Stroke in Athletes with Atrial Fibrillation: A Narrative Review

Area of Science:

• Cardiology
• Sports Medicine
• Neurology

Background:

• Atrial fibrillation (AF) is the most common arrhythmia, significantly increasing stroke risk.
• Moderate exercise lowers AF risk, yet high-level endurance athletes paradoxically show higher AF incidence.
• Stroke risk in athletes with AF is complex due to factors like younger age and higher fitness.

Purpose of the Study:

• To review the incidence, predictors, and management of stroke in athletes with AF.
• To synthesize current literature on AF and stroke in athletic populations.
• To address the uncertainty surrounding stroke risk in athletes with AF.

Main Methods:

• Literature review of key studies on AF, stroke, and athletes.
• Analysis of factors influencing stroke risk in athletes with AF.
• Synthesis of evidence regarding AF management in athletic individuals.

Main Results:

• AF increases stroke risk in athletes, particularly those over 65, but overall risk remains low.
• Older male athletes have higher AF incidence but lower stroke risk than non-athletes.
• Recurrent stroke risk in athletes with AF is similar to non-athletes, despite higher AF rates.

Conclusions:

• Managing AF in athletes is complex, with limited guidance on anti-thrombotic strategies, especially in high-bleeding-risk sports.
• Individualized, shared decision-making is crucial for balancing stroke prevention and athletic performance.
• Rhythm control, like catheter ablation, may be a viable first-line option for athletes avoiding long-term medication.