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Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Regional Development Fund (FEDER) and Spanish Ministry of Health. Introduction Previous research has identified a potential relationship between sleep patterns and atrial fibrillation (AF). Short daytime napping is a widespread healthy habit particularly in Mediterranean countries. However, as far as we know, daytime napping and the risk of developing AF has not been analysed before. Purpose Our objective was to assess the association between daytime napping and the incidence of AF in a Mediterranean cohort. Methods The SUN project is a dynamic, prospective cohort of Spanish university graduates. A total of 20,348 participants, free of AF at baseline, were followed-up for a median time of 13.8 years, with a retention proportion of 91%. Daytime napping was assessed at baseline and participants were categorised according to their average daily napping time. Incident cases of AF were confirmed by a cardiologist according to a prespecified protocol. Multivariable Cox regression models were used to estimate hazard ratios (HR) of AF according to daytime napping time. Results During follow-up, we identified 131 incident cases of AF. In comparison to participants with short daytime napping (30 minutes/day. Conclusions Daytime napping was significantly associated with the risk of developing AF. Sleeping a longer nap (≥30 minutes/day) was associated with an increased risk, while a shorter nap between 15-30 minutes/day was associated with a lower risk of incident AF. These findings suggest a potential novel healthy lifestyle habit in the primary prevention of AF.

Background Obesity is widely recognised as a strong risk factor for atrial fibrillation and recent interest has focused on epicardial fat. Although body mass index is commonly used in the clinical practice, it doesn't precisely estimate adiposity. The Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) is an equation developed for body fat calculation, that has been previously associated with cardiometabolic disease. Our objective was to assess the association between body fat, as captured by the CUN-BAE index, and the incidence of atrial fibrillation in a prospective cohort. Methods The SUN project is a dynamic, prospective cohort of Spanish university graduates. A total of 20.136 participants, free of atrial fibrillation at baseline, were followed-up for a median time of 12 years, with a retention proportion of 91%. CUN-BAE was calculated for each participant taking into account only sex, age and body mass index. Incident cases of atrial fibrillation were confirmed by a cardiologist according to a prespecified protocol. Multivariable Cox regression models were used to estimate hazard ratios (HR) of atrial fibrillation according to calculated body fat. Results During follow-up, we identified 128 incident cases of atrial fibrillation. There was a strong direct association between a higher CUN-BAE index at baseline and incident atrial fibrillation during follow-up. In comparison to participants with a lower body fat category (median 21.3%), those with a higher category of body fat (median 34.8%) exhibited a significant 118% higher relative risk of incident atrial fibrillation (adjusted HR=2.18; 95% CI: 1.22, 3.90). For each 2-unit increase in the CUN-BAE index, atrial fibrillation risk significantly increased by 10%. The risk of incident atrial fibrillation remained significantly associated with adiposity even after further adjustment for obesity (body mass index ≥30 kg/m2) and in repeated measures analysis of the CUN-BAE index every other year. Conclusions Increased body adiposity, as captured by CUN-BAE index, was strongly and independently associated with a higher risk of atrial fibrillation in a Spanish cohort. These findings support the hypothesis that adiposity is closely related with arrhythmogenic mechanisms that could lead to atrial fibrillation and may be predicted using an equation to estimate body fat. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Spanish Ministry of Health and European Regional Development Fund (FEDER)

Funding Acknowledgements Type of funding sources: None. Introduction Permanent His bundle pacing (p-HBP) could be an alternative for cardiac resynchronization therapy (CRT), but an important limitation is that p-HBP cannot always correct the left bundle branch block (LBBB). The aim is to assess electrocardiographic (ECG) patterns of LBBB that can predict ECG response (QRS narrowing) to p-HBP. Methods Prospective descriptive study of patients with LBBB and CRT indication proposed for CRT by p-HBP. We analyzed the correlation between the different ECG patterns and the correction of LBBB. Results We included 70 patients. Once located His bundle electrogram, pacing at this level narrowed the QRS in 81.4% (n=57). We distinguished two ECG patterns in lead V1: QS or rS. Thirty-four patients (51.4%) presented QS pattern in lead V1 (Fig 1A), and in 94.1% of these correction of the LBBB was achieved (Fig 1B). The rS pattern was present in 36 patients and in 69.4% of these the correction of the LBBB was achieved. Differences between both groups were statistically significant (p=.008). The presence of QS pattern in V1 had a sensitivity of 56%, a specificity of 84.6% and a positive predictive value of 94.1% to predict LBBB correction. The AUC by a receiver operating characteristic analysis was .70±. In patients with rS pattern in lead V1, we analyzed the ratio between the descending and the ascending S wave component duration; the difference between patients in whom LBBB was corrected (ratio 0.742±0.124) and patients in whom it was not corrected (0.476±0.124) were statistically significant (p=.001). The AUC by a receiver operating characteristic analysis was .968 (very good predictor of LBBB correction). In this case, a ratio between the descending and the ascending S wave component duration≥0.64 (Fig 2C-D) showed a sensitivity of 92%, a specificity and a PPV of 100%, and a negative predictive value (NPV) of 83.3%. Related to the ratio between the ascending S wave component duration and the total QRS duration, it was 0.513±0.043 in patients with LBBB correction vs 0.60 ± 0.046 in those in whom it did not correct (P=.001). The AUC by a receiver operating characteristics analysis was .896 (good test to predict LBBB correction in patients with rS pattern in lead V1). We analyzed the ratio between the descending and the ascending S wave component duration in the global of patients, including those with QS pattern. Patients in whom it corrected the LBBB presented a ratio of 0.754±0.13 vs 0.459±0.081 in whom it did not correct (P Conclusions In patients with LBBB and CRT indication, the QS pattern in lead V1 predicts the correction of the QRS with HBP. In the case of rS pattern in lead V1, the ratio descending/ascending S wave component duration has a strong correlation with the LBBB correction.