Paroxysmal atrial fibrillation in young and middle-aged athletes (PAFIYAMA) syndrome in the real world: a paradigmatic case report

Gianfranco Cervellin, Fabian Sanchis-Gomar, Ida Filice, Giuseppe Lippi


An enhanced risk of atrial fibrillation (AF) has been clearly documented in endurance athletes over the past decades. In this regard, we have recently described the ‘PAFIYAMA’ (‘paroxysmal AF in young and middle-aged athletes’) syndrome, provided that other risk factors for AF and underlying conditions have been ruled out. We report here a paradigmatic case of PAFIYAMA syndrome. A 32 years old man was admitted to the Emergency Department (ED) complaining for palpitations, lasting for 3 hours. He had never smoked and other risk factors for AF could be ruled out. The electrocardiogram (ECG) was consistent with AF at high ventricular response (130–150 bpm). All laboratory parameters were within the respective reference ranges, and laboratory screening for cocaine, amphetamine, and MDMA was negative. After 12 hours of persistent AF, the patient underwent effective electrical cardioversion. The patient reported an episode of paroxysmal AF (PAF), occurred during practicing strenuously training for a martial arts competition 2 years before the current episode. In the last two weeks, in addition to usual training, the patient was engaged in carrying heavy furniture. He underwent echocardiography within a week from ED discharge, showing a physiologic athlete’s left ventricle (LV) hypertrophy. The patient was discharged with suggestion to reduce his training regimen. A Holter-ECG performed one month after ED discharge showed no signs of arrhythmia, and the patient remained asymptomatic during the following six months of follow-up. Therefore, following the diagnostic algorithm of PAFIYAMA syndrome, this patient can be considered as a paradigmatic case of this recently described syndrome. The potential clinical implications and the impact on patients’ lifestyle are meaningful. New-onset AF in young population is uncommon. For that reason, physicians should be aware about PAFIYAMA syndrome.