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ZAMPIERON A., BUJA A., DORIGO M., BONSO O. & CORSO M. (2012) A comparison of student motivation in selecting bachelors of nursing or paediatric nursing at an Italian university. International Nursing Review Aim: To investigate students' reasons for choosing general or paediatric nursing, and to compare motivation factors and personal characteristics between the two professions. Background: In Italy, nursing students can choose between two distinct career paths: general and paediatric nursing. However, it is unclear what factors motivate a student to choose between these two pathways. Methods: A cross-sectional approach was used to compare a sample of general and paediatric nursing students enrolled in a university in northeast Italy. We administered a questionnaire that covered socio-demographic characteristics and included an instrument of motivation developed by Zysberg & Berry to 224 students enrolled in the 3-year classes. Results: We analysed 215 questionnaires (96%). Paediatric nurses were generally younger, had attended a college preparatory high school and had previously failed another university programme. Many students, in both groups, had a relative who was a nurse, or had cared for a sick friend or family member. Students did not vary significantly in how they evaluated items included in the questionnaire. Conclusion: A career in nursing should be advised for students who are motivated to help other people. Paediatric nursing was identified as an acceptable career choice by students of college preparatory high schools or by students who had initially enrolled in a different university programme. General nursing was a satisfactory choice by students with previous work experience. [ABSTRACT FROM AUTHOR]

MVI Block vs Trigger Ablation in PMFL. Introduction: Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimitral flutter (PMFL). These arrhythmias are usually triggered from sources that may also induce AF. This study aims at determining whether ablation of triggers or completing mitral valve isthmus (MVI) block prevents more arrhythmia recurrences. Methods and Results: Sixty-five patients with recurrent PMFL after initial ablation of long standing persistent AF were included in this study. Thirty-two patients were randomized to MVI ablation only (Group 1) and 33 were randomized to cardioversion and repeat pulmonary vein (PV) isolation plus ablation of non-PV triggers (Group 2). MVI bidirectional block was achieved in all but 1 patient from Group 1. In Group 2, reconnection of 17 PVs was detected in 14 patients (42%). With isoproterenol challenge, 44 non-PV trigger sites were identified in 28 patients (85%, 1.57 sites per patient). At 18-month follow-up, 27 patients (84%) from Group 1 had recurrent atrial tachyarrhythmias, of whom 15 remained on antiarrhythmic drug (AAD); however, 28 patients from Group 2 (85%, P < 0.0001 vs Group 1) were free from arrhythmia off AAD. The ablation strategy used in Group 2 was associated with a lower risk of recurrence (hazard ratio = 0.10, 95% CI 0.04-0.28, P < 0.001) and an improved arrhythmia-free survival (log rank P < 0.0001). Conclusion: In patients presenting with PMFL after ablation for longstanding persistent AF, MVI block had limited impact on arrhythmia recurrence. On the other hand, elimination of all PV and non-PV triggers achieved higher freedom from atrial arrhythmias at follow-up. (J Cardiovasc Electrophysiol, Vol. 23, pp. 137-144, February 2012) [ABSTRACT FROM AUTHOR]

Impact of the Systematic Isolation of the Superior Vena Cava. Background: Pulmonary veins (PVs) have been shown to represent the most frequent sites of ectopic beats initiating paroxysmal atrial fibrillation (AF). However, additional non-PV triggers, arising from different areas, have been reported as well. One of the most common non-PV sites described is the superior vena cava. Aims: The purpose of the study was to investigate the impact resulting from the systematic isolation of the superior vena cava (SVCI) in addition to pulmonary vein antrum isolation (PVAI) on the outcome of paroxysmal, persistent, and permanent AF ablation. Methods: A total of 320 consecutive patients who had been referred to our center in order to undergo a first attempt of AF ablation were randomized into 2 groups. Group I (160 patients) underwent PVAI only; Group II (160 patients) underwent PVAI and SVCI. Results: AF was paroxysmal in 134 (46%), persistent in 75 (23%), and permanent in 111 (31%) of said patients. SVCI was performed on 134 of the 160 patients (84%) in Group II. SVC isolation was not performed on the remaining 26 patients either because of phrenic nerve capture or the lack of SVC potentials. Comparison of the outcome data between the 2 groups, after a follow-up of 12 months, revealed a significant difference in total procedural success solely with patients manifesting paroxysmal atrial fibrillation (56/73 [77%] Group I vs. 55/61 [90%] Group II; P = 0.04; OR 2.78). Conclusions: In our study, the strategy of the empiric SVCI in addition to PVAI has improved the outcome of AF ablation solely in patients manifesting paroxysmal AF. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1–5, January 2010) [ABSTRACT FROM AUTHOR]

Introduction: Image integration is used in AF ablation procedures. To maximize the efficacy of image integration, it is essential to obtain good alignment between the electroanatomical map and the 3D image of the heart. In the present study, we compared an ICE-guided landmark registration with an ICE-guided focused endocardial surface registration. Methods and Results: In 20 patients, registration was based on posterior landmarks acquired under ICE guidance (group A); in another 20 matched patients, a new ICE-guided focused endocardial surface registration technique was used (group B). In these latter patients, a single landmark was acquired in the inferior part of the LIPV, and several surface points were recorded in the posterior area of the left PV antrum and around the antra of the right PVs. The mean ablation point-to-CT image distance was calculated in both groups. In group A, the mean landmark point-to-CT image distance was also calculated after adding the surface registration. The mean landmark point-to-CT image distance was 4.62 ± 1.65 mm and increased to 7.66 ± 2.44 mm when surface registration was added. The ablation point-to-CT image distance was significantly shorter in group B (1.73 ± 0.29 mm vs 3 ± 0.99 mm; P < 0.001). Conclusions: This ICE-guided focused endocardial surface registration seems to be superior to landmark registration in achieving a better alignment between the CT/MR image and the electroanatomical map. The concurrent use of standard surface registration may result in rotation of the atrial chamber. [ABSTRACT FROM AUTHOR]

Aims: Catheter ablation is an effective treatment for atrial fibrillation (AF). The outcome of AF ablation in septuagenarians is not clear. Our aim was to evaluate success rate, outcome, and complication rate of AF ablation in septuagenarians. Methods and Results: We collected data from 174 consecutive patients over 75 years of age who underwent AF ablation from 2001 to 2006. AF was paroxysmal in 55%. High-risk CHADS score (≥2) was present in 65% of the population. Over a mean follow-up of 20 ± 14 months, 127 (73%) maintained sinus rhythm (SR) with a single procedure, whereas 47 patients had recurrence of AF. Twenty of them had a second ablation, successful in 16 (80%). Major acute complications included one CVA and one hemothorax (2/194 [1.0%]). During the follow-up, three patients had a CVA within the first 6 weeks after ablation. Warfarin was discontinued in 138 out 143 patients (96%) who maintained SR without AADs with no embolic event occurring over a mean follow-up of 16 ± 12 months. Conclusion: AF ablation is a safe and effective treatment for AF in septuagenarians. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Balloon-based catheters are an emerging technology in catheter ablation for atrial fibrillation, which aim to achieve consistent and rapid ablation encirclement of pulmonary veins (PVs). Recent emphasis has been placed on achieving more proximal electrical isolation within the PV-left atrial (LA) junction. We sought to evaluate the precise anatomic level of PV electrical disconnection with current design balloon-based catheters. METHODS AND RESULTS: Thirteen patients with drug-refractory paroxysmal atrial fibrillation undergoing balloon catheter ablation with the endoscopic laser system (CardioFocus) or the high frequency-focused ultrasound system (ProRhythm) underwent electroanatomic mapping (EAM) of the left atrium. Intracardiac echocardiographic (ICE) imaging was used for visualization of the position of the balloon catheter during energy delivery. Detailed point analysis of the location of electrical disconnection was then documented on EAM and with ICE. Successful electrical isolation was achieved in all 52 PVs. Despite ICE imaging confirming balloon catheter position at the antrum of the PVs, the location of electrical disconnection was demonstrated to be at or near the tubular ostium of the PVs on EAM and on ICE in all patients. CONCLUSION: Current generation balloon-based catheter ablation achieves electrical isolation distal in the LA-PV junction. This may limit the results of such systems in treating nonparoxysmal forms of atrial fibrillation. [ABSTRACT FROM AUTHOR]

Introduction: Phrenic nerve injury (PNI) is a complication that can occur with catheter ablation. Methods: Data from 17 patients with PNI following different catheter ablation techniques were reviewed. PNI was defined as decreased motility (transient) or paralysis (persistent) of the hemi-diaphragm on fluoroscopy or chest X-ray. Patient's recovery was monitored. Normalization of chest images and sniff test would be considered as complete clinical recovery. Results: Out of the 17 PNI patients (16 right, 1 left), 13 (11 persistent, 2 transient) occurred after pulmonary veins isolation with or without superior vena cava ablation. Three patients had persistent PNI after sinus node modification and one other patient experienced PNI after epicardial ventricular tachycardia ablation. Ablation was performed with different energy source including radiofrequency , cryothermal , ultrasound and laser . Patient's symptoms varied broadly from asymptomatic to dyspnea, and even to respiratory insufficiency that required temporary mechanical ventilation support. Two patients with transient PNI resolved immediately after the procedure and the other 15 persistent PNI patients resolved within a mean time of . Conclusions: PNI caused by catheter ablation appears to functionally recover over time regardless of the energy sources used for the procedure. [ABSTRACT FROM AUTHOR]

Embolic Events and Char Formation. Thromboembolic events are important complications of pulmonary vein isolation (PVI) procedures, occurring in up to 2.8% of patients. In this study, we report the incidence of char formation and embolic events with different anticoagulation protocols prospectively changed to reduce such complication.Methods:A total of 785 patients (mean age: 54 years, 83.5% male) underwent catheter-based PVI for treatment of drug refractory, symptomatic atrial fibrillation (AF). PVI was performed utilizing different strategies including radiofrequency (RF) using temperature control energy delivery and RF using intracardiac echocardiography (ICE)-guided power titration. Patients were divided based on the anticoagulation protocol into three groups: in group 1 (194 patients), activation coagulation time (ACT) was maintained between 250 and 300 seconds; in group 2 (180 patients), ACT was maintained between 300 and 350 seconds plus the IV infusion of eptifibatide (135μg/kg bolus+ 0.5μg/kg/min); and in group 3 (411 patients), ACT was maintained between 350 and 400 seconds.Results:Char formation was detected in 69 patients of group 1, 5 of group 2, and 8 of group 3. An embolic event was observed in 7 patients of group 1, 3 of group 2, and 2 of group 3 (P= 0.01; group 1 vs group 3). Higher degree of anticoagulation with heparin was associated with a reduced incidence of embolic events even after removing the patients undergoing ICE-guided ablation (P= 0.04).Conclusion:More aggressive anticoagulation with heparin reduced periprocedural embolic events. The use of platelet inhibition does not have incremental beneficial effect. None of the anticoagulation protocol abolished char formation.(J Cardiovasc Electrophysiol, Vol. 16, pp. 1-6, June 2005) [ABSTRACT FROM AUTHOR]

Discusses the prevention and treatment of iatrogenic postatrial fibrillation ablation left atrial tachycardia/flutter. Outcome and complications of atrial fibrillation; Incidence, clinical characteristics and mechanism of iatrogenic left atrial tachycardia/flutter following atrial fibrillation ablation; Prevention of postablation left atrial tachycardia/flutter.

Pace Mapping of Koch's Triangle in AVNRT. Introduction:Slow pathway (SP) ablation of AV nodal reentrant tachycardia (AVNRT) can be complicated by second- to third-degree AV block. We assessed the usefulness of pace mapping of Koch's triangle in preventing this complication.Methods and Results:Nine hundred nine consecutive patients undergoing radiofrequency ablation of AVNRT were analyzed. Group 1 (n= 487) underwent conventional slow pathway ablation. Group 2 (n= 422) underwent ablation guided by pace mapping of Koch's triangle, which located the anterogradely conducting fast pathway (AFP) based on the shortest St-H interval obtained by stimulating the anteroseptal, midseptal, and posteroseptal aspects of Koch's triangle. In group 2, AFP was anteroseptal in 384 (91%), midseptal in 33 (7.8%), and posteroseptal or absent in 5 (1.2%). In 32 of 33 patients with midseptal AFP, slow pathway ablation was performed strictly in the posteroseptal area. In 4 of 5 patients with posteroseptal or no AFP, retrograde fast pathway was ablated. Two patients refused ablation. Persistent second- to third-degree AV block was induced in 7 (1.4%) of 487 group 1 patients versus 0 (0%) of 422 group 2 patients (P= 0.038). Ablation was successful in all patients in whom ablation was performed.Conclusion:Pace mapping of Koch's triangle identifies patients in whom the AFP is absent or is abnormally close to the slow pathway. In these cases, guiding ablation helps to avoid AV block.(J Cardiovasc Electrophysiol, Vol. 16, pp. 30-35, January 2005) [ABSTRACT FROM AUTHOR]

BERTAGLIA, E.,et al.: Different Clinical Courses and Predictors of Atrial Fibrillation Occurrence After Transisthmic Ablation in Patients with Preablation Lone Atrial Flutter, Coexistent Atrial Fibrillation, and Drug Induced Atrial Flutter. The aim of this prospective study was to compare the long-term follow-up after transisthmic ablation of patients with preablation lone atrial flutter, coexistent AF, and drug induced atrial flutter to determine if postablation AF followed a different clinical course and displayed different predictors in these groups. The study evaluated 357 patients who underwent transisthmic ablation for typical atrial flutter. These were divided into four groups according to their preablation history. Group A included patients with typical atrial flutter and without preablation AF (n= 120, 33.6%). Group B included patients with preablation AF and spontaneous atrial flutter (n= 132, 37.0%). Group C patients had preablation AF and atrial flutter induced by treatment with IC drugs (propafenone or flecainide) (n= 63, 17.6%) Group D included patients with preablation AF and atrial flutter induced by treatment with amiodarone (n= 42, 11.8%). During a mean follow-up of 15.2‡ 10.6 months (range 6–55 months) AF occurred more frequently in groups B (56.1%) and C (57.1%) patients than in groups A (20.8%, P<0.0001) and D (31.0%, P<0.0001) patients. The results of multivariate analysis revealed that different clinical and echocardiographical variables were correlated with postablation AF occurrence in the different groups. Patients with atrial flutter induced by amiodarone have a significantly lower risk of postablation AF than patients with spontaneous atrial flutter and AF, and those with atrial flutter induced by IC drugs. Different clinical and echocardiographical variables predict postablation AF occurrence in different subgroups of patients.(PACE 2004; 27:1507–1512) [ABSTRACT FROM AUTHOR]

Slow pathway ablation in common AVNRT can be complicated by total AV block. When radio frequency energy is delivered to the posterior aspect of the triangle of Koch, total AV block may be the consequence of the absence of anterograde conduction along the fast pathway or of inadvertent damage to a fast pathway abnormally located close to the slow pathway. To localize the anterogradely conducting fast pathway, the triangle of Koch was pacemapped in 72 patients who underwent the ablation of common AVNRT. In all cases, before ablation the St-H interval was calculated by stimulating the anteroseptal (AS), mid-septal (MS), and posteroseptal (PS) aspect of the triangle of Koch at a rate slightly faster than the sinus rate. In all patients, common AVNRT was induced. In 64 (89%) of 72 patients (group A) the shortest St-H interval was recorded on stimulating the AS region. In six (8%) patients (group B) the shortest St-H interval was recorded on stimulating the MS region. Finally, in two (3%) patients (group C) the shortest St-H interval was recorded stimulating in the PS region. In group C, AH interval, calculated on stimulating in the AS region, was significantly longer than in patients of groups A and B (200 ± 99 ms vs 64 ± 18 and 62 ± 3, respectively). In group A, on stimulating in the AS. MS, and PS regions, the AH interval remained costant in all patients. In contrast, in groups B and C on stimulation in the MS and PS regions, AH interval shortened (in group R from 56 it: 8 to 27 ± 37 and 37 ± 14, respectively; in group C from 200 ± 99 to 170 ± 100 and to 137 ± 109, respectively). In groups A and B, a posteroseptal slow pathway, and in group C, an anteroseptal retrograde fast pathway were succesfully ablated without AV block. Pacemapping of the traingle of Koch can help to recognize patients in whom the anterograde conducting fast pathway is abnormally located far from the anteroseptal region or in whom anterograde conduction of the fast pathway is absent. In these cases the risk of AV block can be reduced by performing slow pathway ablation in a site sufficiently far form the site of the anterograde fast pathway or ablating the retrogradely conducting fast pathway. [ABSTRACT FROM AUTHOR]

We tested the hypothesis that in some patients affected by typical AVNRT, successful catheter ablation treatment may be achieved independently of specific measurable electrophysiological modifications of antegrade AV node conducting properties. Standard electrophysiological parameters and comparable antegrade AV node function curves were obtained, before and after successful ablation, in 104 patients (mean age 52 ± 16 years; 69 women and 35 men) affected by the common form of AVNRT. The end point of the ablation procedure was noninducibility of AVNRT and of no more than one echo beat. For the purpose of this study, AV node duality was defined as an increase of ≥ 50 ms in the A2H2 interval in response to a 10 ms decrease of the A1A2 coupling interval. Before ablation, AV node duality was present in 65 patients (62%) and absent in 39 patients (37%). Ablation caused measurable modifications of electrophysiological properties of the AV node in most patients with elicited AV node duality, but not in most patients without demonstrable AV node duality. After ablation, AV node duality persisted in 20 patients who had it before, whereas a new duality that could not be elicited before appeared in 5 patients. During 19 ± 6 months of follow-up, clinical AVNRT recurred in 1 of 45 patients who had disappearance of AV node duality after ablation, in 1 of 34 patients who did not show AV node duality before and after ablation, and in 1 of 20 patients who had persistence of AV node duality after ablation. In conclusion, modifications of antegrade conduction properties of the AV node are not crucial for the cure of AVNRT in many patients. [ABSTRACT FROM AUTHOR]