{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T18:11:53Z","timestamp":1786990313669,"version":"build-2736575974"},"reference-count":85,"publisher":"Elsevier BV","issue":"8","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T00:00:00Z","timestamp":1709596800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["PG\/13\/99\/30233"],"award-info":[{"award-number":["PG\/13\/99\/30233"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["PG\/14\/24\/30626"],"award-info":[{"award-number":["PG\/14\/24\/30626"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["FS\/19\/1\/34035"],"award-info":[{"award-number":["FS\/19\/1\/34035"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["PG\/22\/10919"],"award-info":[{"award-number":["PG\/22\/10919"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["RG\/11\/18\/29257"],"award-info":[{"award-number":["RG\/11\/18\/29257"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR-11-LABX-0015"],"award-info":[{"award-number":["ANR-11-LABX-0015"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR-15-CE14-0004-01"],"award-info":[{"award-number":["ANR-15-CE14-0004-01"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","heartrhythmjournal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Heart Rhythm"],"published-print":{"date-parts":[[2024,8]]},"DOI":"10.1016\/j.hrthm.2024.02.050","type":"journal-article","created":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T12:26:51Z","timestamp":1709123211000},"page":"1415-1427","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":13,"title":["Symptomatic bradyarrhythmias in the athlete\u2014Underlying mechanisms and treatments"],"prefix":"10.1016","volume":"21","author":[{"given":"Sami","family":"Al-Othman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark R.","family":"Boyett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwilym M.","family":"Morris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aneil","family":"Malhotra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Mesirca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo E.","family":"Mangoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"D\u2019Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.hrthm.2024.02.050_bib1","series-title":"Management of Cardiac Arrhythmias","first-page":"623","article-title":"Arrhythmias in the athlete","author":"McEnteggart","year":"2020"},{"key":"10.1016\/j.hrthm.2024.02.050_bib2","article-title":"Electrocardiographic findings in athletes","volume":"4","author":"Brugada","year":"2006","journal-title":"E J Cardiol Pract"},{"key":"10.1016\/j.hrthm.2024.02.050_bib3","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1136\/hrt.61.2.155","article-title":"Electrocardiographic findings in male veteran endurance athletes","volume":"61","author":"Northcote","year":"1989","journal-title":"Br Heart J"},{"key":"10.1016\/j.hrthm.2024.02.050_bib4","doi-asserted-by":"crossref","first-page":"2412","DOI":"10.1016\/j.jacc.2015.09.041","article-title":"Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 9: Arrhythmias and conduction defects: a scientific statement from the American Heart Association and American College of Cardiology","volume":"66","author":"Zipes","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib5","first-page":"1873","article-title":"Cardiac pauses in competitive athletes: a systematic review examining the basis of current practice recommendations","volume":"18","author":"Senturk","year":"2016","journal-title":"Europace"},{"key":"10.1016\/j.hrthm.2024.02.050_bib6","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1378\/chest.82.1.19","article-title":"Twenty-four hour continuous ECG recordings in long-distance runners","volume":"82","author":"Talan","year":"1982","journal-title":"Chest"},{"key":"10.1016\/j.hrthm.2024.02.050_bib7","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/0002-8703(85)90075-4","article-title":"Prevalence and possible mechanisms of ventricular arrhythmias in athletes","volume":"110","author":"Palatini","year":"1985","journal-title":"Am Heart J"},{"key":"10.1016\/j.hrthm.2024.02.050_bib8","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/j.jacc.2017.01.015","article-title":"International recommendations for electrocardiographic interpretation in athletes","volume":"69","author":"Sharma","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib9","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1136\/bjsm.33.4.239","article-title":"Cardiac assessment of veteran endurance athletes: a 12 year follow up study","volume":"33","author":"Hood","year":"1999","journal-title":"Br J Sports Med"},{"key":"10.1016\/j.hrthm.2024.02.050_bib10","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1093\/eurheartj\/ehm555","article-title":"Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists","volume":"29","author":"Baldesberger","year":"2008","journal-title":"Eur Heart J"},{"key":"10.1016\/j.hrthm.2024.02.050_bib11","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1134\/S2079057019010168","article-title":"Effect of personal history of athletic activity on the clinical course of cardiovascular diseases in former athletes","volume":"9","author":"Zadvorev","year":"2019","journal-title":"Adv Gerontol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib12","doi-asserted-by":"crossref","first-page":"3624","DOI":"10.1093\/eurheartj\/eht188","article-title":"Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study","volume":"34","author":"Andersen","year":"2013","journal-title":"Eur Heart J"},{"key":"10.1016\/j.hrthm.2024.02.050_bib13","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1136\/hrt.23.2.113","article-title":"Cardiological observations at the sixth British Empire and Commonwealth games","volume":"23","author":"Beswick","year":"1961","journal-title":"Br Heart J"},{"key":"10.1016\/j.hrthm.2024.02.050_bib14","doi-asserted-by":"crossref","first-page":"203","DOI":"10.3390\/jcm13010203","article-title":"Intrinsic sinus node\/atrioventricular node dysfunction requiring pacemaker implantation: role of former professional sport activity","volume":"13","author":"Bondarev","year":"2024","journal-title":"J Clin Med"},{"key":"10.1016\/j.hrthm.2024.02.050_bib17","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1152\/japplphysiol.01126.2012","article-title":"Viewpoint: Is the resting bradycardia in athletes the result of remodelling of the sinoatrial node rather than high vagal tone?","volume":"114","author":"Boyett","year":"2013","journal-title":"J Appl Physiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib18","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.pbiomolbio.2021.06.008","article-title":"Regulation of sinus node pacemaking and atrioventricular node conduction by HCN channels in health and disease","volume":"166","author":"Boyett","year":"2021","journal-title":"Progr Biophys Mol Biol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib19","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1161\/CIRCRESAHA.119.316386","article-title":"Intrinsic electrical remodeling underlies atrioventricular block in athletes","volume":"129","author":"Mesirca","year":"2021","journal-title":"Circ Res"},{"key":"10.1016\/j.hrthm.2024.02.050_bib20","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1161\/CIRCRESAHA.117.311607","article-title":"Targeting miR-423-5p reverses exercise training-induced HCN4 channel remodeling and sinus bradycardia","volume":"121","author":"D\u2019Souza","year":"2017","journal-title":"Circ Res"},{"key":"10.1016\/j.hrthm.2024.02.050_bib21","doi-asserted-by":"crossref","first-page":"3775","DOI":"10.1038\/ncomms4775","article-title":"Exercise training reduces resting heart rate via downregulation of the funny channel HCN4","volume":"5","author":"D\u2019Souza","year":"2014","journal-title":"Nat Commun"},{"key":"10.1016\/j.hrthm.2024.02.050_bib22","doi-asserted-by":"crossref","first-page":"1798","DOI":"10.3389\/fphys.2020.519382","article-title":"Genetic ablation of G protein-gated inwardly rectifying K+ channels prevents training-induced sinus bradycardia","volume":"11","author":"Bidaud","year":"2021","journal-title":"Front Physiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib23","doi-asserted-by":"crossref","first-page":"19","DOI":"10.3389\/fphys.2015.00019","article-title":"Functional role of voltage gated Ca2+ channels in heart automaticity","volume":"6","author":"Mesirca","year":"2015","journal-title":"Front Physiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib24","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/S0009-9236(98)90153-9","article-title":"Pharmacokinetic-pharmacodynamic modeling of the effects of ivabradine, a direct sinus node inhibitor, on heart rate in healthy volunteers","volume":"64","author":"Ragueneau","year":"1998","journal-title":"Clin Pharmacol Ther"},{"key":"10.1016\/j.hrthm.2024.02.050_bib25","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.jacc.2014.05.045","article-title":"HCN4 mutations in multiple families with bradycardia and left ventricular noncompaction cardiomyopathy","volume":"64","author":"Milano","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib26","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1073\/pnas.1010122108","article-title":"Deep bradycardia and heart block caused by inducible cardiac-specific knockout of the pacemaker channel gene Hcn4","volume":"108","author":"Baruscotti","year":"2011","journal-title":"Proc Natl Acad Sci U S A"},{"key":"10.1016\/j.hrthm.2024.02.050_bib27","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1038\/ng.2610","article-title":"Identification of heart rate-associated loci and their effects on cardiac conduction and rhythm disorders","volume":"45","author":"den Hoed","year":"2013","journal-title":"Na Genet"},{"key":"10.1016\/j.hrthm.2024.02.050_bib28","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/j.1542-474X.2001.tb00092.x","article-title":"Circadian behavior of P-wave duration, P-wave area, and PR interval in healthy subjects","volume":"6","author":"Dilaveris","year":"2001","journal-title":"Ann Noninvasive Electrocardiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib29","doi-asserted-by":"crossref","first-page":"3565","DOI":"10.1038\/s41598-021-82202-7","article-title":"RNAseq shows an all-pervasive circadian rhythm in the transcriptome of the pacemaker of the heart, the sinus node","volume":"11","author":"Wang","year":"2021","journal-title":"Sci Rep"},{"key":"10.1016\/j.hrthm.2024.02.050_bib30","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.hrthm.2020.11.026","article-title":"A circadian clock in the sinus node mediates day-night rhythms in Hcn4 and heart rate","volume":"18","author":"D\u2019Souza","year":"2021","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.hrthm.2024.02.050_bib31","doi-asserted-by":"crossref","DOI":"10.1098\/rstb.2022.0179","article-title":"Non-canonical role of the sympathetic nervous system in the circadian rhythm in heart rate","volume":"378","author":"Anderson","year":"2023","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"key":"10.1016\/j.hrthm.2024.02.050_bib32","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCRESAHA.123.323464","article-title":"The cardiac glucocorticoid receptor mediates the day-night rhythm in ventricular arrhythmia susceptibility","author":"Tikhomirov","year":"2024","journal-title":"Circ Res"},{"key":"10.1016\/j.hrthm.2024.02.050_bib33","series-title":"Cardiac Electrophysiology: From Cell to Bedside","first-page":"1215","article-title":"Sinus node dysfunction: pathophysiology, clinical features, evaluation, and treatment","author":"Benditt","year":"1995"},{"key":"10.1016\/j.hrthm.2024.02.050_bib34","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1161\/01.CIR.13.6.801","article-title":"Some clinical features of complete heart block","volume":"13","author":"Penton","year":"1956","journal-title":"Circulation"},{"key":"10.1016\/j.hrthm.2024.02.050_bib35","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1093\/cvr\/4.2.160","article-title":"The normal range and determinants of the intrinsic heart rate in man","volume":"4","author":"Jose","year":"1970","journal-title":"Cardiovasc Res"},{"key":"10.1016\/j.hrthm.2024.02.050_bib36","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1253\/jcj.57.760","article-title":"Age-related changes of sinus node function and autonomic regulation in subjects without sinus node disease: assessment by pharmacologic autonomic blockade","volume":"57","author":"Kuga","year":"1993","journal-title":"Jpn Circ J"},{"key":"10.1016\/j.hrthm.2024.02.050_bib37","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/j.hrthm.2017.12.027","article-title":"Structural and functional remodeling of the atrioventricular node with aging in rats: the role of hyperpolarization-activated cyclic nucleotide-gated and ryanodine 2 channels","volume":"15","author":"Saeed","year":"2018","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.hrthm.2024.02.050_bib38","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1113\/jphysiol.2004.072108","article-title":"Ageing-related changes of connexins and conduction within the sinoatrial node","volume":"560","author":"Jones","year":"2004","journal-title":"J Physiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib39","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1023\/A:1021376002896","article-title":"Stereologic study of the sinoatrial node of rats\u2014age related changes","volume":"3","author":"de Melo","year":"2002","journal-title":"Biogerontology"},{"key":"10.1016\/j.hrthm.2024.02.050_bib40","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1161\/CIRCEP.110.960807","article-title":"TGF-\u03b21 mediated fibrosis and ion channel remodeling are key mechanisms producing sinus node dysfunction associated with SCN5A deficiency and aging","volume":"4","author":"Hao","year":"2011","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib41","doi-asserted-by":"crossref","first-page":"7105","DOI":"10.1113\/JP272979","article-title":"The impacts of age and frailty on heart rate and sinoatrial node function","volume":"594","author":"Moghtadaei","year":"2016","journal-title":"J Physiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib42","doi-asserted-by":"crossref","first-page":"37","DOI":"10.3389\/fphys.2015.00037","article-title":"Fibrosis: a structural modulator of sinoatrial node physiology and dysfunction","volume":"6","author":"Csepe","year":"2015","journal-title":"Front Physiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib43","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1093\/oxfordjournals.eurheartj.a060792","article-title":"Age-related changes in structure and relative collagen content of the human and feline sinoatrial node: a comparative study","volume":"16","author":"Alings","year":"1995","journal-title":"Eur Heart J"},{"key":"10.1016\/j.hrthm.2024.02.050_bib44","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.yjmcc.2009.08.023","article-title":"Structural remodelling of the sinoatrial node in obese old rats","volume":"48","author":"Yanni","year":"2010","journal-title":"J Mol Cell Cardiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib45","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1093\/eurheartj\/14.9.1278","article-title":"Electrophysiology of the ageing rabbit and cat sinoatrial node\u2014a comparative study","volume":"14","author":"Alings","year":"1993","journal-title":"Eur Heart J"},{"key":"10.1016\/j.hrthm.2024.02.050_bib46","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.mad.2015.10.003","article-title":"Age-dependent alterations of voltage-gated Na+ channel isoforms in rat sinoatrial node","volume":"152","author":"Huang","year":"2015","journal-title":"Mech Ageing Dev"},{"key":"10.1016\/j.hrthm.2024.02.050_bib47","first-page":"76P","article-title":"A hypothesis to explain the decline of sinoatrial node function with age","volume":"511","author":"Zhang","year":"1998","journal-title":"J Physiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib48","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1113\/expphysiol.2011.057752","article-title":"Ageing-dependent remodelling of ion channel and Ca2+ clock genes underlying sinoatrial node pacemaking","volume":"96","author":"Tellez","year":"2011","journal-title":"Exp Physiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib49","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1161\/CIRCULATIONAHA.106.663070","article-title":"Declining into failure: the age-dependent loss of the L-type calcium channel within the sinoatrial node","volume":"115","author":"Jones","year":"2007","journal-title":"Circulation"},{"key":"10.1016\/j.hrthm.2024.02.050_bib50","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1161\/CIRCRESAHA.109.206078","article-title":"A coupled SYSTEM of intracellular Ca2+ clocks and surface membrane voltage clocks controls the timekeeping mechanism of the heart\u2019s pacemaker","volume":"106","author":"Lakatta","year":"2010","journal-title":"Circ Res"},{"key":"10.1016\/j.hrthm.2024.02.050_bib51","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1007\/s00395-007-0660-5","article-title":"Age-related down-regulation of HCN channels in rat sinoatrial node","volume":"102","author":"Huang","year":"2007","journal-title":"Basic Res Cardiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib52","doi-asserted-by":"crossref","first-page":"18011","DOI":"10.1073\/pnas.1308477110","article-title":"Depressed pacemaker activity of sinoatrial node myocytes contributes to the age-dependent decline in maximum heart rate","volume":"110","author":"Larson","year":"2013","journal-title":"Proc Natl Acad Sci U S A"},{"key":"10.1016\/j.hrthm.2024.02.050_bib53","doi-asserted-by":"crossref","DOI":"10.3389\/fphys.2020.546508","article-title":"Cardiac pacemaker dysfunction arising from different studies of ion channel remodeling in the aging rat heart","volume":"11","author":"Alghamdi","year":"2020","journal-title":"Front Physiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib54","unstructured":"Heath TL, ed. Euclid\u2019s Elements, Book I, Common Notion 5. New York: Dover; 1956."},{"key":"10.1016\/j.hrthm.2024.02.050_bib55","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1136\/pgmj.2004.021493","article-title":"Arrhythmias in an athlete: the effect of de-training","volume":"81","author":"Obel","year":"2005","journal-title":"Postgrad Med J"},{"key":"10.1016\/j.hrthm.2024.02.050_bib56","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/S0167-5273(98)00102-8","article-title":"Cardiovascular adaptations to endurance training and detraining in young and older athletes","volume":"65","author":"Giada","year":"1998","journal-title":"Int J Cardiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib57","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/00005768-200103000-00013","article-title":"Cardiorespiratory and metabolic characteristics of detraining in humans","volume":"33","author":"Mujika","year":"2001","journal-title":"Med Sci Sports Exerc"},{"key":"10.1016\/j.hrthm.2024.02.050_bib58","first-page":"117","article-title":"Cardiovascular future of athletes","volume":"29","author":"Murayama","year":"1980","journal-title":"Jpn J Phys Fit Sports Med"},{"key":"10.1016\/j.hrthm.2024.02.050_bib59","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/0002-8703(75)90421-4","article-title":"Wenckebach A-V block: a frequent feature following heavy physical training","volume":"90","author":"Meytes","year":"1975","journal-title":"Am Heart J"},{"key":"10.1016\/j.hrthm.2024.02.050_bib60","doi-asserted-by":"crossref","first-page":"3","DOI":"10.5958\/2394-2061.2021.00008.2","article-title":"Psychological ramifications of detraining effects in sportspersons amidst the COVID-19 pandemic: a consensus compendium","volume":"12","author":"Kizhakkekara","year":"2020","journal-title":"Open J Psychiatry Allied Sci"},{"key":"10.1016\/j.hrthm.2024.02.050_bib61","doi-asserted-by":"crossref","DOI":"10.3389\/fspor.2021.603415","article-title":"Psychological impact of the COVID-19 pandemic on athletes","volume":"3","author":"Uroh","year":"2021","journal-title":"Front Sports Act Living"},{"key":"10.1016\/j.hrthm.2024.02.050_bib62","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/s40279-012-0013-x","article-title":"Exercise addiction","volume":"43","author":"Landolfi","year":"2012","journal-title":"Sports Med"},{"key":"10.1016\/j.hrthm.2024.02.050_bib63","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.physbeh.2016.01.028","article-title":"Exercise deprivation increases negative mood in exercise-addicted subjects and modifies their biochemical markers","volume":"156","author":"Antunes","year":"2016","journal-title":"Physiol Behav"},{"key":"10.1016\/j.hrthm.2024.02.050_bib64","first-page":"450","article-title":"Pacemaker safety and long-distance running","volume":"12","author":"Bennekers","year":"2004","journal-title":"Neth Heart J"},{"key":"10.1016\/j.hrthm.2024.02.050_bib65","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.eupc.2004.10.003","article-title":"\u201cCardioneuroablation\u201d\u2014new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation","volume":"7","author":"Pachon-M","year":"2005","journal-title":"Europace"},{"key":"10.1016\/j.hrthm.2024.02.050_bib66","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCEP.120.008703","article-title":"Long-term evaluation of the vagal denervation by cardioneuroablation using Holter and heart rate variability","volume":"13","author":"Pachon-M","year":"2020","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib67","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.hrcr.2020.01.006","article-title":"Cardioneuroablation instead of pacemaker implantation in a young patient suffering from permanent 2:1 atrioventricular block after a slow pathway ablation","volume":"6","author":"Bulava","year":"2020","journal-title":"HeartRhythm Case Rep"},{"key":"10.1016\/j.hrthm.2024.02.050_bib68","first-page":"33","article-title":"Cardioneuroablation in the treatment of neurally mediated reflex syncope: a review of the current literature","volume":"45","author":"Aksu","year":"2017","journal-title":"Turk Kardiyol Dern Ars"},{"key":"10.1016\/j.hrthm.2024.02.050_bib69","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1016\/j.hrthm.2019.08.008","article-title":"Cardioneuroablation for neurocardiogenic syncope","volume":"16","author":"Pachon-M","year":"2019","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.hrthm.2024.02.050_bib70","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph191610367","article-title":"Amateur athlete with sinus arrest and severe bradycardia diagnosed through a heart rate monitor: a six-year observation\u2014the necessity of shared decision-making in heart rhythm therapy management","volume":"19","author":"Gajda","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"10.1016\/j.hrthm.2024.02.050_bib71","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1038\/nrcardio.2014.178","article-title":"MicroRNAs and atrial fibrillation: mechanisms and translational potential","volume":"12","author":"Luo","year":"2015","journal-title":"Nat Rev Cardiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib72","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1089\/nat.2020.0871","article-title":"Efficiency and target derepression of anti-miR-92a: results of a first in human study","volume":"30","author":"Abplanalp","year":"2020","journal-title":"Nucleic Acid Ther"},{"key":"10.1016\/j.hrthm.2024.02.050_bib73","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1093\/eurheartj\/ehaa898","article-title":"Novel antisense therapy targeting microRNA-132 in patients with heart failure: results of a first-in-human Phase 1b randomized, double-blind, placebo-controlled study","volume":"42","author":"T\u00e4ubel","year":"2021","journal-title":"Eur Heart J"},{"key":"10.1016\/j.hrthm.2024.02.050_bib74","doi-asserted-by":"crossref","first-page":"9835","DOI":"10.1038\/s41598-020-66673-8","article-title":"Inhibition of G protein-gated K+ channels by tertiapin-Q rescues sinus node dysfunction and atrioventricular conduction in mouse models of primary bradycardia","volume":"10","author":"Bidaud","year":"2020","journal-title":"Sci Rep"},{"key":"10.1016\/j.hrthm.2024.02.050_bib75","doi-asserted-by":"crossref","first-page":"4664","DOI":"10.1038\/ncomms5664","article-title":"Cardiac arrhythmia induced by genetic silencing of \u2018funny\u2019 (f) channels is rescued by GIRK4 inactivation","volume":"5","author":"Mesirca","year":"2014","journal-title":"Nat Commun"},{"key":"10.1016\/j.hrthm.2024.02.050_bib76","doi-asserted-by":"crossref","first-page":"E932","DOI":"10.1073\/pnas.1517181113","article-title":"G protein-gated IKACh channels as therapeutic targets for treatment of sick sinus syndrome and heart block","volume":"113","author":"Mesirca","year":"2016","journal-title":"Proc Natl Acad Sci U S A"},{"key":"10.1016\/j.hrthm.2024.02.050_bib77","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1042\/BJ20082055","article-title":"AMPK and the biochemistry of exercise: implications for human health and disease","volume":"418","author":"Richter","year":"2009","journal-title":"Biochem J"},{"key":"10.1016\/j.hrthm.2024.02.050_bib78","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1038\/s41467-017-01342-5","article-title":"Mammalian \u03b32 AMPK regulates intrinsic heart rate","volume":"8","author":"Yavari","year":"2017","journal-title":"Nat Commun"},{"key":"10.1016\/j.hrthm.2024.02.050_bib79","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1113\/jphysiol.2014.284356","article-title":"CrossTalk opposing view: bradycardia in the trained athlete is attributable to a downregulation of a pacemaker channel in the sinus node","volume":"593","author":"D\u2019Souza","year":"2015","journal-title":"J Physiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib80","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1111\/j.1365-2869.2007.00581.x","article-title":"Robust circadian rhythm in heart rate and its variability: influence of exogenous melatonin and photoperiod","volume":"16","author":"Vandewalle","year":"2007","journal-title":"J Sleep Res"},{"key":"10.1016\/j.hrthm.2024.02.050_bib81","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1186\/s12872-017-0572-8","article-title":"Normal limits of the electrocardiogram derived from a large database of Brazilian primary care patients","volume":"17","author":"Palhares","year":"2017","journal-title":"BMC Cardiovasc Disord"},{"key":"10.1016\/j.hrthm.2024.02.050_bib82","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1111\/j.0954-6820.1975.tb19555.x","article-title":"Treatment of sinoatrial syndrome with permanent cardiac pacing in 90 patients","volume":"198","author":"H\u00e4rtel","year":"1975","journal-title":"Acta Med Scand"},{"key":"10.1016\/j.hrthm.2024.02.050_bib83","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/S0735-1097(02)01722-9","article-title":"Intrinsic sinus and atrioventricular node electrophysiologic adaptations in endurance athletes","volume":"39","author":"Stein","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib84","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/0002-9149(80)90163-0","article-title":"The heart of a dancer: noninvasive cardiac evaluation of professional ballet dancers","volume":"45","author":"Cohen","year":"1980","journal-title":"Am J Cardiol"},{"key":"10.1016\/j.hrthm.2024.02.050_bib85","first-page":"290","article-title":"Electrocardiographic findings in athletic students and sedentary controls","volume":"79","author":"Bj\u00f8rnstad","year":"1991","journal-title":"Cardiology"},{"key":"10.1016\/j.hrthm.2024.02.050_bib86","first-page":"42","article-title":"Ambulatory electrocardiographic findings in top athletes, athletic students and control subjects","volume":"84","author":"Bj\u00f8rnstad","year":"1994","journal-title":"Cardiology"},{"key":"10.1016\/j.hrthm.2024.02.050_bib87","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1136\/bjsm.33.5.319","article-title":"Electrocardiographic changes in 1000 highly trained junior elite athletes","volume":"33","author":"Sharma","year":"1999","journal-title":"Br J Sports Med"}],"container-title":["Heart Rhythm"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1547527124002224?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1547527124002224?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T20:31:40Z","timestamp":1778617900000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1547527124002224"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8]]},"references-count":85,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["S1547527124002224"],"URL":"https:\/\/doi.org\/10.1016\/j.hrthm.2024.02.050","relation":{},"ISSN":["1547-5271"],"issn-type":[{"value":"1547-5271","type":"print"}],"subject":[],"published":{"date-parts":[[2024,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Symptomatic bradyarrhythmias in the athlete\u2014Underlying mechanisms and treatments","name":"articletitle","label":"Article Title"},{"value":"Heart Rhythm","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.hrthm.2024.02.050","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2024 Heart Rhythm Society.","name":"copyright","label":"Copyright"}]}}