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Background Venous ethanol ablation (VEA) is effective for treatment of left ventricular (LV) summit (LVS) arrhythmias. The LVS venous anatomy is poorly understood and has inconsistent nomenclature. Objective The purpose of this study was to delineate the LVS venous anatomy by selective venography and 3-dimensional (3D) mapping during VEA and by venous-phase coronary computed tomographic angiography (vCTA). Methods We analyzed (1) LVS venograms and 3D maps of 53 patients undergoing VEA; and (2) 3D reconstructions of 52 vCTAs, tracing LVS veins. Results Angiography identified the following LVS veins: (1) LV annular branch of the great cardiac vein (GCV) (19/53); (2) septal (rightward) branches of the anterior ventricular vein (AIV) (53/53); and (3) diagonal branches of the AIV (51/53). Collateral connections between LVS veins and outflow, conus, and retroaortic veins were common. VEA was delivered to target arrhythmias in 38 of 53 septal, 6 of 53 annular, and 2 of 53 diagonal veins. vCTA identified LVS veins (range 1–5) in a similar distribution. GCV–AIV transition could either form an angle close to the left main artery bifurcation (n = 16; 88° ± 13°) or cut diagonally (n = 36; 133°±12°) (P ≤.001). Twenty-one patients had LV annular vein. In 28 patients only septal LVS veins were visualized in vCTA, in 2 patients only diagonal veins and in 22 patients both septal and diagonal veins were seen. In 39 patients the LVS veins reached the outflow tracts and their vicinity. Conclusion We provide a systematic atlas and nomenclature of LVS veins related to arrhythmogenic substrates. vCTA can be useful for noninvasive evaluation of LVS veins before ethanol ablation.

Background Venous ethanol infusion via an occlusive balloon has been used as a bailout approach to treat ablation-refractory ventricular arrhythmias (VAs). Unfavorable venous anatomy (lack of intramural veins at the targeted site or collateral vein–ethanol shunting) limits its efficacy. Blocking collateral flow with a second balloon may optimize myocardial ethanol delivery. Objective The purpose of this study was to validate the “double-balloon” approach to enhance ethanol delivery in cases of unfavorable venous anatomy. Methods Eight patients referred after failed ablations (3 left ventricular [LV] summit, 5 scar-related ventricular tachycardia) underwent endocardial mapping and additional radiofrequency ablation without VA resolution. Coronary veins were mapped using a multipolar catheter or wire, and selective venograms were obtained. The double balloon was used when (1) distal collateral branches shunted flow away from the targeted region; (2) the target vein had optimal signals only proximally; or (3) a large vein was targeted that had multiple branches for a large area of interest. Results Acute successful ethanol infusion myocardial delivery and resolution of VA was accomplished using the posterolateral LV veins (n = 2 patients, 3 procedures), lateral LV vein (n = 1), apical anterior interventricular vein (AIV; n = 1), middle cardiac vein (n = 1), and septal branches of the AIV (n = 3). At median follow-up of 313.5 days, 2 patients experienced recurrence. Conclusion The double-balloon technique can enhance ethanol delivery to target isolated vein segments, block collateral flow, or target extensive areas, and can expand the utility of venous ethanol for treatment of VAs.

Objectives The aim of this study was to assess the long-term efficacy and outcomes of retrograde venous ethanol ablation in treating ventricular arrhythmias (VAs). Background Retrograde co...

Sleep apnea is highly associated with atrial fibrillation (AF), and both diseases are highly prevalent in the United States. The mechanistic underpinnings that contribute to their association remain uncertain, but numerous possible mechanisms have been proposed, including dysfunction of the cardiac autonomic nervous system (ANS). Studies have reported that apnea induces hyperactivity of the ANS, leading to increases in AF susceptibility. This review compiles the latest evidence on the role of the ANS in sleep-apnea-induced AF.

Background: NS5806 activates the transient outward potassium current I to, and has been claimed to reproduce Brugada Syndrome (BrS) in ventricular wedge preparations. I to modulates excitation-contraction coupling, which is critical in alternans dynamics. We explored NS5806-arrhythmogenic effects in the intact whole heart and its impact on alternans. Methods: Langendorff-perfused rabbit hearts (n = 20) underwent optical AP and Ca mapping during pacing at decremental cycle lengths (CL). Spontaneous arrhythmias and pacing-induced alternans was characterized at baseline (BL), after perfusing with NS5806, before and after adding verapamil (VP), and SEA0400 (SEA, n = 5 each), to modulate Ca-current and Na-Ca exchange, the main AP-Ca coupling mechanisms. Results: NS5806 induced BrS-like ECG features in 6 out of 20 hearts. NS5806 prolonged steady-state (3 Hz) action potential duration (APD) by 16.8%, Ca decay constant by 34%, and decreased conduction velocity (CV) by 52.6%. After NS5806 infusion, spontaneous ventricular ectopy (VE) and AP/Ca alternans occurred. Pacing-induced alternans during NS5806 infusion occurred at longer CL and were AP/Ca discordant from its onset. Spatially discordant alternans after NS5806 infusion had non-propagation-driven nodal line distribution. No spontaneous phase-2 reentry occurred. Under NS5806 + VP, alternans became AP/Ca concordant and only induced in two out of five; NS5806 + SEA did not affect alternans but suppressed spontaneous ectopy. Conclusions: NS5806 disrupts AP-Ca coupling and leads to Ca-driven, AP/Ca-discordant alternans and VE. Despite BrS-like ECG features, no spontaneous sustained arrhythmias or phase-2 reentry occurred. NS5806 does not fully reproduce BrS in the intact rabbit heart.

Background: The autonomic nervous system response to apnea and its mechanistic connection to atrial fibrillation (AF) are unclear. We hypothesize that sensory neurons within the ganglionated plexi (GP) play a role. We aimed to delineate the autonomic response to apnea and to test the effects of ablation of cardiac sensory neurons with resiniferatoxin (RTX), a neurotoxic TRPV1 (transient receptor potential vanilloid 1) agonist. Methods Sixteen dogs were anesthetized and ventilated. Apnea was induced by stopping ventilation until oxygen saturations decreased to 80%. Nerve recordings from bilateral vagal nerves, left stellate ganglion, and anterior right GP were obtained before and during apnea, before and after RTX injection in the anterior right GP (protocol 1, n=7). Atrial effective refractory period and AF inducibility on single extrastimulation were assessed before and during apnea, and before and after intrapericardial RTX administration (protocol 2, n=9). GPs underwent immunohistochemical staining for TRPV1. Results: Apnea increased anterior right GP activity, followed by clustered crescendo vagal bursts synchronized with heart rate and blood pressure oscillations. On further oxygen desaturation, a tonic increase in stellate ganglion activity and blood pressure ensued. Apnea-induced effective refractory period shortening from 110.20±31.3 ms to 90.6±29.1 ms ( P P =0.0001), and AF was not induced. Vagal bursts remained unchanged. GP cells showed cytoplasmic microvacuolization and apoptosis. Conclusions: Apnea increases GP activity, followed by vagal bursts and tonic stellate ganglion firing. RTX decreases sympathetic and GP nerve activity, abolishes apnea’s electrophysiological response, and AF inducibility. Sensory neurons play a role in apnea-induced AF.

Catheter-based radiofrequency (RF) ablation is an effective, well-established therapy for ventricular tachycardia (VT). However, a large number of patients still have recurrences, particularly those with substrates arising from intramural locations that are inaccessible through endo- or epicardial catheter approaches. Several unconventional ablation techniques have been proposed to treat RF-refractory VT, including transarterial coronary ethanol ablation and retrograde coronary venous ethanol ablation. We review the evidence regarding the mechanisms, procedural aspects, and alcohol ablation outcomes for ventricular arrhythmias.

The impact of obesity in the pathophysiology of human skin seems to be related to various dermatoses, basically resulting from the change in its normal physiology, including changes in the “barrier” and the “envelope" functions as well . However, the available information is still scarce due to the many complexities of the subject. This work aims to define an experimental methodology approach to objectively study the functional changes that characterize the obese skin. This transversal study included 28 healthy volunteers, female (mean age 23 ± 5 years old), after informed consent. Skin functional characterization was obtained in one single measurement by non-invasive techniques, under controlled conditions. Relevant variables were hydration (superficial and deep), barrier function and biomechanical behavior, measured at four different anatomical areas. Through the SPSS (v 20.0) a univariate statistical analysis was performed to calculate central tendency and dispersion measures. The Pearson's and the Spearman's tests were chosen for those variables that followed , or not, a normal distribution, respectively, assuming a confidence level of 95%. Results allow us to propose a methodology for the study of the skin applied to obese patients, including the choice of the anatomical areas and variables appropriate to the intended goal.

In the future, the number of elderly and chronically ill will be quite large. Additionally, pathologies will in many cases be in comorbidity. Alongside this reality, the health care resources will be insufficient for the population, thus the current research for solutions that can be fully implemented in the future. There are available several telemonitoring devices and systems for chronic diseases. Massive use of these devices will be essential to address the current and future lack of health system resources. Research on telemonitoring devices and systems for chronic diseases was con-ducted in academic and scientific databases. The technical specifications were collected in the manufacturers’ web page. The gathered data was analysed and compared in order to propose scenarios for the future trend of technical specifi-cations required in telemonitoring devices/system is performed. Telemonitoring for chronic diseases can bring great benefits to patient and health systems. Widening this practice will be a reality in the near future. This procedure will be fostered by the promotion and regulation of interoperability between de-vices/systems, as well as of front-end programs providing the link between health support systems. Interoperability issues are the main flaw of tedevicesring devices/systems on the market today.

Introduction: The migration of African populations to Europe poses problems of adaptation that may increase the risk of cardiovascular disease. We assessed the cardiovascular risk of Cape Verdean university students studying in Portugal (CV-PT) compared to Cape Verdean university students in Cape Verde (CV-CV) and to Caucasian university students in Portugal (PT-PT). Methods: A cross-sectional study was performed comparing three university populations, 54-62% female, aged 19-28 years: CV-PT (n=104), CV-CV (n=100) and PT-PT (n=100). Anthropometric data, blood pressure (BP), pulse wave velocity (PWV), albuminuria and estimated 24-h urinary sodium excretion (UNa+) using the Kawasaki formula were measured. Results: The CV-PT group had higher body mass index and sodium intake (UNa+: CV-PT 235±91, CV-CV 197±85, PT-PT 194±90 mmol/24 h; p

© Springer International Publishing Switzerland 2015. P. Humbert et al. (eds.), Measuring the Skin

Obesity is an increasing public health issue, particularly in Portugal, where more than 50% of the population is obese. The pathophysiological consequences of being overweight have a severe cutaneous impact. However, there is still a lack of studies to link these alterations to BMI categories. This present work intends to identify the hydration and biomechanical behaviour changes related to weight augmentation. This transversal study was performed on a convenience sample of 57 volunteers, all females, aged between 20 and 46 (30±8) years old. Volunteers were divided in two groups – group I, with a BMI between 19,9 and 24,9 Kg/m2 and group II, between 25 and 29,9 Kg/m2. One single determination of the superficial hydration, transepidermal water loss and biomechanical behaviour of the skin, was obtained with non-invasive methods. The data showed that weight increase positively influences hydration levels and transepidermal water loss, and negatively influences the skin's biomechanical behaviour. Despite the relevance of these results, there is still a need for complementary studies, with a wider number of individuals, in order to better understand its nature and meaning.

© 2017 S. Karger AG, Basel, Background/Aims: Recently classified as an epidemic by the WHO, obesity (as well as the state of being overweight) clearly affects significant populations across all ages. The relationship between obesity and some diseases (e.g. cardiovascular ones) is known, although many paradoxes remain to be explained. Very little information is available, however, regarding its impact on skin physiology and skin disease. This study aims to examine the influence of excessive weight on epidermal hydration and transepidermal water loss, key variables of skin water balance and skin biomechanics. Methods: A convenience sample of 89 healthy female volunteers was selected and divided into 4 groups, according to their BMI (body mass index), as normal (control), overweight, obese (I and II), and morbid. Skin physiology was quantitatively assessed in all individuals in 4 anatomical areas using non-invasive biometrical analysis by reference instrumentation. Descriptive and comparative statistics were applied, adopting a confidence level of 95%. Results: A nonlinear alteration for all variables was detected as a function of BMI. Conclusion: Results suggest that excessive weight might favour skin performance within certain limits, reflecting a particular adaptation of the skin to the weight gain and body contour.

Bioimpedance seems to be particularly suited to the non-invasive measurement of several physiological variables. The present study aimed to ascertain whether the quantification of total body water and intracellular and extracellular fluid compartments, obtained through a bioimpedance-based analytical device, could be correlated with the concentration sodium, potassium and chloride ions, obtained from venous blood ionogram. Volunteers of both genders, of various ages and with various health conditions were studied. None of the volunteers suffered from any hydro-electrolytic disorder. Body water measurements were obtained by a Bodystat® QuadScan 4000 and ionogram obtained through potentiometry. Under the present experimental conditions, which should be considered merely a preliminary approach

Summary Background/purpose The importance of water in human physiology is well known, also for skin functionality. This study was conducted to assess the effects of dietary water on epidermal skin hydration in healthy females. Methods Thirty-four healthy females (mean 24.5 ± 6.34 years old) were selected and characterized according to their dietary daily habits, by a previously validated Food Frequency Questionnaire. For 1 month, these subjects were asked to add 2 L/day of water to their regular dietary habits. Measurements took place at day D0, D15, and D30, and involved general variables (body weight, blood pressure, Body Mass Index) and specific skin physiological variables in five anatomical sites (ventral forearm, anterior leg, dorsal hand, zygomatic area, and forehead) involving epidermal superficial and deep hydration, by capacitance and transepidermal water loss (TEWL). Results This water overload (2 L/day/30 days) did not change the blood volume or weight of the individuals. However, both superficial and deep skin hydration were clearly in those individuals that regularly consumed lees water per day. No significant effect was observed in the TEWL. Conclusions This study clearly suggests that dietary water intake seems to influence skin water content. Nevertheless further in vivo investigations involving other variables, such as biomechanical descriptors, should follow to look deeper into this aspect of skin physiology.

Lídia Palma,1 Liliana Tavares Marques,1 Julia Bujan,2,3 Luís Monteiro Rodrigues1,4 1CBIOS – Research Center for Health Science and Technologies, Universidade Lusófona, Campo Grande, Lisboa, Portugal; 2Department of Medicine and Medical Specialities, Universidad de Alcalá de Henares, Madrid, Spain; 3CIBER-BBN, Madrid, España, Spain; 4Department of Pharmacological Sciences, School of Pharmacy, Universidade de Lisboa, Lisboa, Portugal Abstract: It is generally assumed that dietary water might be beneficial for the health, especially in dermatological (age preventing) terms. The present study was designed to quantify the impact of dietary water on major indicators of skin physiology. A total of 49 healthy females (mean 24.5±4.3 years) were selected and characterized in terms of their dietary daily habits, especially focused in water consumption, by a Food Frequency Questionnaire. This allowed two groups to be set – Group 1 consuming less than 3,200 mL/day (n=38), and Group 2 consuming more than 3,200 mL/day (n=11). Approximately 2 L of water were added to the daily diet of Group 2 individuals for 1 month to quantify the impact of this surplus in their skin physiology. Measurements involving epidermal superficial and deep hydration, transepidermal water loss, and several biomechanical descriptors were taken at day 0 (T0), 15 (T1), and 30 (T2) in several anatomical sites (face, upper limb, and leg). This stress test (2 L/day for 30 days) significantly modified superficial and deep skin hydration, especially in Group 1. The same impact was registered with the most relevant biomechanical descriptors. Thus, in this study, it is clear that higher water inputs in regular diet might positively impact normal skin physiology, in particular in those individuals with lower daily water consumptions. Keywords: dietary water, water consume, skin hydration, TEWL, skin biomechanics