Background
Catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricle`s (LV) papillary muscles (PM) is challenging. In this study we present results of catheter ablation using ...multiple energy sources and image‐based approaches.
Methods
Fifty‐three patients (49 ± 17 years old; 34% females; median LV ejection fraction 53 ± 11%) underwent catheter cryoablation or radiofrequency (RF) ablation with non‐contact force sensing (Non‐CFS) catheters and cardiac computed tomography integration (CTII) into the electroanatomical mapping system or contact force sensing RF (CFS RF) ablation catheters and intracardiac echo‐facilitated 3D electroanatomical mapping. Ventricular arrhythmias foci were mapped at either the anterolateral (ALPM) or posteromedial papillary muscles (PMPM). Ablation was performed using an 8‐mm cryoablation catheter (CRYO); a Non‐CFS 4‐mm open‐irrigated RF catheter; or a CFS RF 3.5‐mm open‐irrigated tip catheter, via transmitral or transaortic approach.
Results
Acute success rate was 83% for Non‐CFS RF/CTII; 100% for CRYO/CTII (n = 16) and CFS RF/ICE3D (n = 14) (P = 0.03). Catheter stability was achieved in all patients treated with Cryo/CTII. VA recurrence at 12 months follow‐up was 48% (n = 11) for Non‐CFS RF/CTII; 19% (n = 3) for CRYO/CTII; and 7% (n = 1) for CFS RF/ICE3D (P = 0.02).
Conclusions
Non‐CFS/CTII was associated with an increased risk of recurrence of the clinical arrhythmia. Ablation with either CFS RF/ICE3D or CRYO/CTII showed high acute success rates and low recurrence rates during follow‐up. Cryoablation provided stable contact and was less arrhythmogenic.
Pulmonary vein isolation (PVI) has become the standard treatment of symptomatic atrial fibrillation. Patients remain hospitalized for at least 24 hours to detect potential complications in most ...centers worldwide. There is still a lack of data about the safety of same-day discharge.
The aim was to compare the safety of same-day discharge with next day discharge after overnight monitoring.The rate of new hospitalization and visits to the emergency department and the costeffectiveness of the same-day discharge approach were evaluated.
We conducted a longitudinal and prospective cohort study of all the consecutive patients undergoing scheduled pulmonary vein ablation of either paroxysmal or persistent atrial fibrillation (AF). The complications were recorded by type and time of occurrence.
Overall 58 patients were discharged within the same day and 137 patients stayed overnight after PVI. There were no significant differences in demography, comorbidities and other predictors of complications. No complications were reported after the sixth hour. We observed a significant difference in the number of visits to emergency department: 15.5% for the same-day discharge group vs. 30.7% for the overnight hospitalization group (p 0.03). Only 50% of the reasons to visit the emergency department were cardiovascular causes. No cases of pericardial tamponade were reported and none of the patients required new hospitalization up to 30 days of follow up.
Same-day discharge after PVI is feasible and cost-effective. This is the first study analyzing the experience in patients undergoing AVP,considering acare based component to this procedure. This approach would provide significant benefits for patients and health care providers.
Summary
Introduction
Management of atrial fibrillation (AF) is hampered by frequent recurrences after restoration of sinus rhythm. Delayed interatrial conduction has been associated with the ...development of AF in different clinical settings. The aim of our study was to assess whether advanced interatrial block (aIAB) was associated with AF recurrence after pharmacological cardioversion with two different antiarrhythmic drugs.
Methods
We included 61 patients with recent onset AF without structural heart disease that underwent successful pharmacological cardioversion. Thirty‐one patients received a single oral dose of propafenone, and 30 patients received iv vernakalant. A 12‐lead ECG (filter 150 Hz, 25 mm/s, 10 mm/mV) after conversion was evaluated for the presence of interatrial block (IAB); partial (pIAB): P‐wave duration > 120 ms, and advanced (aIAB): P‐wave > 120 ms and biphasic morphology (±) in inferior leads. Clinical follow‐up and electrocardiographic recordings were performed for a 12‐month period.
Results
Age was 58 ± 10.4 years and 50.8% were male. aIAB was present in 11 patients (18%) and pIAB in 10 (16.4%). At 1‐year follow‐up, 22 patients (36%) had AF recurrence. The recurrence rate with aIAB was 90.9% versus 70% in those with pIAB and 12.5% in normal P‐wave duration (P = 0.001). The presence of aIAB was strongly associated with AF recurrence (odds ratio 18.4 in multivariable modeling). Recurrence was not affected by the drug used for cardioversion (P = 0.92).
Conclusion
Advanced interatrial block is associated with higher risk of AF recurrence at 1 year after pharmacological cardioversion, independent of the drug used.
Atrial fibrillation (AF) and heart failure (HF) often coexist with an increase in morbidity and mortality. AF catheter ablation (CA) has proved to be a safe and efficient option for HF patients, but ...long-term evolution and prognosis remain uncertain. The aim is to assess the efficacy and safety of CA in HF patients with AF, and analyze HF long-term evolution.
We prospectively analyzed consecutive patients with AF and congestive HF or left ventricular ejection fraction (EF) less than 45%, who underwent CA of AF between 2011 and 2016. We excluded patients who did not complete one year of follow-up.
Seventy-nine patients were included. Mean age was 62.1 years, 72.4% were men, 67.2% had hypertension and 8.6% were diabetics. Mean EF was 49%, left atrial area was 26.5 cm2 and mean CHA2DS2-VASc score was 2. 70.6% were on NYHA FC II-III.The recurrence rate of AF was 60%, and after a second CA the rate decreased to 27.8%. Only persistent AF prior to the procedure was identified as independent predictor of recurrence. There was a significant NYHA FC improvement in the sinus rhythm (SR) group vs those with recurrence (63.6% vs 36.4%; p=0.047). None of the patients in SR were hospitalized, whereas six with recurrence were hospitalized due to HF (0% vs. 18.2%; p = 0.07). The rate of complications was 9.1%.
Catheter ablation of atrial fibrillation in heart failure presents an adequate success rate, improving symptoms and reducing rehospitalizations due to heart failure.
Magnetic nanoparticles were studied to generate novel nanocomposites which maintain both magnetic properties of nanoparticles and self-assembly of amorphous block copolymer matrix. With this goal, ...iron oxide magnetic nanoparticles were modified with polystyrene (PS) brushes by atomic transfer radical polymerization (ATRP) to improve both the dispersion and the affinity of nanoparticles with one of the blocks of polystyrene-b-polybutadiene-b-polystyrene block copolymer. This way of preparation of nanocomposites opens new strategy to the generation of magnetic nanocomposites. The samples were characterized with the use of differential scanning calorimetry (DSC), dynamic mechanical analysis (DMA), rheological measurements, and atomic force microscopy (AFM).
It is well known that activated sludge treatment systems generate a lot of surplus sludge having environmental and economic impacts. Although several approaches have been proposed for the ...treatment/reuse of the excess of sludge, there are few studies focused on decreasing the biomass yield without affecting the metabolic activity. This work reports the effect of low magnitude electrical fields (0.07 to 0.2 V/cm) on the growth yield of a pure strain of
Pseudomonas denitrificans
(used as model microorganism). Cell potentials between 0.2 and 0.57 V were measured during 24 h to the aerobic culture; biomass production and substrate consumption were evaluated at regular intervals. Results indicated that the substrate (lactate) consumption efficiency increased with the applied potential, up to 100%, while the yield diminished 31% (0.34 g biomass/g lactate consumed) at 0.7 V vs. NHE. Bioenergetics showed that the fraction of electron equivalents toward biomass synthesis decreased from 0.68 (when no potential was applied) to 0.47 at 0.57 V, pointing out the redirection of the energy flow toward maintenance to cope with the stress caused by the imposed voltage. Therefore, the electrical stimulus could be used as control of biomass growth in aerobic wastewater treatment lines.
PDF
