Preventive Cardiologist at Baptist Health in Jacksonville, Florida, Dr. Pamela Rama, talks about how too much exercise could cause AFib.
Interview conducted by Ivanhoe Broadcast News in 2023.
Too much exercise can be bad for some people. We never hear that too much exercise can cause problems, but it can cause heart problems?
RAMA: Yes. Basically, low- to moderate-intensity exercise improves one’s cardiovascular health. It can lower one’s blood pressure and help in weight loss, which in turn reduces one’s risk of atrial fibrillation. So, what is atrial fibrillation? Atrial fibrillation is a heart condition where the upper chamber of your heart beats irregularly. This can lead to symptoms such as palpitations, lightheadedness, shortness of breath, fatigue and chest pain. People who have it complain of palpitations and their heart rate can go up to really very high numbers, like 150 to 190 beats a minute. The problem with atrial fibrillation is it puts you at risk of having a stroke because it is such a disorganized rhythm. Now, moderate-intensity exercise can actually reduce your incidence of atrial fibrillation. However, there are trials that have shown that endurance athletes, cross-country skiers, swimmers, people who paticipate in marathons, and bicyclists, have a slight increase in atrial fibrillation in their middle age.
Why would that be?
RAMA: There are a lot of theories about it. One is that when you are an endurance athlete–and you’re talking about elite athletes here–your heart rate tends to be slower as an adaptation to exercise. The heart remodels, particularly, the upper chamber of the heart, which is the left atrium. The atrial fibrillation is generated from the left atrium. When you have a remodeling of that, it makes the left atrium a little bit bigger. You might form some scar tissue, which makes you more prone to having atrial fibrillation. These are select patients; we still don’t know who is going to have atrial fibrillation and who is not. The second thing is that most athletes, as you know, have very slow heart rates at baseline. It’s just that an athlete’s heart is strong, the heart is usually slow. They think the increase in vagal tone, which is normally a good thing, may provoke atrial fibrillation in these athletes and this in combination with the remodelling of the heart. For example, if you’re an endurance athlete and you have a family history of atrial fibrillation, you may be more prone to atrial fibrillation later on in life.
Now, because your heart is actually remodeling itself, is this Afib different than when an Afib of just the person who is a weekend warrior?
RAMA: The atrial fibrillation is atrial fibrillation, but most athletes who have atrail fibrillation are what we call “lone atrial fibrillators.” Lone atrial fibrillators are patients who have atrial fibrillation without underlying diabetes, hypertension, heart failure, or coronary artery disease. Everything else is good with their heart, except for atrial fibrillation. That’s what athletes mostly get–the lone atrial fibrillation. Frankly, their prognosis is better than somebody with underlying coronary artery disease or cardiac conditions.
END OF INTERVIEW
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