407 BRIEF REPORT International Journal of Sports Physiology and Performance, 2016, 11, 407 -409 http://dx.doi.org/10.1123/ijspp.2015-0035 © 2016 Human Kinetics, Inc. Valenzano, Moscatelli, Triggiani, and Cibelli are with the Dept of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy. Capranica, De Ioannon, and Piacentini are with the Dept of Movement, Human and Health Sciences, University of Rome “Foro Italico,” Rome, Italy. Mignardi is with the School of Sport CONI Lazio, Rome, Italy. Messina is with the Section of Human Physiology, Second University of Naples, Naples, Italy. Villani is with the Unit of Sport Medicine, A.S.L. Foggia, S. Severo, Italy. Address author correspondence to Giuseppe Cibelli at giuseppe.cibelli@ unifg.it. Heart-Rate Changes After an Ultraendurance Swim From Italy to Albania: A Case Report Anna Valenzano, Fiorenzo Moscatelli, Antonio Ivano Triggiani, Laura Capranica, Giulia De Ioannon, Maria Francesca Piacentini, Sergio Mignardi, Giovanni Messina, Stefano Villani, and Giuseppe Cibelli Purpose: To evaluate the effect of a solo ultraendurance open-water swim on autonomic and nonautonomic control of heart rate (HR). Methods: A male athlete (age 48 y, height 172 cm, body mass 68 kg, BMI 23 kg/m 2 ) underwent HR-variability (HRV) and circulating catecholamine evaluations at different times before and after an ultraendurance swim crossing the Adriatic Sea from Italy to Albania. HRV was measured in 5-min segments and quantifed by time and frequency domain. Circulating cat- echolamines were estimated by salivary alpha-amylase (sAA) assay. Results: The athlete completed 78.1 km in 23:44 h:min. After arrival, sAA levels had increased by 102.6%. Time- and frequency-domain HRV indexes decreased, as well (mean RR interval, –29,7%; standard deviation of normal mean RR interval, –63,1%; square root of mean squared successive differences between normal-to-normal RR intervals, –49.3%; total power, –74.3%; low frequency, –78.0%; high frequency, –76.4%), while HR increased by 41.8%. At 16-h recovery, sAA had returned to preevent values, while a stable tachycardia was accompanied by reduced HRV measures. Conclusion: To the authors’ knowledge, this is the frst study reporting cardiac autonomic adjust- ments to an extreme and challenging ultraendurance open-water swim. The fndings confrmed that the autonomic drives depend on exercise efforts. Since HRV changes did not mirror the catecholamine response 16 h postevent, the authors assume that the ultraendurance swim differently infuenced cardiac function by both adaptive autonomic and nonautonomic patterns. Keywords: heart-rate variability, solo race, autonomic nervous system, alpha-amylase Despite the popularity of open-water long-distance swimming, there is a lack of knowledge on the specifc physiological challenges an athlete experiences. 1 In fact, ultraendurance exercise under criti- cal environmental conditions presents a unique summated stress, resulting in marked adaptations to the cardiovascular, respiratory, and neuromuscular systems of the body. 2 Heart-rate (HR) variability (HRV) is a valuable tool in both clinical practice and physiologi- cal research, refecting the ability of the cardiovascular system to adapt to external and internal load at rest and during exercise. 3 In particular, with respect to HRV power spectral components, high- frequency (HF; 0.15–0.4 Hz) power is almost entirely mediated by the parasympathetic activity to the sinus node, directly associated with respiratory activity, whereas low-frequency (LF; 0.04–0.15 Hz) power refects the mixed modulation of parasympathetic and sympathetic activities. 4 In addition to the autonomic control, a non- autonomic control of HR is exerted by hormones (catecholamines, cortisol, growth hormone, renin/angiotensin), which may infuence HRV frequencies below 0.3 Hz. Despite HRV’s having been used to evaluate modifcations of autonomic cardiovascular functions during exercise or after a training period, 5,6 the effects of very intense and prolonged exercise on the cardiovascular autonomic function are still not documented. In the last years, sAA has attracted attention as a biomarker of the sympathetic-adrenal medullary system’s response to stress. 7 In a recent paper we investigated pacing, speed, and stroke mechanics during the exceptional solo swimming event of the frst man cross- ing the Adriatic Sea. 8 Here, we focused on alterations in cardiac function after the same event by combining HRV analyses and changes in salivary alpha-amylase (sAA) levels, thus providing useful information on extreme sport performances. Methods A well-experienced athlete (Italian record holder of the English Channel swim, 13:01 h:min, 9 completed Ironman races; age 48 years, height 172 cm, body mass 68 kg, body-mass index 23 kg/m 2 ) performed a 78.1-km swim in open sea across the Otranto Chan- nel, between Punta Palascia, Italy, and Punta Linguetta, Albania, in September 2011. The local university ethical committee approved the study and the athlete gave written informed consent. The athlete was supplied with isotonic sports drinks (Agisko natural sport drink, Parma, Italy) and a water solution containing carbohydrates (Agisko sport drink energy gel, Parma, Italy) at 15-minute intervals. Body temperature was measured with an infrared tympanic thermometer (Microlife MT400 Switzerland) immediately before and after the event. Salivary samples were collected 15 minutes preevent (T 0 ), 90 minutes postevent (T 1 ), and 16 hours postevent recovery (T 2 ) and stored at –80°C until use. sAA was assayed using commercial kits (Salimetrics, USA). HRV was measured from 5-minute beat-to-beat HR recording, taken in supine position, at the same time intervals. The analog ECG signal was acquired using the Biopac ECG100C