Association of Self-reported Sports Volume and Discipline with Atrial Arrhythmia Prevalence in Middle-Aged Males

Abstract Background A J-shaped relationship between exercise and atrial fibrillation (AF) or atrial flutter (AFL) has been described, but the influence of specific sport disciplines is unknown. Purpose To examine the relationship between endurance exercise and AF/AFL prevalence in middle-aged men. Methods We analysed questionnaire data from 3939 candidates for the Master@Heart study, assessing self-reported exercise history, cardiovascular risk factors and history of AF/AFL. Participants were divided into quartiles of lifetime endurance exercise hours: Q1 ≤1778, Q2 1779–5977, Q3 5978–12231, and Q4 >12231 hours. Multivariable logistic regression was performed to assess the relationship between exercise volume and type and AF/AFL. Results AF/AFL prevalence was 7.5% and increased significantly across lifetime exercise quartiles (4.8%, 7.6%, 8.0%, and 9.6% from Q1 to Q4; p < 0.001). Adjusting for age, height, and traditional risk factors, Q2 – Q4 had significantly higher odds ratios of AF/AFL compared to Q1, with the largest effect for Q4 (OR 2.16, 95% CI [1.48–3.15], p < 0.001). As sport, only cycling was independently associated with AF/AFL (OR 1.51 [1.11–2.07], p = 0.010). Conclusion In middle-aged males, greater lifetime endurance exercise volume (>1778 hours) was associated with progressively increased odds ratios of AF/AFL, with the greatest risk in the highest quartile (>12231 hours), independent of traditional risk factors. Cycling specifically was associated with AF/AFL. These findings support existing evidence that high-volume endurance exercise may increase AF/AFL risk, even in traditionally low-risk individuals, and furthermore suggest a possible sports-specific effect.