Background
Relative contraindications to adenosine use have included heart transplant and dipyridamole. We previously demonstrated the safety and efficacy of adenosine‐induced atrioventricular (AV) ...block in healthy young heart transplant recipients while suspending dipyridamole therapy (dual antiplatelet agent). This prospective follow‐up study evaluated the safety and efficacy of adenosine use in the same cohort of heart transplant recipients while on dipyridamole.
Methods
Adenosine was incrementally dosed until AV block occurred (maximum 200 mcg/kg up to 12 mg). The primary outcome was clinically significant asystole (≥12 seconds). Secondary outcomes included maximal adenosine dose, AV block duration, dysrhythmias, and clinical symptoms. Outcomes were compared to the parent study.
Results
Thirty of 39 eligible patients (5‐24 years) were tested. No patient (0%, CI 0%‐8%) experienced clinically significant asystole. AV block occurred in 29/30 patients (97%, CI 86%‐100%). The median dose causing AV block was 50mcg/kg (vs 100 mcg/kg off dipyridamole; P = .011). Seventeen patients (57%, CI 39%‐72%) required less adenosine to achieve AV block on dipyridamole; six (20%) required more. AV block occurred at doses ≥25 mcg/kg in all patients. In pairwise comparison to prior testing off dipyridamole, no significant change occurred in AV block duration, frequency of cardiac ectopy, or incidence of reported symptoms. No atrial fibrillation/flutter occurred.
Conclusions
AV block often occurs at twofold lower adenosine doses in healthy young heart transplant recipients taking oral dipyridamole, compared with previous testing of this cohort off dipyridamole. Results suggest that initial dosing of 25 mcg/kg (maximum 0.8 mg) with stepwise escalation poses low risk of prolonged asystole on dipyridamole.
We examine the influence of moral intuitions on Americans’ divergent attitudes toward Black Lives Matter (BLM) and police. Drawing on Moral Foundations Theory, we hypothesize that individualizing ...moral intuitions that put care and protection of the vulnerable at the center of moral concern (a social justice orientation) lead people to express positive feelings toward BLM and negative feelings toward police, whereas binding moral intuitions that put social stability at the center of moral concern (a social order orientation) lead people to express positive feelings toward police and negative feelings toward BLM. We find strong support for these hypotheses using data from a 2021 YouGov survey of 1,125 U.S. adults including a 100 percent oversample of Black respondents. We also find that belief in systemic racism as a cause of police use of excessive force mediates much of the effects of the moral intuitions measures, except for the association between binding moral intuitions and positive feelings toward police, which is largely direct. Our results provide compelling evidence that moral intuitions play an important role in explaining American's divergent attitudes toward BLM and police.
Hypoplastic left heart syndrome (HLHS) is a severe form of congenital heart disease characterized by underdevelopment of the left heart. There has been no previously defined “classic” ECG pattern in ...a large homogenous population of patients with HLHS. We performed a retrospective review of ECGs from neonates with HLHS from 2001 to 2011 with electrocardiograms available prior to surgical intervention. Eighty-nine neonates met the inclusion criteria and were compared to a control population. HLHS patients had a longer PR interval 108 ± 18 versus 98 ± 11 ms (
p
< 0.05), a wider QRS complex 84 ± 17 versus 54 ± 5 ms (
p
< 0.05), lower voltage S waves in V1 2.0 ± 3.3 versus 5.8 ± 4.6 mm (
p
< 0.001) or absent S waves in V1 52 versus 4 % (
p
< 0.001) and lower voltage R waves in V6 7.8 ± 4.8 versus 9.3 ± 4.2 mm (
p
< 0.05). Patients with HLHS were more likely to have absent Q waves in the lateral precordial leads 78 versus 0 % (
p
< 0.001) and inferior leads 20 versus 1 % (
p
< 0.001) and an abnormal frontal plane QRS axis 26 versus 11 % (
p
< 0.05). HLHS patients were more likely to have a preexcited appearance 11 versus 0 % (
p
= 0.001). Despite these findings, 20 % of patients with HLHS had a normal ECG. Compared to age-matched controls, patients with HLHS were more likely to exhibit a longer PR interval, a wider QRS complex, decreased left-sided forces, an absence of septal Q waves in the inferior and lateral leads, an abnormal frontal plane QRS axis and a preexcited appearance.
Prolongation of the QT interval and development of torsades de pointes are known in patients with complete heart block and profound bradycardia. We report the case of a patient with complete heart ...block and torsades, with long QT seen during a period of junctional tachycardia at a rate faster than the minimum pacemaker rate.
This study sought to demonstrate the feasibility of electromechanical wave imaging (EWI) for localization of accessory pathways (AP) prior to catheter ablation in a pediatric population.
Prediction ...of AP locations in patients with Wolff-Parkinson-White syndrome is currently based on analysis of 12-lead electrocardiography (ECG). In the pediatric population, specific algorithms have been developed to aid in localization, but these can be unreliable. EWI is a noninvasive imaging modality relying on a high frame rate ultrasound sequence capable of visualizing cardiac electromechanical activation.
Pediatric patients with ventricular pre-excitation presenting for catheter ablation were imaged with EWI immediately prior to the start of the procedure. Two clinical pediatric electrophysiologists predicted the location of the AP based on ECG. Both EWI and ECG predictions were blinded to the results of catheter ablation. EWI and ECG localizations were subsequently compared with the site of successful ablation.
Fifteen patients were imaged with EWI. One patient was excluded for poor echocardiographic windows and the inability to image the entire ventricular myocardium. EWI correctly predicted the location of the AP in all 14 patients. ECG analysis correctly predicted 11 of 14 (78.6%) of the AP locations.
EWI was shown to be capable of consistently localizing accessory pathways. EWI predicted the site of successful ablation more frequently than analysis of 12-lead ECG. EWI isochrones also provide anatomical visualization of ventricular pre-excitation. These findings suggest that EWI can predict AP locations, and EWI may have the potential to better inform clinical electrophysiologists prior to catheter ablation procedures.
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Morality is thought to underlie both ideological and punitive attitudes. In particular, moral foundations research suggests that group-oriented moral concerns promote a conservative orientation, ...while individual-oriented moral concerns promote a liberal orientation (Graham, Haidt, & Nosek, 2009). Drawing on classical sociological theory, we argue that endorsement of group-oriented moral concerns also elicits higher levels of punitiveness by promoting a view of crime as being perpetrated against society, while endorsement of individual-oriented moral concerns reduces punitiveness by directing attention toward the welfare of offenders as well as victims. Data from 2 independent samples (N = 1,464 and N = 1,025) showed that endorsement of group-oriented moral concerns was associated with more punitive and more conservative attitudes, while endorsement of individual-oriented moral concerns was associated with less punitive and less conservative attitudes. These results suggest that the association between conservatism and punitiveness is in part spurious because of their grounding in the moral foundations. Consequently, studies that do not take the moral foundations into account are at risk of overstating the relationship between conservatism and punitiveness.
This study sought to describe the electrophysiologic properties and catheter ablation outcomes for atrioventricular reciprocating tacchycardia via twin atrioventricular nodes (T-AVRT).
Although ...catheter ablation for T-AVRT is an established entity, there are few data on the electrophysiological properties and outcomes of this procedure.
An international, multicenter study was conducted to collect retrospective procedural and outcomes data for catheter ablation of T-AVRT.
Fifty-nine patients with T-AVRT were identified (median age at procedure, 8 years interquartile range: 4.4-17.0 years; 49% male). Of these, 55 (93%) were diagnosed with heterotaxy syndrome (right atrial isomerism in 39, left atrial isomerism in 8, and indeterminate in 8). Twenty-three (39%) had undergone Fontan operation (12 extracardiac, 11 lateral tunnel). After the Fontan operation, atrial access was conduit or baffle puncture in 15 (65%), fenestration in 5 (22%), and retrograde in 3 (13%). Acute success was achieved in 43 (91%) of 47 attempts (targeting an anterior node in 23 and posterior node in 24). There was no high-grade AV block or change in QRS duration. Over a median of 3.8 years, there were 3 recurrences. Of 7 patients with failed index procedure or recurrent T-AVRT, 6 (86%) were associated with anatomical hurdles such as prior Fontan or catheter course through an interrupted inferior vena cava–to–azygous vein continuation (P = 0.11).
T-AVRT can be targeted successfully with low risk for recurrence. Complications were rare in this population. Anatomical challenges were common among patients with reduced short and long-term efficacy, representing opportunities for improvement in procedural timing and planning.
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This study examined the relationship between bodily comportment (tattoos and grooming) and the likelihood of going to college among a national sample of 11,010 adolescents gathered as part of the ...National Longitudinal Study of Adolescent Health. Results show that adolescents with tattoos and those judged as poorly groomed by Add Health interviewers were significantly less likely to go to college after graduating from high school. These effects were similar in magnitude to those of other well-known demographic correlates of educational attainment, including family SES and family structure. Results also show that involvement in deviant activities accounted for much of the lower likelihood of going to college among adolescents with tattoos. Similar results were observed across gender, SES, and race groups, with the exception of Asians, for whom the lower likelihood of going to college among those with tattoos was especially pronounced. Overall, this study supports the conclusion that bodily signs constitute an important and relatively untapped source of information for predicting college matriculation among adolescents.
Abstract Introduction Support for anti‐racism policies such as mandatory diversity training and affirmative action varies by race. Research in the racial resentment and symbolic racism traditions ...focuses on whites’ endorsements of stereotypes that blame blacks for their unequal position in society, causing whites to be less supportive of anti‐racism policies. Systemic racism theory suggests an additional hypothesis: People who believe whites are not doing enough to dismantle the systemically racist system that disadvantages blacks and other groups should be more supportive of anti‐racism policies. Methods We examine both hypotheses using data from a national YouGov survey of 1125 U.S. adults gathered in 2021. Results Race differences in support for anti‐racism policies are accounted for by race differences in endorsements of both anti‐black and anti‐white stereotypes. Conclusion Future studies of support for anti‐racism policies should consider the influence of both anti‐black and anti‐white stereotypes.
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