IJCS | Volume 32, Nº4, July/August 2019

DOI: 10.5935/2359-4802.20190055 384 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2019;32(4):384-390 Mailing Address: Tiago Luiz Luz Leiria Av. Princesa Isabel, 395. Postal Code: 90620-000, Santana, Porto Alegre, RS – Brazil. E-mail: pesquisa.leiria@gmail.com / drleiria@gmail.com Physical Activity and Incidence of Atrial Fibrillation - Systematic Review and Meta- Analysis Daniel Carlos Garlip p, Raphael Boesche Guimarae s, Simone Louise Savari s, Clovis Froemming Junio r, Oscar Dutr a, T iago Luiz Luz Leiri a Instituto de Cardiologia / Fundação Universitária de Cardiologia (IC/FUC), Rio Grande do Sul, RS – Brazil Manuscript received on July 18, 2018, revised manuscript on April 10, 2019, accepted on May 04, 2019. Abstract Background: The relationship between exercise and atrial fibrillation (AF) is controversial. Objectives: To analyze the effects of physical activity on the incidence of atrial fibrillation using systematic review and meta-analysis. Methods: Systematic review and meta-analysis of studies that relate physical exercise and atrial fibrillation. The following databases were searched: PubMed, BVS Saúde and Cochrane. The following descriptors were used: "atrial fibrillation", "exercise", "physical activity" and "exercise therapy". All prospective, retrospective, cross-sectional and cohort studies were investigated. All statistical analyzes were provided using Review Manager 5.3 to provide the mean difference (MD) and relative risk (RR) ratio with 95% confidence intervals (95% CI). The statistical method of heterogeneity index was used to assess heterogeneity. Level of significance was 5%. Results: Combined analysis of 11 studies totaling 276,323 participants aged between 12 and 90 years did not suggest a significant increase in AF in individuals submitted to physical exercise (RR = 0.914, 95% CI = 0.833-1.003, heterogeneity: p < 0.001). Conclusions: Physical exercise, lato sensu , without stratification by intensity, sex or age does not seem to be associated with an increase of atrial fibrillation. (Int J Cardiovasc Sci. 2019;32(4):384-390) Keywords: Exercise; Atrial Fibrillation; Asthma; Exercise Therapy; Cardiorespiratory Fitness; Review; Meta- Analysis as Topic. Introduction Atrial fibrillation (AF) is the most frequent arrhythmia occurring in 0.1% – 4.0% of the population and the prevalence increased to 7.2% in patients aged ≥ 65, with an annual increase of 1.6% in patients aged ≥ 75. Characterized by loss of atrial contraction capacity (loss of atrial systole), AF is responsible for almost one- third of hospitalizations for heart rhythm disturbances. It may present high morbidity and mortality due to hemodynamic involvement, cardiomyopathy due to tachycardia and thromboembolic phenomena. Risk factors for the development of AF include cardiac and non-cardiac factors such as age, structural heart disease, hypertension, diabetes mellitus and hyperthyroidism. 1 The change in cardiac function is associatedwith increasedmortality and risk of infarction, decreased quality of life, decreased exercise capacity and impaired left ventricular function. 2 It is known that physical activity is an effective adjunct in the treatment of various types of cardiovascular diseases. However, patients with AF present decreased tolerance to exercise, dyspnea and palpitations. 3 Some Tiago Luiz Luz Leiria, MD, PhD Eletrofisiologista Diretor Tesoureiro da Fundação Universitária de Cardiologia drleiria@gmail.com