Although exercise prevents cardiovascular disease and mortality, vigorous exercise and endurance athletics can cause atrial fibrillation (AF). However, no large cohort study has assessed the relationship between physical activity and AF in the general population. We assessed the effect of physical activity at different energy expenditures on the incidence of AF. We studied 501,690 individuals without pre-existing AF (mean age, 47.6 ± 14.3 years; 250,664 women [50.0%]) included in the Korean National Health Insurance Service database. The physical activity level was assessed using a standardized self-reported questionnaire at baseline. During a median follow-up of 4 years, 3,443 participants (1,432 women [41.6%]) developed AF. The overall incidence of AF at follow-up was 1.79 per 1,000 person-years. The subjects who met the recommended physical activity level (500–1,000 metabolic equivalent task [MET] minutes/week) had a 12% decreased AF risk (adjusted hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.80–0.97), but not the insufficiently (1–500 MET-minutes/week; HR: 0.94, 95% CI: 0.86–1.03) and highly active subjects (≥1,000 MET-minutes/week; HR: 0.93, 95% CI: 0.85–1.03). The recommended minimum key target range of physical activity level was associated with the maximum benefit for reduced AF risk in the general population. The dose-response relationship between physical activity level and AF risk showed a U-shaped pattern. Although exceeding the key target range attenuated this benefit, it did not increase the AF risk beyond that during inactivity.

Background: Although atrial fibrillation (AF) has a risk of cognitive dysfunction, it is not clear whether AF catheter ablation improves or worsens cognitive function. This prospective case-control study sought to assess the 1-year serial changes in the cognitive function with or without AF catheter ablation. Methods: We evaluated the Montreal Cognitive Assessment score in 308 patients (71.4% male, 60.6±9.1 years of age, 34.1% persistent AF) who underwent AF ablation (ablation group) and 50 AF patients on medical therapy who met the same indication for AF ablation (control group), at baseline and 3 and 12 months after enrollment. Cognitive impairment was defined as a published cutoff score of <23 points. To exclude any learning effects, we used the practice-adjusted reliable change index for assessing the cognitive changes. Results: Preablation cognitive impairment was detected in 18.5% (57/308). The Montreal Cognitive Assessment score significantly improved 1 year after radiofrequency catheter ablation in both overall ablation group (24.9±2.9–26.4±2.5; P <0.001) and the propensity-matched ablation group (25.4±2.4–26.5±2.3; P <0.001), but not in the control group (25.4±2.5–24.8±2.5; P =0.012). Preablation cognitive impairment (odds ratio, 13.70; 95% CI, 4.83–38.87; P <0.001) was independently associated with an improvement in the 1-year post-ablation cognitive function. In the reliable change index analyses, 94.7% of propensity-matched ablation group showed an improved/stable cognitive function at the 1-year follow-up. Conclusions: Catheter ablation of AF, at least, does not deteriorate the cognitive function, but rather improves the performance on 1-year follow-up neurocognitive tests, especially in patients with a preablation cognitive impairment.

The higher prevalence of respiratory allergic disease may be due to increased exposure to inhalation allergens. We conducted a survey of allergic diseases in autumn and winter with detection of major indoor allergens in major cities in Korea. We enrolled 110 subjects from the fourth Korea National Health and Nutrition Examination Survey with stratified, cluster, and systematic sampling procedures. All participants answered a health questionnaire as well as underwent a skin prick test (SPT) and ImmunoCAP for 11 indoor major allergens. We also measured the levels of 5 major allergens (Der f 1, Der p 1, Can f 1, Bla g 1, and Asp f 1) in fine indoor dust from the houses of 60 subjects with a 2-site ELISA. The prevalence of allergic rhinitis and asthma were 25.5% and 7.3%, respectively. The most common sensitized allergens identified by SPT and ImmunoCAP were Dermatophagoides farinae (40.9%, 36.8%), followed by cockroach (23.6%, 19.5%), mugwort (13.6%, 22.9%), oak (9.1%, 22.9%), Japanese hop (9.1%, 8.6%), and dog dander (8.2%, 6.9%). There was a modest discrepancy between SPT and ImmunoCAP. Der f 1 and Der p 1 were detected in 91.7% and 45.0% of the enrolled houses, respectively. Der f 1 indicated high concentrations in all specific provinces in Korea; however, Der p 1 measured high only in the south. Dog dander allergens were present in 71.7% of houses; however, Bla g 1 was present in only 11.7% of houses and Asp f 1 was not detected in any houses. The most important inhalant allergens in Korea are house dust mites followed by cockroach, mugwort, oak, Japanese hop, and dog dander in indoor environment, in which The dominant species of house dust mites were different according to region.

Chang S, et al. Clin Endosc. 2014 Sep;47(5):452-454. http://dx.doi.org/10.5946/ce.2014.47.5.452

Background: We previously reported the benefit of linear ablation from the superior vena cava to the right atrial septum ( SVC ‐L) within a year after circumferential pulmonary vein isolation ( CPVI ) in patients with paroxysmal atrial fibrillation ( AF ). We explored the long‐term effects of SVC ‐L and its potential related mechanisms. Methods and Results: Among 2140 consecutive patients with AF ablation, we included 614 patients (73.3% male, aged 57.8±10.7 years, 13.7% with persistent AF ) who did not undergo an extra–pulmonary vein left atrial ablation after propensity score matching; of those, 307 had additional SVC ‐L and 307 had CPVI alone. We evaluated the heart rate variability and computational modeling study to explore mechanisms. Although the procedure time was longer in the SVC ‐L group than the CPVI group ( P <0.001), the complication rates did not differ ( P =0.560). During 40.5±24.4 months of follow‐up, the rhythm outcome was significantly better in the SVC ‐L group than the CPVI group (log rank, P <0.001). At 2‐year follow‐up of heart rate variability, a significantly higher mean heart rate ( P =0.018) and a lower ratio of low/high‐frequency components ( P =0.011) were found with SVC ‐L than CPVI alone. In realistic in silico biatrial modeling, which reflected the electroanatomies of 10 patients, SVC ‐L significantly reduced biatrial dominant frequency compared with CPVI alone ( P <0.001) and increased AF termination and defragmentation rates ( P =0.033). Conclusions: SVC ‐L ablation in addition to CPVI significantly improved the long‐term rhythm outcome over 2 years after AF catheter ablation by mechanisms involving autonomic modulation and AF organization.