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Abstract: Aim: The aim of the study is to show the relationship existing between tissular Doppler imaging (TDI) parameters and functional capacity in highly trained subjects. Methods and patients: We therefore studied 46 patients including 22 untrained and 24 trained subjects. Each subject had pulsed TDI recording of systolic (S) and diastolic (E and A) longitudinal myocardial velocities in the basal portion of the RV free wall (RV), the septum (sep) and the LV free wall (LV) from apical 4C view. Athletes underwent the same day a cardiopulmonary test during which we measured peak (ml/kg/min) and anaerobic threshold (AT, ml/kg/min) and calculated slope. We studied differences between echocardiographic parameters in the two groups using Student test. Coefficients of correlations were calculated using the Spearman method. Results: Differences between two groups concerned Tei index of right (RV) and left ventricle (LV), telediastolic diameter of LV, and A waves on each wall. In athletes RV, sep and LV S waves did not correlate with , AT or RV, sep and LV A waves correlated significantly and negatively with , RV and sep A waves negatively with AT, and sep and LV A waves positively with . Conclusion: In athletes, atrial function shows a negative relationship with cardiopulmonary exercise parameters: the lower the proportion of LV filling due to atrial contraction, the better the level of functional capacity. This is probably due to myocardial structure, which allows more efficient early filling in hypertrophic athlete''s heart. [Copyright &y& Elsevier]

Abstract: The significance of atrial fibrillation (AF) in idiopathic dilated cardiomyopathy (IDCM) remains discussed. The purpose of the study was to evaluate the clinical significance of permanent atrial fibrillation in patients with IDCM. Methods: Systematic noninvasive and invasive studies including Holter monitoring, measurement of left ventricular ejection fraction (LVEF), electrophysiological study and coronary angiography were performed in 323 patients with IDCM; all patients had a left ventricular ejection fraction (LVEF)<40%. The studies were indicated for spontaneous ventricular tachycardia (VT) in 69 patients, syncope in 103 patients and nonsustained VT on Holter monitoring in 151 asymptomatic patients. Sixty-five patients were in permanent AF (group I). Remaining patients were in sinus rhythm at the time of evaluation (group II). Programmed ventricular stimulation using up to 3 extrastimuli in control state and if necessary after isoproterenol was systematic. Patients were followed 3±2 years. Results: Mean age was significantly older in group I (61±8 years) than in group II (52±12) (P <0.01). Syncope (31 vs 36%), spontaneous sustained VT (18 vs 23%); mean LVEF (28±9% vs 29±9%), VT induction (25 vs 35%) were similar in both groups. During the follow-up, there were no statistical differences between groups I and II concerning each event: sudden death occurred in 13 patients, 1.5% of group I patients and 5% of group II patients (NS); a death related to heart failure occurred 22 patients, 5% of group I patients and 7% of group II patients (NS); heart transplantation was performed in 13 patients, 8% of group I patients and 3% of group II patients (NS). Conclusions: An older age is the only significant clinical factor associated with the presence of a permanent atrial fibrillation in idiopathic dilated cardiomyopathy. The presence of permanent AF does not increase the induction of a sustained ventricular tachycardia and does not affect the general prognosis of IDCM. [Copyright &y& Elsevier]

Abstract: In industrialized countries, the number of atrial fibrillation (AF) catheter ablation procedures regularly increases every year, but these interventions are still time consuming and complex, especially for chronic AF. The stakes in the future are twofold : to reduce the duration of each ablation procedure and to increase the success rate for the more difficult AF ablation cases (i.e. : chronic AF), but with the lowest possible complications rate. Some technological improvements may contribute to reach these goals. Intracardiac 3D mapping and navigation systems as well as robotic-assisted catheter manipulation are available and these technologies are regularly upgraded. These systems are helpful both in catheter manoeuvring and repositioning as well as in the understanding of arrhythmia circuits and the definition ablation targets. In addition, these systems are equipped with software specially designed for automatic electrogram analysis to identify myocardial areas which may play a role in the maintenance of chronic AF. Cardiac imaging, such as MRI, may also help identifying arrhythmogenic areas in patients with chronic AF, with subsequent MRI 3D images integrated into a 3D mapping / navigation system. Several companies have invested on the research and development of ablation catheters aiming both at the reduction of procedure time as well as the improvement of the quality of the created lesions, especially with ‘smart’catheters which can appreciate wall contact quality. Whatever the type of catheter shape or type of energy used, technological improvement is needed before the expected efficacy is reached. [Copyright &y& Elsevier]