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Minardi S, Sciarra L, Robles AG, Scara A, Sciarra F, De Masi De Luca G, Romano S. Thromboembolic prevention in athletes: management of anticoagulation in sports players affected by atrial fibrillation. Front Pharmacol 2024; 15:1384213. [PMID: 38803430 PMCID: PMC11129016 DOI: 10.3389/fphar.2024.1384213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Atrial fibrillation (AF) is a common cardiac arrhythmia that poses a significant risk of stroke and thromboembolic events. Anticoagulation therapy is essential for preventing stroke in patients with AF. An increasing number of people of all ages, including cardiac patients, approach physical activity as both a leisure-time exercise and a competitive sport. Therefore, patients at risk of AF are increasingly allowed to practice sports activities. Management of oral anticoagulant therapy (OAT) in these patients is extremely challenging because of the need to balance the risks and benefits of medications, considering both hemorrhagic (in case of trauma) and ischemic complications when the drugs are avoided. Official recommendations are limited for these patients and forbid sports that increase the risk of trauma and consequent bleeding in most cases. These recommendations are strongly influenced by the "traditional" management of OAT, which mainly involves coumarin derivatives. Non-vitamin K antagonist direct oral anticoagulants (DOACs), with their more favorable pharmacokinetic-pharmacodynamic profile than that of coumarin derivatives, may represent an opportunity to modify the approach to sports activity in patients with AF and indications for OAT. This study aimed to review the use of anticoagulants in athletes with AF, highlight their efficacy and safety, and provide practical considerations regarding their management.
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Affiliation(s)
- Simona Minardi
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Luigi Sciarra
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Antonio Gianluca Robles
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Department of Cardiology, L. Bonomo Hospital, Andria, Italy
| | - Antonio Scara
- Department of Cardiology, San Carlo di Nancy-GVM, Rome, Italy
| | | | - Gabriele De Masi De Luca
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Department of Cardiology, Card. G. Panico Hospital, Tricase, Italy
| | - Silvio Romano
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
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Kistler PM, Sanders P, Amarena JV, Bain CR, Chia KM, Choo WK, Eslick AT, Hall T, Hopper IK, Kotschet E, Lim HS, Ling LH, Mahajan R, Marasco SF, McGuire MA, McLellan AJ, Pathak RK, Phillips KP, Prabhu S, Stiles MK, Su RW, Thomas SP, Toy T, Watts TW, Weerasooriya R, Wilsmore BR, Wilson L, Kalman JM. 2023 Cardiac Society of Australia and New Zealand Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation. Heart Lung Circ 2024:S1443-9506(24)00170-7. [PMID: 38702234 DOI: 10.1016/j.hlc.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 05/06/2024]
Abstract
Catheter ablation for atrial fibrillation (AF) has increased exponentially in many developed countries, including Australia and New Zealand. This Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation from the Cardiac Society of Australia and New Zealand (CSANZ) recognises healthcare factors, expertise and expenditure relevant to the Australian and New Zealand healthcare environments including considerations of potential implications for First Nations Peoples. The statement is cognisant of international advice but tailored to local conditions and populations, and is intended to be used by electrophysiologists, cardiologists and general physicians across all disciplines caring for patients with AF. They are also intended to provide guidance to healthcare facilities seeking to establish or maintain catheter ablation for AF.
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Affiliation(s)
- Peter M Kistler
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia.
| | - Prash Sanders
- University of Adelaide, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Chris R Bain
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Karin M Chia
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Wai-Kah Choo
- Gold Coast University Hospital, Gold Coast, Qld, Australia; Royal Darwin Hospital, Darwin, NT, Australia
| | - Adam T Eslick
- University of Sydney, Sydney, NSW, Australia; The Canberra Hospital, Canberra, ACT, Australia
| | | | - Ingrid K Hopper
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Emily Kotschet
- Victorian Heart Hospital, Monash Health, Melbourne, Vic, Australia
| | - Han S Lim
- University of Melbourne, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia; Northern Health, Melbourne, Vic, Australia
| | - Liang-Han Ling
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | - Rajiv Mahajan
- University of Adelaide, Adelaide, SA, Australia; Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Silvana F Marasco
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | | | - Alex J McLellan
- University of Melbourne, Melbourne, Vic, Australia; Royal Melbourne Hospital, Melbourne, Vic, Australia; St Vincent's Hospital, Melbourne, Vic, Australia
| | - Rajeev K Pathak
- Australian National University and Canberra Heart Rhythm, Canberra, ACT, Australia
| | - Karen P Phillips
- Brisbane AF Clinic, Greenslopes Private Hospital, Brisbane, Qld, Australia
| | - Sandeep Prabhu
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Martin K Stiles
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | - Raymond W Su
- Royal Prince Alfred Hospital, Sydney, NSW, Australia; Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Stuart P Thomas
- University of Sydney, Sydney, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia
| | - Tracey Toy
- The Alfred Hospital, Melbourne, Vic, Australia
| | - Troy W Watts
- Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Rukshen Weerasooriya
- Hollywood Private Hospital, Perth, WA, Australia; University of Western Australia, Perth, WA, Australia
| | | | | | - Jonathan M Kalman
- University of Melbourne, Melbourne, Vic, Australia; Royal Melbourne Hospital, Melbourne, Vic, Australia
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Cheng YJ, Deng H, Liao YJ, Fang XH, Liao HT, Liu FZ, He Q, Wang JJ, Wu SL, Lin WD, Xue YM. Role of ideal cardiovascular health metrics in reducing risk of incident arrhythmias. Eur J Prev Cardiol 2024; 31:658-666. [PMID: 37966902 DOI: 10.1093/eurjpc/zwad357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023]
Abstract
AIMS Cardiovascular health (CVH) has been proven to reduce cardiovascular disease burden and mortality, but data are lacking regarding cardiac arrhythmias. The aim of this study was to assess the association between CVH metrics and atrial fibrillation/flutter (AF), ventricular arrhythmias, and bradyarrhythmias. METHODS AND RESULTS This study analysed data from the Atherosclerosis Risk in Communities (ARIC) cohort, with participants recruited from four different communities across the United States. Cardiovascular health metrics were scored at baseline (1987-89) following the American Heart Association's recommendations and categorized as poor, intermediate, or ideal. Arrhythmia episodes were diagnosed by International Classification of Diseases (ICD)-9 code. Adjusted associations were estimated using Cox models and event rates and population attributable fractions were calculated by CVH metrics category. The study population consisted of 13 078 participants, with 2548 AF, 1363 ventricular arrhythmias, and 706 bradyarrhythmias occurred. The adjusted hazard ratios (HRs) for ideal (vs. poor) CVH metrics were 0.59 [95% confidence interval (CI): 0.50-0.69] for AF, 0.38 (95% CI: 0.28-0.51) for ventricular arrhythmias, and 0.70 (95% CI: 0.51-0.97) for bradyarrhythmia. The risk of incident arrhythmias decreased steadily as the CVH metrics improved from 0 to 14 scores. The adjusted population attributable fractions were calculated to be 29.9% for AF, 54.4% for ventricular arrhythmias, and 21.9% for bradyarrhythmia, respectively. The association between CVH metrics and incident arrhythmias was also seen in people who remained free of coronary heart disease over the follow-up. CONCLUSION Achieving ideal CVH metrics recommendations by AHA in midlife was associated with a lower risk of incident arrhythmias later in life.
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Affiliation(s)
- Yun-Jiu Cheng
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
- The Second School of Clinical Medicine, Southern Medical University, No. 1023-1063 ShaTaiNan Rd, Guangzhou 510515, China
| | - Hai Deng
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Yi-Jian Liao
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang, China
| | - Xian-Hong Fang
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Hong-Tao Liao
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Fang-Zhou Liu
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Qian He
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Jin-Jie Wang
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Shu-Lin Wu
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Wei-Dong Lin
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
| | - Yu-Mei Xue
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Rd II, Guangzhou 519041, China
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4
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Dorian D, Gustafson D, Quinn R, Bentley RF, Dorian P, Goodman JM, Fish JE, Connelly KA. Exercise-Dependent Modulation of Immunological Response Pathways in Endurance Athletes With and Without Atrial Fibrillation. J Am Heart Assoc 2024; 13:e033640. [PMID: 38497478 PMCID: PMC11009995 DOI: 10.1161/jaha.123.033640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/12/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common arrhythmia characterized by uncoordinated atrial electrical activity. Lone AF occurs in the absence of traditional risk factors and is frequently observed in male endurance athletes, who face a 2- to 5-fold higher risk of AF compared with healthy, moderately active males. Our understanding of how endurance exercise contributes to the pathophysiology of lone AF remains limited. This study aimed to characterize the circulating protein fluctuations during high-intensity exercise as well as explore potential biomarkers of exercise-associated AF. METHODS AND RESULTS A prospective cohort of 12 male endurance cyclists between the ages of 40 and 65 years, 6 of whom had a history of exercise-associated AF, were recruited to participate using a convenience sampling method. The circulating proteome was subsequently analyzed using multiplex immunoassays and aptamer-based proteomics before, during, and after an acute high-intensity endurance exercise bout to assess temporality and identify potential markers of AF. The endurance exercise bout resulted in significant alterations to proteins involved in immune modulation (eg, growth/differentiation factor 15), skeletal muscle metabolism (eg, α-actinin-2), cell death (eg, histones), and inflammation (eg, interleukin-6). Subjects with AF differed from those without, displaying modulation of proteins previously known to have associations with incident AF (eg, C-reactive protein, insulin-like growth factor-1, and angiopoietin-2), and also with proteins having no previous association (eg, tapasin-related protein and α2-Heremans-Schmid glycoprotein). CONCLUSIONS These findings provide insights into the proteomic response to acute intense exercise, provide mechanistic insights into the pathophysiology behind AF in athletes, and identify targets for future study and validation.
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Affiliation(s)
- David Dorian
- Department of Medicine, Division of CardiologyUniversity of TorontoTorontoOntarioCanada
| | - Dakota Gustafson
- Department of Laboratory Medicine & PathobiologyUniversity of TorontoTorontoOntarioCanada
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoOntarioCanada
- Faculty of Health SciencesQueen’s UniversityKingstonOntarioCanada
| | - Ryan Quinn
- Division of CardiologyLi Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoOntarioCanada
| | - Robert F. Bentley
- Faculty of Kinesiology and Physical EducationUniversity of TorontoTorontoOntarioCanada
| | - Paul Dorian
- Department of Medicine, Division of CardiologyUniversity of TorontoTorontoOntarioCanada
- Division of CardiologyLi Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Keenan Research Centre for Biomedical ScienceSt Michael’s Hospital, University of TorontoTorontoOntarioCanada
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada
- Heart and Stroke Richard Lewar Centre for Research ExcellenceUniversity of TorontoTorontoOntarioCanada
| | - Jack M. Goodman
- Faculty of Kinesiology and Physical EducationUniversity of TorontoTorontoOntarioCanada
- Heart and Stroke Richard Lewar Centre for Research ExcellenceUniversity of TorontoTorontoOntarioCanada
- Division of CardiologySinai Health/University Health NetworkTorontoOntarioCanada
| | - Jason E. Fish
- Department of Laboratory Medicine & PathobiologyUniversity of TorontoTorontoOntarioCanada
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoOntarioCanada
- Peter Munk Cardiac CentreUniversity Health NetworkTorontoOntarioCanada
| | - Kim A. Connelly
- Department of Medicine, Division of CardiologyUniversity of TorontoTorontoOntarioCanada
- Division of CardiologyLi Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Keenan Research Centre for Biomedical ScienceSt Michael’s Hospital, University of TorontoTorontoOntarioCanada
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada
- Heart and Stroke Richard Lewar Centre for Research ExcellenceUniversity of TorontoTorontoOntarioCanada
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5
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Prasitlumkum N, Tokavanich N, Siranart N, Techasatian W, Cheungpasitporn W, Navaravong L, Chokesuwattanaskul R. Atrial fibrillation catheter ablation in endurance athletes: systematic review and meta-analysis. J Interv Card Electrophysiol 2024; 67:329-339. [PMID: 37466821 DOI: 10.1007/s10840-023-01574-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/16/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) management in endurance athletes (EA) is challenging due to the paucity of data, especially on the efficacy and safety of catheter ablation (CA). The hypothesis is that the efficacy and safety of AF CA in EA are comparable to the non-EA. METHODS Databases from EMBASE, Medline, PubMed, and Cochrane were searched from inception through February 2023. Studies with available information on efficacy and safety profiles were included. Effect estimates from the individual studies were extracted and combined using random effect and generic inverse variance method of DerSimonian and Laird. RESULTS Nine observational studies with a total of 1129 participants were identified, of whom 51% were EA. Our analysis found that rate of atrial arrhythmia (AA) recurrences following AF CA was not statistically different between EA and non-EA (RR 1.04, I2 = 57.6%, p = 0.54). The AA survival rates after a single ablation in EA was 60.2%, which improved up to 77% after multiple ablations during the follow-up period. Infrequent complication rates ranging from 0 to 7.6% were observed, with no mortality. CONCLUSIONS Our meta-analysis suggests that AF CA is as effective and safe in EA as in non-EA. In the future, AF CA should be considered as a first-line therapeutic choice in this patient group.
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Affiliation(s)
| | | | - Noppachai Siranart
- Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Witina Techasatian
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
| | | | - Leenhapong Navaravong
- Department of Electrophysiology, Division of Cardiovascular Medicine, University of Utah, Salt Lake, UT, USA
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
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Stylemans D, Vandecruys M, Leunis S, Engelborghs S, Gargioli D, Monbaliu D, Cornelissen V, Van Craenenbroeck AH, De Smet S. Physical Exercise After Solid Organ Transplantation: A Cautionary Tale. Transpl Int 2024; 37:12448. [PMID: 38414660 PMCID: PMC10898592 DOI: 10.3389/ti.2024.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/02/2024] [Indexed: 02/29/2024]
Abstract
An increasing body of randomized controlled trials suggests the safety of engaging in moderate to vigorous intensity exercise training following solid organ transplantation. Fueled by emerging sport events designed for transplant recipients and the ever-growing body of research highlighting the diverse health benefits of physical activity, transplant recipients are now increasingly participating in strenuous and occasionally competitive physical endeavors that largely surpass those evaluated in controlled research settings. This viewpoint article adopts a cautionary stance to counterbalance the prevalent one-sided optimistic perspective regarding posttransplant physical activity. While discussing methodological limitations, we explore plausible adverse impacts on the cardiovascular, immunological, and musculoskeletal systems. We also examine the physiological consequences of exercising in the heat, at high altitude, and in areas with high air pollution. Risks associated with employing performance-enhancing strategies and the conceivable psychological implications regarding physical activity as a tribute to the 'gift of life' are discussed. With a deliberate focus on the potential adverse outcomes of strenuous posttransplant physical activity, this viewpoint aims to restore a balanced dialogue on our comprehension of both beneficial and potentially detrimental outcomes of physical activity that ultimately underscores the imperative of well-informed decision-making and tailored exercise regimens in the realm of posttransplant care.
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Affiliation(s)
- Dimitri Stylemans
- Department of Respiratory Diseases, Pulmonary Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Marieke Vandecruys
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Sofie Leunis
- Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Sofie Engelborghs
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Davide Gargioli
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
- Transplantoux Foundation, Leuven, Belgium
| | - Véronique Cornelissen
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Amaryllis H. Van Craenenbroeck
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Stefan De Smet
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
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7
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Mărgulescu AD, Mas-Lladó C, Prat-Gonzàlez S, Perea RJ, Borras R, Benito E, Alarcón F, Guasch E, Tolosana JM, Arbelo E, Sitges M, Brugada J, Mont L. Combined Area of Left and Right Atria May Outperform Atrial Volumes as a Predictor of Recurrences after Ablation in Patients with Persistent Atrial Fibrillation-A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:151. [PMID: 38256411 PMCID: PMC10818489 DOI: 10.3390/medicina60010151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Left atrial (LA) remodelling and dilatation predicts atrial fibrillation (AF) recurrences after catheter ablation. However, whether right atrial (RA) remodelling and dilatation predicts AF recurrences after ablation has not been fully evaluated. Materials and Methods: This is an observational study of 85 consecutive patients (aged 57 ± 9 years; 70 [82%] men) who underwent cardiac magnetic resonance before first catheter ablation for AF (40 [47.1%] persistent AF). Four-chamber cine-sequence was selected to measure LA and RA area, and ventricular end-systolic image phase to obtain atrial 3D volumes. The effect of different variables on event-free survival was investigated using the Cox proportional hazards model. Results: In patients with persistent AF, combined LA and RA area indexed to body surface area (AILA + RA) predicted AF recurrences (HR = 1.08, 95% CI 1.00-1.17, p = 0.048). An AILA + RA cut-off value of 26.7 cm2/m2 had 72% sensitivity and 73% specificity for predicting recurrences in patients with persistent AF. In this group, 65% of patients with AILA + RA > 26.7 cm2/m2 experienced AF recurrence within 2 years of follow-up (median follow-up 11 months), compared to 25% of patients with AILA + RA ≤ 26.7 cm2/m2 (HR 4.28, 95% CI 1.50-12.22; p = 0.007). Indices of LA and RA dilatation did not predict AF recurrences in patients with paroxysmal AF. Atrial 3D volumes did not predict AF recurrences after ablation. Conclusions: In this pilot study, the simple measurement of AILA + RA may predict recurrences after ablation of persistent AF, and may outperform measurements of atrial volumes. In paroxysmal AF, atrial dilatation did not predict recurrences. Further studies on the role of RA and LA remodelling are needed.
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Affiliation(s)
| | - Caterina Mas-Lladó
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
| | - Susanna Prat-Gonzàlez
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Rosario Jesus Perea
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Roger Borras
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Eva Benito
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Francisco Alarcón
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Eduard Guasch
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Jose María Tolosana
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER Cardiovascular), 08036 Barcelona, Spain
| | - Elena Arbelo
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER Cardiovascular), 08036 Barcelona, Spain
| | - Marta Sitges
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER Cardiovascular), 08036 Barcelona, Spain
| | - Josep Brugada
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER Cardiovascular), 08036 Barcelona, Spain
| | - Lluís Mont
- Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.M.-L.); (L.M.)
- Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER Cardiovascular), 08036 Barcelona, Spain
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8
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Wang Y, Wang Y, Xu D. Effects of different exercise methods and intensities on the incidence and prognosis of atrial fibrillation. Trends Cardiovasc Med 2024:S1050-1738(24)00002-1. [PMID: 38216075 DOI: 10.1016/j.tcm.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/21/2023] [Accepted: 01/06/2024] [Indexed: 01/14/2024]
Abstract
Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, exhibits a higher risk of cardiovascular adverse events. Exercise plays a crucial role in AF prevention, but the effects of different exercise types and doses are inconclusive. This review aims to comprehensively explore the most recent evidence and possible mechanisms of diverse exercise modalities concerning AF incidence and therapeutic outcomes. Multiple studies underscore the efficacy of moderate-intensity continuous training (MICT) in reducing AF incidence and symptom burden, rendering it the currently favored exercise therapy for AF patients. High-intensity interval training (HIIT) shows promise, potentially surpassing MICT, especially in reducing age-related AF susceptibility and improving symptoms and exercise capacity. Conversely, prolonged high-intensity endurance exercise exacerbates AF risk due to excessive exercise volume, with potential mechanisms encompassing irreversible atrial remodeling, heightened inflammation, and increased vagal tone. In summation, MICT is a secure strategy for populations in mitigating the risk associated with AF incidence and secondary cardiovascular events and should be encouraged. Also, it is recommended to initiate large-scale clinical intervention trials encompassing a variety of exercise types to delineate the optimal exercise prescription for cardiovascular patients, including those afflicted with AF.
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Affiliation(s)
- Yurong Wang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Ying Wang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Department of Cardiovascular Medicine, Yueyang Central Hospital, China
| | - Danyan Xu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
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9
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Zacher J, Filipovic K, Predel G, Schmidt T. Exercise and Atrial Fibrillation: The Dose Makes the Poison? A Narrative Review. Int J Sports Med 2024; 45:17-22. [PMID: 37802082 PMCID: PMC10776210 DOI: 10.1055/a-2152-7628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/03/2023] [Indexed: 10/08/2023]
Abstract
"All things are poison, and nothing is without poison; the dosage alone makes it so a thing is not a poison" (Paracelsus, ~ 1538 AD). This well-known quote seems to aptly summarize the current understanding of the interaction between exercise and atrial fibrillation (AF). A host of data strongly suggests that regular exercise has a protective effect against developing AF. A small but well-conducted group of trials also demonstrates beneficial effects of exercise in the treatment of AF. Recently, however, potentially detrimental effects of large volumes of high-intensity exercise on the probability of developing AF have moved into the sports-cardiological focus. This effect is well documented for elite athletes; data regarding the general population is less clear. This review presents the current data regarding the protective, therapeutic and potentially risk-enhancing effects of exercise regarding AF. The authors demonstrate that the benefits are clear and strongly outweigh the potential disadvantages.
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Affiliation(s)
- Jonas Zacher
- Institute of Cardiology and Sports Medicine, Preventative and
Rehabilitative Sports and Performance Medicine, German Sport University Cologne,
Köln, Germany
| | - Karlo Filipovic
- Department of Electrophysiology, University of Cologne, Heart Center,
Uniklinik Köln, Köln, Germany
| | - Georg Predel
- Institute of Cardiology and Sports Medicine, Preventative and
Rehabilitative Sports and Performance Medicine, German Sport University Cologne,
Köln, Germany
| | - Thomas Schmidt
- Institute of Cardiology and Sports Medicine, Preventative and
Rehabilitative Sports and Performance Medicine, German Sport University Cologne,
Köln, Germany
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde,
Germany
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10
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Deka P, Mathison C, Abela G, Karve M. Exercise-induced atrial fibrillation: A case report. Clin Case Rep 2023; 11:e8242. [PMID: 38028109 PMCID: PMC10661303 DOI: 10.1002/ccr3.8242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/25/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message Middle-aged male athletes, with or without underlying coronary artery disease, exhibiting exercise induced blood pressure (BP) variability and diabetes can have an increased risk of developing atrial fibrillation (AF). Assessment in athletes should include long-term arrhythmia monitoring. In addition, it is important to exert patients beyond their calculated target heart rate (HR) during an exercise stress test to detect exercise-induced AF. We suggest this strategy be specifically used for athletes with complaints of intermittent palpitation and chest pain. Referral to an electrophysiologist for a possible ablation procedure should be considered for the management of AF in athletes in whom the use of beta-blockers may limit exercise tolerance. Bleeding risk with the use of oral anticoagulation needs to be adequately evaluated in athletes with AF who engage in high-intensity exercise or activities. Abstract The report highlights the case of a 54-year-old Caucasian male (height 5.11', BMI 29.8) who presented with complaints of chest pain, mild coronary artery disease, palpitation, dizziness, and labile BP with high-intensity biking exercise. Diagnostic tests (exercise stress test, cardiac catheterization, Holter monitor, and Bardy patch) using standard procedure were unsuccessful at detecting the problem. In a repeat exercise stress test, the patient was exerted beyond the calculated HRmax (up to 117%) when the patient's heart rhythm flipped from sinus rhythm to AF. The patient was referred to a cardiac electrophysiologist and an ablation procedure was performed to prevent exercise-induced AF with high-intensity exercise. Young adults, with or without early coronary artery disease, performing high-intensity endurance exercises may be at risk of developing exercise-induced AF. This phenomenon is prevalent and well documented in the skiing population and patients with variance in BP during exercise. Endurance athletes tend to have a lower resting HR. As such, the use of standard rate-control medications in patients with exercise-induced AF may not be appropriate. Referral to a cardiac electrophysiologist and ablation procedures should be considered in this population for management and symptom control. If tolerated, especially in young adults with complaints of palpitation and chest pain, patients should be exerted beyond their calculated HRmax during an exercise stress test to diagnose an underlying condition of exercise-induced AF.
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Affiliation(s)
- Pallav Deka
- College of NursingMichigan State UniversityEast LansingMichiganUSA
- Capital Cardiology PCLansingMichiganUSA
| | | | - George Abela
- College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
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11
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Napoli L, Semple S, McKune AJ. Training and Competition Loads in Women's Rugby Sevens Athletes: Are There Implications for Cardiovascular Health? Int J Sports Physiol Perform 2023; 18:894-900. [PMID: 37491014 DOI: 10.1123/ijspp.2023-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 07/27/2023]
Abstract
National- and international-level rugby sevens athletes are exposed to high training and competition loads over the course of a competitive season. Research on load monitoring and body-system responses is widespread; however, the primary focus has been on optimizing performance rather than investigating or improving cardiovascular health. There is a degree of cardiovascular remodeling, as well as local and systemic inflammation, in response to excessive exercise. These responses are moderated by many factors including previous exercise exposure, current exercise intensity and duration, age, race, and gender, as well as sport-specific physiology. For these reasons, high-performing female rugby sevens athletes may have a unique cardiovascular risk profile different from males and other rugby codes. This review aimed to characterize the training and competition loads, as well as the anthropometric and physiological profiles, of female rugby sevens athletes; discuss the potential impacts these may have on the cardiovascular system; and provide recommendations on future research regarding the relationship between rugby sevens training and competition loads and cardiovascular health. Movement demands, competition formatting, and training routines could all contribute to adverse cardiovascular adaptations. Anthropometric data and physiological characteristics may also increase the risk of cardiovascular disease. Future research needs to adopt measures of cardiovascular health to obtain a greater understanding of cardiovascular profiles and risk factors in female rugby sevens athletes.
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Affiliation(s)
- Luca Napoli
- University of Canberra Research Institute for Sport and Exercise, Bruce, ACT,Australia
| | - Stuart Semple
- University of Canberra Research Institute for Sport and Exercise, Bruce, ACT,Australia
| | - Andrew J McKune
- University of Canberra Research Institute for Sport and Exercise, Bruce, ACT,Australia
- School of Health Sciences, Biokinetics, Exercise and Leisure Sciences, University of KwaZulu-Natal, Durban,South Africa
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12
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Trohman RG, Huang HD, Sharma PS. Atrial fibrillation: primary prevention, secondary prevention, and prevention of thromboembolic complications: part 1. Front Cardiovasc Med 2023; 10:1060030. [PMID: 37396596 PMCID: PMC10311453 DOI: 10.3389/fcvm.2023.1060030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/14/2023] [Indexed: 07/04/2023] Open
Abstract
Atrial fibrillation (AF), is the most common sustained cardiac arrhythmia. It was once thought to be benign as long as the ventricular rate was controlled, however, AF is associated with significant cardiac morbidity and mortality. Increasing life expectancy driven by improved health care and decreased fertility rates has, in most of the world, resulted in the population aged ≥65 years growing more rapidly than the overall population. As the population ages, projections suggest that the burden of AF may increase more than 60% by 2050. Although considerable progress has been made in the treatment and management of AF, primary prevention, secondary prevention, and prevention of thromboembolic complications remain a work in progress. This narrative review was facilitated by a MEDLINE search to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2021. Atrial fibrillation was searched via the terms primary prevention, hyperthyroidism, Wolff-Parkinson-White syndrome, catheter ablation, surgical ablation, hybrid ablation, stroke prevention, anticoagulation, left atrial occlusion and atrial excision. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. In these two manuscripts, we discuss the current strategies available to prevent AF, then compare noninvasive and invasive treatment strategies to diminish AF recurrence. In addition, we examine the pharmacological, percutaneous device and surgical approaches to prevent stroke as well as other types of thromboembolic events.
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13
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Junianto I, Soesanto AM, Radi B, Yonas E, Kuncoro AS, Atmadikoesoemah CA, Sakti DDA. The Influence of Special Military Training on Left Ventricular Adaptation to Exercise in Elite Air Force Soldiers. J Cardiovasc Echogr 2023; 33:69-75. [PMID: 37772047 PMCID: PMC10529291 DOI: 10.4103/jcecho.jcecho_67_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/19/2023] [Accepted: 05/21/2023] [Indexed: 09/30/2023] Open
Abstract
Purpose The purpose of this study was to observe the influence of level physical training intensity on left ventricular (LV) adaptation in elite air force soldiers compared to regular basic military training. Methods The LV adaptation of special military physical training for elite air force soldiers was compared with basic military training for regular troops. A group of the nonmilitary subject was also evaluated as a control group. The presence of LV adaptation was evaluated using some echocardiography parameters, including LV mass index (LVMI), LV ejection fraction (LVEF), global longitudinal strain (GLS), and myocardial work index. The parameters of the myocardial work index include global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE). Results Forty-three elite air force soldiers underwent special military training, 43 regular troops underwent basic military training, and 23 nonmilitary subjects as a control group. Age, heart rate, blood pressure, and Cooper test results significantly differed among the three groups. Multivariate analysis among all groups showed that the level of physical training was associated with the LVMI (coefficient β = 6.061; 95% confidence interval [CI] = 1.91-10.22; P = 0.005), LVEF (coefficient β = -1.409; 95% CI = -2.41-[-0.41]; P = 0.006), LVGLS (coefficient β = 1.726; 95% CI = 1.20-2.25; P < 0.001), GWW (coefficient β = -13.875; 95% CI = -20.88-[-6.87]; P < 0.001), GWE (coefficient β = 0.954; 95% CI = 0.62-1.26; P < 0.001), GCW (coefficient β = 176.128; 95% CI = 121.16-231.10; P < 0.001), and GWI (coefficient β = 196.494; 95% CI = 144.61-248.38; P < 0.001). Conclusions Higher intensity of physical training observed in a special military training is associated with higher LV GLS, GWE, GCW, GWI, and lower GWW value suggesting greater physiological adaptation than the lower intensity training.
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Affiliation(s)
- Iwan Junianto
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Amiliana Mardiani Soesanto
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Basuni Radi
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Emir Yonas
- Faculty of Medicine, Universitas Yarsi, Jakarta, Indonesia
| | - Ario Soeryo Kuncoro
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Celly Anantaria Atmadikoesoemah
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Damba Dwisepto Aulia Sakti
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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14
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De Bosscher R, Dausin C, Janssens K, Bogaert J, Elliott A, Ghekiere O, Van De Heyning CM, Sanders P, Kalman J, Fatkin D, Herbots L, Willems R, Heidbuchel H, La Gerche A, Claessen G. Rationale and design of the PROspective ATHletic Heart (Pro@Heart) study: long-term assessment of the determinants of cardiac remodelling and its clinical consequences in endurance athletes. BMJ Open Sport Exerc Med 2022; 8:e001309. [PMID: 35368514 PMCID: PMC8935177 DOI: 10.1136/bmjsem-2022-001309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 12/25/2022] Open
Abstract
Background Exercise-induced cardiac remodelling (EICR) results from the structural, functional and electrical adaptations to exercise. Despite similar sports participation, EICR varies and some athletes develop phenotypic features that overlap with cardiomyopathies. Training load and genotype may explain some of the variation; however, exercise ‘dose’ has lacked rigorous quantification. Few have investigated the association between EICR and genotype. Objectives (1) To identify the impact of training load and genotype on the variance of EICR in elite endurance athletes and (2) determine how EICR and its determinants are associated with physical performance, health benefits and cardiac pathology. Methods The Pro@Heart study is a multicentre prospective cohort trial. Three hundred elite endurance athletes aged 14–23 years will have comprehensive cardiovascular phenotyping using echocardiography, cardiac MRI, 12-lead ECG, exercise-ECG and 24-hour-Holter monitoring. Genotype will be determined using a custom cardiomyopathy gene panel and high-density single-nucleotide polymorphism arrays. Follow-up will include online tracking of training load. Cardiac phenotyping will be repeated at 2, 5, 10 and 20 years. Results The primary endpoint of the Pro@Heart study is the association of EICR with both training load and genotype. The latter will include rare variants in cardiomyopathy-associated genes and polygenic risk scores for cardiovascular traits. Secondary endpoints are the incidence of atrial and ventricular arrhythmias, physical performance and health benefits and their association with training load and genotype. Conclusion The Pro@Heart study is the first long-term cohort study to assess the impact of training load and genotype on EICR. Trial registration number NCT05164328; ACTRN12618000716268.
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Affiliation(s)
- Ruben De Bosscher
- Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Cardiology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | | | - Kristel Janssens
- Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jan Bogaert
- Radiology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Adrian Elliott
- Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Olivier Ghekiere
- Cardiology, Jessa Hospital Campus Virga Jesse, Hasselt, Belgium.,Cardivacsular Sciences, University Hasselt Biomedical Research Institute Rehabilitation Research Center, Diepenbeek, Belgium
| | - Caroline M Van De Heyning
- Cardiology, University of Antwerp, Antwerpen, Belgium.,Cardiovascular Sciences, University Hospital Antwerp, Edegem, Belgium
| | - Prashanthan Sanders
- Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jonathan Kalman
- Cardiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Diane Fatkin
- Inherited Heart Diseases, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
| | - Lieven Herbots
- Cardiology, Jessa Hospital Campus Virga Jesse, Hasselt, Belgium.,Cardivacsular Sciences, University Hasselt Biomedical Research Institute Rehabilitation Research Center, Diepenbeek, Belgium
| | - Rik Willems
- Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Cardiology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Cardiology, University Hospital Antwerp, Edegem, Belgium.,Cardiovascular Sciences, University of Antwerp, Antwerpen, Belgium
| | - André La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Guido Claessen
- Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Cardiology, KU Leuven University Hospitals Leuven, Leuven, Belgium
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15
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Bressi E, Rebecchi M, Sgueglia M, Crescenzi C, Panattoni G, Martino A, Casalese A, Sangiorgi C, Politano A, Cicogna F, Fagagnini A, Grieco D, DE Ruvo E, Calò L. Atrial fibrillation and sport: need for monitoring. Minerva Cardiol Angiol 2022; 70:594-605. [PMID: 35343173 DOI: 10.23736/s2724-5683.22.05842-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Historically, regular exercise contributed to reduce the arrhythmic burden and improve cardiovascular outcomes in the general population. However, a heightened risk of Atrial Fibrillation (AF) seems to occur mainly amongst endurance athletes. The exact mechanisms are not fully elucidated, but dynamic interactions between electroanatomical changes induced by exercise, the autonomic system, variable triggers, along individual genetic predisposition are the main contributors to AF development in athletes. The type and training load of sports are also crucial in determining the arrhythmogenic milieu predisposing to AF insurgence and perpetuation. Moreover, a sex difference seems to influence an increased risk of AF only in men undergoing strenuous exercise, whereas women appear protected even during more vigorous training. In the absence of solid evidence, the advent of modern technologies could help to monitor and deep investigate the peculiar aspects of AF in these athletes. This review aims to describe the pathophysiology, diagnosis, and management of AF in athletes, shedding light on possible future strategies to face AF in this population.
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Affiliation(s)
- Edoardo Bressi
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy -
| | - Marco Rebecchi
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy
| | | | - Cinzia Crescenzi
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy
| | | | | | | | - Catia Sangiorgi
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy
| | | | | | | | - Domenico Grieco
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy
| | | | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino of Rome, Rome, Italy
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16
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[Catheter ablation of ventricular tachycardia in patients with structural heart disease]. Herz 2022; 47:129-134. [PMID: 35262743 DOI: 10.1007/s00059-022-05103-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/04/2022]
Abstract
Ventricular cardiac rhythm disorders are potentially life-threatening arrhythmias. Ventricular tachycardia (VT) in patients with structural heart disease carries an increased risk of sudden cardiac death. Interventional radiofrequency catheter ablation is increasingly becoming the focus of treatment for ventricular arrhythmias. So far, no randomized study has been able to demonstrate a reduction in mortality; however, depending on the existing cardiomyopathy, interventional VT ablation has proven to be more effective for rhythm stabilization than antiarrhythmic therapy and is subsequently associated with improve quality of life through reduced implantable cardioverter defibrillator (ICD) treatment. The aim of this work is to discuss the pathophysiology, mechanism and treatment of VT with structural heart disease in order to define the role of catheter ablation.
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17
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Tijskens M, Bergonti M, Spera F, Ascione C, Saenen J, Huybrechts W, Miljoen H, Riva S, Wittock A, Heidbuchel H, Tondo C, Sarkozy A. Etiology and Outcome of Catheter Ablation in Patients With Onset of Atrial Fibrillation <45 Years of Age. Am J Cardiol 2022; 166:45-52. [PMID: 34961604 DOI: 10.1016/j.amjcard.2021.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022]
Abstract
Etiologic factors and long-term outcomes of catheter ablation of atrial fibrillation (AF) in young patients have not been well characterized. This study aimed to analyze the etiologic factors and outcomes of pulmonary vein isolation (PVI) in patients with young-onset AF (young-AF, defined as having first documented episode <45 years). Consecutive patients with young-AF undergoing PVI (n = 197) in 2 academic centers were enrolled and followed for 36.1 ± 24.5 months. A control group of patients with AF onset ≥45 years (n = 554) was included. The most frequent risk factors in young-AF were intensive exercise (25%), moderate-to-heavy alcohol consumption (23%), and familial AF (22%). Compared with patients with AF onset ≥45-year, patients with young-AF were more often men (82% vs 66%, p <0.001), had more frequently paroxysmal AF (81% vs 60%, p <0.001), had less left atrial dilatation (40.9 ± 6.2 mm vs 44.2 ± 7.2 mm, p <0.001), and had lower 4-year recurrence rate after last PVI procedure (22% vs 45%, p <0.001). In young-AF, structural heart disease (SHD) was the only independent predictor of recurrence. Patients with young-AF selected to undergo cryoballoon (CB) ablation were younger (35.0 ± 7.7 vs 36.6 ± 6.7 years, p = 0.035) and had less persistent AF (6% vs 24%, p = 0.004) and coronary artery disease (2% vs 7%, p = 0.02) compared with radiofrequency ablation. After excluding patients with persistent AF and SHD, there was no difference in single procedural success between radiofrequency or CB PVI (27% vs 17%, p = 0.11). In conclusion, patients with young-AF have diverse etiologies and high single and multiprocedural PVI successes. SHD is the only independent predictor of recurrence. In patients with young-AF, there is a selection bias for CB ablation.
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18
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Heitmann KA, Løchen ML, Stylidis M, Hopstock LA, Schirmer H, Morseth B. Associations between physical activity, left atrial size and incident atrial fibrillation: the Tromsø Study 1994-2016. Open Heart 2022; 9:e001823. [PMID: 35074937 PMCID: PMC8788327 DOI: 10.1136/openhrt-2021-001823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/09/2022] [Indexed: 11/17/2022] Open
Abstract
AIMS Left atrial (LA) enlargement is an independent risk factor for atrial fibrillation (AF). Interestingly, some athletes have increased risk of AF, which may be linked to LA enlargement; however, little is known about the relationship between LA enlargement and AF risk at moderate-level physical activity (PA). We aimed to explore the associations between PA, LA size and risk of incident AF, and if PA can attenuate the risk of AF with LA enlargement. METHODS This prospective study followed 2479 participants (52.4% female), free from known cardiac pathology, for median 20.2 years. Participants were followed up for hospital-diagnosed AF, confirmed by electrocardiography, from 1994-95 through 2016. At baseline, LA size was evaluated by anteroposterior LA diameter, and PA was self-reported by questionnaire. RESULTS We observed a U-shaped relationship between PA and AF, and moderately active had 32% lower AF risk than inactive (HRadjusted 0.68, 95% CI 0.50 to 0.93). Participants with LA enlargement had 38% higher AF risk compared with participants with normal LA size (HRadjusted 1.38, 95% CI 1.12 to 1.69). However, the increased AF risk with LA enlargement was attenuated by PA; compared with inactive participants with LA enlargement, the AF risk was 45% lower among active with LA enlargement (HRadjusted 0.55, 95% CI 0.39 to 0.79). AF risk in active participants with LA enlargement did not differ from active with normal LA size. These patterns were observed in both men and women, and in participants over/under 65 years. CONCLUSION Moderate PA was associated with reduced AF risk, and PA attenuated the increased risk of AF with LA enlargement in both men and women and all age groups.
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Affiliation(s)
- Kim Arne Heitmann
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Research and Education, University Hospital of North Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Michael Stylidis
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Laila A Hopstock
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bente Morseth
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Research and Education, University Hospital of North Norway, Tromsø, Norway
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19
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Franklin BA, Quindry J. High level physical activity in cardiac rehabilitation: Implications for exercise training and leisure-time pursuits. Prog Cardiovasc Dis 2021; 70:22-32. [PMID: 34971650 DOI: 10.1016/j.pcad.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Regular moderate-to-vigorous physical activity and increased levels of cardiorespiratory fitness (CRF) are widely promoted as cardioprotective measures in secondary prevention interventions. OBSERVATIONS A low level of CRF increases the risk of cardiovascular disease (CVD) to a greater extent than merely being physically inactive. An exercise capacity <5 metabolic equivalents (METs), generally corresponding to the bottom 20% of the fitness continuum, indicates a higher mortality group. Accordingly, a key objective in early cardiac rehabilitation (CR) is to increase the intensity of training to >3 METs, to empower patients to vacate this "high risk" group. Moreover, a "good" exercise capacity, expressed as peak METs, identifies individuals with a favorable long-term prognosis, regardless of the underlying extent of coronary disease. On the other hand, vigorous-to-high intensity physical activity, particularly when unaccustomed, and some competitive sports are associated with a greater incidence of acute cardiovascular events. Marathon and triathlon training/competition also have limited applicability and value in CR, are associated with acute cardiac events each year, and do not necessarily provide immunity to the development of or the progression of CVD. Furthermore, extreme endurance exercise regimens are associated with an increased incidence of atrial fibrillation and accelerated coronary artery calcification. CONCLUSIONS AND RELEVANCE High-intensity training offers a time-saving alternative to moderate intensity continuous training, as well as other potential advantages. Additional long-term studies assessing safety, adherence, and morbidity and mortality are required before high-intensity CR training can be more widely recommended, especially in previously sedentary patients with known or suspected CVD exercising in non-medically supervised settings.
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Affiliation(s)
- Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation, Beaumont Health, Royal Oak, MI, United States of America; Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, United States of America.
| | - John Quindry
- Integrative Physiology and Athletic Training, University of Montana, Missoula, Montana, Bulgaria; International Heart Institute - St Patrick's Hospital, Providence Medical Center, Missoula, Montana, Bulgaria
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20
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Toso E, Gagliardi M, Peyracchia M, Angelini F, Anselmino M, Ferraris F, Giustetto C, Scaglione M, Gaita F. Long-term efficacy and impact on quality of life of atrial fibrillation catheter ablation in competitive athletes. J Sports Med Phys Fitness 2021; 62:1266-1271. [PMID: 34931787 DOI: 10.23736/s0022-4707.21.13257-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Limited data are available on the efficacy of catheter ablation (CA) for sport-associated atrial fibrillation (AF), in particular at long term follow up. Moreover, the impact of AF CA on quality of life (QoL) in this population remains unknown. We aimed to determine AF CA efficacy in athletes, to assess the impact on athletes' QoL (with SF36 score) and on training capabilities in a long term follow up (FU). METHODS A total of 1215 AF patients' candidates to CA between January 2007 and December 2012, were retrospectively screened. Athletes were defined as patients performing ≥ 5h/week of vigorous sports, achieving a total of ≥1500 h lifetime sports activity, for at least one year before AF first symptomatic episode. RESULTS Out of 1215 AF patients, 133 were considered competitive athletes and underwent to CA. Overall, 43% of our cohort showed typical or atypical atrial flutter, which required a more extensive ablation procedure. Before AF, athletes used to practice for a mean of 8.5±2.7 h/week, while after the first AF episode the mean practice duration decreased to 2.82.5 h/week. At 10-year follow up, 83% of athletes did not present any recurrent event, and training capabilities increased up to 5.6±3.6 h/week after the procedure. Moreover, intense physical activity before AF CA was related to longterm AF recurrence rates (P = 0.05). QoL scores significantly improved in each single domains (P < 0.05). CONCLUSIONS AF CA represents an effective procedure to maintain sinus rhythm in athletes, with a significant improvement in QoL.
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Affiliation(s)
- Elisabetta Toso
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy - .,Cardiology Consultant at Juventus Football Club, Turin, Italy -
| | - Marco Gagliardi
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Mattia Peyracchia
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Filippo Angelini
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Matteo Anselmino
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Federico Ferraris
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Carla Giustetto
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Marco Scaglione
- Cardiology Division, Cardinal Massaia Hospital of Asti, Asti, Italy
| | - Fiorenzo Gaita
- Cardiology Division, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.,Cardiology Consultant at Juventus Football Club, Turin, Italy
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21
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Contreras-Briceño F, Herrera S, Vega-Adauy J, Salinas M, Ocaranza MP, Jalil JE, Mandiola J, García L, Chiong M, Castro PF, Lavandero S, Gabrielli L. Circulating Vascular Cell Adhesion Molecule-1 (sVCAM-1) Is Associated With Left Atrial Remodeling in Long-Distance Runners. Front Cardiovasc Med 2021; 8:737285. [PMID: 34790706 PMCID: PMC8591189 DOI: 10.3389/fcvm.2021.737285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/11/2021] [Indexed: 01/26/2023] Open
Abstract
Introduction: An increased risk of atrial fibrillation (AF) has been demonstrated in high-performance athletes. Soluble vascular adhesion molecule-1 (sVCAM-1), a biomarker involved in inflammation and cardiac remodeling, is associated with the development of AF in the general population. However, the relationship between sVCAM-1 and left atrial (LA) remodeling has been poorly investigated in long-distance runners (LDR). Aim: To determine the association between LA remodeling and sVCAM-1 levels in LDR during the training period before a marathon race. Methods: Thirty-six healthy male LDR (37.0 ± 5.3 years; 174.0 ± 7.0 height; BMI: 23.8 ± 2.8; V°O2-peak: 56.5 ± 7.3 mL·kg−1·min−1) were evaluated in this single-blind and cross-sectional study. The LDR were separated into two groups according to previous training levels: high-training (HT) (n = 18) ≥100 km·week−1 and low-training (LT) (n = 18) ≥70 and <100 km·week−1. Also, 18 healthy non-active subjects were included as a control group (CTR). In all participants, transthoracic echocardiography was performed. sVCAM-1 blood levels were measured baseline and immediately finished the marathon race in LDR. Results: HT showed increased basal levels of sVCAM-1 (651 ± 350 vs. 440 ± 98 ng·mL−1 CTR, p = 0.002; and vs. 533 ± 133 ng·mL−1 LT; p = 0.003) and a post-marathon increase (ΔsVCAM-1) (651 ± 350 to 905 ± 373 ng·mL−1; p = 0.002), that did not occur in LT (533 ± 133 to 651 ± 138 ng·mL−1; p = 0.117). In LDR was a moderate correlation between LA volume and sVCAM-1 level (rho = 0.510; p = 0.001). Conclusions: In male long-distance runners, sVCAM-1 levels are directly associated with LA remodeling. Also, the training level is associated with basal sVCAM-1 levels and changes after an intense and prolonged exercise (42.2 km). Whether sVCAM-1 levels predict the risk of AF in runners remains to be established.
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Affiliation(s)
- Felipe Contreras-Briceño
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases (ACCDiS), Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Laboratory of Exercise Physiology, Department Health of Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Herrera
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases (ACCDiS), Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julian Vega-Adauy
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases (ACCDiS), Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel Salinas
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases (ACCDiS), Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Paz Ocaranza
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases (ACCDiS), Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge E Jalil
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases (ACCDiS), Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Mandiola
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases (ACCDiS), Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lorena García
- Advanced Center for Chronic Diseases (ACCDiS) and CEMC, Faculty of Chemical and Pharmaceutical Sciences & Faculty of Medicine, University of Chile, Santiago, Chile
| | - Mario Chiong
- Advanced Center for Chronic Diseases (ACCDiS) and CEMC, Faculty of Chemical and Pharmaceutical Sciences & Faculty of Medicine, University of Chile, Santiago, Chile
| | - Pablo F Castro
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases (ACCDiS), Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Lavandero
- Advanced Center for Chronic Diseases (ACCDiS) and CEMC, Faculty of Chemical and Pharmaceutical Sciences & Faculty of Medicine, University of Chile, Santiago, Chile.,Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Luigi Gabrielli
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases (ACCDiS), Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Laboratory of Exercise Physiology, Department Health of Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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22
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Liao MT, Chen CK, Lin TT, Cheng LY, Ting HW, Lai CL. The Association between Physical Activity and Cardiovascular Implantable Electronic Device-Detected Atrial High Rate Episodes. ACTA CARDIOLOGICA SINICA 2021; 37:600-607. [PMID: 34812233 PMCID: PMC8593477 DOI: 10.6515/acs.202111_37(6).20210620a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Atrial fibrillation is the most common arrhythmia and it is associated with a higher risk of mortality and morbidity. The goal of this study was to assess the correlation between physical activity (PA) and atrial high rate episodes (AHREs) detected by cardiovascular implantable electronic devices (CIEDs). METHODS We prospectively collected data from 81 patients from March 2017 to June 2019. Device-detected PA (hours per day) through an accelerometer and occurrence/burden of AHREs were determined at each outpatient clinic visit. Modest AHREs and long AHREs were defined as at least 1 episode of AHREs lasting ≥ 12 hours and 24 hours, respectively. The percentage of total AHREs in the follow-up period was defined as the burden of AHREs. Generalized estimating equations were used to explore the association between PA and occurrence/burden of AHREs to account for repeated measures within a participant. RESULTS The patients had 336 follow-up visits (mean 4.1 visits each). The prevalence rates of device-detected modest AHREs and long AHREs were 4.8% and 3.9%, respectively. More PA (hours per day) was associated with a lower risk of modest AHREs [odds ratio (OR) 0.671, 95% confidence interval (CI) 0.452-0.997, p = 0.048] and long AHREs (OR 0.536, 95% CI 0.348-0.824, p = 0.004) after adjusting for age, sex, and basic characteristics. More PA had a trend of association with fewer AHREs (β -0.255, 95% CI -0.512 to 0.001, p = 0.051). CONCLUSIONS More PA was associated with a lower risk of AHREs detected by CIEDs in older patients. PA may reduce the risk of AHREs.
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Affiliation(s)
- Min-Tsun Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu
- Institute of Epidemiology and Preventive Medicine, College of Public Health
| | - Chun-Kai Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu
| | - Ting-Tse Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Ying Cheng
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu
| | - Hung-Wen Ting
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu
| | - Chao-Lun Lai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu
- Institute of Epidemiology and Preventive Medicine, College of Public Health
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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23
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Kadhim K, Middeldorp ME, Elliott AD, Agbaedeng T, Gallagher C, Malik V, Wong CX, McEvoy RD, Kalman JM, Lau DH, Linz D, Sanders P. Prevalence and Assessment of Sleep-Disordered Breathing in Patients With Atrial Fibrillation: A Systematic Review and Meta-analysis. Can J Cardiol 2021; 37:1846-1856. [PMID: 34606918 DOI: 10.1016/j.cjca.2021.09.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In this study, we sought to estimate the prevalence of concomitant sleep-disordered breathing (SDB) in patients with atrial fibrillation (AF) and to systematically evaluate how SDB is assessed in this population. METHODS We searched Medline, Embase and Cinahl databases through August 2020 for studies reporting on SDB in a minimum 100 patients with AF. For quantitative analysis, studies were required to have systematically assessed for SDB in consecutive AF patients. Pooled prevalence estimates were calculated with the use of the random effects model. Weighted mean differences and odds ratios were calculated when possible to assess the strength of association between baseline characteristics and SDB. RESULTS The search yielded 2758 records, of which 33 studies (n = 23,894 patients) met the inclusion criteria for qualitative synthesis and 13 studies (n = 2660 patients) met the meta-analysis criteria. The pooled SDB prevalence based on an SDB diagnosis cutoff of apnea-hypopnea index (AHI) ≥ 5/h was 78% (95% confidence interval [CI] 70%-86%; P < 0.001). For moderate-to-severe SDB (AHI ≥ 15/h), the pooled SDB prevalence was 40% (95% CI 32%-48%; P < 0.001). High degrees of heterogeneity were observed (I2 = 96% and 94%, respectively; P < 0.001). Sleep testing with the use of poly(somno)graphy or oximetry was the most common assessment tool used (in 22 studies, 66%) but inconsistent diagnostic thresholds were used. CONCLUSIONS SDB is highly prevalent in patients with AF. Wide variation exists in the diagnostic tools and thresholds used to detect concomitant SDB in AF. Prospective systematic testing for SDB in unselected cohorts of AF patients may be required to define the true prevalence of SDB in this population.
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Affiliation(s)
- Kadhim Kadhim
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Thomas Agbaedeng
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Celine Gallagher
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Varun Malik
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University and Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, and Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
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24
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Chronic Stress, Exercise and Cardiovascular Disease: Placing the Benefits and Risks of Physical Activity into Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189922. [PMID: 34574843 PMCID: PMC8471640 DOI: 10.3390/ijerph18189922] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/18/2022]
Abstract
Chronic stress, which has been exacerbated worldwide by the lingering COVID pandemic, has been strongly linked to cardiovascular disease (CVD). In addition, autonomic dysregulation via sustained sympathetic activity has been shown to increase the risk of arrhythmias, platelet aggregation, acute coronary syndromes and heart failure. Fortunately, effective coping strategies have been shown to attenuate the magnitude of hyperarousal associated with the stress response, including moderate-to-vigorous lifestyle activity and/or structured exercise. A good-to-excellent level of cardiorespiratory fitness also appears to be highly cardioprotective. These beneficial effects have been substantiated by numerous studies that have evaluated the levels of stress reactivity and stress recovery in physically active individuals versus matched sedentary controls, as well as before and after exercise interventions. On the other hand, unaccustomed strenuous exercise in habitually sedentary persons with underlying CVD is associated with a disproportionate incidence of acute cardiac events. Moreover, extreme exercise regimens appear to increase coronary calcification and the likelihood of developing atrial fibrillation. This review summarizes these relations and more, with specific reference to placing the benefits and risks of physical activity into perspective.
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25
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Sun X, Zhao S, Chen K, Hua W, Su Y, Xu W, Wang F, Fan X, Dai Y, Liu Z, Zhang S. Association Between Changes in Physical Activity and New-Onset Atrial Fibrillation After ICD/CRT-D Implantation. Front Cardiovasc Med 2021; 8:693458. [PMID: 34513943 PMCID: PMC8426902 DOI: 10.3389/fcvm.2021.693458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/03/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Changes in physical activity (PA) after implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillators (CRT-D) implantation were unknown. The association of PA changes with new-onset atrial fibrillation (AF), cardiac death and all-cause mortality was unclear in patients at high risk of sudden cardiac death. Methods: Patients receiving ICD/CRT-D implantation from SUMMIT registry were retrospectively analyzed. Changes in PA were considered from baseline status to 1 year after implantation. New-onset AF was defined as the first atrial high-rate episode ≥1% of the daily AF burden detected after implantation. Results: Over a mean follow-up of 50.3 months, 124 new-onset AF events (36.2%), 61 cardiac deaths (17.8%), and 87 all-cause deaths (25.4%) were observed in 343 patients with ICD/CRT-D implantation. PA at 1 year after implantation was increased compared with PA at baseline (11.97 ± 5.83% vs. 10.82 ± 5.43%, P = 0.008), and PA at 1 year was improved in 210 patients (61.2%). Per 1% decrease in PA was associated with 12.4, 18.3, and 14.3% higher risks of new-onset AF, cardiac death and all-cause mortality, regardless of different baseline characteristics. Patients with decreased PA had 2-fold risks of new-onset AF (hazard ratio [HR] = 1.972, 95% confidence interval [CI]: 1.352–2.877, P < 0.001) as high as those with unchanged/increased PA. Decreased PA was an independent risk factor for cardiac death (HR = 3.358, 95% CI: 1.880–5.996, P < 0.001) and all-cause mortality (HR = 2.803, 95% CI:1.732–4.535, P < 0.001). Conclusion: PA decrease after ICD/CRT-D implantation is associated with a higher incidence of new-onset AF, resulting in worsened outcomes in cardiac death and all-cause mortality.
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Affiliation(s)
- Xuerong Sun
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuang Zhao
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Hua
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Xu
- Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing, China
| | - Fang Wang
- Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohan Fan
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Dai
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhimin Liu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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26
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Miguel-Dos-Santos R, Moreira JBN, Loennechen JP, Wisløff U, Mesquita T. Exercising immune cells: The immunomodulatory role of exercise on atrial fibrillation. Prog Cardiovasc Dis 2021; 68:52-59. [PMID: 34274371 DOI: 10.1016/j.pcad.2021.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022]
Abstract
Exercise training is generally beneficial for cardiovascular health, improving stroke volume, cardiac output, and aerobic capacity. Despite these benefits, some evidence indicates that endurance training may increase the risk of atrial fibrillation (AF), particularly in highly trained individuals. Among multiple mechanisms, autonomic tone changes and atrial remodeling have been proposed as main contributors for exercise-induced AF. However, the contribution of local and systemic immunity is poorly understood in the development of atrial arrhythmogenic substrates. Here we aim to update the field of immunomodulation in the context of exercise and AF by compiling and reconciling the most recent evidence from preclinical and human studies and rationalize the applicability of "lone" AF terminology in athletes.
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Affiliation(s)
- Rodrigo Miguel-Dos-Santos
- Department of Physiology, Federal University of Sergipe, Sergipe, Brazil; Cardiac Exercise Research Group (CERG), Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - José Bianco Nascimento Moreira
- Cardiac Exercise Research Group (CERG), Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jan Pål Loennechen
- Cardiac Exercise Research Group (CERG), Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Cardiology, St. Olav's University Hospital, Trondheim, Norway
| | - Ulrik Wisløff
- Cardiac Exercise Research Group (CERG), Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; School of Human Movement and Nutrition Science, University of Queensland, Queensland, Australia.
| | - Thássio Mesquita
- Smidt Heart Institute, Cedars-Sinai Medical Center, California, United States..
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27
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Mesirca P, Nakao S, Nissen SD, Forte G, Anderson C, Trussell T, Li J, Cox C, Zi M, Logantha S, Yaar S, Cartensen H, Bidaud I, Stuart L, Soattin L, Morris GM, da Costa Martins PA, Cartwright EJ, Oceandy D, Mangoni ME, Jespersen T, Buhl R, Dobrzynski H, Boyett MR, D'Souza A. Intrinsic Electrical Remodeling Underlies Atrioventricular Block in Athletes. Circ Res 2021; 129:e1-e20. [PMID: 33849278 DOI: 10.1161/circresaha.119.316386] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Pietro Mesirca
- IGF, Université de Montpellier, CNRS, INSERM, France (P.M., I.B., M.E.M.)
| | - Shu Nakao
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
- Department of Biomedical Sciences, Ritsumeikan University, Japan (S.N.)
| | - Sarah Dalgas Nissen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences (S.D.N., H.C., R.B.), University of Copenhagen, Denmark
| | - Gabriella Forte
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Cali Anderson
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Tariq Trussell
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Jue Li
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Charlotte Cox
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Min Zi
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Sunil Logantha
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, United Kingdom (S.L.)
| | - Sana Yaar
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Helena Cartensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences (S.D.N., H.C., R.B.), University of Copenhagen, Denmark
| | - Isabelle Bidaud
- IGF, Université de Montpellier, CNRS, INSERM, France (P.M., I.B., M.E.M.)
| | - Luke Stuart
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | | | - Gwilym M Morris
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | | | - Elizabeth J Cartwright
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Delvac Oceandy
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Matteo E Mangoni
- IGF, Université de Montpellier, CNRS, INSERM, France (P.M., I.B., M.E.M.)
| | - Thomas Jespersen
- Department of Biomedical Sciences (T.J., M.R.B.), University of Copenhagen, Denmark
| | - Rikke Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences (S.D.N., H.C., R.B.), University of Copenhagen, Denmark
| | - Halina Dobrzynski
- Department of Anatomy, Jagiellonian University Medical College, Poland (H.D.)
| | - Mark R Boyett
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
- Department of Biomedical Sciences (T.J., M.R.B.), University of Copenhagen, Denmark
| | - Alicia D'Souza
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
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28
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Mehta NK, Strickling J, Mark E, Swinehart S, Puthumana J, Lavie CJ, Haines DE, Franklin BA. Beyond cardioversion, ablation and pharmacotherapies: Risk factors, lifestyle change and behavioral counseling strategies in the prevention and treatment of atrial fibrillation. Prog Cardiovasc Dis 2021; 66:2-9. [PMID: 34023354 DOI: 10.1016/j.pcad.2021.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 01/07/2023]
Abstract
IMPORTANCE It has been suggested that atrial fibrillation (AF) is the new cardiovascular disease epidemic of the 21st century. Clinical cardiology has largely focused on AF treatment and associated stroke prevention rather than preventing AF itself. To reduce the global consequences and associated costs of AF, it is critical to now embrace prevention as a priority. Proactively addressing the risk factors for AF and the underlying unhealthy lifestyle habits that contribute to them, using research-based counseling approaches, represents a complementary and adjunctive alternative in combatting this disease burden. OBSERVATIONS Encouraging and sustaining patient involvement to reduce AF incidence and improve outcomes begins with screening to identify risk factors, unhealthy lifestyle habits, and characteristics associated with failed attempts at favorably modifying these causalities. Modulators of and common barriers to achieving risk reduction and lifestyle change include self-efficacy, social support, age, sex, marital and socioeconomic status, education, employment, and psychosocial factors such as depression, isolation, anxiety and chronic life stress. Focused behavioral counseling approaches, including assessing the patient's readiness to change, motivational interviewing and using the 5 A's (assess, advise, agree, assist, arrange), along with employing initial downscaled goals to overcome inertia, are proven methodologies to overcome these common barriers to favorably modifying risk factors and unhealthy lifestyle habits. CONCLUSIONS AND RELEVANCE To complement and enhance the current armamentarium for the medical management of cardiac arrhythmias, there is an urgent need to proactively address the causative factors triggering new-onset, recurrent and persistent AF. Beyond the counseling skills of highly trained professionals (eg, psychiatrists, psychologists), this narrative review highlights the need for and potential impact on lifestyle modification that non-behavioral scientists, including internal medicine, cardiology, and allied health professionals, can have on the patients they serve.
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Affiliation(s)
- Nishaki K Mehta
- Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, United States of America; University of Virginia Medical Center, Charlottesville, VA, United States of America.
| | - Jarred Strickling
- University of Virginia Medical Center, Charlottesville, VA, United States of America
| | - Erica Mark
- University of Virginia Medical Center, Charlottesville, VA, United States of America
| | - Sarah Swinehart
- University of Virginia Medical Center, Charlottesville, VA, United States of America
| | - Joe Puthumana
- University of Virginia Medical Center, Charlottesville, VA, United States of America
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - David E Haines
- Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, United States of America
| | - Barry A Franklin
- Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, United States of America
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29
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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De Bosscher R, Dausin C, Claus P, Bogaert J, Dymarkowski S, Goetschalckx K, Ghekiere O, Belmans A, Van De Heyning CM, Van Herck P, Paelinck B, El Addouli H, La Gerche A, Herbots L, Heidbuchel H, Willems R, Claessen G. Endurance exercise and the risk of cardiovascular pathology in men: a comparison between lifelong and late-onset endurance training and a non-athletic lifestyle - rationale and design of the Master@Heart study, a prospective cohort trial. BMJ Open Sport Exerc Med 2021; 7:e001048. [PMID: 33927885 PMCID: PMC8055127 DOI: 10.1136/bmjsem-2021-001048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction Low and moderate endurance exercise is associated with better control of cardiovascular risk factors, a decreased risk of coronary artery disease and atrial fibrillation (AF). There is, however, a growing proportion of individuals regularly performing strenuous and prolonged endurance exercise in which the health benefits have been challenged. Higher doses of endurance exercise have been associated with a greater coronary atherosclerotic plaque burden, risk of AF and myocardial fibrosis (MF). Methods and analysis Master@Heart is a multicentre prospective cohort study aiming to assess the incidence of coronary atherosclerosis, AF and MF in lifelong endurance athletes compared to late-onset endurance athletes (initiation of regular endurance exercise after the age of 30 years) and healthy non-athletes. The primary endpoint is the incidence of mixed coronary plaques. Secondary endpoints include coronary calcium scores, coronary stenosis >50%, the prevalence of calcified and soft plaques and AF and MF presence. Tertiary endpoints include ventricular arrhythmias, left and right ventricular function at rest and during exercise, arterial stiffness and carotid artery intima media thickness. Two hundred male lifelong athletes, 200 late-onset athletes and 200 healthy non-athletes aged 45–70 will undergo comprehensive cardiovascular phenotyping using CT, coronary angiography, echocardiography, cardiac MRI, 12-lead ECG, exercise ECG and 24-hour Holter monitoring at baseline. Follow-up will include online tracking of sports activities, telephone calls to assess clinical events and a 7-day ECG recording after 1 year. Ethics and dissemination Local ethics committees approved the Master@Heart study. The trial was launched on 18 October 2018, recruitment is complete and inclusions are ongoing. Trial registration number NCT03711539.
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Affiliation(s)
- Ruben De Bosscher
- Cardiovascular Sciences, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium.,Cardiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Christophe Dausin
- Movement Sciences, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Piet Claus
- Cardiovascular Sciences, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Jan Bogaert
- Radiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Steven Dymarkowski
- Radiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Kaatje Goetschalckx
- Cardiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Olivier Ghekiere
- Radiology, Jessa Ziekenhuis Campus Virga Jesse, Hasselt, Limburg, Belgium
| | - Ann Belmans
- Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Flanders, Belgium
| | | | - Paul Van Herck
- Cardiology, University Hospital Antwerp, Edegem, Belgium
| | | | | | - André La Gerche
- Cardiology, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Lieven Herbots
- Cardiology, Jessa Ziekenhuis Campus Virga Jesse, Hasselt, Limburg, Belgium
| | | | - Rik Willems
- Cardiovascular Sciences, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium.,Cardiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Guido Claessen
- Cardiovascular Sciences, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium.,Cardiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
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31
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Exercise and Athletic Activity in Atrial Fibrillation. Card Electrophysiol Clin 2021; 13:173-182. [PMID: 33516395 DOI: 10.1016/j.ccep.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Moderate-intensity exercise improves cardiovascular outcomes. However, mounting clinical evidence demonstrates that long-term, high-intensity endurance training predisposes male and veteran athletes to an increased risk of atrial fibrillation (AF), a risk that is not observed across both genders. Although increased mortality associated with AF in the general population is not shared by athletes, clinically significant morbidities exist (eg, reduced exercise capacity, athletic performance, and quality of life). Additional research is needed to fill current gaps in knowledge pertaining to the natural history, pathophysiologic mechanisms, and management strategies of AF in the athlete.
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32
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 4871] [Impact Index Per Article: 1623.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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33
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Rajanayagam J, Alsabri M. Intense Endurance Exercise: A Potential Risk Factor in the Development of Heart Disease. Cureus 2021; 13:e12608. [PMID: 33585098 PMCID: PMC7872501 DOI: 10.7759/cureus.12608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 11/12/2022] Open
Abstract
Exercise is known to improve cardiac health; however, the upper limit of exercise is not as clear. High-intensity endurance exercise and its association with cardiac dysfunction are becoming more important as more people in the USA participate in endurance activity. Intensive endurance exercise is associated with heart disease. Peer-reviewed primary literature related to endurance exercise, cardiac remodelling, myocardial fibrosis, and arrhythmia was searched and selected from the PubMed Database to be reviewed. Increased cardiac remodelling, myocardial fibrosis, and arrhythmias were associated with increased endurance exercise in most instances. Clinically significant dysfunction from endurance exercise-induced cardiac remodelling and myocardial fibrosis is not certain. However, increased incidence of sinus node disease (SND) and atrial flutter in endurance athletes, even after deconditioning, seems to be most associated with endurance exercise. Cardiac remodelling, fibrosis, and arrhythmia were associated with cardiac dysfunction. All review articles in this study were limited by a low sample size since it was difficult to obtain a full record of previous endurance activity. The reversibility of cardiac changes needs to be further investigated and can be applied in the differential diagnosis of other cardiomyopathies. The interaction between performance-enhancing drugs and endurance exercise needs to be further studied to determine its action on cardiac health. Findings from these studies could contribute to exercise recommendations.
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Affiliation(s)
| | - Mohammed Alsabri
- Paediatrics, Brookdale University Hospital Medical Center, Brooklyn, USA
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34
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Bazan V, Vicente I, Lozano L, Villuendas R, González M, Adeliño R, Bisbal F, Sarrias A, Abad J, Sanz-Santos J, Padilla F, Bayés-Genís A. Previously Undetected Obstructive Sleep Apnea in Patients With New-Onset Atrial Fibrillation. Am J Cardiol 2021; 138:46-52. [PMID: 33058803 DOI: 10.1016/j.amjcard.2020.09.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/30/2022]
Abstract
Obstructive sleep apnea-hypopnea syndrome (OSA) compromises the efficacy of atrial fibrillation (AF) control strategies. Continuous positive airway pressure (CPAP) may ameliorate arrhythmia control especially in early AF stages (new-onset AF). We investigated a practical screening strategy to determine the likelihood of CPAP indication in new-onset AF patients. Seventy-seven consecutive patients with new-onset (<1 month) AF were prospectively evaluated. Of them, 4 were excluded due to previously diagnosed OSA. The remaining 73 (68% persistent AF) fulfilled the Epworth, Berlin and STOP-BANG questionnaires, an ambulatory polysomnography being performed thereafter in all them in order to determine the apnea-hipopnea index (AHI). CPAP was indicated following conventional criteria. The variables associated with the diagnosis of OSA, with the AHI value and with CPAP indication were investigated by means of descriptive, univariate and multivariate analysis. The prevalence of OSA of any degree and CPAP indication was 82% and 37%, respectively. The variables associated (p < 0.05) with a higher AHI were male gender, body mass index, obesity, hypertension, and high-risk scoring at the Berlin and STOP-BANG questionnaires. In the multivariate analysis, the STOP-BANG scoring proved superior to conventional risk factors and became the only variable predicting CPAP indication (odds ratio 4.5 [1.9 to 10.6]; p = 0.01), an optimized cutoff value of ≥4 being newly established (sensitivity/specificity 76/65%). In conclusion, in patients referred with new-onset AF we documented a high risk of OSA and of need for CPAP. A STOP-BANG scoring of ≥4 in our population was a practical screening alternative to direct polysomnography in this setting.
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35
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Oh Y, Yang S, Liu X, Jana S, Izaddoustdar F, Gao X, Debi R, Kim DK, Kim KH, Yang P, Kassiri Z, Lakin R, Backx PH. Transcriptomic Bioinformatic Analyses of Atria Uncover Involvement of Pathways Related to Strain and Post-translational Modification of Collagen in Increased Atrial Fibrillation Vulnerability in Intensely Exercised Mice. Front Physiol 2020; 11:605671. [PMID: 33424629 PMCID: PMC7793719 DOI: 10.3389/fphys.2020.605671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/26/2020] [Indexed: 02/06/2023] Open
Abstract
Atrial Fibrillation (AF) is the most common supraventricular tachyarrhythmia that is typically associated with cardiovascular disease (CVD) and poor cardiovascular health. Paradoxically, endurance athletes are also at risk for AF. While it is well-established that persistent AF is associated with atrial fibrosis, hypertrophy and inflammation, intensely exercised mice showed similar adverse atrial changes and increased AF vulnerability, which required tumor necrosis factor (TNF) signaling, even though ventricular structure and function improved. To identify some of the molecular factors underlying the chamber-specific and TNF-dependent atrial changes induced by exercise, we performed transcriptome analyses of hearts from wild-type and TNF-knockout mice following exercise for 2 days, 2 or 6 weeks of exercise. Consistent with the central role of atrial stretch arising from elevated venous pressure in AF promotion, all 3 time points were associated with differential regulation of genes in atria linked to mechanosensing (focal adhesion kinase, integrins and cell-cell communications), extracellular matrix (ECM) and TNF pathways, with TNF appearing to play a permissive, rather than causal, role in gene changes. Importantly, mechanosensing/ECM genes were only enriched, along with tubulin- and hypertrophy-related genes after 2 days of exercise while being downregulated at 2 and 6 weeks, suggesting that early reactive strain-dependent remodeling with exercise yields to compensatory adjustments. Moreover, at the later time points, there was also downregulation of both collagen genes and genes involved in collagen turnover, a pattern mirroring aging-related fibrosis. By comparison, twofold fewer genes were differentially regulated in ventricles vs. atria, independently of TNF. Our findings reveal that exercise promotes TNF-dependent atrial transcriptome remodeling of ECM/mechanosensing pathways, consistent with increased preload and atrial stretch seen with exercise. We propose that similar preload-dependent mechanisms are responsible for atrial changes and AF in both CVD patients and athletes.
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Affiliation(s)
- Yena Oh
- Department of Biology, York University, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Sibao Yang
- Department of Biology, York University, Toronto, ON, Canada.,Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xueyan Liu
- Department of Biology, York University, Toronto, ON, Canada.,Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Sayantan Jana
- Department of Physiology, Cardiovascular Research Center, University of Alberta, Edmonton, AB, Canada
| | | | - Xiaodong Gao
- Department of Biology, York University, Toronto, ON, Canada
| | - Ryan Debi
- Department of Biology, York University, Toronto, ON, Canada
| | - Dae-Kyum Kim
- Donnelly Centre, University of Toronto, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Kyoung-Han Kim
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ping Yang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zamaneh Kassiri
- Department of Physiology, Cardiovascular Research Center, University of Alberta, Edmonton, AB, Canada
| | - Robert Lakin
- Department of Biology, York University, Toronto, ON, Canada
| | - Peter H Backx
- Department of Biology, York University, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
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36
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Bubnova MG, Aronov DM. Atrial Fibrillation: the Association with Physical Activity and the Effects of Cardiac Rehabilitation. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-10-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this review was to present modern studies that examine the relationship of physical activity and risk of atrial fibrillation (AF) development and the impact of cardiac rehabilitation programs in patients with all forms of AF. Data of 52 Russian and foreign scientific sources published in 1998- 2020 were presented. In our study, 48 patients with paroxysmal AF after radiofrequency ablation (RFA) were randomly assigned to a physical rehabilitation/standard therapy or control (standard therapy) group. Aerobic physical training was conducted for 6 months 3 times a week. AF is one of the most common cardiac arrhythmias. Despite modern advances, results of treatment of this disease are far from optimal. Many problems of patients with AF can be addressed through enrolment in multidisciplinary cardiac rehabilitation programs. But this question remains open. This is mainly due to the complexity of selection of physical rehabilitation program for patients with AF. It is known that physical activity can trigger an episode of AF. In the following review article, the approaches to functional capacity assessment of patient with AF are described, recommendations for prescribing safe exercise training to achieve a therapeutic effect are presented. Various aspects of the effects of physical rehabilitation are discussed, including its impact on cardiovascular risk factors, influence on atrial remodeling processes and associated biomarkers, prevention of AF progression and occurrence of cardiovascular complications. Results of our own research indicate effectiveness of physical training in patients with AF after RFA: increase in exercise duration by 18.6% (p<0.001) and load by 24.8% (p<0.01) during exercise test, increase in level of everyday physical activity by 23.8% (p=0.001); left atrium dimensions remain stable comparing with control group. That was combined with a decrease of post ablation atrial arrhythmias: after 6 months, they were registered in 4.5% of trained patients vs 17.4% of control group patients (p<0.01). Steady growth in the number of patients with AF and catheter ablation procedures around the world dictates the need for organization of multi-purpose medical rehabilitation.
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Affiliation(s)
- M. G. Bubnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. M. Aronov
- National Medical Research Center for Therapy and Preventive Medicine
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37
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Mehta A, Kondamudi N, Laukkanen JA, Wisloff U, Franklin BA, Arena R, Lavie CJ, Pandey A. Running away from cardiovascular disease at the right speed: The impact of aerobic physical activity and cardiorespiratory fitness on cardiovascular disease risk and associated subclinical phenotypes. Prog Cardiovasc Dis 2020; 63:762-774. [PMID: 33189764 DOI: 10.1016/j.pcad.2020.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/08/2020] [Indexed: 02/06/2023]
Abstract
Higher levels of physical activity (PA) and cardiorespiratory fitness (CRF) are associated with lower risk of incident cardiovascular disease (CVD). However, the relationship of aerobic PA and CRF with risk of atherosclerotic CVD outcomes and heart failure (HF) seem to be distinct. Furthermore, recent studies have raised concerns of potential toxicity associated with extreme levels of aerobic exercise, with higher levels of coronary artery calcium and incident atrial fibrillation noted among individuals with very high PA levels. In contrast, the relationship between PA levels and measures of left ventricular structure and function and risk of HF is more linear. Thus, personalizing exercise levels to optimal doses may be key to achieving beneficial outcomes and preventing adverse CVD events among high risk individuals. In this report, we provide a comprehensive review of the literature on the associations of aerobic PA and CRF levels with risk of adverse CVD outcomes and the preceding subclinical cardiac phenotypes to better characterize the optimal exercise dose needed to favorably modify CVD risk.
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Affiliation(s)
- Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nitin Kondamudi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - Ulrik Wisloff
- K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Barry A Franklin
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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38
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Zacher J, Dillschnitter K, Freitag N, Kreutz T, Bjarnason-Wehrens B, Bloch W, Predel HG, Schumann M. Exercise training in the treatment of paroxysmal atrial fibrillation: study protocol of the Cologne ExAfib Trial. BMJ Open 2020; 10:e040054. [PMID: 33130570 PMCID: PMC7783621 DOI: 10.1136/bmjopen-2020-040054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common form of cardiac arrhythmia and is associated with a number of comorbidities such as coronary artery disease and heart failure. While physical activity is already implemented in current international guidelines for the prevention and treatment of AF, the precise role of different types of exercise in the management of AF remains to be elucidated. The primary aim of the Cologne ExAfib Trial is to assess the feasibility and safety of different exercise modes in patients diagnosed with paroxysmal AF. Secondary outcomes include assessments of physical function, AF burden, quality of life and inflammation, as well as morphological and cardiac adaptations. METHODS AND ANALYSIS The study opened for recruitment in September 2019. In the initial pilot phase of this four-armed randomised controlled trial, we aim to enrol 60 patients between 60 years and 80 years of age with paroxysmal AF. After screening and pretesting, patients are randomised into one of the following groups: high-intensity interval training (4×4 min at 75%-85% peak power output (PPO)), moderate-intensity continuous training (25 min at 55%-65% PPO), strength training (whole body, 3 sets of 6-12 repetitions at 70%-90% one repetition maximum [1RM]) or a usual-care control group. Training is performed two times per week for 12 weeks. If the feasibility and safety can be confirmed through the initial pilot phase, the recruitment will be continued and powered for a clinical endpoint.Feasibility and safety are assessed by measures of recruitment and completion, programme tolerance and adherence as well as reported adverse events, including hospitalisation rates. Secondary endpoints are assessed by measures of peak oxygen consumption and the 1RM of selected muscle groups, questionnaires concerning quality of life and AF burden, serum blood samples for the analysis of C reactive protein, interleukin-6, tumour necrosis factor alpha and N-terminal pro-brain natriuretic peptide concentrations and ultrasound for muscle and heart morphology as well as cardiac function. ETHICS AND DISSEMINATION Ethics approval was obtained from the ethics committee of the German Sport University Cologne (No.: 175/2018). All procedures performed in studies involving human participants are in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Manuscripts will be written based on international authorship guidelines. No professional writers will be commissioned for manuscript drafting. The findings of this study will be published in peer-reviewed journals and presented at leading exercise and medicine conferences TRIAL REGISTRATION NUMBER: The study is registered both at the German and at the WHO trial registers (DRKS00016637); Pre-results.
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Affiliation(s)
- Jonas Zacher
- Department of Preventive and Rehabilitative Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
| | - Katrin Dillschnitter
- Department of Preventive and Rehabilitative Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
| | - Nils Freitag
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
| | | | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
| | - Hans-Georg Predel
- Department of Preventive and Rehabilitative Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
| | - Moritz Schumann
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
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Atrial size and sports. A great training for a greater left atrium: how much is too much? Int J Cardiovasc Imaging 2020; 37:981-988. [PMID: 33104945 DOI: 10.1007/s10554-020-02082-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/21/2020] [Indexed: 01/05/2023]
Abstract
Athlete's heart results from physiological adaptations to the increased demands of exercise, and left atrial (LA) enlargement (LAE) is a fundamental component. However, LAE occurs in certain pathological conditions and it might represent a diagnostic challenge in athletes. LA volume index (LAVi) by echo is a convenient diagnostic tool for LAE identification. We hypothesized that accumulated lifetime training thousand hours (LTH) would have a main role in LAE. Therefore, our aim was to assess the association between LTH, LAVi and LAE in athletes. Young and middle-aged males with different training levels were included and grouped as recreational (REa, n = 30), competitive (COa, n = 169) and elite (ELa, n = 80) athletes for LTH calculation and echo assessment. LA dimensions resulted greater in ELa when compared to other groups (p < 0.001). LAVi correlated stronger with LTH than with age (p < 0.001). Polynomial regression analysis showed a non-linear, almost triphasic, effect of cumulative training on LA size (p < 0.02). Multivariate logistic regression, including LTH, age, body surface area, systolic blood pressure and other explanatory variables to predict LAE, showed LTH as the sole significant factor [OR 1.45 (CI 1.1-1.92), p < 0.008]. ROC analysis found an optimal cut off point of 3.6 LTH for LAE identification (AUC = 0.84, p < 0.001. RR = 5.65, p < 0.001). We conclude that LAE associates with LTH more than with other clinical parameters, and with less impact at higher amounts of LTH. Lifetime training greater than 3600 hours increases the probability of finding LAE in athletes. Future research should provide more insights and implications of these findings.
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Abstract
Atrial fibrillation (AF) contributes to morbidity and mortality of millions of individuals. Its molecular, cellular, neurohumoral, and hemodynamic pathophysiological mechanisms are complex, and there is increasing awareness that a wide range of comorbidities can contribute to AF-promoting atrial remodeling. Moreover, recent research has highlighted that AF risk is not constant and that the temporal variation in concomitant conditions contributes to the complexity of AF dynamics. In this review, we provide an overview of fundamental AF mechanisms related to established and emerging comorbidities or risk factors and their role in the AF-promoting effects. We focus on the accumulating evidence for the relevance of temporally dynamic changes in these risk factors and the consequence for AF initiation and maintenance. Finally, we highlight the important implications for future research and clinical practice resulting from the dynamic interaction between AF risk factors and mechanisms.
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Affiliation(s)
- Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands;
| | - Dominik Linz
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands; .,Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands; .,Department of Cardiology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands.,Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 5005 Adelaide, South Australia, Australia
| | - Ulrich Schotten
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands; .,Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands;
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Boersma L, Rienstra M, de Groot JR. Therapeutic options for patients with advanced atrial fibrillation: from lifestyle and medication to catheter and surgical ablation. Neth Heart J 2020; 28:13-18. [PMID: 32780326 PMCID: PMC7419415 DOI: 10.1007/s12471-020-01447-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Atrial fibrillation (AF) is part of a vicious cycle that includes multiple cardiovascular risk factors and comorbidity which can promote atrial remodelling and AF progression. Most AF-related risk factors—hypertension, diabetes, sleep apnoea, obesity and sedentary lifestyle—are in essence modifiable which may prevent AF development. Treatment of associated cardiovascular conditions may prevent both symptoms and future cardiovascular events. For advanced forms of symptomatic AF refractory to lifestyle management and optimal medication, invasive ablation therapies have become a cornerstone. Although electrical trigger isolation from the pulmonary veins is reasonably effective and safe, more potent energy sources including high output-short duration radiofrequency, ultra-low cryo-energy, and electroporation, as well as more sophisticated arrays, balloons, and lattice-tipped catheter tools, are on their way to eliminate existing pitfalls and simplify the procedure. Electroanatomical navigation and mapping systems are becoming available to provide real-time information on ablation lesion quality and the critical pathways of AF in the individual patient to guide more extensive ablation strategies that may enhance long-term outcome for freedom of advanced AF. Surgical techniques, either stand-alone or concomitant to structural cardiac repair, hybrid, or convergent, with novel less invasive access options are developing and can be helpful in situations unsuitable for catheter ablation.
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Affiliation(s)
- L Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. .,Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - M Rienstra
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J R de Groot
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Peritz DC, Catino AB, Csecs I, Kaur G, Kheirkhahan M, Loveless B, Wasmund S, Kholmovski E, Morris A, Marrouche NF. High-intensity endurance training is associated with left atrial fibrosis. Am Heart J 2020; 226:206-213. [PMID: 32615358 DOI: 10.1016/j.ahj.2020.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Endurance athletes are at higher risk for developing atrial fibrillation as compared to the general population. The exact mechanism to explain this observation is incompletely understood. Our study aimed to determine whether degree of left atrial fibrosis detected by late gadolinium-enhancement magnetic resonance imaging (LGE-MRI) differed between Masters athletes and non-athlete controls. METHODS We recruited 20 endurance healthy Masters athletes and 20 healthy control subjects who underwent cardiac MRI. Healthy controls were recruited during screening colonoscopies and Masters athletes were recruited through word of mouth and at competitions. The two groups were age and gender matched. None of the participants were known to have an arrhythmia. Fibrosis, as measured by late gadolinium-enhancement, was measured in each participant by blinded readers. The degree of left atrial fibrosis was compared between the two groups. All participants were recruited from the Salt Lake City region and scanned at the University of Utah healthcare complex. RESULTS Left ventricular function was normal in all study participants. Left atrial volumes were significantly larger in the athletes (74.2 ml ± 14.4) as compared to the healthy control subjects (60.8 mL ± 21.4) (P = .02). Mean left atrial fibrosis score, reported as a percentage of the LA, was 15.5% ± 5.9 in the athlete cohort compared to 9.6% ± 4.9 in the controls (P = .002). CONCLUSIONS To our knowledge this is the first study that describes, characterizes and specifically quantifies fibrotic changes within the left atrium of highly trained endurance athletes. Increased atrial fibrosis seen in this population may be an early indicator for endurance athletes at risk of developing atrial arrhythmias.
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O'Keefe EL, Torres-Acosta N, O'Keefe JH, Lavie CJ. Training for Longevity: The Reverse J-Curve for Exercise. MISSOURI MEDICINE 2020; 117:355-361. [PMID: 32848273 PMCID: PMC7431070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A wealth of scientific literature backs the unique therapeutic benefits of exercise for quality of life, cardiovascular (CV) health, and longevity. Consequently, many have assumed that more exercise is always better. However, chronic excessive endurance exercise might adversely impact CV health. Ultra-endurance races can inflict acute myocardial damage, as evidenced by elevations in troponin and brain natriuretic peptide. Moreover, sudden cardiac arrest occurs more often in marathons and triathlons than in shorter races. Veteran endurance athletes often show abnormal cardiac remodeling with increased risk for myocardial fibrosis and coronary calcification. Chronic excessive exercise has been consistently associated with increased risks of atrial fibrillation (AF), and along with some attenuation of longevity benefits. The optimal dose of exercise remains unknown and probably differs among individuals. Current studies suggest that 2.5 to 5 hours/week of moderate or vigorous physical activity will confer maximal benefits; >10 hours/week may reduce these health benefits.
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Affiliation(s)
| | | | - James H O'Keefe
- MSMA member since 2003, is at Saint Luke's Mid America Heart Institute, Kansas City, Missouri and University of Missouri-Kansas City, Kansas City, Missouri
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, the University of Queensland School of Medicine, New Orleans, Louisiana
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Franklin BA, Thompson PD, Al-Zaiti SS, Albert CM, Hivert MF, Levine BD, Lobelo F, Madan K, Sharrief AZ, Eijsvogels TMH. Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective-An Update: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e705-e736. [PMID: 32100573 DOI: 10.1161/cir.0000000000000749] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epidemiological and biological plausibility studies support a cause-and-effect relationship between increased levels of physical activity or cardiorespiratory fitness and reduced coronary heart disease events. These data, plus the well-documented anti-aging effects of exercise, have likely contributed to the escalating numbers of adults who have embraced the notion that "more exercise is better." As a result, worldwide participation in endurance training, competitive long distance endurance events, and high-intensity interval training has increased markedly since the previous American Heart Association statement on exercise risk. On the other hand, vigorous physical activity, particularly when performed by unfit individuals, can acutely increase the risk of sudden cardiac death and acute myocardial infarction in susceptible people. Recent studies have also shown that large exercise volumes and vigorous intensities are both associated with potential cardiac maladaptations, including accelerated coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, and atrial fibrillation. The relationship between these maladaptive responses and physical activity often forms a U- or reverse J-shaped dose-response curve. This scientific statement discusses the cardiovascular and health implications for moderate to vigorous physical activity, as well as high-volume, high-intensity exercise regimens, based on current understanding of the associated risks and benefits. The goal is to provide healthcare professionals with updated information to advise patients on appropriate preparticipation screening and the benefits and risks of physical activity or physical exertion in varied environments and during competitive events.
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Wingerter R, Steiger N, Burrows A, Estes NAM. Impact of Lifestyle Modification on Atrial Fibrillation. Am J Cardiol 2020; 125:289-297. [PMID: 31761147 DOI: 10.1016/j.amjcard.2019.10.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022]
Abstract
Atrial Fibrillation (AF) is the most common arrhythmia in adults, and the rapid increase in AF prevalence has been classified by experts as an epidemic. The mechanisms of AF are complex and incompletely understood. While many aspects of management are now based on high quality evidence, other clinical decisions are based on experience and judgment. This article provides an up to date review relating to lifestyle modification and its effect on AF to inform clinical treatment. This comprehensive review used PubMed and Google Scholar to perform keyword searches of articles published between 1998 and the present, with the exception of the 1978 "Holiday Heart" article. Robust data has emerged identifying multiple risk factors for development of AF, including age, sex, hypertension, diabetes mellitus, obesity, alcohol consumption, exercise, and obstructive sleep apnea. Recent evidence indicates that lifestyle modification has a significant role in mitigating the risk and burden of AF. In conclusion, based on the available evidence, an interdisciplinary approach to lifestyle modification will likely reduce risk and/or symptom burden of AF.
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Affiliation(s)
- Rebecca Wingerter
- College of Medicine at University of Central Florida, Orlando, Florida
| | | | | | - N A Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Atrial fibrillation: A review of modifiable risk factors and preventive strategies. ACTA ACUST UNITED AC 2020; 57:99-109. [PMID: 30648669 DOI: 10.2478/rjim-2018-0045] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Indexed: 11/20/2022]
Abstract
Atrial fibrillation (AF), as the most common cardiac arrhythmia worldwide, is associated with increased mortality and morbidity. Successful therapeutic strategies have been introduced so far, but they are associated with significant costs. Therefore, identification of modifiable risk factors of AF and the development of appropriate preventive strategies may play a substantial role in promoting community health and reducing health care system costs. Modifiable cardiovascular risk factors including obesity, hypertension, diabetes mellitus, obstructive sleep apnea, alcohol consumption, smoking, and sedentary lifestyles have been proposed as possible contributors to the development and progression of AF. In this review, we discuss the role of modifiable risk factors in the development and management of AF and the evidence for the underlying mechanism for each of the potential risk factor.
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Centurión OA, Candia JC, Scavenius KE, García LB, Torales JM, Miño LM. The Association Between Atrial Fibrillation and Endurance Physical Activity: How Much is too Much? J Atr Fibrillation 2019; 12:2167. [PMID: 32435330 DOI: 10.4022/jafib.2167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/14/2019] [Accepted: 06/26/2019] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in middle-aged athletes. Physical exercise performed in a regular basis has been shown to be beneficial for cardiovascular health. Moderate physical exercise, aside from producing a nice, peaceful and well-being sensation, has been associated with a reduced risk of AF. However, more strenuous endurance exercise, like the one experiencing marathon runners, seems to increase the risk of AF in healthy athletes without organic heart disease. On the other hand, low physical activity was found to be a risk factor for the appearance of AF. Nevertheless, the relationship of exercise to AF is complex, influenced by the intensity and the duration of the physical activity, and seems to have a U-shaped relationship with the greatest levels of physical activity possibly increasing AF incidence. There is cumulative data associating moderate physical activity to reduced AF incidence, hence physicians should recommend moderate exercise training to patients with AF. This may not only reduce AF risk, but would also contribute to an overall cardiovascular benefit. However, since there is also important data suggesting significant increased incidence of AF in elite athletes with long-term endurance physical activity, it may be a serious concern to go to the extreme. In most things in life it is much better and wiser to be well balanced, always in equilibrium.
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Affiliation(s)
- Osmar Antonio Centurión
- Department of Health Science's Investigation. Sanatorio Metropolitano. Fernando de la Mora. Paraguay.,Department of Health Science's Investigation. Sanatorio Metropolitano. Fernando de la Mora. Paraguay
| | - José C Candia
- Division of Cardiovascular Medicine. Clinical Hospital. Asunción National University (UNA). San Lorenzo. Paraguay
| | - Karina E Scavenius
- Department of Health Science's Investigation. Sanatorio Metropolitano. Fernando de la Mora. Paraguay.,Division of Cardiovascular Medicine. Clinical Hospital. Asunción National University (UNA). San Lorenzo. Paraguay
| | - Laura B García
- Department of Health Science's Investigation. Sanatorio Metropolitano. Fernando de la Mora. Paraguay.,Division of Cardiovascular Medicine. Clinical Hospital. Asunción National University (UNA). San Lorenzo. Paraguay
| | - Judith M Torales
- Department of Health Science's Investigation. Sanatorio Metropolitano. Fernando de la Mora. Paraguay.,Division of Cardiovascular Medicine. Clinical Hospital. Asunción National University (UNA). San Lorenzo. Paraguay
| | - Luís Marcelo Miño
- Department of Health Science's Investigation. Sanatorio Metropolitano. Fernando de la Mora. Paraguay.,Division of Cardiovascular Medicine. Clinical Hospital. Asunción National University (UNA). San Lorenzo. Paraguay
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Tirapu L, San Antonio R, Tolosana JM, Roca-Luque I, Mont L, Guasch E. Exercise and atrial fibrillation: how health turns harm, and how to turn it back. Minerva Cardioangiol 2019; 67:411-424. [DOI: 10.23736/s0026-4725.19.04998-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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49
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D’Souza A, Trussell T, Morris GM, Dobrzynski H, Boyett MR. Supraventricular Arrhythmias in Athletes: Basic Mechanisms and New Directions. Physiology (Bethesda) 2019; 34:314-326. [DOI: 10.1152/physiol.00009.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Athletes are prone to supraventricular rhythm disturbances including sinus bradycardia, heart block, and atrial fibrillation. Mechanistically, this is attributed to high vagal tone and cardiac electrical and structural remodeling. Here, we consider the supporting evidence for these three pro-arrhythmic mechanisms in athletic human cohorts and animal models, featuring current controversies, emerging data, and future directions of relevance to the translational research agenda.
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Affiliation(s)
- Alicia D’Souza
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Tariq Trussell
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Gwilym M. Morris
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Mark R. Boyett
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
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Svedberg N, Sundström J, James S, Hållmarker U, Hambraeus K, Andersen K. Long-Term Incidence of Atrial Fibrillation and Stroke Among Cross-Country Skiers. Circulation 2019; 140:910-920. [PMID: 31446766 DOI: 10.1161/circulationaha.118.039461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies have revealed a higher incidence of atrial fibrillation among well-trained athletes. We aim to investigate associations of endurance training with incidence of atrial fibrillation and stroke and to establish potential sex differences of such associations in a cohort of endurance trained athletes. METHODS All Swedish skiers (208 654) completing 1 or more races in the 30 to 90 km cross-country skiing event Vasaloppet (1989-2011) and a matched sample (n=527 448) of nonskiers were followed until first event of atrial fibrillation or stroke. Cox regression was used to investigate associations of number of completed races and finishing time with incidence of atrial fibrillation and stroke. RESULTS Female skiers in Vasaloppet had a lower incidence of atrial fibrillation than did female nonskiers (hazard ratio [HR], 0.55; 95% CI, 0.48-0.64), independent of finishing time and number of races. Male skiers had a similar incidence to that of nonskiers (HR, 0.98; 95% CI, 0.93-1.03). Skiers with the highest number of races or fastest finishing times had the highest incidence. Skiers of either sex had a lower incidence of stroke than did nonskiers (HR, 0.64; 95% CI, 0.60-0.67), independent of the number of races and finishing time. Skiers with atrial fibrillation had higher incidence of stroke than did skiers and nonskiers without atrial fibrillation (men: HR, 2.28; 95% CI, 1.93-2.70; women: HR, 3.51; 95% CI, 2.17-5.68; skiers with atrial fibrillation vs. skiers without atrial fibrillation). After diagnosis of atrial fibrillation, skiers with atrial fibrillation had a lower incidence of stroke (HR, 0.73; 95% CI, 0.50-0.91) and lower mortality compared with nonskiers with atrial fibrillation (HR, 0.57; 95% CI, 0.49-0.65). CONCLUSIONS Female skiers in Vasaloppet had lower incidence of atrial fibrillation and stroke. Male skiers had similar incidence of atrial fibrillation and lower risk of stroke. Men with higher number of races and faster finishing times had the highest incidence of atrial fibrillation. After diagnosis of atrial fibrillation, skiers had lower incidence of stroke and death than did nonskiers with atrial fibrillation. This indicates that although on an individual level atrial fibrillation in well-trained individuals is associated with higher incidence of stroke, on population level, risk of stroke is low and that exercise should not be avoided.
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Affiliation(s)
- Niclas Svedberg
- Department of Medical Sciences, Uppsala University, Sweden (N..S., J.S., S.J., U.H., K.H., K.A.).,Department of Cardiology, Falun Hospital, Sweden (N.S., K.H.)
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Sweden (N..S., J.S., S.J., U.H., K.H., K.A.)
| | - Stefan James
- Department of Medical Sciences, Uppsala University, Sweden (N..S., J.S., S.J., U.H., K.H., K.A.)
| | - Ulf Hållmarker
- Department of Medical Sciences, Uppsala University, Sweden (N..S., J.S., S.J., U.H., K.H., K.A.).,Department of Medicine, Mora Hospital, Sweden (U.H.)
| | - Kristina Hambraeus
- Department of Medical Sciences, Uppsala University, Sweden (N..S., J.S., S.J., U.H., K.H., K.A.).,Department of Cardiology, Falun Hospital, Sweden (N.S., K.H.)
| | - Kasper Andersen
- Department of Medical Sciences, Uppsala University, Sweden (N..S., J.S., S.J., U.H., K.H., K.A.)
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