Atrial fibrillation in athletes: From epidemiology to treatment in the novel oral anticoagulants era

It has been documented that physical activity may increase the risk of atrial fibrillation (AF) in active or former competitive athletes. Different mechanisms are involved and responsible for the development of the arrhythmia, such as structural changes of the left atrium, influences of autonomic nervous system with enhanced vagal tone, and the use of prohibited substances with arrhythmogenic effects. Difficulties in the management of AF in athletes may derive from the low compliance to antiarrhythmic therapy and the selection of the most appropriate strategy for thromboembolic risk prevention. In fact, the majority of athletes are young, healthy, without any particular risk factor, except for arterial hypertension which can be the only risk factor in the evaluation of antithrombotic therapy with the CHA2DS2-VASc score. The integration of actual score with serum biomarkers and other clinical factors may be useful to identify patients who will benefit the most from anticoagulation. Nowadays the non-vitamin K antagonist oral anticoagulants (NOACs) may represent a valid alternative to vitamin K antagonists (VKA) in the prevention of ischemic stroke due to AF with a better safety profile.