Anabolic steroids as the substrate for atrial fibrillation: a case report

Atrial fibrillation (AF) is the most frequently encountered sustained arrhythmia worldwide. This supraventricular rhythm disorder is precipitated by advanced age, valvular heart disease, hypertension, heart failure, congenital heart defects, and others. However, the role of anabolic steroids (ASs) abuse in precipitating AF remains insufficiently researched and largely underreported, despite their known cardiovascular risks.

We present the case of a 40-year-old male bodybuilder who was admitted to the emergency department with symptomatic AF. His medical history revealed the use of ASs, which was suspected to be the trigger. A thorough biological evaluation and echocardiography were performed, revealing no structural or functional cardiac abnormalities. After electrical cardioversion and discontinuation of AS use, the patient's rhythm returned to normal, with no recurrence of arrhythmia during follow-up.

This case highlights the potential but underexplored link between AS use and the onset of AF. Although ASs are known to affect cardiovascular health by promoting hypertension, left ventricular hypertrophy, and endothelial dysfunction, their role in arrhythmogenesis, particularly in AF, remains unclear. In this patient, the absence of other identifiable triggers, combined with the resolution of symptoms upon steroid cessation, strongly suggests a causal relationship. Further research is needed to clarify the mechanisms through which ASs may contribute to the development of AF, particularly in younger, otherwise healthy individuals such as athletes and bodybuilders. This case underscores the importance of awareness among clinicians regarding the potential cardiac risks associated with AS use.