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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.

OBJECTIVES: The efficacy of concomitant ablation techniques in patients with paroxysmal atrial fibrillation (AF) undergoing mitral valve surgery remains under debate. The aim of this prospective, randomized, single-centre study was to compare pulmonary vein isolation (PVI) only versus a left atrial maze (LAM) procedure in patients with paroxysmal AF during mitral valve surgery. METHODS: Between February 2009 and June 2011, 52 patients with a mean age of 54.2 (standard deviation 7.2 years) underwent mitral valve surgery and concomitant bipolar radiofrequency ablation for paroxysmal AF. Patients were randomized into the PVI group (n= 27) and the LAM group (n= 25). After surgery, an implantable loop recorder for continuous electrocardiography (ECG) monitoring was implanted. Patients with an AF burden (AF%) of

We appreciate the interest that Dr. Staessen and colleagues have expressed regarding our recently published study [(1)][1]. We have addressed each of the issues. The study was initially registered with a larger estimated sample size, formally anticipating correction or revision as the study

Catheter Versus Surgical Ablation Introduction The aim of this prospective randomized study was to compare the efficacy and safety of catheter ablation (CA) versus surgical ablation (SA) in the treatment of paroxysmal and persistent AF after failed initial pulmonary vein isolation procedure. Methods and Results Patients with a history of symptomatic AF after a previous failed first ablation procedure were eligible for this study. Patients were randomized to CA (n = 32) or SA (n = 32) redo ablation. The primary endpoint was recurrence of atrial tachyarrhythmia at 1 year of follow-up. At the 12-month follow-up, 26 (81%) of the 32 SA group patients and 15 (47%) of the 32 CA group were AF/AT-free on no antiarrhythmic drugs (P = 0.004, log-rank test). In patients with PAF, 17 (85%) patients of the 20 in SA group and 10 (56%) patients of the 18 in CA group were AF-free (P = 0.04, log-rank test). In patients with PersAF, 9 (75%) patients of the 12 in SA group and 5 (36%) patients of the 14 in CA group were AF-free (P = 0.04, log-rank test). The number of the serious adverse event in the SA group was significantly higher (1 CA group vs 7 SA group; P = 0.02). Conclusion In patients with PAF and PersAF after failed initial CA, SA is superior to CA for maintenance of sinus rhythm, although serious adverse event rate is significantly higher for SA.

Background— The aim of this prospective randomized study was to assess whether an early reablation was superior to antiarrhythmic drug (AAD) therapy in patients with previous failed pulmonary vein isolation. Methods and Results— Patients with paroxysmal atrial fibrillation (AF) eligible for AAD therapy or reablation after a previously failed initial pulmonary vein isolation procedure were eligible for this study and were followed up for 3 years to assess rhythm by means of an implanted cardiac monitor. After the blanking period postablation, 154 patients had symptomatic AF recurrences and were randomized to AAD (n=77) or repulmonary vein isolation (n=77). At the end of follow-up, 61 (79%) patients in the AAD group and 19 (25%) patients in the reablation group demonstrated AF% progression ( P P P P Conclusions— Redo AF ablation was substantially more effective than AAD in reducing the progression and prevalence of AF after the failure of an initial ablation. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01709682.

Background: Advancing age is associated with a greater prevalence of coronary artery disease in heart failure with reduced ejection fraction and with a higher risk of complications after coronary artery bypass grafting (CABG). Whether the efficacy of CABG compared with medical therapy (MED) in patients with heart failure caused by ischemic cardiomyopathy is the same in patients of different ages is unknown. Methods: A total of 1212 patients (median follow-up, 9.8 years) with ejection fraction ≤35% and coronary disease amenable to CABG were randomized to CABG or MED in the STICH trial (Surgical Treatment for Ischemic Heart Failure). Results: Mean age at trial entry was 60 years; 12% were women; 36% were nonwhite; and the baseline ejection fraction was 28%. For the present analyses, patients were categorized by age quartiles: quartile 1, ≤54 years; quartile, 2 >54 and ≤60 years; quartile 3, >60 and ≤67 years; and quartile 4, >67 years. Older versus younger patients had more comorbidities. All-cause mortality was higher in older compared with younger patients assigned to MED (79% versus 60% for quartiles 4 and 1, respectively; log-rank P =0.005) and CABG (68% versus 48% for quartiles 4 and 1, respectively; log-rank P P =0.388) or CABG group (39% versus 35% for quartiles 4 and 1, respectively; log-rank P =0.103). Cardiovascular deaths accounted for a greater proportion of deaths in the youngest versus oldest quartile (79% versus 62%). The effect of CABG versus MED on all-cause mortality tended to diminish with increasing age ( P interaction =0.062), whereas the benefit of CABG on cardiovascular mortality was consistent over all ages ( P interaction =0.307). There was a greater reduction in all-cause mortality or cardiovascular hospitalization with CABG versus MED in younger compared with older patients ( P interaction =0.004). In the CABG group, cardiopulmonary bypass time or days in intensive care did not differ for older versus younger patients. Conclusions: CABG added to MED has a more substantial benefit on all-cause mortality and the combination of all-cause mortality and cardiovascular hospitalization in younger compared with older patients. CABG added to MED has a consistent beneficial effect on cardiovascular mortality regardless of age. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00023595.

The Integrable Optics Test Accelerator (IOTA) is a storage ring for advanced beam physics research currently being built and commissioned at Fermilab. It will operate with protons and electrons using injectors with momenta of 70 and 150 MeV/c, respectively. The research program includes the study of nonlinear focusing integrable optical beam lattices based on special magnets and electron lenses, beam dynamics of space-charge effects and their compensation, optical stochastic cooling, and several other experiments. In this article, we present the design and main parameters of the facility, outline progress to date and provide the timeline of the construction, commissioning and research. The physical principles, design, and hardware implementation plans for the major IOTA experiments are also discussed., Comment: 42 pages, 31 figures

The aim of this prospective randomized study was to assess the impact of renal artery denervation in patients with a history of refractory atrial fibrillation (AF) and drug-resistant hypertension who were referred for pulmonary vein isolation (PVI).Hypertension is the most common cardiovascular condition responsible for the development and maintenance of AF. Treating drug-resistant hypertension with renal denervation has been reported to control blood pressure, but any effect on AF is unknown.Patients with a history of symptomatic paroxysmal or persistent AF refractory to ≥2 antiarrhythmic drugs and drug-resistant hypertension (systolic blood pressure160 mm Hg despite triple drug therapy) were eligible for enrolment. Consenting patients were randomized to PVI only or PVI with renal artery denervation. All patients were followed ≥1 year to assess maintenance of sinus rhythm and to monitor changes in blood pressure.Twenty-seven patients were enrolled, and 14 were randomized to PVI only, and 13 were randomized to PVI with renal artery denervation. At the end of the follow-up, significant reductions in systolic (from 181 ± 7 to 156 ± 5, p0.001) and diastolic blood pressure (from 97 ± 6 to 87 ± 4, p0.001) were observed in patients treated with PVI with renal denervation without significant change in the PVI only group. Nine of the 13 patients (69%) treated with PVI with renal denervation were AF-free at the 12-month post-ablation follow-up examination versus 4 (29%) of the 14 patients in the PVI-only group (p = 0.033).Renal artery denervation reduces systolic and diastolic blood pressure in patients with drug-resistant hypertension and reduces AF recurrences when combined with PVI.

Recurrences are common within the first months following atrial fibrillation (AF) ablation. However, prior studies using only intermittent ECG recording have not shown a powerful correlation with ultimate response.The purpose of this study was to use continuous AF monitoring with an implanted monitor to assess the AF burden measured continuously during the first months postablation and the relationship to subsequent AF recurrences.Six hundred thirteen patients with symptomatic drug-refractory AF (17% with persistent AF) were part of this retrospective analysis. All patients underwent circumferential pulmonary vein isolation and were implanted with a subcutaneous AF monitor (Reveal XT, Medtronic) for collecting data on AF burden (AF%) during a 12-month follow-up period. AF freedom (responders) was defined as AF% ≤0.5% during each monthly telemetric follow-up. A receiver operating characteristic curve analysis was performed to identify the value in AF% during the first months in the postablation blanking period that was predictive of later recurrence of AF. Sensitivity of 90% was selected as the target value.After the first ablation procedure, 396 of the 613 patients (65%) were responders (AF ≤0.5%) at 12 months: 346 of 508 (68%) in the paroxysmal AF group and 50 of 105 (47%) in the persistent AF group. Using the receiver operating characteristic curve, the specificity corresponding to 90% sensitivity was 85% for AF% at 2 months. The corresponding threshold in the AF burden during the blanking period able to identify patients at risk for late recurrences was 4.5%, corresponding to a cumulative 65.9 hours (2.75 days) spent in AF during the first 2 months. In a multivariate analysis, AF%4.5% during the first 2 months was highly significant (P.001), and the odds ratio of responders/nonresponders was 39.8 (95% CI, 19.1-82.9).The AF burden measured during the blanking period can predict the response to catheter ablation at 12 months. AF% ≥4.5% at 2 months assessed by continuous monitoring is a powerful predictor of subsequent AF recurrences after initial ablation, thus providing relevant clinical information to select patients for early reintervention.

This paper presents results from the United Nations Environment Programme (UNEP)-coordinated project, “Reducing Mercury Emissions from Coal Combustion in the Energy Sector”, implemented in the Russ...

Background: The effectiveness of ganglionated plexi (GP) ablation in patients with atrial fibrillation (AF) is ambiguous. Some researchers had already suggested that additional identification of complex fractionated atrial electrograms (CFAE) around the areas with a positive reaction to high-frequency stimulation (HFS) might improve the accuracy of GP's boundaries location, then enhancing the success rate of ablation. The purpose of this study was to assess the safety and efficacy of GP ablation directed by HFS and CFAE in patients with paroxysmal AF (PAF). Methods and Results: Sixty-two patients with PAF (age 57±8 years) underwent GP ablation. Ablation targets were the sites where vagal reflexes were evoked by HFS and additional extended ablation CFAE area around the areas where vagal reflexes were evoked. At 12 months, 71% of patients were free of symptomatic AF. At 3 months after ablation the root mean square successive differences and HF were significantly lower in patients without AF recurrence (P < 0.0001 and P = 0.004). The LF/HF ratio was significantly higher in patients without AF recurrence (P = 0.02). Conclusion: Enhanced GP ablation directed by HFS and CFAE can be safely performed and enables maintenance of sinus rhythm in the majority of patients with PAF for a 12-month period. Denervation of the intrinsic cardiac autonomic nervous system may be the preferable target of catheter ablation of AF. (PACE 2012;XX:1–9)

The PREVENT AF I study demonstrated that prophylactic pulmonary vein isolation (PVI) in patients with typical atrial flutter (AFL) resulted in substantial reduction of new onset atrial fibrillation (AF) during 1-year follow up as assessed by continuous implantable loop recorder (ILR). To assess the

A novel cardiac gamma camera utilises physiologic uptake of Iodine-123 Meta -iodobenzylguanidine (123I –m IBG) to visualise cardiac sympathetic innervation. Physiologic uptake of 123I – m IBG provides anatomical quantification of autonomic nervous system (ANS) structures with discrete uptake

We retrospectively analyzed the temporal and spatial variations of four different physical parameters characterizing the state of the atmosphere and ionosphere several days before the M9 Tohoku, Japan earthquake of March 11, 2011. The data include outgoing long wave radiation (OLR), GPS/TEC, lower Earth orbit ionospheric tomography and critical frequency foF2. Our first results show that on March 7th a rapid increase of emitted infrared radiation was observed from the satellite data and an anomaly developed near the epicenter. The GPS/TEC data indicate an increase and variation in electron density reaching a maximum value on March 8. Starting from this day in the lower ionosphere also there was confirmed an abnormal TEC variation over the epicenter. From March 3 to 11 a large increase in electron concentration was recorded at all four Japanese ground-based ionosondes, which returned to normal after the main earthquake. The joint preliminary analysis of atmospheric and ionospheric parameters during the M9 Tohoku, Japan earthquake has revealed the presence of related variations of these parameters implying their connection with the earthquake process. This study may lead to a better understanding of the response of the atmosphere/ionosphere to the great Tohoku earthquake.

Background: Modification of left atrial ganglionated plexi (GP) is a promising technique for the treatment of paroxysmal atrial fibrillation (AF) but its therapeutic efficacy is not established. This study aimed at evaluating the effectiveness of anatomic GP modification by means of an implantable arrhythmia monitoring device. Methods: In 56 patients with paroxysmal AF, radiofrequency ablation at anatomic sites, where the main clusters of GP have been identified in the left atrium, was performed. In all patients, an electrocardiogram monitor (Reveal XT, Medtronic Inc., Minneapolis, MN, USA) was implanted before (n = 7) or immediately after (n = 49) AF ablation. Results: Average duration of the procedure was 142 ± 18 min and average fluoroscopy time 20 ± 7 min. In total, 53–81 applications of RF energy were delivered (mean of 18.2 ± 3.8 at each of the four areas of GP ablation). Heart rate variability was assessed in 31 patients. Standard deviation of RR intervals over the entire analyzed period, the root mean square of differences between successive RR intervals, and high frequencies decreased, while HRmin, HRmean, and LF to HF ratio increased immediately postablation; these values returned to baseline 6 months after the procedure. At end of 12-month follow-up, 40 (71%) patients were free of arrhythmia recurrence. Ten patients had AF recurrence, two patients had left atrial flutter, and four patients had episodes of flutter as well as AF recurrence. Duration of episodes of AF after ablation gradually decreased over the follow-up period. Conclusions: Regional ablation at the anatomic sites of the left atrial GP can be safely performed and enables maintenance of sinus rhythm in 71% of patients with paroxysmal AF for a 12-month period. (PACE 2010; 33:1231–1238)

Background: Epicardial implantation of a cardiac resynchronization therapy (CRT) system during coronary artery bypass grafting (CABG) may be an additional treatment method for improving left ventricle (LV) systolic function and dyssynchrony in patients with ischemic heart failure. Objective: The objective was to compare the long-term results in patients with severe ischemic heart failure who underwent CABG alone or CABG combined with concomitant epicardial implantation of a CRT system. Methods: One hundred sixty-four consecutive patients with severe ischemic heart failure and LV dyssynchrony were enrolled into 2 groups: CABG alone (n = 80) and epicardial CRT implantation during CABG (CABG + CRT) (n = 84). This prospective, randomized, and single-blind study was designed to compare clinical and echocardiography data after 6, 12, and 18 months of follow-up. Results: In the CABG group, LV systolic function, dyssynchrony signs, and quality of life did not change postoperatively, compared with preoperative data. In contrast, these parameters significantly improved in the CABG + CRT group. The 2 treatment groups did not differ with respect to postoperative improvement in Canadian Cardiovascular Society class ( P = .68). The improvement in the New York Heart Association functional class was much more pronounced in the CABG + CRT group than in the CABG group ( P = .029). In the CABG group, 21 patients (26.2%) had died by the 18-month follow-up, compared with 9 patients (10.7%) in the CABG + CRT group (P = .012, log-rank test). Conclusion: Epicardial implantation of a CRT system concomitantly with CABG facilitates the early postoperative period, improves LV systolic function, improves the quality of life, and decreases LV dyssynchrony. Moreover, mortality in the CABG + CRT group was significantly lower than in the CABG group.

This report describes a case of left atrial appendectomy after a failed endocardial catheter ablation of a continuous drug-refractory left atrial appendage (LAA) tachycardia in a 9-year-old boy. Electrophysiologic study showed atrial tachycardia (AT) originating in the LAA. Numerous radiofrequency applications with an irrigated-tip catheter were ineffective. During surgery, direct pressure on the apex of the LAA by forceps immediately terminated the AT and restored sinus rhythm. After a left atrial appendectomy, the patient remained free of any arrhythmias during a follow-up period of 18 months.

Background Selective ganglionated plexi (GP) ablation guided by high-frequency stimulation has been proposed for the treatment of paroxysmal atrial fibrillation (AF), but the efficacy of the method is not established. Objective This study sought to compare selective ablation of GP identified by high-frequency stimulation with extensive regional ablation targeting the anatomic areas of GP in patients with paroxysmal AF. Methods Eighty patients with paroxysmal AF (age 53 ± 9 years) were randomized to undergo selective GP ablation or regional left atrial ablation at the anatomic sites of GP. For selective GP ablation (n = 40), ablation targets were the sites where vagal reflexes were evoked by high-frequency stimulation. Vagal reflexes were defined as prolongation of the R-R interval by >50% and a concomitant decrease in blood pressure (>20 mm Hg) during AF. The end point of the procedure was failure to reproduce vagal reflexes with repeated high-frequency stimulation. For anatomic ablation, lesions were delivered at the sites of GP clustering. Results At 13.1 ± 1.9 months, 42.5% of patients with selective GP and 77.5% of patients with anatomic ablation were free of symptomatic paroxysmal AF (PAF) ( P = .02). Parasympathetic denervation was more prominent in patients with anatomic than selective GP ablation, and in patients free of AF compared to these with AF recurrence immediately after ablation, but this trend was abolished at 6 months. Conclusion Selective GP ablation directed by high-frequency stimulation does not eliminate paroxysmal AF in the majority of patients. An anatomic approach for regional ablation at the sites of GP confers better results.

Objective A brass comb burn model that creates 3 full-thickness burns separated by 3 interspaces of unburned skin representing the zone of ischemia has been described in rats. We evaluated this model in pigs. Methods Design—observational. Subjects—6 pigs (20-25 kg). Interventions—4 burns created on each animal on the dorsum using a brass comb with 4 rectangular prongs preheated in boiling water and applied for 30 seconds resulting in 4 rectangular 10 × 20–mm full-thickness burns separated by three 5 × 20–mm unburned interspaces. Outcomes—wounds observed at 1, 2, 3, and 7 days for evidence of necrosis in unburned interspaces. Full-thickness biopsies from interspaces were evaluated with hematoxylin-eosin staining 7 days after injury for evidence of necrosis. Data analysis—the percentages of interspaces progressing to necrosis were analyzed with descriptive statistics. Results Twenty-four comb burns with 72 unburned interspaces were created evenly distributed between the animals. The percentages of interspaces that progressed to full-thickness necrosis at 1, 2, 3, and 7 days after injury were 88.9% (64/72; 95% confidence interval [CI], 79.6%-94.3%), 88.9% (64/72; 95% CI, 79.6%-94.3%), 88.9% (64/72; 95% CI, 79.6%-94.3%), and 97.7% (70/72; 95% CI, 90.4%-99.2%), respectively. There was perfect agreement between gross inspection and histomorphology. Conclusions The comb burn model in swine results in the progression of most unburned ischemic interspaces to full-thickness necrosis within 1 to 7 days.

A series of in situ gelable hydrogels were prepared from oxidized dextran (Odex) and N-carboxyethyl chitosan (CEC) without any extraneous crosslinking agent. The gelation readily took place at physiological pH and body temperature. The gelation process was monitored rheologically, and the effect of the oxidation degree of dextran on the gelation process was investigated. The higher the oxidation degree of Odex, the faster the gelation. A highly porous hydrogel structure was revealed under scanning electron microscopy (SEM). Swelling and degradation of the Odex/CEC hydrogels in PBS showed that both swelling and degradation were related to the crosslinking density of the hydrogels. In particular, the hydrogels underwent fast mass loss in the first 2 weeks, followed by a more moderate degradation. The results of long-term cell viability tests revealed that the hydrogels were non-cytotoxic. Mouse fibroblasts were encapsulated in the hydrogels and cell viability was at least 95% within 3 days following encapsulation. Furthermore, cells entrapped inside the hydrogel assumed round shape initially but they gradually adapted to the new environment and spread-out to assume more spiny shapes. Additionally, the results from applying the Odex/CEC system to mice full-thickness transcutaneous wound models suggested that it was capable of enhancing wound healing.

Anthropogenic pressures have resulted in measurable impacts on the coastal ecosystems of the northern (Sevastopol Bay, Ukraine) and eastern (Batumi aquatoria, Georgia) Black Sea. Indices suggest that major impacts are relatively localized and are comparable to similar situations in the northern Atlantic. In contrast, biodiversity was appreciably lower than from comparable north Atlantic waters. The number of macrobenthic species was typically round 50, less than half the number that might be expected from similar exercises in US or European waters. Site-specific indices likewise indicated a somewhat lower diversity within communities, yielding metrics which would indicate a measure of stress in N. Atlantic situations. Microbial status was generally good, although regions close to urbanisation did not comply with standards laid down in the current EC Bathing Water Directive (76/EC/160). Likewise viruses were more commonly, although not exclusively, associated with urban locations, as were phages. Microbial investigation of the sediments confirmed the presence of heterotrophic and oil-oxidising bacteria. Abundance of the latter was closely correlated to the degree of oil contamination of the sediments, and to temperature, although for both, the results showed that the increase in bacterial abundance did level off beyond a certain point. Numbers of oil-oxidising bacteria in the water column displayed a classical response to temperature, with abundance doubling over a 10 °C rise in temperature. Overall the results suggest that while indices in current use are useful in evaluating coastal quality in the Black Sea, some adjustments would be necessary especially in the establishment of baseline or reference values.

Objectives: Cutaneous burns are dynamic injuries with a central zone of necrosis surrounded by a zone of ischemia. Conversion of this ischemic zone to full necrosis over the days following injury is due in part to highly reactive oxygen radicals. Curcumin is a component of the Oriental spice turmeric that has been shown to have antioxidant and antiapoptotic properties. The authors hypothesized that treatment of burns with curcumin would reduce the conversion of the ischemic zone to full necrosis. Methods: This was a randomized controlled experiment. Twenty Sprague-Dawley rats were used. Two burns were created on each animal’s dorsum using a brass comb with four rectangular prongs preheated in boiling water and applied for 30 seconds, resulting in four rectangular 10 20–mm full-thickness burns separated by three 5 20–mm unburned interspaces (zone of ischemia). Animals were randomized to curcumin or vehicle by oral gavage 30 minutes before injury and at 24, 48, and 72 hours after injury. Wounds were observed at one, two, and three days after injury for visual evidence of necrosis in the unburned interspaces. Full-thickness biopsy specimens from the interspaces were evaluated with hematoxylin and eosin staining seven days after injury for evidence of necrosis. The percentage of interspaces that progressed to necrosis was compared with chi-square tests. Results: Forty comb burns with 120 unburned interspaces were created, evenly distributed between curcumin and vehicle alone. The percentage of interspaces that progressed to full-thickness necrosis at one, two, three, and seven days after injury in the curcumin and vehicle groups were 30% versus 63% (p = 0.003), 30% versus 70% (p < 0.001), 63% versus 95% (p = 0.02), and 63% versus 95% (p = 0.02), respectively. Conclusions: Pretreatment of rats with oral curcumin followed by once-daily oral treatment for three days reduced the percentage of unburned skin interspaces that progressed to full necrosis. ACADEMIC EMERGENCY MEDICINE 2007; 14:1125–1129 a 2007 by the Society for Academic Emergency Medicine

Aim To compare the quality of life (QoL) of patients with persistent atrial fibrillation (AF) and ischaemic heart disease after modified mini-maze (MM) procedure or pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) with patients in the control group (coronary artery bypass graft [CABG]) alone. Methods In this prospective randomised study, we included 95 patients with persistent AF and coronary heart disease who underwent open-heart surgery combined with intraoperative irrigated RFA (irrRFA). Patients were randomly assigned to three groups: CABG and PVI using irrRA (CABG+PVI, n=31), CABG and MM procedure using irrRA (CABG+MM, n=30), and isolated CABG (CABG alone, n=34). All patients received implantable loop recorders (ILRs). Patient QoL was assessed using the Short Form 36 (SF-36) preoperatively, and one and two years post-operatively. The study primary end point was freedom from AF one year after operation, measured by implantable loop recorders (ILRs); secondary endpoint included long-term clinical outcomes. Results No reoperations or hospital mortalities were recorded. Mean follow-up was 14.4±9.7 months. The percentages of patients free from AF determined by ILR were 80%, 86.2%, and 44.1% in the CABG+PVI, CABG+MM, and in the CABG alone groups, respectively. The QoL significantly improved in CABG+PVI and CABG+MM groups compared with CABG alone group in most domains. Conclusion Effective elimination of AF during CABG surgery improves QoL in all physical health domains of the SF-36 and the role-emotional functioning domain. Thus, patients with concomitant AF and coronary heart disease may benefit from intraoperative radiofrequency ablation to prevent relapse of the arrhythmia.

The study examined the effect of VEGF and erythropoietin on proliferative and migratory activities of skin fibroblasts and multipotent mesenchymal stromal cells of human adipose tissue. VEGF stimulated proliferation and migration of fi broblasts, but produced no significant effect on functional activity of multipotent mesenchymal stem cells. Erythropoietin stimulated proliferation of both cell types, but did not affect their migration.

Renal artery denervation (RDN) has provided incremental atrial fibrillation (AF) suppression after pulmonary vein isolation (PVI) in patients with AF in the setting of drug-resistant hypertension, but the antiarrhythmic mechanism by which RND functions is unknown. All patients from two randomized

The combination of left atrial appendage (LAA) occlusion with pulmonary vein isolation (PVI) potentially represents a comprehensive treatment for atrial fibrillation (AF), controlling symptoms while at the same time reducing the risk of stroke and the need for chronic anticoagulation. The aim of this randomized clinical trial was to assess the impact of LAA closure added to PVI in patients with high-risk AF. Patients with a history of symptomatic paroxysmal or persistent AF refractory to ≥2 antiarrhythmic drugs, CHA2DS2-VASc score ≥2, and HAS-BLED score ≥3 were randomized to PVI-only (n = 44) or PVI with LAA closure (n = 45). Six patients in PVI + LAA closure group crossed over to PVI-only group due to failure of LAA closure device implantation. On-treatment comparisons at the 24 month follow-up revealed that 33 (66 %) of the 50 PVI group and 23 (59 %) of the 39 PVI with LAA closure group were AF-free on no antiarrhythmic drugs (p = 0.34). The PVI + LAA closure treatment was significantly associated with a higher AF burden during the blanking period: 9.7 ± 10.8 vs 4.2 ± 4.1 % (p = 0.004). At the end follow-up, there were no serious complications and no strokes or thromboembolic events in either group. The combination of LAA closure device implantation with PVI was safe but was not observed to influence the success of PVI in patients with symptomatic refractory AF. Early AF after ablation, however, is increased by LAA closure. URL: http://www.clinicaltrials.gov . Unique identifier: NCT01695824.

Purpose. The results of cryoballoon ablation (CBA) procedure have been mainly derived from studies conducted in experienced atrial fibrillation (AF) ablation centres. Here, we report on CBA efficacy and complications resulting from real practice of this procedure at both high- and low-volume centres.Methods. Among 62 Russian centres performing AF ablation, 15 (24%) used CBA technology for pulmonary vein isolation. The centres were asked to provide a detailed description of all CBA procedures performed and complications, if encountered.Results. Thirteen sites completed interviews on all CBAs in their centres (>95% of CBAs in Russia). Six sites were high-volume AF ablation (>100 AF cases/year) centres, and 7 were low-volume AF ablation. There was no statistical difference in arrhythmia-free rates between high- and low-volume centres (64.6 versus 60.8% at 6 months). Major complications developed in 1.5% of patients and were equally distributed between high- and low-volume centres. Minor procedure-related events were encountered in 8% of patients and were more prevalent in high-volume centres. Total event and vascular access site event rates were higher in women than in men.Conclusions. CBA has an acceptable efficacy profile in real practice. In less experienced AF ablation centres, the major complication rate is equal to that in high-volume centres.

The article presents a description of a new approach to the organization of natural language processing (NLP) in general and to machine translation (MT) architecture in particular, based on the new ideas of behavior-based (BB) artificial intelligence and MT conceptions. These new NLP technological priniciples and approaches were taken as the basis for creation and development of a polyfunctional multilanguage system "Linguistic Automaton" (LINGTON) carried out by a team of scientists and researchers, known as the International Speech Statistics Group (SSG) founded and headed by Prof. Rajmund Piotrowski.

A novel cardiac gamma camera utilises the radiopharmaceutical Iodine-123 Meta- iodobenzylguanidine (123I –m IBG) to visualise cardiac sympathetic innervation. Physiologic uptake of 123I –m IBG provides anatomical quantification of autonomic nervous system (ANS) structures, with discrete uptake

Catheter ablation is less successful for persistent atrial fibrillation (Pers AF) than for paroxysmal atrial fibrillation. Some studies suggest that left atrial appendage (LAA) isolation in addition to pulmonary vein isolation (PVI) is required in persistent atrial fibrillation. We randomly

В данной статье представлен автоматизированный регулятор для поддержания давления масла во время запрессовки деталей гидропрессовым методом с целью повышения стабильности гидропрессовой сборки и качества собираемых соединений с гарантированным натягом. Регулятор разработан на основе гидроаккумулятора и мехатронного силового механизма с поступательным движением опоры в вертикальном направлении. Силовой механизм обеспечивает перемещение плунжера гидроаккумулятора, что позволяет регулировать объем рабочей полости гидроаккумулятора, в которую поступает масло, вытекающее из зоны сопряжения деталей во время запрессовки, и, соответственно, регулировать давление масла в системе. Далее в данной статье приведены конструктивная, структурная и кинематическая схемы разработанного регулятора. Датчик силы выполняет роль обратной связи и обеспечивает автоматическое управление ходом силового механизма и последовательно соединенного с ним плунжера гидроаккумулятора. Для регулирования скорости вращения двигателя используется преобразователь частоты, который настроен на работу в режиме скалярного управления и инерционного останова для обеспечения плавного разгона и быстрого торможения двигателя гидростанции. Результаты тестирования регулятора на способность поддержания давления в заданном диапазоне подтверждают его работоспособность и соответствие требованиям, предъявляемым гидропрессовой сборкой соединений с натягом.

Background Renal artery denervation (RDN) has provided incremental atrial fibrillation (AF) suppression after pulmonary vein isolation (PVI) in patients with AF in the setting of drug-resistant hypertension. Objective To assess the relationship between changes of mean blood pressure (BP) and AF recurrences/AF burden after PVI combined with RDN. Methods All patients from two randomized studies with symptomatic paroxysmal AF and/or persistent AF and resistant hypertension who underwent PVI-only (n=37) or PVI with RDN (n=39), and implantable cardiac monitor (ICM) implantation were eligible for this study. Mixed-effects linear models were used to investigate the effect of RDN on mean BP and mean AF burden and associations between the two during the 12-month follow-up. Results Concomitant RDN was associated with a significant reduction in both mean AF burden (2.43 [95% CI: 1.76-3.09] % vs 6.95 [95% CI: 5.44-8.45] %) and mean BP (104 [95% CI: 103-106] mm Hg vs 112 [95% CI: 110-113] mm Hg). Decrease in mean BP was positively correlated with decline in mean AF burden: reduction of 5-10 mm Hg was accompanied by a 7.0% decreased mean AF burden, with greater reduction (up to 20 mm Hg) associated with on average 17.7% lower mean AF burden. Conclusions Renal artery denervation when added to PVI decreases AF recurrences, AF burden, and mean BP. Reduction in mean BP is associated with both AF burden and recurrences. Further large-scale studies are needed to define the mechanistic pathway(s) of the antiarrhythmic effects of RDN.

The $e^+e^-\to\eta\gamma$ cross section has been measured in the center-of-mass energy range 1.07--2.00 GeV using the decay mode $\eta\to 3\pi^0$, $\pi^0\to \gamma\gamma$. The analysis is based on 36 pb$^{-1}$ of integrated luminosity collected with the SND detector at the VEPP-2000 $e^+e^-$ collider. The measured cross section of about 35 pb at 1.5 GeV is explained by decays of the $\rho(1450)$ and $\phi(1680)$ resonances.

OBJECTIVES: We report our experience with a modified mini-maze procedure and pulmonary vein isolation using radiofrequency energy for treating persistent atrial fibrillation during coronary artery bypass grafting (CABG). METHODS: Ninety-five patients with persistent atrial fibrillation and coronary heart disease underwent open heart surgery combined with intraoperative irrigated radiofrequency ablation. Patients were randomized into the following three groups: CABG and irrigated radiofrequency pulmonary vein isolation (CABG+PVI, n= 31); CABG and an irrigated radiofrequency modified mini-maze procedure (CABG +MM, n= 30); and isolated CABG (CABG alone, n= 34). All patients received implantable loop recorders. RESULTS: No reoperation and no hospital mortality were recorded. Mean follow-up was 14.4 ± 9.7 months. The implantable loop recorder-determined freedom from atrial fibrillation was 80% in the CABG+PVI group, 86.2% in the CABG+MM group and 44.1% in the CABG alone group. CONCLUSIONS: Patients with concomitant atrial fibrillation and coronary heart disease may benefit from intraoperative ablation to prevent relapse of arrhythmia.

Objective monitoring of the level of anesthesia is crucial in carefully controlled translational neuroscience studies. The usefulness of bispectral index (BIS) in monitoring human anesthesia is well established. However, the validity of its application remains unproven in laboratory animals. We assessed whether BIS could be used reliably in monitoring the depth of deep anesthesia in 8 New Zealand white rabbits. Experimental baseline anesthesia was maintained with continuous infusion of propofol and administration of isoflurane, both of which were titrated to EEG activity. The rabbits were allocated randomly to receive 3 increasing concentrations of common anesthetic drugs (etomidate, propofol, and isoflurane) aimed to produce burst suppression of EEG activity yielding at least 10 s of sustained EEG silence. Rabbits had a 20-min recovery interval between challenges. Transient cerebral hypoperfusion to produce reversible EEG silence due to ischemia was induced as a fourth challenge, followed by terminal arrest, in each animal. BIS, EEG, and physiologic data were analyzed for each rabbit. We observed stable BIS values in the range of 40 to 60 during the administration of baseline anesthesia. However, as the depth of anesthesia deepened with the anesthetic drug challenges, the BIS value paradoxically increased with increasing doses. The BIS signal quality index declined while the total power decreased. In contrast to these unexpected results, BIS values decreased rapidly to near 0 during terminal arrest, as expected. Therefore, we do not consider BIS to be a useful method for monitoring deep levels of anesthesia in laboratory rabbits.

The potential role of renal denervation (RD) in patients with AF and less severe hypertension is unknown.The purpose of this study was to assess the potential role of RD as an adjunct to pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) and moderate resistant or severe resistant hypertension.The data for this study were obtained from 2 different prospective randomized studies, analyzed by meta-analysis. Patients with paroxysmal AF or persistent AF and moderate resistant hypertension (office blood pressure BP ≥140/90 mm Hg and160/100 mm Hg; first study; n = 48) or severe resistant hypertension (≥160/100 mm Hg; second study; n = 38) were randomized to PVI or PVI with RD.At 12 months, 26 of the 41 PVI with RD patients (63%) were AF-free vs 16 of the 39 patients (41%) in the PVI-only group (P = .014). In patients with severe hypertension, 11 of the 18 PVI with RD patients (61%) vs 5 of the 18 PVI-only patients (28%) were AF-free (P = .03). For moderate hypertension, the differences were less dramatic: 11 of 21 (52%) vs 15 of 23 (65%) when RD added (P = .19). The superior efficacy of adding RD was most apparent in persistent AF and severe hypertension (hazard ratio 0.25, confidence interval 0.09-0.72, P = .01). Duration of the procedure and fluoroscopy were nonsignificantly longer in the RD group.RD may improve the results of PVI in patients with persistent AF and/or severe resistant hypertension.

Cardiovascular diseases are a leading cause of mortality worldwide. Terminally differentiated adult cardiomyocytes lack the innate ability to regenerate. Cell- and gene-based therapies are emerging as exciting new experimental strategies for myocardial repair and treatment of a variety of cardiovascular diseases. The potential advantages and shortcomings of each strategy for electrophysiological disorders are discussed. Since the first description of human induced pluripotent stem cell-derived cardiomyocytes, these cells have garnered tremendous interest for their potential use in patient-specific analysis and therapy. However, a full understanding of their electrophysiological and contractile function is necessary before this potential can be realized. This review focuses on the mechanisms by which stem cell therapy may function as an antiarrhythmic treatment and early clinical results.

In patients with atrial flutter who undergo cavotricuspid isthmus ablation, long-term electrocardiographic (ECG) monitoring may identify new onset of atrial fibrillation (AF).To ascertain, through the use of an implantable loop recorder (ILR) with a dedicated AF detection algorithm, the incidence, duration, and burden of new AF in these patients and to develop an optimal postablation ECG monitoring strategy.We enrolled 20 patients with flutter, a CHADS2 score of 2-3, and no prior episode of AF. After cavotricuspid isthmus ablation, we implanted an ILR, which was interrogated routinely; all stored ECGs were adjudicated.During a mean follow-up of 382 ± 218 days, 3 patterns were observed. First, in 11 (55%) patients, stored ECGs confirmed AF at 62 ± 38 days after ablation. Second, in 4 (20%) patients, although the ILR suggested AF, episodes actually represented sinus rhythm with frequent premature atrial contractions and/or oversensing. Third, in 5 (25%) patients, no AF was observed. Episodes4 hours were associated with low AF burden (1%) or false detections. The 1-year freedom from any episode of AF4 and12 hours was 52% and 83%, respectively.Our data show that many (but not all) patients develop new AF within the first 4 months of flutter ablation. Since external ECG monitoring for this duration is impractical, the ILR has an important role for long-term AF surveillance. Future research should be directed toward identifying the relationship between duration/burden of AF and stroke and improving existing ILR technology.

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).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.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.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 (p0.001). Post-ablation atrial flutter did not differ between groups: 5.1% in PVI, 4.9% in GP, and 6.1% in PVI+GP. No serious adverse procedure-related events were encountered.Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF.