Abstract Background Determining the optimal HV interval cutoff for predicting the need for pacemaker (PM) implantation has been a recent focus of research. Current ESC guidelines recommend HV > 70 ...msec based on initial studies; however, new data suggest that a cutoff of >60 msec could appropriately identify patients at high risk for requiring PM implantation. While previous studies have indicated that women with bundle branch block (BBB) have a lower risk of AV block (AVB), gender differences in the optimal cutoff for considering a positive EPS have not been thoroughly investigated. Methods This cohort study included consecutive patients with unexplained syncope and BBB, enrolled from January 2010 to October 2021, with a median follow-up time of 3 years. Patients underwent a stepwise workup protocol involving an electrophysiological study (EPS) and long-term follow-up with an implantable cardiac monitor (ICM). Results Of the 503 patients in the study, 185 (38%) were women. The median age was 78 years (IQR 71-83), the median LVEF was 58% (IQR 50-62), and 110 (22%) had ischemic heart disease. The ECG showed LBBB in 194 (39%) patients and RBBB in 287 (57%). Among these, 177 (35%) also had left anterior hemiblock. The median HV interval was 60 msec (IQR 52-73), and EPS was diagnostic in 252 (50%) patients, with the majority (221, 44%) for AVB. In 91 patients with initially negative EPS, a diagnosis was made during follow-up with an ICM, and in 35, AVB was documented. In patients with negative EPS, an HV interval >60 msec was associated with an increased risk of AVB during follow-up (HR 2.5, 95% CI 1.6-4). However, significant gender differences were found. The risk of AVB was 2.5 times higher in men (95% CI 1-6) (Figure 1). Furthermore, sensitivity, specificity, PPV, and NPV for the cutoff of 60 msec were 47%/84%/51%/82% in men and 21%/78%/21%/78% in women. The AUC to predict AVB was 0.72 (95% CI 0.6-0.8) in men and 0.51 (95% CI 0.4-0.6) in women (Figure 2). Conclusions In patients with initially negative EPS, an HV interval >60 msec was associated with a higher risk of AVB during follow-up; however, significant gender differences were observed in diagnostic accuracy. In women, a cutoff of HV interval >60 msec presented poor diagnostic accuracy compared to men. Moreover, the HV interval did not adequately predict the development of AVB in women with a basal HV interval <70 msec, suggesting it may not be suitable for considering PM implantation in female patients.FIGURE 1FIGURE 2
Abstract Introduction Patients with D- transposition of the great arteries (TGA) treated with Senning or Mustard surgeries have high incidence of supraventricular tachycardias (SVTs). Accessing to ...the pulmonary venous atrium (PVAt) is frequently required to perform the ablation, however it can be challenging. Aim To investigate the differences between a retrograde aortic approach (Re-Aa) and transbaffle approach (TBa) for PVAt ablation in this set of patients. Methods Prospective observational study in a third level hospital since April 2018 until October 2022, with a medium-term follow-up. All consecutive patients (pt) with history of SVT and atrial switch surgery that underwent electrophysiologic study (EP) and electroanatomic mapping using a high-density Grid mapping catheter and a contact-force ablation catheter were included. Results A total of 25 EPs were performed in 20 pt (13 (52%) Female, median age 37 y.o IQR 34-41, median follow-up time 13 month IQR 10-37). In 14 pt the PVAt was mapped and ablated via Re-Aa, and in 11 with TBa. Table 1 shows basal patients characteristics, note that no significant differences between groups were found. In 19 pt (76%) a CTI-dependent flutter was documented (10 (71%) in Re-Aa group and 9 (82%) in TBa, p=0.6). Furthermore, in 7 pt other tachycardia circuits were found. Accurate mapping of all the CTI walls were achieved with both strategies, however, the posterior PVAt wall and the pulmonary veins were suboptimal mapped with Re-Aa due to a lack of catheter contact. Acute ablation success was 83% in Re-Aa and 100% in TBa (p=0.5). Despite a higher recurrence rate in the Re-Aa in the first months (20% vs 0%), no significant differences in recurrences were found between groups within 1 year of follow-up (HR 1.3 95%CI: 0,2-7, p=0.8) (FIGURE). Complication rate was 20% in Re-Aa and 0% in TBa. All complications were directly related to the arterial vascular access (1 femoral pseudoaneurysm, 1 iliac dissection, 1 mediastinal hematoma), and were successfully treated. Conclusion In D-TGA treated with atrial switch surgery, PVAt mapping and ablation is feasible with both strategies with a high acute success rate and without significant differences in recurrences at mid-term follow up. However, TBa is associated with a lower complications rate and also with a better catheter contact and accurate mapping in the PVAt posterior wall.
Background: The electromagnetic form factors of the proton measured by unpolarized and polarized electron scattering experiments show a significant disagreement that grows with the squared four ...momentum transfer (Q2). Calculations have shown that the two measurements can be largely reconciled by accounting for the contributions of two-photon exchange (TPE). TPE effects are not typically included in the standard set of radiative corrections since theoretical calculations of the TPE effects are highly model dependent, and, until recently, no direct evidence of significant TPE effects has been observed. Purpose: We measured the ratio of positron-proton to electron-proton elastic-scattering cross sections in order to determine the TPE contribution to elastic electron-proton scattering and thereby resolve the proton electric form factor discrepancy. Methods: We produced a mixed simultaneous electron-positron beam in Jefferson Lab's Hall B by passing the 5.6 GeV primary electron beam through a radiator to produce a bremsstrahlung photon beam and then passing the photon beam through a convertor to produce electron/positron pairs. The mixed electron-positron (lepton) beam with useful energies from approximately 0.85 to 3.5 GeV then struck a 30-cm long liquid hydrogen (LH2) target located within the CEBAF Large Acceptance Spectrometer (CLAS). By detecting both the scattered leptons and the recoiling protons we identified and reconstructed elastic scattering events and determined the incident lepton energy. A detailed description of the experiment is presented. Results: We present previously unpublished results for the quantity R2γ, the TPE correction to the elastic- scattering cross section, at Q2 ≈ 0:85 and 1.45 GeV2 over a large range of virtual photon polarization ε. Conclusions: Our results, along with recently published results from VEPP-3, demonstrate a non-zero contribution from TPE effects and are in excellent agreement with the calculations that include TPE effects and largely reconcile the form-factor discrepancy up to Q2 ≈ 2 GeV2. These data are consistent with an increase in R2γ with decreasing " at Q2 ≈ 0:85 and 1.45 GeV2. There are indications of a slight increase in R2γ with Q2.
Abstract
INTRODUCTION
Cardiac implantable electronic device (CIED) infection is a severe disease with an increasing incidence due to the rise in the number of CIEDs implanted world-wide. Complete ...hardware removal is the treatment of choice, but there is little clinical data about the best antimicrobial strategy, such as the best choice of antibiotics, treatment duration and when to switch to oral administration in cases of local CIED infections.
PURPOSE
In 2013, we designed a new protocol for CIED infection management, by which local infections were treated with complete hardware removal followed by empiric parenteral antibiotic during the first 72h, which was replaced to an oral agent (in case of negative blood cultures) and continued for 10 days. The oral antibiotic was selected according to the local cultures when positive, or to Clindamicin, Levofloxacin or Cotrimoxazole when no germ was identified. Our purpose is to describe our experience and results after the implementation of this strategy.
METHODS
We retrospectively reviewed all consecutive local CIED infection cases from the implementation of the protocol until September 2019, and evaluated the population characteristics, type of infection, rate of positive cultures and outcomes.
RESULTS
We identified 74 cases of CIED infection, of which 46 (62%) were local. The average age of this population was 75.3 ± 13.2 yo and 65% (30) were male. The predominant comorbidities were diabetes (41%), congestive heart failure (30%), and malignancies (22%). Eighteen patients (39%) had previous local infection treated medically without hardware removal. Mean number of previous procedures was 2.65 ± 1.8, and 34 (74%) of the devices were pacemakers (single and dual chamber), 5 (11%) ICDs, 6 (13%)CRT-P and 1 (2%) CRT-D. Blood cultures were negative in all cases, whereas local cultures (exudate or intraoperative tissue) were positive in 32 (70%). The most frequent microorganisms were Staphylococcus epidermidis in 18 (56%) and Staphylococcus aureus in 8 (25%), including 1 case of meticillin-resistance. Intravenous Vancomycin was administered in all cases during 72 h, followed by oral antibiotics for a mean duration of 8.8 ± 3.3 days. Hardware removal was intended in all cases, with complete or clinical success in 42 and 3 cases respectively (global success rate 97.8%), and in one case (2.2%) an epicardial lead was not removed. During a mean follow-up of 30 months, 1 infection-related death occurred (2%) due to a side effect of intravenous antibiotic therapy, and there was 1 infection relapse (2%) in the only patient without complete hardware removal, related to the remnant epicardial lead.
CONCLUSIONS
Oral antimicrobial treatment with good bioavailability agents, associated with complete hardware removal is an effective strategy for the management of local CIED infections, with a low recurrence rate, and avoiding long hospitalizations and potential side effects of intravenous antibiotic therapy.
In this study, we present the final results for the deuteron spin structure functions obtained from the full data set collected with Jefferson Lab's CLAS in 2000-2001. Polarized electrons with ...energies of 1.6, 2.5, 4.2 and 5.8 GeV were scattered from deuteron (15ND3) targets, dynamically polarized along the beam direction, and detected with CLAS. From the measured double spin asymmetry, the virtual photon absorption asymmetry Ad1 and the polarized structure function gd1 were extracted over a wide kinematic range (0.05 GeV2 < Q2 < 5 GeV2 and 0.9 GeV < W < 3 GeV). We use an unfolding procedure and a parametrization of the corresponding proton results to extract from these data the polarized structure functions An1 and g1n of the (bound) neutron, which are so far unknown in the resonance region, W < 2 GeV. We compare our final results, including several moments of the deuteron and neutron spin structure functions, with various theoretical models and expectations as well as parametrizations of the world data. The unprecedented precision and dense kinematic coverage of these data can aid in future extractions of polarized parton distributions, tests of perturbative QCD predictions for the quark polarization at large x, a better understanding of quark-hadron duality, and more precise values for higher-twist matrix elements in the framework of the Operator Product Expansion.
Photoproduction of the f1(1285) meson Schumacher, Reinhard A.; Adhikari, K. P.; Akbar, Z. ...
Physical review. C,
06/2016, Volume:
93, Issue:
6
Journal Article
Peer reviewed
Open access
The $f_1(1285)$ meson with mass $1281.0 \pm 0.8$ MeV/$c^2$ and width $18.4 \pm 1.4$ MeV (FWHM) was measured for the first time in photoproduction from a proton target using CLAS at Jefferson Lab. ...Differential cross sections were obtained via the $\eta\pi^{+}\pi^{-}$, $K^+\bar{K}^0\pi^-$, and $K^-K^0\pi^+$ decay channels from threshold up to a center-of-mass energy of 2.8 GeV. The mass, width, and an amplitude analysis of the $\eta\pi^{+}\pi^{-}$ final-state Dalitz distribution are consistent with the axial-vector $J^P=1^+$ $f_1(1285)$ identity, rather than the pseudoscalar $0^-$ $\eta(1295)$. The production mechanism is more consistent with $s$-channel decay of a high-mass $N^*$ state, and not with $t$-channel meson exchange. Decays to $\eta\pi\pi$ go dominantly via the intermediate $a_0^\pm(980)\pi^\mp$ states, with the branching ratio $\Gamma(a_0\pi \text{ (no} \bar{K} K\text{)}) / \Gamma(\eta\pi\pi \text{(all)}) = 0.74\pm0.09$. The branching ratios $\Gamma(K \bar{K} \pi)/\Gamma(\eta\pi\pi) = 0.216\pm0.033$ and $\Gamma(\gamma\rho^0)/\Gamma(\eta\pi\pi) = 0.047\pm0.018$ were also obtained. The first is in agreement with previous data for the $f_1(1285)$, while the latter is lower than the world average.
Results are presented for the first measurement of the double-polarization helicity asymmetry E for the η photoproduction reaction γp→ηp. Data were obtained using the FROzen Spin Target (FROST) with ...the CLAS spectrometer in Hall B at Jefferson Lab, covering a range of center-of-mass energy W from threshold to 2.15 GeV and a large range in center-of-mass polar angle. As an initial application of these data, the results have been incorporated into the Jülich–Bonn model to examine the case for the existence of a narrow N⁎ resonance between 1.66 and 1.70 GeV. The addition of these data to the world database results in marked changes in the predictions for the E observable from that model. Further comparison with several theoretical approaches indicates these data will significantly enhance our understanding of nucleon resonances.
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