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Aims: Our study assesses the value of electrograms (EGMs) characteristics to identify a ventricular tachycardia (VT) isthmus entrance in patients with post-infarct VT. Post-infarct VTs are mostly due to a re-entrant circuit. A pacemapping (PM) approach is able to localize the VT isthmus during sinus rhythm. Limited data are available about the role of local EGMs in defining VT isthmus location.Methods and Results: Twenty consecutive patients (70% male) referred for post-infarct VT catheter ablation were included in the present study. The VT isthmus was defined according to the PM method. At each recording site, 10 characteristics of the local EGM were assessed to predict the location of the VT isthmus entrance. In total, 924 EGMs were acquired, of which 127 were located in the VT isthmus entrance. Logistic regression analysis showed that bipolar voltage, number of EGM positive peaks, and sQRS interval were independently associated with VT isthmus entrance location. The ROC curve best fitted the model at the cut-off 0.1641 (sensitivity 72%, specificity 75.2%, positive predictive value 31.3%, negative predictive value 94.4%, area under the curve 0.78, P < 0.001). Based upon these results, we developed an algorithm implemented in an automatic calculator to determine the likelihood that an EGM is located at a VT isthmus entrance.Conclusion: Our study suggests that three EGM characteristics: bipolar voltage, number of positive peaks, and sQRS interval can successfully identify a VT isthmus entrance in post-infarct patients. [ABSTRACT FROM AUTHOR]

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Tetralogy of Fallot (ToF) occurs in about 4 births/1000/year and represents about one tenth of all congenital heart diseases. Nowadays 86% of patients reach adulthood with corrective surgery. Before the 1980s, these patients were treated only with "surgical palliation", which consisted in the creation of a systemic to pulmonary artery shunt or a pulmonary valvulotomy, whereas after the introduction of extracorporeal circulation, corrective surgery is performed electively between 3 and 6 months of life. After repair patients during their life may develop hemodynamic lesions, including right ventricular outflow tract dysfunction, and arrhythmias which can occur in over 30% of cases. It is estimated that these patients present a risk of sudden death of 0.2%/year. Therefore, for the prevention and treatment of arrhythmic events, a periodic follow-up in specialized centres for adult congenital heart disease is mandatory, because most often arrhythmias are triggered by the presence of hemodynamic lesions, first of all pulmonary regurgitation.

Background: Subcutaneous implantable cardioverter defibrillator (S-ICD) is a well-established therapy for sudden death prevention. Considering the painful nature of the procedure anaesthesia may be required for analgo-sedation. Hypnosis is emerging as a promising therapeutic strategy for pain control. Few data are available regarding the use of hypnosis as adjunctive technique for pain control during S-ICD implantation., Methods: Thirty consecutive patients referred to our centre for S-ICD implantation were prospectively and alternatively allocated with 1:1 ratio in two groups: A) Standard analgo-sedation approach (Hypnosis non responder patients) B) Standard analgo-sedation approach with the addition of hypnotic communication (Hypnosis responder patients). Peri-procedural pain perception and anxiety, perceived procedural length, type and dosage of administered analgesic drugs have been measured using validate scores and compared., Results: Hypnotic communication was offered to 15 patients of which was successful in 11 patients (73%). There were no statistical differences between the two study groups according to baseline characteristics. Hypnosis communication resulted in significant pain perception reduction (Group A 6,9 ± 1,6 Vs Group B 1,1 ± 0,9, p value < 0,01), peri -procedural anxiety (Group A 3,5 ± 1,6 Vs Group B 1,9 ± 0,5, p value < 0,01) and reduced perceived procedural length (Group A 58,7 ± 13,4 min Vs Group B 44,7 ± 5,5 min, p value < 0,01). Fentanyl dosage was significantly lower in Group B patients., Conclusions: Our results demonstrated a significant reduction of perceived pain, anxiety, procedural time and use of analgesic drugs in hypnosis responder patients. These results reinforce the beneficial effects of the hypnotic technique in patients undergoing S-ICD implantation., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

Aims: Our study assesses the value of electrograms (EGMs) characteristics to identify a ventricular tachycardia (VT) isthmus entrance in patients with post-infarct VT. Post-infarct VTs are mostly due to a re-entrant circuit. A pacemapping (PM) approach is able to localize the VT isthmus during sinus rhythm. Limited data are available about the role of local EGMs in defining VT isthmus location., Methods and Results: Twenty consecutive patients (70% male) referred for post-infarct VT catheter ablation were included in the present study. The VT isthmus was defined according to the PM method. At each recording site, 10 characteristics of the local EGM were assessed to predict the location of the VT isthmus entrance. In total, 924 EGMs were acquired, of which 127 were located in the VT isthmus entrance. Logistic regression analysis showed that bipolar voltage, number of EGM positive peaks, and sQRS interval were independently associated with VT isthmus entrance location. The ROC curve best fitted the model at the cut-off 0.1641 (sensitivity 72%, specificity 75.2%, positive predictive value 31.3%, negative predictive value 94.4%, area under the curve 0.78, P < 0.001). Based upon these results, we developed an algorithm implemented in an automatic calculator to determine the likelihood that an EGM is located at a VT isthmus entrance., Conclusion: Our study suggests that three EGM characteristics: bipolar voltage, number of positive peaks, and sQRS interval can successfully identify a VT isthmus entrance in post-infarct patients., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Aims: Atrial fibrillation (AF) transcatheter ablation is a safe and effective procedure. However, outcome over 10 years of follow-up has never been reported. The aim of this study is to assess outcome, describe predictors of recurrences, and report on quality of life (QoL) the decade after an AF ablation., Methods and Results: Patients referred for AF ablation in a single high volume centre from June 2004 to June 2006 were enrolled and followed in a prospective fashion by yearly clinical assessment and Holter monitoring. Among 255 patients (42.7% paroxysmal AF, 77% males, after a follow-up of 125 ± 7 months), 132 (52%) were arrhythmia-free including (58, 32% after a single procedure) while 27 (10%) progressed to permanent AF. At multivariate analysis, a greater left atrium antero-posterior diameter (HR 1.05 95% CI 1.02-1.09, P = 0.02) related to arrhythmic recurrences, while no increase in blood pressure (HR 0.06 95% CI 0.02-0.20, P = 0.01), BMI (HR 0.06 95% CI 0.02-0.09, P < 0.001), and fasting glucose (HR 0.58 95% CI 0.36-0.92, P = 0.02) during follow-up were protective for arrhythmic recurrences. Overall QoL improved significantly, significantly related to the absence of recurrences, arrhythmic burden reduction and blood pressure, and BMI control (P < 0.001)., Conclusion: The outcome of AF ablation over more than 10 years is characterized by a low incidence of progression towards permanent AF. Greater LA anteroposterior diameter related to arrhythmic recurrences, while blood pressure, BMI, and fasting blood glucose control emerged as predictors of sinus rhythm maintenance. Eventually, QoL improved significantly over the follow-up., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.)

In the aircraft productive sector, the risk assessment of repetitive occupational activities through the OCRA method presents some major obstacles: - high number of different tasks (more than 20) carried out during the work shift. - definite identification of the number of technical actions per cycle. Risk assessment through the traditional OCRA method provides in this sector a index which varies according to the sampling of the occupational tasks, rather than reflecting the effective risk level. The study raises an OCRA-based method which is applicable in the aircraft production sector and defines the overall ergonomic load for homogeneous groups of exposed workers, based on production data specified for each aircraft model.