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In patients with a prior myocardial infarction (MI), angiographic predictors of ventricular tachycardia (VT) recurrence after ablation are lacking. Recently, a proarrhythmic effect of a chronic total occlusion (CTO) in a coronary artery has been suggested.A total of 191 patients with prior MI were referred to our Hospital between 2010 and June 2013 for a first ablation of VT. Of these, 84 patients (44%) with stable coronary artery disease that underwent a coronary angiography during the index hospitalization were included in this study. A CTO in an infarct-related artery (IRA-CTO) was present in 47 patients (56%). Patients with and without IRA-CTO did not differ in terms of comorbidities, severity of heart failure, presentation of VT or acute outcome of ablation, that was completely successful in 93% of cases. At electroanatomic mapping, IRA-CTO was associated with greater scar and especially with greater area of border zone (34 cm(2) vs. 19 cm(2) , P = 0.001). Median follow-up was 19 months (IQR 18). At follow-up, patients with IRA-CTO had a significantly higher rate of VT recurrence (47% vs. 16%, P = 0.003). At multivariate analysis, IRA-CTO resulted to be an independent predictor of VT recurrence after ablation (HR 4.05, P = 0.004).IRA-CTO is an independent predictor of VT recurrence after ablation and identifies a subgroup of patients with high recurrence rate despite a successful procedure. IRA-CTO is associated with greater scars and border zone area; however, this association does not completely justify its proarrhythmic effect.

Background— The mechanism of cardiac resynchronization therapy (CRT)–induced proarrhythmia remains unknown. We postulated that pacing from a left ventricular (LV) lead positioned on epicardial scar can facilitate re-entrant ventricular tachycardia. The aim of this study was to investigate the relationship between CRT-induced proarrhythmia and LV lead location within scar. Methods and Results— Twenty-eight epicardial and 63 endocardial maps, obtained from 64 CRT patients undergoing ventricular tachycardia ablation, were analyzed. A positive LV lead/scar relationship, defined as a lead tip positioned on scar/border zone, was determined by overlaying fluoroscopic projections with LV electroanatomical maps. CRT-induced proarrhythmia occurred in 8 patients (12.5%). They all presented early with electrical storm (100% versus 39% of patients with no proarrhythmia; P P P =0.03 on epicardial bipolar scar, 80% versus 17% P =0.02 on epicardial unipolar scar, and 80% versus 17% P =0.02 on any-epicardial scar). Ablation was performed within epicardial scar, close to the LV lead, and allowed CRT reactivation in all patients. Conclusions— CRT-induced proarrhythmia presented early with electrical storm and was associated with an LV lead positioning within epicardial scar. Catheter ablation allowed for resumption of biventricular stimulation in all patients.

Objectives: Our aim was to conduct a comparative study in a large cohort of myopathic patients carrying LMNA gene mutations to evaluate clinical and molecular features associated with different phenotypes. Methods: We performed a retrospective cohort study of 78 myopathic patients with LMNA mutation and 30 familial cases with LMNA mutation without muscle involvement. We analyzed features characterizing the various forms of LMNA -related myopathy through correlation statistics. Results: Of the 78 patients, 37 (47%) had limb-girdle muscular dystrophy 1B (LGMD1B), 18 (23%) congenital muscular dystrophy (MDCL), 17 (22%) autosomal dominant Emery-Dreifuss muscular dystrophy 2 (EDMD2), and 6 (8%) an atypical myopathy. The myopathic phenotypes shared a similar cardiac impairment. Cardioverter defibrillator or pacemaker was implanted in 41 (53%) myopathic patients compared to 7 (23%) familial cases without muscle involvement ( p = 0.005). Heart transplantation was performed in 8 (10.3%) myopathic patients and in none of the familial cases. Ten (12.8%) myopathic patients died; there were no deaths among the familial cases ( p = 0.032). Missense mutations were found in 14 patients (82%) with EDMD2 and 14 patients (78%) with MDCL compared to 17 patients (45%) with LGMD1B and 4 (67%) atypical patients. Frameshift mutations were detected in 17 (45%) LGMD1B compared to 3 (18%) EDMD2, 1 (6%) MDCL, and 2 (33%) with atypical myopathy ( p = 0.021). Furthermore, frameshift mutations were found in 30 of 73 patients (41%) with heart involvement compared to 4 of 35 (11%) without heart involvement ( p = 0.004). Conclusions: Our data provided new insights in LMNA -related myopathies, whose natural history appears to be dominated by cardiac involvement and related complications.

Bile duct injuries are a serious complication of biliary surgery. We report a case of benign obstruction of the common hepatic duct associated with common hepatic duct-duodenal spontaneous fistula following complex surgical intervention. We managed percutaneously the fistula with balloon dilatation and long-term stenting, as the fistula allowed biliary flow in the duodenum. We avoided reintervention preserving biliary flow, with good clinical results after a follow-up of 3 years. We emphasize the role of a clinically focused approach to percutaneous management of complications following biliary surgery.

The growing complexity of electrical power grids is demanding increasingly innovative solutions to build more stable and secure grids, a trending that is particularly evident across the spectrum of industrialized countries. Such a need is also clear for emerging countries, wherein China has rapidly become a key development player whose technological solutions could have a pivotal impact on other infrastructure-hungry regions of the world (e.g. Sub-Saharan Africa). This paper provides an overview of the smart grid transmogrification, via the state-of-the-practice application of proactive and responsive nodes - synchrophasors - within the U.S. power grid and presents a comparison with the efforts of other actors, such as China and Sub-Saharan African. Specifically, the potential advantages of the application of synchrophasors, as well as the issues challenging their application, are taken into account. As happens in ecological systems, value is created “by making connections,” and synchrophasors do indeed enable “collective intelligence,” “promote collaboration,” and well contribute towards scalability and sustainability - the realm of Digital Ecosystems.

Brugada syndrome is an inherited arrhythmogenic disorder leading to sudden death predominantly in the 3–4 decade. To date the only reliable treatment is the implantation of a cardioverter defibrillator; however, better criteria for risk stratification are needed, especially for asymptomatic subjects. Brugada syndrome genetic bases have been only partially understood, accounting for

Lead extraction (LE) techniques have evolved from simple traction to extraction with dilators and powered sheaths with very high success rates. On the basis of the systematic implementation of a stepwise approach, we aimed to identify those characteristics that can predict the need for advanced LE techniques.Between April 2005 and March 2012, 208 consecutive LE procedures were performed and 456 leads were extracted using an initial superior approach. Advanced techniques for LE (step 4 according to our stepwise approach) were used in 122 patients (58.7%).Younger patient age (odds ratio [OR] = 0.963, P = 0.002), longer duration of the initial implantation (OR = 1.013, P = 0.002), the number of extracted leads (OR = 2.184, P0.001), and the presence of right ventricular defibrillator leads (OR = 2.144, P = 0.049) independently predicted the necessity of using step 4 in multivariate analysis. A prediction tool was created taking into account four categorical variables derived even from Receiver Operating Curve analysis of quantitative characteristics (age70.7 years, implant duration37 months, extraction of at least two leads, one of them being a defibrillator lead). The absence of all the four characteristics was accompanied by 0% positive predictive value for the requirement of step 4 for LE, whereas the coexistence of all four risk factors is characterized by 87% requirement of advanced LE.In most of the patients with indication for LE, use of a powered sheath extraction is necessary in order to obtain clinical success. We have identified four patient and lead characteristics that may help the operator plan the means of extraction.

Irrigated-tip catheter technology has been used for the elimination of resistant accessory pathways (AP) in adults with Wolff-Parkinson-White (WPW) syndrome. However, there are persistent concerns regarding the safety of irrigated catheters in the pediatric population. In this report we present our experience, in terms of effectiveness and safety, of irrigated catheter technology in children and adolescents who underwent ablation of WPW.We prospectively followed up all patients less than 18 years old (n = 41, mean age of 12.8 years old) who were referred to our center for radiofrequency (RF) catheter ablation of WPW between January 2010 and July 2011. Catheter ablation was performed in all patients using an open irrigated-tip catheter (Celsius Thermocool 3.5 mm, 7F, B-type, Biosense Webster, Diamond Bar, CA, USA). Power was started from 15 W up to 30 W in right-sided AP; RF pulses in left-sided APs were delivered at 40 W while 20 W was delivered inside the coronary sinus.Mean procedure time was 26.4 minutes and mean fluoroscopy time was 12.2 minutes. Overall procedural success was obtained in 39/41 (95.1%) patients after the first procedure. No complications were observed after the procedure. All patients attended their scheduled follow-up visit at 3, 6, and 12 months and no recurrences were observed based on 12-lead electrocardiogram and 24-hour Holter monitoring.RF ablation of APs using open irrigated-tip catheters can be performed in children and adolescents with a high acute and long-term success rate, very short procedure times, and acceptable fluoroscopy times.

In the last few decades, characterized by intense environmental, landscape and socio-economic-financial changes, unexpected issues concerning the primary sector are arising and asks to researchers an urgent and deep reformulation both of the conceptual and technological tools used in the applied research. The concept of innovation is now radically changed, starting from a prevailing formula of linear top-down technology transfer, which has characterized the green revolution of the 1960s, to nowadays approach characterized by the innovation of a complex system, aimed at creating sustainable and shared opportunities through economic and institutional development. Those who now work in public or private bodies oriented to research for innovation are struggling to maintain their specific study area, but within integrated schemes where technical and scientific aspects are in interaction with organizational, institutional and political issues. Innovation can tackle several issues: new products, new technologies, new markets, new procedures (institutions) and new policies. The series of scientific and conceptual tools framed into the Agro-ecology domain seems appropriate to plan development initiatives of which the primary objective is ensuring a sustainable management of all the resources involved in agricultural production processes, while promoting food security and sovereignty, as well as protecting the rural landscape. By studying a target agro-ecosystem it is possible to identify and characterize the relationships between both the internal components and the system structures and functions at different levels of complexity of plot, farm and country, without neglecting the interactions among scientific, technological and socio-economic factors, and ultimately tending towards a science aimed at conflict resolution. Given the challenges that agricultural development is going to face in the next decades, it is indeed essential to support the planning and implementation of sound agro-ecological policies through an appropriate set of advanced tools. Particularly, a key aspect to empower all the stakeholders involved in the research, development, dissemination and application of new methods and technologies is the identification of information and communication systems that farmers and policy makers need in order to cope with fast-changing conditions in a complex system. University and research centers can act as institutional facilitators of dialogue and development policies among different stakeholders, catalyzing participation and promoting participatory problem-solving strategies for agricultural development and cooperation.

Much of the research that goes into Big Data, and specifically on Collaborative Big Data, is focused upon questions, such as: • how to get more of it? (e.g., participatory mechanisms, social media, geo-coded data from personal electronic devices) and • how to handle it? (e.g., how to ingest, sort, store, and link up disparate data sets). A question that receives far less attention is that of Collaborative analysis of Big Data; how can a multi-disciplinary layered analysis of Big Data be used to support robust decisions, especially in a collaborative setting, and especially under time pressure? The robust Decision Engineering required can be achieved by employing an approach related to Network Science, that we call Relationship Science. In Relationship Science, our methodological framework, karassian netchain analysis (KNA), is utilized to ascertain islands of stability or positive influence dominating sets (PIDS), so that a form of annealed resiliency or latent stability is achieved, thereby mitigating against unintended consequences, elements of instability, and “perfect storm” crises lurking within the network.

BACKGROUND. Loss-of-function mutations in the SCN5A gene, encoding the cardiac Nav1.5 sodium channel, have been previously associated with Brugada syndrome (BrS). Despite the low prevalence of the disease, we identified a patient carrying two SCN5A mutations. We aimed at establishing a correlation between genotype, clinical phenotype and in vitro sodium current.MATERIALS AND METHODS. A 3 years old boy presented with right bundle branch block and ST-segment elevation. Genetic analysis and electrophysiology studies in transfected HEK293 cells were performed to identify possibly disease-causing variants and assess their effect on sodium channel function.RESULTS. Two SCN5A variants were identified: a new frameshift deletion causing premature truncation of the putative protein (c.3258_3261del4) and a missense substitution (p.F1293S). In vitro studies revealed that the truncated mutant did not produce functional channels and decreased total sodium current when co-expressed with p.F1293S channels compared to p.F1293S alone. In addition, p.F1293S channels presented with a steep slope of steady-state activation voltage-dependency, which was shifted towards more positive potentials by the co-expression with the truncated channel. p.F1293S channels also showed shift towards more positive potentials of the steady-state inactivation both alone and co-expressed with the deletion mutant.CONCLUSIONS. Our data identified a severe reduction of sodium channel current associated with two distinct SCN5A changes. However, all mutation carriers were asymptomatic and BrS ECG was observed only transiently in the compound heterozygous subject. These observations underline the difficulty of genotype/phenotype correlations in BrS patients and support the idea of a polygenic disorder, where different mutations and variants can contribute to the clinical phenotype.

Background— Sudden cardiac death can be the first clinical presentation of asymptomatic ventricular preexcitation. Methods and Results— From 1995 to 2005, we prospectively collected clinical and electrophysiological data among 293 adults with asymptomatic ventricular preexcitation (61.4% males; median age, 36 years; interquartile range [IQR], 28 to 47.5). After electrophysiological testing, patients were prospectively followed, taking no drugs. The primary end point of the study was the occurrence of a first arrhythmic event. Predictors of arrhythmic events were analyzed by univariate and multivariate Cox models. Over a median follow-up of 67 months (minimum to maximum, 8 to 90), after electrophysiological testing, 262 patients (median age, 37 years; IQR, 30 to 48) did not experience arrhythmic events, remaining totally asymptomatic, whereas 31 patients (median age, 25 years; IQR, 22 to 29; median follow-up, 27 months; minimum to maximum, 8 to 55) had a first arrhythmic event, which was potentially life-threatening in 17 of them (median age, 24 years; IQR, 20 to 28.5; median follow-up, 25 months; minimum to maximum, 9 to 55). Potentially life-threatening tachyarrhythmias resulted in resuscitated cardiac arrest (1 patient), presyncope (7 patients) syncope (4 patients), or dizziness (5 patients). In multivariate analysis age ( P =0.004), inducibility ( P =0.001) and anterograde effective refractory period of the accessory pathway ≤250 ms ( P =0.001) predicted potentially life-threatening arrhythmias. Conclusions— These results indicate that prognosis of adults who present with asymptomatic ventricular preexcitation is good, and the risk of a significant event is small. Short anterograde effective refractory period of the accessory pathway and inducibility at baseline are independent predictors of potentially life-threatening arrhythmic events, and the risk decreases with increasing age.

AIMS: To evaluate the prevalence, clinical significance, and prognosis of latent Brugada syndrome (BrS) in patients with new-onset atrial fibrillation (AF) unmasked by class 1C antiarrhythmic drugs. METHODS AND RESULTS: Between January 2000 and June 2008, all consecutive patients with new-onset AF, who after flecainide exhibited typical Brugada ECG pattern, underwent electrophysiologic, pharmacologic, and genetic testing. Among 346 patients [median age 53 years; interquartile range (IQR), 15], 11 (3.2%; median age 51 years; IQR, 19) diagnosed as lone AF exhibited typical Brugada ECG pattern. Genetic testing was negative. Ventricular tachycardia/ventricular fibrillation (VT/VF) was induced by electrophysiologic testing (five patients) or during flecainide infusion (one patient). Six patients with type 1 ECG pattern and inducible VT/VF underwent ICD implantation. During a median follow-up of 31.5 months (range: 10-85) after ICD implantation, three patients developed BrS and one of them experienced VF. Patients without ICD (five patients) remained asymptomatic during a median follow-up of 74 months. Persistent type 1 pattern occurred only in the three patients who developed BrS. CONCLUSION: This study, for the first time, reveals the prevalence of latent BrS in patients with new-onset lone AF, which may precede VT/VF. Persistence of type 1 and ventricular tachyarrhythmias inducibility represents a marker of electrical instability leading to sudden death.

Background. In the era of catheter ablation there are no prospective data on AF progression according to AF guidelines classification and management. Methods. Of 402 screened patients with first-detected paroxysmal AF, 106 (mean age, 57.5 years) were enrolled for this prospective study. Of them, 54 (mean age, 53.3 years) had lone AF and 52 (mean age, 62.0 years) had comorbidities. Patients were treated according to recent guidelines management. Primary endpoint of the study was the cumulative probability of progression to permanent AF over a 5-year follow-up among patients who underwent catheter ablation or antiarrhythmic drug therapy alone (ADT). Predictors of progression to permanent AF were also analyzed by multivariate analysis. Results. At the end of the 5-year follow-up, 50 patients with lone AF had no further recurrences after the first episode in the absence of ADT. The remaining 56 patients at a median follow-up of 19 months after the first episode experienced recurrent episodes of paroxysmal AF requiring ADT (45 patients) or catheter ablation (11 patients) because of ADT failure. Patients who underwent ablation had similar clinical characteristics as patients on ADT. K-M curves demonstrated that patients on ADT were more likely to progress to permanent AF than those who underwent catheter ablation (p=0.029, by log-rank test, Figure 1 ). Age (p Conclusions. Over a 5-year follow-up, catheter ablation is of benefit in delaying arrhythmia progression. Age, diabetes and heart failure predict progression to permanent AF.

The aim of this study was to describe the natural history of asymptomatic ventricular pre-excitation in children and to determine predictors of potentially life-threatening arrhythmic events.Sudden death can be the first clinical manifestation in asymptomatic children with ventricular pre-excitation, but reduction of its incidence by prophylactic ablation requires the identification of subjects at high risk.Between 1995 and 2005 we prospectively collected clinical and electrophysiologic data from 184 children (66% male; median age 10 years; range 8 to 12 years) with asymptomatic ventricular pre-excitation on the electrocardiogram. After electrophysiologic testing, subjects were followed as outpatients taking no medications. The primary end point of the study was the occurrence of arrhythmic events. Predictors of potentially life-threatening arrhythmias were analyzed.Over a median follow-up of 57 months (min/max 32/90 months) after electrophysiologic testing, 133 children (mean age 10 years; range 8 to 12 years) did not experience arrhythmic events, remaining totally asymptomatic, while 51 children had within 20 months (min/max 8/60 months) a first arrhythmic event, which was potentially life-threatening in 19 of them (mean age 10 years; range 10 to 14 years). Life-threatening tachyarrhythmias resulted in cardiac arrest (3 patients), syncope (3 patients), atypical symptoms (8 patients), or minimal symptoms (5 patients). Univariate analysis identified tachyarrhythmia inducibility (p0.001), anterograde refractory period of accessory pathways (APERP)/=240 ms (p0.001), and multiple accessory pathways (p0.001) as risk factors for potentially life-threatening arrhythmic events. Independent predictors by multivariate analysis were APERP (p = 0.001) and multiple accessory pathway (p = 0.001).These findings are potentially relevant in terms of early identification of high-risk asymptomatic children with ventricular pre-excitation. Subjects with short APERPs and multiple pathways are at higher risk of developing life-threatening arrhythmic events and are the best candidates for prophylactic ablation.

Background: patients with long-lasting permanent atrial fibrillation (AF) are often destined to remain in AF life-long. In this cohort outcomes of ablation techniques are disappointing, with 20 –74% success rate and 30 –50% repeat procedure. The adjunctive clinical benefit of targeting multiple right and left atrial (LA) sites beyond the pulmonary vein (PV)-LA junction with the aim of achieving acute AF termination has not been prospectively evaluated in a randomized study. Methods and results: 60 patients with permanent atrial fibrillation of more than 1 year duration, with early recurrence after electrical cardioversion and medical therapy with one or more antiarrhythmic agents were enrolled (mean age 59±10, mean AF duration 60 months, mean LA dimension 44±7 mm, left ventricular EF >40% in all) and randomized to standard circumferential PV ablation (CPVA, control group, N=30) or an extended CPVA schema targeting also inferior LA, atrial septum, LA appendage, coronary sinus and right atrium (test group, N=30). In the test group the procedural endpoint was sinus rhythm (SR) restoration by radiofrequency energy; at each step average cycle length was measured and ablation was stopped if patient gained SR. In the control group the standard CPVA technique was applied. All patient transmitted daily transtelephonic ECG strips whereas at 3, 6 and 12 months an echocardiogram and a 48 hour Holter was obtained. Antiarrhythmic drug therapy was continued for 3 months after ablation in both group (blanking period in which patients were allowed to undergo electrical cardioversion). AF terminated in 5% and 55% of control and test subjects; mean procedure duration was 66 and 88 minutes in the 2 groups; No significant complications occurred in both groups. After a mean follow-up of 4 months, 67% of control patients were sinus as compared with 83% in the test group (p Conclusion: Preliminary data show that a modified CPVA ablation strategy in patients with permanent AF is associated with acute AF termination in 55% of patients and achieves medium term restoration and maintenance of sinus rhythm in 83% of patients.

We compared ablation strategy with antiarrhythmic drug therapy (ADT) in patients with paroxysmal atrial fibrillation (PAF).Atrial fibrillation (AF) ablation strategy is superior to ADT in patients with an initial history of PAF, but its role in patients with a long history of AF as compared with ADT remains a challenge.One hundred ninety-eight patients (age, 56 +/- 10 years) with PAF of 6 +/- 5 years' duration (mean AF episodes 3.4/month) who had failed ADT were randomized to AF ablation by circumferential pulmonary vein ablation (CPVA) or to the maximum tolerable doses of another ADT, which included flecainide, sotalol, and amiodarone. Crossover to CPVA was allowed after 3 months of ADT.By Kaplan-Meier analysis, 86% of patients in the CPVA group and 22% of those in the ADT group who did not require a second ADT were free from recurrent atrial tachyarrhythmias (AT) (p0.001); a repeat ablation was performed in 9% of patients in the CPVA group for recurrent AF (6%) or atrial tachycardia (3%). At 1 year, 93% and 35% of the CPVA and ADT groups, respectively, were AT-free. Ejection fraction, hypertension, and age independently predicted AF recurrences in the ADT group. Circumferential pulmonary vein ablation was associated with fewer cardiovascular hospitalizations (p0.01). One transient ischemic attack and 1 pericardial effusion occurred in the CPVA group; side effects of ADT were observed in 23 patients.Circumferential pulmonary vein ablation is more successful than ADT for prevention of PAF with few complications. Atrial fibrillation ablation warrants consideration in selected patients in whom ADT had already failed and maintenance of sinus rhythm is desired. (A Controlled Randomized Trial of CPVA Versus Antiarrhythmic Drug Therapy in for Paroxysmal AF: APAF/01; http://clinicaltrials.gov/ct/show; NCT00340314).

Background— Circumferential pulmonary vein ablation (CPVA) is effective in curing atrial fibrillation (AF), but new-onset left atrial tachycardia (AT) is a potential complication. We evaluated whether a modified CPVA approach including additional ablation lines on posterior wall and the mitral isthmus would reduce the incidence of AT after PV ablation. Methods and Results— A total of 560 patients (291 men, 52%; age, 56.5±7.3 years) entered the study; 280 were randomized to CPVA alone (group 1) and 280 to modified CPVA (group 2). The primary end point was freedom from AT after the procedure. In group 1, 28 patients (10%) experienced new-onset AT, and 41 (14.3%) experienced recurrent AF. In group 2, 11 patients (3.9%) experienced AT, and 36 (12.9%) had recurrent AF. Group 1 was more likely to experience AT than group 2 ( P =0.005). Freedom from AF after ablation was similar in both groups ( P =0.57). Among those in group 1, gap-related macroreentrant AT was documented in 23 of the 28 patients (82%), and focal AT was found in 5 (18%). In group 2, gap-related macroreentrant AT was found in 8 of the 11 patients (73%), and focal AT was seen in 3 (27%). Two patients in group 1 and 1 patient in group 2 had both AT and AF. The strongest predictor of AT was the presence of gaps ( P Conclusions— Modified CPVA is as effective as CPVA in preventing AF but is associated with a lower risk of developing incessant AT.

Few data have been published on transcatheter ablation of atrial fibrillation (AF) in patients with mitral valve prostheses. Thus, we sought to report our experience.Ablation is an effective treatment for AF. Patients with prosthetic mitral valves represent a special group because of an increased risk from the ablation procedure due to the possibility of damage to the prosthetic valve.Between July 2001 and July 2003, 26 patients with mitral valve prostheses (MVP) underwent circumferential pulmonary vein ablation for AF. A matched group of 52 ablated patients without MVP acted as control subjects. After a blanking period of three months, a follow-up of 12 months was considered for MVP patients and controls. Holter recordings were performed in all subjects at 3, 6, and 12 months.Radiation exposure was higher in the MVP group, with fluoroscopy times of 35.3 +/- 21 min versus 20.9 +/- 15 min in controls. At the end of follow-up, 73% of MVP patients were in sinus rhythm, compared with 75% of controls. Atrial tachycardia occurred in six (23%) MVP patients, requiring repeat ablation in three, and one (2%) control subject, which settled without treatment. One transient ischemic attack and one femoral pseudoaneurysm occurred in the MVP group. No complications occurred in the control group.Ablation of AF in patients with MVP is feasible, with outcomes similar to those of standard patients. Complications were higher among MVP patients with a greater radiation exposure and a higher incidence of post-ablation atrial tachycardia.

The purpose of this study was to evaluate the electroanatomic characteristics of left atrial tachycardia (AT) in a series of patients who underwent circumferential pulmonary vein ablation (CPVA) and to describe the ablation strategy and clinical outcome.Circumferential pulmonary vein ablation is an effective treatment for atrial fibrillation. A potential midterm complication is the development of left AT. There are only isolated reports describing mapping and ablation of such arrhythmias.Thirteen patients (age 57.4 +/- 8.9 years, five female) underwent mapping and ablation of 14 left ATs via an electroanatomic mapping system a mean of 2.6 +/- 1.6 months after CPVA.Three patients were characterized as having focal AT (cycle length: 266 +/- 35.9 ms). Of 11 macro-re-entrant tachycardias studied in the remaining 10 patients (cycle length: 275 +/- 75 ms), 5 showed single-loop and 6 dual-loop circuits. Re-entrant circuits used the mitral isthmus, the posterior wall, or gaps on previous encircling lines. Such gaps and all three foci occurred anterior to the left superior pulmonary vein or at the septal aspect of the right pulmonary veins. Thirteen of 14 tachycardias (93%) were successfully ablated.Left AT after CPVA can be due to a macro-re-entrant or focal mechanism. Re-entry occurs most commonly across the mitral isthmus, the posterior wall, or gaps on previous ablation lines. Such gaps and foci occur most commonly at the anterior aspect of the left superior pulmonary vein and at the septal aspect of the right pulmonary veins. These arrhythmias can be successfully mapped and ablated with an electroanatomic mapping system.

This study was designed to investigate the potential of circumferential pulmonary vein (PV) ablation for atrial fibrillation (AF) to maintain sinus rhythm (SR) over time, thus reducing mortality and morbidity while enhancing quality of life (QoL).Circumferential PV ablation is safe and effective, but the long-term outcomes and its impact on QoL have not been assessed or compared with those for medical therapy.We examined the clinical course of 1,171 consecutive patients with symptomatic AF who were referred to us between January 1998 and March 2001. The 589 ablated patients were compared with the 582 who received antiarrhythmic medications for SR control. The QoL of 109 ablated and 102 medically treated patients was measured with the SF-36 survey.Median follow-up was 900 days (range 161 to 1,508 days). Kaplan-Meier analysis showed observed survival for ablated patients was longer than among patients treated medically (p0.001), and not different from that expected for healthy persons of the same gender and calendar year of birth (p = 0.55). Cox proportional-hazards model revealed in the ablation group hazard ratios of 0.46 (95% confidence interval [CI], 0.31 to 0.68; p0.001) for all-cause mortality, of 0.45 (95% CI, 0.31 to 0.64; p0.001) for morbidities mainly due to heart failure and ischemic cerebrovascular events, and of 0.30 (95% CI, 0.24 to 0.37; p0.001) for AF recurrence. Ablated patients' QoL, different from patients treated medically, reached normative levels at six months and remained unchanged at one year.Pulmonary vein ablation improves mortality, morbidity, and QoL as compared with medical therapy. Our findings pave the way for randomized trials to prospect a wider application of ablation therapy for AF.

Purpose: Previous clinical studies have shown the efficacy of thrombolysis in patients affected by pulmonary embolism. However, there is no standardized technique or dose regimen for pulmonary thrombolysis, and direct comparison between the various reported data is difficult. We have developed a new method of thrombolysis based on local infusion of urokinase by which catheter position and infusion duration can be precisely adjusted to the individual patient's condition. The aim of this study was to evaluate the effectiveness and safety of our procedure. Materials and methods: Fourteen consecutive patients entered the study over a 2-year period. The diagnosis of pulmonary embolism was confirmed by means of pulmonary angiography and the severity of embolism was assessed by the Miller method. All patients underwent intrapulmonary thrombolysis with urokinase: an initial bolus of 3,300 IU/kg in 10 min was followed by infusion of 1,000–1,500 IU/kg per hour for 24 h. Blood samples for study of the coagulation and fibrinolytic systems were taken every 8 h. Pulmonary angiography was repeated after 24 h to evaluate treatment results. Variation of catheter tip position and the continuation of thrombolysis for a new cycle of 24 h were decided on by a medical team individually for each patient. All adverse events were recorded; if a major complication (severe bleeding) occurred, thrombolytic administration was interrupted. Results: In one patient thrombolysis was interrupted after 24 h because of the onset of hematemesis. Mean Miller index fell from 19.42 ± 4.76 to 12.85 ± 5.26 in 14 patients (P < 0.01). A systemic effect of the urokinase was not suspected as both coagulation tests and the platelet counts were unchanged. Conclusion: Our results suggest that our procedure of local administration of urokinase could provide a suitable approach to thrombolytic therapy in patients with massive pulmonary embolism. However, further research with a larger number of patients is needed to confirm our preliminary data.

ObjectivesWe assessed feasibility of magnetic catheter guidance in patients with atrial fibrillation (AF) undergoing circumferential pulmonary vein ablation (CPVA).BackgroundNo data are available on feasibility of remote navigation for AF ablation.MethodsForty patients underwent CPVA for symptomatic AF using the NIOBE II remote magnetic system (Stereotaxis Inc., St. Louis, Missouri). Ablation was performed with a 4-mm tip, magnetic catheter (65°C, maximum 50 W, 15 s). The catheter tip was guided by a uniform magnetic field (0.08-T), and a motor drive (Cardiodrive unit, Stereotaxis Inc.). Left atrium maps were created using an integrated CARTO RMT system (Stereotaxis Inc.). End point of ablation was voltage abatement >90% of bipolar electrogram amplitude.ResultsRemote ablation was successful in 38 of 40 patients without complications. The median mapping and ablation time was 152.5 min (range, 90 to 380 min) but was much longer in the first 12 patients (192.5 min vs. 148 min; p = 0.012). Median ablation time was 49.5 min (range, 17 to 154 min), but it was much shorter in the last 28 patients than in the first 12 patients (49 min vs. 70 min; p = 0.021). Patients receiving remote ablation had longer procedure times than control patients (p < 0.001) with similar mapping time but shorter ablation time on right-sided pulmonary veins. Many more mapping points regardless of their location were collected remotely (p < 0.001).ConclusionsRemote magnetic navigation for AF ablation is safe and feasible with a short learning curve. Although all procedures were performed by a highly experienced operator, remote AF ablation can be performed even by less experienced operators.

In the context of work at the EU Soil Observatory (EUSO), an attempt is made to make a survey of EU supranational soil-related datasets in the EU, stemming from various sources. This work describes efforts made in the EUSO Working Group on Soil Data to find such data availability from a systematic literature search. Understanding the soil data availability due to research and innovation (R&I) investment is crucial to enhance the knowledge capacity and limit anthropogenic disturbance on soil dynamics in current global climate changes. When working at supranational scales, the international peer review literature reveals the data availability. Therefore, most research papers rely on datasets collected under supranational institutional efforts, rigorous laboratory standards and high representativeness of sample-to-population scale variability. On soils, we based all our main productive activities. Increasing our knowledge of soil properties, mapping and modelling its processes helps to quantify the capacity and define thresholds of pressures that need to be respected to prevent irreversible changes. To this end, a systematic bibliographic search was carried out using Scopus and the Web of Knowledge (WoS) and their research performance assessment tools which provide extreme value in understanding the data impact on the scientific community and the related output to the policy development and practical benefit for the society. The main objective of the present work is to prepare an inventory of the produced soil-related EU-wide data related to soil, published in the international peer review literature. A simple query was used to collect the vast majority of peer-review scientific contributions in Scopus and WoS. The search is limited to the topic areas of soil science, geomorphology, geology, agricultural sciences, ecology and other related environmental sectors. From the original search (WoS=481, Scopus=260) we identified 616 articles, with 125 duplicates. The contribution shows how to merge results from citation and abstract databases (SCOPUS and WoS). The screening process of the resulting database was carried out in collaboration with the Sub-WG data from EU projects. Practically, soil datasets were listed and counted following inclusion and exclusion criteria using the spreadsheet developed in the EUSO Working Group on soil data. Data from the bibliometric analysis were further analysed in R through the Bibliometrix R package. The metadata analysis shows that 85% of soil datasets used in publications for soil assessment at the EU scale belong to i) Land Use and Coverage Area frame Survey (LUCAS) soil module followed by ii) Geochemical Mapping Of Agricultural And Grazing Land Soil (GEMAS), and iii) World Soil Information Service (WoSIS)which represent the harmonized collection of legacy soil profiles. This indicates that harmonization procedures among the primary sources are still needed to increase data numerosity and improve models and estimations. In a future extension of the work, we will provide the list of publications with the related soil datasets and metadata. This work contributes to a common ground for a future EU soil data infrastructure and monitoring system (EU and national collaborations) linked to the European Soil Observatory EUSO.

Ten Mozambican Community Multimedia Centers (CMCs) were investigated by analyzing Social Representations of users and staff members. Photo-elicitation, an underexplored methodological approach in the domain of Information and Communication Technologies for Development (ICT4D), was employed to conduct the study, and a three-step qualitative content analysis was performed on both visual and textual data. Results tend to confirm and build upon outcomes from the existing literature on Public Access Venues (PAVs). Local communities value these centers because they bring social recognition to people working or learning there. The venues are associated with a symbolism that extends from the social recognition of the individual to the development and social inclusion of the whole community, which, because of the presence of the venue, does not feel left behind. In this vein, the study also shows that the importance of CMCs is often not related to the newest technology available, but to the technology that reaches the most of the community. The study also highlights neglected dimensions of CMCs, such as the importance of the exterior appearance of the venue, and the perception of a switch in their nature from static centers funded by third parties towards more entrepreneurial-driven ones. The presented research also contributes to the ICT4D field by proposing a promising research protocol, which is able to elicit representations otherwise difficult to obtain.