Alterations in atrial electrogram amplitude as steady sinus rhythm transitions to paroxysmal atrial fibrillation during continuous monitoring in patients with implantable cardiac devices: Insights from the IMPACT study

OBJECTIVES

We aimed to evaluate whether device measured amplitudes of atrial electrogram (AEGM) would change when measured in sinus rhythm (SR) transitioning to paroxysmal atrial fibrillation (AF) from previous steady SR, and significance of such change.

METHODS

From the IMPACT trial's database we selected two groups; (A) those who developed AF (n = 164), and (B) propensity-matched control (n = 459) who stayed in SR during continuous Home Monitoring (HM) to compare AEGMs amplitudes at baseline SR and transition phase.

RESULTS

During 420.0 ± 349.2 days (mean ± SD) from first postenrollment HM transmission to AF event transmission in Group A, and corresponding 515.3 ± 407.0 days in Group B, baseline and transition AEGM amplitude were 2.88 ± 1.146 and 2.74 ± 1.186 mV, respectively, for Group A (p = .1), and 2.88 ± 1.155 and 2.79 ± 1.145, respectively, for Group B (p < .005). Comparison of differences of AEGM amplitude, 0.14 ± 1.072 mV in Group A and 0.09 ± 0.893 mV in Group B were insignificant (p = .3). Age, sex, and hypertension identified as confounders had no association to AEGM changes (p = NS).

CONCLUSIONS

Independent of age, sex, and hypertension, AEGMs amplitudes decline over a long period of time in patients with defibrillators and substrate for AF. The significance of such change remains unclear as it occurs whether patients develop AF or not, but raises a possibility of progressive atrial myopathy that patients with substrate for AF may be predisposed to.

"To Tech or Not to Tech?" A Critical Decision-Making Framework for Implementing Technology in Sport

The current technological age has created exponential growth in the availability of technology and data in every industry, including sport. It is tempting to get caught up in the excitement of purchasing and implementing technology, but technology has a potential dark side that warrants consideration. Before investing in technology, it is imperative to consider the potential roadblocks, including its limitations and the contextual challenges that compromise implementation in a specific environment. A thoughtful approach is therefore necessary when deciding whether to implement any given technology into practice. In this article, we review the vision and pitfalls behind technology's potential in sport science and medicine applications and then present a critical decision-making framework of 4 simple questions to help practitioners decide whether to purchase and implement a given technology.

Ongoing Risk of Ventricular Arrhythmias and All-Cause Mortality at Implantable Cardioverter Defibrillator Generator Change: A Systematic Review and Meta-Analysis

[Figure: see text].

Risk of ventricular arrhythmia in cardiac resynchronization therapy responders and super-responders: a systematic review and meta-analysis

AIMS

Response to cardiac resynchronization therapy (CRT) is associated with improved survival, and reduction in heart failure hospitalization, and ventricular arrhythmia (VA) risk. However, the impact of CRT super-response [CRT-SR, increase in left ventricular ejection fraction (LVEF) to ≥ 50%] on VA remains unclear.

METHODS AND RESULTS

We undertook a meta-analysis aimed at determining the impact of CRT response and CRT-SR on risk of VA and all-cause mortality. Systematic search of PubMed, EMBASE, and Cochrane databases, identifying all relevant English articles published until 31 December 2019. A total of 34 studies (7605 patients for VA and 5874 patients for all-cause mortality) were retained for the meta-analysis. The pooled cumulative incidence of appropriate implantable cardioverter-defibrillator therapy for VA was significantly lower at 13.0% (4.5% per annum) in CRT-responders, vs. 29.0% (annualized rate of 10.0%) in CRT non-responders, relative risk (RR) 0.47 [95% confidence interval (CI) 0.39-0.56, P < 0.0001]; all-cause mortality 3.5% vs. 9.1% per annum, RR of 0.38 (95% CI 0.30-0.49, P < 0.0001). The pooled incidence of VA was significantly lower in CRT-SR compared with CRT non-super-responders (non-responders + responders) at 0.9% vs. 3.8% per annum, respectively, RR 0.22 (95% CI 0.12-0.40, P < 0.0001); as well as all-cause mortality at 2.0% vs. 4.3%, respectively, RR 0.47 (95% CI 0.33-0.66, P < 0.0001).

CONCLUSIONS

Cardiac resynchronization therapy super-responders have low absolute risk of VA and all-cause mortality. However, there remains a non-trivial residual absolute risk of these adverse outcomes in CRT responders. These findings suggest that among CRT responders, there may be a continued clinical benefit of defibrillators.

Watching for Disease: the Changing Paradigm of Disease Screening in the Age of Consumer Health Devices

There has been a recent proliferation of consumer health devices (CHDs) that enable user-initiated screening for a variety of diseases. These devices represent a paradigm shift in the deployment of disease screening, a process that has historically been led by clinicians following the guidance of professional bodies. The detection of AF via CHDs is a contemporary example of this phenomenon and highlights several important implications of the shift of disease screening from clinicians to CHD users. These include responsibility for patient data and outcomes, healthcare costs and access, and an evolution of the patient-provider relationship. However, as CHD technologies mature and become more affordable, they have the potential to detect actionable subclinical disease and improve health. Rather than allow CHDs to enter the marketplace organically with the potential for unintended negative consequences, it is critical that clinical, research, and industry communities proactively collaborate and establish best practices for their use.

Ibrutinib-Associated Atrial Fibrillation

Ibrutinib, a novel and potent Bruton tyrosine kinase inhibitor, is an effective and well-tolerated treatment for a variety of B-cell lymphomas. However, its use is associated with an increased incidence of atrial fibrillation (AF), ranging from 4% to 16%. We reviewed the original clinical trials that led to the approval of ibrutinib, as well as several other prospective and retrospective studies, to better appreciate the incidence of ibrutinib-associated AF. Based on 16 studies included in our analysis, the incidence of ibrutinib-associated AF was 5.77 per 100 person-years, which is much higher than rates previously reported with ibrutinib and compared with the general adult population. New onset AF in cancer patients is associated with a significantly higher risk of heart failure and thromboembolism, even after adjusting for known risk factors. In addition, ibrutinib poses unique challenges due to its interactions with many medications that are commonly used to manage AF. Ibrutinib also inhibits platelet activation and decisions regarding anticoagulation have to be carefully weighed against this increased risk of bleeding. Ibrutinib's interaction with calcium channel blockers, digoxin, amiodarone, and direct oral anticoagulants can result in either ibrutinib or other drug-related toxicity and careful selection and dose adjustment may be needed. Ibrutinib-associated AF can be a therapy-limiting side effect and physicians should be familiar with the special management considerations imposed by this agent. We review the potential mechanisms and incidence of ibrutinib-associated AF and propose an algorithm for its management.

The Effects of the Removal of Electronic Devices for 48 Hours on Sleep in Elite Judo Athletes

This study examined the effects of evening use of electronic devices (i.e., smartphones, etc.) on sleep quality and next-day athletic and cognitive performance in elite judo athletes. Over 6 consecutive days and nights, 23 elite Australian judo athletes were monitored while attending a camp at the Australian Institute of Sport (AIS). In 14 athletes, all electronic devices were removed on days 3 and 4 (i.e., for 48 hours: the "device-restricted group"), whereas 9 were permitted to use their devices throughout the camp (the "control group"). All athletes wore an activity monitor (Readiband) continuously to provide measures of sleep quantity and quality. Other self-reported (diary) measures included time in bed, electronic device use, and rate of perceived exertion during training periods. Cognitive performance (Cogstate) and physical performance (single leg triple hop test) were also measured. When considering night 2 as a "baseline" for each group, removal of electronic devices on nights 3 and 4 (device-restricted group) resulted in no significant differences in any sleep-related measure between the groups. When comparing actigraphy-based measures of sleep to subjective measures, all athletes significantly overestimated sleep duration by 58 ± 85 minutes (p = 0.001) per night and underestimated time of sleep onset by 37 ± 72 minutes (p = 0.001) per night. No differences in physical or cognitive function were observed between the groups.

CONCLUSION

This study has shown that the removal of electronic devices for a period of two nights (48 hours) during a judo camp does not affect sleep quality or quantity or influence athletic or cognitive performance.

Taekwondo Fighting in Training Does Not Simulate the Affective and Cognitive Demands of Competition: Implications for Behavior and Transfer

Enhancing practice design is critical to facilitate transfer of learning. Considerable research has focused on the role of perceptual information in practice simulation, yet has neglected how affect and cognition are shaped by practice environments and whether this influences the fidelity of behavior (Headrick et al., 2015). This study filled this gap by examining the fidelity of individual (cognition, affect, and actions) and interpersonal behavior of 10 highly skilled Australian Taekwondo athletes fighting in training compared to competition. Interpersonal behavior was assessed by tracking location coordinates to analyze distance-time coordination tendencies of the fighter-fighter system. Individual actions were assessed through notational analysis and approximate entropy calculations of coordinate data to quantify the (un)predictability of movement displacement. Affect and cognition were assessed with mixed-methods that included perceptual scales measuring anxiety, arousal, and mental effort, and post-fight video-facilitated confrontational interviews to explore how affect and cognitions might differ. Quantitative differences were assessed with mixed models and dependent t-tests. Results reveal that individual and interpersonal behavior differed between training and competition. In training, individuals attacked less (d = 0.81, p < 0.05), initiated attacks from further away (d = -0.20, p < 0.05) and displayed more predictable movement trajectories (d = 0.84, p < 0.05). In training, fighters had lower anxiety (d = -1.26, p < 0.05), arousal (d = -1.07, p < 0.05), and mental effort (d = -0.77, p < 0.05). These results were accompanied by changes in interpersonal behavior, with larger interpersonal distances generated by the fighter-fighter system in training (d = 0.80, p < 0.05). Qualitative data revealed the emergence of cognitions and affect specific to the training environment, such as reductions in pressure, arousal, and mental challenge. Findings highlight the specificity of performer-environment interactions. Fighting in training affords reduced affective and cognitive demands and a decrease in action fidelity compared to competition. In addition to sampling information, representative practice needs to consider modeling the cognitions and affect of competition to enhance transfer.

Human behaviours associated with dominance in elite amateur boxing bouts: A comparison of winners and losers under the Ten Point Must System

Humans commonly ascertain physical dominance through non-lethal fighting by participating in combat sports. However, the behaviours that achieve fight dominance are not fully understood. Amateur boxing competition, which is judged using the subjective “Ten Point Must-System”, provides insight into fight dominance behaviours. Notational analysis was performed on 26 elite male competitors in a national boxing championship. Behavioural (guard-drop time; movement style [stepping/bouncing time]; clinch-time; interaction-time) and technical (total punches; punches landed [%Hit]; air punches [%Air]; defence) measures were recorded. Participants reported effort required (0–100%) and perceived effect of fatigue on their own performance (5-point Likert scale) following bouts. Differences between winners and losers, and changes across the duration of the bout were examined. Winners punched more accurately than losers (greater %Hit [33% vs. 23%] and lower %Air [17% vs. 27%]) but total punches, defence and interaction-time were similar. From rounds 1–2, clinch-time and guard drops increased whilst bouncing decreased. Perceived effect of fatigue increased throughout the bout while perceived effort increased only from rounds 2–3. %Hit and movement index together in regression analysis correctly classified 85% of bout outcomes, indicating that judges (subjectively) chose winning (dominant) boxers according to punch accuracy and style, rather than assertiveness (more punches thrown). Boxers appear to use tactical strategies throughout the bout to pace their effort and minimise fatigue (increased guard drops, reduced bouncing), but these did not influence perceived dominance or bout outcome. These results show that judges use several performance indicators not including the total number of successful punches thrown to assess fight dominance and superiority between fighters. These results provide valuable information as to how experienced fight observers subjectively rate superiority and dominance during one-on-one human fighting.

Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals

OBJECTIVE

To determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making.

DESIGN

In this cross-sectional study, electronic surveys containing a hypothetical decision-making scenario were sent to medical professionals to select between two colon cancer screening tests for a population.

SETTING

Three Greater Boston academic medical institutions: Tufts University School of Medicine, Tufts Medical Centre and Lahey Hospital and Medical Centre.

PARTICIPANTS

819 medical students, 497 residents-in-training and 671 practising physicians were contacted electronically using institutional and organisational directories.

MAIN OUTCOMES AND MEASURES

Stratified opinions of medical providers and trainee subgroups regarding cost-effectiveness and equity.

RESULTS

A total of 881 respondents comprising 512 medical students, 133 medical residents-in-training and 236 practising physicians completed the survey (total response rate 44.3%). Thirty-six per cent of medical students, 44% of residents-in-training and 53% of practising physicians favoured the less effective and more equitable screening test. Residents-in-training (OR 1.49, CI 1.01 to 2.21; p=0.044) and practising physicians (OR 2.12, CI 1.54 to 2.92; p<0.001) were more likely to favour the equitable option compared with medical students. Moreover, female responders across all three cohorts favoured the more equitable screening test to a greater degree than did male responders (OR 1.70, CI 1.29 to 2.24; p<0.001).

CONCLUSIONS

Cost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women.

A case of video-assisted thoracoscopic resection of malignant transformation of pulmonary recurrent respiratory papillomatosis

Recurrent respiratory papillomatosis (RRP) is a disease of the respiratory tract caused by infection with the human papillomavirus (HPV) and is characterized by multiple recurring papillomas throughout the respiratory tract. Although rare, extra laryngeal involvement carries the risk of malignant transformation in 3-7% of adults. We report the case of a patient with unmonitored juvenile onset RRP with pulmonary involvement found to have malignant transformation to squamous cell carcinoma (SCC). Incidentally found on chest radiography for mild chest wall trauma, she was found to have a large left lower lobe mass with pathology consistent with SCC. The patient underwent surgical management with thoracoscopic left lower lobectomy and mediastinal lymph node dissection followed by adjuvant chemoradiation for pathologic stage IIIA SCC. Surveillance imaging at 6 months shows no evidence of disease progression.

The Effects of Attentional Focusing Instructions on Force Production During the Isometric Midthigh Pull

Verbal instructions play a key role in motor learning and performance. Whereas directing one's attention toward bodily movements or muscles (internal focus) tends to hinder performance, instructing persons to focus on the movement outcome, or an external object related to the performed task (external focus) enhances performance. The study's purpose was to examine whether focus of attention affects maximal force production during an isometric midthigh pull (IMTP) among 18 trained athletes (8F & 10M). Athletes performed 3 IMTP trials a day for 3 consecutive days. The first day was a familiarization session in which athlete's received only control instructions. The following 2 days athletes received either control, internal, or external focus of attention instructions in a randomized, within-subject design. Compared to performance with an internal focus of attention, athletes applied 9% greater force when using an external focus of attention (p < 0.001, effect size [ES] = 0.33) and 5% greater force with control instructions (p = 0.001, ES = 0.28). A small positive 3% advantage was observed between performances with an external focus of attention compared with control instructions (p = 0.03, ES = 0.13). Focusing internally on body parts and/or muscle groups during a movement task that requires maximal force hinders performance, whereas focusing on an object external to the self leads to enhanced force production, even when using a simple multijoint static task such as the IMTP.

Determinants of Time in Therapeutic Range in Patients Receiving Oral Anticoagulants (A Substudy of IMPACT)

Implanted cardiac arrhythmia devices can detect atrial tachyarrhythmias (atrial high-rate episodes [AHREs]) that are considered to correlate with atrial fibrillation and risk of stroke. In the IMPACT trial, oral anticoagulation was initiated when AHREs were detected by implanted cardioverter-defibrillators and withdrawn when they abated, according to a protocol accounting both for AHRE duration as detected by remote device monitoring and stroke risk assessment. In this analysis, we ascertained determinants of time in therapeutic range (TTR) among protocol-determined vitamin K antagonist-treated patients during the trial. We enrolled 2,718 patients with at least 1 additional stroke risk factor (CHADS₂ score ≥1) at 104 arrhythmia centers. The sex, age <60, medical history, treatments interacting with VKA, tobacco use (2 points) and race (2 points for non-Caucasian) (SAMe-TT₂R₂) score is a simple clinical-derived score designed to aid decision-making on whether a patient is likely to achieve good anticoagulation control on vitamin K antagonist (e.g., warfarin), which was calculated and related to TTR achieved using the Rosendaal method. We analyzed 229 patients (mean age 66.7 years; mean CHADS₂ score 2.85 [SD 1.1]) with mean TTR of 0.536 (SD 0.23) overall. Univariate analysis identified 5 variables associated with differences in mean TTR. Mean TTR was lower in those who were women (p = 0.031), of black race (p = 0.005) and in New York Heart Association class IV (p = 0.014), whereas hemoglobin >13.5 g/dl (p = 0.010) and New York Heart Association class I (p = 0.037) were associated with higher mean TTR. There was a significant difference in mean TTR value between US and non-US sites (Canada and Germany) (mean TTR for US: 0.513 vs non-US: 0.686; p <0.0001). Mean TTR was significantly lower (Δ = 0.1382, 95% CI 0.0382 to 0.2382) for patients with SAMe-TT₂R₂ scores of 4 (p = 0.007) and higher (Δ = 0.0612, 95% CI 0.0005 to 0.1219) for patients with SAMe-TT₂R₂ scores of 1 (p = 0.048). Linear regression confirmed a significant association between lower SAMe-TT₂R₂ score and improved anticoagulation control (p = 0.0021) with a 1-unit decrease in SAMe-TT₂R₂ score associated with an increase in TTR of 0.0404 (95% CI 0.0149 to 0.0659). In conclusion, clinical, geographical, and demographic factors were associated with the quality of anticoagulation control as reflected by TTR. Although overall TTR in this population was poor, lower SAMe-TT₂R₂ scores were associated with better TTR.

Ventilatory acclimatisation is beneficial for high-intensity exercise at altitude in elite cyclists

AIM

The aim of this study was to examine the relationship between ventilatory adaptation and performance during altitude training at 2700 m.

METHODS

Seven elite cyclists (age: 21.2 ± 1.1 yr, body mass: 69.9 ± 5.6 kg, height 176.3 ± 4.9 cm) participated in this study. A hypoxic ventilatory response (HVR) test and a submaximal exercise test were performed at sea level prior to the training camp and again after 15 d at altitude (ALT15). Ventilation (VE), end-tidal carbon-dioxide partial pressure (PETCO2) and oxyhaemoglobin saturation via pulse oximetry (SpO2) were measured at rest and during submaximal cycling at 250 W. A hill climb (HC) performance test was conducted at sea level and after 14 d at altitude (ALT14) using a road of similar length (5.5-6 km) and gradient (4.8-5.3%). Power output was measured using SRM cranks. Average HC power at ALT14 was normalised to sea level power (HC%). Multiple regression was used to identify significant predictors of performance at altitude.

RESULTS

At ALT15, there was a significant increase in resting VE (10.3 ± 1.9 vs. 12.2 ± 2.4 L·min(-1)) and HVR (0.34 ± 0.24 vs. 0.71 ± 0.49 L·min(-1)·%(-1)), while PETCO2 (38.4 ± 2.3 vs. 32.1 ± 3.3 mmHg) and SpO2 (97.9 ± 0.7 vs. 94.0 ± 1.7%) were reduced (P < .05). Multiple regression revealed ΔHVR and exercise VE at altitude as significant predictors of HC% (adjusted r(2) = 0.913; P = 0.003).

CONCLUSIONS

Ventilatory acclimatisation occurred during a 2 wk altitude training camp in elite cyclists and a higher HVR was associated with better performance at altitude, relative to sea level. These results suggest that ventilatory acclimatisation is beneficial for cycling performance at altitude.

Impact of Altitude on Power Output during Cycling Stage Racing

PURPOSE

The purpose of this study was to quantify the effects of moderate-high altitude on power output, cadence, speed and heart rate during a multi-day cycling tour.

METHODS

Power output, heart rate, speed and cadence were collected from elite male road cyclists during maximal efforts of 5, 15, 30, 60, 240 and 600 s. The efforts were completed in a laboratory power-profile assessment, and spontaneously during a cycling race simulation near sea-level and an international cycling race at moderate-high altitude. Matched data from the laboratory power-profile and the highest maximal mean power output (MMP) and corresponding speed and heart rate recorded during the cycling race simulation and cycling race at moderate-high altitude were compared using paired t-tests. Additionally, all MMP and corresponding speeds and heart rates were binned per 1000 m (<1000 m, 1000-2000, 2000-3000 and >3000 m) according to the average altitude of each ride. Mixed linear modelling was used to compare cycling performance data from each altitude bin.

RESULTS

Power output was similar between the laboratory power-profile and the race simulation, however MMPs for 5-600 s and 15, 60, 240 and 600 s were lower (p ≤ 0.005) during the race at altitude compared with the laboratory power-profile and race simulation, respectively. Furthermore, peak power output and all MMPs were lower (≥ 11.7%, p ≤ 0.001) while racing >3000 m compared with rides completed near sea-level. However, speed associated with MMP 60 and 240 s was greater (p < 0.001) during racing at moderate-high altitude compared with the race simulation near sea-level.

CONCLUSION

A reduction in oxygen availability as altitude increases leads to attenuation of cycling power output during competition. Decrement in cycling power output at altitude does not seem to affect speed which tended to be greater at higher altitudes.

The impact of a simulated grand tour on sleep, mood, and well-being of competitive cyclists

AIM

Professional cycling is considered one of the most demanding of all endurance sports. The three major professional cycling stages races (i.e. Tour de France, Giro d'Italia and Vuelta a España) require cyclists to compete daily covering between ~150-200 km for three consecutive weeks. Anecdotal evidence indicates that such an event has a significant effect on the sleep, mood, and general well-being of cyclists, particularly during the latter stages of the event. The primary aim of this study was to simulate a grand tour and determine the impact a grand tour has on the sleep, mood, and general well-being of competitive cyclists.

METHODS

Twenty-one male cyclists (M±SD, age 22.2±2.7 years) were examined for 39 days across three phases (i.e. baseline, simulated grand tour, and recovery). Sleep was assessed using sleep diaries and wrist activity monitors. Mood and general well-being were assessed using the Brunel Mood Scale (BRUMS) and Visual Analogue Scales (VAS).

RESULTS

The amount and quality of sleep as assessed by the wrist activity monitors declined during the simulated grand tour. In contrast, self-reported sleep quality improved throughout the study. Cyclists' mood and general well-being as indicated by vigour, motivation, physical and mental state declined during the simulated tour.

CONCLUSION

Future investigations should examine sleep, mood and well-being during an actual grand tour. Such data could prove instrumental toward understanding the sleep and psychological changes that occur during a grand tour.

Body composition of female road and track endurance cyclists: Normative values and typical changes

The aims of this study were to describe normative values and seasonal variation of body composition in female cyclists comparing female road and track endurance cyclists, and to validate the use of anthropometry to monitor lean mass changes. Anthropometric profiles (seven site skinfolds) were measured over 16 years from 126 female cyclists. Lean mass index (LMI) was calculated as body weight × skinfolds(-x). The exponent (x) was calculated as the slope of the natural logarithm of body weight and skinfolds. Percentage changes in LMI were compared to lean mass changes measured using dual-energy X-ray absorptiometry (DXA) in a subset of 25 road cyclists. Compared to sub-elite and elite cyclists, world class cyclists were (mean [95% CI]) 1.18 kg [0.46, 1.90] and 0.60 kg [0.05, 1.15] lighter and had skinfolds that were 7.4 mm [3.8, 11.0] and 4.6 mm [1.8, 7.4] lower, respectively. Body weight (0.41 kg [0.04, 0.77]) and skinfolds (4.0 mm [2.1, 6.0]) were higher in the off-season compared to the early-season. World class female road cyclists had lower body weight (6.04 kg [2.73, 9.35]) and skinfolds (11.5 mm [1.1, 21.9]) than track endurance cyclists. LMI (mean exponent 0.15 [0.13, 0.18]) explained 87% of the variance in DXA lean mass. In conclusion, higher performing female cyclists were lighter and leaner than their less successful peers, road cyclists were lighter and leaner than track endurance cyclists, and weight and skinfolds were lowest early in the season. LMI appears to be a reasonably valid tool for monitoring lean mass changes.

Physical Demands of Sprinting in Professional Road Cycling

The aim of this study was to quantify the demands of road competitions ending with sprints in male professional cycling. 17 races finished with top-5 results from 6 male road professional cyclists (age, 27.0±3.8 years; height, 1.76±0.03 m; weight, 71.7±1.1 kg) were analysed. SRM power meters were used to monitor power output, cadence and speed. Data were averaged over the entire race, different durations prior to the sprint (60, 10, 5 and 1 min) and during the actual sprint. Variations in power during the final 10 min of the race were quantified using exposure variation analysis. This observational study was conducted in the field to maximize the ecological validity of the results. Power, cadence and speed were statistically different between various phases of the race (p<0.001), increasing from 316±43 W, 95±4 rpm and 50.5±3.3 km·h(-1) in the last 10 min, to 487±58 W, 102±6 rpm and 55.4±4.7 km·h(-1) in the last min prior to the sprint. Peak power during the sprint was 17.4±1.7 W·kg(-1). Exposure variation analysis revealed a significantly greater number of short-duration high-intensity efforts in the final 5 min of the race, compared with the penultimate 5 min (p=0.010). These findings quantify the power output requirements associated with high-level sprinting in men's professional road cycling and highlight the need for both aerobic and anaerobic fitness.