ObjectiveA systematic review, meta-analysis and meta-regression were performed on selected studies to investigate the incidence of atrial fibrillation (AF) among athletes compared with non-athlete controls.DesignMeta-analysis with heterogeneity analysis and subsequent meta-regression to model covariates were performed. The mode of exercise (endurance and mixed sports) and age were the a priori determined covariates.Data sourcesPubMed, MEDLINE, Science Direct, SPORTDiscus and the Cochrane library were searched.Eligibility criteriaResearch articles published after 1990 and before 2 December 2020 were included if they reported the number of AF cases in athletes with non-athlete (physically active or inactive) control groups, were case–control or cohort studies and if data allowed calculation of OR.ResultsThe risk of developing AF was significantly higher in athletes than in non-athlete controls (OR: 2.46; 95% CI 1.73 to 3.51; p<0.001, Z=4.97). Mode of exercise and risk of AF were moderately correlated (B=0.1259, p=0.0193), with mixed sport conferring a greater risk of AF than endurance sport (B=−0.5476, p=0.0204). Younger (<55 years) athletes were significantly more likely to develop AF compared with older (≥55 years) athletes (B=−0.02293, p<0.001).ConclusionAthletes have a significantly greater likelihood of developing AF compared with non-athlete controls, with those participating in mixed sport and younger athletes at the greatest risk. Future studies of AF prevalence in athletes according to specific exercise dose parameters, including training and competition history, may aid further in delineating those at risk.

Valvular heart disease (VHD) is highly prevalent in patients with chronic kidney disease (CKD) from the early stages to end-stage renal disease (ESRD). Aortic and mitral valves are the most frequently affected, leading to aortic valve and/or mitral annular calcification, which, in turn, causes either valve stenosis or regurgitation at an accelerated rate compared with the general population. Tricuspid regurgitation is also prevalent in CKD and ESRD, and haemodialysis patients are at an increasingly high risk of infective endocarditis. As for pathophysiology, several mechanisms causing VHD in CKD have been proposed, highlighting the complexity of the process. Echocardiography constitutes the gold standard for the assessment of VHD in CKD/ESRD patients, despite the progress of other imaging modalities. With regard to treatment, the existing 2017 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on the management of VHD addressing patients with normal kidney function are also applied to patients with CKD/ESRD.

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Massive hemoptysis is a life-threatening medical condition which usually occurs in the course of parenchymal destructive diseases. We herein report the case of a 61-year-old male patient who presented with massive hemoptysis six months after commencement of dual antiplatelet therapy with acetylsalicylic acid and ticagrelor, for drug-eluting coronary stents. Control of bleeding with discontinuation of both antiplatelet agents, as well as negative imaging and laboratory studies for other pulmonary hemorrhage causes, indicate that either of the antiplatelet drugs or combination thereof was the cause of the pulmonary hemorrhage. In contrast to the previous limited case reports with pulmonary hemorrhage early during antiplatelet therapy with ticagrelor, this case highlights that it can even occur later in the course of antiplatelet therapy.

mitral valve surgery and had a complicated post-operative recovery with multi-organ failure. 2 patients required readmission for urgent pericardiocentesis. 12 (30%) patients experienced no complications following surgery. Conclusion Patients undergoing myectomy for HCM with obstruction in our centre predominantly have concurrent cardiac lesions requiring surgical correction. Myectomy is effective at reducing LVOT gradients and improving patient symptoms, however there are associated perioperative risks.Complications associated with patients undergoing complex cardiac surgery include bleeding requiring further intervention and rhythm issues such as AF. A smaller proportion of complications included stroke and renal failure.