Exercise and the heart: unmasking Mr Hyde

As physicians, we often face patients with cardiovascular risk factors or different kinds of heart disease. We prescribe statins, ACE inhibitors or β-blockers, but also (should) encourage our patients to engage in regular physical activity to reduce cardiovascular disease burden...

Diagnosis, pathophysiology, and management of exercise-induced arrhythmias

The cardiovascular benefits of physical activity are indisputable. Nevertheless, growing evidence suggests that both atrial fibrillation and right ventricular arrhythmia can be caused by intense exercise in some individuals. Exercise-induced atrial fibrillation is most commonly diagnosed in middle-aged, otherwise healthy men who have been engaged in endurance training for >10 years, and is mediated by atrial dilatation, parasympathetic enhancement, and possibly atrial fibrosis. Cardiac ablation is evolving as a first-line tool for athletes with exercise-induced arrhythmia who are eager to remain active. The relationship between physical activity and right ventricular arrhythmia is complex and involves genetic and physical factors that, in a few athletes, eventually lead to right ventricular dilatation, followed by subsequent myocardial fibrosis and lethal ventricular arrhythmias. Sinus bradycardia and atrioventricular conduction blocks are common in athletes, most of whom remain asymptomatic, although incomplete reversibility has been shown after exercise cessation. In this Review, we summarize the evidence supporting the existence of exercise-induced arrhythmias and discuss the specific considerations for the clinical management of these patients

Exercise, sex and atrial fibrillation: arrhythmogenesis beyond Y-chromosome?

Although prevailing research trends favour large clinical trials and registries, meticulous observation during daily clinical practice remains a valuable source for hypothesis generation in medical research. Clinical experience has allowed the identification of several risk factors in the cardiovascular field...

Safety culture maturity in several latin America mining activities

Health and safety is a crucial issue in the mining industry because of the implication of fatalities in this sector. A study of safety culture maturity in several Latin America countries has been done based on the model from Filho et al. [1]. The questionnaire includes 28 items regarding the type of activity, number of employees and safety culture characteristics of the activity: Information of accidents and misses, organizational structure to deal with the information, involvement of the company in health and safety issues, the way it communicates accidents and misses and commitment of the company towards health and safety. The questionnaire was completed by 58 mining company managers from Bolivia, Peru, Colombia and Mexico. Results show different behaviours depending on the type of company, cooperative or private company. When private companies are analysed, it is seen a level of maturity according to the size of the company, whereas cooperatives does not have a clear trend in terms of size apart from very small cooperatives, less than 10 employees. However, there is a remarkable difference between cooperatives that have implemented continuous improvement systems and the others. In particular, cooperatives with a continuous improvement system have been analysed, displaying much higher safety culture levels. Therefore, it can be concluded that private companies improve their level of safety culture as the size of the company increase, because procedures and control systems are implemented. When cooperative or small companies introduce similar systems they also achieve substantial gains, but their approach is different. Managers from cooperatives have to see economic reasons to implement it, such as the Fairmined certificate.Peer ReviewedPostprint (published version

Atrial fibrillation progression: How sick is the atrium?

After many years of lack of interest in the atrium by clinical cardiologists, the evidence of increased morbidity and mortality in patients with atrial fibrillation (AF) relocated the atrium to a central position in cardiology more than 2 decades ago.1 First came the studies showing improved outcome with the use of anticoagulants; later, the ever-lasting controversy on rate vs rhythm control; and at present, new imaging techniques and new therapeutic tools to better define atrial remodeling and improve therapy..

Analysis of ECG in athletes running in mountain route conditions

The purpose of this work is to analyse changes in ECG and heart rate variability (HRV) metrics in athletes during 10 km running in mountain route conditions. Eighteen healthy athletes carrying a 12-lead ECG GE Holter recorder and a heart rate monitor ran a route with slopes similar as trail races. QRS duration, QRS area, R-wave peak, ST elevation at J-point and J+60 ms, ST slope and T-wave peak indices were computed after signal-averaging ECG segments at different sloping stages of running (S1-S6) and at a control stage (S0) before running. HRV analysis included standard time and frequency metrics: mean RR (normal, N) interval, SDNN, RMSSD, low and high frequency absolute and normalized power (LF, HF, LFn, HFn) and LF/HF ratio. QRS area and R-peak were reduced during stage 1 in lateral leads, comparing to rest before running. ST slope was significantly higher during upslope stages in leads II, V4 and V5. T-wave amplitude increased significantly in precordial leads during upload running. ST segment depressed in leads II, III and V5 respect control. Mean RR, SDNN, LF and LFn showed high significant differences (p<0.01) among stages and HF and LF/HF were also varying (p<0.05). Changes of ECG and HRV indices can help understanding the cardiac function in runners performing extreme stress.Postprint (published version

Mechanisms of atrial fibrillation in athletes: what we know and what we do not know.

Exercise is an emerging cause of atrial fibrillation (AF) in young individuals without coexisting cardiovascular risk factors. The causes of exercise-induced atrial fibrillation remain largely unknown, and conclusions are jeopardised by apparently conflicting data. Some components of the athlete's heart are known to be arrhythmogenic in other settings. Bradycardia, atrial dilatation and, possibly, atrial premature beats are therefore biologically plausible contributors to exercise-induced AF. Challenging findings in an animal model suggest that exercise might also prompt the development of atrial fibrosis, possibly due to cumulative minor structural damage after each exercise bout. However, there is very limited, indirect data supporting this hypothesis in athletes. Age, sex, the presence of comorbidities and cardiovascular risk factors, and genetic individual variability might serve to flag those athletes who are at the higher risk of exercise-induced AF. In this review, we will critically address current knowledge on the mechanisms of exercise-induced AF

Validity of the Polar V800 monitor for measuring heart rate variability in mountain running route conditions

PURPOSE: This study was conducted to test, in mountain running route conditions, the accuracy of the Polar V800 monitor as a suitable device for monitoring the heart rate variability (HRV) of runners. METHOD: Eighteen healthy subjects ran a route that included a range of running slopes such as those encountered in trail and ultra-trail races. The comparative study of a V800 and a Holter SEER 12 ECG Recorder included the analysis of RR time series and short-term HRV analysis. A correction algorithm was designed to obtain the corrected Polar RR intervals. Six 5-min segments related to different running slopes were considered for each subject. RESULTS: The correlation between corrected V800 RR intervals and Holter RR intervals was very high (r = 0.99, p  0.05) and were well correlated (r ≥ 0.96, p < 0.001). CONCLUSION: Narrow limits of agreement, high correlations and small effect size suggest that the Polar V800 is a valid tool for the analysis of heart rate variability in athletes while running high endurance events such as marathon, trail, and ultra-trail races. KEYWORDS: HRV; Open field running conditions; Polar V800 heart rate monitor; Validatio