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Sports and cardiac arrhythmias
Prática desportiva e arritmias cardíacas
Daniel Bonhorst
Instituto Português do Ritmo Cardíaco, Porto Salvo, Portugal
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D:</span> Coronary angiography from patient 11 showing the angiographic result after stent implantation. <span class="elsevierStyleBold">Panels E-F</span>: Optical coherence tomography from patient 22 of distal segment of right coronary artery, depicting intramural hematoma (asterisk). <span class="elsevierStyleBold">Panels G-H:</span> Cross-sectional intravenous ultrasound views from patient 9 depicting intramural hematoma (asterisk) causing luminal stenosis in the mid-LAD.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Glória Abreu, Carlos Galvão Braga, João Costa, Pedro Azevedo, Jorge Marques" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Glória" "apellidos" => "Abreu" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Galvão Braga" ] 2 => array:2 [ "nombre" => "João" "apellidos" => "Costa" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Azevedo" ] 4 => array:2 [ "nombre" => "Jorge" "apellidos" => "Marques" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918302770?idApp=UINPBA00004E" "url" => "/21742049/0000003700000008/v1_201808120420/S2174204918302770/v1_201808120420/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2174204918302794" "issn" => "21742049" "doi" => "10.1016/j.repce.2018.01.007" "estado" => "S300" "fechaPublicacion" => "2018-08-01" "aid" => "1265" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2018;37:693-701" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1543 "formatos" => array:3 [ "EPUB" => 98 "HTML" => 1186 "PDF" => 259 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Noninvasive predictors of cardiac arrhythmias in bodybuilders" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "693" "paginaFinal" => "701" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Preditores não invasivos das arritmias cardíacas nos fisiculturistas" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 884 "Ancho" => 3166 "Tamanyo" => 98209 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Tp-e interval (A), Tp-e/QT ratio (B), and Tp-e/QTc ratio (C) in bodybuilders compared with controls. QTc: corrected QT dispersion; Tp-e: interval between peak and end of the T wave.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Kadir Uğur Mert, Serdar İlgüy, Gurbet Özge Mert, Muhammet Dural, Kemal Iskenderov" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Kadir Uğur" "apellidos" => "Mert" ] 1 => array:2 [ "nombre" => "Serdar" "apellidos" => "İlgüy" ] 2 => array:2 [ "nombre" => "Gurbet Özge" "apellidos" => "Mert" ] 3 => array:2 [ "nombre" => "Muhammet" "apellidos" => "Dural" ] 4 => array:2 [ "nombre" => "Kemal" "apellidos" => "Iskenderov" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918302794?idApp=UINPBA00004E" "url" => "/21742049/0000003700000008/v1_201808120420/S2174204918302794/v1_201808120420/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Sports and cardiac arrhythmias" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "703" "paginaFinal" => "705" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Daniel Bonhorst" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Daniel" "apellidos" => "Bonhorst" "email" => array:1 [ 0 => "danielbonhorst@iprc.pt" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Instituto Português do Ritmo Cardíaco, Porto Salvo, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Prática desportiva e arritmias cardíacas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The relationship between sports and the occurrence of cardiac arrhythmias has been the subject of considerable interest in recent years. This relationship is affected by various factors including the intensity of training, gender, age, race and the type of sports.</p><p id="par0010" class="elsevierStylePara elsevierViewall">According to Mitchell's classification,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> different sports can be characterized by their dynamic (resistance or isotonic) and static (strength or isometric) components. Dynamic exercise involves changes in muscle length and joint movement with rhythmic contractions that develop a relatively small intramuscular force, while static exercise involves development of a relatively large intramuscular force with little or no change in muscle length or joint movement. These two types of exercise should be thought of as the two opposite poles of a continuum, with most physical activities involving both static and dynamic components in varying proportions. Thus, each sport can be classified according to the level of intensity of its dynamic and static components.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Increases in preload and afterload during chronic intensive exercise are associated with symmetrical enlargement of the cardiac chambers. Compared to non-athletes of similar age and size, athletes show a 10-20% increase in left ventricular wall thickness and a 10-15% increase in left and right ventricular cavity size.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Generally, the largest cavities are found in athletes who participate in endurance (dynamic) sports, such as rowing or cycling.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Predominantly isometric training, such as weightlifting or wrestling, is often associated with left ventricular wall thickness that is near normal but disproportionate in relation to cavity size.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Investigation of the occurrence of arrhythmias in athletes has mainly focused on endurance sports such as marathons, triathlons and cycling,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5,6</span></a> in which exercise is extreme and mainly dynamic.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In their article published in this issue of the <span class="elsevierStyleItalic">Journal</span>, Mert et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> focus on athletes who participate in a popular sport (bodybuilding) that can be used as a model for studying the relationship between the type of physical exertion and the occurrence of cardiac arrhythmias. Bodybuilding is an intense but mainly static sport that induces cardiac pressure overload and hence considerable stress on the cardiac muscle. By inducing significant muscle hypertrophy and cardiac wall fibrosis, bodybuilding can alter the electrophysiological properties of the heart, potentially increasing susceptibility to malignant arrhythmias.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study population and a control group were analyzed using standard methods of cardiovascular and systemic assessment, based on demographic, echocardiographic and electrocardiographic parameters, the latter including 24-hour Holter monitoring and measures of dispersion of ventricular repolarization.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The study offers an interesting approach to the debate concerning the relationship between sports and the heart, particularly the distinction between athlete's heart and a pathologic heart, the different types of cardiac adaptation and their potential consequences, the effects of intense static exercise on cardiac arrhythmias, and a discussion of possible arrhythmogenic mechanisms and how to assess their risk.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The echocardiographic findings were compatible with cardiac adaptation to a mainly static sport that induces pressure overload, leading to an increase in the relative wall thickness of the left chambers, with little effect on left chamber size.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> The study also confirmed the association between static exercise and increased right cavity size<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> and pulmonary artery pressure.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Holter monitoring confirmed that sports participation and static exercise in particular can induce cardiac arrhythmias, with a significantly higher number of atrial and ventricular extrasystoles being recorded in bodybuilders than in controls.</p><p id="par0055" class="elsevierStylePara elsevierViewall">However, in this respect, we believe that the study data can hardly be considered to identify a population at high arrhythmic risk. First, few ventricular extrasystoles (VEs) were found (mean of 5.5 VEs/hour in the study group); second, there were practically no complex arrhythmias (only two cases of non-sustained ventricular tachycardia); and finally, Holter monitoring has limited value for identifying arrhythmic risk, especially when there is no structural heart disease, as shown by the spontaneous variability of the arrhythmias documented.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Atrial arrhythmias are of less importance in determining arrhythmic risk, especially for the normal hearts of subjects in this study as shown by the echocardiographic and electrocardiographic findings, and in fact no cases of atrial fibrillation were found.</p><p id="par0065" class="elsevierStylePara elsevierViewall">With regard to the mechanisms underlying the ventricular arrhythmias detected in the study population, the authors focused on the involvement in arrhythmogenesis of heterogeneity in ventricular repolarization.</p><p id="par0070" class="elsevierStylePara elsevierViewall">It has long been suggested that ventricular repolarization is involved in the induction of arrhythmias and that analysis of repolarization can be used for stratification of arrhythmic risk in a range of conditions. Various structural and electrical alterations can affect this phase of the cardiac cycle, by altering refractory periods and conduction velocities in adjacent myocardial areas. This has aroused interest in analyzing spatial heterogeneity and temporal fluctuations in ventricular repolarization as indices of arrhythmogenicity.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> The simplest method to assess repolarization is to analyze the QT interval or, better, corrected QT (QTc), either of which is a well-known indicator of arrhythmic risk if prolonged.</p><p id="par0075" class="elsevierStylePara elsevierViewall">A more thorough assessment of arrhythmic risk will include analysis of QT dispersion, defined as the difference between the longest and shortest QT intervals on the 12-lead electrocardiogram (ECG). This is a better indicator of non-uniform prolongation of ventricular repolarization and heterogeneity of refractory periods.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Novel markers have been proposed that appear to be superior for assessing the degree of dispersion of left ventricular intramural repolarization and that in some pathological conditions correlate better with the risk of ventricular arrhythmia. They include Tp-e, the interval between the peak and the end of the T wave, and more recent markers such as the Tp-e/QT and Tp-e/QTc ratios.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> Panikkath et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> proposed that Tp-e prolongation corresponds to transmural dispersion of repolarization in the ventricular myocardium, a period during which epicardial cells have repolarized and are fully excitable, but M cells in the subendocardium are still in the process of repolarization and are vulnerable to the occurrence of early afterdepolarizations. If conditions are favorable, these early afterdepolarizations can trigger polymorphic ventricular tachycardia or ventricular fibrillation.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the present study, Mert et al. found a positive correlation between the presence of ventricular arrhythmias and changes in these new indices that were not detectable by simple measurement of QT or QTc interval. This supports the notion that these novel markers may be useful to stratify arrhythmic risk in sports of this type.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Given the limitations of the study, its conclusions – that measurement of right ventricular dimensions by echocardiography and analysis of dispersion of repolarization on the ECG using the new indices may be useful in assessing arrhythmic risk in athletes performing strength (static) exercise – are only hypothetical, and remain to be confirmed in future studies with larger samples and with a sufficiently long follow-up of the athletes included. It would also be interesting to compare the value of these indices in bodybuilders with those of athletes who perform mainly dynamic (endurance) exercise, since the effects on the heart differ according to the type of exercise and the mechanisms of arrhythmogenesis may also be different.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bonhorst D. Prática desportiva e arritmias cardíacas. Rev Port Cardiol. 2018;37:703–705.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Task Force 8: classification of sports" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.H. Mitchell" 1 => "W.L. Haskell" 2 => "P. Snell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2005.02.015" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2005" "volumen" => "45" "paginaInicial" => "1364" "paginaFinal" => "1367" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15837288" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise and the heart: the good, the bad, and the ugly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Sharma" 1 => "A. Merghani" 2 => "L. Mont" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehv090" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2015" "volumen" => "36" "paginaInicial" => "1445" "paginaFinal" => "1453" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25839670" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0070" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physiologic left ventricular cavity dilatation in elite athletes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Pelliccia" 1 => "F. Culasso" 2 => "F.M. Di Paolo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1999" "volumen" => "130" "paginaInicial" => "23" "paginaFinal" => "31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9890846" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0075" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sudden death in young athletes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.J. Maron" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra022783" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2003" "volumen" => "349" "paginaInicial" => "1064" "paginaFinal" => "1075" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12968091" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0080" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.J. Maron" 1 => "A. Pelliccia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.106.613562" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2006" "volumen" => "114" "paginaInicial" => "1633" "paginaFinal" => "1644" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17030703" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0085" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Potential adverse cardiovascular effects from excessive endurance exercise" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.H. O’Keefe" 1 => "H.R. Patil" 2 => "C.J. Lavie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.mayocp.2012.04.005" "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc" "fecha" => "2012" "volumen" => "87" "paginaInicial" => "587" "paginaFinal" => "595" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22677079" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0090" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive predictors of cardiac arrhythmias in bodybuilders" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K.U. Mert" 1 => "S. Ilgüy" 2 => "G. Özge" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2018.01.010" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2018" "volumen" => "37" "paginaInicial" => "693" "paginaFinal" => "701" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30017203" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0095" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sports-specific features of athlete's heart and their relation to echocardiographic parameters" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Barbier" 1 => "N. Ville" 2 => "G. Kervio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00059-006-2862-2" "Revista" => array:6 [ "tituloSerie" => "Herz" "fecha" => "2006" "volumen" => "31" "paginaInicial" => "531" "paginaFinal" => "543" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17036184" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0100" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventricular repolarization measures for arrhythmic risk stratification" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Monitillo" 1 => "M. Leone" 2 => "C. Rizzo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4330/wjc.v8.i1.57" "Revista" => array:6 [ "tituloSerie" => "World J Cardiol" "fecha" => "2016" "volumen" => "8" "paginaInicial" => "57" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26839657" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0105" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The meaning of the Tp-Te interval and its diagnostic value" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. Kors" 1 => "H.J. Ritsema van Eck" 2 => "G. van Herpen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jelectrocard.2008.07.030" "Revista" => array:6 [ "tituloSerie" => "J Electrocardiol" "fecha" => "2008" "volumen" => "41" "paginaInicial" => "575" "paginaFinal" => "580" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18954608" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0110" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Epub ahead of print]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Panikkath" 1 => "K. Reinier" 2 => "A. Uy-Evanado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCEP.110.960658" "Revista" => array:6 [ "tituloSerie" => "Circ Arrhythm Electrophysiol" "fecha" => "2011" "volumen" => "4" "paginaInicial" => "441" "paginaFinal" => "447" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21593198" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003700000008/v1_201808120420/S2174204918302460/v1_201808120420/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003700000008/v1_201808120420/S2174204918302460/v1_201808120420/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918302460?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 27 | 2 | 29 |
| 2024 October | 178 | 30 | 208 |
| 2024 September | 173 | 63 | 236 |
| 2024 August | 177 | 25 | 202 |
| 2024 July | 136 | 37 | 173 |
| 2024 June | 142 | 24 | 166 |
| 2024 May | 132 | 36 | 168 |
| 2024 April | 163 | 26 | 189 |
| 2024 March | 142 | 21 | 163 |
| 2024 February | 163 | 28 | 191 |
| 2024 January | 149 | 24 | 173 |
| 2023 December | 124 | 34 | 158 |
| 2023 November | 224 | 21 | 245 |
| 2023 October | 234 | 26 | 260 |
| 2023 September | 178 | 19 | 197 |
| 2023 August | 193 | 41 | 234 |
| 2023 July | 199 | 9 | 208 |
| 2023 June | 146 | 13 | 159 |
| 2023 May | 172 | 33 | 205 |
| 2023 April | 170 | 10 | 180 |
| 2023 March | 179 | 28 | 207 |
| 2023 February | 247 | 27 | 274 |
| 2023 January | 233 | 24 | 257 |
| 2022 December | 123 | 25 | 148 |
| 2022 November | 132 | 32 | 164 |
| 2022 October | 109 | 31 | 140 |
| 2022 September | 93 | 45 | 138 |
| 2022 August | 109 | 52 | 161 |
| 2022 July | 100 | 43 | 143 |
| 2022 June | 83 | 26 | 109 |
| 2022 May | 64 | 30 | 94 |
| 2022 April | 74 | 24 | 98 |
| 2022 March | 59 | 49 | 108 |
| 2022 February | 103 | 32 | 135 |
| 2022 January | 116 | 30 | 146 |
| 2021 December | 68 | 33 | 101 |
| 2021 November | 101 | 40 | 141 |
| 2021 October | 105 | 55 | 160 |
| 2021 September | 61 | 27 | 88 |
| 2021 August | 56 | 27 | 83 |
| 2021 July | 55 | 35 | 90 |
| 2021 June | 76 | 28 | 104 |
| 2021 May | 61 | 40 | 101 |
| 2021 April | 78 | 56 | 134 |
| 2021 March | 90 | 17 | 107 |
| 2021 February | 82 | 22 | 104 |
| 2021 January | 49 | 21 | 70 |
| 2020 December | 56 | 14 | 70 |
| 2020 November | 59 | 17 | 76 |
| 2020 October | 56 | 15 | 71 |
| 2020 September | 63 | 10 | 73 |
| 2020 August | 37 | 11 | 48 |
| 2020 July | 61 | 10 | 71 |
| 2020 June | 50 | 10 | 60 |
| 2020 May | 53 | 12 | 65 |
| 2020 April | 69 | 11 | 80 |
| 2020 March | 57 | 17 | 74 |
| 2020 February | 77 | 21 | 98 |
| 2020 January | 71 | 8 | 79 |
| 2019 December | 37 | 12 | 49 |
| 2019 November | 48 | 12 | 60 |
| 2019 October | 39 | 9 | 48 |
| 2019 September | 28 | 9 | 37 |
| 2019 August | 39 | 9 | 48 |
| 2019 July | 33 | 13 | 46 |
| 2019 June | 33 | 13 | 46 |
| 2019 May | 28 | 7 | 35 |
| 2019 April | 44 | 20 | 64 |
| 2019 March | 108 | 13 | 121 |
| 2019 February | 82 | 8 | 90 |
| 2019 January | 112 | 9 | 121 |
| 2018 December | 131 | 13 | 144 |
| 2018 November | 71 | 13 | 84 |
| 2018 October | 85 | 30 | 115 |
| 2018 September | 62 | 30 | 92 |
| 2018 August | 81 | 51 | 132 |
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