Certo Pereira Joana, Lima Maria Rita, Moscoso Costa Francisco, Gomes Daniel A, Maltês Sérgio, Cunha Gonçalo, Dores Hélder, Adragão Pedro
Hospital de Santa Cruz, 2790-134 Lisbon, Portugal.
Hospital da Luz, 1500-650 Lisbon, Portugal.
Diagnostics (Basel). 2024 Dec 25;15(1):9. doi: 10.3390/diagnostics15010009.
Atrial fibrillation (AF) is the most common sustained arrhythmia, linked with a significantly heightened risk of stroke. While moderate exercise reduces AF risk, high-level endurance athletes paradoxically exhibit a higher incidence. However, their stroke risk remains uncertain due to their younger age, higher cardiovascular fitness, and lower rate of comorbidities. Several key studies highlight that AF may increase the risk of stroke in endurance athletes, particularly those over 65. However, the overall risk within this population remains relatively low. Notably, older male athletes show a higher AF incidence but experience lower stroke risk than their non-athletic counterparts. Regular physical activity prior to a first stroke appears to reduce mortality, though recurrent stroke risk in athletes with AF mirrors that of non-athletes, despite an elevated AF incidence. Management of AF in athletes is complex, with limited evidence guiding anti-thrombotic strategies. In this setting, specific recommendations are sparse, particularly in sports where bleeding risk is heightened. Individualized management, emphasizing shared decision-making, is critical to balance stroke prevention with athletic performance. Rhythm control strategies, such as catheter ablation, may be a reasonable first-line treatment option for athletes, particularly in those desiring to avoid long-term medication. This review synthesizes the current literature on the incidence, predictors, and management of stroke in athletes with AF.
心房颤动（AF）是最常见的持续性心律失常，与中风风险显著升高有关。适度运动可降低房颤风险，但高水平耐力运动员却反常地呈现出更高的发病率。然而，由于他们年龄较轻、心血管健康状况较好且合并症发生率较低，其中风风险仍不确定。多项关键研究强调，房颤可能会增加耐力运动员尤其是65岁以上运动员的中风风险。不过，这一人群中的总体风险仍然相对较低。值得注意的是，老年男性运动员房颤发病率较高，但与非运动员同龄人相比，中风风险较低。首次中风前的规律体育活动似乎可降低死亡率，尽管房颤运动员的复发性中风风险与非运动员相当，但其房颤发病率较高。运动员房颤的管理很复杂，指导抗血栓形成策略的证据有限。在这种情况下，具体建议很少，尤其是在出血风险增加的运动项目中。强调共同决策的个体化管理对于平衡中风预防和运动表现至关重要。节律控制策略，如导管消融术，可能是运动员合理的一线治疗选择，特别是对于那些希望避免长期用药的运动员。本综述综合了目前关于房颤运动员中风发病率、预测因素和管理的文献。
