New Insights Into the Initiation of Atrial Fibrillation

Background— This study investigated onset scenarios of atrial fibrillation (AF), the first phase of the Atrial Fibrillation Therapy (AFT) trial, to determine potential arrhythmogenic triggers as targets for atrial pacing algorithms that have been proposed for prevention of AF. Methods and Results— Ninety-eight patients (58 men; age 65±11 years) with recurrent, symptomatic, drug-refractory AF and a conventional pacemaker indication in 31 of 98 received a dual-chamber pacemaker. Using novel diagnostic pacemaker features AF onset scenarios were prospectively evaluated in 612 AF episodes during a 2-month monitoring period, with atrial pacing limited to 40 bpm. The most common onset scenario was premature atrial complexes (PACs) before AF (48% onsets per patient), followed by bradycardia (33%), sudden onset (17%), and tachycardia (0%). Combinations of onset scenarios were frequent (median 2 different scenarios per patient). A main study finding was the significance of repetitive AF, with 33% of onsets per patient being initiated within 5 minutes of a previous AF episode. Sudden onsets were more frequent among patients with than without repetitive AF (24% versus 0% onsets per patient, P =0.011), whereas the proportion of PACs before AF was not statistically different (50% versus 37%, P =0.52); however, patients with repetitive AF had more PACs per hour (72 versus 29, P =0.023) and a higher number of AF episodes per day (17 versus 0, P =0.001) and were more likely to have at least 1 PAC-related onset (90% versus 53%, P <0.0001). Conclusions— Novel diagnostic pacemaker features allowed a detailed individual analysis of rate and rhythm changes before AF and thus uncovered a substantial intraindividual and interindividual variability of AF onset scenarios

A New Frontier of Photocatalysis Employing Micro-Sized TiO2: Air/Water Pollution Abatement and Self-Cleaning/ Antibacterial Applications

This chapter presents the use of a commercial micro-sized TiO2 powder as an alternative to the traditional nano-powders as semiconductors in photocatalytic processes. Results of the photocatalytic efficiency towards the photodegradation of the traditional pollutant molecules both in gas phase (nitrogen oxides (NOx) and volatile organic compounds (VOCs)) and in water phase (phenol) are presented and compared to the results obtained with two nano-sized reference powders. Micro-sized TiO2 is also industrially coated at the surfaces of porcelain grés tiles (Active Clean Air and Antibacterial Ceramic™). The possibility to have a photocatalytic material, strongly stuck at the surface of a vitrified tile, increases the use of photocatalysis in real conditions: no problem of filtration of the semiconductor from the liquid medium after use and no risks of leakage of nanoparticles in the atmosphere. Tests were performed using reactors equipped with UV-A lamps and with suitable analytical systems, depending on the final purpose. Characterization data from both powders and coated tiles are put in correlation with the photocatalytic results to understand the semiconductor action during the photocatalytic process. Polluting molecules were chosen in order to cover all the common aspects of environmental pollution: NOx and some VOCs represent the model molecules to test the efficiency of the micro-sized TiO2 (degradation from the pristine molecule to CO2 or inorganic salts) in gas phase. As for the water pollution, phenol was chosen as common pollutant in worldwide rivers. Moreover, tests on self-cleaning and antibacterial properties are also reported. The positive results of micro-sized TiO2 both in powder and coated onto the surface of porcelain grés tiles open the way to new photocatalytic products that do not make use of nanoscale powders avoiding problems to human safety caused by the inherent toxicity of the nanoparticles

Photocatalytic TiO2: From Airless Jet Spray Technology to Digital Inkjet Printing

TiO2 powders can be employed as both photocatalytic and structural materials, leading to applications in external coatings or in interior furnishing devices, including cement mortar, tiles, floorings, and glass supports. The technology of photocatalytic building materials is connected with the widespread production of photocatalytic active tiles. All the techniques proposed in the study involve the employment of nanosized TiO2: this represents a new problem to be dealt with, as inhaling nanoparticles exposes workers during industrial production and people in everyday locations to their dangerousness. Only very recently the employment of microsized TiO2 has been proposed, and the authors in this manuscript report the use of micrometric titania materials, but employing a new deposition technique, which is digital inkjet printing. It represents an improvement of the classical spray coating methods, as it requires piezoelectric heads to precisely direct the deposition of the suspension with an electrostatic field. The mixture contains aqueous/organic components containing micrometric TiO2: to form a suspension, which is printed onto the surface of porcelain grès, large slabs using a digital printer. Many advantages are immediately evident, namely rapid and precise deposition, (almost) no waste of raw materials, thereby highlighting the economy, environmental friendliness, and sustainability of the process. All the materials we obtained have been thoroughly characterized by means of several experimental physico-chemical techniques, such as Raman microspectroscopy and scanning electron microscopy coupled with elemental analysis. Two different model VOCs, ethanol and toluene, and NOx have been selected to test the photocatalytic performances of the abovementioned tiles. Moreover, the antibacterial properties of the tiles have been determined, using Escherichia coli as example. Life cycle assessments (LCAs) for the two processes were modeled for 1 m2 of tiles produced in Modena, Italy. The impact assessments revealed that jet spraying exhibited uniformly greater impacts than digital inkjet printing and that the principal impacts were in human toxicity, cancer effects, freshwater ecotoxicity, and climate change. Most of the impacts were associated with the energy required for the production processes. Further considerations revealed that jet spraying is projected to generate twice as much CO2 and 30% more NOx than digital inkjet printing

The role of physical activity in individuals with cardiovascular risk factors: an opinion paper from Italian Society of Cardiology-Emilia Romagna-Marche and SIC-Sport

: Regular physical activity is a cornerstone in the prevention and treatment of atherosclerotic cardiovascular disease (CVD) due to its positive effects in reducing several cardiovascular risk factors. Current guidelines on CVD suggest for healthy adults to perform at least 150\u200amin/week of moderate intensity or 75\u200amin/week of vigorous intensity aerobic physical activity. The current review explores the effects of physical activity on some risk factors, specifically: diabetes, dyslipidemia, hypertension and hyperuricemia. Physical activity induces an improvement in insulin sensitivity and in glucose control independently of weight loss, which may further contribute to ameliorate both diabetes-associated defects. The benefits of adherence to physical activity have recently proven to extend beyond surrogate markers of metabolic syndrome and diabetes by reducing hard endpoints such as mortality. In recent years, obesity has greatly increased in all countries. Weight losses in these patients have been associated with improvements in many cardiometabolic risk factors. Strategies against obesity included caloric restriction, however greater results have been obtained with association of diet and physical activity. Similarly, the beneficial effect of training on blood pressure via its action on sympathetic activity and on other factors such as improvement of endothelial function and reduction of oxidative stress can have played a role in preventing hypertension development in active subjects. The main international guidelines on prevention of CVD suggest to encourage and to increase physical activity to improve lipid pattern, hypertension and others cardiovascular risk factor. An active action is required to the National Society of Cardiology together with the Italian Society of Sports Cardiology to improve the prescription of organized physical activity in patients with CVD and/or cardiovascular risk factors

Ventricular Arrhythmias in Athletes: Role of a Comprehensive Diagnostic Workup

Background: Ventricular arrhythmias (VAs) represent a critical issue with regard to sports eligibility assessment in athletes. The ideal diagnostic evaluation of competitive and leisure-time athletes with complex VAs has not been clearly defined. Objective: The purpose of this study was to assess the clinical implications of invasive electrophysiological assessments and endomyocardial biopsy (EMB) among athletes with VAs. Methods: We evaluated 227 consecutive athletes who presented to our institutions after being disqualified from participating in sports because of VAs. After noninvasive tests, electrophysiological study (EPS), electroanatomic mapping (EAM), and EAM- or cardiac magnetic resonance imaging–guided EMB was performed, following a prespecified protocol. Sports eligibility status was redefined at 6-month follow-up. Results: From our sample, 188 athletes (82.8%) underwent EAM and EPS, and 42 (15.2%) underwent EMB. A diagnosis of heart disease could be formulated in 30% of the study population (67/227; 95% confidence interval [CI] 0.24–0.36) after noninvasive tests; in 37% (83/227; 95% CI 31%–43%) after EPS and EAM; and in 45% (102/227; 95% CI 39%–51%) after EMB. In the subset of athletes undergoing EMB, invasive diagnostic workup allowed diagnostic reclassification of half of the athletes (n = 21 [50%]). Reclassification was particularly common among subjects without definitive findings after noninvasive evaluation (n = 23; 87% reclassified). History of syncope, abnormal echocardiogram, presence of late gadolinium enhancement, and abnormal EAM were linked to sports ineligibility at 6-month follow-up. Conclusion: A comprehensive invasive workup provided additional diagnostic elements and could improve the sports eligibility assessment of athletes presenting with VAs. The extensive invasive evaluation presented could be especially helpful when noninvasive tests show unclear findings