Welcome to our second issue of 2014, in which we review yet another recent study on the impact of serum magnesium insufficiency. This time, revealing the relationship between low serum magnesium levels 20 years earlier in otherwise healthy individuals from the famous Framingham Heart Study, and their subsequent future development of AFIB.

Next up we review a late breaking study just released from embargo last week from the Missouri Medical Journal with a novel look at the long-term impact of extreme endurance exercise on men who ran at least 1 marathon a year for 25 years while doing 25 to 30 miles of weekly training runs. We have looked before at the downside of too much of a good thing in the form of excess endurance exercise and sports. Yet, this study, and companion review article, wraps the issue up with appropriate balance and evidence that seems relevant for a good number of afibbers who engage in intensive exercise programs.

Our third study review deals with the key issue and debate in AFIB circles on the merits of using Isoproterenol (ISP), an adrenaline-like drug, and/or Adenosine as a drug challenge to confirm that no active triggers are likely to return while one is still on the table during an index or follow up ablation procedure. The majority of US ablation centers now seem to employ ISP challenge while the opposite is true in Europe. It looks like the prevalent EU view may come under pressure here to adapt, as more and more evidence strongly points to the value and potential impact of this protocol in improving long-term ablation outcomes while maintaining a safe procedure.

We also feature a special research report, taking up over half of this issues content, on the important topic of Silent Cerebral Ischemia or Lesions (SCI/SCL) that is a growing focus of research and concern in AFIB circles. These tiny white spots are associated foremost with having active AFIB itself, but can also occur to a lesser degree as an iatrogenic result of catheter ablation, as well as most other invasive cardiovascular procedures. In any event, it’s clear the issue warrants an in-depth overview to give our readers the best balance of information we have on how to best minimize the potential impact of SCI.

This issue wraps up with an overview of two very informative conferences I recently had the pleasure to attend – EP-Live 2014 in Austin Texas in late February and the 2nd Annual International Symposium on the Left Atrial Appendage held in mid-March in Orlando Florida. While both were very different in nature, they each covered a broad range of key topics of interest to all of us which we will look at in more detail in future issues. These conferences offered me an invaluable opportunity to hear from, meet and connect with number of top EPs, interventional cardiologists and cardiovascular surgeons from around the world, each sharing their own unique insights and perspectives on this most dynamic and challenging field of medicine.

I want to remind those subscribers that may rarely visit our website message board of what a rich and dynamic resource it has been for so many over the years, and invite you to drop in more often in-between our bi-monthly reviews here on The AFIB Report. Find us here at: afibbers.net Forum 9.

Wishing you good health and lots of NSR,

Shannon