Right heart structure and function in lifelong recreational endurance athletes with and without paroxysmal atrial fibrillation

Predictive value of left and right atrial strain for the detection of device-detected atrial fibrillation in patients with cryptogenic stroke and implantable cardiac monitor

BACKGROUND AND OBJECTIVE

Device-detected atrial fibrillation (DDAF) is frequently identified using implantable cardiac monitors (ICMs) following cryptogenic stroke (CS). While left atrium (LA) echocardiographic parameters have been linked to DDAF risk, right atrial (RA) parameters remain underexplored. This study aimed to assess the relationship between speckle-tracking echocardiography parameters and the occurrence of DDAF detected via ICM in patients with CS.

METHODS

We retrospectively analyzed consecutive CS patients who received an ICM at our institution. All underwent transthoracic echocardiography to evaluate LA, RA, left and right ventricle (LV, RV) function using standard and strain-derived parameters. The primary endpoint was the first DDAF episode lasting >6 min recorded by ICM.

RESULTS

Between May 2013 and July 2022, 204 patients (82 % males, median age 69 years) received an ICM. Over a median follow-up of 15.3 months [interquartile range: 7.4-23.5], DDAF was detected in 96 patients (47.0 %). LA peak longitudinal strain (adjusted-hazard ratio [HR] 0.87, 95 %CI 0.84-0.89, p < 0.001), peak conduit strain (adjusted-HR 1.17, 95 %CI 1.13-1.22, p < 0.001), and peak contraction strain (adjusted-HR 1.17, 95 % CI 1.11-1.22, p < 0.001) significantly predicted DDAF. RA peak longitudinal strain (adjusted-HR 0.89, 95 % CI 0.83-0.95, p < 0.001) and peak contraction strain (adjusted-HR 1.39, 95 % CI 1.26-1.53, p < 0.001) were also predictive, but peak conduit strain was not (p = 0.103). No significant associations were found for LV or RV parameters.

CONCLUSIONS

LA and RA strain analyses are valuable for predicting DDAF detection following CS and can aid in risk stratification before ICM insertion.

What every intensivist should know about the IVC

Assessment of the IVC by point-of-care ultrasound in the context of resuscitation has been a controversial topic in the last decades. Most of the focus had been on its use as a surrogate marker for fluid responsiveness, with results being equivocal. We review its important anatomical aspects as well as the physiological rationale behind ultrasound assessment and propose a new way to do so, as well as explain its central role in the concept of fluid tolerance.

Effects of training adaption in endurance athletes with atrial fibrillation: protocol for a multicentre randomised controlled trial

Endurance athletes have a high prevalence of atrial fibrillation (AF), probably caused by exercise-induced cardiac remodelling. Athletes diagnosed with AF are often advised to reduce the intensity and amount of training but the efficacy of this intervention has not been investigated in endurance athletes with AF. Effects of detraining in endurance athletes with atrial fibrillation is a two-arm international multicentre randomised (1:1) controlled trial on the effects of a period of training adaption on AF burden in endurance athletes with paroxysmal AF. One-hundred-and-twenty endurance athletes diagnosed with paroxysmal AF are randomised to a 16-week period of intervention (training adaption) or a control group. We define training adaption as training with a heart rate (HR) not exceeding 75% of the individual maximum HR (HRmax), and total duration of weekly training not exceeding 80% of the self-reported average before the study. The control group is instructed to uphold training intensity including sessions with HR ≥85% of HRmax. AF burden is monitored with insertable cardiac monitors, and training intensity with HR chest-straps and connected sports watches. The primary endpoint, AF burden, will be calculated as the cumulative duration of all AF episodes lasting ≥30sec divided by total duration of monitoring. Secondary endpoints include number of AF episodes, adherence to training adaption, exercise capacity, AF symptoms and health-related quality of life, echocardiographic signs of cardiac remodelling and risk of cardiac arrhythmias related to upholding training intensity.

Trial registration number

NCT04991337.

Study protocol version

4.7 (Date 9 March 2023).