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We present the recommendations of the Preventive Activities and Health Promotion Programme (PAPPS) of the semFYC (Spanish Society of Family and Community Medicine) to promote healthy lifestyles using intervention methodology, and preventive actions against tobacco and alcohol use, healthy eating, physical activity in leisure time, prevention of traffic accidents, and child restraint systems. The recommendations have been updated, and new aspects highlighted, such as the definition of low-risk alcohol consumption, and the references have been updated. For the main recommendations, we include specific tables showing the quality of the evidence and the strength of the recommendation.

[EN] Background and objectives: Macroreentrant atrial tachyarrhythmias (MRATs) can be caused by different reentrant circuits. The treatment for each MRAT type may require ablation at different sites, either at the right or left atria. Unfortunately, the reentrant circuit that drives the arrhythmia cannot be ascertained previous to the electrophysiological intervention. Methods: A noninvasive approach based on the comparison of atrial vectorcardiogram (VCG) loops is proposed. An archetype for each group was created, which served as a reference to measure the similarity between loops. Methods were tested in a variety of simulations and real data obtained from the most common right (peritricuspid) and left (perimitral) macroreentrant circuits, each divided into clockwise and counterclockwise subgroups. Adenosine was administered to patients to induce transient AV block, allowing the recording of the atrial signal without the interference of ventricular signals. From the vectorcardiogram, we measured intrapatient loop consistence, similarity of the pathway to archetypes, characterisation of slow velocity regions and pathway complexity. Results: Results show a considerably higher similarity with the loop of its corresponding archetype, in both simulations and real data. We found the capacity of the vectorcardiogram to reflect a slow velocity region, consistent with the mechanisms of MRAT, and the role that it plays in the characterisation of the reentrant circuit. The intra-patient loop consistence was over 0.85 for all clinical cases while the similarity of the pathway to archetypes was found to be 0.85 +/- 0.03, 0.95 +/- 0.03, 0.87 +/- 0.04 and 0.91 +/- 0.02 for the different MRAT types (and p < 0 . 02 for 3 of the 4 groups), and pathway complexity also allowed to discriminate among cases (with p < 0 . 05 ). Conclusions: We conclude that the presented methodology allows us to differentiate between the most common forms of right and left MRATs and predict the existence and location of a slow conduction zone. This approach may be useful in planning ablation procedures in advance., This work was supported by PID2019-109547RB-I00 (National Research Program, Ministerio de Ciencia e Innovacion, Spanish Government), CIBERCV CB16/11/00486 (Instituto de Salud Carlos III) and PROMETEOII/2014/037 (Generalitat Valenciana).

[EN] Ablation of pulmonary veins has emerged as a key procedure for normal rhythm restoration in atrial fibrillation patients. However, up to half of ablated Atrial fibrillation (AF) patients suffer recurrences during the first year. In this article, simultaneous intra-atrial recordings registered at pulmonary veins previous to the ablation procedure were analyzed. Spatial cross-correlation and transfer entropy were computed in order to estimate spatial organization. Results showed that, in patients with arrhythmia recurrence, pulmonary vein electrical activity was less correlated than in patients that maintained sinus rhythm. Moreover, correlation function between dipoles showed higher delays in patients with AF recurrence. Results with transfer entropy were consistent with spatial cross-correlation measurements. These results show that arrhythmia drivers located at the pulmonary veins are associated with a higher organization of the electrical activations after the ablation of these sites., This research was funded by Spanish Ministry of Research and Innovation : PID2019-109547RB-I00. This research was supported by the PID2019-109547RB-I00 National Research Program RETOS from the Spanish Ministry of Research and Innovation and partialy by GVA (PROMETEO/2018/078) & ISCIII (CB16/11/00486). Thanks to Michael Charles Willoughby for English language and scientific editing services.

The objective of this study is to non-invasively characterise a variety of atrial flutter (AFL) types, defined by a maroreentrant circuit. A vectorcardiographic approach is proposed to compare atrial macroreentrant circuits. Vectorcardiogram (VCG) arechetypes are computed so that parameters such as similarity among loops can be calculated. The methodology was employed in a set of artificial VCGs created from a computational simulation based on a mathematical model and in signals from real patients. Adenosine was used to block the ventricular contribution to the ECG signal, later transformed to a VCG analysed from different perspectives. Results demonstrate a high similarity for cases belonging to a group with its archetype in synthetic and real cases. Slow conduction velocity regions were found to be very well represented in VCGs, in accordance with AFL mechanisms and its importance when characterising atrial macroreentries. The conclusion is that our methodology allows differentiation between the most recurrent types of AFL through the analysis of its VCG representation, predicting the presence of slow conduciton regions along the macroreentry. This can be very useful when planning in advance the ablation procedure.

Although Atrial Fibrillation (AF) is the most frequent cause of cardioembolic stroke, the arrhythmia remains underdiagnosed, as it is often asymptomatic or intermittent. Automated detection of AF in ECG signals is important for patients with implantable cardiac devices, pacemakers or Holter systems. Such resource-constrained systems often operate by transmitting signals to a central server where diagnostic decisions are made. In this context, ECG signal compression is being increasingly investigated and employed to increase battery life, and hence the storage and transmission efficiency of these devices. At the same time, the diagnostic accuracy of AF detection must be preserved. This paper investigates the effects of ECG signal compression on an entropy-based AF detection algorithm that monitors R-R interval regularity. The compression and AF detection algorithms were applied to signals from the MIT-BIH AF database. The accuracy of AF detection on reconstructed signals is evaluated under varying degrees of compression using the state-of-the-art Set Partitioning In Hierarchical Trees (SPIHT) compression algorithm. Results demonstrate that compression ratios (CR) of up to 90 can be obtained while maintaining a detection accuracy, expressed in terms of the area under the receiver operating characteristic curve, of at least 0.9. This highlights the potential for significant energy savings on devices that transmit/store ECG signals for AF detection applications, while preserving the diagnostic integrity of the signals, and hence the detection performance.

Atrial fibrillation (AF) is already the most frequent arrhythmia in the clinical practice. Pulmonary vein ablation has emerged as a treatment that is able to make disappear the arrhythmia, nevertheless up to half of ablated AF patients suffer recurrences within the first year. In this study multiple simultaneous intra-atrial bipolar recordings were located at three locations, pulmonary veins and the right and the left atrium before the ablation procedure. Signal organization parameters were determined using cross-correlation analysis along the three main atrial regions. The results showed that before the procedure, patients with recurrence in the arrhythmia showed that left atrial activity was less correlated with other atrial regions compared with patients that maintained sinus rhythm. Moreover, time-lagged correlation coefficient between two time series showed higher delays in patients that experienced recurrence of AF. These results can be helpful for procedures designing to end AF.

Time and frequency domain analysis has been applied to atrial electrograms to quantify the temporal and spatial organization during atrial fibrillation (AF). Intracardiac recordings obtained before AF ablation procedure were analyzed in order to predict the recurrence outcome of AF after an ablation intervention. Such analysis may be used to quantify both temporal/ frequency and spatial organization during AF. Pulmonary vein electrogram recordings from ten AF patients were analyzed. Results showed changes in spectral characteristics with higher dispersion in spatial organization along the pulmonary veins in patients that had recurrence in the arrhythmia 0.14±0.01 vs. 0.07±0.02 in patients that maintained sinus rhythm (p

The goal of pulmonary vein ablation for atrial fibrillation (AF) is returning to normal sinus rhythm; nevertheless it success is limited in part by uncertainly in the mechanisms that sustain AF. 43 AF patients were submitted to an ablation procedure and monitored after ablation. Dominant frequency from intra-atrial recordings obtained before the intervention were analysed in order to predict AF recurrence. The novelty of this study is that dominant frequency was calculated from reconstructed signal by singular spectrum analysis (SSA) application. Patients that maintained sinus rhythm and patients with recurrence in AF showed differences in left atrium dominant frequencies, with higher values in the recurrent AF group than in group without recurrence in the arrhythmia (p=0.02). Moreover, differences between both atria were found in the non-recurrent group, with 5.76 ± 1.31 Hz in the left atrium vs. 6.25±1.23 Hz in the right atrium (p=0.03). These findings show the potential of SSA as a preprocessing method and results are congruent with previous studies.

Arrhythmogenic cardiomyopathy (AC) is an inherited rare disease that can cause sudden cardiac death. Due to its heterogeneous phenotipe, a compendium of criteria collected in a Task Force Criteria (TFC) have to be met for its diagnosis, being dysshynchrony one of those criteria. The classical form of the disease involves the right ventricle, while the left ventricle AC (AC-LV) has been less studied. We aim to study dyssynchrony in AC-LV patients. The sample consisted of 36 subjects diagnosed with AC-LV and 23 non-affected relatives who were non-carriers of the pathogenic mutation of the proband. From each individual, radial, circumferential and longitudinal strain were obtained in the 16 AHA segments of the myocardium and dyssynchrony was calculated as the standard deviation of the time-to-peak strain. LV ejection fraction (LVEF) was also obtained. Finally, a clustering algorithm was applied to the 3-axis dyssynchronies and the LVEF. The clustering algorithm performed well (silhouette = 0.6) and detected 2 clusters (cluster1 = 23 controls + 19 AC-LV patients and cluster2 = 17 AC-LV patients). Radial dyssynchrony was the feature with the higher predictor importance. In conclusion, 47% of AC-LV patients present impaired dyssynchrony. Radial dyssynchrony was the most affected parameter among all dyssynchronies and LVEF.

Background The dominant atrial frequency is a key parameter for the analysis of atrial fibrillation (AF) from intracardiac recordings. The preprocessing approach employed by Botteron et al. in an early work is able to retrieve this frequency. The preprocessing steps are: (1) 40–250-Hz band-pass filtering, (2) rectification, and (3) 20 Hz low-pass filtering. Methods and results The theoretical aspects of this process are addressed. Moreover, its time-domain and frequency-domain properties are evaluated using both simulations and real electrogram (EGM) recordings. The fundamental frequency is emphasized, due to the rectification step. As the interval between consecutive activations becomes more irregular, fundamental frequency detection becomes less robust. In the case of fractionated EGM, this approach fails. In time-domain, the waveform of the atrial beats are dramatically modified, hence hindering any further analysis on the morphology of the activations. Conclusions Botteron preprocessing succeeds in estimating the dominant atrial rate in most EGMs during AF. However, this approach presents some limitations and improved methods are required.

During atrial fibrillation (AF), multiple wandering propagation wavelets at high rates drift around both atria under controversial hierarchical models. Antiarrhythmic drugs modify the cardiac ionic currents supporting the fibrillation process within the atria, and can alter AF propagation dynamics and even terminate the arrhythmia. However, some other drugs, theoretically nonantiarrhythmic, may slightly block particular cardiac ionic currents through uncertain mechanisms in such a subtle way at regular heart rates that may have been pharmacologically overlooked. These potential effects might be better exposed at much higher activation rates as in AF, where atrial cells depolarize over 400 times per second. In this review, we aimed to compile and discuss results from several studies evaluating the net effect of profound sedation with propofol on atrial cells and atrioventricular (AV) conduction. Propofol is a very commonly used anesthetic agent, and its possible effect on AF dynamics has systematically not been taken into account in the myriad of clinical studies dealing with AF intracardiac recordings. The possible effect of sedation with propofol on AF was evaluated through the analysis of AF propagation patterns before and after its infusion in a series of patients submitted to pulmonary vein ablation. Effect on AV conduction will be discussed as well.