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Two questions motivated this study: 1) Will meteorological droughts become more frequent and severe during the twenty-first century? 2) Given the projected global temperature rise, to what extent does the inclusion of temperature (in addition to precipitation) in drought indicators play a role in future meteorological droughts? To answer, we analyzed the changes in drought frequency, severity, and historically undocumented extreme droughts over 1981-2100, using the standardized precipitation index (SPI; including precipitation only) and standardized precipitation-evapotranspiration index (SPEI; indirectly including temperature), and under two representative concentration pathways (RCP4.5 and RCP8.5). As input data, we employed 103 high-resolution (0.44 degrees) simulations from the Coordinated Regional Climate Downscaling Experiment (CORDEX), based on a combination of 16 global circulation models (GCMs) and 20 regional circulation models (RCMs). This is the first study on global drought projections including RCMs based on such a large ensemble of RCMs. Based on precipitation only, similar to 15% of the global land is likely to experience more frequent and severe droughts during 2071-2100 versus 1981-2010 for both scenarios. This increase is larger (similar to 47% under RCP4.5, similar to 49% under RCP8.5) when precipitation and temperature are used. Both SPI and SPEI project more frequent and severe droughts, especially under RCP8.5, over southern South America, the Mediterranean region, southern Africa, southeastern China, Japan, and southern Australia. A decrease in drought is projected for high latitudes in Northern Hemisphere and Southeast Asia. If temperature is included, drought characteristics are projected to increase over North America, Amazonia, central Europe and Asia, the Horn of Africa, India, and central Australia; if only precipitation is considered, they are found to decrease over those areas.

Two questions motivated this study: 1) Will meteorological droughts become more frequent and severe during the twenty-first century? 2) Given the projected global temperature rise, to what extent does the inclusion of temperature (in addition to precipitation) in drought indicators play a role in future meteorological droughts? To answer, we analyzed the changes in drought frequency, severity, and historically undocumented extreme droughts over 1981-2100, using the standardized precipitation index (SPI; including precipitation only) and standardized precipitation-evapotranspiration index (SPEI; indirectly including temperature), and under two representative concentration pathways (RCP4.5 and RCP8.5). As input data, we employed 103 high-resolution (0.44 degrees) simulations from the Coordinated Regional Climate Downscaling Experiment (CORDEX), based on a combination of 16 global circulation models (GCMs) and 20 regional circulation models (RCMs). This is the first study on global drought projections including RCMs based on such a large ensemble of RCMs. Based on precipitation only, similar to 15% of the global land is likely to experience more frequent and severe droughts during 2071-2100 versus 1981-2010 for both scenarios. This increase is larger (similar to 47% under RCP4.5, similar to 49% under RCP8.5) when precipitation and temperature are used. Both SPI and SPEI project more frequent and severe droughts, especially under RCP8.5, over southern South America, the Mediterranean region, southern Africa, southeastern China, Japan, and southern Australia. A decrease in drought is projected for high latitudes in Northern Hemisphere and Southeast Asia. If temperature is included, drought characteristics are projected to increase over North America, Amazonia, central Europe and Asia, the Horn of Africa, India, and central Australia; if only precipitation is considered, they are found to decrease over those areas.

BACKGROUND Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. Catheter ablation for atrial fibrillation has been proposed as a means of improving outcomes among patients with heart failure who are otherwise receiving appropriate treatment. METHODS We randomly assigned patients with symptomatic paroxysmal or persistent atrial fibrillation who did not have a response to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take these drugs to undergo either catheter ablation (179 patients) or medical therapy (rate or rhythm control) (184 patients) for atrial fibrillation in addition to guidelines-based therapy for heart failure. All the patients had New York Heart Association class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator. The primary end point was a composite of death from any cause or hospitalization for worsening heart failure. RESULTS After a median follow-up of 37.8 months, the primary composite end point occurred in significantly fewer patients in the ablation group than in the medicaltherapy group (51 patients [28.5%] vs. 82 patients [44.6%]; hazard ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.87; P = 0.007). Significantly fewer patients in the ablation group died from any cause (24 [13.4%] vs. 46 [25.0%]; hazard ratio, 0.53; 95% CI, 0.32 to 0.86; P = 0.01), were hospitalized for worsening heart failure (37 [20.7%] vs. 66 [35.9%]; hazard ratio, 0.56; 95% CI, 0.37 to 0.83; P = 0.004), or died from cardiovascular causes (20 [11.2%] vs. 41 [22.3%]; hazard ratio, 0.49; 95% CI, 0.29 to 0.84; P = 0.009). CONCLUSIONS Catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy. (Funded by Biotronik; CASTLE-AF

The present invention is related to a breath pacing device (10) for pacing the respiratory activity of a subject, comprising an output unit (12) for outputting a sequence of output signals, a control unit (16) provided to control the output unit, and an input unit (14) connected to or integrated into the output unit for generating an input signal related to a respiration characteristic of a subject. The control unit is provided to control the length of the sequence at least based on characteristics of the input signal. The invention is further related to a corresponding method for pacing the respiratory activity of a subject.

BACKGROUND Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. Catheter ablation for atrial fibrillation has been proposed as a means of improving outcomes among patients with heart failure who are otherwise receiving appropriate treatment. METHODS We randomly assigned patients with symptomatic paroxysmal or persistent atrial fibrillation who did not have a response to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take these drugs to undergo either catheter ablation (179 patients) or medical therapy (rate or rhythm control) (184 patients) for atrial fibrillation in addition to guidelines-based therapy for heart failure. All the patients had New York Heart Association class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator. The primary end point was a composite of death from any cause or hospitalization for worsening heart failure. RESULTS After a median follow-up of 37.8 months, the primary composite end point occurred in significantly fewer patients in the ablation group than in the medicaltherapy group (51 patients [28.5%] vs. 82 patients [44.6%]; hazard ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.87; P = 0.007). Significantly fewer patients in the ablation group died from any cause (24 [13.4%] vs. 46 [25.0%]; hazard ratio, 0.53; 95% CI, 0.32 to 0.86; P = 0.01), were hospitalized for worsening heart failure (37 [20.7%] vs. 66 [35.9%]; hazard ratio, 0.56; 95% CI, 0.37 to 0.83; P = 0.004), or died from cardiovascular causes (20 [11.2%] vs. 41 [22.3%]; hazard ratio, 0.49; 95% CI, 0.29 to 0.84; P = 0.009). CONCLUSIONS Catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy. (Funded by Biotronik; CASTLE-AF

The present invention is related to a breath pacing device (10) for pacing the respiratory activity of a subject, comprising an output unit (12) for outputting a sequence of output signals, a control unit (16) provided to control the output unit, and an input unit (14) connected to or integrated into the output unit for generating an input signal related to a respiration characteristic of a subject. The control unit is provided to control the length of the sequence at least based on characteristics of the input signal. The invention is further related to a corresponding method for pacing the respiratory activity of a subject.

Aims To investigate the effects of cardiac resynchronization therapy (CRT) on survival in heart failure (HF) patients with permanent atrial fibrillation (AF) and the role of atrio-ventricular junction (AVJ) ablation in these patients. Methods and results Data from 1285 consecutive patients implanted with CRT devices are presented: 1042 patients were in sinus rhythm (SR) and 243 (19%) in AF. Rate control in AF was achieved by either ablating the AVJ in 118 patients (AVJ-abl) or prescribing negative chronotropic drugs (AF-Drugs). Compared with SR, patients with AF were significantly older, more likely to be non-ischaemic, with higher ejection fraction, shorter QRS duration, and less often received ICD back-up. During a median follow-up of 34 months, 170/1042 patients in SR and 39/243 in AF died (mortality: 8.4 and 8.9 per 100 person-year, respectively). Adjusted hazard ratios were similar for all-cause and cardiac mortality [0.9 (0.57-1.42), P = 0.64 and 1.00 (0.60-1.66) P = 0.99, respectively]. Among AF patients, only 11/118 AVJ-abl patients died vs. 28/125 AF-Drugs patients (mortality: 4.3 and 15.2 per 100 person-year, respectively, P < 0.001). Adjusted hazard ratios of AVJ-abl vs. AF-Drugs was 0.26 [95% confidence interval (CI) 0.09-0.73, P = 0.010] for all-cause mortality, 0.31 (95% CI 0.10-0.99, P = 0.048) for cardiac mortality, and 0.15 (95% CI 0.03-0.70, P = 0.016) for HF mortality. Conclusion Patients with HF and AF treated with CRT have similar mortality compared with patients in SR. In AF, AVJ ablation in addition to CRT significantly improves overall survival compared with CRT alone, primarily by reducing HF death

Aims To investigate the effects of cardiac resynchronization therapy (CRT) on survival in heart failure (HF) patients with permanent atrial fibrillation (AF) and the role of atrio-ventricular junction (AVJ) ablation in these patients. Methods and results Data from 1285 consecutive patients implanted with CRT devices are presented: 1042 patients were in sinus rhythm (SR) and 243 (19%) in AF. Rate control in AF was achieved by either ablating the AVJ in 118 patients (AVJ-abl) or prescribing negative chronotropic drugs (AF-Drugs). Compared with SR, patients with AF were significantly older, more likely to be non-ischaemic, with higher ejection fraction, shorter QRS duration, and less often received ICD back-up. During a median follow-up of 34 months, 170/1042 patients in SR and 39/243 in AF died (mortality: 8.4 and 8.9 per 100 person-year, respectively). Adjusted hazard ratios were similar for all-cause and cardiac mortality [0.9 (0.57-1.42), P = 0.64 and 1.00 (0.60-1.66) P = 0.99, respectively]. Among AF patients, only 11/118 AVJ-abl patients died vs. 28/125 AF-Drugs patients (mortality: 4.3 and 15.2 per 100 person-year, respectively, P < 0.001). Adjusted hazard ratios of AVJ-abl vs. AF-Drugs was 0.26 [95% confidence interval (CI) 0.09-0.73, P = 0.010] for all-cause mortality, 0.31 (95% CI 0.10-0.99, P = 0.048) for cardiac mortality, and 0.15 (95% CI 0.03-0.70, P = 0.016) for HF mortality. Conclusion Patients with HF and AF treated with CRT have similar mortality compared with patients in SR. In AF, AVJ ablation in addition to CRT significantly improves overall survival compared with CRT alone, primarily by reducing HF death