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Background This study aimed to clarify P‐wave duration (PWD) ability before pacemaker implantation to predict worsening atrial fibrillation (AF) burden after the procedure. Methods We retrospectively investigated 75 patients who underwent permanent pacemaker implantation due to sick sinus syndrome (SSS) at Komaki City Hospital between January 2006 and May 2019. Worsening AF burden was defined as an increase in the number of AF episodes, each lasting ≥5.5 hours a day. Results In the study population, 17 patients (23%) had worsening AF burden during the follow‐up period. These patients had significantly longer PWD in lead Ⅱ (117.9 ± 19.9 ms vs 101.3 ± 20.0 ms, P = .002) than the patients without worsening AF burden. The best discriminative cutoff value for PWD in lead Ⅱ was 108 ms (sensitivity, 77%; specificity, 67%). In multivariate analysis, PWD in lead II ≥108 ms (hazard ratio, 5.395; 95% confidence interval, 1.352‐21.523; P = .017) was an independent predictor of worsening AF burden. Patients with PWD in lead II

Introduction . Accuracy for screw placement in the dorsal pelvic ring can be enhanced using intraoperative 3D navigation. Advances in intraoperative imaging lead to benefits for pelvic surgery. New c-arms are equipped with flat panel detectors, which have a larger detector and assure higher image quality with accompanying dose reduction. A hybrid OR is defined by a fixed imaging system in an operating room providing the benefit of the surgical environment in combination with advanced intraoperative imaging. Aim of our investigation was to analyze the accuracy of navigated sacroiliac (SI) and transsacral transiliac (TSTI) screws in the dorsal pelvic ring, which were implanted with a hybrid OR in the first five years of use. Material and methods . All percutaneous SI or TSTI screws implanted in the hybrid OR using intraoperative navigation in the first 5 years of utilization (between June 2012 to June 2017) were included. Intraoperative 3D-scans and postoperative computed tomography were examined for screw perforation. Results . 210 SI and TSTI screws were implanted in 187 patients using intraoperative navigation in the hybrid-OR. 90.6 % of SI screws showed no cortical perforation. 6,3 % had a grade 1, 2.4 % a grade 2 and 0.8 % a grade 3 perforation. In 80.7 % of TSTI screws no perforation and in 13.3 % a grade 1 perforation was detected. 3.6 % showed a grade 2 and 2.4 % a grade 3 perforation. No significant difference between both screw types regarding the grade of cortical perforation could be seen. No significant relation between perforation rate and year of operation could be detected. Conclusion . Intraoperative navigation in a hybrid OR ensures a high accuracy for SI screws. Due to the large field of view and high image quality TSTI screws can be safely implanted in S1 and S2. Utilization of a hybrid-OR is accompanied with a steep learning curve.

Echocardiographic evaluation of chronic aortic regurgitation (AR) severity can lead to diagnostic ambiguity due to few feasible parameters or incongruent findings. The aim of the present study was to improve the diagnostic usefulness of left ventricular (LV) enlargement and aortic end-diastolic flow velocity (EDFV) using cardiovascular magnetic resonance (CMR) as reference. Patients (n = 120) were recruited either prospectively (n = 45) or retrospectively (n = 75). Severe AR (CMR regurgitant fraction > 33%) was present in 51% and 93% of the patients had LV ejection fraction ≥ 50%. EDFV and LV end-diastolic volume index (EDVI) were assessed by echocardiography using the traditional (excluding trabeculae) and recommended approach (including trabeculae). The patients were randomised to a derivation (n = 60) or a test group (n = 60). EDVI (traditional/recommended) to rule in (>99/118 ml/m2) and rule out severe AR (≤75/87 ml/m2) were identified using ROC analyses in the derivation group. The corresponding thresholds for EDFV were >17 cm/s and ≤10 cm/s. In the test group, the positive/negative likelihood ratios to rule in/rule out severe AR using EDVI were 10.0/0.14 (traditional), 6.2/0.11 (recommended), and using EDFV were 10.2/0.08. To rule in and rule out severe AR using derived cut-off values instead of >2 SD reduced the false positives by 92%, whereas using EDFV ≤10 cm/s instead of ≤20 cm/s reduced the false negatives by 94%. In conclusion, EDVI and EDFV as quantitative parameters are useful to rule in or rule out severe chronic AR. Importantly, other causes of LV enlargement have to be considered.

BACKGROUND: Although patients with kidney disease may be particularly susceptible to the adverse health effects associated with lead exposure, whether levels of lead found commonly in drinking water are associated with adverse outcomes in patients with ESKD is not known. METHODS: To investigate associations of lead in community water systems with hemoglobin concentrations and erythropoietin stimulating agent (ESA) use among incident patients with ESKD, we merged data from the Environmental Protection Agency (EPA) Safe Drinking Water Information System (documenting average 90(th) percentile lead concentrations in community water systems during 5 years before dialysis initiation, according to city of residence) with patient-level data from the United States Renal Data System. RESULTS: Among 597,968 patients initiating dialysis in the United States in 2005 through 2017, those in cities with detectable lead levels in community water had significantly lower pre-ESKD hemoglobin concentrations and more ESA use per 0.01 mg/L increase in 90(th) percentile water lead. Findings were similar for the 208,912 patients with data from the first month of ESKD therapy, with lower hemoglobin and higher ESA use per 0.01 mg/L higher lead concentration. These associations were observed at lead levels below the EPA threshold (0.015 mg/L) that mandates regulatory action. We also observed environmental inequities, finding significantly higher water lead levels and slower declines over time among Black versus White patients. CONCLUSIONS: This first nationwide analysis linking EPA water supply records to patient data shows that even low levels of lead that are commonly encountered in community water systems throughout the United States are associated with lower hemoglobin levels and higher ESA use among patients with advanced kidney disease.

Flow blockage of the fuel assembly in the lead-based fast reactor (LFR) may produce critical local spots, which will result in cladding failure and threaten reactor safety. In this study, the flow blockage characteristics were analyzed with the sub-channel analysis method, and the circumferentially-varied method was employed for considering the non-uniform distribution of circumferential temperature. The developed sub-channel analysis code SACOS-PB was validated by a heat transfer experiment in a blocked 19-rod bundle cooled by lead-bismuth eutectic. The deviations between the predicted coolant temperature and experimental values are within ±5%, including small and large flow blockage scenarios. And the temperature distributions of the fuel rod could be better simulated by the circumferentially-varied method for the small blockage scenario. Based on the validated code, the analysis of blockage characteristics was conducted. It could be seen from the temperature and flow distributions that a large blockage accident is more destructive compared with a small one. The sensitivity analysis shows that the closer the blockage location is to the exit, the more dangerous the accident is. Similarly, a larger blockage length will lead to a more serious case. And a higher exit temperature will be generated resulting from a higher peak coolant temperature of the blocked region. This work could provide a reference for the future design and development of the LFR.

The effect of flow rate variations on the performance of high-temperature metal oxide gas sensors is investigated in a new proposed chamber and compared to four conventional structures. Velocity, temperature, and gas concentration at the sensor surface were calculated by Computational Fluid Dynamics (CFD) studies. Responses and rise times of a TGS-2602 sensor were experimentally measured. Calculations indicate that increasing the flow rate increases the velocity and decreases the rise time and sensor temperature. The chamber structure also affects these parameters. Particularly, when the sensor is exposed to fluid from more faces, the sensor temperature is more affected by the flow rate. Comparing theoretically and experimentally results revealed that as flow rate variates or while using different structures, the surface temperature is the main factor that changes the sensor sensitivity. It is proved that in chambers with more sensor temperature variations, the highest response variations occur. Flow rate variations can lead to increased, decreased, or even peaked of the sensor response, depending on the sensor operating temperature related to the optimum temperature of the sensor. The sensor rise time depends on the chambers, but the differences were fewer than 8 seconds. It is concluded that in the new structure, slight response variation occurs at flow rate changes by placing the sensor in a cavity inside the chamber. Finally, using the proposed design is more accessible than eliminating the effect of flow rate fluctuations from the sensor response.

Trauma-induced complete lead fracture is a rare complication of pacemaker implantation. Only a few cases have been previously reported. Common treatment included replacement of pacemaker and/or extraction of fractured lead. In this report, however, we describe this unique case of complete traumatic pacemaker lead fracture. The patient had her right-ventricular lead fractured after a bicycle accident and had lived with the fractured lead for 8 months prior to her hospitalization. After examinations, she was treated with a relatively conservative strategy. The pacemaker and fractured lead were left for further observation and follow-up.

AIM The present study aims to determine the association of trace elements and oxidative and DNA damage biomarkers with fall incidence among community-dwelling older adults. METHODS This study is part of the Long-term Research Grant Scheme - Towards Useful Ageing cohort study in Malaysia. Of a total of 174 participants with complete trace elements and oxidative and DNA damage data during baseline, only 147 (84.5%) were successfully followed up after 18 months. Participants who experienced any fall events in the previous 18 months during the follow-up were categorized as fallers. RESULTS Thirty participants (20.4%) reported at least one fall in the previous 18 months. The mean concentrations of aluminium, lead and zinc were significantly higher (P

Aims Handheld electrocardiogram (ECG) monitors are increasingly used by both healthcare workers and patients to diagnose cardiac arrhythmias. There is a lack of studies validating the use of handheld devices against the standard 12-lead ECG. The Kardia 6L is a novel handheld ECG monitor which can produce a 6-lead ECG. In this study, we compare the 6L ECG against the 12-lead ECG. Methods and results A prospective study consisting of unselected cardiac inpatients and outpatients at Leeds Teaching Hospital NHS Trust. All participants had a 12- and 6-lead ECGs. All ECG parameters were analysed by using a standard method template for consistency between independent observers. Electrocardiograms from the recorders were compared by the following statistical methods: linear regression, Bland–Altman, receiver operator curve, and kappa analysis. There were 1015 patients recruited. The mean differences between recorders were small for PR, QRS, cardiac axis, with receiver operator analysis area under the curve (AUC) of >80%. Mean differences for QT and QTc (between recorders) were also small, with AUCs for QT leads of >75% and AUCs for QTc leads of >60%. Key findings from Bland–Altman analysis demonstrate overall an acceptable agreement with few outliers instances ( Conclusion Several parameters recorded by the Kardia 6L (QT interval in all six leads, rhythm detection, PR interval, QRS duration, and cardiac axis) perform closely to the gold standard 12-lead ECG. However, that consistency weakens for left ventricular hypertrophy, QRS amplitudes (Lead I and AVL), and ischaemic changes.

Transfer of contaminants to and from the skin surface has been postulated to occur through a number of different pathways and compartments including: object(s)-to-skin, skin-to-skin, skin-to-clothing, skin-to-gloves, air-to-skin, skin-to-lips, and skin-to-saliva. However, many identified transfer pathways have been only minimally examined to determine the potential for measurable transfer. The purpose of this study was to quantitatively evaluate repeated transfer between different compartments using elemental metallic lead (Pb) in the solid form using a series of systematic measurements in human subjects. The results demonstrated that some transfer pathways and compartments are significantly more important than others. Transfer of Pb could not be measured from skin to cotton clothing or skin to laminate countertop surfaces. However, transfer was consistently measured for skin-to-skin and between the skin and the surface of nitrile gloves, suggesting the potential for significant transfer to or from these compartments in real-world exposure scenarios, and the importance of these pathways. With repeated contacts, transfer increased non-linearly between 1 and 5 contacts, but appeared to approach a steady state distribution among the compartments within 10 contacts. Consistent with other studies, relative to 100% transfer for a single contact, the quantitative transfer efficiency decreased with repeated contacts to 29% after 5 contacts and 11-12% after 10 contacts; for skin-to-skin transfer measurements, transfer efficiency after either 5 or 10 contacts was approximately 50% of the single contact transfer. These data are likely to be useful for refining current approaches to modeling of repeated contacts for dermal exposure and risk assessment.

BackgroundOxygen-delivering modalities like humidified high-flow nasal cannula (HFNC) and noninvasive positive-pressure ventilation (NIV) are suspected of generating aerosols that may contribute to transmission of disease such as coronavirus disease 2019. We sought to assess if these modalities lead to increased aerosol dispersal compared to the use of non-humidified low-flow nasal cannula oxygen treatment (LFNC).MethodsAerosol dispersal from 20 healthy volunteers using HFNC, LFNC and NIV oxygen treatment was measured in a controlled chamber. We investigated effects related to coughing and using a surgical face mask in combination with the oxygen delivering modalities. An aerodynamic particle sizer measured aerosol particles (APS3321, 0.3–20 µm) directly in front of the subjects, while a mesh of smaller particle sensors (SPS30, 0.3–10 µm) was distributed in the test chamber.ResultsNon-productive coughing led to significant increases in particle dispersal close to the face when using LFNC and HFNC but not when using NIV. HFNC or NIV did not lead to a statistically significant increase in aerosol dispersal compared to LFNC. With non-productive cough in a room without air changes, there was a significant drop in particle levels between 100 cm and 180 cm from the subjects.ConclusionsOur results indicate that using HFNC and NIV does not lead to increased aerosol dispersal compared to low-flow oxygen treatment, except in rare cases. For a subject with non-productive cough, NIV with double-limb circuit and non-vented mask may be a favourable choice to reduce the risk for aerosol spread.

Limited data exist on the prevalence and prognosis of isolated posterior ST-segment elevation acute myocardial infarction (STEMI), revealed with a posterior chest lead. Furthermore, the utility of a synthesized-V7-9 lead in the diagnosis of STEMI is unclear; therefore, we aimed to evaluate its usefulness. We enrolled 142 consecutive patients with STEMI with the culprit lesion on the left circumflex artery (STEMI-LCx) undergoing percutaneous coronary intervention (PCI) between January 2009 and December 2019. We retrospectively checked the ST-segment change of both standard 12-lead and synthesized-V7-9 lead in all patients with STEMI-LCx. Based on electrocardiogram (ECG) findings, isolated posterior STEMI that was only revealed in synthesized-V7-9 lead was classified as "STEMI-LCx-synV7-9" and the remaining as "STEMI-LCx-12ECG." The prevalence of STEMI-LCx-synV7-9 in patients with STEMI-LCx was assessed. The incidence of all-cause death, cardiac death, and mechanical complications within 30 days, 3 months, and 1 year was also assessed according to each STEMI-LCx. STEMI-LCx-synV7-9 and STEMI-LCx-12ECG occurred in 10 (7.0%) and 132 (93.0%) patients, respectively. No significant difference was found in patients' characteristics between the two groups. The patients with STEMI-LCx-synV7-9 had significantly higher incidences of cardiac death within 3 months and 1 year (30.0% vs. 6.1%, P = 0.031, 30.0% vs. 7.6%, P = 0.050, respectively) and mechanical complications in each follow-up period (20.0% vs. 1.5%, P = 0.025) than those with STEMI-LCx-12ECG. STEMI-LCx-synV7-9 was observed in 7.0% of the patients with STEMI-LCx. Our findings suggest that the synthesized-V7-9 lead helps diagnose isolated posterior STEMI and might improve prognosis in patients with STEMI-LCx.

Objectives We aimed to investigate the association between hypertension and asymptomatic lower extremity artery disease (LEAD) in outpatients with known history of coronary artery disease (CAD). Methods Patients with known history of CAD who have been undergone coronary angiography and have significant coronary artery stenosis (more than 60%) were included. LEAD was defined as ankle-brachial index (ABI) Results One hundred and four patients were included. 82.7% of patients were male. Mean age was 57.05 ± 7.97. The prevalence of hypertension was 35.6%, and the prevalence of LEAD was 16.3%. A higher proportion of LEAD was found in hypertensive (18.9%) compared to non-hypertensive (14.9%), although not statistically significant (OR: 1.33; 95% CI: 0.46 to 3.85; p=0.598). There was an association between ABI and systolic BP (p=0.016), but not with diastolic BP (p=0.102). Conclusions Our study showed that the prevalence of LEAD in hypertension, especially in the CAD population, is relatively high. There was no association between hypertension and LEAD, but a higher prevalence of LEAD was found in hypertensive patients. Nevertheless, LEAD screening is still recommended in hypertensive patients, especially in the CAD population, given the fact that outcomes of health and mortality are worse for those with concomitants of these diseases.

BACKGROUND: Medical device-related pressure injuries (MDRPIs) present a substantial safety risk for children who are hospitalized. PURPOSE: This study aimed to describe patient and clinical characteristics of children who develop MDRPIs related to electroencephalogram (EEG) leads, determine risk factors associated with their development, and determine if there are common risk factors that can lead to actionable strategies to reduce MDRPIs related to EEG leads. METHODS: A retrospective review was completed of the electronic health records of all 3136 children who had EEG lead placements between January 1, 2014, and April 16, 2018, at a large tertiary care children’s hospital. Data abstracted included demographic variables, patient and pressure injury characteristics, as well as length of stay. RESULTS: Twenty-four (24) of the 3136 children (0.8%) developed an MDRPI. Most were stage 2 pressure injuries. Patients who developed a pressure injury were significantly younger than patients who did not (median age, 0.9 and 5.2 years, respectively; P = .005). Fifty percent (50%) of all patients who developed pressure injuries were younger than 1 year of age compared with 27% of patients who did not develop pressure injuries. The median length of stay for patients in whom MDRPI developed was 84.5 days (interquartile range, 45–137) versus 3.0 days (interquartile range, 2–8) for those who did not develop an MDRPI (P < .001). The mortality rate during the hospital stay was 21% (n = 5) for those who developed MDPRIs versus 4% (n = 19) for those who did not (P = .002). All patients received standard preventive strategies. CONCLUSION: The incidence of MDRPIs in this patient population was significantly higher in younger and longer-stay patients, and their mortality rate was significantly higher. This suggests that the patients who developed an MDRPI were more critically ill than those who did not. Vigilant assessment and more research are needed to determine if there are appropriate strategies to reduce MDRPIs related to EEG lead placement.

Purpose of Review Cardiac resynchronization therapy (CRT) represents a well-established and effective non-pharmaceutical heart failure (HF) treatment in selected patients. Still, a significant number of patients remain CRT non-responders. An optimal placement of the left ventricular (LV) lead appears crucial for the intended hemodynamic and hence clinical improvement. A well-localized target area and tools that help to achieve successful lead implantation seem to be of utmost importance to reach an optimal CRT effect. Recent Findings Recent studies suggest previous multimodal imaging (CT/cMRI/ECG torso) to guide intraprocedural LV lead placement. Relevant benefit compared to empirical lead optimization is still a matter of debate. Technical improvements in leads and algorithms (e.g., multipoint pacing (MPP), adaptive algorithms) promise higher procedural success. Recently emerging alternatives for ventricular synchronization such as conduction system pacing (CSP), LV endocardial pacing, or leadless pacing challenge classical biventricular pacing. Summary This article reviews current strategies for a successful planning, implementation, and validation of the optimal CRT implantation. Pre-implant imaging modalities offer promising assistance for complex cases; empirical lead positioning and intraoperative testing remain the cornerstone in most cases and ensure a successful CRT effect.

The effect of repeated exposure of lower doses of lead and endosulfan were evaluated on apoptosis in male wistar rats. Rats of group I served as untreated control. Group II received drinking water with lead as lead acetate @100 ppm (Pb100). Group III was given feed containing technical grade endosulfan @ 10 ppm (E10). Group IV was exposed to Pb (100) +E (10). Splenocytes were analysed for estimating apoptotic percentage in rats. The results suggest that apoptotic percentage was not changed in the lower doses of endosulfan and lead when administered alone and also in combination in the present study.

Springs are mechanical devices which are used quite extensively in different industries and mechanisms. Traditionally, springs have been manufactured by wrapping a hot wire around a rotating mandrel. This process has certain limitations because it is difficult to vary the spring parameters such as pitch and wire diameter. However, through the use of AM processes, with the complexity-for-free approach, it is possible to design and manufacture springs with variable spring parameters. Furthermore, it is also possible to create springs with multiple helices as opposed to traditional springs with a single helix. In this study, 32 springs with different numbers of helices, variable pitch profiles, variable wire diameters, and constant mass were designed. The springs were manufactured for experimental validation using HP MJF 520, which is a hybrid AM process. The stiffness of these springs was calculated analytically, through FEA, and experimentally validated. It was observed that increasing the number of helices in a spring leads to an increase in the stiffness of the spring. Furthermore, springs with variable pitch profiles and variable wire diameters have greater stiffness as compared to springs with constant parameters. However, with the increase in stiffness, the fatigue life of the springs decreases exponentially. Improvement in the stiffness of the springs without increasing the mass and therefore cost can lead to new and improved designs. These springs show great potential for industries where weight is an important consideration, such as aerospace and automotive. As these springs have a higher stiffness for the same mass, they can lead to designs with a light weight, and lower package volumes.

Running is a popular activity practiced worldwide. It is important to understand how running affects joint health to provide recommendations to sports medicine practitioners and runners. Our aim was to summarize the influence of running on lower limb cartilage morphology and composition using quantitative magnetic resonance imaging (MRI). Prospective repeated-measures studies evaluating cartilage using MRI before and after running were included. Data sources included Pubmed, Embase, CINAHL, SportDiscus, Web of Science, and Cochrane Central Registry of Controlled Trials. Qualitative analyses considered the number and methodological quality ratings of studies based on the QualSyst tool, and recommendations were based on the strength of evidence (strong, moderate, limited, or very limited). Quantitative analysis involved meta-analyses, for which effect sizes were calculated as Hedge’s g standardized mean differences. We included 43 articles, assessing seven outcomes (lesions, volume, thickness, glycosaminoglycan content, and T1ρ, T2, and T2* relaxation times). Nineteen articles were rated as high quality, 24 were rated as moderate quality, and none were rated as low quality. Qualitative analyses suggest that running may cause an immediate reduction in knee cartilage volume, thickness, as well as T1ρ and T2 relaxation times immediately; however, these changes did not persist. Meta-analyses revealed a small and moderate decrease immediately following a single running bout in T2 relaxation time in the medial femur and tibia, respectively. Qualitative analyses indicated that the influence of repeated exposure to running on cartilage morphology and composition was limited. Despite conflicting evidence regarding pre-existing knee cartilage lesions, moderate evidence suggests that running does not lead to the formation of new lesions. Repeated running exposure did not cause changes to foot and ankle cartilage thickness or composition. Changes to lower limb cartilage following running are transient. Immediate changes to cartilage morphology and composition, which likely reflect natural fluid dynamics, do not persist and were generally not significant when pooled statistically. Results suggest that cartilage recovers well from a single running bout and adapts to repeated exposure. Given that moderate evidence indicates that running does not lead to new lesions, future trials should focus on clinical populations, such as those with osteoarthritis. Not applicable.

The objectives were to determine whether levator ani muscle (LAM) motor function is associated with female stress urinary incontinence (SUI) severity, and whether changes in LAM motor function induced through pelvic floor muscle training (PFMT) are associated with improvements in SUI signs and symptoms. Pelvic morphology and LAM function were evaluated using ultrasound imaging and manual palpation using the elements of the PERFECT Scheme (Power, Endurance, Repetitions, Fast contractions, Elevation, Co-contraction and Timing) before and after women with SUI underwent a 12-week PFMT intervention. SUI severity was determined subjectively (ICIQ-FLUTS-UI) and objectively (30-min pad test [30MPT]). At baseline (n = 97), less leakage on the 30MPT was weakly associated with higher bladder neck position (ρs = −0.209,p = 0.044), yet with lower LAM function based on the PERFECT Scheme (overall score: ρs = 0.206, p = 0.043; repeated maximum voluntary contractions (MVCs): ρs = 0.203, p = 0.046; power/motor control: ρs = 0.214, p = 0.035). Lower symptom severity (ICIQ-FLUTS-UI) was associated with observed perineal lift during coughing (U = 34.000; p = 0.042). All measures of SUI severity and LAM function were significantly improved after PFMT intervention. Greater improvements in bladder neck elevation during MVC (ρs = −0.261, p = 0.027) and greater reductions in levator plate length during MVC (ρs = 0.292, p = 0.016) were weakly associated with greater reductions in leakage (30MPT), the latter also being associated with more improvement symptoms (ICIQ-FLUTS-UI; ρs = 0.238, p = 0.041). Greater improvement in the ability to repeat MVCs (ρs = 0.303, p = 0.009) was weakly associated with smaller improvements in symptoms (ICIQ-FLUTS-UI). Improvements in bladder neck support and elevation show weak associations with improvement in SUI signs and symptoms. LAM function as measured by the PERFECT Scheme is not associated with SUI severity in women, and improvements in LAM function when measured by the PERFECT Scheme are not associated with improvements in SUI signs and symptoms.

Background::A deep learning model (DLM) that enables non-invasive hypokalemia screening from an electrocardiogram (ECG) may improve the detection of this life-threatening condition. This study aimed to develop and evaluate the performance of a DLM for the detection of hypokalemia from the ECGs of emergency patients.Methods::We used a total of 9908 ECG data from emergency patients who were admitted at the Second Affiliated Hospital of Nanchang University, Jiangxi, China, from September 2017 to October 2020. The DLM was trained using 12 ECG leads (lead I, II, III, aVR, aVL, aVF, and V 1- 6) to detect patients with serum potassium concentrations

This work addresses the challenge of deriving a simple but effective multi-physic model useful for the design and simulation of hyperthermia devices for ensuring a high-quality treatment. An existing compact patch antenna working at 434 MHz is re-designed using the proposed methodology. The proposed general approach is used to investigate the specific case of the hyperthermia treatment of abdominal rhabdomyosarcoma. Instead of using patient-specific geometries with discrete vascular tree models, a surface phantom with a continuum 3D blood perfusion model of tumors is used. The geometrical parameters of the antennas are selected to provide a robust design against the variation of the phantom parameters. The effectiveness of the antenna is evaluated simulating the treatment with a recent non-linear multi-physic model, considering the different description of tumor vasculature. A more robust and effective design is obtained, with respect to its previous version. Indeed, the antenna bandwidth is increased with about 7%. The treatment performed using the old version of the antenna lead to unsuccessful results (40 °C after 60 min), whilst the novel robust design could successfully treat the target region. The new version of the patch can withstand a temperature of 42.5 °C for 60 min of treatment. To further enhance the effectiveness of the treatment, the use of a time-modulated power is studied. The proposed model could be extended to different body regions and used to develop an application-oriented design of antennas for hyperthermia treatment.

Background Postoperative rehabilitation is considered essential and indeed routine practice following rTSA. However, the optimal approach to postoperative rehabilitation is unknown, based on protocols for anatomic TSA, and published literature is sparse, as is the quantity and quality of research evidence. The aim of this study is to outline the accelerated rehabilitation protocol (with immediate activity and no immobilization at all) following reverse total shoulder arthroplasty (rTSA) and assess its safety and effectiveness compared to the more conservative rehabilitation protocols of immobilization in a sling for 6 weeks and for 3 weeks. Materials and methods Between July 2005 and October 2017, a total of 357 consecutive rTSA in 320 patients underwent a primary rTSA and were included in the study. Patients were divided into 3 groups depending on rehabilitation protocol (6 and 3 weeks' postoperative immobilization, respectively, for groups 1 and 2, and no immobilization for group 3). Patients were assessed preoperatively and reviewed at 3 weeks, 3, 6, and 12 months, and yearly thereafter postoperatively. Constant score (CS), Subjective Shoulder Value (SSV), patient satisfaction, and pain scores were used at each appointment and patients assessed both clinically and radiographically. Results Mean age at surgery was 76 years (range 40-93). At 1-year follow-up, the CS improved from 16.6 (adjusted 23.9) to 63.2 (adjusted 91.5) in group 1 (n = 114), from 21.5 (adjusted 30.7) to 67.7 (adjusted 98.4) in group 2 (n = 125), and from 22.6 (adjusted 31.3) to 66.6 (adjusted 94.9) in group 3 (n = 118). Pain score improved from 3.1/15 preoperatively to 12.5/15 postoperatively in group 1, from 3.5/15 to 13/15 in group 2, and from 3.7/15 to 12.5/15 in group 3. SSV improved to 8.5/10, 8.6/10, and 8.1/10 for groups 1, 2, and 3, respectively. Mean range of motion (ROM) improved to 142° elevation and 131° abduction in group 1, 153° elevation and 144° abduction in group 2, and 149° elevation and 146° abduction in group 3. No statistically significance differences were observed in CS, SSV, patient satisfaction, pain, and ROM between the 3 groups. Less postoperative complications were observed in group 3 (No immobilization). Conclusion Accelerated rehabilitation regime post rTSA without immobilization is safe and lead to reliable good clinical results and quick return to function. This study confirms noninferiority of the accelerated rehabilitation regime with fewer postoperative complications related to falls. Accelerated rehabilitation regime post rTSA have further psychological and emotional advantage to the patient, with earlier return to normal function and regaining independence. We recommend the accelerated rehabilitation regime without immobilization following rTSA.

Aims Pulmonary hypertension (PH) is a serious disorder that can complicate pulmonary and cardiovascular diseases. Right atrial (RA) pressure is a robust predictor of the pulmonary hypertension severity, which is measured via right heart catheterization. Limited studies have been carried out to assess the association between electrocardiogram data and the RA pressure as a prognostic factor of PH. In this study, the relation between P wave and PR segment changes with RA pressure was evaluated. Methods and results In this study, 94 patients in PH groups of 1, 3, and 4, based on the World Health Organization classification, were entered. RA pressure was measured using the right heart catheterization. PR segment and P wave morphology in leads II and V1 were evaluated in patient's electrocardiogram. The median age of the patients was 35.5 years old in which 64.9% of them were female. The distribution of patients in groups 1, 3, and 4 PH were 77.7%, 5.3%, and 17%, respectively. Among the studied P wave and PR segment changes, PR segment depression in lead II and pulmonary P wave in lead V1 had significant relation with the RA pressure (P‐value 14 mmHg) were 80%, 84%, and 94%. The specificity and negative predictive values of pulmonary P wave in lead V1 were determined 89% and 88%. Conclusions It was found that the PR segment depression in lead II and pulmonary P wave in lead V1 associate with the RA pressure in patients with precapillary PH. PR segment depression had useful sensitivity, specificity, and negative predictive values, and the pulmonary P wave in lead V1 had acceptable specificity and negative predictive values for detection of patients with high RA pressure. Therefore, the electrocardiogram can be used as a screening tool for determination of pulmonary hypertension severity.

Objectives Percutaneous catheter drainage (PCD) is usually performed to treat acute pancreatitis complicated by infected walled-off necrosis (WON). Insufficient drainage of infected WON may lead to a prolonged recovery process. Here, we introduce a modified PCD strategy that uses the triple guidance of choledochoscopy, ultrasonography, and computed tomography (CUC-PCD) to improve the therapeutic efficiency. Methods This study retrospectively analysed 73 patients with acute pancreatitis-related WON from January 2015 to January 2021. The first 38 patients were treated by ultrasonography/computed tomography-guided PCD (UC-PCD), and the next consecutive 35 patients by CUC-PCD. Perioperative data, procedural technical information, treatment outcomes, and follow-up data were collected. Results Demographic characteristics were statistically comparable between the two treatment groups (p > 0.05). After 48 h of PCD treatment, the CUC-PCD group achieved a significantly smaller size of the infected WON (p = 0.023), lower inflammatory response indexes (p = 0.020 for white blood cells, and p = 0.031 for C-reactive protein), and severity scores than the UC-PCD group (p p = 0.001), hospitalisation duration (p = 0.000), and global costs (p = 0.000) were observed in the CUC-PCD group compared to the UC-PCD group. There were no differences between the two groups regarding the rate of complications. Conclusions CUC-PCD is a safe and efficient approach with potential clinical applicability for treating infected WON owing to its feasibility in placing the drainage catheter at the optimal location in real time and performing primary necrosectomy without sinus tract formation and enlargement.

Background In radiotherapy, respiratory-induced tumor motion is typically measured using a single four-dimensional computed tomography acquisition (4DCT). Irregular breathing leads to inaccurate motion estimates, potentially resulting in undertreatment of the tumor and unnecessary dose to healthy tissue. The aim of the research was to determine if a daily pre-treatment 4DMRI-strategy led to a significantly improved motion estimate compared to single planning 4DMRI (with or without outlier rejection). Methods 4DMRI data sets from 10 healthy volunteers were acquired. The first acquisition simulated a planning MRI, the respiratory motion estimate (constructed from the respiratory signal, i.e. the 1D navigator) was compared to the respiratory signal in the subsequent scans (simulating 5–29 treatment fractions). The same procedure was performed using the first acquisition of each day as an estimate for the subsequent acquisitions that day (2 per day, 4–20 per volunteer), simulating a daily MRI strategy. This was done for three outlier strategies: no outlier rejection (NoOR); excluding 5% of the respiratory signal whilst minimizing the range (Min95) and excluding the datapoints outside the mean end-inhalation and end-exhalation positions (MeanIE). Results The planning MRI median motion estimates were 27 mm for NoOR, 18 mm for Min95, and 13 mm for MeanIE. The daily MRI median motion estimates were 29 mm for NoOR, 19 mm for Min95 and 15 mm for MeanIE. The percentage of time outside the motion estimate were for the planning MRI: 2%, 10% and 32% for NoOR, Min95 and MeanIE respectively. These values were reduced with the daily MRI strategy: 0%, 6% and 17%. Applying Min95 accounted for a 30% decrease in motion estimate compared to NoOR. Conclusion A daily MRI improved the estimation of respiratory motion as compared to a single 4D (planning) MRI significantly. Combining the Min95 technique with a daily 4DMRI resulted in a decrease of inclusion time of 6% with a 30% decrease of motion. Outlier rejection alone on a planning MRI often led to underestimation of the movement and could potentially lead to an underdosage. Trial registration: protocol W15_373#16.007

Objective The purpose of this work is the clinical commissioning of a recently developed in-vivo range verification system for the head treatment of pediatric medulloblastoma patients. Inaccurate beam range for such treatment could lead to either inadequate dose coverage of the target volume or excessive dose to the head skin resulting permanent alopecia. Methods The in-vivo range verification system is designed to perform pre-treatment range verification and adjustment. An array of Si-diode detectors is to be placed on the patient immobilization mask in the exit direction of a whole-brain field; signal is analyzed, and the extracted water equivalent path length (WEPL) is compared to the expected one, revealing if a range correction is needed. The method was tested in solid water and anthropomorphic head phantom, with validation based on independent WEPL measurements. The measured WEPL were compared to those computed by the treatment planning system (TPS). Results The accuracy for the WEPL measurements by the diode system in both solid water and anthropomorphic head phantom were on average within a millimeter from more accurate measurement by the dose-extinction technique, with the error range for the two phantoms as (0–1 ​mm) and (0–1.3 ​mm), respectively. When compared to the WEPL calculated by the treatment planning system, the measured values were on average within 1 ​% (range 0–3%) of the beam range. The accuracy of dose measurements by the diodes in the fall-off part of the depth dose profile was validated against the reference Markus chamber. No need for further correction (due to different beam parameters and detector dose ageing effects) was found. Conclusions The range verification workflow was successfully tested in the anthropomorphic head phantom. The performance of the in-vivo range verification system and related workflow meet the clinical requirements in terms of the needed WEPL accuracy for pretreatment range verification.

Background Dynamic myocardial CT perfusion (CTP) has emerged as a potential strategy to combine anatomical and functional evaluation in a single modality. However, this method results in a high radiation dose. Methods Dynamic CTP was performed in 56 patients with suspected or known ischemic heart disease of whom 48 had complete CT-data. Datasets with reduced sampling rate of 2- and 3 RR-intervals (2RR and 3RR) were constructed post hoc. Myocardial blood flow (MBF) estimates from the 2RR and 3RR datasets were compared with estimates based on the full dataset (1RR) using the two one-sided test of equivalence for paired samples. Results Significant equivalence was found for rest MBFLV (p ​ Conclusion MBF can be quantitated with dynamic CTP using a sampling strategy of one volume for every second heartbeat. This strategy could lead to a significant reduction in radiation dose.

Cardiac magnetic resonance imaging (CMR) image quality can be degraded by artifact in patients with cardiac implantable electronic devices (CIED). We aimed to establish a clinical risk score, so patient selection for diagnostic CMR could be optimised.In this retrospective cohort study, CMRs performed for clinical use in subjects with CIED from January 2016 to May 2019 were reviewed. Subject anthropometry, CIED generator/lead specifications and pre-scan chest X-ray (CXR) measurements were collected. Generator-related artifact size was measured on axial steady state free precession images. Interpretability of late gadolinium enhancement (LGE) imaging was performed based on a three-grade visual score attributed to each of 17 myocardial segments.Fifty-seven (57) patients (59±16 years, 74% male) fitted the inclusion criteria. Artifact precluded left ventricle (LV) evaluation (≥5 segments) in 17 (30%). Artifact was more common with implantable cardioverter-defibrillators, related to generator volume, mass, height, width, thickness, and area, along with right ventricular (RV) lead length and diameter (all p0.05). Artifact was associated with distance from generator to LV apex, generator to RV lead tip and shortest distance from generator to heart on CXR (all p0.05). On multivariable regression modelling, RV lead diameter (OR 5.861, 95% CI 1.866-18.407, p=0.002) and distance from generator to LV apex (OR 0.693, 95% CI 0.511-0.940, p=0.019) were independent predictors of artifact. Multivariable predictors were used to develop Device Related CMR Artifact Prediction Score (DR-CAPS), where all patients with DR-CAPS=0 had fully interpretable LGE imaging.Simple, readily available measures, such as lead characteristics and pre-scan CXR measures, can stratify patients via an artifact prediction score to optimise selection for diagnostic CMR.

A 53-year-old man with a subcutaneous implantable cardioverter-defibrillator (S-ICD) presented with inappropriate shocks. He underwent device extraction, and the lead was freed using a rotating mechanical dilator sheath. As patients with S-ICDs get older, extractions will become more complicated and more common. We have described a novel method of S-ICD lead extraction. (Level of Difficulty: Advanced.), Central Illustration

Objectives The aim of this study is to evaluate device size selection in patients within the borderline annulus size range undergoing transcatheter aortic valve replacement (TAVR) and to assess if pre-procedural patient-specific computer simulation will lead to the selection of a different device size than standard of care. Background In TAVR, appropriate device sizing is imperative. In borderline annulus size cases no standardised technique for tailored device size selection is currently available. Pre-procedural patient-specific computer simulation can be used, predicting the risk for paravalvular leakage (PVL) and need for permanent pacemaker implantation (PPI). Methods In this multicentre retrospective study, 140 patients in the borderline annulus size range were included. Hereafter, device size selection was left to the discretion of the operator. After TAVR, in 24 of the 140 patients, patient-specific computer simulation calculated the most appropriate device size expected to give the lowest risk for PVL and need for PPI. In these 24 patients, device size selection based on patient-specific computer simulation was compared with standard-of-care device size selection relying on a standardised matrix (Medtronic). Results In a significant proportion of the 140 patients (26.4%) a different device size than recommended by the matrix was implanted. In 10 of the 24 patients (41.7%) in whom a computer simulation was performed, a different device size was recommended than by means of the matrix. Conclusions Device size selection in patients within the borderline annulus size range is still ambiguous. In these patients, patient-specific computer simulation is feasible and can contribute to a more tailored device size selection.

Carotid artery stenosis is a serious medical condition that can lead to stroke. Using machine learning method to construct classifier model, carotid artery stenosis can be diagnosed with transcranial doppler data. We propose an improved fuzzy support vector machine model to predict carotid artery stenosis, with the maximum geometric mean as the optimization target. The fuzzy membership function is obtained by combining information entropy with the normalized class-center distance. Experimental results showed that the proposed model was superior to the benchmark models in sensitivity and geometric mean criteria.

Understanding how aging affects the safety performance of lithium-ion batteries under mechanical abuse is of great importance. In this study, pouch cell batteries with four different aging levels (0%, 10%, 20% and 30% capacity fading), which respectively represent fresh, prior-scrapped, normally scrapped and over-scrapped batteries, are prepared at 0 °C and subjected to indentation loading. Mechanical-electrical-thermal responses of these batteries are compared. Results show that aged pouch cells have right-shifted force-displacement curves, higher inflection force and higher peak force. After short circuit, voltage dropping is faster and electric energy is released in a shorter duration for aged ones, leading to a higher temperature for the whole battery cell. For cells with 30% capacity fading, the voltage dropping and temperature increasing are in a steep behavior. And the generated heat after short circuit is concentrated in the indented area, resulting a localized peak temperature of 117 ∘ C . To clarify the observations, mechanical tests in the component level are carried out. Results reveal that the response changes in cell tests are mainly from the anode. Compression test of aged anode electrode shows consistent mechanical response changes with cell test. The delay of anode fracture under compression loading lead to the enlargement of the shear fracture zone, together with the formation of sharp lithium dendrite, resulting in more severe short circuit.

Central nervous system high‐grade glioma (HGG) occurring in an infratentorial midline location is not commonly found in the pediatric population. Though pediatric HGGs appear similar to their adult counterparts histopathologically, they differ in molecular, genetic, and clinical characteristics. Evidence for the management of HGG is sparse in the literature. Surgery in the form of maximum safe resection is the backbone of management and has been variably supplemented with external beam radiotherapy and cytotoxic chemotherapy. The outcome, though largely dismal, has some positive surprises too. As shown in the presented case, the combined modality of management in a 5‐year‐old female child has resulted in a disease‐free survival of 3.5 years.

(1-x)BiFe0·94Zn0·03Ti0·03O3-xBaTiO3 (BFZN-BT) ceramics are prepared via sol-gel method, followed by conventional solid-state sintering or two-step sintering processes. Then, systematic experimental characterization and performance evaluation are carried out to investigate this technique and its effects on eight different ceramic samples. Owing to morphotropic phase boundary and optimal sintering conditions, 0.7BiFe0·94Zn0·03Ti0·03O3-0.3BaTiO3 ceramic sintered at T1 = 1025 °C and T2 = 900 °C shows the largest rhombohedral distortion (90°−αR = 0.14°) and tetragonal distortion (cT/αT = 1.021), as well as low leakage (1.19 × 10−5 A/cm2), excellent d33 = 149 pC/N, 2Pr = 85.1 μC/cm2 and Curie temperature of 461 °C. Moreover, large unipolar strain of 0.307% and d 33 ∗ value of 516 p.m./V are also obtained for this ceramic. Overall, the proposed strategy exhibits promise in the advancement of eco-friendly lead-free piezoceramics.

In this study, novel lead-free (1-x)Sr0·7Bi0·2TiO3-xLa(Mg0·5Zr0.5)O3 ((1-x)SBT-xLMZ) ceramics were designed and fabricated by the conventional solid-state reaction method. The dielectric performance, energy storage characteristics and charge-discharge behavior of the ceramics were systematically investigated. Specifically, the temperature stability of dielectric constant is improved by doping SBT with LMZ. On a separate note, BDS is also enhanced ascribed to the reduction of the grain size. Consequently, the 0.87SBT-0.13LMZ exhibits high critical electric field of 340 kV/cm with ultrahigh efficiency (η) of 98.2% and recoverable energy storage density (Wrec) of 1.22 J/cm3. Moreover, pulsed charge-discharge test elucidates that 0.87SBT-0.13LMZ possesses great thermal stability (30 °C–150 °C) along with a fast discharge period of 0.125 μs, high power density (PD) of 72.38 MW/cm3 as well as a high pulsed discharge energy density (1.2 J/cm3) at 380 kV/cm. Based on these outstanding characteristics, the 0.87SBT-0.13LMZ is considered as a potential candidate for pulse systems.

Introduction Laparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al. the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. Materials and methods This study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologistas (ASA) physical status I-II, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. Results There was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022 respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). Discussion In conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.

Aim and objective The objective of this study was to evaluate the AccuVeinAV400® viewing device for peripheral venous catheter insertion in children on the first try. Background Inserting a peripheral venous catheter is the most frequent invasive procedure carried out by healthcare professionals in hospitalised children. Several attempts are sometimes necessary, and veins can be damaged. Design A quasi-experimental cluster randomised controlled trial based on the CONSORT 2010 guidelines. Methods This randomised study comparing standard practice to the use of AccuVein400® was carried out on children who were less than 3 years old, with difficult intravenous access (DIVA Score), hospitalised in three paediatric units and who needed cannulation. Result A total of 304 children were included (156 in the AccuVein arm and 148 in the standard arm). There was no significant difference between AccuVein and standard groups in age (respectively, 2.5 ± 0.9 years vs. 2.5 ± 0.8), or mean DIVA score (respectively 5.9 ± 1.3 vs. 5.5 ± 1.2). The success of cannulation on the first attempt was 40.38% in the AccuVein arm vs. 41.2% in the standard arm (p = .6). The caregiver's assessment of pain on the Face Legs Activity Cry Consolability scale was 4.8 ± 0.2 in the AccuVein arm vs. 5.0 ± 0.2 (p = .4). Conclusions The use of AccuVein400® did not lead to greater success in intravenous insertion at the first attempt in children under 3 years of age with difficult intravenous access. Relevance to clinical practice This device can therefore be used according to the healthcare professionals' situation and needs. It is widely used in paediatric wards, and our study shows that it offers a support tool that reassures healthcare professionals and helps validate their choice of vein easiest to catheterise.

Aims Many cardiac pacemakers and defibrillators are not approved by regulators for magnetic resonance imaging (MRI). Even following generator exchange to an approved magnetic resonance (MR)-conditional model, many systems remain classified ‘non-MR conditional’ due to the leads. This classification makes patient access to MRI challenging, but there is no evidence of increased clinical risk. We compared the effect of MRI on non-MR conditional and MR-conditional pacemaker and defibrillator leads. Methods and results Patients undergoing clinical 1.5T MRI with pacemakers and defibrillators in three centres over 5 years were included. Magnetic resonance imaging protocols were similar for MR-conditional and non-MR conditional systems. Devices were interrogated pre- and immediately post-scan, and at follow-up, and adverse clinical events recorded. Lead parameter changes peri-scan were stratified by MR-conditional labelling. A total of 1148 MRI examinations were performed in 970 patients (54% non-MR conditional systems, 39% defibrillators, 15% pacing-dependent) with 2268 leads. There were no lead-related adverse clinical events, and no clinically significant immediate or late lead parameter changes following MRI in either MR-conditional or non-MR conditional leads. Small reductions in atrial and right ventricular sensed amplitudes and impedances were similar between groups, with no difference in the proportion of leads with parameter changes greater than pre-defined thresholds (7.1%, 95% confidence interval: 6.1–8.3). Conclusions There was no increased risk of MRI in patients with non-MR conditional pacemaker or defibrillator leads when following recommended protocols. Standardizing MR conditions for all leads would significantly improve access to MRI by enabling patients to be scanned in non-specialist centres, with no discernible incremental risk.

Increasing energy efficiency requirements lead to substantial increases in residential air handler unit’s length, in turn preventing usage of requiring inlet ductwork for rating tests due to testin...

Background State-of-the-art behavioral weight loss treatment (SBT) can lead to clinically meaningful weight loss, but only 30–60% achieve this goal. Developing adaptive interventions that change based on individual progress could increase the number of people who benefit. Purpose Conduct a Sequential Multiple Assignment Randomized Trial (SMART) to determine the optimal time to identify SBT suboptimal responders and whether it is better to switch to portion-controlled meals (PCM) or acceptance-based treatment (ABT). Method The BestFIT trial enrolled 468 adults with obesity who started SBT and were randomized to treatment response assessment at Session 3 (Early TRA) or 7 (Late TRA). Suboptimal responders were re-randomized to PCM or ABT. Responders continued SBT. Primary outcomes were weight change at 6 and 18 months. Results PCM participants lost more weight at 6 months (−18.4 lbs, 95% CI −20.5, −16.2) than ABT participants (−15.7 lbs, 95% CI: −18.0, −13.4), but this difference was not statistically significant (−2.7 lbs, 95% CI: −5.8, 0.5, p = .09). PCM and ABT participant 18 month weight loss did not differ. Early and Late TRA participants had similar weight losses (p = .96), however, Early TRA PCM participants lost more weight than Late TRA PCM participants (p = .03). Conclusions Results suggest adaptive intervention sequences that warrant further research (e.g., identify suboptimal responders at Session 3, use PCMs as second-stage treatment). Utilizing the SMART methodology to develop an adaptive weight loss intervention that would outperform gold standard SBT in a randomized controlled trial is an important next step, but may require additional optimization work. Clinical Trial information ClinicalTrials.gov identifier; NCT02368002

Purpose Atrial fibrillation (AF) ablation is a common procedure to reduce cardiovascular morbidity but is limited by recurrence. The objective of this study was to determine if post-ablation acute surface P wave morphology and other electrocardiographic parameters correlate with AF recurrence. Methods The Avoiding Bladder Catheters During AF ablation (ABCD-AF) trial was a randomized, prospective trial in 160 subjects undergoing AF ablation. The present study examined correlation between AF recurrence in follow-up and acute post-ablation electrocardiographic P wave parameters. Results Median follow-up was 255 (188, 306) days. The ABCD-AF cohort had a mean age of 62.7 ± 12.8 with 32.1% being females. Rate of recurrent AF was 35.8%, with a median time to AF of 135 (109, 182) days. There was no baseline demographic associated with AF recurrence. There was more AF recurrence in those with longer follow-up (p = 0.001). Lead 2 PR interval, lead 2 P wave duration/PR (Pdur/PR), lead V1 PR interval, and lead V1 Pdur/PR were all significantly associated with recurrent AF (p = 0.03, 0.02, 0.01, 0.01). Longer PR and shorter Pdur/PR predicted AF recurrence. In a multivariable model, lead V1 Pdur/PR provided the best predictor of AF recurrence, with an odds ratio of 0.018 (p = 0.016) per standard deviation change. Conclusions Shorter P wave duration combined with longer AV node delay, as measured by proportion of the PR that the P wave occupies, was the best predictor of AF recurrence post-ablation.