All models included inverse probability weighting to adjust for age, sex, BMI, type of AF, cardiovascular history (atrial flutter, hypertension, LV hypertrophy, coronary artery disease, obstructive sleep apnea, and valvular heart disease), and AF duration. The difference in the total number of ablations between these two groups was assessed with Poisson regression models. Differences in rates of freedom from atrial arrhythmias between athletes and nonathletes were assessed with log‐binomial regression models. Fisher exact tests and t tests were also used to assess associations between patient characteristics and freedom from atrial arrhythmias. Differences in demographic and patient history between athletes and nonathletes were assessed with Fisher exact tests for categorical variables and t tests for continuous variables.

Patient characteristics and variables related to athletic history were summarized as frequency and percentage for categorical variables and mean or median for continuous variables. A group of controls who were not identified as being high‐endurance athletes and who underwent catheter ablation for AF were matched to athletes in a 3‐to‐1 ratio on the basis of age, sex, and closest date of AF catheter ablation procedure. Potential athletes were contacted by telephone, and only high‐endurance athletes were enrolled. Those who had a sports activity history were identified with the keywords “athlete” and “sports.” Additional chart review was then performed to identify potential endurance athletes. Patients were retrospectively identified from our patient database by using Current Procedural Terminology codes for catheter ablation procedures. The study included patients at the three academic campuses in Rochester, Minnesota Phoenix, Arizona and Jacksonville, Florida. We performed a retrospective cohort study of patients undergoing first‐time catheter ablation using cryoablation or radiofrequency technology for AF at Mayo Clinic from Januto December 31, 2018. This study was approved by the Mayo Clinic Institutional Review Board. The current study aimed to determine the outcomes of catheter ablation for AF in high‐endurance athletes compared with nonathletes. 8 Although rhythm control with antiarrhythmic medications can be tried, rhythm control with medications fails for many athletes, and pulmonary vein isolation is required. Furthermore, β‐blockers are prohibited in many sports by the World Anti‐Doping Agency. Rate control is often not tolerated because of high vagal tone and resting bradycardia. However, deconditioning is sometimes not a practical or desired option because it can lead to decreased quality of life and affect the continued participation of athletes in their respective competitive sports. 3 Deconditioning, in which athletes are recommended to decrease their intensity and duration of exercise, is a common first step with some evidence for benefit. Guidelines on AF in athletes include the 36th Bethesda Conference Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities 2 and The European Society of Cardiology Guidelines for the management of AF. In high‐endurance athletes with AF, management is challenging and recommendations are largely based on anecdotal evidence and expert opinion. Whereas moderate exercise appears to be protective against AF, at extreme levels of exercise the risk is increased, which results in a U‐shaped curve. Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice, and an increasingly recognized risk factor for AF is participation in high‐endurance sports.

Atrial flutter ablation location