Abstract Background Circumferential pulmonary veins ablation (CPVA) with posterior wall isolation (PWI) using radiofrequency catheter ablation (RFCA) is gaining increasing interest in terms of safety ...and efficacy. Purpose To compare procedural data and efficacy between two radiofrequency ablation protocols for the treatment of persistent atrial fibrillation (PersAF): very high power-short duration (vHPSD) ablation using a novel temperature-controlled ablation catheter and Ablation Index (AI) guided RFCA using traditional contact-force catheter. Methods This single center prospective study enrolled 75 consecutive patients (Group 1) with symptomatic PersAF undergoing RFCA using a novel contact-force catheter optimized for temperature-controlled ablation with microelectrodes and 6 thermocouples for real-time temperature monitoring during ablation. The vHPSD algorithm modulates power to maintain target temperature during these lesions (90 Watts, 4 s) in the posterior wall. RF delivery in anterior regions was performed in a temperature guided setting (1-45W, 45°C) to achieve a 500-550 AI. These patients were compared to 75 propensity matched patients (Group 2) undergoing PersAF ablation with traditional AI-guided ablation. Procedural data were compared between the two groups (Table 1). Procedural outcome was considered as loop recorder documented atrial arrhythmias recurrences and compared between the two groups. Results Seventy-five patients (69% male, 63.1±11.2 years old) underwent ablation with vHPSD protocol (Group 1). CPVA and PWI was achieved in all patients with total procedure and fluoroscopy times of 67.5±28.8 min and 4.5±2.8 min, respectively. After 12-month median follow-up, 57/75 patients (76%) were free from AF. Seventy-five propensity matched patients (69% male, 60.7±9.9 years old) have undergone ablation with standard contact-force catheter. CPVA and PWI was achieved in all patients with total procedure and fluoroscopy times of 81.99±20.5 min and 5.7±2.1 min, respectively. After 12-month median follow-up, 55/75 patients (73%) were free from AF. Procedural and fluoroscopy times were significantly lower in in Group 1 than in Group 2 (Table 1). AF recurrencies were comparable between the two groups as assessed with survival analysis (Figure 1, log-rank 0.509). There were no deaths or other severe periprocedural complications. Conclusions PWI on top of CPVA is effective in limiting arrhythmic recurrences following RFCA of PersAF. Compared to standard AI guided ablation, vHPSD protocol significantly reduces procedural time and fluoroscopy exposure. Clinical outcomes between the two protocols are similar.Figure 1
Abstract Aims This study sought to examine the efficacy of radiofrequency catheter ablation (RFCA) for premature ventricular complexes (PVCs) originating from the outflow tracts. The investigation ...utilized the QDOT MICRO™ (QDOT) catheter, known for enabling a temperature-controlled ablation strategy. Methods and results The study began in November 2022 at a single center. All patients (n=100, 57% male, mean age 49±18) were prospectively and consecutively enrolled and underwent PVCs ablation with QDOT-MICRO™ catheter. The procedural and efficacy data of the study population were compared with those of a control group composed of a cohort of 100 propensity score-matched patients who underwent the same procedure with the ThermoCool® SmartTouch® Catheter using the Ablation Index strategy. Acute procedural success was defined as the elimination of the targeted PVCs at the termination of the procedure. Clinical success was defined as at least an 80% decrease in PVCs burden. Follow-up visits with 24- to 48-h Holter monitoring were performed at baseline and 1, 3, and every 3 months thereafter. Both patients with follow-up <6 months and non-outflow tracts PVCs were excluded. In the study cohort, the average PVCs burden was 21,13% (IQR: 12,50, 24,44) and the RVOT PVCs were 58% (n=58). The mean procedure and fluoroscopy times were 113±103 and 18±15, respectively, and significantly differ between both groups (p=0.02 and p<0.001, respectively). Signals detected by the microelectrodes at the effective site of ablation differed significantly from those recorded by the standard bipolar electrodes (p<0.001). No major complication occurred during the procedures, and there was no procedure-related mortality. The freedom from PVCs recurrences was 86% in the QDOT group and 84% in the STSF group.Freedom from PVCs recurrences at a mean follow-up of 11.5±1.6 months did not significantly differ between both groups (86% vs 84%, respectively; p=0.65). Conclusion This study suggests that RFCA using the QDOT MICRO™ catheter is not only effective but also comparable to the standard approach for treating outflow tract PVCs. Moreover, the study highlights shorter fluoroscopy and procedure times, reinforcing the catheter's efficiency and safety. The use of microelectrodes proved beneficial in enhancing precision in RF delivery.
During climacteric the reduction or interruption of estrogenic stimulus determines a gradual atrophy of the tissues of the urogenital tract.Vulvovaginal atrophy can be cause of dryness, itch, ...burning, and dyspareunia. Vulvovaginal atrophy is associated also with depression. Hence the importance of an appropriate treatment of the vulvovaginal atrophy. Between therapeutic options we can add, particularly for women who suffer only from vaginal symptoms, the spa therapy that uses mineral waters with benefic effects on vaginal tissue wellness and health. On the basis of considerations described above and on the insufficient literature data, the objective of our single-arm pilot study has been to evaluate, in women suffering from vulvovaginal atrophy, the effects and safety of a vaginal douching cycle with sulphurous mineral water and impact on depression disorder frequently observed.
The study was conducted on 24 women affected by vulvovaginal atrophy; mean age:57±11 years; age range:42-81 years. The subjects were treated, for 2 weeks, with sulphurous vaginal douching from Terme of Telese S.p.A. (Benevento-Italy). At the beginning and at the end of the SPA treatment the following symptoms were evaluated: dryness, burning, itch, dyspareunia and leucorrhoea (using VAS scale); the impact on psychological distress (using S.D.S. Zung-test).
At the end of the spa treatment, the mean values±SD, compared to baseline, have showed a significant (p<0.05) reduction in leucorrhoea (-88%), in vulvar itch (-79%), in vaginal burning (-71%), in vaginal dryness (-65%) with an improvement of psichological distress as demonstrated by S.D.S. Zung-test.
The data of this single-arm pilot clinical trial show that the sulphurous vaginal douching cycle can be considered very useful in women suffering from vulvovaginal atrophy with improving of the quality of life and social relationship.
Technologies are difficult to assess in an early stage of development. A comparison between innovative and conventional technologies is often complex due to differences in scale (large-scale with ...several 100 t/d vs. demonstrator-scale with less than 100kg/d) and subsequent efficiency. A methodology is implemented using Key Performance Indicators (KPIs) enhanced by Life Cycle Assessment (LCA) aspects and incorporating industrial principles for technology assessment. The methodology is applied to identify the trade-off between direct and indirect emissions and to evaluate scale dependency with focus on energy and broader sustainability. The applicability is illustrated for glass and ceramic frits production and supported by experimental data for conventionally and innovatively heated processes.
Nearly a quarter of the energy consumption of Europe is required for industrial processes. Huge efficiency potentials can be exploited. One such is under research within the EU funded project DAPhNE ...by developing an integrated solution for energy intensive firing processes with microwave technologies. A methodology towards the preliminary definition of Key Performance Indicators (KPIs) with focus on economical, environmental and operational aspects is presented within this paper. By means of lab-scale measurements, the preliminary selected KPIs are determined and benchmarked against conventional KPIs to develop an eco-efficient production system. Moreover life cycle assessment (LCA) results support the evaluation and quantify the environmental benefits of microwave heating. Lab-scale results indicate a high carbon emission reduction potential.
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