Aims To evaluate the effectiveness and safety of cryoballoon ablation (CBA) compared with radiofrequency ablation (RFA) for symptomatic paroxysmal or drug-refractory persistent atrial fibrillation (AF). Methods and results Prospective cluster cohort study in experienced CBA and RFA centres. Primary endpoint was ‘atrial arrhythmia recurrence’, secondary endpoints were as follows: procedural results, safety, and clinical course. A total of 4189 patients were included: CBA 2329 (55.6%) and RFA 1860 (44.4%). Cryoballoon ablation population was younger, with fewer comorbidities. Procedure time was longer in the RFA group (P = 0.01). Radiation exposure was 2487 (CBA) and 1792 cGycm2 (RFA) (P < 0.001). Follow-up duration was 441 (CBA) and 511 days (RFA) (P < 0.0001). Primary endpoint occurred in 30.7% (CBA) and 39.4% patients (RFA) [adjusted hazard ratio (adjHR) 0.85, 95% confidence interval (CI) 0.70–1.04; P = 0.12). In paroxysmal AF, CBA resulted in a lower risk of recurrence (adjHR 0.80, 95% CI 0.64–0.99; P = 0.047). In persistent AF, the primary outcome was not different between groups. Major adverse cardiovascular and cerebrovascular event rates were 1.0% (CBA) and 2.8% (RFA) (adjHR 0.53, 95% CI 0.26–1.10; P = 0.088). Re-ablations (adjHR 0.46, 95% CI 0.34–0.61; P < 0.0001) and adverse events during follow-up (adjHR 0.64, 95% CI 0.48–0.88; P = 0.005) were less common after CBA. Higher rehospitalization rates with RFA were caused by re-ablations. Conclusions The primary endpoint did not differ between CBA and RFA. Cryoballoon ablation was completed rapidly; the radiation exposure was greater. Rehospitalization due to re-ablations and adverse events during follow-up were observed significantly less frequently after CBA than after RFA. Subgroup analysis suggested a lower risk of recurrence after CBA in paroxysmal AF. Trial Registration ClinicalTrials.gov (NCT01360008), https://clinicaltrials.gov/ct2/show/NCT01360008.

Aim The aim of the present study was to examine the effect of exercise intervention in hypoxia as a novel treatment method for obesity in older men. Methods A total of 24 obese 65–70‐year‐old Korean men (66.5 ± 0.8 years) were randomly assigned to undergo hypoxic training (n = 12) or normoxic training (n = 12), and all participants carried out an exercise intervention composed of aerobic exercise on a treadmill (30 min) and bicycle (30 min), and resistance exercise (30–40 min) in normoxia, and 3000‐m normobaric hypoxia separately for a total of 12 weeks, three times a week. Health‐related dependent variables (body composition, physical fitness, pulmonary function and heart rate variability) were evaluated at pre‐ and post‐exercise intervention. Results Hypoxic training showed more improved body composition (bodyweight −5.68 vs −3.16 kg, %body fat −5.50 vs −1.97%, fat‐free mass 2.09 vs 1.06 kg), physical fitness (chair sit‐to‐stand 5.67 vs 4.58, pegboard 3.58 vs 2.17, tandem test −1.74 vs −1.31 s, one leg standing 6.27 vs 3.71 s), pulmonary function (forced vital capacity 0.15 vs 0.02 L, forced expiratory volume in 1 s 0.23 vs 0.01 L, percent of forced expiratory volume in 1 s 0.87 vs 0.08, maximal voluntary ventilation 5.26 vs 2.22 L) and heart rate variability (high frequency 0.94 vs 0.19 ms2, low frequency/high frequency −0.28 vs −0.08, salivary cortisol −0.13 vs −0.04 μg/dL) than normoxic training. Conclusions Compared with normoxic training, hypoxic training is a novel and successful health promotion method in obese older populations. Geriatr Gerontol Int 2019; 19: 311–316.

This study evaluated the effects of intermittent interval training in hypoxic conditions for six weeks compared with normoxic conditions, on hemodynamic function, autonomic nervous system (ANS) function, immune function, and athletic performance in middle- and long-distance runners. Twenty athletes were divided into normoxic training (normoxic training group (NTG); n = 10; residing and training at sea level) and hypoxic training (hypoxic training group (HTG); n = 10; residing at sea level but training in 526-mmHg hypobaric hypoxia) groups. All dependent variables were measured before, and after, training. The training frequency was 90 min, 3 d per week for six weeks. Body composition showed no significant difference between the two groups. However, the HTG showed more significantly improved athletic performance (e.g., maximal oxygen uptake). The hemodynamic function (e.g., oxygen uptake, oxygen pulse, and cardiac output) during submaximal exercise and ANS function (e.g., standard deviation and root mean square of successive differences, high frequency, and low/high frequency) improved more in the HTG. Immune function parameters were stable within the normal range before and after training in both groups. Therefore, hypoxic training was more effective in enhancing athletic performance, and improving hemodynamic and ANS function; further, it did not adversely affect immune function in competitive runners.

The aim of this study was to investigate the microstructural alterations of white matter (WM) in Alzheimer’s disease (AD) patients with apathy and to observe the relationships with the severity of apathy. Sixty drug-naïve subjects took part in this study (30 apathetic and 30 nonapathetic subjects with AD). The loss of integrity in WM was compared in AD patients with and without apathy through measurement of fractional anisotropy (FA) using by tract-based spatial statistics (TBSS). In addition, we explored the correlation pattern between FA values and the severity of apathy in AD patients with apathy. The apathy group had significantly reduced FA values (pcorrected<0.05) in the genu of the corpus callosum compared to the nonapathy group. The severity of apathy was negatively correlated with FA values of the left anterior and posterior cingulum, right superior longitudinal fasciculus, splenium, body and genu of the corpus callosum and bilateral uncinate fasciculusin the apathy group (pcorrected<0.05). This study was the first to explore FA values in whole brain WM in AD patients with apathy. The findings of these microstructural alterations of WM may be the key to the understanding of underlying neurobiological mechanism and clinical significances of apathy in AD.