{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:36:49Z","timestamp":1792798609016,"version":"4.5.0"},"reference-count":35,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The Norwegian Health Association, Norway","award":["Not available"],"award-info":[{"award-number":["Not available"]}]},{"name":"Vestre Viken Hospital Trust, Norway","award":["Not available"],"award-info":[{"award-number":["Not available"]}],"id":[{"id":"https:\/\/ror.org\/03wgsrq67","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,24]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess atrial fibrillation (AF) burden, symptoms and quality of life (QoL) in endurance athletes with paroxysmal AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>Otherwise healthy endurance athletes with paroxysmal AF in Norway, Australia and Belgium. The current study presents baseline measurements collected before the intervention of a randomised controlled trial on effects of individually tailored training adaptation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>AF burden (percentage time in AF) was measured by insertable cardiac monitors (Confirm Rx, Abbott). AF-related symptoms and QoL were assessed using the Atrial Fibrillation Effect on QualiTy-of-Life Questionnaire (AFEQT) with any score &lt;80 defined as clinically relevant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>43 athletes (age 57\u00b110 (mean\u00b1SD), range 33\u201375 years, 3\u2009women) were included. The athletes were monitored for 50\u00b118 days. Median AF burden was 0.18% (IQR 0%\u20132.6%). Out of 29 athletes with at least one AF episode, 21 (72%) had AF episodes &gt;60\u2009min. 13 athletes (30%) had AFEQT overall score &lt;80, indicating reduced QoL, and 23 athletes (53%) had significant symptoms. AF burden above median, and episodes &gt;60\u2009min were associated with reduced QoL (mean AFEQT score 78 vs 90, p=0.001 and 78 vs 90, p=0.001, respectively). There were large individual variations between the athletes concerning AF burden, symptoms and QoL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although most athletes were still competing, more than half had troublesome symptoms. One-third had reduced QoL, which was associated with higher AF burden and longer duration of AF episodes. Variations between the athletes highlight the need for individually tailored AF management in athletes with paroxysmal AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04991337\">NCT04991337<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-100496","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T18:25:46Z","timestamp":1754418346000},"page":"e100496","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Arrhythmia burden, symptoms and quality of life in female and male endurance athletes with paroxysmal atrial fibrillation: a multicentre cohort study in Norway, Australia and Belgium"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct04991337","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04991337","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04991337","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9638-7681","authenticated-orcid":false,"given":"Turid","family":"Apelland","sequence":"first","affiliation":[{"name":"Department of Medical Research, B\u00e6rum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway"},{"name":"Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2877-9904","authenticated-orcid":false,"given":"Jon Magne","family":"Letnes","sequence":"additional","affiliation":[{"name":"Clinic of Cardiology, Trondheim University Hospital St Olav\u2019s Hospital, Trondheim, Norway"},{"name":"Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3176-6751","authenticated-orcid":false,"given":"Kristel","family":"Janssens","sequence":"additional","affiliation":[{"name":"HEART Laboratory, St Vincent\u2019s Institute of Medical Research, Melbourne, Victoria, Australia"},{"name":"Exercise and Nutrition Research Program, Australian Catholic University, Mary MacKillop Institute for Health Research, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Claessen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, KU Leuven, Leuven, Belgium"},{"name":"Faculty of Medicine and Life Sciences, Biomedical Research Institute, Diepenbeek, Belgium"},{"name":"Department of Cardiology, Jessa Hospital Hassel, Hasselt, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnljot","family":"Tveit","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway"},{"name":"Department of Medical Research, B\u00e6rum sykehus, Gjettum, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas Berg","family":"Sellevold","sequence":"additional","affiliation":[{"name":"Clinic of Cardiology, Trondheim University Hospital St Olav\u2019s Hospital, Trondheim, Norway"},{"name":"Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Mitchell","sequence":"additional","affiliation":[{"name":"HEART Laboratory, St Vincent\u2019s Institute of Medical Research, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rik","family":"Willems","sequence":"additional","affiliation":[{"name":"Cardiology, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium"},{"name":"Cardiovascular Sciences, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Onarheim","sequence":"additional","affiliation":[{"name":"Department of Medical Research, B\u00e6rum sykehus, Gjettum, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Enger","sequence":"additional","affiliation":[{"name":"Department of Medical Research, B\u00e6rum sykehus, Gjettum, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevda Ece","family":"Kizilkilic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Life Sciences, Biomedical Research Institute, Diepenbeek, Belgium"},{"name":"Ghent University Faculty of Sciences, Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6568-451X","authenticated-orcid":false,"given":"Hielko","family":"Miljoen","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospital Antwerp, Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Elliott","sequence":"additional","affiliation":[{"name":"Discipline of Physiology, University of Adelaide, Adelaide, South Australia, Australia"},{"name":"Medical Research Institute, Royal Adelaide Hospital, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Pal","family":"Loennechen","sequence":"additional","affiliation":[{"name":"Clinic of Cardiology, Trondheim University Hospital St Olav\u2019s Hospital, Trondheim, Norway"},{"name":"Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"La Gerche","sequence":"additional","affiliation":[{"name":"St Vincent\u2019s Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia"},{"name":"St Vincent\u2019s Institute of Medical Research, Fitzroy, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9682-5255","authenticated-orcid":false,"given":"Marius","family":"Myrstad","sequence":"additional","affiliation":[{"name":"Department of Medical Research, B\u00e6rum sykehus, Gjettum, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,5]]},"reference":[{"key":"2025123106452883000_15.8.e100496.1","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1093\/europace\/eux294","article-title":"The athlete\u2019s heart is a proarrhythmic heart, and what that means for clinical decision making","volume":"20","author":"Heidbuchel","year":"2018","journal-title":"Europace"},{"key":"2025123106452883000_15.8.e100496.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.07.014"},{"key":"2025123106452883000_15.8.e100496.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht188"},{"key":"2025123106452883000_15.8.e100496.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.07.047"},{"key":"2025123106452883000_15.8.e100496.5","unstructured":"Gelder IC Rienstra M , Bunting KV , et al . ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024."},{"key":"2025123106452883000_15.8.e100496.6","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.1093\/eurjpc\/zwad218","article-title":"Atrial fibrillation in female endurance athletes","volume":"31","author":"Myrstad","year":"2023","journal-title":"Eur J Prev Cardiol"},{"key":"2025123106452883000_15.8.e100496.7","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2022-106035"},{"key":"2025123106452883000_15.8.e100496.8","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1177\/2047487318754930","article-title":"The ambiguity of physical activity, exercise and atrial fibrillation","volume":"25","author":"Morseth","year":"2018","journal-title":"Eur J Prev Cardiol"},{"key":"2025123106452883000_15.8.e100496.9","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1038\/s41569-022-00820-8","article-title":"Epidemiology and modifiable risk factors for atrial fibrillation","volume":"20","author":"Elliott","year":"2023","journal-title":"Nat Rev Cardiol"},{"key":"2025123106452883000_15.8.e100496.10","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1016\/j.hlc.2020.11.007","article-title":"Factors Contributing to Exercise Intolerance in Patients With Atrial Fibrillation","volume":"30","author":"Elliott","year":"2021","journal-title":"Heart Lung Circ"},{"key":"2025123106452883000_15.8.e100496.11","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz897"},{"key":"2025123106452883000_15.8.e100496.12","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1007\/s00392-015-0898-0","article-title":"Physical activity, symptoms, medication and subjective health among veteran endurance athletes with atrial fibrillation","volume":"105","author":"Myrstad","year":"2016","journal-title":"Clin Res Cardiol"},{"key":"2025123106452883000_15.8.e100496.13","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1177\/2047487320925635","article-title":"Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions: Part 1: Supraventricular arrhythmias. A Position Statement of the Section of Sports Cardiology and Exercise from the European Association of Preventive Cardiology (EAPC) and the European Heart Rhythm Association (EHRA), Both Associations of the European Society of Cardiology","volume":"28","author":"Heidbuchel","year":"2021","journal-title":"Eur J Prev Cardiol"},{"key":"2025123106452883000_15.8.e100496.14","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2020","journal-title":"Eur Heart J"},{"key":"2025123106452883000_15.8.e100496.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2020.05.009"},{"key":"2025123106452883000_15.8.e100496.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2020.06.013"},{"key":"2025123106452883000_15.8.e100496.17","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eup320"},{"key":"2025123106452883000_15.8.e100496.18","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eur142"},{"key":"2025123106452883000_15.8.e100496.19","doi-asserted-by":"crossref","DOI":"10.1136\/bmjsem-2023-001541","article-title":"Effects of training adaption in endurance athletes with atrial fibrillation: protocol for a multicentre randomised controlled trial","volume":"9","author":"Apelland","year":"2023","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2025123106452883000_15.8.e100496.20","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/eurheartj\/ehaa605","article-title":"ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease","volume":"42","author":"Pelliccia","year":"2020","journal-title":"Eur Heart J"},{"key":"2025123106452883000_15.8.e100496.21","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.97.22.2283"},{"key":"2025123106452883000_15.8.e100496.22","doi-asserted-by":"publisher","DOI":"10.1097\/HJR.0b013e32833bo969"},{"key":"2025123106452883000_15.8.e100496.23","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ijcard.2016.10.047","article-title":"Atrial fibrillation in highly trained endurance athletes - Description of a syndrome","volume":"226","author":"Sanchis-Gomar","year":"2017","journal-title":"Int J Cardiol"},{"key":"2025123106452883000_15.8.e100496.24","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001193"},{"key":"2025123106452883000_15.8.e100496.25","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.110.958033"},{"key":"2025123106452883000_15.8.e100496.26","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1016\/j.jacep.2023.05.037","article-title":"Baseline Health Status and its Association With Subsequent Cardiovascular Events in Patients With Atrial Fibrillation","volume":"9","author":"Ikemura","year":"2023","journal-title":"JACC Clin Electrophysiol"},{"key":"2025123106452883000_15.8.e100496.27","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eut395"},{"key":"2025123106452883000_15.8.e100496.28","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1016\/j.echo.2022.06.008","article-title":"Right Heart Structure and Function in Lifelong Recreational Endurance Athletes with and without Paroxysmal Atrial Fibrillation","volume":"35","author":"S\u00f8rensen","year":"2022","journal-title":"J Am Soc Echocardiogr"},{"key":"2025123106452883000_15.8.e100496.29","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1093\/eurheartj\/ehac692","article-title":"Healthcare utilization and quality of life for atrial fibrillation burden: the CIRCA-DOSE study","volume":"44","author":"Andrade","year":"2023","journal-title":"Eur Heart J"},{"key":"2025123106452883000_15.8.e100496.30","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000568"},{"key":"2025123106452883000_15.8.e100496.31","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae373"},{"key":"2025123106452883000_15.8.e100496.32","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1016\/j.hlc.2023.08.009","article-title":"The Experiences of Endurance Athletes With Atrial Fibrillation: Tensions and Takeaways","volume":"32","author":"Galloway","year":"2023","journal-title":"Heart Lung Circ"},{"key":"2025123106452883000_15.8.e100496.33","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1016\/j.hlc.2023.11.001","article-title":"The Race to Improve Care for Athletes with Atrial Fibrillation","volume":"32","author":"Elliott","year":"2023","journal-title":"Heart Lung Circ"},{"key":"2025123106452883000_15.8.e100496.34","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.echo.2022.12.006","article-title":"Exercise-Induced Cardiac Remodeling and Atrial Fibrillation in Female Endurance Athletes","volume":"36","author":"Myrstad","year":"2023","journal-title":"J Am Soc Echocardiogr"},{"key":"2025123106452883000_15.8.e100496.35","unstructured":"Sietsema KE , Sue DY , Stringer WW , et al . Whipp\u2019s Principles of Exercise Testing and Interpretation: Including Pathophysiology and Clinical Applications. 6th edn. Philadelphia: Wolters Kluwer Health\/Lippincott Williams & Wilkins, 2020."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-100496","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T14:46:07Z","timestamp":1767192367000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-100496"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":35,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,5]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1136\/bmjopen-2025-100496"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-100496","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]}}}