. In: Atti del Convegno di Aggiornamento in Cardiologia dello Sport, pp 69–78Google Scholar
  52. 52.
    Palmieri M, Bracchetti D (2002) Atti del Convegno di Aggiornamento in Cardiologia dello Sport, pp 1–203Google Scholar
  53. 53.
    Karch MR, Ndrepepa G, Schneider MAE et al (2003) Single chamber atrial fibrillation involving only the left atrium: implications for maintenance and radiofrequency ablation therapy. Pacing Clin Electrophysiol 26:883–981PubMedCrossRefGoogle Scholar
  54. 54.
    Schweikert RA, Lugones AP, Kanagaratnam L et al (2001) A simple method of mapping atrial premature depolarization triggering atrial fibrillation. Pacing Clin Electrophysiol 24:22–27PubMedCrossRefGoogle Scholar
  55. 55.
    Wang T-D, Chen W-J, Su S-S, Su T-C, Chen M-F, Liau C-S, Lee Y-T (2001) Increased levels of tissue plasminogen activator antigen and factor VIII activity in nonvalvular atrial fibrillation: relation to predictors of thromboembolism. J Cardiovasc Electrophysiol 12:877–884PubMedCrossRefGoogle Scholar
  56. 56.
    Schuessler RB (2001) Does size matter? J Cardiovasc Electrophysiol 12:875–876PubMedCrossRefGoogle Scholar
  57. 57.
    Santini M (2002) Non pharmacological treatment of atrial fibrillation. Arianna Editrice, pp 1–325Google Scholar
  58. 58.
    Lau C-P, Tse H-F (2001) Early reinitiation of atrial fibrillation after electrical defibril-lation: a new electrophysiological phenomenon. Pacing Clin Electrophysiol 24:1581–1582PubMedCrossRefGoogle Scholar
  59. 59.
    Maounis T, Kyrozi E, Katsaros K et al (2000) The prognostic significance of atrial arrhythmias recorded early after cardioversion for atrial fibrillation. Pacing Clin Electrophysiol 24:1076–1081CrossRefGoogle Scholar
  60. 60.
    Wu T-J, Doshi RN, Huang H-L et al (2002) Simultaneous biatrial computerized mapping during permanent atrial fibrillation in patients with organic heart disease. J Cardiovasc Electrophysiol 13:571–577PubMedCrossRefGoogle Scholar
  61. 61.
    Erdogan A, Carlsson J, Neumann T et al (2001) Quality-of-life in patients with paroxysmal atrial fibrillation after catheter ablation: results of long-term follow-up. Pacing Clin Electrophysiol 26:678–684CrossRefGoogle Scholar
  62. 62.
    Leclercq J-F, De Sisti A, Fiorello P et al (2000) Is dual better than single site atrial pacing in the prevention of atrial fibrillation? Pacing Clin Electrophysiol 23:2101–2107PubMedCrossRefGoogle Scholar
  63. 63.
    De Ambroggi L (2002) Atrial fibrillation in 2000 electrocardiology. Proceedings of the XXVII International Congress in Electrocardiology, Milan, 27 June-1 July 2002Google Scholar
  64. 64.
    Furlanello F, Cappato R., De Ambroggi L (2003) Evaluation of the arrhythmic athlete. Proceedings of a one-day workshop, Milan, 3 March 2003Google Scholar
  65. 65.
    (2003) Atrial fibrillation and arrhythmic syndromes. In: Atti del Convegno “Esperienze a confronto” II giornata livornese di Medicina dello Sport. 30–31 May 2003, pp 1–75Google Scholar
  66. 66.
    Furlanello F (2003) Atrial fibrillation. In: Proceedings of the Italian Congress of the SIC SPORT. Montecatini, 16–17 June 2003, pp 1–96Google Scholar
  67. 67.
    Naccarella F (2003) Dati preliminari del registro prospettico italiano RETE MIDAS-Medtronic, Milan, 3 March 2003 “Fibrillazione atriale ed aritmie negli atleti di calcio e basket”Google Scholar
  68. 68.
    Furlanello F, Fernando F, Galassi A, Bertoldi A (2001) Ventricular arrhythmias in apparently healthy athletes. In: Malik M (ed) Risk of arrhythmia and sudden death. BMJ Books, London, pp 316–324Google Scholar
  69. 69.
    Furlanello F, Bertoldi A, Galassi A et al (1999) Management of severe cardiac arrhythmic events in elite athletes. Pacing Clin Electrophysiol 22:A 165CrossRefGoogle Scholar
  70. 70.
    Furlanello F, Bertoldi A, Dallago M et al (1998) Atrial fibrillation in elite athletes. J Cardiovasc Electrophysiol 98(Suppl):563–568Google Scholar
  71. 71.
    Furlanello F, Bertoldi A, Fernando F, Biffi A (2000) Competitive athletes with arrhythmias. Classification, evaluation and treatment. In: Bayes de Luna A, Furlanello F, Maron BJ, Zipes DP (eds) Arrhythmias and sudden death in athletes. Kluwer Academic, Dordrecht, pp 89–105Google Scholar
  72. 72.
    Furlanello F, Bertoldi A, Dallago M et al (1994) Atrial fibrillation in top-level athletes. In: Olsson SB, Allessie MA, Campbell RWF (eds) Atrial fibrillation: mechanisms therapeutic strategies. Futura, Armonk, NY, pp 203–204Google Scholar
  73. 73.
    Furlanello F, Bentivegna S, Cappato R, De Ambroggi L (2003) Arrhythmogenic effects of illicit drugs in athletes. Submitted for publication in IHJ 2003Google Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • F. Naccarella
    • 1
  • F. Furlanello
    • 2
    • 3
  • A. Bertoldi
    • 4
  • S. Sdringola Maranga
    • 5
  • G. Lepera
    • 1
  • R. Cappato
    • 6
  1. 1.Cardiology DepartmentAzienda USL Citta’ di Bologna, Cardiology DH DSBolognaItaly
  2. 2.Cardiology and Arrhythmology DepartmentPoliclinico San DonatoMilanItaly
  3. 3.Cardiology DepartmentVilla Bianca HospitalTrentoItaly
  4. 4.Cardiology DepartmentSanta Chiara HospitalTrentoItaly
  5. 5.Cardiology DepartmentHermann Memorial HospitalHoustonUSA
  6. 6.Cardiology-Centro Aritmologia Clinica ed ElettrofisiologiaPoliclinico San DonatoMilanItaly

Personalised recommendations