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Introduction: Typical atrial flutter (AFL) is a macroreentrant tachycardia in which intracardiac conduction rotates counterclockwise around the tricuspid annulus. Typical AFL has specific electrocardiographic characteristics, including a negative sawtooth‐like wave in the inferior lead and a positive F wave in lead V1. This study aimed to analyze the origin of the positive F wave in lead V1, which has not been completely understood. Methods: This study enrolled 10 patients who underwent radiofrequency catheter ablation for a typical AFL. Electroanatomical mapping was performed both during typical AFL and entrainment from the right atrial appendage (RAA). The 12‐lead electrocardiogram (ECG) and three‐dimensional (3D) electroanatomical maps were analyzed. Results: The positive F wave in lead V1 changed during entrainment from the RAA in all the cases. The 3D map during entrainment from the RAA revealed an area of antidromic capture around the RAA, which collided with the orthodromic wave in the anterior right atrium. This area of antidromic capture around the RAA was the only difference from the 3D electroanatomical map of AFL and is considered the cause of the change in the F wave in lead V1 during entrainment. Conclusion: The analysis of the differences in the 12‐lead ECG and 3D maps between tachycardia and entrainment from the RAA clearly demonstrated that activation around the RAA is responsible for the generation of the positive F wave in lead V1 of typical AFL. [ABSTRACT FROM AUTHOR]

Introduction: The reduction of fluoroscopic exposure during catheter ablation of supraventricular arrhythmias is widely adopted by experienced electrophysiology physicians with a relatively short learning curve and is becoming the standard of care in many parts of the world. While observational studies in the United States and some parts of Western Europe have evaluated the minimal fluoroscopic approach, there are scarce real‐world data for this technique and the generalizability of outcomes in other economic regions. Method: The AALARA study is a prospective, observational, multicenter, and multinational open‐label study. Patients were recruited from 13 countries across Central Eastern Europe, North and South Africa, the Middle East, and the CIS (Commonwealth of Independent States), with different levels of operator expertise using minimal fluoroscopic exposure techniques. Data on radiation exposure, procedural success, complications, recurrence, and quality of life changes were collected and analyzed. Result: A total of 680 patients were enrolled and followed for 6 months. The majority were ablation naïve with the commonest arrhythmia ablated being typical AVNRT (58%) followed by Atrial Flutter (23%). Zero fluoroscopy exposure was observed in almost 90% of the cases. Fluoroscopy was most commonly used during the ablation phase of the procedure. We observed a high acute success rate (99%), a low complication rate (0.4%), and a 6‐month recurrence rate of 3.8%. There was a significant improvement in the patient's symptoms and quality of life as measured by patient global assessment. Conclusion: The routine use of a 3D mapping system during right‐sided ablation was associated with low radiation exposure and associated with high acute success rate, low complications, and recurrence rate along with significant improvement in quality of life. The data confirm the reproducibility of this approach in real‐world settings across different healthcare systems, and operator experience supporting this approach to minimize radiation exposure without compromising efficacy and safety. Trial Registration: NCT04716270 [ABSTRACT FROM AUTHOR]

Background: Ablation techniques have evolved greatly with advances in high-density 3D mapping systems over the last few years. Some patients develop atypical atrial flutter (AAFL) after pulmonary vein isolation (PVI). The data regarding follow-up after AAFL ablation as well as predictors of arrhythmia recurrence are lacking. This analysis aims to report procedure success rates and establish predictors of long-term success. Methods and Results: This retrospective cohort study included 45 patients (median age: 69 years; 40% female) who qualified for their first AAFL after PVI. The procedures were performed with the use of conventional ablation-index-guided ThermoCool Smarttouch SF and QDOT MICRO catheters. Freedom from arrhythmia recurrence was used as a primary end point. After 52 weeks of follow-up, 60% of patients suffered from arrhythmia recurrence, but over 70% of the studied cohort reported symptom improvement. In multivariate analysis, class I antiarrhythmics prescription (HR = 0.24 [95% CI 0.06–0.94], p = 0.04) was associated with the lack of arrhythmia recurrence during the follow-up, while cardioversion during procedure was associated with increased risk of arrhythmia recurrence (HR = 7.05 [95% CI 2.09–23.72], p = 0.002). Conclusions: Long-term success of AAFL ablation procedures is not satisfactory despite improvement in symptoms. Class I antiarrhythmics prescription at the discharge contributes to higher chances of sinus rhythm maintenance, whereas cardioversion during the procedure is related to increased risk of arrhythmia recurrence. [ABSTRACT FROM AUTHOR]

Background: Mesial temporal lobe epilepsy (MTLE) epileptiform discharges have been reported to arise from the hippocampus or the extrahippocampal medial temporal cortex, such as the amygdala, and then propagate to the temporal lobe cortex. The surgical ablation of which of these structures would result in a better postoperative outcome is debatable. Objective: To assess the possible factors that might have influenced the postoperative outcome of a group of drug-resistant mesial MTLE patients who underwent stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC). Design: Single-center, retrospective. Methods: The present study utilized a pre- and postoperative gray matter voxel-by-voxel ablation mapping comparison approach, along with a white matter mapping of longitudinal changes in the native space technique, to evaluate the association between the post-SEEG implantation signal recordings (obtained from clinically relevant electrode contacts used during RFTC) and the post-RFTC ablation volume of the different selected regions of interest (ROIs). Results: The study included 22 patients (12 men and 10 women, mean age 28.86 ± 14.04 years). Sixteen patients (72.72%) were seizure-free (SF), and six patients (27.27%) were non-SF. Five patients (22.72%) experienced mild side effects following RFTC. The post-RFTC follow-up period varied from 12 to 48 months, with an average of 24.17 ± 9.86 months. The SF group was associated with a higher number of implanted electrode contacts in the amygdala that were used during RFTC, a larger preoperative volume of the amygdala; a larger ablation volume of both the amygdala and rhinal cortex. The ablation volume of the white matter was statistically similar between both groups. Conclusion: This study provides valuable insights into the significance of the amygdala and rhinal cortex as ROIs in the preoperative evaluation of patients with MTLE. Future implantation scheme plans should consider evaluating the preoperative volume of these ROIs. Additionally, increasing the number of electrode contacts implanted within these regions might be beneficial to capture more clinically relevant signals and enhance their ablation volume. [ABSTRACT FROM AUTHOR]

In this study, we analyzed the success rate of cryoablation for septal accessory pathways in pediatric patients using a three-dimensional mapping method. 102 pediatric patients underwent septal accessory pathway ablation, with cryoablation performed for an average of 4 minutes in each application using a 6 or 8-mm cryoablation catheter with three-dimensional mapping. The mean age and weight of the patients were 11.3 ± 5.4 years and 35.6 ± 14.3 kg, respectively. Most patients (70.6%) had a manifest accessory pathway, while 29.4% had a concealed one. The locations of the accessory pathways were anteroseptal (37.3%), midseptal (22.5%), and posteroseptal (40.2%). The successful ablation effect time was 8.9 ± 7.3 seconds. Two patients experienced early recurrence on the day after the procedure, but the second procedure was successful in both cases. Throughout the course of the procedure, nodal rhythm manifested in five individuals, representing 4.9% of the sample; incomplete right bundle branch block was observed in four patients, accounting for 3.9% of the cohort; prolongation of the PR interval occurred in four cases, making up 3.9% of the total; and second-degree atrioventricular block was identified in two patients, constituting 1.9% of the study population. These electrocardiographic (ECG) changes returned to normal the following day, except for two patients with right bundle branch block, whose ECG findings returned to normal within the first month. The mean follow-up period was 56.71 ± 29.5 months, during which recurrence was observed in two patients with manifest preexcitation in the first and third months after the procedure. However, a second ablation procedure was successfully performed in these patients, and no second recurrence was detected during the follow-up period. Cryoablation with electroanatomic mapping system is a safe and effective procedure with high success rates in pediatric patients with septal and perinodal accessory pathways. [ABSTRACT FROM AUTHOR]

Accurate preoperative and intra-operative localization of occult breast lesions is important. We aimed to compare the clinical efficacy of body surface mapping plus wire-guided localization (BWL) and body surface mapping plus methylene blue-guided localization (BML) in occult breast lesions. Patient samples were obtained from the Xuzhou Central Hospital from 01 January 2018 to 31 December 2020. A total of 315 patients with a single occult breast lesion were included, comprising 225 cases in the BWL group and 90 cases in the BML group, were eligible for this study. We found that the average localization time in the BWL group was significantly greater than in the BML group (2.9 min vs. 1.6 min), while no significant difference was observed in the degree of pain, which was mild, between the two groups (average score, 1.3 vs. 1.5, respectively). The localization success rate and surgical resection rate were 100% in both groups. In addition, no significant difference was observed between the BWL group and BML group in terms of the average time of surgery (8.5 min vs. 9.8 min), the subjective difficulty of surgery, which was easy in both groups (average score, 2.1 vs. 2.4), and the average volume of surgical specimens (1.8 mL vs. 2.4 mL). Further, in the follow-up 3 months after surgery, the resection rate of lesions was 100%, and both groups demonstrated similar cosmetic effect scores. These findings indicated that both BWL and BML have the advantages of accurate localization, high resection rate, few adverse reactions, and excellent cosmetic effects in patients with occult breast lesions. Although both localization methods might be suitable for hospitals in remote areas, our results indicated that BML might be relatively simpler and more economical. [ABSTRACT FROM AUTHOR]

Ventricular diverticula are saccule‐like structures formed by the protrusion of the ventricular myocardium from the endocardial surface towards the free wall. Most diverticula are muscular structures, and patients usually have no obvious clinical symptoms. However, diverticula may contribute to arrhythmogenesis due to localized myocardial structural disturbances. Right ventricular apical diverticulum (RVAD) is very rare, and we report a case of highly symptomatic accelerated idioventricular rhythm (AIVR) originating from the RVAD that underwent intracardiac echocardiography (ICE)–guided catheter ablation with no recurrence during follow‐up. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate and perform diagnostic test meta‐analysis on whether slow left atrial conduction velocity (LACV) in the anterior wall calculated by electroanatomic mapping predicts atrial fibrillation (AF) recurrence after catheter ablation. Methods: Extensive literature search was performed on PubMed, SCOPUS, and EuropePMC up to June 5, 2024. The exposure group included AF patients with slow LACV in the anterior wall, while the control group included AF patients without slow LACV in the anterior wall. Slow LACV in the anterior wall was defined as LACV below study‐specific cut‐off points in m/s, measured by invasive electroanatomic mapping. The primary outcome of this study was AF recurrence, defined as AF/Atrial Flutter/Atrial Tachyarrhythmias lasting over 30 s at least 3 months after the blanking period postablation. Results: This systematic review and meta‐analysis included seven studies, involving a sample size of 1428 patients with mean follow‐up duration were 13 months. Patients with AF recurrence has slower LACV in the anterior wall (mean difference − 0.16 m/s [−0.18, −0.15], p <.001). Slow LACV in the anterior wall defined as LACV below 0.70–0.88 m/s was associated with increased AF (adjusted OR 3.41 [1.55, 7.50], p =.002). Slow LACV in the anterior wall has an AUROC of 0.80 [0.76–0.83], sensitivity of 70% [52, 84], specificity of 76% [67, 83], positive likelihood ratio of 2.9 [2.3, 3.6], negative likelihood ratio of 0.39 [0.25, 0.63] for predicting AF recurrence postablation. Conclusion: Slow LACV in the anterior wall was associated with AF recurrence after catheter ablation. [ABSTRACT FROM AUTHOR]

Background: CARTONET® enables automatic ablation site classification and reconnection site prediction using machine learning. However, the accuracy of the site classification model and trends of the site prediction model for potential reconnection sites are uncertain. Methods: We studied a total of 396 cases. About 313 patients underwent pulmonary vein isolation (PVI), including a cavotricuspid isthmus (CTI) ablation (PVI group) and 83 underwent PVI and additional ablation (i.e., box isolation) (PVI+ group). We investigated the sensitivity and positive predictive value (PPV) for automatic site classification in the total cohort and compared these metrics for PV lesions versus non‐PV lesions. The distribution of potential reconnection sites and confidence level for each site was also investigated. Results: A total of 29,422 points were analyzed (PV lesions [n = 22 418], non‐PV lesions [n = 7004]). The sensitivity and PPV of the total cohort were 71.4% and 84.6%, respectively. The sensitivity and PPV of PV lesions were significantly higher than those of non‐PV lesions (PV lesions vs. non‐PV lesions, %; sensitivity, 75.3 vs. 67.5, p <.05; PPV, 91.2 vs. 67.9, p <.05). CTI and superior vena cava could not be recognized or analyzed. In the potential reconnection prediction model, the incidence of potential reconnections was highest in the posterior, while the confidence was the highest in the roof. Conclusion: The automatic site classification of the CARTONET®R12.1 model demonstrates relatively high accuracy in pulmonary veins excluding the carina. The prediction of potential reconnection sites feature tends to anticipate areas with poor catheter stability as reconnection sites. [ABSTRACT FROM AUTHOR]

Accurately mapping the surface water bodies through remote sensing technology is of great significance for water resources management, flood monitoring, and drought monitoring. At present, many scholars at home and abroad carry out research on deep learning image recognition algorithms based on convolutional neural networks, and a variety of variant-based convolutional neural networks are proposed to be applied to extract water bodies from remote sensing images. However, due to the low depth of convolutional layers employed and underutilization of water spectral feature information, most of the water body extraction methods based on convolutional neural networks (CNNs) for remote sensing images are limited in accuracy. In this study, we propose a novel surface water automatic extraction method based on the convolutional neural network (CRAUnet++) for Sentinel-2 images. The proposed method includes three parts: (1) substituting the feature extractor of the original Unet++ with ResNet34 to enhance the network's complexity by increasing its depth; (2) Embedding the Spatial and Channel 'Squeeze and Excitation' (SCSE) module into the up-sampling stage of the network to suppress background features and amplify water body features; (3) adding the vegetation red edge-based water index (RWI) into the input data to maximize the utilization of water body spectral information of Sentinel-2 images without increasing the data processing time. To verify the performance and accuracy of the proposed algorithm, the ablation experiment under four different strategies and comparison experiment with different algorithms of RWI, FCN, SegNet, Unet, and DeepLab v3+ were conducted on Sentinel-2 images of the Poyang Lake. The experimental result shows that the precision, recall, F1, and IoU of CRAUnet++ are 95.99%, 96.41%, 96.19%, and 92.67%, respectively. CRAUnet++ has a good performance in extracting various types of water bodies and suppressing noises because it introduces SCSE attention mechanisms and combines surface water spectral features from RWI, exceeding that of the other five algorithms. The result demonstrates that CRAUnet++ has high validity and reliability in extracting surface water bodies based on Sentinel-2 images. [ABSTRACT FROM AUTHOR]

Objective: Tinnitus may be associated with various brain changes. However, the degenerative changes in patients with tinnitus have not been extensively investigated. We aimed to evaluate degenerative, structural, and functional brain changes in patients with mild cognitive impairment (MCI) who also suffer from tinnitus. Materials and methods: This study included participants aged 60 to 80 years with MCI and a hearing level better than 40 dB. The participants were classified into two groups: MCI with tinnitus (MCI-T) and MCI without tinnitus (MCI-NT). All patients underwent Tinnitus Handicap Inventory (THI), 3 T brain MRI, F18-florapronol PET, and F18-FDG PET. Results: The MCI-T group exhibited higher ß-amyloid deposition in the superior temporal gyrus, temporal pole, and middle temporal gyrus compared to the MCI-NT group (p < 0.05 for all). Additionally, the MCI-T group showed increased metabolism in the inferior frontal gyrus, insula, and anterior cingulate cortex (ACC) (p < 0.005 for all). The THI score was strongly correlated with increased volume in the insula, ACC, superior frontal gyrus, supplementary motor area, white matter near the hippocampus, and precentral gyrus (p < 0.05 for all). Moreover, the MCI-T group demonstrated higher metabolic activity in the default mode network (DMN) and lower activity in the executive control network (ECN) (p < 0.05 for all). In the MCI-T group, the posterior DMN was positively correlated with the visual network and negatively with the ECN, whereas in the MCI-NT group, it correlated positively with the ECN. Conclusion: The MCI-T group exhibited greater ß-amyloid accumulation in the auditory cortex and more extensive changes across various brain networks compared with the MCI-NT group, potentially leading to diverse clinical symptoms such as dementia with semantic deficits or depression. Tinnitus in MCI patients may serve as a biomarker for degenerative changes in the temporal lobe and alterations in brain network dynamics. [ABSTRACT FROM AUTHOR]

Background: Improved characterization of arrhythmias is based on minimally invasive catheterizations. However, these catheterizations have been poorly explored in horses because apart from 3‐dimensional (3D) mapping systems, continuous guidance of the catheter's position with adequate detail is difficult using current imaging modalities. Hypothesis: Position multiple electrophysiology catheters simultaneously at predetermined strategical positions in the heart using transthoracic echocardiographic guidance. Animals: Eight adult healthy horses. Methods: Observational study. Two electrophysiological studies were performed: 1 procedure with catheters positioned in the right heart in the standing sedated horse and 1 procedure under general anesthesia with catheters positioned in the left heart. Except for the coronary sinus catheter, each catheter positioning was simultaneously guided by right‐parasternal transthoracic echocardiography and 3D electro‐anatomical mapping. Results: For each catheter position, a central imaging plane was taken as the starting point, after which the imaging probe was shifted, rotated, and angulated to visualize the catheter over its entire length, including its distal electrode. Catheter positionings in the right heart and left ventricle were successfully guided in the majority of the horses whereas catheter positionings in the left atrium, and especially the pulmonary veins, were challenging to guide echocardiographically. Conclusions and Clinical Importance: Ultrasound guidance of catheters to specific positions useful for electrophysiological mapping was feasible in the right heart and left ventricle but challenging for the left atrium. This approach creates a perspective for minimally invasive arrhythmia diagnosis without the need for a 3D mapping system. Left parasternal views and intracardiac echocardiography might provide better guidance for left atrial positions. [ABSTRACT FROM AUTHOR]

Atrial arrhythmogenic substrate is a key determinant of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI), and reduced conduction velocities have been linked to adverse outcome. However, a noninvasive method to assess such electrophysiologic substrate is not available to date. This study aimed to noninvasively assess regional conduction velocities and their association with arrhythmia-free survival after PVI. A consecutive 52 patients scheduled for AF ablation (PVI only) and 19 healthy controls were prospectively included and received electrocardiographic imaging (ECGi) to noninvasively determine regional atrial conduction velocities in sinus rhythm. A novel ECGi technology obviating the need of additional computed tomography or cardiac magnetic resonance imaging was applied and validated by invasive mapping. Mean ECGi-determined atrial conduction velocities were significantly lower in AF patients than in healthy controls (1.45 ± 0.15 m/s vs 1.64 ± 0.15 m/s; P <.0001). Differences were particularly pronounced in a regional analysis considering only the segment with the lowest average conduction velocity in each patient (0.8 ± 0.22 m/s vs 1.08 ± 0.26 m/s; P <.0001). This average conduction velocity of the "slowest" segment was independently associated with arrhythmia recurrence and better discriminated between PVI responders and nonresponders than previously proposed predictors, including left atrial size and late gadolinium enhancement (magnetic resonance imaging). Patients without slow-conduction areas (mean conduction velocity <0.78 m/s) showed significantly higher 12-month arrhythmia-free survival than those with 1 or more slow-conduction areas (88.9% vs 48.0%; P =.002). This is the first study to investigate regional atrial conduction velocities noninvasively. The absence of ECGi-determined slow-conduction areas well discriminates PVI responders from nonresponders. Such noninvasive assessment of electrical arrhythmogenic substrate may guide treatment strategies and be a step toward personalized AF therapy. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Catheter ablation (CA) is a well-established treatment in patients with ventricular tachycardia and appropriate implantable cardioverter defibrillator (ICD) therapies. Methods: We enrolled 57 consecutive carriers of ICD undergoing CA for electrical storm (ES). Our aim was to investigate differences in clinical, device-related, and electroanatomic features among patients who had history of appropriate ICD interventions before the ES compared to those who had not. The primary endpoint was a composite of death from any cause and recurrences of sustained VT, ventricular fibrillation, appropriate ICD therapy, or ES. Results: During a median follow up of 39 months, 28 patients (49%) met the primary endpoint. Those with previous ICD interventions had a higher prevalence of late potentials and a greater unipolar low-voltage area at electroanatomic mapping. Patients who met the primary endpoint had a higher prevalence of ATP/shock episodes preceding the ES event. At Cox regression analysis, non-ischemic dilated cardiomyopathy (NIDCM), QRS duration, and previous ATP and/or shock before the ES were associated with arrhythmic recurrences and/or death. At multivariate analysis, NIDCM and previous shock were associated with arrhythmic recurrences and/or death. Conclusions: A history of recurrent ICD therapies predicts worse outcomes when CA is needed because of ES. Although more studies are needed to definitively address this question, our data speak in support of an early referral for CA of ES. [ABSTRACT FROM AUTHOR]

Background: Gastric sensorimotor disorders are prevalent. While gastric emptying measurements are commonly used, they may not fully capture the underlying pathophysiology. Body surface gastric mapping (BSGM) recently emerged to assess gastric sensorimotor dysfunction. This study assessed varying meal size on BSGM responses to inform test use in a wider variety of contexts. Methods: Data from multiple healthy cohorts receiving BSGM were pooled, using four different test meals. A standard BSGM protocol was employed: 30‐min fasting, 4‐h post‐prandial, using Gastric Alimetry® (Alimetry, New Zealand). Meals comprised: (i) nutrient drink + oatmeal bar (482 kcal; 'standard meal'); (ii) oatmeal bar alone; egg and toast meal, and pancake (all ~250 kcal). Gastric Alimetry metrics included BMI‐adjusted Amplitude, Principal Gastric Frequency, Gastric Alimetry Rhythm Index (GA‐RI) and Fed:Fasted Amplitude Ratio (ff‐AR). Key Results: 238 participants (59.2% female) were included. All meals significantly increased amplitude and frequency during the first postprandial hour (p < 0.05). There were no differences in postprandial frequency across meals (p > 0.05). The amplitude and GA‐RI of the standard meal (n = 110) were significantly higher than the energy bar alone (n = 45) and egg meal (n = 65) (all p < 0.05). All BSGM metrics were comparable across the three smaller meals (p > 0.05). A higher symptom burden was found in the oatmeal bar group versus the standard meal and pancake meal (p = 0.01, 0.003, respectively). Conclusions & Inferences: The consumption of lower calorie meals elicited different postprandial responses, when compared to the standard Gastric Alimetry meal. These data will guide interpretations of BSGM when applied with lower calorie meals. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to assess morphological and quantitative changes of the anterior cruciate ligament (ACL) and cartilage after ACL repair. Methods: 7T MRI of the knee was acquired in 31 patients 1.5 years after ACL repair and in 13 controls. Proton density-weighted images with fat saturation (PD-fs) were acquired to assess ACL width, signal intensity, elongation, and fraying. T2/T2* mapping was performed for assessment of ACL and cartilage. Segmentation of the ACL, femoral, and tibial cartilage was carried out at 12 ROIs. The outcome evaluation consisted of the Lysholm Knee Score and International Knee Documentation Committee (IKDC) subjective score and clinical examination. Results: ACL showed a normal signal intensity in 96.8% and an increased width in 76.5% after repair. Fraying occurred in 22.6% without having an impact on the clinical outcome (Lysholm score: 90.39 ± 9.75, p = 0.76 compared to controls). T2 analysis of the ACL revealed no difference between patients and controls (p = 0.74). Compared to controls, assessment of the femoral and tibial cartilage showed a significant increase of T2* times in all ROIs, except at the posterolateral femur. Patients presented a good outcome in clinical examination with a Lysholm score of 87.19 ± 14.89 and IKDC of 80.23 ± 16.84. Conclusion: T2 mapping results suggest that the tissue composition of the ACL after repair is similar to that of a native ACL after surgery, whereas the ACL exhibits an increased width. Fraying of the ACL can occur without having any impact on functional outcomes. T2* analysis revealed early degradation at the cartilage. Clinical relevance statement: MRI represents a noninvasive diagnostic tool for the morphological and compositional assessment of the anterior cruciate ligament after repair, whereas knowledge about post-surgical alterations is crucial for adequate imaging interpretation. Key Points: • There has been renewed interest in repairing the anterior cruciate ligament with a proximally torn ligament. • T2 times of the anterior cruciate ligament do not differ between anterior cruciate ligament repair patients and controls. • T2 mapping may serve as a surrogate for the evaluation of the anterior cruciate ligament after repair. [ABSTRACT FROM AUTHOR]

Background: Identification of infrequent nonpulmonary vein trigger premature atrial contractions (PACs) is challenging. We hypothesized that pace mapping (PM) assessed by correlation scores calculated by an intracardiac pattern matching (ICPM) module was useful for locating PAC origins, and conducted a validation study to assess the accuracy of ICPM‐guided PM. Methods: Analyzed were 30 patients with atrial fibrillation. After pulmonary vein isolation, atrial pacing was performed at one or two of four sites on the anterior and posterior aspects of the left atrium (LA, n = 10/10), LA septum (n = 10), and lateral RA (n = 10), which was arbitrarily determined as PAC. The intracardiac activation obtained from each pacing was set as an ICPM reference consisting of six CS unipolar electrograms (CS group) or six CS unipolar electrograms and four RA electrograms (CS–RA group). Results: The PM was performed at 193 ± 107 sites for each reference pacing site. All reference pacing sites corresponded to sites where the maximal ICPM correlation score was obtained. Sites with a correlation score ≥98% were rarely obtained in the CS‐RA than CS group (33% vs. 55%, P =.04), but those ≥95% were similarly obtained between the two groups (93% vs. 88%, P =.71), and those ≥90% were obtained in all. The surface areas with correlation scores ≥98% (0[0,10] vs. 10[0,35] mm2, P =.02), ≥95% (10[10,30] vs. 50[10,180] mm2, P =.002) and ≥90% (60[30,100] vs. 170[100,560] mm2, P =.0002) were smaller in the CS‐RA than CS group. Conclusions: ICPM‐guided PM was useful for identifying the reference pacing sites. Combined use of RA and CS electrograms may improve the mapping quality. [ABSTRACT FROM AUTHOR]

Numerous body locations have been utilized to obtain an accurate body temperature. While some are commonly used, their accuracy, response time, invasiveness varies greatly, and determines their potential clinical and/or research use. This review discusses human body temperature locations, their accuracy, ease of use, advantages, and drawbacks. We explain the concept of core body temperature and which of the locations achieve the best correlation to this temperature. The body locations include axilla, oral cavity, rectum, digestive and urinary tracts, skin, tympanic, nasopharynx, esophagus, and pulmonary artery. The review also discusses the latest temperature technologies, heat‐flux technology and telemetric ingestible temperature pills, and the body locations used to validate these devices. Rectal and esophageal measurements are the most frequently used. [ABSTRACT FROM AUTHOR]

Electrocardiography imaging (ECGi) is a non‐invasive inverse reconstruction procedure which employs body surface potential maps (BSPM) obtained from surface electrode array measurements to improve the spatial resolution and interpretability of conventional electrocardiography (ECG) for the diagnosis of cardiac dysfunction. ECGi currently lacks precision, which has prevented its adoption in clinical setups. The introduction of high‐density electrode arrays could increase ECGi reconstruction accuracy but is not attempted before due to manufacturing and processing limitations. Advances in multiple fields have now enabled the implementation of such arrays which poses questions on optimal array design parameters for ECGi. In this work, a novel conducting polymer electrode manufacturing process on flexible substrates is proposed to achieve high‐density, mm‐sized, conformable, long‐term, and easily attachable electrode arrays for BSPM with parameters optimally selected for ECGi applications. Temporal, spectral, and correlation analysis are performed on a prototype array demonstrating the validity of the chosen parameters and the feasibility of high‐density BSPM, paving the way for ECGi devices fit for clinical application. [ABSTRACT FROM AUTHOR]

Background: CHA2DS2-VASc score-related differences have been reported in atrial fibrotic remodeling and prognosis of atrial fibrillation (AF) patients after ablation. There are currently no data on the efficacy of low voltage zone (LVZ)-guided ablation in persistent AF patients according to CHA2DS2-VASc score. We assessed in a cohort of persistent AF patients the extent of LVZ, the regional distribution of LA voltage and the outcome of LA voltage-guided substrate ablation in addition to PVI according to CHA2DS2-VASc score. Methods: 138 consecutive persistent AF patients undergoing a first voltage-guided catheter ablation were enrolled. 58 patients with CHAD2DS2-VASc score ≥ 3 and 80 patients with CHAD2DS2-VASc score ≤ 2 were included. LA voltage maps were obtained using 3D-electroanatomical mapping system in sinus rhythm. LVZ was defined as < 0.5 mV. Results: In the high CHAD2DS2-VASc score group, LA voltage was lower (1.5 [1.1–2.5] vs. 2.3 [1.5–2.8] mV, p = 0.02) and LVZs were more frequently identified (40% vs. 18%), p < 0.01). Female with CHA2DS2-VASc score ≥ 3 (p = 0.031), LA indexed volume (p = 0.009) and P-wave duration ≥ 150 ms (p = 0.001) were predictors of LVZ. After a 36-month follow-up, atrial arrhythmia-free survival was similar between the two groups (logrank test, P = 0.676). Conclusions: AF patients with CHAD2DS2-VASc score ≥ 3 display more LA substrate remodeling with lower voltage and more LVZs compared with those with CHAD2DS2-VASc score ≤ 2. Despite this atrial remodeling, they had similar and favorable 36 months results after one single procedure. Unlike male with CHAD2DS2-VASc score ≥ 3, female with CHAD2DS2-VASc score ≥ 3 was predictor of LVZ occurrence. [ABSTRACT FROM AUTHOR]

Introduction: This study sought to elucidate the impact of vein of Marshall (VOM) chemical ablation on atrial fibrillation (AF) drivers by investigating the changes in CARTOFINDER mappings before and after VOM chemical ablation in patients with persistent AF. Methods: This study included 23 consecutive patients undergoing catheter ablation for long‐persistent AF (>18 months). VOM chemical ablation was performed following pulmonary vein isolation. CARTOFINDER and AF cycle length (AFCL) maps were created in the left atrium (LA) before and after VOM chemical ablation. The LA was divided into 8 segments, and the number of focal activation points with 6 or more repetitions was counted in each segment. Results: The number of focal activation points was largest in the LA appendage (LAA). After VOM chemical ablation, the number of focal activation points in the LA decreased significantly (37 [interquartile range, IQR: 19–55] vs. 15 [IQR: 7–21], p <.001), and median AFCL was significantly prolonged (159 [147–168] vs. 164 [150–173] ms, p <.001). In the assessment of each segment, significant decreases in focal activation points were observed in the inferior, lateral, and anterior segments and LAA. Among the focal activation points disappearing after chemical ablation, the number in the non‐ethanol‐affected area was significantly larger than that in the affected area (13 [8–25] vs. 4 [1–10], p <.001). Conclusions: VOM chemical ablation decreases AF drivers detected by CARTOFINDER. Mechanisms other than direct myocardial damage are considered to contribute the attenuation of AF drivers. [ABSTRACT FROM AUTHOR]

Background: Chronic nausea and vomiting syndromes (CNVS), gastroparesis and functional dyspepsia (FD) are complex disorders. Body Surface Gastric Mapping (BSGM), a new test of gastric function, using Gastric Alimetry® (Alimetry, New Zealand) may be useful for de-escalating healthcare utilisation. This study aimed to define healthcare costs and estimate health economic impacts of implementing this test in patients with chronic gastroduodenal symptoms. Methods: Consecutive patients at a tertiary referral centre evaluated with Gastric Alimetry were included. Frequency and cost data relating to medical investigations, hospital and outpatient presentations were evaluated. Costs of healthcare utilisation were calculated, and the potential cost savings of implementing Gastric Alimetry within a diagnostic decision-tree model were estimated. Results: Overall, 31 consecutive patients (mean age 36.1 years; 83.9% female; predominant symptoms: nausea [83.9%], pain [61.3%], vomiting [67.7%] and bloating [35.5%]) completed Gastric Alimetry testing. Repeat gastroscopy and abdominal CT rates were 29% (8/28) and 85% (11/13), respectively. Gastric Alimetry testing identified spectral abnormalities in 45.2% of patients, and symptom profiling classified a further 29.1% of patients. Median annualised cost difference after test introduction was NZ$-12,032. Estimated reductions in investigation-related costs when incorporating Gastric Alimetry into the diagnostic workflow model were approximately NZ$1,300 per patient. Conclusions: Healthcare utilisation and confirmatory testing rates remain high in nausea and vomiting syndromes. This study presents real-world data, together with a decision-tree analysis, showing Gastric Alimetry can streamline clinical care pathways, resulting in reduced healthcare utilisation and cost. [ABSTRACT FROM AUTHOR]

Background: Many diagnostic tests for gastroduodenal symptoms, such as gastric emptying scintigraphy (GES), gastric emptying breath tests (GEBT), and electrogastrography (EGG) show variable intra‐individual reproducibility over time. This study investigated the short‐ and long‐term reproducibility of body surface gastric mapping (BSGM), a non‐invasive test for assessing gastric function, in controls and patients with chronic gastroduodenal disorders. Methods: Participants completed three standardized BSGM tests using Gastric Alimetry® (Alimetry, New Zealand). The test encompassed a fasting baseline (30 min), a 482 kCal standard meal, and a 4 h postprandial recording. The first two tests were >6 months apart and the last occurred ~1 week after the second test, to evaluate long and short‐term reproducibility. Results: Fourteen patients with upper gastrointestinal symptoms and 14 healthy controls were recruited. There were no significant differences in any BSGM metrics between the tests at short and long term (all p > 0.180). Lin's concordance correlation coefficients (CCC) for the primary metrics were high, ranging from 0.58 to 0.96, with intra‐individual coefficients of variance (CVintra) ranging from 0.2% to 1.9%. Reproducibility was higher, and intra‐individual variation lower, than in previous studies of GES (CCC = 0.54–0.83, CVintra = 3%–77%), GEBT (CVintra = 8%–11%), and EGG (CVintra = 3%–78%). Conclusions: BSGM spectral metrics demonstrate high reproducibility and low intra‐individual variation at both short and long term, with superior results to comparable tests. The high reproducibility of Gastric Alimetry supports its role as a diagnostic aid for gastric dysfunction and a reliable tool for evaluating treatment outcomes and disease progression over time. [ABSTRACT FROM AUTHOR]

Cardiac remodeling in rats with post-infarction chronic heart failure caused by anterior transmural myocardial infarction leads to an atypical location of areas of positive and negative cardioelectric potentials on the body surface before the onset of the PII-wave on the ECG in the limb leads, which is a sign of increased heterogeneity of atrial depolarization associated with the appearance of additional excitation focus in the left atrium. A course of therapy with fabomotizole leads to a decrease in the heterogeneity of atrial depolarization at the initial stages of the formation of the cardioelectric field of the atria on the body surface before the onset of the PII-wave, thereby producing an antiarrhythmic effect. [ABSTRACT FROM AUTHOR]

Introduction: Catheter ablation of ectopy originating from the vicinity of the His bundle can be challenging. Methods and Results: We report a case of a 33‐year‐old man with narrow QRS ectopy with preferential conduction from a para‐Hisian origin to the proximal left fascicles, which was successfully eliminated by radiofrequency ablation in the right coronary cusp, guided by ultrahigh‐resolution mapping of the His bundle, bundle branch, and fascicular electrograms. Conclusion: Some narrow QRS ectopy may originate from the vicinity of the conduction system, instead of the "true" conduction system, and have concealed connections from its origin to the conduction system. [ABSTRACT FROM AUTHOR]

Introduction: Precise electrocardiographic localization of accessory pathways (AP) can be challenging. Seminal AP localization studies were limited by complexity of algorithms and sample size. We aimed to create a nonalgorithmic method for AP localization based on color‐coded maps of AP distribution generated by a web‐based application. Methods: APs were categorized into 19 regions/types based on invasive electrophysiologic mapping. Preexcited QRS complexes were categorized into 6 types based on polarity and notch/slur. For each QRS type in each lead the distribution of APs was visualized on a gradient map. The principle of common set was used to combine the single lead maps to create the distribution map for AP with any combination of QRS types in several leads. For the validation phase, a separate cohort of APs was obtained. Results: A total of 800 patients with overt APs were studied. The application used the exploratory data set of 553 consecutive APs and the corresponding QRS complexes to generate AP localization maps for any possible combination of QRS types in 12 leads. Optimized approach (on average 3 steps) for evaluation of preexcited electrcardiogram was developed. The area of maximum probability of AP localization was pinpointed by providing the QRS type for the subsequent leads. The exploratory data set was validated with the separate cohort of APs (n = 256); p =.23 for difference in AP distribution. Conclusions: In the largest data set of APs to‐date, a novel probabilistic and semi‐automatic approach to electrocardiographic localization of APs was highly predictive for anatomic localization. [ABSTRACT FROM AUTHOR]

Objective: Cortical intracerebral electrical stimulation is an important tool for language mapping in the presurgical work‐up of patients with drug‐resistant focal epilepsy. Language mapping with stereo–electroencephalography (EEG) is usually performed by high‐frequency stimulations (HFS: 50 Hz), whereas low‐frequency stimulations (LFS: 1 Hz) are usually considered useful for primary cortices mapping. Little is known in literature about "intermediate" frequencies (IFS: 6–15 Hz). Our objective is to explore the clinical usefulness of IFS in language mapping and identify factors, beyond the electrical parameters, that impact the mapping. Methods: We studied 23 patients submitted to stereo‐EEG for presurgical evaluation. Language mapping was performed in the anterior, posterior and/or basal language region of the dominant hemisphere for language. We included all contact positions within these regions stimulated by HFS (50 Hz, 5 s, 1–3 mA) and IFS (6‐15 Hz, 15 s, 5 mA). We compared the capability of both stimulation methods to induce a language deficit without afterdischarges (ADs), and we analyzed factors related to clinical examination, region, and stimulation technique by multivariate analysis. Results: A total of 211 stimulations (98 HFS, 113 IFS) in 70 cortical sites within the anterior (84 stimulations), posterior (137), and basal language region (60) were included. IFS induced more frequently language deficits not associated to AD compared to HFS (37.1% vs 25.7%, p =.0043), whereas HFS provoked more diffuse AD (34.7% vs 15.0%, p =.001). Investigating multiple language functions increased the probability of revealing a deficit (odds ratio [OR] 3.16, p =.0016), independently of the stimulation method. Significance: IFS are valuable for language mapping, thereby improving the probability of inducing a clinical deficit not accompanied by an AD. The completeness of the clinical examination independently affects the sensitivity of the mapping. IFS are a new tool with potential usefulness for the cortical mapping of other associative cortical regions. [ABSTRACT FROM AUTHOR]

Background: The relationship between liver fibrosis and left atrial (LA) remodeling in atrial fibrillation (AF) remains uncertain. We examined the associations between the fibrosis-4 (FIB4) index, an indicator of liver fibrosis, and both LA low-voltage areas (LVAs) on electroanatomic mapping and AF recurrence postablation. Methods: We recruited 343 patients who underwent radiofrequency catheter ablation (RFCA) or cryoballoon ablation (CBA) for AF. First, the association between the FIB4 index and LA LVAs (<0.5 mV) was evaluated in RFCA using electroanatomic mapping (n = 214). Next, the utility of a FIB4 index ≥1.3, recommended cut-off value of liver fibrosis, was verified to assess the risk for AF recurrence in CBA without additional LVA ablation (n = 129). Results: Patients with a FIB4 index ≥1.3 had a higher prevalence of LA LVAs (>5 cm²) compared to those without. Additionally, the quantitative size of LVAs showed a positive correlation with the FIB4 index (R = .642, p < .001). In multivariate logistic models, a FIB4 index ≥1.3 was related to the presence of LVAs after adjusting for LA diameter, right atrial end-systolic area, and nonparoxysmal AF (odds ratio 2.508; p = 0.039). In CBA, AF recurrence rate was 13.1% during 3--12 months postablation. In multivariate Cox models, a FIB4 index ≥1.3 was an important predictor of AF recurrence (hazard ratio 3.796; p = .037), suggesting that LVAs might be associated with AF recurrence after CBA. Conclusion: The FIB4 index was a novel predictor of the existence of LA LVAs on electroanatomic mapping and AF recurrence after CBA. [ABSTRACT FROM AUTHOR]

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) sometimes recurs even after anatomical slow pathway (SP) ablation targeting the rightward inferior extension (RIE). This multicenter study aimed to determine the reasons for AVNRT recurrence. Methods and Results: Forty-six patients were treated successfully for recurrent AVNRT. Initial treatment was for 38 slow-fast AVNRTs, 3 fast-slow AVNRTs, 2 slow-slow AVNRTs, 2 slow-fast and fast-slow AVNRTs, and 1 noninducible AVNRT. All initial treatments were of RF application to the RIE; SP elimination was achieved in 11, dual AVN physiology was seen in 29, and AVNRT remained inducible in 5. The recurrent AVNRTs included 34 slow-fast AVNRTs, 6 fast-slow AVNRTs, 3 slow-slow AVNRTs, 2 slow-fast and fast-slow AVNRTs, and 1 slow-fast and slow-slow AVNRTs. Successful ablation site was within the RIE in 39 and left inferior extension in 7. In 30 of 39, the successful RIE site was in the same area or higher than that of the initial procedure. Conclusion: For a high majority (around 85%) of patients in whom AVNRT recurs after initial ablation success, the site of a second successful procedure will be within the RIE even though the RIE was originally targeted. Furthermore, a high majority (around 86%) of sites of successful ablation will be higher than those originally targeted. [ABSTRACT FROM AUTHOR]

Background Fluoroscopy-guided catheter ablation has become the gold standard for treatment of cardiac arrhythmias. High resolution electro-anatomical mapping systems have become fundamental to perform these procedures. Recently, interventional cardiac magnetic resonance (iCMR) has been proposed as an alternative for fluoroscopy to guide atrial flutter ablations. The clinical experience with iCMR and dedicated three-dimensional mapping systems is growing. NorthStar is currently the first available vendor-neutral mapping system. Case summary We performed a real-time CMR-guided cavotricuspid isthmus (CTI) catheter ablation (CA) on a 69-year-old man using a novel mapping system (NorthStar Mapping System, Imricor Medical Systems, MN, USA). Starting from the CMR imaging, a pre-rendered segmentation model was loaded on NorthStar and used to guide the catheters, display voltage and activation maps, show mapping and ablation points. NorthStar can also take full control of the CMR scanner (i.e. start/stop sequences for anatomical information, tissue characterization, and catheter visualization) and communicate with the recorder/stimulator system (Advantage-MR EP, Imricor Medical Systems, MN, USA). With comparable procedural time to standard fluoroscopy-guided CA, CTI bidirectional block was achieved, without any complication. Discussion Using the NorthStar Mapping System, we managed to achieve a successful CMR-guided CTI ablation without any complication. Its further use should be explored, especially in more complex arrhythmias where a substrate-guided ablation is critical, as it could significantly improve results in terms of arrhythmia recurrence. [ABSTRACT FROM AUTHOR]

The article focuses on the study of scar-related ventricular tachycardia (VT) termination mechanisms, particularly through examining the role of circuit entrance sites. Topics include distinctions between fixed and functional lines of block within VT circuits; findings from spontaneous VT termination mapping that emphasize the importance of entrance sites over exit sites; and implications of these insights for refining VT ablation strategies.

A study published in the American Journal of Physiology: Gastrointestinal & Liver Physiology examines the potential impact of the menstrual cycle on gastric myoelectrical activity in healthy humans. The study introduces a new technique called "body surface gastric mapping" (BSGM), which is an improved version of the traditional electrogastrography (EGG) method. The researchers found that the principal frequency of gastric slow waves is higher in the luteal phase compared to the follicular phase in premenopausal women. However, the clinical relevance of this finding and the mechanisms behind it remain unclear. The study highlights the need for further research and caution in interpreting the results. [Extracted from the article]

Functional magnetic resonance imaging (fMRI) has been extensively used as a tool to map the brain processes related to somatosensory stimulation. This mapping includes the localization of task-related brain activation and the characterization of brain activity dynamics and neural circuitries related to the processing of somatosensory information. However, the magnetic resonance (MR) environment presents unique challenges regarding participant and equipment safety and compatibility. This study aims to systematically review and analyze the state-of-the-art methodologies to assess the safety and compatibility of somatosensory stimulation devices in the MR environment. A literature search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines, was performed in PubMed, Scopus, and Web of Science to find original research on the development and testing of devices for somatosensory stimulation in the MR environment. Nineteen records that complied with the inclusion and eligibility criteria were considered. The findings are discussed in the context of the existing international standards available for the safety and compatibility assessment of devices intended to be used in the MR environment. In sum, the results provided evidence for a lack of uniformity in the applied testing methodologies, as well as an in-depth presentation of the testing methodologies and results. Lastly, we suggest an assessment methodology (safety, compatibility, performance, and user acceptability) that can be applied to devices intended to be used in the MR environment. [ABSTRACT FROM AUTHOR]

Biopsychosocial factors are associated with disorders of gut-brain interaction (DGBI) and exacerbate gastrointestinal symptoms. The mechanisms underlying pathophysiological alterations of stress remain unclear. Corticotropin-releasing hormone (CRH) is a central regulator of the hormonal stress response and has diverse impact on different organ systems. The aim of the present study was to investigate the effects of peripheral CRH infusion on meal-related gastrointestinal symptoms, gastric electrical activity, and gastric sensorimotor function in healthy volunteers (HVs). In a randomized, double-blinded, placebo-controlled, crossover study, we evaluated the effects of CRH on gastric motility and sensitivity. HVs were randomized to receive either peripheral-administered CRH (100 µg bolus + 1 µg/kg/h) or placebo (saline), followed by at least a 7-day washout period and assignment to the opposite treatment. Tests encompassed saliva samples, gastric-emptying (GE) testing, body surface gastric mapping (BSGM, Gastric Alimetry; Alimetry) to assess gastric myoelectrical activity with real-time symptom profiling, and a gastric barostat study to assess gastric sensitivity to distention and accommodation. Twenty HVs [13 women, mean age 29.2 ± 5.3 yr, body mass index (BMI) 23.3 ± 3.8 kg/m2] completed GE tests, of which 18 also underwent BSGM measurements during the GE tests. The GE half-time decreased significantly after CRH exposure (65.2 ± 17.4 vs. 78.8 ± 24.5 min, P = 0.02) with significantly increased gastric amplitude [49.7 (34.7–55.6) vs. 31.7 (25.7–51.0) µV, P < 0.01], saliva cortisol levels, and postprandial symptom severity. Eleven HVs also underwent gastric barostat studies on a separate day. However, the thresholds for discomfort during isobaric distensions, gastric compliance, and accommodation did not differ between CRH and placebo. NEW & NOTEWORTHY: In healthy volunteers, peripheral corticotropin-releasing hormone (CRH) infusion accelerates gastric-emptying rate and increases postprandial gastric response, accompanied by a rise in symptoms, but does not alter gastric sensitivity or meal-induced accommodation. These findings underscore a significant link between stress and dyspeptic symptoms, with CRH playing a pivotal role in mediating these effects. [ABSTRACT FROM AUTHOR]

Introduction: Peak frequency (PF) mapping is a novel method that may identify critical portions of myocardial substrate supporting reentry. The aim of this study was to describe and evaluate PF mapping combined with omnipolar voltage mapping in the identification of critical isthmuses of left atrial (LA) atypical flutters. Methods and Results: LA omnipolar voltage and PF maps were generated in flutter using the Advisor HD‐Grid catheter (Abbott) and EnSite Precision Mapping System (Abbott) in 12 patients. Normal voltage was defined as ≥0.5 mV, low‐voltage as 0.1−0.5 mV, and scar as <0.1 mV. PF distributions were compared with ANOVA and post hoc Tukey analyses. The 1 cm radius from arrhythmia termination was compared to global myocardium with unpaired t‐testing. The mean age was 65.8 ± 9.7 years and 50% of patients were female. Overall, 34 312 points were analyzed. Atypical flutters most frequently involved the mitral isthmus (58%) or anterior wall (25%). Mean PF varied significantly by myocardial voltage: normal (335.5 ± 115.0 Hz), low (274.6 ± 144.0 Hz), and scar (71.6 ± 140.5 Hz) (p < .0001 for all pairwise comparisons). All termination sites resided in low‐voltage regions containing intermediate or high PF. Overall, mean voltage in the 1 cm radius from termination was significantly lower than the remaining myocardium (0.58 vs. 0.95 mV, p < .0001) and PF was significantly higher (326.4 vs. 245.1 Hz, p < .0001). Conclusion: Low‐voltage, high‐PF areas may be critical targets during catheter ablation of atypical atrial flutter. [ABSTRACT FROM AUTHOR]

Objective: The talus is an important component in the ankle, and its treatment after injury is crucial. However, complications and adverse events due to incomplete traditional classifications may still occur, and these classifications fail to analyze the patterns and distribution of fractures from a three‐dimensional perspective. Therefore, in this study, we aimed to analyze the location and distribution of fracture lines in different types of talus fractures using three‐dimensional (3D) and heat mapping techniques. Additionally, we aimed to determine the surface area of the talus that can be utilized for different approaches of internal fixation, aiding in the planning of surgical procedures. Methods: We retrospectively analyzed data from CT scans from 126 patients diagnosed with talus fractures at our two hospitals. We extracted the CT data of a healthy adult and created a standard talus model. We performed 3D reconstruction using patients' CT images and superimposed the fracture model onto the standard model for drawing fracture lines. Subsequently, we converted the fracture lines into a heat map for visualization. Additionally, we measured 20 specimens to determine the boundary for various ligaments attached to the talus. We determined the surface area of the talus available for different surgical approaches by integrating the boundary data with previously reported data on area of exposure. Results: Without considering the displacement distance of the fracture, fracture types were classified as follows, by combining Hawkins and Sneppen classifications: talar neck, 41.3%; posterior talar tubercle, 22.2%; body for the talus and comminuted, 17.5%; lateral talar tubercle, 11.9%; and talar head, 7.1%. We established fracture line and heat maps using this classification. Additionally, we demonstrated the available area for anteromedial, anterolateral, posteromedial, posterolateral, and medial malleolus osteotomy and Chaput osteotomy approaches. Conclusion: Fracture line and heat map analyses can aid surgeons in planning a single or combined surgical approach for the reduction and internal fixation of talus fractures. Demonstrating the different surgical approaches can help surgeons choose the most effective technique for individual cases. [ABSTRACT FROM AUTHOR]

Purpose: Platelet‐rich plasma (PRP) augmentation has been proposed to improve the results of anterior cruciate ligament reconstruction (ACLR). The present study aims to quantify the available evidence to support the use of PRP as biological augmentation in ACLR surgery. Methods: A systematic literature search was conducted on the PubMed, Cochrane, Web of Science and Embase databases on 10 March 2023. Inclusion criteria were randomised controlled trials (RCTs), written in English, addressing PRP augmentation in ACLR surgery, with no time limitation. A scoping review was performed to map the body of literature by examining the evidence related to specific aspects of patients' treatment and evaluation. Risk of bias evaluation was performed with the Cochrane risk‐of‐bias tool for randomised trials Version 2 (RoB 2), while the quality assessment was performed with the use of the Coleman Score. Results: Out of 983 articles retrieved, 23 RCTs on 943 knees were included in this scoping review. PRP was administered in a liquid form in nine studies and clotted in 11 studies, while in three studies both liquid and clotted PRP were used. Hamstring auto/allografts were used in 14 studies, patellar tendon auto/allografts were used in eight studies and one study described ACLR with peroneus longus allografts. The map of the evidence documented high heterogeneity also in terms of surgical technique, objective and subjective outcome measures and radiological assessment, as well as follow‐up times ranging from 1 day to 2 years, with virtually no overlapping data among studies neither in terms of treatments nor evaluations. Risk of bias evaluation showed an overall low quality of the included studies. Conclusions: The available literature addressing PRP augmentation in ACLR is largely scattered. PRP was produced and applied following different procedures, and high variability was detected across the included studies for every aspect of ACLR surgery and evaluation. Currently, a meaningful comparison of the available studies is not possible as the quantification of the literature results is biased by their heterogeneity. Future studies should provide more standardisation to investigate the benefits of biological augmentation in ACL surgery and confirm the promising yet weak evidence of PRP potential as well as the most suitable application modality, before routine use in clinical practice. Level of Evidence: Levels I and II, scoping review. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare the originally applied frequency allocation of cochlear implant electrodes assigned by default at the time of activation with a more recent frequency allocation that is anatomy-based by a software called OTOPLAN®. Based on a computed tomography scan of the temporal bone, this software calculates the position of each electrode in the cochlea and its corresponding tonotopic frequency. We also evaluated whether patients with a significant mismatch between these two allocations present poorer speech intelligibility. Materials and Methods: Patients who underwent cochlear implantation from 2016 to 2021 at the University Hospital of Liege were included in this retrospective study. We used OTOPLAN® to calculate the tonotopic frequency allocation of each electrode according to its exact position in the cochlear duct. This anatomical frequency mapping was compared with the default frequency mapping at the time of cochlear implant activation. Finally, we compared the mismatch with the patients' auditory performance, represented by the Auditory Capacity Index (ACI). Results: Thirteen patients were included in the study. All patients had a mismatch between the two frequency maps, to a variable extent (200 Hz–1,100 Hz). Frequency shift was significantly inversely correlated with ACI and with the time needed to improve speech intelligibility. Conclusion: Our primary results show that patients with a larger mismatch between default frequency mapping and anatomically assigned frequency mapping experience poorer hearing performance and slower adaptation to a cochlear implant. [ABSTRACT FROM AUTHOR]

Background Left ventricular (LV) summit arrhythmias account for up to 14% of LV arrhythmias. The ablation of LV summit arrhythmias is challenging, as testified by the fact that radiofrequency (RF) catheter ablation failure is frequent. Retrograde coronary venous ethanol infusion has been proposed as an alternative approach for the ablation of LV summit arrhythmias. Case summary A 47-year-old man with Lamin A/C cardiomyopathy was referred for the ablation of a pleiomorphic ventricular tachycardia (VT) storm, with dominant morphology compatible with LV summit origin. He first received a combined endo- and epicardial RF ablation with the elimination of three clinically relevant VTs. However, the dominant VT could not be ablated due to the proximity of the coronary vasculature and phrenic nerve and remained inducible. Accordingly, an urgent rescue redo procedure consisting of retrograde coronary venous ethanol ablation was performed. Based on the best pace-match and precocity, the first septal, retro-pulmonary branch and the first diagonal branch were infused with ethanol with immediate cessation of the tachycardia and non-inducibility. Anti-arrhythmic drugs were withdrawn, while guideline-directed medical therapy for heart failure was continued. No complications occurred. After 3 months, the patient remained free from any arrhythmias. Discussion Ablation of LV summit arrhythmias is challenging, especially in the context of an electrical storm or in patients with structural heart disease. In such a situation, rescue ablation with retrograde coronary venous ethanol infusion represents an attractive alternative ablation modality. [ABSTRACT FROM AUTHOR]

Background: Unidentified heart failure occurs in patients with multiple myeloma when their heart was involved. CMR with late gadolinium enhancement (LGE) and T1 mapping can identify myocardial amyloid infiltrations. Purpose: To explore the role of CMR with late gadolinium enhancement (LGE) and T1 mapping for detection of multiple myeloma patients'heart. Material and methods: A total of 16 MM patients with above underwent CMR (3.0-T) with T1 mapping (pre-contrast and post-contrast) and LGE imaging. In addition, 26 patients with non-obstructive hypertrophic cardiomyopathy and 26 healthy volunteers were compared to age- and sex-matched healthy controls without a history of cardiac disease, diabetes mellitus, or normal in CMR. All statistical analyses were performed using the statistical software GraphPad Prism. The measurement data were represented by median (X) and single sample T test was adopted. Enumeration data were represented by examples and Chi-tested was adopted. All tests were two-sided, and P values < 0.05 were considered statistically significant. Results: In MM group, LVEF was lower than healthy controls and higher than that of non-obstructive hypertrophic cardiomyopathy group, but without statistically significant difference (%: 49.1 ± 17.5 vs. 55.6 ± 10.3, 40.4 ± 15.6, all P > 0.05). Pre-contrast T1 values of MM group were obviously higher than those of healthy controls and non-obstructive hypertrophic cardiomyopathy group (ms:1462.0 ± 71.3vs. 1269.3 ± 42.3, 1324.0 ± 45.1, all P < 0.05). 16 cases (100%) in MM group all had LGE. Conclusion: LGE joint T1 mapping wider clinical use techniques and follow-up the patients'disease severity. [ABSTRACT FROM AUTHOR]

Introduction: Assessing a patient's risk of scar-based ventricular tachycardia (VT) after myocardial infarction is a challenging task. It can take months to years after infarction for VT to occur. Also, if selected for ablation therapy, success rates are low. Methods: Computational ventricular models have been presented previously to support VT risk assessment and to provide ablation guidance. In this study, an extension to such virtual-heart models is proposed to phenomenologically incorporate tissue remodeling driven by mechanical load. Strain amplitudes in the heart muscle are obtained from simulations of mechanics and are used to adjust the electrical conductivity. Results: The mechanics-driven adaptation of electrophysiology resulted in a more heterogeneous distribution of propagation velocities than that of standard models, which adapt electrophysiology in the structural substrate from medical images only. Moreover, conduction slowing was not only present in such a structural substrate, but extended in the adjacent functional border zone with impaired mechanics. This enlarged the volumes with high repolarization time gradients (≥10 ms/mm). However, maximum gradient values were not significantly affected. The enlarged volumes were localized along the structural substrate border, which lengthened the line of conduction block. The prolonged reentry pathways together with conduction slowing in functional regions increased VT cycle time, such that VT was easier to induce, and the number of recommended ablation sites increased from 3 to 5 locations. Discussion: Sensitivity testing showed an accurate model of strain-dependency to be critical for low ranges of conductivity. The model extension with mechanics-driven tissue remodeling is a potential approach to capture the evolution of the functional substrate and may offer insight into the progression of VT risk over time. [ABSTRACT FROM AUTHOR]

Background: Catheter ablation in patients with ventricular arrhythmias (VA), such as ventricular tachycardias (VT) or frequent premature ventricular complexes (PVC), is increasingly considered an effective and safe therapy when performed in experienced centers. This study sought to determine acute success rates and complication rates of ablation procedures for patients with VA in a Swiss tertiary care center. Methods: All patients who underwent ablation therapy for VT and PVC at the University Heart Center in Zurich, Switzerland, between March 2012 and April 2017 were included in this analysis. Results: A total of 120 patients underwent catheter ablation for VT and PVC (69 and 51, respectively). Seventy percent of patients were male, and the mean age was 55.3 years. The most common indication for ablation was high PVC burden (47.5%), followed by paroxysmal VT (38.3%), ICD shocks (23.3%), incessant VT (12.5%), electrical storm (7.5%), and syncope (3.3%). Acute success rates for VT and PVC ablations were 94.2% and 92.2%, respectively. Rates for complications (including major and minor) for VT and PVC were 10.1% and 7.8%, respectively. Complications occurred only in patients with structural heart disease; no complications were noted in structurally normal hearts. Conclusions: Our results suggest that catheter ablation for VT and PVC has high acute success rates with a reasonable risk for complications in the setting of tertiary care centers, comparable to those reported in other studies. [ABSTRACT FROM AUTHOR]

Objectives: Accurate presurgical brain mapping enables preoperative risk assessment and intraoperative guidance. This cross‐sectional study investigated whether constrained spherical deconvolution (CSD) methods were more accurate than diffusion tensor imaging (DTI)‐based methods for presurgical white matter mapping using intraoperative direct electrical stimulation (DES) as the ground truth. Methods: Five different tractography methods were compared (three DTI‐based and two CSD‐based) in 22 preoperative neurosurgical patients undergoing surgery with DES mapping. The corticospinal tract (CST, N = 20) and arcuate fasciculus (AF, N = 7) bundles were reconstructed, then minimum distances between tractograms and DES coordinates were compared between tractography methods. Receiver‐operating characteristic (ROC) curves were used for both bundles. For the CST, binary agreement, linear modeling, and posthoc testing were used to compare tractography methods while correcting for relative lesion and bundle volumes. Results: Distance measures between 154 positive (functional response, pDES) and negative (no response, nDES) coordinates, and 134 tractograms resulted in 860 data points. Higher agreement was found between pDES coordinates and CSD‐based compared to DTI‐based tractograms. ROC curves showed overall higher sensitivity at shorter distance cutoffs for CSD (8.5 mm) compared to DTI (14.5 mm). CSD‐based CST tractograms showed significantly higher agreement with pDES, which was confirmed by linear modeling and posthoc tests (PFWE <.05). Conclusions: CSD‐based CST tractograms were more accurate than DTI‐based ones when validated using DES‐based assessment of motor and sensory function. This demonstrates the potential benefits of structural mapping using CSD in clinical practice. [ABSTRACT FROM AUTHOR]

The main goal of this study is to determine typical values of dose area product (DAP) and difference in the effective dose (ED) for pediatric electrophysiological procedures on the heart in relation to patient body mass. This paper also shows DAP and ED in relation to the indication, the arrhythmia substrate determined during the procedure, and in relation to the reason for using radiation. Organ doses are described as well. The subjects were children who have had an electrophysiological study done with a 3D mapping system and X-rays in two healthcare institutions. Children with congenital heart defects were excluded. There were 347 children included. Significant difference was noted between mass groups, while heavier children had higher values of DAP and ED. Median DAP in different mass groups was between 4.00 (IQR 1.00–14.00) to 26.33 (IQR 8.77–140.84) cGycm2. ED median was between 23.18 (IQR 5.21–67.70) to 60.96 (IQR 20.64–394.04) µSv. The highest DAP and ED in relation to indication were noted for premature ventricular contractions and ventricular tachycardia—27.65 (IQR 12.91–75.0) cGycm2 and 100.73 (IQR 53.31–258.10) µSv, respectively. In arrhythmia substrate groups, results were similar, and the highest doses were in ventricular substrates with DAP 29.62 (IQR 13.81–76.0) cGycm2 and ED 103.15 (IQR 60.78–266.99) µSv. Pediatric electrophysiology can be done with very low doses of X-rays when using 3D mapping systems compared to X-rays-based electrophysiology, or when compared to pediatric interventional cardiology or adult electrophysiology. [ABSTRACT FROM AUTHOR]

• Pedicle Screw can cross the midline of the vertebrae without causing a pedicle screw breach. • Screw safety cone angle increase from L1 to L5. • L4 allows the most screw crossing from midline. Pedicle screw breach (PSB) is not uncommon following lumbar instrumentation, and in some instances, it may lead to vascular and/or neurologic complications. Previous literature suggested that screws crossing the vertebral midline on an anterior-posterior (AP) radiograph (or midsagittal on CT) are concerning for medial pedicle breach. Our primary aim was to map out the safe zones (SZ) of bilateral pedicle instrumentation and their relationship at each lumbar vertebral level. Our secondary aim was to evaluate the presence of SZs' intersection at each lumbar level, denoting safe midline pedicle screw crossing not otherwise associated with medial pedicle breach. Retrospective Anatomical Study. Adult patients in the from "The Cancer Imaging Archive" (TCIA) database who have not had thoraco-lumbo-sacral fusion. Physiologic measures obtained through 3D analysis of CT images and virtual pedicle screws. CT scans of 51 patients were randomly selected from "The Cancer Imaging Archive" (TCIA) online database for analysis. The Sectra 3D Spine software was used to create 3D renderings, place virtual screws, and make measurements. At each lumbar vertebra, the right and left pedicle corridors were mapped. At each pedicle, two screw positions were templated, the "medial limit screw" (MLS) and the "lateral limit screw" (LLS). Each limit screw was the most extreme position that the screw could exist in without causing a medial or lateral breach. The safe zone was defined as the zone between MLS and LLS. Measurements were taken for each level (between L1 and L5) and side (Left, Right). A total of 253 lumbar vertebrae from 51 patients (mean age 53.1, 56.9% male) were included. Two vertebrae from two patients were removed for poor image quality. Out of the 506 screw positions analyzed in our study, 97.4% had overlapping SZ and crossed the midplane without medial pedicle breach. The significant factors (p<.01) for safe midplane-crossing screws included: the screw length (L1–L5); the laterality of the screw entry point (L1–L4); and the pedicle diameter (L2 and L5). A midline crossing pedicle screw on a lumbar AP radiograph is not necessarily indicative of a medial pedicle screw breach. Anatomical (ie, larger pedicle diameter) and technical (ie, longer screws, and lateral entry points) factors allow for safety zone intersections and indicate safe midline crossing by pedicle screws. [ABSTRACT FROM AUTHOR]

Introduction: The optimal slow pathway (SP) ablation site in cases with an inferiorly located His bundle (HIS) remains unclear. Methods and Results: In 45 patients with atrioventricular nodal reentrant tachycardia, the relationship between the HIS location and successful SP ablation site was assessed in electroanatomical maps. We assessed the location of the SP ablation site relative to the bottom of the coronary sinus ostium in the superior‐to‐inferior (SPSI), anterior‐to‐posterior (SPAP), and right‐to‐left (SPRL) directions. The HIS location was assessed in the same manner. The HIS location in the superior‐to‐inferior direction (HISSI), SPSI, SPAP, and SPRL were 17.7 ± 6.4, 1.7 ± 6.4, 13.6 ± 12.3, and −1.0 ± 13.0 mm, respectively. The HISSI was positively correlated with SPSI (R2 = 0.62; P <.01) and SPAP (R2 = 0.22; P <.01), whereas it was not correlated with SPRL (R2 = 0.01; P =.65). The distance between the HIS and SP ablation site was 17.7 ± 6.4 mm and was not affected by the location of HIS. The ratio of the amplitudes of atrial and ventricular potential recorded at the SP ablation site did not differ between the high HIS group (HISSI ≥ 13 mm) and low HIS group (HISSI < 13 mm) (0.10 ± 0.06 vs. 0.10 ± 0.06; P =.38). Conclusion: In cases with an inferiorly located HIS, SP ablation should be performed at a lower and more posterior site than in typical cases. [ABSTRACT FROM AUTHOR]

Background: In patients having non-cardiac surgery, perioperative cardiovascular problems constitute the primary contributor to both morbidity and death. Objective: Uncovering hidden cardiac problems among asymptomatic patients that may cause complications during and after low to intermediate risk non-cardiac surgery. Subjects and Methods: The study was conducted on 300 cases; and all of them were subjected to full preoperative cardiac assessment including full history taking, clinical examination, laboratory investigations, 12-lead surface ECG and transthoracic echocardiography to exclude any case with significant heart disease. All patients were followed up during hospital stay for assessment of perioperative complications. Results: Regarding incidence of complications and types of cardiac complications distribution among study groups, 275 patients (91.7%) had no complications and 25 patients (8.3%) had complications in the form of: sinus tachycardia (5 patients "1.7%"), hypotension (4 patients "1.3%"), Supra ventricular tachycardia (4 patients "1.3%"), arrested (3 patients "1.0%"), venous thrombosis (3 patients "1.0%"), Atrial fibrillation (2 patients "0.7%"), pulmonary embolism (2 patients "0.7%"), acute pulmonary edema (one patient "0.3%") and suspected pulmonary embolism (one patient "0.3%"). Conclusion: There was a statistically significant increase in postoperative complications among cardiac patients who did not exhibit any symptoms. The clinical and predictive use of routine preoperative electrocardiography (ECG) and echocardiography (ECHO) in persons having low- to intermediate-risk surgery for major cardiac adverse events is limited. [ABSTRACT FROM AUTHOR]