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Premature atrial contractions are a common cardiac phenomenon. Although previously considered a benign electrocardiographic finding, they have now been associated with a higher risk of incident atrial fibrillation (AF) and other adverse outcomes such as stroke and all-cause mortality. Since premature atrial contractions can be associated with these adverse clinical outcomes independently of AF occurrence, different explanations have being proposed. The concept of atrial cardiomyopathy, where AF would be an epiphenomenon outside the causal pathway between premature atrial contractions and stroke has received traction recently. This concept suggests that structural, functional, and biochemical changes in the atria lead to arrhythmia occurrence and thromboembolic events. Some consensus about diagnosis and treatment of this condition have been published, but this is based on scarce evidence, highlighting the need for a clear definition of excessive premature atrial contractions and for prospective studies regarding antiarrhythmic therapies, anticoagulation or molecular targets in this group of patients.

INTRODUCTION: Atrial fibrillation and heart failure frequently co-exist and the combination is associated with a worse prognosis than either condition alone. A number of pharmacological agents and invasive procedures have been shown to benefit this complex patient group.OBJECTIVE: In this review, we compare different therapeutic approaches to atrial fibrillation and heart failure, including pharmacotherapy, left atrial catheter ablation and pace-and-ablate.EXPERT OPINION: Left atrial catheter ablation is an efficacious option for restoring sinus rhythm and is most likely to provide benefit to those in whom durable sinus rhythm can be expected, and whose life expectancy is not significantly reduced by other pathologies or advanced age. A pace-and-ablate approach, particularly with physiological pacing, may provide more benefit to those with low chance of maintaining sinus rhythm. Both invasive options generally outperform pharmacotherapy, although it is important to individualize the approach for each patient through shared decision-making.

Atrial fibrillation (AF) is associated with an increased risk of stroke, which can be prevented by the use of oral anticoagulation. Although non-vitamin K antagonist oral anticoagulants (NOACs) have become the first choice for stroke prevention in the majority of patients with non-valvular AF, adherence and persistence to these medications remain suboptimal, which may translate into poor health outcomes and increased healthcare costs. Factors influencing adherence and persistence have been suggested to be patient-related, physician-related, and healthcare system-related. In this review, we discuss factors influencing patient adherence and persistence to NOACs and possible problem solving strategies, especially involving an integrated care management, aiming for the improvement in patient outcomes and treatment satisfaction.

A epidemia de Coronavirus Disease 2019 disseminou-se pelo mundo em poucos meses, levando à sua designação de pandemia. Múltiplas medidas de saúde pública foram implementadas nos países afetados para conter e mitigar a disseminação da doença. A necessidade de distanciamento físico leva a que esta pandemia tenha um impacto importante na sociedade e particularmente no desporto, provocando cancelamento e adiamento de treinos, competições e eventos. No entanto, o início da pandemia data já de 2019, com preocupações globais, não só na fase aguda da doença com as suas consequências imediatas, mas também com as eventuais sequelas a médio e a longo prazo e o risco de cronicidade de alguns sintomas, em particular na população jovem. Neste artigo revemos a limitada evidência científica atual acerca da relevância clínica das sequelas da COVID-19, em particular do foro respiratório e cardíaco, e finalizamos com recomendações de avaliação das sequelas em atletas e com indicações para regresso seguro à prática desportiva. info:eu-repo/semantics/publishedVersion