European Heart Journal

Sudden cardiac death (SCD) is a tragic incident accountable for up to 50% of deaths from cardiovascular disease. Sports-related SCD (SrSCD) is a phenomenon which has previously been associated with both competitive and recreational sport activities. SrSCD has been found to occur 5â€“33-fold less frequently in women than in men, and the sex difference persists despite a rapid increase in female participation in sports. Establishing the reasons behind this difference could pinpoint targets for improved prevention of SrSCD. Therefore, this review summarizes existing knowledge on epidemiology, characteristics, and causes of SrSCD in females, and elaborates on proposed mechanisms behind the sex differences. Although literature concerning the aetiology of SrSCD in females is limited, proposed mechanisms include sex-specific variations in hormones, blood pressure, autonomic tone, and the presentation of acute coronary syndromes. Consequently, these biological differences impact the degree of cardiac hypertrophy, dilation, right ventricular remodelling, myocardial fibrosis, and coronary atherosclerosis, and thereby the occurrence of ventricular arrhythmias in male and female athletes associated with short- and long-term exercise. Finally, cardiac examinations such as electrocardiograms and echocardiography are useful tools allowing easy differentiation between physiological and pathological cardiac adaptations following exercise in women. However, as a significant proportion of SrSCD causes in women are non-structural or unexplained after autopsy, channelopathies may play an important role, encouraging attention to prodromal symptoms and family history. These findings will aid in the identification of females at high risk of SrSCD and development of targeted prevention for female sport participants.

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Leadless vs. transvenous single-chamber ventricular pacing in the Micra CED study: 2-year follow-up

Mikhael F El-Chami, Lindsay Bockstedt, Colleen Longacre, Lucas Higuera, Kurt Stromberg, George Crossley, Robert C Kowal, Jonathan P Piccini

doi : 10.1093/eurheartj/ehab767

European Heart Journal, Volume 43, Issue 12, 21 March 2022, Pages 1207â€“1215

Clinical trials have demonstrated the safety and efficacy of the Micra leadless VVI pacemaker; however, longer-term outcomes in a large, real-world population with a contemporaneous comparison to transvenous VVI pacemakers have not been examined. We compared reinterventions, chronic complications, and all-cause mortality at 2 years between leadless VVI and transvenous VVI implanted patients.

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Leadless pacing: is this the end of the road for transvenous pacemakers?

Haran Burri

doi : 10.1093/eurheartj/ehab769

European Heart Journal, Volume 43, Issue 12, 21 March 2022, Pages 1216â€“1218

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Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial

Stephan Willems, Katrin Borof, Axel Brandes, GÃ¼nter Breithardt, A John Camm, Harry J G M Crijns, Lars Eckardt, Nele Gessler, Andreas Goette, Laurent M Haegeli, Hein Heidbuchel, Josef Kautzner, G AndrÃ© Ng, Renate B Schnabel, Anna Suling, Lukasz Szumowski, Sakis Themistoclakis, Panos Vardas, Isabelle C van Gelder, Karl Wegscheider, Paulus Kirchhof

doi : 10.1093/eurheartj/ehab593

European Heart Journal, Volume 43, Issue 12, 21 March 2022, Pages 1219â€“1230

Clinical practice guidelines restrict rhythm control therapy to patients with symptomatic atrial fibrillation (AF). The EAST-AFNET 4 trial demonstrated that early, systematic rhythm control improves clinical outcomes compared to symptom-directed rhythm control.

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Rhythm control in asymptomatic â€˜earlyâ€™ atrial fibrillation: birth of a new paradigm?

Robert Hatala

doi : 10.1093/eurheartj/ehab811

European Heart Journal, Volume 43, Issue 12, 21 March 2022, Pages 1231â€“1233

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Purkinje network and myocardial substrate at the onset of human ventricular fibrillation: implications for catheter ablation

Michel Haissaguerre, Ghassen Cheniti, Meleze Hocini, Frederic Sacher, F. Daniel Ramirez, Hubert Cochet, Laura Bear, Romain Tixier, Josselin Duchateau, Rick Walton, Elodie Surget, Tsukasa Kamakura, Hugo Marchand, Nicolas Derval, Pierre Bordachar, Sylvain Ploux, Takamitsu Takagi, Thomas Pambrun, Pierre Jais, Louis Labrousse, Mark Strik, Hiroshi Ashikaga, Hugh Calkins, Ed Vigmond, Koonlawee Nademanee, Olivier Bernus, Remi Dubois

doi : 10.1093/eurheartj/ehab893

European Heart Journal, Volume 43, Issue 12, 21 March 2022, Pages 1234â€“1247

Mapping data of human ventricular fibrillation (VF) are limited. We performed detailed mapping of the activities underlying the onset of VF and targeted ablation in patients with structural cardiac abnormalities.

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Ventricular fibrillation: combined myocardial substrate and Purkinje ablation

Peter Taggart, Martyn P. Nash, Pier Lambiase

doi : 10.1093/eurheartj/ehab912

European Heart Journal, Volume 43, Issue 12, 21 March 2022, Pages 1248â€“1250

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Role of plakophilin-2 expression on exercise-related progression of arrhythmogenic right ventricular cardiomyopathy: a translational study

Marina Cerrone, Grecia M MarrÃ³n-LiÃ±ares, Chantal J M van Opbergen, Sarah Costa, Mimount Bourfiss, Marta PÃ©rez-HernÃ¡ndez, Florencia Schlamp, Fabian Sanchis-Gomar, Kabir Malkani, Kamelia Drenkova, Mingliang Zhang, Xianming Lin, Adriana Heguy, Birgitta K Velthuis, Niek H J Prakken, Andre LaGerche, Hugh Calkins, Cynthia A James, Anneline S J M Te Riele, Mario Delmar

doi : 10.1093/eurheartj/ehab772

European Heart Journal, Volume 43, Issue 12, 21 March 2022, Pages 1251â€“1264

Exercise increases arrhythmia risk and cardiomyopathy progression in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients, but the mechanisms remain unknown. We investigated transcriptomic changes caused by endurance training in mice deficient in plakophilin-2 (PKP2cKO), a desmosomal protein important for intercalated disc formation, commonly mutated in ARVC and controls.

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Cardiac desmosomal reserve: another piece of the exercise-induced arrhythmogenic cardiomyopathy puzzle?

Kristina H. Haugaa, Christine Rootwelt-Norberg

doi : 10.1093/eurheartj/ehab873

European Heart Journal, Volume 43, Issue 12, 21 March 2022, Pages 1265â€“1267

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The association of atrial fibrillation with mortality in patients with breast cancer

Jean Jacques Noubiap

doi : 10.1093/eurheartj/ehac004

European Heart Journal, Volume 43, Issue 12, 21 March 2022, Page 1268

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The association of atrial fibrillation with mortality in patients with breast cancer: author reply

Avirup Guha, Alvaro Alonso, Daniel Addison

doi : 10.1093/eurheartj/ehac005

European Heart Journal, Volume 43, Issue 12, 21 March 2022, Pages 1269â€“1270

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Mechanical coronary artery stenosis induced by active fixation left ventricular lead: a case of acute complication after cardiac resynchronization therapy device implantation

Satoshi Oka, Hiroyuki Endo, Kensuke Takagi, Kenichiro Yamagata

doi : 10.1093/eurheartj/ehab879

European Heart Journal, Volume 43, Issue 12, 21 March 2022, Page 1271

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Pacemaker malcapture and wide QRS complexes

Bruno Miranda Castilho, Kevin Domingues, Ana Filipa DamÃ¡sio

doi : 10.1093/eurheartj/ehab880

European Heart Journal, Volume 43, Issue 12, 21 March 2022, Page 1272

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Erratum to: Role of plakophilin-2 expression on exercise-related progression of arrhythmogenic right ventricular cardiomyopathy: a translational study

doi : 10.1093/eurheartj/ehab868

European Heart Journal, Volume 43, Issue 12, 21 March 2022, Page 1250

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