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Int J Cardiol. 2017 Jan 1;226:11-20. doi: 10.1016/j.ijcard.2016.10.047. Epub 2016 Oct 19.

Atrial fibrillation in highly trained endurance athletes - Description of a syndrome.

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Department of Physiology, Faculty of Medicine, University of Valencia and Fundación Investigación Hospital Clínico Universitario de Valencia, Instituto de Investigación INCLIVA, Valencia, Spain; Research Institute Hospital 12 de Octubre ('i+12'), Madrid, Spain. Electronic address:
Research Institute Hospital 12 de Octubre ('i+12'), Madrid, Spain.
Section of Clinical Biochemistry, University of Verona, Verona, Italy.
Emergency Department, Academic Hospital of Parma, Parma, Italy.
Faculty of Health, School of Medicine, University Witten/Herdecke, Hagen, Germany.
EFSMA and German Fed. Sports Medicine, Remscheid, Germany.
Faculty of Medicine, Physical Education and Sports Section, University of Zaragoza, Zaragoza, Spain.
Research Institute Hospital 12 de Octubre ('i+12'), Madrid, Spain; European University of Madrid, Madrid, Spain.


Atrial fibrillation (AF) is the most common heart arrhythmia, the risk of which typically increases with age. This condition is commonly associated with major cardiovascular diseases and structural heart damage, while it is rarely observed in healthy young people. However, increasing evidence indicates that paroxysmal AF can also onset in young or middle-aged and otherwise healthy endurance athletes (e.g., cyclists, runners and cross-country skiers). Here we review the topic of AF associated with strenuous endurance exercise (SEE), for example cycling, running and cross-country skiing, especially at a competitive level, and we propose the definition of a new syndrome based on the accumulating data in the literature: SEE-related AF under the acronym of 'PAFIYAMA' ('paroxysmal AF in young and middle-aged athletes'). Special emphasis is given to the proper differentiation of PAFIYAMA from 'classical AF' regarding pathophysiology, diagnosis and medical management.


Arrhythmias; Endurance; Exercise; Fibrosis; Left atrium; Remodeling

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