Ablation May Be Better Choice for Athletes with Atrial Fibrillation

Athletes who undergo ablation to treat their irregular heartbeat caused by atrial fibrillation (AF) experience greater improvement in sports performance compared to those who use antiarrhythmic medications, new research shows.

The study, led by Rachel Lampert, MD, Robert W Berliner Professor of Medicine in the Section of Cardiovascular Medicine at Yale School of Medicine, evaluated data from 1,055 participants (78% male, median age 61–71) who responded to an online survey. The findings, recently published in the journal Heart Rhythm, could help guide decision-making for athletes diagnosed with AF.

“Atrial fibrillation affects everyone, and I see in my own athlete-patients how much it impacts their quality of life,” said Lampert. “These patients have never been studied in a systematic way.”

Atrial fibrillation is an arrhythmia (irregular heartbeat) that affects how blood is pumped throughout the body. It can lead to heart palpitations, fatigue, shortness of breath, dizziness, weakness, and rapid heart rate.

Athletes, especially those who participate in endurance sports, such as cycling and running, experience AF at a higher rate than the general population. Patients diagnosed with AF have two treatment options—antiarrhythmic medications or catheter ablation, a minimally invasive procedure that uses heat or cold to produce scar tissue inside the heart to restore a regular heartbeat.

AF patients are also encouraged to adopt lifestyle changes, such as weight loss, exercise, and control of alcohol, caffeine, and tobacco, to decrease arrhythmia symptoms. In this survey, the athletes’ symptoms only rarely improved from these lifestyle changes or from reduced training.

The study results are based on data gathered by an internet-based survey to understand how AF impacts athletes, and how treatments used by athletes with the heart condition affect their sports performance, training, and symptoms.

“Surveys are preliminary data that rely on who chooses to answer and how they respond,” said Lampert. “The results do allow us, though, to get a sense of what’s going on.”

The results show that many athletes use medications, such as beta-blockers, calcium channel blockers, and the antiarrhythmic drug flecainide to control heart rhythm. This treatment option was reported to be only partially effective and was also reported to be accompanied by unwelcome side effects, including fatigue, low energy, and decreased athletic performance.

Unlike what happens with antiarrhythmic medications, almost half of athletes who underwent ablation did not experience a recurrence of AF symptoms. Compared to those taking medication for the condition, the survey showed that the respondents who received ablation were more likely to report improvement in sports performance and an ability to return to competition. Strengths of the study include the large sample size and community-based participation. The respondents were self-described as “athletes” and had a range of athletic participation.

The survey results suggest that, for athletes, ablation may be more effective for treating AF as well as for minimizing the negative side effects associated with antiarrhythmic medications. These outcomes may improve the likelihood that athletes can regain the level of sports performance they experienced prior to the onset of AF. Lampert stresses that prospective studies are needed to confirm the impact of AF and its treatment in athletes.