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

Abstract

Objectives: To assess atrial fibrillation (AF) burden, symptoms and quality of life (QoL) in endurance athletes with paroxysmal AF.

Design: Prospective cohort study.

Setting and participants: 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.

Methods: 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 <80 defined as clinically relevant.

Results: 43 athletes (age 57±10 (mean±SD), range 33-75 years, 3 women) were included. The athletes were monitored for 50±18 days. Median AF burden was 0.18% (IQR 0%-2.6%). Out of 29 athletes with at least one AF episode, 21 (72%) had AF episodes >60 min. 13 athletes (30%) had AFEQT overall score <80, indicating reduced QoL, and 23 athletes (53%) had significant symptoms. AF burden above median, and episodes >60 min 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.

Conclusions: 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.

Trial registration number: NCT04991337.

Keywords: Adult cardiology; CARDIOLOGY; Quality of Life; SPORTS MEDICINE.

Figure 1. Insertable cardiac monitor (ICM) report from an endurance athlete in the study, demonstrating detection of an atrial fibrillation (AF) episode. (A) Time in seconds (x-axis) and heart rate in beats per minute (bpm) (y-axis). The report shows an initial regular heart rate of ~50 bpm, followed by a sudden change to complete irregular rhythm. (B) The corresponding EGM demonstrating initial sinus rhythm, followed by irregular rhythm that triggers the ICM to recognise the rhythm as AF.

Figure 2. Mean Atrial Fibrillation Effect on QualiTy-of-Life Questionnaire (AFEQT) overall scores (0–100) across three categories of atrial fibrillation (AF) burden (percent of time in AF) in endurance athletes with paroxysmal AF; (0% (n=14), 0.001%–1% (n=13) and >1% (n=16).

Figure 3. Mean Atrial Fibrillation Effect on QualiTy-of-Life Questionnaire (AFEQT) overall scores (0–100) in endurance athletes with paroxysmal atrial fibrillation (AF) (n=43) across categories of at least one AF episode lasting >60 min (n=21) or all episodes with duration ≤60 min (n=22).

Figure 4. Atrial fibrillation (AF) burden in % (red columns), Atrial Fibrillation Effect on QualiTy-of-Life Questionnaire (AFEQT) overall scores range 0–100 (blue columns) and history of previous AF ablation (marked with an ‘A’) for each of the 43 endurance athletes participating in the study.