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To investigate the relationship between epicardial adipose tissue (EAT) volume and distribution and the parameters of global cardiac and regional left atrial (LA) sympathetic activity in patients with atrial fibrillation (AF). The data of the 45 consecutive patients scheduled for an index catheter ablation (CA) for AF were analyzed. Total and peri-atrial EAT volumes were measured by cardiac CT. Parameters of global cardiac sympathetic activity and discrete sympathetic regions around LA were assessed by 123I-mIBG SPECT/CT. The patients were followed up for AF recurrences assessment during 12 months after CA. A total of 133 (mean per patient 2.96 ± 1.07) discrete 123I-mIBG uptake areas (DUAs), corresponding to typical anatomical locations of LA ganglionated plexi (GP), were identified. Peri-atrial EAT volume was associated with the number of DUAs (regression estimate, 5.1 [95% CI, 0.3–9.9], p = 0.03). There was no statistically significant association between either total or peri-atrial EAT volumes and risks of AF recurrence. The washout rate (WR) was associated with reduced risk of AF recurrence (HR = 0.95; 95% CI 0.92–0.99; p = 0.01), while left ventricular (LV) myocardium 123I-mIBG summed defect score (SDS) was linked to increased hazards of AF recurrence (HR = 1.04; 95% CI 1.01–1.08; p = 0.03). Peri-atrial EAT volume is associated with regions of sympathetic activity corresponding to typical anatomical locations of LA GP. The WR was associated with reduced risk of AF recurrence while LV myocardial SDS was linked to increased hazards of AF recurrence.

Objectives This study sought to determine the impact of adjunctive renal sympathetic denervation to catheter ablation in patients with atrial fibrillation (AF) and history of hypertension. Background There are limited data regarding the impact of upstream adjunctive renal sympathetic denervation (RSDN) to pulmonary vein isolation (PVI) in patients with symptomatic atrial fibrillation (AF) and hypertension. Methods The data for this study were obtained from 2 prospective randomized pilot studies, the HFIB (Adjunctive Renal Denervation to Modify Hypertension and Sympathetic tone as Upstream Therapy in the Treatment of Atrial Fibrillation)-1 (n = 30) and HFIB (Adjunctive Renal Denervation to Modify Hypertension and Sympathetic tone as Upstream Therapy in the Treatment of Atrial Fibrillation)-2 (n = 50) studies, and we performed a meta-analysis including all published studies comparing RSDN+PVI versus PVI alone up to January 25, 2020, in patients with AF and hypertension. Results At 24 months, AF recurrence occurred in 53% and 38% in the PVI and PVI+RSDN groups (p = 0.43) in the HFIB-1 study, respectively, and 27% and 25% in the PVI and PVI+RSDN groups (p = 0.80) in the HFIB-2 study, respectively. When combined in a meta-analysis including 6 studies (n = 725), adjunctive RSDN significantly decreased the risk of AF recurrence (risk ratio [RR]: 0.68; 95% confidence interval [CI]: 0.55 to 0.83; p = 0.0002; I2 = 0%) when compared with PVI. Six renal artery complications occurred in the HFIB-1 study and none occurred in the HFIB-2 study with RSDN. However, in the meta-analysis, there were no significant differences in overall complications between both groups (RR: 1.43; 95% CI: 0.63 to 3.22; p = 0.40; I2 = 7%). When compared with baseline, RDSN significantly reduced the systolic blood pressure (–12.1 mm Hg; 95% CI: –20.9 to –3.3 mm Hg; p Conclusions The pilot HFIB-1 and HFIB-2 studies did not demonstrate a benefit with RSDN as an adjunctive upstream therapy during PVI. However, in the meta-analysis, adjunctive RSDN to PVI appears to be safe, and improves clinical outcomes in AF patients with a history of hypertension.

Purpose. This multicenter, prospective registry evaluated the comparative safety and efficacy of left atrial appendage occlusion (LAAO) using the Watchman device (WD) and the Amplatzer Cardiac Plug (ACP) in patients with nonvalvular atrial fibrillation (NVAF) in real-world clinical practice in Russia. Methods. The study included data from 200 consecutive NVAF patients (66.8±7.8years, 44.5% female, median CHA2DS2VASc 4, median HAS-BLED 3) who had undergone LAAO implantation using WD (n=108) or ACP (n=92) from September 2015 to December 2017 in 5 medical centers in Russia. The primary safety endpoint was the procedure-related major adverse events, and the primary efficacy endpoint was the composite of thromboembolic events, device thrombosis, hemorrhagic events, and unexplained death during the 12-month follow-up. Results. Successful LAAO was performed in all 92 (100%) patients with ACP and 105 (97.2%) with WD (p=0.053). At 12 months, primary safety endpoint occurred in 6.5% of patients in the ACP group with no events in the WD group (6.5% vs. 0%,p=0.008). During the 12-month follow-up, the primary efficacy endpoint has occurred in 8.3% of patients in the WD group (n=9) and 1.1% of patients in the ACP group (n=1) (p=0.016). Conclusions. In this multicenter prospective registry, LAA closure with the WD was associated with significantly higher thromboembolic events rate in NVAF patients. Patients, receiving the ACP, had more procedure-related major adverse events. However, further multicenter studies are necessary to evaluate these findings.

Oral anticoagulation reduces the ischemic stroke risk in patients with nonvalvular atrial fibrillation (NVAF) but inherently increases the bleeding risk. Percutaneous left atrial appendage occlusio...

Remote magnetic navigation (RMN) can be safely and effectively utilized in patients with difficult cardiac arrhythmias and complex anatomy. Interruption of the inferior vena cava (IVC) is a rare congenital abnormality that results in the inability to use conventional femoral access in patients that require interventional procedures. The present case demonstrates the feasibility of left atrial flutter (LA) ablation using RMN via jugular approach in a patient with interruption of IVC. This article is protected by copyright. All rights reserved

OBJECTIVEIntracerebral convection-enhanced delivery (CED) has been limited to short durations due to a reliance on externalized catheters. Preclinical studies investigating topotecan (TPT) CED for glioma have suggested that prolonged infusion improves survival. Internalized pump-catheter systems may facilitate chronic infusion. The authors describe the safety and utility of long-term TPT CED in a porcine model and correlation of drug distribution through coinfusion of gadolinium.METHODSFully internalized CED pump-catheter systems were implanted in 12 pigs. Infusion algorithms featuring variable infusion schedules, flow rates, and concentrations of a mixture of TPT and gadolinium were characterized over increasing intervals from 4 to 32 days. Therapy distribution was measured using gadolinium signal on MRI as a surrogate. A 9-point neurobehavioral scale (NBS) was used to identify side effects.RESULTSAll animals tolerated infusion without serious adverse events. The average NBS score was 8.99. The average maximum volume of distribution (Vdmax) in chronically infused animals was 11.30 mL and represented 32.73% of the ipsilateral cerebral hemispheric volume. Vdmax was achieved early during infusions and remained relatively stable despite a slight decline as the infusion reached steady state. Novel tissue TPT concentrations measured by liquid chromatography mass spectroscopy correlated with gadolinium signal intensity on MRI (p = 0.0078).CONCLUSIONSProlonged TPT-gadolinium CED via an internalized system is safe and well tolerated and can achieve a large Vdmax, as well as maintain a stable Vd for up to 32 days. Gadolinium provides an identifiable surrogate for measuring drug distribution. Extended CED is potentially a broadly applicable and safe therapeutic option in select patients.

Background Pulmonary artery denervation (PADN) procedure has not been applied to patients with residual chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary endarterectomy (PEA). Objectives This study sought to assess the safety and efficacy of PADN using remote magnetic navigation in patients with residual CTEPH after PEA. Methods Fifty patients with residual CTEPH despite medical therapy at least 6 months after PEA, who had mean pulmonary artery pressure ≥25 mm Hg or pulmonary vascular resistance (PVR) > 400 dyn‧s‧cm−5 based on right heart catheterization were randomized to treatment with PADN (PADN group; n = 25) using remote magnetic navigation for ablation or medical therapy with riociguat (MED group; n = 25). In the MED group, a sham procedure with mapping but no ablation was performed. The primary endpoint was PVR at 12 months after randomization. Key secondary endpoint included 6-min walk test. Results After PADN procedure, 2 patients (1 in each group) developed groin hematoma that resolved without any consequences. At 12 months, mean PVR reduction was 258 ± 135 dyn‧s‧cm−5 in the PADN group versus 149 ± 73 dyn‧s‧cm−5 in the MED group, mean between-group difference was 109 dyn‧s‧cm−5 (95% confidence interval: 45 to 171; p = 0.001). The 6-min walk test distance was significantly increased in the PADN group as compared to distance in the MED group (470 ± 84 m vs. 399 ± 116 m, respectively; p = 0.03). Conclusions PADN in patients with residual CTEPH resulted in substantial reduction of PVR at 12 months of follow-up, accompanied by improved 6-min walk test.

Patients awaiting lung transplantation face high wait-list mortality, as injury precludes the use of most donor lungs. Although ex vivo lung perfusion (EVLP) is able to recover marginal quality donor lungs, extension of normothermic support beyond 6 h has been challenging. Here we demonstrate that acutely injured human lungs declined for transplantation, including a lung that failed to recover on EVLP, can be recovered by cross-circulation of whole blood between explanted human lungs and a Yorkshire swine. This xenogeneic platform provided explanted human lungs a supportive, physiologic milieu and systemic regulation that resulted in functional and histological recovery after 24 h of normothermic support. Our findings suggest that cross-circulation can serve as a complementary approach to clinical EVLP to recover injured donor lungs that could not otherwise be utilized for transplantation, as well as a translational research platform for immunomodulation and advanced organ bioengineering. In a new strategy for increasing the availability of lungs for transplantation, human lungs declined for transplantation because of their poor quality can be recuperated by connecting them to the circulation of a pig.

Catheter navigation and 3-dimensional (3D) cardiac mapping are essential components of minimally invasive electrophysiological procedures.The purpose of this study was to develop a novel 3D mapping system (KODEX - EPD, EPD Solutions, Best, The Netherlands) that measures changing electric field gradients induced on intracardiac electrodes to enable catheter localization and real-time 3D cardiac mapping.We first validated the accuracy of the system's measurement and localization capabilities by comparing known and KODEX - EPD-measured distances and locations at 12 anatomical landmarks in both the atria and ventricles of 4 swine. Next, in vivo images of 3D porcine cardiac anatomy generated by KODEX - EPD and widely used CARTO 3 system (Biosense Webster, Inc., Diamond Bar, CA) were compared with gold standard computed tomography images acquired from the same animals. Finally, 3D maps of atrial anatomy were created for 22 patients with paroxysmal atrial fibrillation (Dielectric Unravelling of Radiofrequency ABLation Effectiveness trial).First, the mean error between known and measured distances was 1.08 ± 0.11 mm (P.01) and the overall standard deviation between known and measured locations in 12 areas of the porcine heart was 0.35 mm (P.01). Second, an expert comparison of 3D image quality revealed that KODEX - EPD is noninferior to CARTO 3. Third, the system enabled 3D imaging of atrial anatomy in humans, provided real-time images of atrioventricular valves, and detected important anatomical variations in a subset of patients.The KODEX - EPD system is a novel 3D mapping system that accurately detects catheter location and can generate high-resolution images without the need for preacquired imaging, specialty catheters, or a point-by-point mapping procedure.

The paper is devoted to the analysis of the problem of determining the source code author , which is of interest to researchers in the field of information security, computer forensics, assessment of the quality of the educational process, protection of intellectual property. The paper presents a detailed analysis of modern solutions to the problem. The authors suggest two new identification techniques based on machine learning algorithms: support vector machine, fast correlation filter and informative features; the technique based on hybrid convolutional recurrent neural network. The experimental database includes samples of source codes written in Java, C ++, Python, PHP, JavaScript, C, C # and Ruby. The data was obtained using a web service for hosting IT-projects – Github. The total number of source codes exceeds 150 thousand samples. The average length of each of them is 850 characters. The case size is 542 authors. The experiments were conducted with source codes written in the most popular programming languages. Accuracy of the developed techniques for different numbers of authors was assessed using 10-fold cross-validation. An additional series of experiments was conducted with the number of authors from 2 to 50 for the most popular Java programming language. The graphs of the relationship between identification accuracy and case size are plotted. The analysis of result showed that the method based on hybrid neural network gives 97% accuracy, and it’s at the present time the best-known result. The technique based on the support vector machine made it possible to achieve 96% accuracy. The difference between the results of the hybrid neural network and the support vector machine was approximately 5%.

Background Expression of the Receptor for Advanced Glycation Endproducts (RAGE) initiates pro-inflammatory pathways resulting in lung destruction. We hypothesized that RAGE directed imaging demonstrates increased lung uptake in smoke-exposure. Methods After exposure to room air or to cigarette smoke for 4-weeks or 16-weeks, rabbits were injected with 99mTc-anti-RAGE F(ab’)2 and underwent Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) imaging. Lung radiotracer uptake was calculated as percent injected dose (%ID). Lungs were dissected for gamma well counting and histological analysis. Results 99mTc-anti-RAGE F(ab’)2 SPECT/CT imaging demonstrated increased lung expression of RAGE with smoke exposure compared to room air control at 4-weeks: Room air right (R) 0.75 ± 0.38%ID, left (L) 0.62 ± 0.32%ID vs. Smoke exposed R 0.17 ± 0.03, L 0.17 ± 0.02%ID (p = 0.02 and 0.028, respectively). By 16-weeks of smoke exposure, the uptake decreased to 0.19 ± 0.05%ID R and 0.17 ± 0.05%ID L, significantly lower than 4-week imaging (p = 0.0076 and 0.0129 respectively). Staining for RAGE confirmed SPECT results, with the RAGE ligand HMGB1 upregulated in the macrophages of 4-week smoke-exposed rabbits. Conclusions RAGE-directed imaging identified pulmonary RAGE expression acutely in vivo in an animal model of emphysema early after smoke exposure, with diminution over time. These studies document the extent and time course of RAGE expression under smoke exposure conditions and could be utilized for disease monitoring and examining response to future RAGE-targeted therapies. Electronic supplementary material The online version of this article (10.1186/s12931-019-1064-4) contains supplementary material, which is available to authorized users.

The number of available donor organs limits lung transplantation, the only lifesaving therapy for the increasing population of patients with end-stage lung disease. A prevalent etiology of injury that renders lungs unacceptable for transplantation is gastric aspiration, a deleterious insult to the pulmonary epithelium. Currently, severely damaged donor lungs cannot be salvaged with existing devices or methods. Here we report the regeneration of severely damaged lungs repaired to meet transplantation criteria by utilizing an interventional cross-circulation platform in a clinically relevant swine model of gastric aspiration injury. Enabled by cross-circulation with a living swine, prolonged extracorporeal support of damaged lungs results in significant improvements in lung function, cellular regeneration, and the development of diagnostic tools for non-invasive organ evaluation and repair. We therefore propose that the use of an interventional cross-circulation platform could enable recovery of otherwise unsalvageable lungs and thus expand the donor organ pool., Gastric aspiration severely injures donor lungs, frequently making them unacceptable for transplantation. Here the authors show that an interventional cross-circulation platform enables the regeneration of severely damaged lungs in a swine model of gastric aspiration injury.

Introduction: A novel cardiac gamma camera utilizes the radiopharmaceutical Iodine-123-Meta-iodobenzylguanidine (123I-MIBG) to visualize cardiac sympathetic innervation. Physiological accumulation of123I-mIBG provides an anatomical quantitative determination of the structures of the autonomic nervous system (ANS) with discrete uptake areas (DUA) of sympathetic activity located in the left atrium (LA) corresponding to the main ganglionic plexi (GP) clusters that could not previously be visualized.Aim: to visualize the DUA of the heart in patients with paroxysmal atrial fibrillation (AF) and to assess the effect of radiofrequency ablation (RFA) on DUA in LA.Materials and Methods. Computed tomography (CT) of the heart and radionuclide imaging with123I-mIBG were performed in 15 patients with paroxysmal AF. The results of the study were combined with preliminary taken CT images to create a detailed anatomical map of the sympathetic activity of the heart. The processed images were combined with the 3D reconstruction of the LA, obtained with the navigation system (CARTO 3, CARTO RMT). In DUA, high-frequency stimulation (HFS) followed by RF ablation was performed using the current recommended parameters.Results. Forty-eight DUA (median 3 [3; 3]) were identified. Average activity of DUA was 1315 [1171; 1462] cnt / sec / ml. Positive response to HFS in the DUA was obtained in 8 (53.3 %) patients. Prior to ablation, no response was received to HFS in areas of LA outside the DUA. After ablation, there was no response to HFS in the DUA sites. At repeated scans 3 DUA (median 0 [0; 0]; pConclusion. In patients with AF, the areas of sympathetic activity in LA can be visualized by physiological localized uptake of123I-mIBG. Radiofrequency catheter ablation can target the identified sympathetic innervation structures in AF patients precisely and effectively.

ObjectivesThe association between obesity and atrial fibrillation (AF) is well-established. We aimed to evaluate the impact of index body mass index (BMI) on AF recurrence at 12 months following catheter ablation using propensity-weighted analysis. In addition, periprocedural complications and fluoroscopy details were examined to assess overall safety in relationship to increasing BMI ranges.MethodsBaseline, periprocedural and follow-up data were collected on consecutive patients scheduled for AF ablation. There were no specific exclusion criteria. Patients were categorised according to baseline BMI in order to assess the outcomes for each category.ResultsAmong 3333 patients, 728 (21.8%) were classified as normal (BMI 2), 1537 (46.1%) as overweight (BMI 25.5–29.0 kg/m2) and 1068 (32.0%) as obese (BMI ≥30.0 kg/m2). Procedural duration and radiation dose were higher for overweight and obese patients compared with those with a normal BMI (p=0.002 and p2led to a 1.2-fold increased likelihood of experiencing recurrent AF at 12-months follow-up as compared with overweight patients (HR 1.223; 95% CI 1.047 to 1.429; p=0.011), while no significant correlation was found between overweight and normal BMI groups (HR 0.954; 95% CI 0.798 to 1.140; p=0.605) and obese versus normal BMI (HR 1.16; 95% CI 0.965 to 1.412; p=0.112).ConclusionsPatients with a baseline BMI ≥30 kg/m2have a higher recurrence rate of AF following catheter ablation and therefore lifestyle modification to target obesity preprocedure should be considered in these patients.

Transcatheter procedures offer an alternative to cardiac surgery in select patients with structural heart disease (SHD). Unfortunately, inadvertent disruption of electrical pathways and subsequent development of new onset conduction disturbances can occur in up to 5–70% of percutaneous interventions, result in pacemaker implantation, and confer a worse prognosis. The physical proximity between the conduction system (atrioventricular node, bundle of His, and bundle branches) and the site of percutaneous repair is increasingly recognized as a key factor influencing new onset conduction disturbance development in procedures located near the conduction system. This review covers the incidence, clinical significance, and mechanisms of new onset conduction disturbances and discusses current and emerging strategies to address this complication in these populations.

The electron lens in the Fermilab Integrable Optics Test Accelerator (IOTA) will enable new research in nonlinear integrable optics, space-charge compensation, electron cooling, and the stability of intense beams. This research addresses scientific questions on high-brightness beams and operational challenges of high-power accelerators for nuclear and particle physics. We review the roles that electron lenses play in this field and the physical principles behind their applications. The design criteria and specifications for the IOTA storage ring and electron lens are then discussed. We conclude with a description of the components of the apparatus.

Background Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery with typical appearance at early days after operation and leads to increase morbidity and mortality in the short and long term follow up. Spinal cord stimulation (SCS) was proven to be effective in chronic pain and intractable angina pectoris treatment. Recently, animal studies demonstrated that spinal cord stimulation could suppress AF and reduce AF burden. Aim To test safety and efficacy of the temporary SCS in early postoperative period in patients undergoing coronary artery bypass grafting Methods Fifteen patients (10 men, mean age 61±7.5 years) with indications for coronary artery bypass grafting (CABG) and history of paroxysmal AF underwent percutaneous lead placement for temporary SCS. Under local anesthesia and fluoroscopic guidance, the leads were placed at C7-Th4 level according to patient's sense of paresthesia and connected with spinal cord stimulator externally fixed on patient's chest. Temporary SCS was performed 3 days before CABG and turned off during surgery. At the end of CABG, the SCS was turned on in the intensive care unit and continued for 7 days. After that the temporary leads were removed. The primary safety objective was to test safety of the temporary SCS in early postoperative period, including 30 days occurrence of MACE (Death, stroke or TIA, myocardial infarction), acute spinal cord and kidney injury. The efficacy endpoint included occurrence of AF or any atrial tachyarrhythmias lasting ≥30 seconds during 30 days after surgery. All patients had continuous external ECG monitoring for 30 days after surgery. Results In all (100%) patients temporary leads for SCS were implanted successfully and standard on-pump elective CABG was performed thereafter. There were no any adverse events related to temporary SCS in either patient till the end of follow up. There were no significant differences in CK-MB and creatinine levels as compared with baseline data (p=0.2 and 0.3, respectively). No patients developed AF or atrial tachyarrhythmias during follow up according 30-days ECG monitoring. Conclusions The first results of the temporary spinal cord stimulation to prevent AF after coronary surgery demonstrated safety and efficacy of this therapy. The parallel group randomizes study is under way (NCT 03539354) Funding Acknowledgement Type of funding source: None

OnBehalf EHRA-ESC EORP AFA LT registry Introduction Despite the effectiveness of atrial fibrillation (AF) catheter ablation (CA), antiarrhythmic therapy (AAT) remains an important part of the complex treatment. Purpose To analyze AAT dynamics in Russian patients undergoing AF ablation, and to reveal potential factors associated with ongoing AAT in patients without arrhythmia recurrence. Methods The ESC-EHRA AF ablation registry was conducted in 2012-2016 in EHRA countries. The current analysis included 476 patients (57.1 male; 57.1 ± 8.7 years) who underwent AF ablation in 13 Russian clinics. AAT before, during and at 12-month follow-up (12-FU) was assessed. At baseline, paroxysmal AF was present in 320 (67.2%) patients, persistent AF - in 94 (19.7%), long-standing persistent AF- in 53 (11,1%), in 9 (1.9%) AF type was unknown. Hypertension (H) was present in 355 (74.6%) patients; congestive heart failure (CHF) (NYHA≥2) in 184 (38.7%) patients; coronary artery disease (CAD) in 132 (27.7%) patients. The CA was the first in 396 (83.2%) cases, redo ablation was performed in 80 (16.8%) cases. AF recurrences were registered according to local clinical practice. Any atrial tachyarrhythmia >30s was considered as a recurrence. Results A three-month FU (3-FU) visit was performed in 476 (100%) patients, 12-FU - in 390 (81.9%). Prior to PV isolation 439 (92.2%) patients received AAT, while after ablation there was an increase in the number of patients on AAT - 459 (96.4%). The highest number of patients on AAT was detected at 3-FU - 463 (97.3%). During 12 months at least one episode of arrhythmia recurrence was documented in 203 (52.1%) patients, and 370 (94.8%) patients were on AAT at the 12-month visit. After the 12-month visit 307 (78.7%) patients continued to receive AAT, and in 187 (47.9%) of them there was no arrhythmia recurrence after the index ablation. Five (2.7%) of these patients continued a Ic class AAT drug, 35 (18.7%) patients - class III, 129 (69.0%) patients - β-blockers (BB) and 18 (9.6%) patients - calcium channel blockers (CCB). All 187 patients had co-morbidities (75.4% - H; 41.7% - CHF (NYHA≥2; 31.6% - CAD). There were no statistically significant predictors of AAT use in patients without arrhythmia reccurence. According to the univariant regression analysis, the use of AAT III class (mainly-sotalol) at 12 months had a small but statistically significant negative association with left atrial size enlargement (OR = 0.917; 0.860-0.997); class III AAT was negatevely associated with BB therapy (OR = 0.057; 0.016-0.198); CCB therapy was associated with an older age (OR = 1.073; 1.053-1.151). Conclusions About one-half of patients without apparent arrhythmia recurrence following AF ablation do receive AAT. There were no clinical or procedure-related factors associated with AAT after effective AF ablation. Paradoxically, patients with a smaller left atrial size and without arrhythmia recurrence had more chances to receive class III AAT, what requires further analysis.

IMPORTANCE: Renal denervation can reduce cardiac sympathetic activity that may result in an antiarrhythmic effect on atrial fibrillation. OBJECTIVE: To determine whether renal denervation when added to pulmonary vein isolation enhances long-term antiarrhythmic efficacy. DESIGN, SETTING, AND PARTICIPANTS: The Evaluate Renal Denervation in Addition to Catheter Ablation to Eliminate Atrial Fibrillation (ERADICATE-AF) trial was an investigator-initiated, multicenter, single-blind, randomized clinical trial conducted at 5 referral centers for catheter ablation of atrial fibrillation in the Russian Federation, Poland, and Germany. A total of 302 patients with hypertension despite taking at least 1 antihypertensive medication, paroxysmal atrial fibrillation, and plans for ablation were enrolled from April 2013 to March 2018. Follow-up concluded in March 2019. INTERVENTIONS: Patients were randomized to either pulmonary vein isolation alone (n = 148) or pulmonary vein isolation plus renal denervation (n = 154). Complete pulmonary vein isolation to v an end point of elimination of all pulmonary vein potentials; renal denervation using an irrigated-tip ablation catheter delivering radiofrequency energy to discrete sites in a spiral pattern from distal to proximal in both renal arteries. MAIN OUTCOMES AND MEASURES: The primary end point was freedom from atrial fibrillation, atrial flutter, or atrial tachycardia at 12 months. Secondary end points included procedural complications within 30 days and blood pressure control at 6 and 12 months. RESULTS: Of the 302 randomized patients (median age, 60 years [interquartile range, 55-65 years]; 182 men [60.3%]), 283 (93.7%) completed the trial. All successfully underwent their assigned procedures. Freedom from atrial fibrillation, flutter, or tachycardia at 12 months was observed in 84 of 148 (56.5%) of those undergoing pulmonary vein isolation alone and in 111 of 154 (72.1%) of those undergoing pulmonary vein isolation plus renal denervation (hazard ratio, 0.57; 95% CI, 0.38 to 0.85; P = .006). Of 5 prespecified secondary end points, 4 are reported and 3 differed between groups. Mean systolic blood pressure from baseline to 12 months decreased from 151 mm Hg to 147 mm Hg in the isolation-only group and from 150 mm Hg to 135 mm Hg in the renal denervation group (between-group difference, −13 mm Hg; 95% CI, −15 to −11 mm Hg; P

Aims The ESC EORP EHRA Atrial Fibrillation (AF) Ablation Long-Term registry was designed to assess management and outcomes of AF catheter ablation procedures in Europe. To investigate the current ablation approaches and their outcomes for patients with paroxymal AF (PAF) and non-PAF in Europe. Methods and results Data from index ablations were collected in 27 European countries at 104 centres in a prospective fashion. Pre-procedural, procedural, and 1-year follow-up data were captured on a web-based electronic case record form. Data on the ablation procedure were available for 3446 patients. Of these, 2513 patients and 933 patients underwent pulmonary vein isolation (PVI) or PVI plus (PVIplus) additional ablation, respectively. The ablation strategy was limited to PVI in 81% and 56% of patients in the PAF and non-PAF group, respectively (P Conclusion In patients with PAF and non-PAF, the ablation strategies of PVI and PVIplus led to similar arrhythmia-free survival rates after 1 year. A considerable hospital readmission rate was noted.

Aims Hypertension (HTN) is a well-known contributor to cardiovascular disease, including heart failure (HF) and coronary artery disease, and is the leading risk factor for premature death world-wide. A J- or U-shaped relationship has been suggested between blood pressure (BP) and clinical outcomes in different studies. However, there is little information about the significance of BP on the outcomes of patients with coronary artery disease and left ventricular dysfunction. This study aimed to determine the relationship between BP and mortality outcomes in patients with ischaemic cardiomyopathy. Methods and results The influence of BP during a median follow-up of 9.8 years was studied in a total of 1212 patients with ejection fraction ≤35% and coronary disease amenable to coronary artery bypass grafting (CABG) who were randomized to CABG or medical therapy alone (MED) in the STICH (Surgical Treatment for Ischaemic Heart Failure) trial. Landmark analyses were performed starting at 1, 2, 3, 4, and 5 years after randomization, in which previous systolic BP values were averaged and related to subsequent mortality through the end of follow-up with a median of 9.8 years. Neither a previous history of HTN nor baseline BP had any significant influence on long-term mortality outcomes, nor did they have a significant interaction with MED or CABG treatment. The landmark analyses showed a progressive U-shaped relationship that became strongest at 5 years (χ2 and P-values: 7.08, P = 0.069; 8.72, P = 0.033; 9.86; P = 0.020; 8.31, P = 0.040; 14.52, P = 0.002; at 1, 2, 3, 4, and 5-year landmark analyses, respectively). The relationship between diastolic BP (DBP) and outcomes was similar. The most favourable outcomes were observed in the SBP range 120-130, and DBP 75-85 mmHg, whereas lower and higher BP were associated with worse outcomes. There were no differences in BP-lowering medications between groups. Conclusion A strong U-shaped relationship between BP and mortality outcomes was evident in ischaemic HF patients. The results imply that the optimal SBP might be in the range 120-130 mmHg after intervention, and possibly be subject to pharmacologic action regarding high BP. Further, low BP was a marker of poor outcomes that might require other interactions and treatment strategies. Clinical trial registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.

Background: The risk of sudden cardiac death (SCD) in patients with heart failure after coronary artery bypass graft surgery (CABG) has not been examined in a contemporary clinical trial of surgical revascularization. This analysis describes the incidence, timing, and clinical predictors of SCD after CABG. Methods: Patients enrolled in the STICH trial (Surgical Treatment of Ischemic Heart Failure) who underwent CABG with or without surgical ventricular reconstruction were included. We excluded patients with prior implantable cardioverter-defibrillator and those randomized only to medical therapy. The primary outcome was SCD as adjudicated by a blinded committee. A Cox model was used to examine and identify predictors of SCD. The Fine and Gray method was used to estimate the incidence of SCD accounting for the competing risk of other deaths. Results: Over a median follow-up of 46 months, 113 of 1411 patients who received CABG without (n = 934) or with (n = 477) surgical ventricular reconstruction had SCD; 311 died of other causes. The mean left ventricular ejection fraction at enrollment was 28±9%. The 5-year cumulative incidence of SCD was 8.5%. Patients who had SCD and those who did not die were younger and had fewer comorbid conditions than did those who died of causes other than SCD. In the first 30 days after CABG, SCD (n=5) accounted for 7% of all deaths. The numerically greatest monthly rate of SCD was in the 31- to 90-day time period. In a multivariable analysis including baseline demographics, risk factors, coronary anatomy, and left ventricular function, end-systolic volume index and B-type natriuretic peptide were most strongly associated with SCD. Conclusions: The monthly risk of SCD shortly after CABG among patients with a low left ventricular ejection fraction is highest between the first and third months, suggesting that risk stratification for SCD should occur early in the postoperative period, particularly in patients with increased preoperative end-systolic volume index or B-type natriuretic peptide. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT0002359.

Aims Cardiac arrhythmias following acute myocardial infarction (AMI) can be associated with major adverse cardiovascular events. Data on the “real incidence” of post-MI arrhythmias are limited. We aimed to determine the rate and burden of cardiac arrhythmias by the use of insertable cardiac monitors (ICM) in patients with preserved left ventricular ejection fraction (LVEF) after AMI. Methods and results In this prospective observational study, patients with LVEF ≥40% who underwent PCI within 7 days following AMI were enrolled to receive an ICM. Primary outcome was the incidence of new-onset atrial fibrillation (AF) measured by the ICM during a follow-up of 2 years; results: Of 165 consecutive patients with AMI, 50 (30.3%) eligible patients were recruited (mean age 57.8 ± 8.3, 88% male). During follow-up, AF was the most frequently detected arrhythmia. Twenty-nine (58%, 95% CI: 42–70%) patients developed new-onset AF, with a cumulative rate of all detected arrhythmias of 65%. Median time to the first detected AF episode was 4.8 months and the peak cumulative AF burden was detected between 3 and 6 months. Twenty-seven (93%) out of 29 patients with AF were asymptomatic. Cox regression analysis found that baseline troponin level (hazard ratio [HR] for 1 ng/mL increment: 1.03, 95% CI: 1.01–1.06, P = 0.01) and CHA2DS2-VASc score of 4 (HR: 11.42, 95% CI: 1.01–129.06, P = 0.04) were independent risk factors of new-onset AF post-AMI. Conclusion AF is a frequent but largely underestimated cardiac arrhythmia after AMI. More rigorous monitoring strategies resulting in crucial medical interventions (e.g. implementation of oral anti-coagulation) are needed. Clinical Trial Registration . Unique identifier: [NCT02492243][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02492243&atom=%2Feuropace%2Fearly%2F2017%2F01%2F08%2Feuropace.euw344.atom

Background/Introduction Pulmonary endarterectomy (PEA) is the gold standard of CTEPH treatment. However, residual CTEPH develops in 10–40% of patients after PEA, which leads to progression of right ventricular insufficiency. Currently, the only way to treat residual CTEPH is PAH-specific drug therapy. However, this treatment is not indicated for all patients because of the arterial hypotension and dyspeptic disorders. Purpose To assess the safety and efficacy of radiofrequent pulmonary artery denervation (PADN) in patients with residual CTEPH after PEA. Methods In 2015, a randomized pilot study was conducted to evaluate PADN in patients with residual CTEPH (NCT 02745106). 278 patients with CTEPH after PEA were screened. In 62 of them, according to the echocardiography, residual CTEPH (systolic pulmonary artery pressure (PAP) ≥45 mm Hg) was detected. In 50 patients, residual CTEPH was confirmed during right heart catheterization (RHC): mean PAP ≥25 mmHg and pulmonary vascular resistance (PVR) >400 dyn s cm–5. Patients were randomized into two groups: 25 in PADN group and 25 in drug therapy group with riociguat. Mean age was 39 years [26; 51]. The mean duration after PEA was 4.5 years [1; 8.5]. The primary end point was PVR in the short-term and long-term follow-up. Secondary end points were: mean PAP, cardiac output, 6-minute walk test (6MWD) and NYHA functional class. All patients were followed up for 12 months after discharge. The PADN procedure was performed using electrophysiological catheter Navistar RMT Thermocool, Biosense Webster, Diamond Bar, CA, USA and non-fluroscopic 3D navigation system. Results There was no mortality. In two patients (one in each group) hematoma developed in femoral vein puncture site without any consequences. The mean surgery time was 105 [93; 120] minutes. After 12 months, PVR was significantly lower in the PADN group compared with the drug treatment group (343±149 dyn s cm–5 vs 444±145 dyn s cm–5, respectively; mean difference −101, 95% confidence interval from −193 to −10; p=0.032). The mean PAP was also significantly lower in the PADN group (25.8±7.3 mm Hg vs. 33.8±6.4 mm Hg, p Conclusions The PADN technique showed its safety and efficacy in the treatment of patients with residual CTEPH and can be used in clinical practice. The obtained first results showed that the proposed PADN, together with optimal medical therapy, can take a place in the treatment of residual CTEPH after PEA.

The study object - technological process of interference fits assembling is identified, the scheme with oil supply from the end face is adopted as the technological scheme. Technological pressing equipment is considered, its applicability for hydropress assembling is evaluated. The main aspects of hydropress joints assembling on a base of mechatronic press are established: increasing of assembling performance, its stability. Mathematical models and an algorithm that regulate the process of liquid friction and formation of an oil layer between the contacting surfaces of joint mating parts are developed. The basic requirements for the regulation channels of control system that ensure the quality of hydropress fits during automated assembling are established.

Aims Delay of progression from paroxysmal to persistent atrial fibrillation (AF) is an important measure of long-term success of AF treatment. However, published data on the impact of catheter ablation on AF progression are limited. This study evaluates whether radiofrequency (RF) catheter ablation delays the progression of AF compared with antiarrhythmic drug (AAD) treatment using current AF management guidelines. Methods This prospective, randomized, controlled, two-arm, open-label trial was conducted at 29 hospitals and medical centres across 13 countries. Patients were randomized 1 : 1 to RF ablation or AAD treatment. The primary endpoint was the rate of persistent AF/atrial tachycardia (AT) at 3 years. Results After early study termination following slow enrolment, 255 (79%) of the planned 322 patients were enrolled (RF ablation, n = 128, AAD, n = 127); 36% of patients in the RF ablation group and 41% in the AAD group completed 3 years of follow-up. For the primary endpoint, the Kaplan–Meier estimate of the rate of persistent AF/AT at 3 years was significantly lower with RF ablation [2.4% (95% confidence interval (CI), 0.6–9.4%)] than with AAD therapy [17.5% (95% CI, 10.7–27.9%); one-sided P = 0.0009]. Patients ≥65 years were ∼4 times more likely to progress to persistent AF/AT than patients Conclusions Radiofrequency ablation is superior to guideline-directed AAD therapy in delaying the progression from paroxysmal to persistent AF.

Background— Animal models suggest that the neurotransmitter inhibitor, botulinum toxin, when injected into the epicardial fat pads can suppress atrial fibrillation inducibility. The aim of this prospective randomized double-blind study was to compare the efficacy and safety of botulinum toxin injection into epicardial fat pads for preventing atrial tachyarrhythmias. Methods and Results— Patients with history of paroxysmal atrial fibrillation and indication for coronary artery bypass graft surgery were randomized to botulinum toxin (Xeomin, Merz, Germany; 50 U/1 mL at each fat pad; n=30) or placebo (0.9% normal saline, 1 mL at each fat pad; n=30) injection into epicardial fat pads during surgery. Patients were followed for 1 year to assess maintenance of sinus rhythm using an implantable loop recorder. All patients in both groups had successful epicardial fat pad injections without complications. The incidence of early postoperative atrial fibrillation within 30 days after coronary artery bypass graft was 2 of 30 patients (7%) in the botulinum toxin group and 9 of 30 patients (30%) in the placebo group ( P =0.024). Between 30 days and up to the 12-month follow-up examination, 7 of the 30 patients in the placebo group (27%) and none of the 30 patients in the botulinum toxin group (0%) had recurrent atrial fibrillation ( P =0.002). There were no complications observed during the 1-year follow-up. Conclusions— Botulinum toxin injection into epicardial fat pads during coronary artery bypass graft provided substantial atrial tachyarrhythmia suppression both early as well as during 1-year follow-up, without any serious adverse events. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01842529.

Background ― Cadmium zinc telluride (CZT) solid-state detectors have been recently introduced in the field of nuclear medicine in cardiology. The aim of the current study was to investigate the scintigraphic patterns of total uptake and the regional distribution of iodine-123 metaiodobenzylguanidine (123I-mIBG) in healthy volunteers and patients with atrial fibrillation (AF) using a gamma camera equipped CZT detectors. Material and Methods ― The total number of included subjects was 30 (15 patients with a paroxysmal form of AF and 15 healthy volunteers). Using a novel single-photon emission computed tomography (SPECT) cardiac dedicated gamma camera equipped CZT-detectors the scintigraphy was performed 15 minutes and 4 hours after intravenous administration of norepinephrine structural analogue 123I-mIBG. Thus, data from early and delayed phases were obtained. The heart-to-mediastinum ratio of 123I-mIBG uptake at 15 minutes (HMRe) and 4 hours (HMRd), as well as the washout rate (WR) and summed 123I-mIBG score (SMSe, SMSd) were measured. Results ― Patients and volunteers showed comparable results of the median ratio of 123I-mIBG uptake in the heart and mediastinum (HMR) in the early and delayed phases (p>0.05). In 14 (93%) patients with AF, 123I-mIBG uptake defects in LV myocardium were detected as compared with 8 (53%) healthy individuals (p

Botulinum toxin (BTX) injections into epicardial fat pads in patients undergoing coronary artery bypass grafting (CABG) has resulted in suppression of atrial fibrillation (AF) during the early postoperative period through 1-year of follow-up in a pilot program.The purpose of this study was to report 3-year AF patterns by the use of implantable cardiac monitors (ICMs).Sixty patients with a history of paroxysmal AF and indications for CABG were randomized 1:1 to either BTX or placebo injections into 4 posterior epicardial fat pads. All patients received an ICM with regular follow-up for 3 years after surgery. The primary end point of the extended follow-up period was incidence of any atrial tachyarrhythmia after 30 days of procedure until 36 months on no antiarrhythmic drugs. The secondary end points included clinical events and AF burden.At the end of 36 months, the incidence of any atrial tachyarrhythmia was 23.3% in the BTX group vs 50% in the placebo group (hazard ratio 0.36; 95% confidence interval 0.14-0.88; P = .02). AF burden at 12, 24, and 36 months was significantly lower in the BTX group than in the placebo group: 0.22% vs 1.88% (P = .003), 1.6% vs 9.5% (P.001), and 1.3% vs 6.9% (P = .007), respectively. In the BTX group, 2 patients (7%) were hospitalized during follow-up compared with 10 (33%) in the placebo group (P = .02).Injection of BTX into epicardial fat pads in patients undergoing CABG resulted in a sustained and substantial reduction in atrial tachyarrhythmia incidence and burden during 3-year follow-up, accompanied by reduction in hospitalizations.

Test results of axial shift of “technical ceramics - glass” parts in taper interference fit joint under axial loading are presented. The load-carrying capacity was tested under normal conditions; a servo press was used to load the test samples. The tested samples were assembled by thermal method.

Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction.Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35% or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point.Right ventricular dysfunction was mild in 102 patients (12%) and moderate or severe in 78 patients (9%). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P.0001) compared with normal or mildly reduced right ventricular function. A significant interaction between right ventricular dysfunction and treatment allocation was observed. Patients with moderate or severe right ventricular dysfunction who received coronary artery bypass grafting + surgical ventricular reconstruction had significantly worse outcomes compared with patients who received coronary artery bypass grafting alone on both the primary (hazard ratio, 1.86; confidence interval, 1.06-3.26; P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality (P = .022).Adding surgical ventricular reconstruction to coronary artery bypass grafting may worsen long-term survival in patients with ischemic cardiomyopathy with moderate to severe right ventricular dysfunction, which reflects advanced left ventricular remodeling.

Summary Objective There are limited clinical treatments for temporomandibular joint (TMJ) pathologies, including degenerative disease, disc perforation and heterotopic ossification (HO). One barrier hindering the development of new therapies is that animal models recapitulating TMJ diseases are poorly established. The objective of this study was to develop an animal model for TMJ cartilage degeneration and disc pathology, including disc perforation and soft tissue HO. Methods New Zealand white rabbits (n = 9 rabbits) underwent unilateral TMJ disc perforation surgery and sham surgery on the contralateral side. A 2.5 mm defect was created using a punch biopsy in rabbit TMJ disc. The TMJ condyles and discs were evaluated macroscopically and histologically after 4, 8 and 12 weeks. Condyles were blindly scored by four independent observers using OARSI recommendations for macroscopic and histopathological scoring of osteoarthritis (OA) in rabbit tissues. Results Histological evidence of TMJ condylar cartilage degeneration was apparent in experimental condyles following disc perforation relative to sham controls after 4 and 8 weeks, including surface fissures and loss of Safranin O staining. At 12 weeks, OARSI scores indicated experimental condylar cartilage erosion into the subchondral bone. Most strikingly, HO occurred within the TMJ disc upon perforation injury in six rabbits after 8 and 12 weeks. Conclusion We report for the first time a rabbit TMJ injury model that demonstrates condylar cartilage degeneration and disc ossification, which is indispensible for testing the efficacy of potential TMJ therapies.

The effect of cell culturing protocol with various adhesion proteins and different culture time on the profile of cytokine and growth factors produced by endothelial progenitor cells harvested after mobilization with granulocyte colony-stimulating factor was examined in patients with chronic heart failure. The endothelial progenitor cells cultured on fibronectin or gelatin produced a broad and overall similar spectrum of cytokines and growth factors, the levels of which depended on the culture time. On culture day 16, the cells grown on fibronectin diminished the production of cytokines and growth factors (IL-10, IL-18, IL-8, erythropoietin, and VEGF), while the cells grown on gelatin down-regulated the synthesis of TNF-α, IL-8, and erythropoietin, although they up-regulated the production of IL-10, IL-18, and VEGF.

Objective We aimed to assess early neointimal healing by optical coherence tomography (OCT) 3 months after implantation of the ultrathin Orsiro® sirolimus-eluting stent with biodegradable polymer. Background New generations of drug-eluting stents with biodegradable polymer have been developed to avoid the continued vascular irritation of durable polymers. Methods In this prospective, open-label study, 34 patients received an Orsiro® sirolimus-eluting stent with biodegradable polymer. In a subgroup of patients (n = 15), the intervention was performed under OCT guidance. All patients underwent OCT-examination at three months. The primary endpoint was 3-month neointimal healing (NIH) score, calculated by weighing the presence of filling defects, malapposed and uncovered struts. Secondary endpoint was maturity of tissue coverage at 3 months. Results At 3 months, NIH score was 13.7 (5.4-22), covered struts per lesion were 90% (84-97%), malapposed struts were 2.7% (0.8-5.4%) and rate of mature tissue coverage was 47% (42-53%). No target lesion failure occurred up to 12 months. Patients with OCT-guided stent implantation demonstrated a trend toward earlier stent healing as demonstrated by superior NIH scores (angio guided: 17.6% [8.8-26.4]; OCT-guided: 9.8% [4.0-15.5]; mean difference -8, [95%CI: -18.7-2.9], P = 0.123). This group had significantly more covered struts per lesion (angio-guided: 86% [82-90]; 95% [92-99]; mean difference 9% [95%CI: 3-15], P = 0.001). Conclusion The Orsiro® sirolimus-eluting stent with biodegradable polymer shows early vascular healing with a high rate of strut coverage at 3-month follow-up. OCT guided stent implantation had a positive impact on early vascular healing.

site infection after spine surgery. The purpose of the present study was to assess the efficacy of intrawound vancomycin powder in terms of eradicating a known bacterial surgical site contamination in a rabbit spine surgery model. Methods: TwentyNewZealandWhiterabbitsunderwentlumbarpartiallaminectomyandwireimplantation.Thesurgicalsites were inoculated, prior to closure, by injecting 100 mL of cefazolin-sensitive and vancomycin-sensitive Staphylococcus aureus (S. aureus)(1 ·10 8 colony-forming units[CFU]/mL) into the wound. Preoperative cefazolin wasadministered to all rabbits, and vancomycin powder (100 mg) was placed into the wound of ten rabbits prior to closure. The rabbits were killed on postoperative day four, and tissue and wire samples were obtained forbacteriologic assessment. An independent samplest testwas used to assess mean group differences, and a Fisher exact test was used to assess differences in categorical variables. Results: Thevancomycin-treatedandthecontrolrabbitsweresimilarinweight(mean[andstandarddeviation],4.1±0.5kg and 4.0±0.4 kg, respectively; p=0.60) and sex distribution and had similar durations of surgery (21.7±7.7 minutesand 16.9±6.7 minutes; p = 0.15). The bacterial cultures of the surgical site tissues were negative for all ten vancomycin-treated rabbits and positive for all ten control rabbits (p < 0.0001). Bacterial growth occurred in thirty-nine of forty samples from the control group but in zero of forty samples from the vancomycin group (p < 0.0001). All blood and liver samples were sterile. No rabbit had evidenceof sepsis or vancomycin toxicity. Gross examination of the surgicalsites showed no differencesbetween thegroups. Conclusions: In a rabbit spine-infection model, intrawound vancomycin powder in combination with preoperative cefazolineliminatedS.aureussurgicalsitecontamination.Allrabbitsthatweremanagedwithonlyprophylacticcefazolinhad persistent S. aureus contamination. Clinical Relevance: This animal study supports the findings in prior clinical reports that intrawound vancomycin powder helps reduce the risk of surgical site infections.

Objective To test the hypothesis that perioperative OMEGA-3 polyunsaturated fatty acid infusion would reduce the incidence of postoperative atrial fibrillation in patients after coronary artery bypass grafting as assessed by an implantable continuous cardiac monitor. Design Prospective, randomized, double-blind, placebo-controlled study. Setting Tertiary cardiothoracic referral center. Participants Thirty-nine patients with coronary artery disease who underwent surgery with cardiopulmonary bypass. Interventions Patients were assigned randomly to receive either OMEGA-3 polyunsaturated fatty acids (200 mg/kg/day starting before anesthesia induction for 24 hours followed by 100 mg/kg/day for 7 days) or placebo. The primary outcome was freedom from atrial fibrillation at 2-year follow-up. Reveal ® cardiac monitor was implanted subcutaneously in all patients. Data from the cardiac monitor were collected on the 10th day and 3, 6, 12, and 24 months postoperatively. Measurement and Main Results Postoperative atrial fibrillation developed in 4 (19%) patients in the control group and in 5 (27.8%) patients in the study group at 10-day follow-up (p = 0.88). At 2-year follow-up, 5 (27.8%) patients in the control group and 6 (35.3%) patients in the study group had atrial fibrillation (p = 0.9). Atrial fibrillation duration predicted risk of cardiovascular hospitalization at the 2-year follow-up (regression coefficient estimate = 0.24, standard error 0.02, p 2 = 0.74). Conclusions Infusion of OMEGA-3 polyunsaturated fatty acids failed to prevent the occurrence of atrial fibrillation in 2 years after coronary artery bypass grafting surgery. The cumulative atrial fibrillation duration registered by the continuous cardiac monitor at the 2-year follow-up was a significant predictor of an adverse outcome.

Although catheter ablation of isthmus-dependent atrial flutter (AFL) is successful at eliminating the target arrhythmia, many patients subsequently experience new-onset atrial fibrillation (AF).The aim of this study was to determine whether AF can be prevented by prophylactic pulmonary vein ablation in patients with AFL.A prospective, single-blind, randomized clinical trial in patients whose sole arrhythmia was AFL without AF was conducted. Patients were randomized to cavotricuspid isthmus ablation alone or with concomitant pulmonary vein isolation. All patients received an implantable cardiac monitor.Fifty patients completed the trial, and patients were well matched. Isthmus ablation was successful in all patients; pulmonary vein isolation was successful in 25 (100%) randomized patients. Procedure (P.0001) and fluoroscopy (P.0001) times were longer in the combined ablation group. More patients in the isthmus ablation-only group experienced new-onset AF during follow-up (52% vs. 12%; P = .003). The 1-year AF burden also favored the combined ablation group compared with the isthmus ablation-only group (8.3% vs. 4.0%; P = .034). In the isthmus ablation-only group, 8 (32%) patients subsequently underwent another ablation for AF. The performance of pulmonary vein isolation and male sex were independent predictors of freedom from AF.In the PREVENT-AF Study I randomized clinical trial of patients in whom only typical AFL had been observed clinically, the addition of pulmonary vein isolation to cavotricuspid isthmus ablation resulted in a marked reduction of new-onset AF during clinical follow-up as assessed with a continuous implantable cardiac monitor.

We studied the phenotype and cytokine production in peripheral blood mononuclear cells mobilized from the bone marrow after administration of granulocyte colony-stimulating factor (G-CSF) and the relationship of these parameters with clinical efficacy of autologous intramyocardial injection of donor cells in patients with chronic heart failure. We found that mononuclear cells contain endothelial progenitor cells and are capable of producing pleiotropic cytokines exhibiting angiogenic and cardioprotective properties. High concentration of cells with of CD34+ and CD34+/CD133+ phenotype in the cell transplant and enhanced production of IL-10, TNF-α, and granulocyte-macrophage-CSF by blood mononuclear cells mobilized from the bone marrow can contribute to improvement of myocardial perfusion and increase in left ventricular ejection fraction after intramyocardial transplantation and can serve as predictors of high efficiency of cell therapy. Peripheral blood is an available source of progenitor cells, while mononuclear cells after administration of granulocyte-CSF can produce a reparative effect on ischemic myocardium.

Evaluation of lung disease is limited by the inability to visualize ongoing pathological processes. Molecular imaging that targets cellular processes related to disease pathogenesis has the potential to assess disease activity over time to allow intervention before lung destruction. Because apoptosis is a critical component of lung damage in emphysema, a functional imaging approach was taken to determine if targeting apoptosis in a smoke exposure model would allow the quantification of early lung damage in vivo. Rabbits were exposed to cigarette smoke for 4 or 16 weeks and underwent single-photon emission computed tomography/computed tomography scanning using technetium-99m-rhAnnexin V-128. Imaging results were correlated with ex vivo tissue analysis to validate the presence of lung destruction and apoptosis. Lung computed tomography scans of long-term smoke-exposed rabbits exhibit anatomical similarities to human emphysema, with increased lung volumes compared with controls. Morphometry on lung tissue confirmed increased mean linear intercept and destructive index at 16 weeks of smoke exposure and compliance measurements documented physiological changes of emphysema. Tissue and lavage analysis displayed the hallmarks of smoke exposure, including increased tissue cellularity and protease activity. Technetium-99m-rhAnnexin V-128 single-photon emission computed tomography signal was increased after smoke exposure at 4 and 16 weeks, with confirmation of increased apoptosis through terminal deoxynucleotidyl transferase dUTP nick end labeling staining and increased tissue neutral sphingomyelinase activity in the tissue. These studies not only describe a novel emphysema model for use with future therapeutic applications, but, most importantly, also characterize a promising imaging modality that identifies ongoing destructive cellular processes within the lung.

Importance Catheter ablation is effective in restoring sinus rhythm in atrial fibrillation (AF), but its effects on long-term mortality and stroke risk are uncertain. Objective To determine whether catheter ablation is more effective than conventional medical therapy for improving outcomes in AF. Design, Setting, and Participants The Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation trial is an investigator-initiated, open-label, multicenter, randomized trial involving 126 centers in 10 countries. A total of 2204 symptomatic patients with AF aged 65 years and older or younger than 65 years with 1 or more risk factors for stroke were enrolled from November 2009 to April 2016, with follow-up through December 31, 2017. Interventions The catheter ablation group (n = 1108) underwent pulmonary vein isolation, with additional ablative procedures at the discretion of site investigators. The drug therapy group (n = 1096) received standard rhythm and/or rate control drugs guided by contemporaneous guidelines. Main Outcomes and Measures The primary end point was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. Among 13 prespecified secondary end points, 3 are included in this report: all-cause mortality; total mortality or cardiovascular hospitalization; and AF recurrence. Results Of the 2204 patients randomized (median age, 68 years; 37.2% female; 42.9% had paroxysmal AF and 57.1% had persistent AF), 89.3% completed the trial. Of the patients assigned to catheter ablation, 1006 (90.8%) underwent the procedure. Of the patients assigned to drug therapy, 301 (27.5%) ultimately received catheter ablation. In the intention-to-treat analysis, over a median follow-up of 48.5 months, the primary end point occurred in 8.0% (n = 89) of patients in the ablation group vs 9.2% (n = 101) of patients in the drug therapy group (hazard ratio [HR], 0.86 [95% CI, 0.65-1.15];P = .30). Among the secondary end points, outcomes in the ablation group vs the drug therapy group, respectively, were 5.2% vs 6.1% for all-cause mortality (HR, 0.85 [95% CI, 0.60-1.21];P = .38), 51.7% vs 58.1% for death or cardiovascular hospitalization (HR, 0.83 [95% CI, 0.74-0.93];P = .001), and 49.9% vs 69.5% for AF recurrence (HR, 0.52 [95% CI, 0.45-0.60];P Conclusions and Relevance Among patients with AF, the strategy of catheter ablation, compared with medical therapy, did not significantly reduce the primary composite end point of death, disabling stroke, serious bleeding, or cardiac arrest. However, the estimated treatment effect of catheter ablation was affected by lower-than-expected event rates and treatment crossovers, which should be considered in interpreting the results of the trial. Trial Registration ClinicalTrials.gov Identifier:NCT00911508

Objectives The aim of this study was to investigate whether the combination of conventional pulmonary vein isolation (PVI) by circumferential antral ablation with ganglionated plexi (GP) modification in a single ablation procedure, yields higher success rates than PVI or GP ablation alone, in patients with paroxysmal atrial fibrillation (PAF). Background Conventional PVI transects the major left atrial GP, and it is possible that autonomic denervation by inadvertent GP ablation plays a central role in the efficacy of PVI. Methods A total of 242 patients with symptomatic PAF were recruited and randomized as follows: 1) circumferential PVI (n = 78); 2) anatomic ablation of the main left atrial GP (n = 82); or 3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary endpoint was freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT), verified by monthly visits, ambulatory electrocardiographic monitoring, and implantable loop recorders, during a 2-year follow-up period. Results Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the PVI, GP, and PVI+GP groups, respectively (p = 0.004 by log-rank test). PVI+GP ablation strategy compared with PVI alone yielded a hazard ratio of 0.53 (95% confidence interval: 0.31 to 0.91; p = 0.022) for recurrence of AF or AT. Fluoroscopy duration was 16 ± 3 min, 20 ± 5 min, and 23 ± 5 min for PVI, GP, and PVI+GP groups, respectively (p Conclusions Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF.