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Background and aimsAn insufficient number of premature ventricular complexes (PVCs) during catheter ablation (CA) may prohibit adequate mapping of the site of origin. Parameters to predict this situation have not been established. Our objective was to quantify the association between preprocedural information and the probability of a sufficient number of PVCs for adequate mapping and successful CA.MethodsClinical characteristics and results from examinations and procedural data were collected retrospectively from health journals for patients admitted for CA of PVCs from 2011 to 2020.ResultsIn total, 46 of 332 patients (14%) had an insufficient number of PVCs to enable adequate electroanatomical mapping. Patients with a sufficient number of PVCs had nominally more PVCs in the 24-h electrocardiogram (ECG), with a strong statistical trend [16,007 (6,509–26,205) vs. 8,332 (3,066–20,974), p = 0.055]. The receiver operator curve for a sufficient number of PVCs in 24-h ECGs had an area under the curve of 0.610 (95% CI 0.498–0.722, p = 0.055). The best predictive values were found at >10,000 PVCs per 24-h, with a positive predictive value of 67% and a negative predictive value of 57%. Patients for whom activation mapping was used as the sole mapping method had more PVCs in the 24-h ECG than did patients for whom pace mapping was added or used as an alternative [19,769 (10,564–30,526) vs. 15,237 (6,000–25,033), p = 0.022]. Neither acute outcome nor procedure time depended on the mapping strategy.ConclusionThe number of PVCs in a 24-h ECG was moderately associated with the presence of a sufficient number of PVCs to perform electroanatomical mapping during CA. The presence of more PVCs in the preprocedural 24-h ECG was associated with the use of activation mapping as the sole mapping strategy.

Despite positioning itself as the ‘climate bank of Asia and the Pacific’, it is difficult to ascertain the Asian Development Bank’s claims of climate adaptation finance., Oxfam analysed the bank’s 2019–2023 climate finance portfolio and conducted a detailed assessment of 15 climate adaptation projects, comprising 43% of reported adaptation finance for FY 2021 and 2022. Oxfam found that the Asian Development Bank (ADB) hugely overstates the reported amounts with potential over-reporting of 44% in average for the assessed projects., This briefing paper calls for a transformative shift in the ADB’s adaptation finance strategies. The ADB must improve the accuracy and transparency of climate finance reporting and realign financial flows with the needs of the region's most vulnerable communities.

In 2009, high-income countries committed in the Copenhagen Accords to mobilize US$100 billion a year by 2020 in climate finance for low- and middle-income countries. Oxfam reported on the progress of this commitment in 2016, 2018 and 2020. This year’s report finds that high-income countries have not only failed to deliver on their commitment, but also – as in previous years – generous accounting practices have allowed them to overstate the level of support they have actually provided. Moreover, much of the finance has been provided as loans, which means that it risks increasing the debt burden of the countries it is supposed to help., This paper calls on high-income countries to accelerate the mobilization and provision of climate finance, and to make up the shortfall from previous years, in a way that is equitable and just. High-income countries must provide finance that is transparent, with genuine accountability mechanisms, and that allows for far more local ownership and responsiveness to the needs of communities it is intended to reach. People on the frontlines of the climate crisis must have the funding they were promised for adaptation and mitigation, and to address the loss and damage they are already experiencing as a result of climate impacts., En 2009, les pays à revenu élevé se sont engagés par le biais de l’Accord de Copenhague à mobiliser 100 milliards de dollars par an avant 2020 dans le cadre du financement climat pour les pays à revenu faible et intermédiaire. Oxfam a rendu compte de la progression dans la réalisation de cet engagement en 2016, 2018 et 2020. Cette dernière édition du rapport révèle que les pays à revenu élevé ont non seulement manqué à leur engagement, mais ils ont, au cours des années précédentes, recouru à des pratiques comptables généreuses leur ayant permis de surestimer le niveau de soutien qu’ils apportent en réalité. De plus, une grande partie des financements ont été fournis sous forme de prêts, au risque d’augmenter le poids de la dette des pays qu’ils sont censés aider., Ce rapport appelle les pays à revenu élevé à accélérer la mobilisation et la fourniture des financements climat ainsi qu’à compenser les lacunes des années précédentes, de manière équitable et juste. Les pays à revenu élevé doivent fournir des financements transparents, s’articulant autour de véritables mécanismes de redevabilité, pour une plus grande appropriation locale et une bien meilleure réactivité aux besoins des communautés visées. Les populations se trouvant en première ligne de la crise climatique doivent impérativement recevoir le financement promis afin de faire face à l’adaptation et à l’atténuation et compenser les pertes et dommages découlant déjà des impacts climatiques.

BackgroundThe effect of prolonged, high-intensity endurance exercise on myocardial function is unclear. This study aimed to determine the left ventricular (LV) response to increased exercise duration and intensity using novel echocardiographic tools to assess myocardial work and fatigue.Materials and methodsLV function was assessed by echocardiography before, immediately, and 24 h after a cardiopulmonary exercise test (CPET) and a 91-km mountain bike leisure race. Cardiac Troponin I (cTnI) was used to assess myocyte stress.Results59 healthy recreational athletes, 52 (43–59) years of age, 73% males, were included. The race was longer and of higher intensity generating higher cTnI levels compared with the CPET (p < 0.0001): Race/CPET: exercise duration: 230 (210, 245)/43 (40, 45) minutes, mean heart rate: 154 ± 10/132 ± 12 bpm, max cTnI: 77 (37, 128)/12 (7, 23) ng/L. Stroke volume and cardiac output were higher after the race than CPET (p < 0.005). The two exercises did not differ in post-exercise changes in LV ejection fraction (LVEF) or global longitudinal strain (GLS). There was an increase in global wasted work (p = 0.001) following the race and a persistent reduction in global constructive work 24 h after exercise (p = 0.003).ConclusionIncreased exercise intensity and duration were associated with increased myocardial wasted work post-exercise, without alterations in LVEF and GLS from baseline values. These findings suggest that markers of myocardial inefficiency may precede reduction in global LV function as markers of myocardial fatigue.

AimsArrhythmic mitral valve syndrome is linked to life-threatening ventricular arrhythmias. The incidence, morphology and methods for risk stratification are not well known. This prospective study aimed to describe the incidence and the morphology of ventricular arrhythmia and propose risk stratification in patients with arrhythmic mitral valve syndrome.MethodsArrhythmic mitral valve syndrome patients were monitored for ventricular tachyarrhythmias by implantable loop recorders (ILR) and secondary preventive implantable cardioverter-defibrillators (ICD). Severe ventricular arrhythmias included ventricular fibrillation, appropriate or aborted ICD therapy, sustained ventricular tachycardia and non-sustained ventricular tachycardia with symptoms of hemodynamic instability.ResultsDuring 3.1 years of follow-up, severe ventricular arrhythmia was recorded in seven (12%) of 60 patients implanted with ILR [first event incidence rate 4% per person-year, 95% confidence interval (CI) 2–9] and in four (20%) of 20 patients with ICD (re-event incidence rate 8% per person-year, 95% CI 3–21). In the ILR group, severe ventricular arrhythmia was associated with frequent premature ventricular complexes, more non-sustained ventricular tachycardias, greater left ventricular diameter and greater posterolateral mitral annular disjunction distance (all P < 0.02).ConclusionsThe yearly incidence of ventricular arrhythmia was high in arrhythmic mitral valve syndrome patients without previous severe arrhythmias using continuous heart rhythm monitoring. The incidence was even higher in patients with secondary preventive ICD. Frequent premature ventricular complexes, non-sustained ventricular tachycardias, greater left ventricular diameter and greater posterolateral mitral annular disjunction distance were predictors of first severe arrhythmic event.

Context Glucose-dependent insulinotropic polypeptide (GIP) has been proposed to exert insulin-independent effects on lipid and bone metabolism. Objective We investigated the effects of a 6-day subcutaneous GIP infusion on circulating lipids, white adipose tissue (WAT), brown adipose tissue (BAT), hepatic fat content, inflammatory markers, respiratory exchange ratio (RER), and bone homeostasis in patients with type 1 diabetes. Methods In a randomized, placebo-controlled, double-blind, crossover study, 20 men with type 1 diabetes underwent a 6-day continuous subcutaneous infusion with GIP (6 pmol/kg/min) and placebo (saline), with an interposed 7-day washout period. Results During GIP infusion, participants (26 ± 8 years [mean ± SD]; BMI 23.8 ± 1.8 kg/m2; glycated hemoglobin A1c 51 ± 10 mmol/mol [6.8 ± 3.1%]) experienced transiently increased circulating concentrations of nonesterified fatty acid (NEFA) (P = 0.0005), decreased RER (P = 0.009), indication of increased fatty acid β-oxidation, and decreased levels of the bone resorption marker C-terminal telopeptide (P = 0.000072) compared with placebo. After 6 days of GIP infusion, hepatic fat content was increased by 12.6% (P = 0.007) and supraclavicular skin temperature, a surrogate indicator of BAT activity, was increased by 0.29 °C (P < 0.000001) compared with placebo infusion. WAT transcriptomic profile as well as circulating lipid species, proteome, markers of inflammation, and bone homeostasis were unaffected. Conclusion Six days of subcutaneous GIP infusion in men with type 1 diabetes transiently decreased bone resorption and increased NEFA and β-oxidation. Further, hepatic fat content, and supraclavicular skin temperature were increased without affecting WAT transcriptomics, the circulating proteome, lipids, or inflammatory markers.