Incidence of cardiac arrhythmias and left ventricular hypertrophy in recreational scuba divers.

INTRODUCTION: The aims of this study were to investigate the potential impact of age, sex and body mass index (BMI) upon the incidence of arrhythmias pre- and post- diving, and to identify the prevalence of left ventricular hypertrophy (LVH) in older recreational divers. METHODS: Divers aged ≥ 40 years participating in group dive trips had ECG rhythm and echocardiograph recordings before and after diving. Arrhythmias were confirmed by an experienced human reader. LVH was identified by two-dimensional echocardiography. Weighted (0.5 fractional) values were used to account for participation by seven divers in 14 trips. RESULTS: Seventy-seven divers undertook 84 dive trips and recorded 677 dives. Among divers with no pre-trip arrhythmias (n = 55), we observed that 6.5 (12%) recorded post-trip arrhythmias and the median increase was 1.0 arrhythmia. In divers with pre-trip arrhythmias, 14.5 had a median of 1.0 fewer post-trip arrhythmias, 2.0 had no change and 5.5 had a median of 16.0 greater. Age, but neither sex nor BMI, was associated with change in the number of arrhythmias before and after dive trips (P = 0.02). The relative risk for experiencing a change in the frequency of arrhythmias after a diver trip, was 2.1 for each additional 10 years of age (95% CI 1.1, 4.0). Of the 60 divers with imaging of their heart, five had left ventricular hypertrophy. CONCLUSIONS: We observed a higher than expected prevalence of arrhythmias. Divers with pre-trip arrhythmias tended to be older than divers without pre-trip arrhythmias (P = 0.02). The prevalence of LVH in our cohort was one quarter of that found post-mortem in scuba fatalities.

Neither a Multi-Ingredient Pre-Workout Supplement nor Caffeine Were Effective at Improving Markers of Blood Flow or Upper-Body Resistance Exercise Performance.

Few studies have measured the effects of multi-ingredient pre-workout supplements on blood flow or heart rate variability or have compared a multi-ingredient pre-workout supplement to a matched single ingredient. This study examined the effects of a multi-ingredient pre-workout supplement, an equivalent amount of caffeine, and placebo on markers of resistance training performance, blood flow, blood pressure, and heart rate variability. The study utilized a randomized, placebo-controlled, repeated-measures, crossover design. Twelve resistance-trained males (22.75 ± 4.51 yrs; 183.4 ± 7.37 cm; 91.05 ± 17.77 kg) completed the study. Resistance exercise performance was defined as total work performed during elbow flexion and extension on an isokinetic dynamometer. Blood flow was calculated using time-averaged mean velocity and blood vessel diameter of the right brachial artery, which were measured via Doppler ultrasound. Heart rate was recorded using an electrocardiogram. Neither a multi-ingredient pre-workout supplement nor caffeine alone improved upper-body resistance exercise performance or markers of blood flow relative to placebo. No differences in heart rate variability were observed across treatments. A multi-ingredient pre-workout supplement was not effective at improving performance or blood flow and did not alter autonomic nervous system function.

Endothelial, Cardiovascular, and Performance Responses to L-Arginine Intake and Resistance Exercise.

The purpose of this study was to examine the acute endothelial, cardiovascular, and performance responses to L-arginine intake by assessing flow-mediated dilation (FMD) and various indicators (e.g., heart rate, heart rate variability (HRV), blood pressure, torque) both before and after resistance exercise. Thirty (15 male, 15 female) physically active participants (mean ± SD: age 20.4 ± 1.8 years, height 176.9 ± 10.2 cm, body mass 76.0 ± 12.2 kg) volunteered for a randomized, cross-over, double-blind, placebo-controlled clinical trial. Participants completed five sets of elbow extension-flexion exercise after consumption of either 3 g L-arginine or 3 g of placebo. There was a significant decline in post-exercise elbow extension (p = 0.014) and flexion peak torque (p < 0.001). FMD response after exercise was ~5.8% less than before resistance exercise (L-arginine and placebo data pooled, p < 0.001). Baseline brachial artery diameter significantly increased post-FMD (p < 0.001), post-resistance exercise (p < 0.001), and post-resistance exercise FMD (p < 0.001). There were significant time effects for HRV when expressed as the square root of the mean of the sum of squares of differences between adjacent RR intervals (RMSSD) or the proportion of differences between adjacent normal (NN) RR intervals that exceed 50 ms (pNN50) (all p-values < 0.05), but there were no treatment or interaction effects (all p-values > 0.05). We conclude the increased vasodilation due to acute resistance exercise was not enhanced by acute supplementation with L-arginine nor was exercise performance augmented. Further, the relative contribution of sympathetic nervous system input increased with resistance exercise but was not influenced by the addition of L-arginine.

New system for digital to analog transformation and reconstruction of 12-lead ECGs.

INTRODUCTION: We describe initial validation of a new system for digital to analog conversion (DAC) and reconstruction of 12-lead ECGs. The system utilizes an open and optimized software format with a commensurately optimized DAC hardware configuration to accurately reproduce, from digital files, the original analog electrocardiographic signals of previously instrumented patients. By doing so, the system also ultimately allows for transmission of data collected on one manufacturer's 12-lead ECG hardware/software into that of any other. MATERIALS AND METHODS: To initially validate the system, we compared original and post-DAC re-digitized 12-lead ECG data files (∼5-minutes long) in two types of validation studies in 10 patients. The first type quantitatively compared the total waveform voltage differences between the original and re-digitized data while the second type qualitatively compared the automated electrocardiographic diagnostic statements generated by the original versus re-digitized data. RESULTS: The grand-averaged difference in root mean squared voltage between the original and re-digitized data was 20.8 µV per channel when re-digitization involved the same manufacturer's analog to digital converter (ADC) as the original digitization, and 28.4 µV per channel when it involved a different manufacturer's ADC. Automated diagnostic statements generated by the original versus reconstructed data did not differ when using the diagnostic algorithm from the same manufacturer on whose device the original data were collected, and differed only slightly for just 1 of 10 patients when using a third-party diagnostic algorithm throughout. CONCLUSION: Original analog 12-lead ECG signals can be reconstructed from digital data files with accuracy sufficient for clinical use. Such reconstructions can readily enable automated second opinions for difficult-to-interpret 12-lead ECGs, either locally or remotely through the use of dedicated or cloud-based servers.