Agbelu Abdulhakeem Oluwasegun1, Ochuele Dominic Agida2,3, Moses Adondua Abah2,3, Micheal Oladosu Abimbola3,4 and Ngbede Blessing Ene2
1Department of Medicine and Surgery, Faculty of Clinical Sciences, Obafemi Awolowo College of Health Sciences, Sagamu, Ogun State, Nigeria
2Department of Biochemistry, Faculty of Biosciences, Federal University Wukari, Taraba State, Nigeria
3ResearchHub Nexus Institute, Nigeria
4Department of Chemical Sciences, Faculty of Science, Anchor University, Ayobo, Lagos State, Nigeria
Received: July 28, 2026/ Revised: Aug 30, 2026/Accepted: Sept 3, 2026
(✉) Corresponding Author: Agbelu Abdulhakeem Oluwasegun; Segunagbelu@gmail.com
DOI: https://doi.org/10.47587/SA.2026.7302
Highlights
- A narrative review examines the emerging association between endurance training and atrial fibrillation (AF) in athletes.
- Structural, electrical, autonomic, inflammatory, and genetic mechanisms contributing to athlete-associated AF are critically discussed.
- Left atrial enlargement, myocardial fibrosis, and altered autonomic regulation may increase AF susceptibility during prolonged high-intensity training.
- Diagnostic challenges and limitations of conventional thromboembolic risk assessment in athletic populations are highlighted.
- Contemporary management strategies, including lifestyle modification, pharmacotherapy, catheter ablation, and individualized return-to-play decisions, are evaluated.
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is increasingly recognized among endurance athletes despite the well-established cardiovascular benefits of regular physical activity. While moderate exercise reduces AF risk, prolonged high-intensity training may promote structural, electrical, and autonomic cardiac remodeling that predisposes susceptible athletes to atrial arrhythmogenesis. These adaptations, including left atrial enlargement, myocardial fibrosis, heightened vagal tone, and altered electrophysiological properties, create a complex clinical paradox in which exercise serves as both a protective and predisposing factor. The unique characteristics of athlete-associated AF also present important challenges in diagnosis, thromboembolic risk assessment, and clinical management, as conventional risk prediction tools and treatment strategies may not fully reflect the physiological adaptations or performance demands of this population. This narrative review synthesizes current evidence on the mechanisms linking training-induced cardiac remodeling to AF development in athletes, with emphasis on the interplay between structural remodeling, autonomic regulation, inflammation, and genetic susceptibility. It further examines the clinical presentation and diagnostic evaluation of AF in athletic populations, highlighting considerations for thromboembolic risk stratification and the limitations of existing scoring systems. Contemporary management approaches, including lifestyle modification, pharmacological therapy, catheter ablation, and individualized return-to-play recommendations, are critically discussed within the context of shared decision-making and athlete-centered care. Finally, emerging research priorities, including improved athlete-specific risk prediction, advanced imaging, wearable technologies, and long-term outcome evaluation, are outlined. By integrating current mechanistic and clinical evidence, this review provides a concise framework to support evidence-based prevention, diagnosis, management, and safe return-to-play decisions for athletes with AF while identifying key areas requiring further investigation.
Keywords: Atrial fibrillation, Athletes, Cardiac remodeling, Thromboembolic risk and Catheter ablation, and Return-to-play
References
Abah MA, Archibong EU, Oladosu MA, Chikelum EP, Ekekwe AC, Tatah SV, Olanrewaju AO, et al. (2025). The protective role of sickle cell trait against Plasmodium falciparummalaria. Journal of Human Virology and Retrovirology 12(1):23-31. https://doi.org/10.15406/jhvrv.2025.12.00283.
Abah MA, Oladosu MA, Elijah OK, Chikelum EP, Olanrewaju AB, et al. (2025). The evolving role of sodium-glucose linked transporter-2 (SGLT2) inhibitors in heart failure management: A paradigm shift. Open Journal of Cardiology and Heart Diseases 5(1):OJCHD.000605. https://doi.org/10.31031/OJCHD.2025.05.000605.
Ali-Ahmed, F., Pieper, K., North, R., Allen, L. A., Chan, P. S., Ezekowitz, M. D. et al. (2020). Shared decision-making in atrial fibrillation: patient-reported involvement in treatment decisions. European heart journal. Quality of care & clinical outcomes. 6(4):263–272. https://doi.org/10.1093/ehjqcco/qcaa040
Alsunbuli, A. (2020). Rhythm control treatment strategies for atrial fibrillation: current consensus and future possibilities. Clinical medicine. 20(2): s4–s5. https://doi.org/10.7861/clinmed.20-2-s4
Calkins, H., Hindricks, G., Cappato, R., Kim, Y. H., Saad, E. B., Aguinaga, L. et al. (2017). 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart rhythm. 14(10): e275–e444. https://doi.org/10.1016/j.hrthm.2017.05.012
Hindricks, G., Potpara, T., Dagres, N., Arbelo, E., Bax, J. J., Blomström-Lundqvist, C. et al. (2021). 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. European heart journal. 42(5): 373–498. https://doi.org/10.1093/eurheartj/ehaa612
January, C. T., Wann, L. S., Calkins, H., Chen, L. Y., Cigarroa, J. E., Cleveland, J. C. et al. (2019). 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology. 74(1): 104–132. https://doi.org/10.1016/j.jacc.2019.01.011
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M. et al. (2024). 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 149(1):e1–e156. https://doi.org/10.1161/CIR.0000000000001193
Kirchhof, P., Camm, A. J., Goette, A., Brandes, A., Eckardt, L., Elvan, A. et al. (2020). Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. The New England journal of medicine. 383(14): 1305–1316. https://doi.org/10.1056/NEJMoa2019422
Kourek, C., Briasoulis, A., Tsougos, E. and Paraskevaidis, I. (2024). Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature. Journal of Cardiovascular Development and Disease. 11(10): 315. https://doi.org/10.3390/jcdd11100315
La Gerche, A., Claessen, G., Dymarkowski, S., Voigt, J. U., De Buck, F., Vanhees, L. et al. (2015). Exercise-induced right ventricular dysfunction is associated with ventricular arrhythmias in endurance athletes. European heart journal. 36(30): 1998–2010. https://doi.org/10.1093/eurheartj/ehv202
Lampert, R., Chung, H., Ackerman, J., Arroyo, R., Darden, D., Deo, R. et al. (2024). 2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play. Heart Rhythm. 21(10):e151-e252. https://doi.org/10.1016/j.hrthm.2024.05.018.
Mfon, N.P., Obi, B.E., Chuwang, M.C., Nkemehule, F., Oladosu, M.A., Abah, M.A., Besong, S.O., Oluwafunmbi, O.A., Olosunde, A., Amadi, C.S., Nkemehule, F., Onyema, A.D., Oladosu, O.A., Ocheineh, A.J., Onyeoche, A.S. (2025). Evaluation of the Effects of Cannabis sativa on the Body Weight and Uterus of Female Albino Rats. Trends in Medical Research, 20(1), 44-49. https://doi.org/10.3923/tmr.2025.44.49
Minardi, S., Sciarra, L., Robles, A. G., Scara, A., Sciarra, F., De Masi De Luca, G. and Romano, S. (2024). Thromboembolic prevention in athletes: Management of anticoagulation in sports players affected by atrial fibrillation. Frontiers in Pharmacology. 15:1384213. https://doi.org/10.3389/fphar.2024.1384213
Mont, L., Elosua, R. and Brugada, J. (2009). Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 11(1):11–17. https://doi.org/10.1093/europace/eun289
Moses Adondua Abah, et al. (2026). Emerging Trends in Pharmaceutical Analysis: A Review of Modern Techniques and Methodologies for Drug Development and Quality Control, J. Modern Medical Research and Clinical Techniques1(1): dx.doi.org/JMMRCT/PP.0009
Muir, S. M., Badin, A., Albers, A. R., Grewal, K. and colleagues. (2025). Atrial fibrillation in an elite athlete: Continuous ECG monitoring guiding therapy and return to play. JACC: Case Reports. 30(13). https://doi.org/10.1016/j.jaccas.2025.103507
Myrstad, M., Sørensen, E., Janssens, K., Mitchell, A., Apelland, T., Claessen, G. and La Gerche, A. (2023). Exercise-Induced Cardiac Remodeling and Atrial Fibrillation in Female Endurance Athletes. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 36(3):344–345. https://doi.org/10.1016/j.echo.2022.12.006
Nattel, S., Heijman, J., Zhou, L. and Dobrev, D. (2020). Molecular Basis of Atrial Fibrillation Pathophysiology and Therapy: A Translational Perspective. Circulation research. 127(1): 51–72. https://doi.org/10.1161/CIRCRESAHA.120.316363
Papalamprakopoulou, Z., Stavropoulos, D., Moustakidis, S., Avgerinos, D., Efremidis, M. and Kampaktsis, P. N. (2024). Artificial intelligence-enabled atrial fibrillation detection using smartwatches: Current status and future perspectives. Frontiers in Cardiovascular Medicine. 11: 1432876. https://doi.org/10.3389/fcvm.2024.1432876
Park, Y. J. and Bae, M. H. (2025). Screening and diagnosis of atrial fibrillation using wearable devices. The Korean journal of internal medicine. 40(1): 7–14. https://doi.org/10.3904/kjim.2023.521
Pelliccia, A., Sharma, S., Gati, S., Bäck, M., Börjesson, M., Caselli, S. et al. (2021). 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. European heart journal. 42(1): 17–96. https://doi.org/10.1093/eurheartj/ehaa605
Petzl, A. M., Jabbour, G., Cadrin-Tourigny, J., Pürerfellner, H., Macle, L., Khairy, P. et al. (2024). Innovative approaches to atrial fibrillation prediction: should polygenic scores and machine learning be implemented in clinical practice?. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 26(8): euae201. https://doi.org/10.1093/europace/euae201
Pham, H. N., Abdelnabi, M. H., Ibrahim, R., Sainbayar, E., Truong, H. H., Habib, E. et al. (2025). Exercise and Atrial Fibrillation: Current Evidence, Knowledge Gaps, and Future Directions. Reviews in cardiovascular medicine. 26(7): 39200. https://doi.org/10.31083/RCM39200
Platonov, P. G., Mitrofanova, L. B., Orshanskaya, V. and Ho, S. Y. (2011). Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age. Journal of the American College of Cardiology. 58(21): 2225–2232. https://doi.org/10.1016/j.jacc.2011.05.061
Sepehri Shamloo, A., Arya, A., Dagres, N. and Hindricks, G. (2018). Exercise and Atrial Fibrillation: Some Good News and Some Bad News. Galen medical journal. 7:e1401. https://doi.org/10.22086/gmj.v0i0.1401
Turagam, M. K., Flaker, G. C., Velagapudi, P., Vadali, S. and Alpert, M. A. (2015). Atrial Fibrillation In Athletes: Pathophysiology, Clinical Presentation, Evaluation and Management. Journal of atrial fibrillation. 8(4): 1309. https://doi.org/10.4022/jafib.1309
Tzeis, S., Gerstenfeld, E. P., Kalman, J., Saad, E. B., Sepehri Shamloo, A., Andrade, J. G. et al. (2024). 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Journal of arrhythmia. 40(6): 1217–1354. https://doi.org/10.1002/joa3.13082
Van Gelder, I. C., Rienstra, M., Bunting, K. V., Casado-Arroyo, R., Caso, V., Crijns, H. J. G. M. et al. (2024). 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European heart journal. 45(36): 3314–3414. https://doi.org/10.1093/eurheartj/ehae176
Vyas, R., Jain, S., Thakre, A., et al. (2024). Smart watch applications in atrial fibrillation detection: Current state and future directions. Journal of Cardiovascular Electrophysiology. 35(12): 2474–2482. https://doi.org/10.1111/jce.16451
Wang, X., Bampton, T. J., Dharmaprani, D., Mahajan, R., Palmer, L. J., et al. (2025). Machine learning and deep learning predictive models for prognosis in patients with atrial fibrillation: A systematic review and meta-analysis. BMJ Digital Health & AI. 1:e000154. DOI:10.1136/bmjdhai-2025-000154
Writing Committee Members, Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y. et al. (2024). 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 83(1): 109–279. https://doi.org/10.1016/j.jacc.2023.08.017
Zarak, M. S., Khan, S. A., Majeed, H., et al. (2024). Systematic review of validation studies for the use of wearable smartwatches in the screening of atrial fibrillation. International Journal of Arrhythmia. 25: 11. https://doi.org/10.1186/s42444-024-00118-5
How to cite this article
Agbelu, A. O., Agida, O. D., Abah, M. A., Abimbola, M. O., & Ene, N. B. (2026). Atrial fibrillation in athletes: A narrative review of training-induced remodeling, thromboembolic risk, and return-to-play guidelines. Science Archives, 7(3), 299–308. https://doi.org/10.47587/SA.2026.7302
This work is licensed under a Creative Commons Attribution 4.0 International License
