Long-term follow-up and treatment in a case of PAFIYAMA syndrome: urgent need for identifying related biomarkers

Long-term strenuous exercise increases the risk of new-onset AF. In this regard, the paroxysmal atrial fibrillation in young and middle-aged athletes (PAFIYAMA) syndrome has been recently described. However, the clinical management of this syndrome has not been clearly described so far. Reducing exercise intensity and duration and the pill in pocket approach seems to be an effective and elective option until we have more data about this syndrome. We present here a follow-up treatment of a PAFIYAMA syndrome case in which antiarrhythmic therapy was not tolerated well because of sinus bradycardia and other adverse effects and a catheter ablation of the pulmonary veins (PVs) was finally required to successfully terminate the atrial fibrillation (AF) episodes. Ablation of PVs appears to be an option in patients with not well-tolerated PAFIYAMA syndrome who are determined to continue exercising. Provided this syndrome is finally confirmed, identifying specific biomarkers might is urgently needed in order to monitoring and predicting the risk of cardiac maladaptation in response to exercise, especially in the atria, and thus prevent PAFIYAMA syndrome.