Temporal Association Between Exercise and Arrhythmia Episodes in Endurance Athletes With Paroxysmal Atrial Fibrillation
Key result
Exercise sessions are not linked to increased AF rates in endurance athletes.
- n=47
Why the study?
Atrial fibrillation is prevalent in endurance athletes and many report exercise as a trigger for AF episodes, but the temporal association is unclear.
Does exercise trigger atrial fibrillation episodes in endurance athletes with paroxysmal AF?
Comparison
AF episodes during or after exercise sessions vs unrelated to exercise (>3 hours after)
Design
Observational study with continuous arrhythmia and exercise monitoring
Follow-up
Median 42 days (1008 hours)
Authors
Discussion
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Implication
May support continued exercise without restriction in endurance athletes with paroxysmal AF; leaves open whether activity modification alters outcomes.
Key Points
- To assess the temporal association between exercise sessions and arrhythmia episodes in endurance athletes diagnosed with paroxysmal atrial fibrillation.
- Interventional study (NCT04991337) evaluating 47 endurance athletes (mean age 57±10 years, range 33–75 years, 3 women) diagnosed with paroxysmal atrial fibrillation.
- Arrhythmia episodes were continuously tracked using insertable cardiac monitors over 55,994 total hours (median 1,008 hours [42 days]), alongside exercise tracking via sports watches and chest straps.
- Workouts were categorized by intensity using percentage of individual maximum heart rate: high intensity (76%–84%) and very high intensity (≥85%).
- Thirty-one athletes (66%) experienced a total of 1,445 atrial fibrillation episodes during monitoring, with 13 athletes (27%) experiencing episodes during exercise and 2 during high-intensity sessions.
- The event rate of atrial fibrillation per 24 hours was 0.34 (95% CI, 0.13–0.65) during exercise and 0.37 (95% CI, 0.10–0.71) within 3 hours post-exercise, compared to 0.61 (95% CI, 0.26–1.13) during non-exercise periods (>3 hours post-exercise).
- No exercise-related episodes of ventricular tachycardia were observed during the monitoring period.
Study Design
Type
Observational (n=47)
Structured PICO
Does exercise trigger atrial fibrillation episodes in endurance athletes with paroxysmal AF?
P
Population
47 endurance athletes (mean age 57, 6.4% female) with paroxysmal atrial fibrillation monitored for a median of 42 days.
E
Exposure
Exercise sessions (monitored via sports watches and chest straps)
C
Comparator
Periods unrelated to exercise (>3 hours after exercise)
O
Outcome
Event rates of atrial fibrillation per 24 hours and temporal relation of arrhythmias with exercise sessionssurrogate
Main Result
Absolute Event Rate: 0.34% vs 0.61%
In endurance athletes with paroxysmal AF, exercise sessions were not associated with an increased rate of AF episodes during or immediately following the activity.
Cite This Study
Apelland et al. (2026) conducted an observational in Paroxysmal Atrial Fibrillation (n=47). Exercise sessions vs. Periods unrelated to exercise (>3 hours after) was evaluated on Event rate of AF per 24 hours. Exercise sessions in endurance athletes with paroxysmal AF did not increase the AF event rate during (0.34 per 24 hours) or following exercise (0.37) compared to unrelated periods (0.61).