Search

BACKGROUND: Little is known about genome-wide changes in the atrial transcriptome as a cause or consequence of atrial fibrillation (AF), and the effect of its common and clinically relevant comorbidity, heart failure (HF).OBJECTIVE: To explore candidate disease processes for atrial fibrillation, we investigated gene expression changes in atrial tissue samples from patients with and without AF, stratified by HF.METHODS: RNA sequencing was performed in right and left atrial appendage tissue in 195 patients undergoing open-heart surgery from centers participating in the CATCH-ME consortium (no history of AF (n=91), paroxysmal AF (n=53) and persistent/permanent AF (n=51)). Analyses were stratified into patients with and without HF (n=75/120), and adjusted for age, sex, atrial side, and a combination of clinical characteristics.RESULTS: We identified 35 genes associated with persistent AF compared to patients without a history of AF, both in the presence or absence of HF (false discovery rateCONCLUSIONS: Analysis of atrial gene expression profiles identified numerous novel genes associated with persistent AF, in presence or absence of HF. Interestingly, no consistent transcriptional changes were associated with paroxysmal AF, suggesting that AF-induced changes in gene expression predominate other changes.

Aims The risk of developing atrial fibrillation (AF) and its complications continues to increase, despite good progress in preventing AF-related strokes. Methods and results This article summarizes the outcomes of the 7th Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA) held in Lisbon in March 2019. Sixty-five international AF specialists met to present new data and find consensus on pressing issues in AF prevention, management and future research to improve care for patients with AF and prevent AF-related complications. This article is the main outcome of an interactive, iterative discussion between breakout specialist groups and the meeting plenary. AF patients have dynamic risk profiles requiring repeated assessment and risk-based therapy stratification to optimize quality of care. Interrogation of deeply phenotyped datasets with outcomes will lead to a better understanding of the cardiac and systemic effects of AF, interacting with comorbidities and predisposing factors, enabling stratified therapy. New proposals include an algorithm for the acute management of patients with AF and heart failure, a call for a refined, data-driven assessment of stroke risk, suggestions for anticoagulation use in special populations, and a call for rhythm control therapy selection based on risk of AF recurrence. Conclusion The remaining morbidity and mortality in patients with AF needs better characterization. Likely drivers of the remaining AF-related problems are AF burden, potentially treatable by rhythm control therapy, and concomitant conditions, potentially treatable by treating these conditions. Identifying the drivers of AF-related complications holds promise for stratified therapy.

His bundle pacing was developed while seeking a physiological alternative to biventricular cardiac resynchronization therapy. However, His bundle pacing may not be adequate in all patients. In this scenario, left bundle branch pacing has arisen as a new cardiac resynchronization therapy modality to correct left bundle branch block and restore ventricular synchrony. (Level of Difficulty: Intermediate.), Graphical abstract

Europace : the European journal of pacing, arrhythmias and cardiac electrophysiology euac062 (2022). doi:10.1093/europace/euac062, Published by Oxford Univ. Press, Oxford

Cardiovascular research is in an ongoing quest for a superior imaging method to integrate gross-anatomical information with microanatomy, combined with quantifiable parameters of cardiac structure. In recent years, synchrotron radiation-based X-ray Phase Contrast Imaging (X-PCI) has been extensively used to characterize soft tissue in detail. The objective was to use X-PCI to comprehensively quantify ischemic remodeling of different myocardial structures, from cell to organ level, in a rat model of myocardial infarction. Myocardial infarction-induced remodeling was recreated in a well-established rodent model. Ex vivo rodent hearts were imaged by propagation based X-PCI using two configurations resulting in 5.8 µm and 0.65 µm effective pixel size images. The acquired datasets were used for a comprehensive assessment of macrostructural changes including the whole heart and vascular tree morphology, and quantification of left ventricular myocardial thickness, mass, volume, and organization. On the meso-scale, tissue characteristics were explored and compared with histopathological methods, while microstructural changes were quantified by segmentation of cardiomyocytes and calculation of cross-sectional areas. Propagation based X-PCI provides detailed visualization and quantification of morphological changes on whole organ, tissue, vascular as well as individual cellular level of the ex vivo heart, with a single, non-destructive 3D imaging modality., Scientific Reports, 11, ISSN:2045-2322

A model for High Pressure Grinding Rolls (HPGR) was developed in this work based on the widely used Population Balance Model (PBM). This approach uses a variety of different functions one of which is the breakage distribution function. The methodology to determine the function parameters is presented and using these values, the model was compared with real processed materials from an HPGR pilot plant, with tungsten ore as the test material. The results of the model parameter determination, and the product of the comminution in the HPGR, showed the dependency of material breakage on the material characteristics, and on the operative and process conditions. The model presented is reasonably robust, showing less error than the 3.0 Root Mean Square Error when compared with a heterogeneous feed particle size distribution material. The operational gap was also studied, and its dependency on the feed particle size, porosity, moisture, and specific pressing force was proven. Keywords: HPGR, Modelling, Breakage, Comminution

Obstructive sleep apnea syndrome (OSA) promotes aortic dilatation, increased stiffness and accelerated atherosclerosis, but the mechanisms of vascular remodelling are not known. We aimed to assess vascular remodelling, its mechanisms, and the effect of mesenchymal stem cells (MSC) infusions in a clinically relevant rat model of chronic OSA involving recurrent airway obstructions leading thoracic pressure swings and intermittent hypoxia/hypercapnia (OSA-rats). Another group of rats were placed in the same setup without air obstructions (Sham-rats) and were considered controls. Our study demonstrates that chronic, non-invasive repetitive airway obstructions mimicking OSA promote remarkable structural changes of the descending thoracic aorta such as eccentric aortic hypertrophy due to an increased wall thickness and lumen diameter, an increase in the number of elastin fibers which, in contrast, get ruptured, but no changes in tunica media fibrosis. As putative molecular mechanisms of the OSA-induced vascular changes we identified an increase in reactive oxygen species and renin-angiotensin system markers and an imbalance in oxide nitric synthesis. Our results also indicate that MSC infusion blunts the OSA-related vascular changes, most probably due to their anti-inflammatory properties.

Cardiovascular diseases (CVDs) affect the myocardium and vasculature, inducing remodelling of the heart from cellular to whole organ level. To assess their impact at micro and macroscopic level, multi-resolution imaging techniques that provide high quality images without sample alteration and in 3D are necessary: requirements not fulfilled by most of current methods. In this paper, we take advantage of the non-destructive time-efficient 3D multiscale capabilities of synchrotron Propagation-based X-Ray Phase Contrast Imaging (PB-X-PCI) to study a wide range of cardiac tissue characteristics in one healthy and three different diseased rat models. With a dedicated image processing pipeline, PB-X-PCI images are analysed in order to show its capability to assess different cardiac tissue components at both macroscopic and microscopic levels. The presented technique evaluates in detail the overall cardiac morphology, myocyte aggregate orientation, vasculature changes, fibrosis formation and nearly single cell arrangement. Our results agree with conventional histology and literature. This study demonstrates that synchrotron PB-X-PCI, combined with image processing tools, is a powerful technique for multi-resolution structural investigation of the heart ex-vivo. Therefore, the proposed approach can improve the understanding of the multiscale remodelling processes occurring in CVDs, and the comprehensive and fast assessment of future interventional approaches., Scientific Reports, 9, ISSN:2045-2322

Purpose We aimed to describe the use of high-flow nasal oxygen (HFNO) in patients with COVID-19 acute respiratory failure and factors associated with a shift to invasive mechanical ventilation. Methods This is a multicenter, observational study from a prospectively collected database of consecutive COVID-19 patients admitted to 36 Spanish and Andorran intensive care units (ICUs) who received HFNO on ICU admission during a 22-week period (March 12-August 13, 2020). Outcomes of interest were factors on the day of ICU admission associated with the need for endotracheal intubation. We used multivariable logistic regression and mixed effects models. A predictive model for endotracheal intubation in patients treated with HFNO was derived and internally validated. Results From a total of 259 patients initially treated with HFNO, 140 patients (54%) required invasive mechanical ventilation. Baseline non-respiratory Sequential Organ Failure Assessment (SOFA) score [odds ratio (OR) 1.78; 95% confidence interval (CI) 1.41-2.35], and the ROX index calculated as the ratio of partial pressure of arterial oxygen to inspired oxygen fraction divided by respiratory rate (OR 0.53; 95% CI: 0.37-0.72), and pH (OR 0.47; 95% CI: 0.24-0.86) were associated with intubation. Hospital site explained 1% of the variability in the likelihood of intubation after initial treatment with HFNO. A predictive model including non-respiratory SOFA score and the ROX index showed excellent performance (AUC 0.88, 95% CI 0.80-0.96). Conclusions Among adult critically ill patients with COVID-19 initially treated with HFNO, the SOFA score and the ROX index may help to identify patients with higher likelihood of intubation.

[EN] Background Multipoint pacing (MPP) in cardiac resynchronization therapy (CRT) activates the left ventricle from two locations, thereby shortening the QRS duration and enabling better resynchronization; however, compared with conventional CRT, MPP reduces battery longevity. On the other hand, electrocardiogram-based optimization using the fusion-optimized intervals (FOI) method achieves more significant reverse remodeling than nominal CRT programming. Our study aimed to determine whether MPP could attain better resynchronization than single-point pacing (SPP) optimized by FOI. Methods This prospective study included 32 consecutive patients who successfully received CRT devices with MPP capabilities. After implantation, the QRS duration was measured during intrinsic rhythm and with three pacing configurations: MPP, SPP-FOI, and MPP-FOI. In 14 patients, biventricular activation times (by electrocardiographic imaging, ECGI) were obtained during intrinsic rhythm and for each pacing configuration to validate the findings. Device battery longevity was estimated at the 45-day follow-up. Results The SPP-FOI method achieved greater QRS shortening than MPP (-56 +/- 16 vs. -42 +/- 17 ms, p < .001). Adding MPP to the best FOI programming did not result in further shortening (MPP-FOI: -58 +/- 14 ms, p = .69). Although biventricular activation times did not differ significantly among the three pacing configurations, only the two FOI configurations achieved significant shortening compared with intrinsic rhythm. The estimated battery longevity was longer with SPP than with MPP (8.1 +/- 2.3 vs. 6.3 +/- 2.0 years, p = .03). Conclusions SPP optimized by FOI resulted in better resynchronization and longer battery duration than MPP., Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares, Grant/Award Number: CB16/11/00354; Instituto de Salud Carlos III, Grant/Award Numbers: DTS16/0160, PI16/00435, PI16/00703, PI17/01059, PI17/01106; Sociedad Espanola de Cardiologia, Grant/Award Numbers: 2018, SEC_ESTIM_01; Agencia deGestio d'Ajuts Universitaris i de Recerca, Grant/AwardNumber: 2017_SGR_1548; Fundacio laMarato de TV3, Grant/Award Number: 20152730; Horizon 2020 Framework Programme, Grant/Award Number: 633196 - CATCH MEproject; European Regional Development Fund, Grant/Award Number: EITHealth 19600 AFFINE

It is a well-known fact that the value of the Bond work index (wi) for a given ore varies along with the grinding size. In this study, a variability bysis is carried out with the Bond standard grindability tests on different critical metal ores (W, Ta), ranging from coarse grinding (rod mills) to fine grinding (ball mills). The relationship between wi and grinding size did not show a clear correlation, while the grindability index (gpr) and the grinding size showed a robust correlation, fitting in all cases to a quadratic curve with a very high regression coefficient. This result suggests that, when performing correlation studies among ore grindability and rock mechanics parameters, it is advised to use the grindability index instead of the Bond work index.

The purpose of this work is to analyse changes in ECG and heart rate variability (HRV) metrics in athletes during 10 km running in mountain route conditions. Eighteen healthy athletes carrying a 12-lead ECG GE Holter recorder and a heart rate monitor ran a route with slopes similar as trail races. QRS duration, QRS area, R-wave peak, ST elevation at J-point and J+60 ms, ST slope and T-wave peak indices were computed after signal-averaging ECG segments at different sloping stages of running (S1-S6) and at a control stage (S0) before running. HRV analysis included standard time and frequency metrics: mean RR (normal, N) interval, SDNN, RMSSD, low and high frequency absolute and normalized power (LF, HF, LFn, HFn) and LF/HF ratio. QRS area and R-peak were reduced during stage 1 in lateral leads, comparing to rest before running. ST slope was significantly higher during upslope stages in leads II, V4 and V5. T-wave amplitude increased significantly in precordial leads during upload running. ST segment depressed in leads II, III and V5 respect control. Mean RR, SDNN, LF and LFn showed high significant differences (p

An improved approach is presented to model the product particle size distribution resulting from grinding in high-pressure roll crusher with the aim to be used in standard high-pressure grinding rolls (HPGR). This approach uses different breakage distribution function parameter values for a single particle compression condition and a bed compression condition. Two materials were used for the experiments, altered Ta-bearing granite and a calc-silicate tungsten ore. A set of experiments was performed with constant operative conditions, while varying a selected condition to study the influence of the equipment set-up on the model. The material was comminuted using a previously determined specific pressing force, varying the feed particle size, roll speed and the static gap. A fourth group of experiments were performed varying the specific pressing force. Experimental results show the high performance of the comminution in a high-pressure environment. The static gap was the key in order to control the product particle size. A mathematical approach to predict the product particle size distribution is presented and it showed a good fit when compared to experimental data. This is the case when a narrow particle size fraction feed is used, but the fit became remarkably good with a multi-size feed distribution. However, when varying the specific pressing force in the case of the calc-silicate material, the results were not completely accurate. The hypothesis of simultaneous single particle compression and bed compression for different size ranges and with different parameters of the distribution function was probed and reinforced by various simulations that exchanged bed compression parameters over the single particle compression distribution function, and vice versa.

The Penouta Sn-Ta deposit, in the northwest of Spain, is a greisenized granitic cupola where Ta minerals occur mainly as disseminations in a leucogranite body intruded in Precambrian–Lower Cambrian gneisses and mica-schists. This leucogranite is a medium- to fine-grained inequigranular rock consisting mainly of quartz, albite, K-feldspar and muscovite. Accessory minerals are mainly of spessartine, zircon, cassiterite, Nb-Ta oxides, monazite, xenotime, native bismuth and pyrite. The alteration processes were mainly albitization, muscovitization and kaolinitization.This leucogranite is peraluminous and P-poor, with 0.03–0.07 wt.% P2O5, 900–1500 ppm Rb, 30–65 ppm Cs, 120–533 ppm Li, 80–140 ppm Ta, 51–81 ppm Nb and up to 569 ppm of Sn.Mineralogical characterization of Nb-Ta oxide minerals was determined by X-ray diffraction, scanning electron microscopy, electron microprobe analysis and mineral liberation analysis. Mn-rich members of the columbite-group minerals (CGM) are the most common Ta-bearing phases, but microlite, wodginite, tapiolite and Ta-rich cassiterite occur also. CGM crystals are commonly zoned concentrically, with a Nb-rich core surrounded by a Ta-rich rim, with a sharp boundary between them. Convoluted zoning occurs also. Dissolution textures resulting from the corrosion of columbite and tantalite rims, in particular, are common. The Mn/(Mn + Fe) ratio varies between 0.33 and 0.97 and the Ta/(Ta + Nb) ratio between 0.07 and 0.93. Wodginite and microlite formed as late replacements of CGM and occur associated with tantalite and cassiterite. Subhedral to anhedral cassiterite crystals, usually up to 200 μm across, occur in two generations: the earlier one is Nb,Ta-poor whereas in the later generation, the Ta content can reach >9 wt.% of Ta2O5and 1.7 wt.% of Nb. The presence of a fluid phase in the apical zone of the granite, probably related to the separation of a fluid/vapour of the melt, could explain the sponge-like textures, the Ta enrichment associated with these textures, the occurrence of Ta-enriched mineral phases (microlite and wodginite) and their common interstitial character.

The modelling of high pressure grinding rolls is described by the population balance model, a mass balance which includes several functions that are related to the mineral characteristics, material kinetics and operative conditions of the device. The breakage distribution function is one of these functions and refers to the way in which the daughter particles are generated by the process of comminution. The piston-die press is presented as a methodology to determine the breakage distribution function of two different materials, from the mechanical response point of view: altered granite and a cal-silicate material. The aim is to determine the relation between the operative conditions and the mineral characteristics in order to explain and predict the breakage function parameters. The materials were characterised using XRD and single compression strength tests. The altered granite is a brittle material, which generates more fines under single compression conditions compared to bed compression conditions, mainly due to the mineral composition and the response of the material to the breakage action. The cal-silicate material shows a normal trend in its breakage behaviour. As is expected, the mineralogical characterisation is a useful tool to predict the values of the parameters of the breakage distribution function.

There are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new approaches to screening and diagnosis, enhancing integration of AF care, developing clinical pathways for treating complex patients, improving stroke prevention strategies, and better patient selection for heart rate and rhythm control. Ultimately, these approaches can lead to better outcomes for patients with AF.

Aims: Left atrial (LA) fibrosis can be identified by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) in patients with atrial fibrillation (AF). However, there is limited information about anatomical fibrosis distribution in the left atrium. The aim is to determine whether there is a preferential spatial distribution of fibrosis in the left atrium in patients with AF. Methods and results: A 3-Tesla LGE-CMR was performed in 113 consecutive patients referred for AF ablation. Images were post-processed and analysed using ADAS-AF software (Galgo Medical), which allows fibrosis identification in 3D colour-coded shells. A regional semiautomatic LA parcellation software was used to divide the atrial wall into 12 segments: 1–4, posterior wall; 5–6, floor; 7, septal wall; 8–11, anterior wall; 12, lateral wall. The presence and amount of fibrosis in each segment was obtained for analysis. After exclusions for artefacts and insufficient image quality, 76 LGE-MRI images (68%) were suitable for fibrosis analysis. Segments 3 and 5, closest to the left inferior pulmonary vein, had significantly higher fibrosis (40.42% ± 23.96 and 25.82% ± 21.24, respectively; P 60 years was significantly associated with increased LA fibrosis [95% confidence interval (CI) 0.19–8.39, P = 0.04] and persistent AF approached significance (95% CI −0.19% to 7.83%, P = 0.08). Conclusion: In patients with AF, the fibrotic area is preferentially located at the posterior wall and floor around the antrum of the left inferior pulmonary vein. Age >60 years was associated with increased fibrosis. This work was partially supported by Fondo de Investigaciones Sanitarias-Instituto de Salud Carlos III (PI13/01747 and PI16/00435); Agencia de gestió d´Ajuts Universitaris I de Recerca (AGAUR) Exp: 2014_SGR_471; CERCA programme/Generalitat de Catalunya; European Regional Development Fund (ERDF. European Union. A Way of Making Europe), the European Union's Horizon 2020 research and innovation programme under grant agreement No 633196 (CATCH ME), a grant by La MARATÓ-TV3 (20152730) and the Spanish Ministry of Economy and Competitiveness (DPI2015-71640-R).

Arrhythmogenic right ventricular (RV) remodeling has been reported in response to regular training, but it remains unclear how exercise intensity affects the presence and extent of such remodeling. We aimed to assess the relationship between RV remodeling and exercise load in a long-term endurance training model. Wistar rats were conditioned to run at moderate (MOD; 45 min, 30 cm/s) or intense (INT; 60 min, 60 cm/s) workloads for 16 wk; sedentary rats served as controls. Cardiac remodeling was assessed with standard echocardiographic and tissue Doppler techniques, sensor-tip pressure catheters, and pressure-volume loop analyses. After MOD training, both ventricles similarly dilated (~16%); the RV apical segment deformation, but not the basal segment deformation, was increased [apical strain rate (SR): −2.9 ± 0.5 vs. −3.3 ± 0.6 s−1, SED vs. MOD]. INT training prompted marked RV dilatation (~26%) but did not further dilate the left ventricle (LV). A reduction in both RV segments' deformation in INT rats (apical SR: −3.3 ± 0.6 vs. −3.0 ± 0.4 s−1 and basal SR: −3.3 ± 0.7 vs. −2.7 ± 0.6 s−1, MOD vs. INT) led to decreased global contractile function (maximal rate of rise of LV pressure: 2.53 ± 0.15 vs. 2.17 ± 0.116 mmHg/ms, MOD vs. INT). Echocardiography and hemodynamics consistently pointed to impaired RV diastolic function in INT rats. LV systolic and diastolic functions remained unchanged in all groups. In conclusion, we showed a biphasic, unbalanced RV remodeling response with increasing doses of exercise: physiological adaptation after MOD training turns adverse with INT training, involving disproportionate RV dilatation, decreased contractility, and impaired diastolic function. Our findings support the existence of an exercise load threshold beyond which cardiac remodeling becomes maladaptive. NEW & NOTEWORTHY Exercise promotes left ventricular eccentric hypertrophy with no changes in systolic or diastolic function in healthy rats. Conversely, right ventricular adaptation to physical activity follows a biphasic, dose-dependent, and segmentary pattern. Moderate exercise promotes a mild systolic function enhancement at the right ventricular apex and more intense exercise impairs systolic and diastolic function.

13 páginas, 9 tablas, 2 figuras. Contiene material suplementario., Arrhythmogenic cardiomyopathy (ACM) is a disorder characterized by a progressive ventricular myocardial replacement by fat and fibrosis, which lead to ventricular arrhythmias and sudden cardiac death. Mutations in the desmosomal gene Plakophilin-2 (PKP2) accounts for >40% of all known mutations, generally causing a truncated protein. In a PKP2-truncated mouse model, we hypothesize that content of transgene, endurance training and aging will be determinant in disease progression. In addition, we investigated the molecular defects associated with the phenotype in this model. We developed a transgenic mouse model containing a truncated PKP2 (PKP2-Ser329) and generated three transgenic lines expressing increasing transgene content. The pathophysiological features of ACM in this model were assessed. While we did not observe fibro-fatty replacement, ultrastructural defects were exhibited. Moreover, we observed transgene content-dependent development of structural (ventricle dilatation and dysfunction) and electrophysiological anomalies in mice (PR interval and QRS prolongation and arrhythmia induction). In concordance with pathological defects, we detected a content reduction and remodeling of the structural proteins Desmocollin-2, Plakoglobin, native Plakophilin-2, Desmin and β-Catenin as well as the electrical coupling proteins Connexin 43 and cardiac sodium channel (Nav1.5). Surprisingly, we observed structural but not electrophysiological abnormalities only in trained and old mice. We demonstrated that truncated PKP2 provokes ACM in the absence of fibro-fatty replacement in the mouse. Transgene dose is essential to reveal the pathology, whereas aging and endurance training trigger limited phenotype. Molecular abnormalities underlay the structural and electrophysiological defects., This work was supported by grants from “Fundació la Caixa”, Red de Investigación Cardiovascular from Instituto Salud Carlos III (RD12/0042/0044 and RD12/0042/0019), MINECO (SAF2012-39732), and Fundació Marató TV3 2014, Spain.

Health and safety is a crucial issue in the mining industry because of the implication of fatalities in this sector. A study of safety culture maturity in several Latin America countries has been done based on the model from Filho et al. [1]. The questionnaire includes 28 items regarding the type of activity, number of employees and safety culture characteristics of the activity: Information of accidents and misses, organizational structure to deal with the information, involvement of the company in health and safety issues, the way it communicates accidents and misses and commitment of the company towards health and safety. The questionnaire was completed by 58 mining company managers from Bolivia, Peru, Colombia and Mexico. Results show different behaviours depending on the type of company, cooperative or private company. When private companies are analysed, it is seen a level of maturity according to the size of the company, whereas cooperatives does not have a clear trend in terms of size apart from very small cooperatives, less than 10 employees. However, there is a remarkable difference between cooperatives that have implemented continuous improvement systems and the others. In particular, cooperatives with a continuous improvement system have been analysed, displaying much higher safety culture levels. Therefore, it can be concluded that private companies improve their level of safety culture as the size of the company increase, because procedures and control systems are implemented. When cooperative or small companies introduce similar systems they also achieve substantial gains, but their approach is different. Managers from cooperatives have to see economic reasons to implement it, such as the Fairmined certificate.

Aims Long-term endurance sport practice has been increasingly recognized as a risk factor for lone atrial fibrillation (AF). However, data on the outcome of circumferential pulmonary vein ablation (CPVA) in endurance athletes are scarce. The aim of the study was to evaluate the efficacy of CPVA in AF secondary to endurance sport practice. Methods and results Patients submitted to CPVA answered a questionnaire about lifetime history of endurance sport practice. Endurance athletes were defined as those who engaged in >3 h per week of high-intensity exercise for at least the 10 years immediately preceding their AF diagnosis. A series of 182 consecutive patients was included (51 ± 11 years, 65% with paroxysmal AF, 81% men, 42 ± 6 mm mean left atrial diameter); 107 (59%) patients had lone AF, and 42 of them (23% of the study population) were classified as endurance athletes (lone AF sport group). Freedom from arrhythmia after a single CPVA was similar in the lone AF sport group compared with the remaining patients ( P = 0.446). Left atrial size and long-standing AF were the only independent predictors for arrhythmia recurrence after ablation. Conclusion Circumferential pulmonary vein ablation was as effective in AF secondary to endurance sport practice as in other aetiologies of AF.

Atrial fibrillation (AF) is a global health problem. The condition brings an increased risk of stroke, systemic embolism, and heart failure (HF) and is associated with impaired quality of life, frequent hospitalizations, and mortality.[1][1] Observational studies have been the main source of

Pathological biomechanical stresses cause cardiac hypertrophy, which is associated with QT prolongation and arrhythmias. Previous studies have demonstrated that repolarizing K(+) current densities are decreased in pressure overload-induced left ventricular hypertrophy, resulting in action potential and QT prolongation. Cardiac hypertrophy also occurs with exercise training, but this physiological hypertrophy is not associated with electrical abnormalities or increased arrhythmia risk, suggesting that repolarizing K(+) currents are upregulated, in parallel with the increase in myocyte size, to maintain normal cardiac function. To explore this hypothesis directly, electrophysiological recordings were obtained from ventricular myocytes isolated from two mouse models of physiological hypertrophy, one produced by swim-training of wild-type mice and the other by cardiac-specific expression of constitutively active phosphoinositide-3-kinase-p110α (caPI3Kα). Whole-cell voltage-clamp recordings revealed that repolarizing K(+) current amplitudes were higher in ventricular myocytes isolated from swim-trained and caPI3Kα, compared with wild-type, animals. The increases in K(+) current amplitudes paralleled the observed cellular hypertrophy, resulting in normalized or increased K(+) current densities. Electrocardiographic parameters, including QT intervals, as well as ventricular action potential waveforms in swim-trained animals/myocytes were indistinguishable from controls, demonstrating preserved electrical function. Additional experiments revealed that inward Ca(2+) current amplitudes/densities were also increased in caPI3Kα, compared with WT, left ventricular myocytes. The expression of transcripts encoding K(+), Ca(2+) and other ion channel subunits was increased in swim-trained and caPI3Kα ventricles, in parallel with the increase in myocyte size and with the global increases in total cellular RNA expression. In contrast to pathological hypertrophy, therefore, the functional expression of repolarizing K(+) (and depolarizing Ca(2+)) channels is increased with physiological hypertrophy, reflecting upregulation of the underlying ion channel subunit transcripts and resulting in increased current amplitudes and the normalization of current densities and action potential waveforms. Taken together, these results suggest that activation of PI3Kα signalling preserves normal myocardial electrical functioning and could be protective against the increased risk of arrhythmias and sudden death that are prevalent in pathological cardiac hypertrophy.

INTRODUCTION To investigate the relation between left atrial (LA) volume, sphericity, and fibrotic content derived from contrast-enhanced cardiac magnetic resonance imaging (CE-CMR) and their impact on the outcome of catheter ablation for atrial fibrillation (AF). METHODS AND RESULTS In 83 patients undergoing catheter ablation for AF, CE-CMR was used to assess LA volume, sphericity, and fibrosis. There was a significant correlation between LA volume and sphericity (R = 0.535, P

Although prevailing research trends favour large clinical trials and registries, meticulous observation during daily clinical practice remains a valuable source for hypothesis generation in medical research. Clinical experience has allowed the identification of several risk factors in the cardiovascular field. For instance, two groups of investigators noticed in parallel that patients with atrial fibrillation (AF) but no cardiovascular disease used to be healthy, fit, heavily trained middle-aged men. By the end of the 1990s and beginning of the 2000s, a series of articles were published confirming their observations: a history of continued endurance training associated with an increased risk of AF. Initial small case–control and cohort studies almost exclusively included men to accurately and homogeneously fit their observations and hypothesis, with women representing only 2% of all patients (figure 1). The link between physical activity and AF remained suspicious of bias and was largely disputed in the scientific community until the publication of large epidemiological studies. Similar to previous small studies, these were initially carried out in men; women were progressively included in subsequent works (figure 1). Finally, as evidence of this association had already been firmly established in men, an increasing need to test its validity in women aroused. Two studies exclusively focusing in women recalled initial clinical observations:1 ,2 women were not seemingly affected by the AF risks of exercise. Figure 1 Graphical summary of some representative studies assessing exercise-induced atrial fibrillation (AF) risk depending on the gender composition and design of the study. Upper panel: Overall percentage of women included for each type of study, from initial small case–control/cohorts studies ( 3000 individuals). Lower panel: Relative risk (RR) or OR of exercise-induced AF (sedentary vs …