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Purpose: Assessing cardiopulmonary function during swimming is a complex and cumbersome procedure. Backward extrapolation is often used to predict peak oxygen uptake (...O2peak) during unimpeded swimming, but error can derive from a delay at the onset of ...O2 recovery. The authors assessed the validity of a mathematical model based on heart rate (HR) and postexercise ...O2 kinetics for the estimation of ...O2peak during exercise. Methods: 34 elite swimmers performed a maximal front-crawl 200-m swim. ...O2 was measured breath by breath and HR from beat-to-beat intervals. Data were time-aligned and 1-s-interpolated. Exercise ...O2peak was the average of the last 20 s of exercise. Postexercise ...O2 was the first 20-s average during the immediate recovery. Predicted ...O2 values (p...O2) were computed using the equation: p...O2 (0 = ...O2 (t) HRend-exercise/HR(t). Average values were calculated for different time intervals and compared with measured exercise ...O2peak. Results: Postexercise ...O2 (0-20 s) underestimated ...O2peak by 3.3% (95% CI = 9.8% underestimation to 3.2% overestimation, mean difference = -116 mL/min, SEE = 4.2%, P = .001). The best ...O2peak estimates were offered by p...O2peak from 0 to 20 s (r² = .96, mean difference = 17 mL/ min, SEE = 3.8%). Conclusions: The high correlation (r² = .86-.96) and agreement between exercise and predicted ...O2 support the validity of the model, which provides accurate ...O2peak estimations after a single maximal swim while avoiding the error of backward extrapolation and allowing the subject to swim completely unimpeded. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the concurrent and construct validity of the Borg (0–10) and children’s OMNI scales for quantifying the exercise intensity and training load (TL) in youth soccer players. Methods: Twelve children (mean ± SD age 11.4 ± 0.5 y, height 154.3 ± 6.5 cm, body mass 39.5 ± 5.4 kg) took part in this study. Exercise intensity and TL were calculated on the basis of the session rating of perceived exertion (sRPE) and heart rate (HR; Edwards method) during 20 technical-tactical training sessions. Players’ sRPEs were obtained from the Borg and OMNI scales. Results: Low correlations between HR-based TL and sRPE TL based on the Borg (r = .17, P = .335) and OMNI (r = .34, P = .007) scales were obtained. Significant (P < .001) relationships in sRPE (r = .76) and TL (r = .79) between RPE scales were found. Conclusion: The current data do not support the relationship between the sRPE and HR methods for quantifying TL in youth soccer players. However, the sRPE method could be considered a better indicator of global internal TL, since sRPE is a measure of both physical and psychological stress. In addition, the authors demonstrated the construct validity for the OMNI scale to control exercise demands. [ABSTRACT FROM AUTHOR]

Background: Systolic blood pressure (SBP) and heart rate (HR) are well-known prognostic factors in heart failure (HF). Aims: Our objective was to assess the value of the combination of admission SBP and HR to estimate 1-year mortality risks in elderly patients admitted due to a first episode of acute HF (AHF). Methods: During a 36-month period, we retrospectively reviewed 901 consecutive patients aged ≥ 75 admitted because of a first episode of AHF. According to admission SBP–HR combinations, three groups were defined: "low-risk" (HR < 70 bpm and SBP ≥ 140 mmHg), "moderate-risk" (HR < 70 bpm and SBP < 140 mmHg or HR ≥ 70 bmp and SBP ≥ 120 mmHg), and "high-risk" (HR ≥ 70 bpm and SBP < 120 mmHg). We analyzed all-cause mortality using Cox mortality analysis. Results: One-year mortality ranged from 16.5% for patients in the low-risk group to 50% for those in the high-risk group (p < 0.0001). Multivariate Cox regression for 1-year mortality showed hazard risk (HzR) ratios, compared to that (HzR 1) of the low-risk reference group, of 1.759 (95% CI 1.035–2.988, p = 0.037) for moderate-risk, and 3.171 (95% CI 1.799–5.589, p = 0.0001) for high-risk group. Prior use of a high number of chronic therapies (HzR 1.045), lower admission diastolic BP (HzR 0.986) and higher admission serum potassium values (HzR 1.534) were also significantly associated with mortality. Conclusion: In elderly population firstly hospitalized due to AHF, the simple combined admission measurement of SBP and HR predicts higher risk for 1-year all-cause mortality. [ABSTRACT FROM AUTHOR]

Photoplethysmographic imaging (PPG) is currently used to measure heart rate (HR) and the accuracy of PPG can be influenced by pigmentation of the skin; however, the effects of skin color-related artifacts on PPG during exercise remain unclear. This study aimed to assess the agreement between the Apple Watch photoplethysmography sensor and a criterion, for measuring heart rate across a range of intensities during exercise and to determine the influence of skin type on the accuracy of the measure. Forty-five males (20–43 y) completed the Fitzpatrick Skin Scale and were classified into three different skin type groups: a) types II (n = 15), III (n = 15) and IV (n = 15). Participants performed a graded incremental cycle-ergometer test while simultaneously wearing the Apple Watch and a Polar monitor as a criterion measure. Data from both devices were collected in 5-s epochs. Correlations between devices were very good (0.96–0.99 [95%CI: 0.94 to 0.99]). Significant differences were observed between skin types II and III when the intensity of the exercise was increased, albeit with trivial to small effect sizes (ES: 0.05 to 0.28). All significant differences corresponded to <2% of relative difference between both devices. Bland-Altman analyses showed a trivial but systematic underestimation of HR in the Apple Watch compared to Polar for all skin types during exercise. In conclusion, the Apple Watch accurately measures HR when cycling at different intensities and certain types of skin seem not to influence these measures, which may have important implications for controlling the intensity of exercise. [ABSTRACT FROM AUTHOR]

Objectives: To identify the immediate and middle-term effects of the right carotid sinus compression technique on blood pressure and heart rate in hypertensive patients. Design: Randomized blinded experimental study. Settings: Primary health centers of Cáceres (Spain). Subjects: Sixty-four medicated patients with hypertension were randomly assigned to an intervention group (n = 33) or to a control group (n = 31). Intervention: In the intervention group a compression of the right carotid sinus was applied for 20 sec. In the control group, a placebo technique of placing hands on the radial styloid processes was performed. Outcome measures: Blood pressure and heart rate were measured in both groups before the intervention (preintervention), immediately after the intervention, 5 min after the intervention, and 60 min after the intervention. Results: The intervention group significantly decreased systolic and diastolic blood pressure and heart rate immediately after the intervention, with a large clinical effect; systolic blood pressure remained reduced 5 min after the intervention, and heart rate remained reduced 60 min after the intervention. No significant changes were observed in the control group. Conclusions: Right carotid sinus compression could be clinically useful for regulating acute hypertension. [ABSTRACT FROM AUTHOR]

Background and Objectives: Diminished heart rate variability has been found to be associated with high anxiety symptomatology. Since adolescence is the period of onset for many anxiety disorders, this study aimed to determine sex- and anxiety-related differences in heart rate variability and complexity in adolescents.Methods: We created four groups according to sex and anxiety symptomatology: high-anxiety girls (n = 24) and boys (n = 25), and low-anxiety girls (n = 22) and boys (n = 24) and recorded their cardiac function while they performed regular school activities. A series of two-way (sex and anxiety) MANOVAs were performed on time domain variability, frequency domain variability, and non-linear complexity.Results: We obtained no multivariate interaction effects between sex and anxiety, but highly anxious participants had lower heart rate variability than the low-anxiety group. Regarding sex, girls showed lower heart rate variability and complexity than boys.Conclusions: The results suggest that adolescent girls have a less flexible cardiac system that could be a marker of the girls' vulnerability to developing anxiety disorders. [ABSTRACT FROM AUTHOR]

Background: Premature infants are exposed to high levels of noise in the neonatal intensive care unit (NICU).Purpose: This study evaluated the effect of a relaxing music therapy intervention composed by artificial intelligence on respiratory rate, systolic and diastolic blood pressure, and heart rate.Methods: A double-blind, randomized, controlled trial was conducted in the NICUs of 2 general public hospitals in Andalusia, Spain. Participants were 17 healthy premature infants, randomly allocated to the intervention group or the control group (silence) at a 1:1 ratio. To be included in the study, the subjects were to be 32 to 36 weeks of gestation at birth (M= 32.33; SD = 1.79) and passed a hearing screening test satisfactorily. The intervention lasted 20 minutes, 3 times a day for 3 consecutive days, while infants were in the incubator. Infants' heart rate, respiratory rate, and blood pressure were assessed before and after each intervention session.Results: After each session, the respiratory rate decreased in the experimental group (main between-groups effect (F1,13 = 6.73, P = .022, ηpartial = 0.34). Across the sessions, the heart rate increased in the control group (main between-groups effect, F1,11 = 5.09, P = .045, ηpartial = 0.32).Implications For Research: Future studies can use this music intervention to assess its potential effects in premature infants.Implications For Practice: Nurses can apply the relaxing music intervention presented in this study to ameliorate the impact of the stressful environment on premature infants. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the effects of accumulated internal training load (ITL) during the preseason (4 weeks) on changes in the intermittent performance, in a professional soccer team. Twelve professionals soccer players (Mean ± SD age: 27.7 ± 4.3 years; height: 177.1 ± 6.2 cm; body mass: 73.1 ± 5.2 kg; % body fat [Faulkner]: 10.2 ± 1.2) belonging to a Spanish second division team (2013-2014) participated in this study. The 30-15 intermittent fitness test was performed before and after the preseason, and the speed for the last period completed by each player was recorded (VIFT). During the preseason, the team alternated practice of training sessions (TRNs) with friendly matches (FMs). Session rating of perceived exertion (sRPE), heart rate (HR), and HR reserve were analyzed every TRN and FM to calculate ITL (ITL: sRPE-TL, Edward's-TL and Edward's-TLres). The players' VIFT substantially increased after the preseason period (20.1 ± 0.8 vs. 21.1 ± 0.8 km⋅h-1; effect size [ES] = 1.15 ± 0.25; almost certainly). The average value of sRPE throughout FMs was substantially greater than the value of the TRNs (7.4 ± 0.9 vs. 5.25 ± 0.2; ES = 2.31 ± 2.45; almost certainly). sRPE-TL, practice volume, and sum of RPE during the preseason were positively and largely correlated (r = 0.70-0.75) with changes on intermittent performance. No relationships were found between HR-derived measures of exercise load and changes on intermittent fitness. The present results suggest that practice volume and subjective measures of TL, related better than HR-based TL methods to changes on intermittent performance after the preseason, in professional soccer players. [ABSTRACT FROM AUTHOR]

The aim of the present study was to analyse the training load in wheelchair basketball small-sided games and determine the relationship between heart rate (HR)-based training load and perceived exertion (RPE)-based training load methods among small-sided games bouts. HR-based measurements of training load included Edwards’ training load and Stagno’s training impulses (TRIMPMOD) while RPE-based training load measurements included cardiopulmonary (session RPEres) and muscular (session RPEmus) values. Data were collected from 12 wheelchair basketball players during five consecutive weeks. The total load for the small-sided games sessions was 67.5 ± 6.7 and 55.3 ± 12.5 AU in HR-based training load (Edwards’ training load and TRIMPMOD), while the RPE-based training loads were 99.3 ± 26.9 (session RPEres) and 100.8 ± 31.2 AU (session RPEmus). Bout-to-bout analysis identified greater session RPEmus in the third [P < 0.05; effect size (ES) = 0.66, moderate] and fourth bouts (P < 0.05; ES = 0.64, moderate) than in the first bout, but other measures did not differ. Mean correlations indicated a trivial and small relationship among HR-based and RPE-based training loads. It is suggested that HR-based and RPE-based training loads provide different information, but these two methods could be complementary because one method could help us to understand the limitations of the other. [ABSTRACT FROM PUBLISHER]

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There are downloadable applications (Apps) for cell phones that can measure heart rate in a simple and painless manner. The aim of this study was to assess the reliability of this type of App for a Smartphone using an Android system, compared to the radial pulse and a portable pulse oximeter. We performed a pilot observational study of diagnostic accuracy, randomized in 46 healthy volunteers. The patients’ demographic data and cardiac pulse were collected. Radial pulse was measured by palpation of the radial artery with three fingers at the wrist over the radius; a low-cost portable, liquid crystal display finger pulse oximeter; and a Heart Rate Plus for Samsung Galaxy Note®. This study demonstrated high reliability and consistency between systems with respect to the heart rate parameter of healthy adults using three systems. For all parameters, ICC was > 0.93, indicating excellent reliability. Moreover, CVME values for all parameters were between 1.66−4.06 %. We found significant correlation coefficients and no systematic differences between radial pulse palpation and pulse oximeter and a high precision. Low-cost pulse oximeter and App systems can serve as valid instruments for the assessment of heart rate in healthy adults. [ABSTRACT FROM AUTHOR]

Previous studies have researched the ergogenic effect of caffeine in different shooting actions, but none of them in a stressful combat action. This study aimed to analyse the effect of a dose of 400 mg of caffeine monohydrate on the psycho-physiological response and marksmanship of soldiers in close quarter combat (CQC). We analysed the heart rate, blood lactate concentration, cortical arousal, state anxiety and marksmanship of 19 soldiers in the Spanish Army (38.9 ± 4.1 years; 177.4 ± 5.3 cm; 78.8 ± 7.6 kg) before and after a CQC simulation in a double-blind procedure. Caffeine intake did not improve shooting performance in CQC; however, it increased cognitive and somatic anxiety levels. Practitioner Summary: According to the previous literature, the ingestion of caffeine could help soldiers in operations conducted in sleep deprivation conditions, but in stressful combat situations it does not improve the marksmanship of soldiers. [ABSTRACT FROM PUBLISHER]

Objective Baroreceptor stimulation yields antinociceptive effects. In this study, baroreceptors were stimulated by a respiratory maneuver, with the effect of this manipulation on pain perception subsequently measured. Methods Thirty-eight healthy participants were instructed to inhale slowly (control condition) and to hold the air in lungs after a deep inhalation (experimental condition). It was expected that breath-holding would increases blood pressure (BP) and thus stimulate the baroreceptors, which in turn would reduce pain perception. Pain was induced by pressure algometry on the nail of the left-index finger, at three different pressure intensities, and quantified by visual analogue scales. Heart rate (HR) and BP were continuously recorded. Results Pain perception was lower when pain pressure was administered during the breath-holding phase versus the slow inhalation phase, regardless of the pressure intensity. During breath-holding, a rapid increase in BP and decrease in HR were observed, demonstrating activation of the baroreceptor reflex. Conclusion Pain perception is reduced when painful stimulation is applied during breath-holding immediately following a deep inhalation. These results suggest that a simple and easy-to-perform respiratory maneuver could be used to reduce acute pain perception. [ABSTRACT FROM AUTHOR]

Prior reports have described the limitations of quantifying internal training loads using hear rate (HR)-based objective methods such as the training impulse (TRIMP) method, especially when high-intensity interval exercises are performed. A weakness of the TRIMP method is that it does not discriminate between exercise and rest periods, expressing both states into a single mean intensity value that could lead to an underestimate of training loads. This study was designed to compare Banister's original TRIMP method (1991) and a modified calculation procedure (TRIMPc) based on the cumulative sum of partial TRIMP, and to determine how each model relates to the session rating of perceived exertion (s-RPE), a HR-independent training load indicator. Over four weeks, 17 elite swimmers completed 328 pool training sessions. Mean HR for the full duration of a session and partial values for each 50 m of swimming distance and rest period were recorded to calculate the classic TRIMP and the proposed variant (TRIMPc). The s-RPE questionnaire was self-administered 30 minutes after each training session. Both TRIMPc and TRIMP measures strongly correlated with s-RPE scores (r = 0.724 and 0.702, respectively; P < 0.001). However, TRIMPc was ∼9% higher on average than TRIMP (117 ± 53 vs. 107 ± 47; P < 0.001), with proportionally greater inter-method difference with increasing workload intensity. Therefore, TRIMPc appears to be a more accurate and appropriate procedure for quantifying training load, particularly when monitoring interval training sessions, since it allows weighting both exercise and recovery intervals separately for the corresponding HR-derived intensity. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to compare the heart rate (HR) and rate of perceived exertion (RPE) responses as internal load indicators while performing duet routines during training and competition in synchronized swimming (SS). Researchers evaluated 10 Olympic swimming medalists. They found that the internal load imposed by SS duets performed during training is virtually identical to that elicited in a real competitive situation and that practicing competitive routines is suitable for developing and maintaining the cardiovascular fitness needed by swimmers.

The article focuses on a study aimed at examining mechanical, physical and physiological parameters of soldiers during symmetrical and asymmetrical simulations of combat. The soldiers wore a global positioning system device which recorded distance and speed. The maximum speed in asymmetrical combat was found to be more than that in symmetrical combat.

The article reports on research which was conducted to investigate the physical and physiological demands of field referees and assistant referees during the America's cup soccer competition. Researchers evaluated seven referees and seven assistants. They found that both types of referees exhibited similar physical demands as those that had previously been reported by European referees during international tournaments.

Purpose: The aim of this study was to analyze the physiological demands and thermal strain of wildland firefighters during real wildfire suppression. Methods: The response of core temperature and heart rate (HR) were analyzed in 200 wildland firefighters during wildfire suppression activities of different duration: <1 h ( n = 52), 1-3 h ( n = 70), 3-5 h ( n = 44), and >5 h ( n = 34). The exercise workload (TRIMP), the physiological strain index (PSI), and cumulative heat strain index (CHSI) were calculated using the time spent in different intensity zones, the HR, and core temperature. Results: Mean HR was significantly higher ( P < 0.05) in wildfires <1 h (133 ± 2 bpm) and 1-3 h (128 ± 1 bpm) versus 3-5 h (120 ± 3 bpm) and >5 h (116 ± 32 bpm). The time spent in higher intensity zones increased ( P < 0.05) when wildfire duration increased. TRIMP accumulation increased with wildfire duration (54.9 ± 3.2, 167.4 ± 5.9, 296.0 ± 8.3, 511.7 ± 12.8 in <1, 1-3, 3-5, and >5 h, respectively). Neither core temperature (37.4 ± 0.1°C) nor PSI (4.5 ± 0.2) were influenced by wildfire duration. The CHSI increased ( p < 0.05) in the following order: <1 h (104 ± 23), 1-3 h (1,396 ± 275), 3-5 h (4,586 ± 387), and >5 h (10,703 ± 710). Conclusions: The results demonstrate the high work strain sustained by Spanish wildland firefighters during wildfire suppression. Both workload and CHSI increased with the wildfires duration although the pace of work was faster in wildfires of a shorter duration. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine physical, physiological, and motor responses and perceived exertion during different soccer drills. In small-sided games, the individual playing area (∼275 m2, ∼175 m2, and ∼75 m2) was varied while the number of players per team was kept constant: 5 vs. 5 plus goalkeepers. Participants were ten male youth soccer players. Each session comprised three small-sided game formats, which lasted 8 min each with a 5-min passive rest period between them. A range of variables was recorded and analysed for the three drills performed over three training sessions: (a) physiological, measured using Polar Team devices; (b) physical, using GPS SPI elite devices; (c) perceived exertion, rated using the CR-10 scale; and (d) motor response, evaluated using an observational tool that was specially designed for this study. Significant differences were observed for most of the variables studied. When the individual playing area was larger, the effective playing time, the physical (total distance covered; distances covered in low-intensity running, medium-intensity running, and high-intensity running; distance covered per minute; maximum speed; work-to-rest ratio; sprint frequency) and physiological workload (percent maximum heart rate; percent mean heart rate; time spent above 90% maximum heart rate), and the rating of perceived exertion were all higher, while certain motor behaviours were observed less frequently (interception, control and dribble, control and shoot, clearance, and putting the ball in play). The results show that the size of the pitch should be taken into account when planning training drills, as it influences the intensity of the task and the motor response of players. [ABSTRACT FROM AUTHOR]

Copyright of Apunts: Educació Física i Esports is the property of Institut Nacional d'Educacio Fisica de Catalunya and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known., Research Question: Does an association exist between baseline HR and PE outcome across the continuum of HR values?, Study Design and Methods: The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes., Results: A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of ≥ 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of < 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2% to 98.0%., Interpretation: In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE., (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Purpose: To develop gender-specific operational equations for prediction of cardiorespiratory fitness in female footballers., Method: Forty-eight semiprofessional female footballers performed an intermittent progressive maximal running test for determination of fixed blood lactate concentration (FBLC) thresholds. Relationships between FBLC thresholds and the physiological responses to submaximal running were examined. Developed equations (n = 48) were compared with equations previously obtained in another investigation performed in males (n = 100)., Results: Submaximal velocity associated with 90% maximal heart rate was related to FBLC thresholds (r = .76 to .79; P < .001). Predictive power (R2 = .82 to .94) of a single blood lactate concentration (BLC) sample measured at 10 or 11.5 km·h-1 was very high. A single BLC sample taken after a 5-minute running bout at 8.5 km·h-1 was related to FBLC thresholds (r = -.71; P < .001). No difference (P = .15) in the regression lines predicting FBLC thresholds from velocity associated with 90% maximal heart rate was observed between the female and male cohorts. However, regressions estimating FBLC thresholds by a single BLC sample were different (P = .002)., Conclusions: Velocity associated with 90% maximal heart rate was robustly related to FBLC thresholds and might serve for mass field testing independently of sex. BLC equations accurately predicted FBLC thresholds. However, these equations are gender-specific. This is the first study reporting operational equations to estimate the FBLC thresholds in female footballers. The use of these equations reduces the burden associated with cardiorespiratory testing. Further cross-validation studies are warranted to validate the proposed equations and establish them for mass field testing.

Introduction: The study of chronic and acute responses when exposed to extreme, aggressive and stressful environments, such as in combat environments, is becoming increasingly popular as such information leads to better optimisation of soldiers' physical and psychological performance, as well as mission effectiveness and efficiency. Due to internal complexity, uncertainty and variability of real combat scenarios, a specific approach to all possible types of military combat scenarios is necessary., Methods: Modifications in the autonomic modulation and cortical arousal before and after asymmetrical, symmetrical and close quarter combat simulations were analysed in 31 male professional veteran soldiers (age: 34.5±4.2 years) with between seven and 18 years of experience in their respective units, as well as experience in international missions in current conflict areas such as Lebanon, Afghanistan, Bosnia, Kosovo and Iraq., Results: The three combat situations produced a non-significant decrease in cortical arousal after combat simulations, presenting a trivial effect size in symmetrical and close quarter combat situations and a small effect size in asymmetrical situations. HR increased significantly in the three combat situations, and close quarter combat produced the highest sympathetic modulation of the three situations analysed., Conclusion: Symmetrical, asymmetrical and close quarter combat situations produced an increase in sympathetic modulation, being highest in the close quarter combat situation, where actions are performed at a close distance and in closed spaces., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Resting heart rate (HR) taken in the office has been shown to be associated with cardiovascular outcomes in the general population, hypertension and heart failure. It is unknown whether 24-h oscillographic pulse rate measurement as an approximation of HR derived from ambulatory blood pressure monitoring (ABPM) associates with cardiovascular outcomes in hypertensive patients., Methods: We evaluated ABPM recordings from 56 901 patients with complete 3373 421 HR measures entering the final analysis from the Spanish Blood Pressure Monitoring Registry for a median follow-up time of 5.1 years. We explored the association of office HR, mean 24-h HR, mean day HR, mean night HR as well as day-night HR differences, morning mean HR, morning HR surge and night peak HR to all-cause death, cardiovascular death and noncardiovascular death. Data were analyzed by Cox regression analysis, analysis of variance and chi-square test., Results: The Spanish ABPM Registry recorded data in 223 primary care centers in Spain from 2004 until 31 December 2014 at the end of recruitment. Office HR was 3.5 bpm higher than mean 24-h HR, office mean HR versus mean night was 10.4 bpm higher and mean day versus mean night HR 9.3 bpm higher, while there were no relevant difference between office and mean day HR. Office mean, 24-h day and night HR more than 90 bpm were associated with an increased risk for all-cause and noncardiovascular death, whereas for cardiovascular death only mean night HR was predictive. The strongest association to all-cause death was observed with mean night HR [hazard ratio 3.80 (2.87-5.03)], mean 24-h HR [2.85 (2.30-3.54)] and mean day HR [2.22 (1.83-2.70)]. Day-night dipping of more than 8 bpm was associated with a 20% lesser risk on all-cause, cardiovascular and noncardiovascular death. Results were robust after adjusting for relevant risk indicators., Conclusion: HR parameters derived from ABPM provide important information, in particular association with death by mean night HR, mean 24-h HR and reduced day-night HR dipping less than 8 bpm superior to office HR.

Background: Conduction disturbances are the most frequent complication of transcatheter aortic valve replacement (TAVR). However, no data exists regarding the outcomes of intraprocedural high-degree atrioventricular block (HAVB) or complete heart block (CHB) in patients without previous conduction disturbances., Objectives: The aim of this study was to evaluate the outcomes of intraprocedural-HAVB/CHB in patients without previous intraventricular conduction disturbances., Methods: The occurrence of intraprocedural-HAVB/CHB was assessed in 676 consecutive patients undergoing TAVR, and two groups were established according to its duration: persistent-HAVB/CHB (PHAVB/CHB) and transient-HAVB/CHB (THAVB/CHB), not present at the end of the procedure., Results: Intraprocedural-HAVB/CHB occurred in 50 patients (7.4%), being persistent in 32 (64.0%), and transient in 18 (36.0%). The use of Medtronic Corevalve Revalving System (MCRS) and a greater oversizing of the valve increased the risk of intraprocedural-HAVB/CHB (p < 0.001). Permanent pacemaker implantation (PPI) was more frequent in the PHAVB/CHB than in the THAVB/CHB group (96.9% vs. 33.3%; p < 0.001). At 1-month follow-up, the PHAVB/CHB group showed a 98% ventricular pacing rate (VPR) compared to 16% in the THAVB/CHB group (p < 0.001), and similar VPR were observed at 1-year follow-up (98% vs. 37%, p < 0.001). Left ventricular ejection fraction (LVEF) decreased at 1-year follow-up in patients with PHAVB/CHB (-3.9 ± 1.8%, p = 0.003)., Conclusions: In TAVR recipients with no prior intraventricular conduction disturbances, intraprocedural-HAVB/CHB occurred in 7.4% of cases. HAVB/CHB was persistent in most cases and determined a high rate of PPI post-TAVR. Very high VPR at 1- and 12-month follow-up were observed, which in turn was associated with a negative effect on LVEF. These results support early PPI and close follow-up in patients developing intraprocedural-PHAVB/CHB., (© 2019 Wiley Periodicals, Inc.)

Background: In mass casualty incidents (MCI), death usually occurs within the first few hours and thus early transfer to a trauma centre can be crucial in selected cases. However, most triage systems designed to prioritize the transfer to hospital of these patients do not assess the need for surgery, in part due to inconclusive evidence regarding the value of such an assessment. Therefore, the aim of the present study was to evaluate the capacity of a new triage system-the Prehospital Advanced Triage Method (META)-to identify victims who could benefit from urgent surgical assessment in case of MCI., Methods: Retrospective, descriptive, observational study of a multipurpose cohort of patients included in the severe trauma registry of the Gregorio Marañón University General Hospital (Spain) between June 1993 and December 2011. All data were prospectively evaluated. All patients were evaluated with the META system to determine whether they met the criteria for urgent transfer. The META defines patients in need of urgent surgical assessment: (a) All penetrating injuries to head, neck, torso and extremities proximal to elbow or knee, (b) Open pelvic fracture, (c) Closed pelvic fracture with mechanical or haemodynamic instability and (d) Blunt torso trauma with haemodynamic instability. Patients who fulfilled these criteria were designated as "Urgent Evacuation for Surgical Assessment" (UESA) cases; all other cases were designated as non-UESA. The following variables were assessed: patient status at the scene; severity scales [RTS, Shock index, MGAP (Mechanism, Glasgow coma scale, Age, pressure), GCS]; need for surgery and/or interventional procedure to control bleeding (UESA); and mortality. The two groups (UESA vs. non-UESA) were then compared., Results: A total of 1882 cases from the database were included in the study. Mean age was 39.2 years and most (77%) patients were male. UESA patients presented significantly worse on-scene hemodynamic parameters (systolic blood pressure and heart rate) and greater injury severity (RTS, shock index, and MGAP scales). No differences were observed for respiratory rate, need for orotracheal intubation, or GCS scores. The anatomical injuries of patients in the UESA group were less severe but these patients had a greater need for urgent surgery and higher mortality rates., Conclusion: These findings suggest that the META triage classification system could be beneficial to help identify patients with severe trauma and/or in need of urgent surgical assessment at the scene of injury in case of MCI. These findings demonstrate that, in this cohort, the META fulfils the purpose for which it was designed.

Aims: We evaluated the ability of an ultrahigh mapping system to identify the most convenient Rhythmia ablation target (RAT) in intra-atrial re-entrant tachycardias (IART) in terms of the narrowest area to transect to interrupt the re-entry., Methods: A total of 24 consecutive patients were enrolled with a total of 26 IARTs. The Rhythmia mapping system was used to identify the RAT in all IARTs., Results: In 18 cases the RAT matched the mid-diastolic phase of the re-entry whereas in 8 cases the RAT differed. In these patients, the mid-diastolic tissue in the active circuit never represented the area with the slowest conduction velocity of the re-entry. The mean conduction velocity at the mid-diastolic site was significantly slower in the group of patients in which the RAT matched the mid-diastolic site (P = 0.0173) and that of the remaining circuit was significantly slower in the group in which the RAT did not match (P = 0.0068). The mean conduction velocity at the RAT was comparable between the two groups (P = 0.66)., Conclusion: Identifying the RAT in challenging IARTs by means of high-density representation of the wavefront propagation of the tachycardia seems feasible and effective. In one-third of cases this approach identifies an area that differs from the mid-diastolic corridor.

Introduction: Recurrences after atrial fibrillation (AF) ablation are still common. Among the reported clinical and imaging predictors of recurrences, diagnosis-to-ablation time (DAT) has been defined as a predictor of ablation outcome in single-center studies. We aimed to validate DAT in a multicenter real-life cohort., Methods: This was a multicenter study including consecutive patients undergoing first paroxysmal and persistent AF ablation with radiofrequency or cryoballoon catheters during 2013. Cox proportional hazard regression models were performed to identify predictors of recurrence., Results: In total, 309 patients were included across nine centers (71% men, 57 ± 10 years old, 46% with hypertension, and 66% with CHA 2 DS 2 -VASc ≤ 1). Most patients had paroxysmal AF (67%) and underwent radiofrequency ablation (68%) with a median DAT of 51 (43) months. Patients with DAT ≤ 1 year (16.6%) were less likely to have repeat procedures (4% vs 18%; P = .017). The adjusted proportional hazards Cox model identified hypertension (P = .005), heart failure (P = .011), nonparoxysmal AF (P = .038), DAT > 1 year (P = .007), and LA diameter (P = .026) as independent predictors for AF recurrence. DAT > 1 year was the only modifiable factor independently associated with recurrence (HR 4.2 [95% CI, 1.5-11.9]) CONCLUSION: Diagnosis-to-ablation time is a modifiable factor independently associated with recurrent arrhythmia and repeat ablation after first AF ablation. An early intervention strategy during the first year from AF diagnosis might improve outcomes., (© 2019 Canadian Society for Chemical Engineering.)

The aim of this study was to evaluate the stress suffered by medical residents as the result of being on call for 24 hours, from a multidimensional approach. Two groups of medical residents selected according to their work shift, participated in the study: one group (n = 40) was sleep-deprived after having been actively on-call for 24 hours, and another contrast group (n = 18) had performed a normal work day and were not sleep-deprived. All participants completed pre-post measures during a 24 h cycle. These were administered on both occasions at 8 am. The measures included HRV, cortisol, cognitive performance and transitory mood. The effect of the group x phase interaction was significant for all variables analysed, indicating that doctors in the 24h on-call shift group showed significant deterioration in all physiological, performance and mood indicators in comparison with the participants in the group not on call. These results suggest the need to review medical on-call systems, in order to reduce the stress load, which has a direct effect on working conditions., Competing Interests: The authors have declared that no competing interests exist.

This study investigated the effect of a 3-km walking test (3kWT) carrying different military equipment on shooting performance, rating of perceived exertion (RPE), heart rate (HR), and test time. The relative combat wear and backpack weight (as percentage of soldier's body weight [%BW]) was reported and, along with HR, its relationship to marksmanship variables was tested. Thirty-nine Spanish Army males walked as fast as possible to complete the 3kWT in the following conditions in a randomized order: unloaded walking; wearing the combat uniform; and carrying the combat uniform plus combat backpack. A shooting test was completed before and after the 3kWT. The HR and RPE were evaluated. The marksmanship variables and HR were analysed using a two-way repeated measures ANOVA, and a repeated ANOVA was also used for 3kWT completion time and HR reserve analysis. Correlation analyses were performed between the equipment's weight, HR, and marksmanship variables. The results showed that shooting score decreased after the 3kWT in both load conditions (p < 0.001). The 3kWT time, RPE, and HR increased from control to load conditions, and also between load conditions. The HR reserve showed no significant effects between conditions. The %BW of the backpack condition negatively influenced aiming accuracy (r = -0.35; p = 0.04) and cleanness triggering (r = 0.37; p = 0.03). Correlations between HR and shooting variables were non-significant. In conclusion, wearing the Spanish Army combat wear and backpack resulted in shooting performance degradation. Furthermore, fatigue and RPE increased and this could decrease physical marksmanship and performance capacity in combat situations.

Background: Patients with COPD are at higher risk of presenting with atrial fibrillation (AF). Information about clinical outcomes and optimal medical treatment of AF in the setting of COPD remains missing. We aimed to describe the prevalence of COPD in a sizeable cohort of real-world AF patients belonging to the same healthcare area and to examine the relationship between comorbid COPD and AF prognosis., Methods: Prospective analysis performed in a specific healthcare area. Data were obtained from several sources within the "data warehouse of the Galician Healthcare Service" using multiple analytical tools. Statistical analyses were completed using SPSS 19 and STATA 14.0., Results: A total of 7,990 (2.08%) patients with AF were registered throughout 2013 in our healthcare area (n=348,985). Mean age was 76.83±10.51 years and 937 (11.7%) presented with COPD. COPD patients had a higher mean CHA 2 DS 2 -VASc (4.21 vs 3.46; P =0.02) and received less beta-blocker and more digoxin therapy than those without COPD. During a mean follow-up of 707±103 days, 1,361 patients (17%) died. All-cause mortality was close to two fold higher in the COPD group (28.3% vs 15.5%; P <0.001). Independent predictive factors for all-cause mortality were age, heart failure, diabetes, previous thromboembolic event, dementia, COPD, and oral anticoagulation (OA). There were nonsignificant differences in thromboembolic events (1.7% vs 1.5%; P =0.7), but the rate of hemorrhagic events was significantly higher in the COPD group (3.3% vs 1.9%; P =0.004). Age, valvular AF, OA, and COPD were independent predictive factors for hemorrhagic events. In COPD patients, age, heart failure, vasculopathy, lack of OA, and lack of beta-blocker use were independent predictive factors for all-cause mortality., Conclusion: AF patients with COPD have a higher incidence of adverse events with significantly increased rates of all-cause mortality and hemorrhagic events than AF patients without COPD. However, comorbid COPD was not associated with differences in cardiovascular death or stroke rate. OA and beta-blocker treatment presented a risk reduction in mortality while digoxin use exerted a neutral effect., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Hypoxia remains the most important hazard in high altitude flights, but there is still a need for deeper analysis of the effect of hypoxia exposition in the psychophysiological and cognitive functions. The aim of this study was to study the effect of hypoxia training in cortical arousal, autonomic modulation, muscle strength and cognitive function. We analysed 23 male aircrew personnel of the Spanish Army and Air Force (10 Helicopter Pilots, 7 Transport Aircrew, 3 Transport Pilots and 3 F-18 Fighter Pilots) before, during and after a normobaric hypoxia exposition. Hypoxia produced an increase in perceived stress and effort, a higher Heart Rate and a decreased function of breath muscles. Working memory and pattern recognition were impaired after hypoxia exposition. Significant differences were found in cognitive tests performance among aircrew groups, suggesting differences on their previous training. These results can improve specific training for better preparation of pilots and aircrews for hypoxic threats. Practitioner summary: Distinct aircrew preparation produces a different hypoxia exposition effect on psychophysiological response and cognitive functions. Hypoxia produced an increase in Heart Rate, a decreased function of breath muscles, being more negatively affected in Transport Pilots. Cognition abilities were impaired after hypoxia exposition, independently of the aircrew group.

The aim of this study was to quantify the food intake of an International Cyclist Union (UCI) World Tour professional cyclist team and to analyse changes in body composition during the Tour of Spain. Nine male professional road cyclists (31.3 ± 3.0 years) volunteered to participate in the study. Nutritional data were collected each day throughout the 3-week Tour by two trained investigators who weighed the food ingested by the cyclists. Mean nutritional intake of the cyclists was as follows: carbohydrate, 12.5 ± 1.8 g/kg/day of body weight (BW) (65.0 ± 5.9%); fat, 1.5 ± 0.5 g/kg/day BW (17.9 ± 5.6%); and protein, 3.3 ± 0.3 g/kg/day BW (17.1 ± 1.6%). Intake of all micronutrients, except for folate, vitamin D and potassium (which were 78.7%, 46% and 84% of Recommended Dietary Allowances (RDA), respectively), exceeded the RDA. Height, weight, skinfolds, circumferences and diameters were taken following the guidelines outlined by the International Society for the Advancement of Kinanthropometry. Body density, body fat percentage, muscle mass, total muscle mass and fat mass of the arms and thighs were calculated. Percentage body fat, fat mass and upper arm fat mass significantly decreased (p < .05) after the Tour independent of the equation method used in the calculations. Total muscle mass remained unchanged. Generally, this sample of cyclists consumed more protein and less fat than the recommended amount and had low weight, BMI and fat mass. It is suggested that sports nutritionists design personalised diets in order to maintain a correct proportion of nutrients as well as controlling possible anthropometrical changes that could affect performance.

Aims: Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is usually associated to conduction gaps in pulmonary veins (PVs). Our objective was to characterize gaps in patients with recurrences after a first radiofrequency (RF) or cryoballoon (CB) PVI procedure, using a high-density mapping (HDM) system., Methods and Results: Fifty patients with AF recurrence after a first PVI procedure (pre-RF 25 patients; pre-CB 25 patients) were included at two centres. Activation map (AM) and voltage map (VM) of the left atrium and PVs were built using the HDM Rhythmia® system. Superior PVs were reconnected more frequently in both groups. Right PVs were reconnected more frequently in pre-RF patients. Pre-RF patients had more reconnected veins than pre-CB patients (mean ± standard deviation: 3.00 ± 0.96 vs. 1.88 ± 1.13; P < 0.001) and more gaps (4.84 ± 2.06 vs. 2.16 ± 1.49; P < 0.001). Gaps in the VM were wider in pre-CB patients (16.5 ± 9.5 mm vs. 12.1 ± 4.8 mm; P = 0.006). There was a gap in 179 of the 800 PV segments analysed (22%); 52% were identified in both AM and VM maps; 39% only in the AM and 8% only in the VM. The highest sensitivity and specificity for gap detection was obtained with VM in pre-CB patients and with AM in pre-RF patients., Conclusion: In conclusion, HDM seems to be a useful and precise tool to detect conduction gaps after a first PVI procedure. The anatomical pattern and location of gaps depends on the technique used previously, usually being multiple, smaller, and better detected by AM after RF, and fewer, wider, and better detected by VM after CB.

BACKGROUND: Studies support the use of new training models based on low volume and high intensity in athletes, especially in soldier populations, showing greater physical improvements than conventional and classic approaches. We conducted this study to analyze the psychophysiological response of soldiers in two different high intensity interval training protocols (HIIT), resisted (RHIIT) and endurance (EHIIT), in order to determine which HIIT elicits a psychophysiological response similar to that in actual theaters of operation. METHODS: We recruited 21 professional soldiers from the Spanish Army. HIIT protocols were conducted in accordance with actual military scenarios, performed at 36-38°C. RESULTS: Both protocols, RHIIT and EHIIT, produced a significant increase in blood lactate (1.6 ± 0.3 to 6.4 ± 4.8 and 1.7 ± 0.6 to 11.2 ± 5.0, respectively), rate of perceived exertion, heart rate, and lower limb explosive strength; skin temperature and bodyweight presented significant decreases. Only EHIIT presented a significant increase on cortical arousal (35.9 ± 2.1 to 37.3 ± 2.8) and isometric hand-grip strength, achieving similar psychophysiological response as in previous simulated combat studies. DISCUSSION: Both endurance and resisted high interval intensity training protocols produced a significant increase in the psychophysiological response of soldiers. EHIIT presented more similarities with actual combat situations. Tornero-Aguilera JG, Clemente-Suárez VJ. Resisted and endurance high intensity interval training for combat preparedness. Aerosp Med Hum Perform. 2019; 90(1):32-36.

Objectives: To analyze heart rate control in hospital emergency departments and outcomes in patients with recent onset atrial fibrillation (AF) so that targets for improvement can be identified., Material and Methods: Multicenter, prospective observational cross-sectional study in a representative sample of 124 hospitals of the Spanish health services, based on records in the HERMES-AF database (Hospital Emergency Department Management Strategies for AF) for May 23 to June 5, 2011. Patients with symptomatic AF within 48 hours of onset were enrolled when the decision was made to attempt restoration of sinus rhythm., Results: We included 337 patients. Chemical cardioversion was used in 311 (92.3%) and electrical cardioversion in 52 (15%), after drugs had failed in half the cases. Sinus rhythm was restored in 278 patients (82.5%), and symptoms resolved in 94%. Adverse effects were recorded in 0.9% but none were serious. Amiodarone was independently associated with a lower rate of restored sinus rhythm (odds ratio [OR], 0.442; 95% CI, 0.238-0.823; P=.01) than electrical cardioversion (OR, 4.0; 95% CI, 1.2-13.3; P=.024). The use of class Ic antiarrhythmic agents was associated with a higher percentage of discharges in less than 6 hours (OR, 2.6; 95% CI, 1.6-4.3; P< .001), and amiodarone was associated with hospital stays longer than 24 hours (OR, 2.7; 95% CI, 1.5-4.8; P< .003)., Conclusion: Emergency department restoration of sinus rhythm in patients with AF is safe, effective, and associated with clinical benefits. Quality of care could be improved by replacing the use of amiodarone with faster and more effective treatments such as electrical cardioversion or the use of class Ic agents.

Caffeine is one of the ergogenic substances most used by warfighters in current operation areas, but the effect on the organic response and operational performed is already poor knowledge. This research aimed to study the acute effect of 400 mg of caffeine monohydrate on the psycho-physiological response and rifle marksmanship of warfighters during a close quarter combat simulation. We analysed parameter of heart rate, blood lactate, cortical arousal, state anxiety and marksmanship of 20 Spanish Army veteran warfighters before and after a close quarter combat simulation in a double-blind procedure, also a correlation analysis was conducted between all the study variables. Marksmanship of warfighters did not improve with the caffeine ingestion, but it produced an increase in blood lactate concentration (caffeine: 1.9 ± 0.5 vs. 9.2 ± 1.1 mmol.l−1; placebo: 1.8 ± 0.7 vs. 6.9 ± 2.2 mmol.l−1), cortical arousal (% of change: caffeine: 2.51; placebo: −1.96) and heart rate (caffeine: 80.0 ± 7.2 vs. 172.9 ± 28.2 bpm; placebo: 79.3 ± 6.4 vs. 154.0 ± 26.8 bpm). In addition, higher heart rate values correlated negatively with marksmanship in close quarter combat. We concluded that caffeine intake did not improve the warfighters rifle marksmanship in close quarter combat possibly due to the increase in the physiological response. [ABSTRACT FROM AUTHOR]

Vaquera, A, Suárez-Iglesias, D, Guiu, X, Barroso, R, Thomas, G, and Renfree, A. Physiological responses to and athlete and coach perceptions of exertion during small-sided basketball games. J Strength Cond Res 32(10): 2949-2953, 2018-This study describes heart rate (HR) responses during different small-sided games (SSGs) in junior basketball players and identifies the level of agreement between athlete and coach perceptions of internal training load calculated using the in-task rating of perceived exertion (RPE) method. Over a 6-week period, 12 male junior basketball players, who played in the Spanish national under-18 League, played 7 games of one-a-side (1v1), 6 games of 2-a-side (2v2), 8 games of 5-a-side (5v5), and 5 games of superiority (3v2) situations. During 1v1, 2v2, 5v5, and 3v2, peak HRs were 90.27 ± 3.37%, 92.68 ± 3.29%, 92.01 ± 3.48%, and 88.74 ± 5.77% of HRmax, respectively. These differences were statistically significant between 1v1 and 2v2 (p < 0.01), 1v1 and 5v5 (p ≤ 0.05), 2v2 and 3v2 (p < 0.001), and 5v5 and 3v2 (p < 0.001). Mean HR was 79.5 ± 4.4%, 83.1 ± 4.2%, 91.2 ± 4.7%, and 78.5 ± 7.5% of HRmax during 1v1, 2v2, 5v5, and 3v2, respectively, and differences were observed between 1v1 and 2v2 (p < 0.001), 2v2 and 3v2 (p < 0.001), and 5v5 and 3v2 (p ≤ 0.05). There were differences in athletes and coaches in-task RPE in all SSGs (all p < 0.0001 apart from 5 × 5 p = 0.0019). The 2v2 format elicited a higher mean in-task RPE in comparison with all other SSGs (p < 0.001), possibly because 2v2 imposes a greater cognitive load.

Aims: Current navigation systems incorporate algorithms for automatic identification of local activation time (LAT). However, data about their utility and accuracy in premature ventricular complex (PVC) ablation procedures are scarce. This study analyses the accuracy of an algorithmic method based on automatic annotation of the maximal negative slope of the unipolar electrogram within the window demarcated by the bipolar electrogram compared with conventional manual annotation during PVC ablation procedures., Methods and Results: Forty patients with successful ablation of focal PVC in three centres were included. Electroanatomical activation maps obtained with the automatic system (WF-map) were compared with manual annotation maps (M-map). Correlation and concordance of LAT obtained with both methods were assessed at 3536 points. The distance between the earliest activation site (EAS) and the effective radiofrequency application point (e-RFp) were determined in M-map and WF-map. The distance between WF-EAS and M-EAS was assessed. Successful ablation sites included left ventricular outflow tract (LVOT; 55%), right ventricular outflow tract (40%), and tricuspid annulus (5%). Good correlation was observed between the two annotation approaches (r = 0.655; P < 0.0001). Bland-Altman analysis revealed a systematic delayed detection of LAT by WF-map (bias 33.8 ± 30.9 ms), being higher in LVOT than in the right ventricle (42.6 ± 29.2 vs. 27.2 ± 30.5 ms, respectively; P < 0.0001). No difference in EAS-eRFp distance was observed between M-map and WF-map (1.8 ± 2.8 vs. 1.8 ± 3.4 mm, respectively; P = 0.986). The median (interquartile range) distance between WF-EAS and M-EAS was 2.2(0-6) mm., Conclusion: Good correlation was found between M-map and WF-map. Local activation time detection was systematically delayed in WF-map, especially in LVOT. Accurate identification of e-RFp was achieved with both annotation approaches.

Aims: Ventricular tachycardia (VT) substrate ablation is based on detailed electroanatomical maps (EAM). This study analyses whether high-density multielectrode mapping (MEM) is superior to conventional point-by-point mapping (PPM) in guiding VT substrate ablation procedures., Methods and Results: This was a randomized controlled study (NCT02083016). Twenty consecutive ischemic patients undergoing VT substrate ablation were randomized to either group A [n = 10; substrate mapping performed first by PPM (Navistar) and secondly by MEM (PentaRay) ablation guided by PPM] or group B [n = 10; substrate mapping performed first by MEM and second by PPM ablation guided by MEM]. Ablation was performed according to the scar-dechanneling technique. Late potential (LP) pairs were defined as a Navistar-LP and a PentaRay-LP located within a three-dimensional distance of ≤ 3 mm. Data obtained from EAM, procedure time, radiofrequency time, and post-ablation VT inducibility were compared between groups. Larger bipolar scar areas were obtained with MEM (55.7±31.7 vs. 50.5±26.6 cm2; P = 0.017). Substrate mapping time was similar with MEM (19.7±7.9 minutes) and PPM (25±9.2 minutes); P = 0.222. No differences were observed in the number of LPs identified within the scar by MEM vs. PPM (73±50 vs. 76±52 LPs per patient, respectively; P = 0.965). A total of 1104 LP pairs were analysed. Using PentaRay, far-field/LP ratio was significantly lower (0.58±0.4 vs. 1.64±1.1; P = 0.01) and radiofrequency time was shorter [median (interquartile range) 12 (7-20) vs. 22 (17-33) minutes; P = 0.023]. No differences were observed in VT inducibility after procedure., Conclusion: MEM with PentaRay catheter provided better discrimination of LPs due to a lower sensitivity for far-field signals. Ablation guided by MEM was associated with a shorter radiofrequency time.

We aimed to evaluate the association of aortic and brachial short-term blood pressure variability (BPV) with the presence of target organ damage (TOD) in hypertensive patients. One-hundred seventy-eight patients, aged 57 ± 12 years, 33% women were studied. TOD was defined by the presence of left ventricular hypertrophy on echocardiogram, microalbuminuria, reduced glomerular filtration rate, or increased aortic pulse wave velocity. Aortic and brachial BPV was assessed by 24-hour ambulatory BP monitoring (Mobil-O-Graph). TOD was present in 92 patients (51.7%). Compared to those without evidence of TOD, they had increased night-to-day ratios of systolic and diastolic BP (both aortic and brachial) and heart rate. They also had significant increased systolic BPV, as measured by both aortic and brachial daytime and 24-hours standard deviations and coefficients of variation, as well as for average real variability. Circadian patterns and short-term variability measures were very similar for aortic and brachial BP. We conclude that BPV is increased in hypertensive-related TOD. Aortic BPV does not add relevant information in comparison to brachial BPV., (©2018 Wiley Periodicals, Inc.)

Introduction: Little is known about the risk of pacemaker implantation after common atrial flutter ablation in the long-term., Methods: We retrospectively reviewed the electrophysiology laboratory database at two Spanish University Hospitals from 1998 to 2012 to identify patients who had undergone successful ablation for cavotricuspid dependent atrial flutter. Cox regression analysis was used to examine the risk of pacemaker implantation., Results: A total of 298 patients were considered eligible for inclusion. The mean age of the enrolled patients was 65.7±11. During 57.7±42.8 months, 30 patients (10.1%) underwent pacemaker implantation. In the stepwise multivariate models only heart rate at the time of the ablation (OR: 0.96; 95% CI: 0.93-0.98; p<0.0001) and intraventricular conduction disturbances in the baseline ECG (OR: 3.87; 95% CI: 1.54-9.70; p=0.004) were independents predictors of the need of pacemaker implantation. A heart rate of ≤65 bpm was identified as the optimal cut-off value to predict the need of pacemaker implantation in the follow-up (sensitivity: 79%, specificity: 74%) by ROC curve analyses., Conclusion: This is the first study of an association between the slow conducting common atrial flutter and subsequent risk of pacemaker implantation. In light of these findings, assessing it prior to ablation can be helpful for the risk stratification of sinus node disease or atrioventricular conduction disease requiring a pacemaker implantation in patients with persistent atrial flutter., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: For patients with acute symptomatic pulmonary embolism (PE), the Bova score classifies their risk for PE-related complications within 30 days after diagnosis. The original Bova score was derived from 2,874 normotensive patients with acute PE who participated in one of six prospective PE studies., Methods: We retrospectively assessed the validity of the Bova risk model in normotensive patients with acute PE diagnosed in an academic urban ED. Two clinician investigators used baseline data for the model's four prognostic variables to stratify patients into the three Bova risk stages (I-III) for 30-day PE-related complications. Intraclass correlation coefficient (ICC) and the κ statistic were used to assess interrater variability., Results: The Bova risk score classified the majority of the cohort of 1,083 patients into the lowest Bova risk stage (stage I, 80%; stage II, 15%; stage III, 5%), The primary end point occurred in 91 of the 1,083 patients (8.4%; 95% CI, 6.7%-10%) during the 30 days after PE diagnosis. Risk stage correlated with the PE-related complication rate (class I, 4.4%; class II, 18%; class III, 42%; ICC, 0.93 [95% CI, 0.92-0.94]; κ statistic, 0.80; P < .001), in-hospital complication rate (class I, 3.7%; class II, 15%; class III, 37%), and 30-day PE-related mortality (class I, 3.1%; class II, 6.8%; class III, 10.5%)., Conclusions: The Bova risk score accurately stratifies normotensive patients with acute PE into stages of increasing risk of PE-related complications that occur within 30 days of PE diagnosis.

Introduction: An empirical sequence of burst antitachycardia pacing (ATP) is effective in terminating fast ventricular tachycardias (FVT) in patients with implantable cardioverter-defibrillators (ICDs). We aimed to determine whether multiple ATP bursts for termination of FVT results in shock reduction compared to a single ATP burst., Methods and Results: We analyzed data from the Umbrella trial, a multicenter prospective observational study of ICD patients followed by the CareLink Monitoring System. We compared the safety and effectiveness of a single ATP burst (Group 1) with a strategy of successive ATP sequences (Group 2) for termination of FVT episodes (cycle lengths 250-320 milliseconds) before shock therapy. Over a mean follow-up of 35 months, a total of 650 FVT episodes were detected in 154 patients (mean cycle length: 299 ± 18 milliseconds). Effectiveness of the first burst ATP in Group 1 was 73% and shocks were required in 27% of episodes. Effectiveness of the first burst ATP in Group 2 was 77%, and this increased to 91% with the third or successive ATP bursts. Shocks were required in 9% of episodes in group 2, representing a 67% reduction in the need of high-energy shocks. Median duration of FVT episodes and mortality in both groups were similar. Multivariate analysis indicated that programming multiple ATP bursts (OR 3.4, 95%CI 1.7-6.8, P = 0.001) was an independent predictor of ATP effectiveness., Conclusion: This study provides first evidence that a strategy of multiple burst ATP sequences for termination of FVT episodes leads to a clinically meaningful reduction in the need for shocks., (© 2015 Wiley Periodicals, Inc.)

Objectives: To examine the effects of a supervised aerobic exercise programme on heart rate variability (HRV) parameters and symptom severity in women with fibromyalgia (FM)., Methods: Thirty-two women with FM were randomly allocated to one of two groups: aerobic exercise (AE) or usual care control for 24 weeks. Women allocated to AE performed two aerobic exercise sessions per week of 45-60 min duration including 15-20 min of steady-state aerobic exercise at 60-65% of predicted maximum heart rate (HRmax) and 15 min of interval training at 75-80% HRmax (six repetitions of 1.5 min, with 1 min interpolated rest intervals). Cardiac autonomic modulation was assessed using power spectral analysis of HRV. Symptom severity was assessed by a 10 cm visual analogue scale (VAS) for pain, sleep disturbances, stiffness, anxiety and depression., Results: After 24 weeks, the women in the exercise group showed an increase (4.8 ± 0.2 to 5.2 ± 0.2) in total power (LnTP, p<0.001), low frequency power (LnLF, p<0.01), high frequency power (LnHF, p<0.001), and the root-mean-square of successive R-R intervals (rMSSD, p<0.001). In addition, significant group-by-time interaction effects were observed for LnHF (p=0.036) and LnLF/HF (p=0.014). Improvements in anxiety and depression were also observed in AE versus control patients., Conclusions: These results show that a programme of aerobic exercise training induced changes in cardiac autonomic nervous system modulation in FM and that these changes in HRV parameters were accompanied by changes in anxiety and depression.

Background and Aims: Diets with a high glycemic index (GI), high glycemic load (GL), or both, increase the risk of cardiovascular disease. This study examined the association of GI and GL in a regular diet with the peripheral augmentation index (i.e., a marker of vascular aging) in a sample of adults., Methods and Results: Cross-sectional study. The findings presented in this manuscript are a subanalysis of the EVIDENT study whose purpose was to analyze the relationship between lifestyle and arterial aging. For the sample population, 1553 individuals aged 20-80 years were selected through random sampling from the patients of general practitioners at six health centers in Spain. GI and GL for each patient's diet were calculated from a previously validated, semi-quantitative, 137-item food frequency questionnaire. The peripheral augmentation index corrected for a heart rate of 75 bpm (PAIx75) was measured with pulse-wave application software (A-Pulse CASP). Based on a risk factor adjusted regression model, for every 5 unit increase in GI, the PAIx75 increased by 0.11 units (95% CI: 0.04-0.19). Similarly, for every increase in 10 units in GL, the PAIx75 increased by 1.13 (95% CI: 0.21-2.05). High PAIx75 values were observed in individuals with diets in the third GI tertile (i.e., the highest), and lower PAIx75 values in those with diets in the first tertile (i.e., the lowest), (93.1 vs. 87.5, respectively, p = 0.001)., Conclusions: GI and GL were directly associated with PAIx75 values in adults without cardiovascular diseases regardless of age, gender, physical activity, and other confounders., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: To assess the incidence and timing of hypotension after carotid artery stenting (CAS) and its correlation with postoperative complications., Background: CAS-associated postoperative hypotension has been linked to surgical morbidity and mortality, especially to stroke and cardiac complications., Methods: Ninety-seven consecutive patients undergoing transcervical CAS were monitored for at least 12 hr after operation. Hypotension was defined as systolic blood pressure < 90 mm Hg. Patients were divided into three groups: normal blood pressure and early (≤6 hr) and late (>6 hr) hypotension. Complications were recorded., Results: Hypotension occurred in 34% of the patients (early hypotension in 63% of them). Hypotension was recorded in 21.6% of patients during surgery and in 21.6%, 15.5%, and 1.0% at 6, 12, and 24 hr postoperatively. Bradycardia occurred in 26.8% during operation and in 25.8%, 13.4%, and 10.3% at 6, 12, and 24 hr after surgery. Intraoperative bradycardia (P = 0.01) and hypotension (P = 0.02) were predictors of postoperative hypotension. The overall rate of complications was 5% without differences between the study groups. The mean length of stay was 3, 3.6, and 2.8 days in the normotensive, early hypotension, and late hypotension groups, respectively., Conclusions: Most postoperative hypotension episodes occurred within the first 6 hr, and more than one-third between the 6 and 12 hr post-procedure. All patients with late hypotension were asymptomatic. There was no difference in complications between the study groups. In patients undergoing ambulatory CAS, hemodynamic monitoring in the postoperative period is particularly important during the first 12 hr., (© 2014 Wiley Periodicals, Inc.)

Objective: Epidemiological studies have shown that an elevated resting heart rate (HR) is a risk factor for both total and cardiovascular mortality. Our aim was to estimate the night-time HR cut-off point that best predicts cardiovascular risk office tachycardia in hypertensive patients., Design and Method: Untreated hypertensive patients without concomitant cardiovascular diseases were included. Office and ambulatory HRs were measured. Cardiovascular risk office tachycardia was defined by office HR at least 85 beats per minute (bpm). Different night-time HR cut-offs were estimated by receiver operating characteristic curve analyses to predict cardiovascular risk office tachycardia. The best cut-off was selected on the basis of its combined sensitivity and specificity., Results: A total of 32 569 hypertensive patients were included: 46.5% women, mean age (SD) 52 (14) years, office blood pressure 146 (16)/89 (11) mmHg, diabetes 10.3%, smoking 19.2%, BMI 29 (6.8) kg/m, office HR 77 (11.2) bpm, and night-time HR 64.9 (9.3) bpm. A total of 7070 (21.7%) patients were found to have cardiovascular risk office tachycardia. The night-time HR value that better predicted cardiovascular risk office tachycardia was more than 66 bpm. In comparison with patients with night HR below this value, those with night-time tachycardia were predominantly women, younger, with higher ambulatory blood pressure, greater BMI, and higher prevalence of diabetes and smoking. All comparisons were statistically significant (P less than 0.001)., Conclusion: A mean night-time HR more than 66 bpm is a good predictor of cardiovascular risk office tachycardia in untreated hypertensive patients and could be considered a variable associated with an increased cardiovascular risk.