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En 1935, el médico y neuroanatomista Joseph Klingler desarrollo la técnica para conservación del encéfalo humano para disección, mediante el uso de la fijación y congelamiento, técnica que actualmente lleva su nombre. El objetivo de este trabajo fue desarrollar un protocolo de conservación del sistema nervioso central, con fines de docencia y disección de fibras de sustancia blanca mediante la técnica de Klingler estandarizada en encefalos de bovino. Los encefalos fueron fijados y conservados con formaldehido al 10% por 4 meses. Posteriormente, fueron sometidos a inmersión en agua corriente por 24 horas, con la finalidad de evitar los efectos irritativos relacionados con la exposición continua a formaldehído. Enseguida, y con ayuda de unas pinzas de relojero de punta fina y tijeras de microdisección rectas se eliminaron los vasos sanguíneos, aracnoides y restos de sangre. Una vez disecados los elementos mencionados, cada uno de los encefalos fue colocado en una bolsa de polietileno con formaldehido al 10%, manteniéndolos durante 10 días a -18ºC. en un congelador horizontal, de la marca “Whirlpool®” Una vez transcurrido el tiempo de congelamiento, se retiraron las bolsas con los encefalos, dejando descongelar a temperatura ambiente durante 24 horas. Se logró desarrollar satisfactoriamente en el Anfiteatro de la Universidad Cuauhtémoc Plantel San Luis Potosí, México, un protocolo de conservación del sistema nervioso central mediante la técnica de Klingler estandarizada, obteniendo una excelente fijación de los encefalos de bovino, y una fragmentación adecuada de la corteza cerebral.

Ablation of atrial fibrillation (AF) is usually not considered in patients with rheumatic mitral stenosis (RMS). We analyzed the results of a combined procedure of AF ablation and percutaneous balloon mitral commissurotomy (PBMC).We prospectively included 22 patients with severe RMS to undergo a combined PBMC + AF ablation procedure. Noninvasive mapping of the atria was also performed. A historical sample of propensity-scored matched patients who underwent PBMC alone was used as controls. The primary endpoint was freedom from AF/AT at 1-year. Multivariate analysis evaluated sinus rhythm (SR) predictors.Successful pulmonary vein isolation and electrocardiographic imaging-based drivers ablation was performed in 20 patients following PBMC. At 1-year, 75% of the patients in the combined group were in SR compared to 40% in the propensity-score matched group (p = 0.004). The composite of AF recurrence, need for mitral surgery and all-cause mortality was also more frequent in the control group (65% vs. 30%; p = 0.005). Catheter ablation (odds ratio [OR] 1.58; 95% confidence interval [CI] [1.17-17.37]; p = 0.04) and AF type (OR 1.46; 95% CI [1.05-82.64]; p 0.001) were the only independent predictors of SR at 1-year. Noninvasive mapping in the combined group showed that the number of simultaneous rotors (OR 2.10; 95% CI [1.41-10.2]; p = 0.04) was the only independent predictor of AF.A combined procedure of AF ablation and PBMC significantly increased the proportion of patients in sinus rhythm at 1-year. Noninvasive mapping may help to improve AF characterization and guide personalized AF treatment.

In patients with ischemic cardiomyopathy and an implantable cardioverter-defibrillator (ICD), catheter ablation and antiarrhythmic drugs (AADs) reduce ICD shocks, but the most effective approach remains uncertain.This trial compares the efficacy and safety of catheter ablation vs AAD as first-line therapy in ICD patients with symptomatic ventricular tachycardias (VTs).The SURVIVE-VT (Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia) is a prospective, multicenter, randomized trial including patients with ischemic cardiomyopathy and appropriated ICD shock. Patients were 1:1 randomized to complete endocardial substrate-based catheter ablation or antiarrhythmic therapy (amiodarone + beta-blockers, amiodarone alone, or sotalol ± beta-blockers). The primary outcome was a composite of cardiovascular death, appropriate ICD shock, unplanned hospitalization for worsening heart failure, or severe treatment-related complications.In this trial, 144 patients (median age, 70 years; 96% male) were randomized to catheter ablation (71 patients) or AAD (73 patients). After 24 months, the primary outcome occurred in 28.2% of patients in the ablation group and 46.6% of those in the AAD group (hazard ratio [HR]: 0.52; 95% CI: 0.30-0.90; P = 0.021). This difference was driven by a significant reduction in severe treatment-related complications (9.9% vs 28.8%, HR: 0.30; 95% CI: 0.13-0.71; P = 0.006). Eight patients were hospitalized for heart failure in the ablation group and 13 in the AAD group (HR: 0.56; 95% CI: 0.23-1.35; P = 0.198). There was no difference in cardiac mortality (HR: 0.93; 95% CI: 0.19-4.61; P = 0.929).In ICD patients with ischemic cardiomyopathy and symptomatic VT, catheter ablation reduced the composite endpoint of cardiovascular death, appropriate ICD shock, hospitalization due to heart failure, or severe treatment-related complications compared to AAD. (Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia [SURVIVE-VT]: NCT03734562).

ObjectiveThe role of age in clinical characteristics and catheter ablation outcomes of atrioventricular nodal re-entrant tachycardia (AVNRT) or orthodromic atrioventricular re-entrant tachycardia (AVRT) has been assessed in retrospective studies categorising age by arbitrary cut-offs, but contemporary analyses of age-related trends are lacking. We aimed to study the relationship of age with epidemiological, clinical features and catheter ablation outcomes of AVNRT and AVRT.MethodsWe recruited 600 patients (median age 56 years, 60% female) with a confirmed diagnosis of AVNRT (n=455) or AVRT (n=145) by means of an electrophysiological study. They were interrogated for arrhythmia-related symptoms with a structured questionnaire and followed up to 1 year. We analysed age as a continuous variable using regression models and adjusting for relevant covariables.ResultsBoth typical and atypical forms of AVNRT upraised with age while AVRT decreased (p0.05 for all).ConclusionsAge, evaluated as a continuous variable, had a significant association with the clinical profile of patients with AVNRT and AVRT. Nevertheless, catheter ablation outcomes and complications were not significantly related to patients’ age.

The differential diagnosis between orthodromic atrioventricular reentry tachycardia (AVRT) and atypical AV nodal reentrant tachycardia (aAVNRT) is sometimes challenging. We hypothesize that aAVNRTs have more variability in the retrograde conduction time at tachycardia onset than AVRTs.We aimed to assess the variability in retrograde conduction time at tachycardia onset in AVRT and aAVNRT and to propose a new diagnostic tool to differentiate these two arrhythmia mechanisms. We measured the VA interval of the first beats after tachycardia induction until it stabilized. The difference between the maximum and minimum VA intervals (∆VA) and the number of beats needed for the VA interval to stabilize was analyzed. Atrial tachycardias were excluded.A total of 107 patients with aAVNRT (n = 37) or AVRT (n = 64) were included. Six additional patients with decremental accessory pathway-mediated tachycardia (DAPT) were analyzed separately. All aAVNRTs had VA interval variability. The median ∆VA was 0 (0 - 5) ms in AVRTs vs 40 (21 - 55) ms in aAVNRTs (p 0.001). The VA interval stabilized significantly earlier in AVRTs (median 1.5 [1 - 3] beats) than in aAVNRTs (5 [4 - 7] beats; p 0.001). A ∆VA 10 ms accurately differentiated AVRT from aAVNRT with 100% of sensitivity, specificity, and positive and negative predictive values. The stabilization of the VA interval at 3 beats of the tachycardia onset identified AVRT with sensitivity, specificity, and positive and negative predictive values of 64.1%, 94.6%, 95.3%, and 60.3%, respectively. A ∆VA 20 ms yielded good diagnostic accuracy for DAPT.A ∆VA 10 ms is a simple and useful criterion that accurately distinguished AVRT from atypical AVNRT. Central panel: Scatter plot showing individual values of ∆VA in atypical AVNRT and AVRT. Left panel: induction of atypical AVNRT. The VA interval stabilizes at the 5th beat and the ∆VA is 62 ms (maximum VA interval: 172 ms - minimum VA interval: 110 ms). Right panel: induction of AVRT. The tachycardia has a fixed VA interval from the first beat. ∆VA is 0 ms.

Background: Data on atrial fibrillation (AF) ablation and outcomes are limited in patients with congenital heart disease (CHD). We aimed to investigate the characteristics of patients with CHD presenting for AF ablation and their outcomes. Methods: A multicenter, retrospective analysis was performed of patients with CHD undergoing AF ablation between 2004 and 2020 at 13 participating centers. The severity of CHD was classified using 2014 Pediatric and Congenital Electrophysiology Society/Heart Rhythm Society guidelines. Clinical data were collected. One-year complete procedural success was defined as freedom from atrial tachycardia or AF in the absence of antiarrhythmic drugs or including previously failed antiarrhythmic drugs (partial success). Results: Of 240 patients, 127 (53.4%) had persistent AF, 62.5% were male, and mean age was 55.2±13.3 years. CHD complexity categories included 147 (61.3%) simple, 68 (28.3%) intermediate, and 25 (10.4%) severe. The most common CHD type was atrial septal defect (n=78). More complex CHD conditions included transposition of the great arteries (n=14), anomalous pulmonary veins (n=13), tetralogy of Fallot (n=8), cor triatriatum (n=7), single ventricle physiology (n=2), among others. The majority (71.3%) of patients had trialed at least one antiarrhythmic drug. Forty-six patients (22.1%) had reduced systemic ventricular ejection fraction Conclusions: AF ablation in CHD was safe and resulted in AF control in a majority of patients, regardless of complexity. Future work should address the most appropriate ablation targets in this challenging population.

O presente artigo tem como objetivo apresentar o uso das línguas na Organização das Nações Unidas (ONU). Para tal discussão trouxemos um breve histórico sobre a criação da ONU, para compreendermos as relações das línguas mantidas no e através do discurso fundacional. A partir disso exporemos como foi determinado o estabelecimento dos idiomas de trabalho e oficial da ONU, a partir de sua criação histórica, de base europeia e estadunidense. Com isso, buscamos mostrar que os discursos presentes em alguns documentos da organização não abordam explicitamente o uso institucional das línguas, mantendo assim as relações já pré-estabelecidas. This article aims to present the functioning of languages in the United Nations (UN). For this, a brief history of the creation of the UN was necessary to understand the language relations maintained in and through the foundational discourse. From this we will try to show how the establishment of working and official languages of the United Nations was determined, from its historical creation, with a European and American base. Thus, we seek to show that the discourses present in some of the organization's documents do not explicitly address the institutional use of languages, thus maintaining pre-established power relations.

Background: Atrial tachyarrhythmias (ATs) represent the major late complications of congenital heart diseases (CHDs) following surgery. Little is known about the association between echocardiographic parameters and AT. Aims: This study aimed to investigate a potential correlation among clinical, echocardiographic, and electrocardiographic parameters and AT as well as to analyze outcomes in adults with CHD and AT. Methods: A retrospective case‑control study was performed in adults with CHD. We included 71 patients with AT and 71 control individuals matched by sex, age, and the type of CHD without AT, all from the same institute. Medical records, electrocardiograms, and echocardiograms were reviewed. Adverse cardiovascular events were recorded and defined as cardiovascular mortality, admission for heart failure, or stroke. The univariate and multivariate logistic regression analysis of possible risk factors and the Kaplan–Meier analysis of adverse cardiovascular events were performed. Results: Subpulmonary ventricular systolic pressure≥40 mm Hg (hazard ratio [HR], 6.8; 95% CI, 2.4–18; P < 0.001), right atrial dilatation≥21 cm2 (HR, 3.1; 95% CI, 1.2–7.6; P = 0.01), and significant tricuspid regurgitation (HR, 4; 95% CI, 1.3–10; P = 0.02) were identified as the main risk factors for AT. Patients with AT had worse outcomes, more frequently developed adverse cardiovascular events (86% vs 14%; P < 0.01), and exhibited a 58% event‑free survival rate compared with 98% of the patients without AT after 8 years of follow‑up (log rank, 6.6; P = 0.01). Conclusions: Among patients with CHD, the main risk factors for AT include right atrial dilatation, high subpulmonary ventricular systolic pressure, and significant tricuspid regurgitation. The presence of AT may increase the risk of adverse cardiac events.

[Objectives] To develop, calibrate, test and validate a logistic regression model for accurate risk prediction of sudden cardiac death (SCD) and non-fatal sudden cardiac arrest (SCA) in adults with congenital heart disease (ACHD), based on baseline lesion-specific risk stratification and individual’s characteristics, to guide primary prevention strategies., [Methods] We combined data from a single-centre cohort of 3311 consecutive ACHD patients (50% male) at 25-year follow-up with 71 events (53 SCD and 18 non-fatal SCA) and a multicentre case–control group with 207 cases (110 SCD and 97 non-fatal SCA) and 2287 consecutive controls (50% males). Cumulative incidences of events up to 20 years for specific lesions were determined in the prospective cohort. Risk model and its 5-year risk predictions were derived by logistic regression modelling, using separate development (18 centres: 144 cases and 1501 controls) and validation (two centres: 63 cases and 786 controls) datasets., [Results] According to the combined SCD/SCA cumulative 20 years incidence, a lesion-specific stratification into four clusters—very-low (12%)—was built. Multivariable predictors were lesion-specific cluster, young age, male sex, unexplained syncope, ischaemic heart disease, non-life threatening ventricular arrhythmias, QRS duration and ventricular systolic dysfunction or hypertrophy. The model very accurately discriminated (C-index 0.91; 95% CI 0.88 to 0.94) and calibrated (p=0.3 for observed vs expected proportions) in the validation dataset. Compared with current guidelines approach, sensitivity increases 29% with less than 1% change in specificity., [Conclusions] Predicting the risk of SCD/SCA in ACHD can be significantly improved using a baseline lesion-specific stratification and simple clinical variables.

O uso de plataformas como o Twitter por políticos, como Bolsonaro, tem mudado a comunicação política. Associado a isso, a rapidez com que a informação circula por tais ambientes proporciona a disseminação de desinformação e fake news, especialmente durante a pandemia do COVID-19 a partir de 2020. Diante disso, o artigo busca entender como o presidente Jair Bolsonaro utilizou o fenômeno das fake news como base da sua comunicação política durante a pandemia do COVID-19 e qual a influência desse fenômeno para a política externa brasileira. A hipótese inicial é de que a propagação de informações sem conteúdo confiáveis é utilizada como ferramenta política por Jair Bolsonaro. Nesse cenário, a política externa brasileira sofre influências diretas devido a ocorrência de tal fenômeno, com novas diretrizes internacionais e posicionamentos, acarretando a perda de credibilidade internacional brasileira e, ainda, colocando em risco a aquisição de vacinas pelo país.Palavras-chave: Fake News; Jair Bolsonaro; Política ExternaABSTRACTThe usage of social media, like Twitter, by politicians, such as Jair Bolsonaro, have changed the political communication. That said, the information has circulated quickly and provides a favorable environment for disinformation and fake news, especially during the COVID-19 pandemic from 2020. Based on that, the article aims to understand how the Brazilian president, Jair Bolsonaro, has used fake News as the ground for your political communication during the COVID-19 pandemic. It also aims to understand which is the influence of this phenomena to the Brazilian foreign policy. The initial hypothesis is that the dissemination of information without reliable content is used as political tool by Bolsonaro. In this scenario, the Brazilian foreign policy is under direct influence of this phenomena, with new international guidelines and positioning, resulting in the loss of the Brazilian international credibility and risking the vaccines acquisition by the country.Keywords: Fake News; Jair Bolsonaro; Foreign Policy. Recebido em: 14/04/2021 | Aceito em: 29/10/2021.

El síndrome de Mirizzi es una de las complicaciones más raras de la colecistitis cronicaslitiasíca, el cual, por definición, es la compresión extrínseca por la vesícula biliar hacia el conducto biliar principal, o bien, su fistulización. La colecistitis crónica litiasíca es la aparición de lítos en la vesícula biliar cuya causa es multifactorial, y se indica la cirugía cuando ya hay presencia de cuadros de dolor normalmente exacerbados por ingesta de alimentos ricos en grasas. La presentación clínica clásica del síndrome de Mirizzi es un cuadro de dolor abdominal de típico cólico acompañado a su vez de ictericia en ocasiones indistinguible de la coledocolitiasis. Existen múltiples clasificaciones de síndrome de Mirizzi, pero en este apartado solo se trabajarán las de Csendes y Mcsherry. Se realiza una serie de casos retrospectiva de expedientes electrónicos de manera confidencial, obteniendo desde enero del 2015 hasta diciembre del 2021 en nuestra unidad se efectuaron 1508 colecistectomías tanto abierta como laparoscópica, obteniendo 25 pacientes con síndrome de Mirizzi en el Hospital General de Mexicali en Baja California, México.

O presente trabalho tem como finalidade propor uma análise sobre o posicionamento brasileiro nas resoluções aprovadas por votação no Conselho de Direitos Humanos das Nações Unidas durante os períodos de sessões ordinárias, entre 2006 a 2020. O intervalo de tempo analisado corresponde aos governos de Luís Inácio Lula da Silva (2003-2010), Dilma Rousseff (2011-2016), Michel Temer (2016-2018) e Jair Bolsonaro (2019-). Por conseguinte, pergunta-se como o Brasil se posicionou nesse Conselho durante o 1o período ao 45o período de sessão ordinária. Para isso, o trabalho se desenvolve a partir de duas perspectivas: observar o padrão de voto brasileiro nas Resoluções recolhidas em relação (i) a seus pares regionais e (ii) em relação aos temas discutidos nesse fórum multilateral. A pesquisa é conduzida através de uma metodologia qualitativa e quantitativa, buscando o voto brasileiro – nos 313 documentos analisados – como variável dependente. Apresenta-se como hipótese do trabalho que o posicionamento brasileiro no Conselho de Direitos Humanos das Nações Unidas é marcado por comportamentos de votação irregulares ao longo dos 14 anos, rupturas que são reflexos das trocas de governos no poder executivo do Brasil. Portanto, confere-se que a política externa brasileira em relação ao tema de direitos humanos se modifica juntamente com as alterações internas do país, evidenciando a compreensão de que política externa é também uma política pública. This study seeks to analyze the Brazilian position in the Resolutions approved by vote in the United Nations Human Rights Council during the ordinary sessions, between 2006 and 2020. The period of analysis corresponds to the Luís Inácio Lula da Silva government (2003-2010); Dilma Rousseff (2011-2016); Michel Temer (2016-2018) and Jair Bolsonaro (2019-). Therefore, it is questioned: how it is the Brazil positions in this Council from the 1st period to the 45th ordinary session. The analysis undertaken is proposed from two perspectives: observing the pattern of Brazilian voting in the Resolutions collected in relation to (i) its regional peers and (ii) in relation to the themes discussed in this multilateral forum. The research is conducted through a qualitative and quantitative methodology, seeking the Brazilian vote – in the 313 responsible documents – as a dependent variable. It is presented as a working hypothesis that the Brazilian position in the United Nations Human Rights Council is marked by irregular voting behavior over the 14 years, ruptures that are reflections of the changes of governments in the executive power of Brazil. Therefore, it is observed that the Brazilian foreign policy in relation to the issue of human rights vary along with the country's internal changes, showing the understanding that foreign policy is also a public policy. Dissertação (Mestrado) 2021-10-08

Introduction Treatment of atrial fibrillation (AF) remains sub-optimal, with low success in pulmonary vein isolation (PVI) ablation procedures in long-standing-persistent AF patients. The maintenance mechanisms of AF are still under debate. Rotational activity (RA) events, also known as rotors, may play a role in perpetuating AF. The characterisation of these drivers during electroanatomical (EA) guided ablation procedures in relationship with follow-up and recurrence ratios in AF patients is necessary to design new ablation strategies to improve the AF treatment success. Purpose We report an AF patient cohort of endocardial mapping and PVI ablation procedures with additional RA events detected during the EA study. We aim to study the presence and distribution of RA in AF patients and its impact on AF recurrence when only PVI ablation is performed. Methods 75 persistent consecutive AF patients (age 60.7±9.8, 74.7% men) underwent EA mapping and RA detection with an automatic algorithm. The presence of RA was annotated on the EA map based on the unipolar electrograms (EGMs) registered with a 20-pole catheter. RA presence was analysed at different left atrial locations (37.2±14.8 sites per patient). AF recurrence was evaluated in follow-up after treatment. Results At follow-up (9±5 months), 50% of the patients presented AF recurrence. Patients with RA had more dilated atria in terms of volumes (p=0.002) and areas (p=0.001). Patients with RA exhibited higher mean voltage EGMs 0.6±0.3 mV vs 0.5±0.2 mV (p=0.036), with shorter cycle lengths 169.1±26.0 ms vs. 188.4±44.2 ms (p=0.044). Finally, patients with RA presented more AF recurrence rates than patients with no RA events (p=0.007). No significant differences were found in terms of comorbidities, e.g., heart failure, hypertension, COPD, stroke, SHD, or diabetes mellitus. Conclusions The results show that patients with more RA events and those with RA outside the PVI ablated regions presented higher AF recurrence episodes than those with no RA or events inside the areas affected by radio-frequency ablation. The study suggests that further ablation treatment of the areas harboring RA might be necessary to reduce the recurrence ratio in AF patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III; Sociedad Española de Cardiología

Background/Introduction Several ECG signs have been proposed to discern the focal origin of ventricular outflow tract arrhythmias with a transition ≥V3. Their independent predictive value is unclear. Purpose The aim of the study is to establish a predictive model of independent ECG parameters to obtain an acute success in right-sided catheter ablation of isolated premature ventricular contractions (PVCs) or ventricular tachycardia (VT) from the ventricular outflow tract with a transition ≥V3. Methods We included 122 patients (62 women, mean age 54±16 years) with documented PVCs or VT showing a lower axis and predominantly negative QRS complexes in V1 and V2 who underwent ablation between January 2014 and June 2020. The achievement of acute ablation success from right endocardial positions was assessed. We performed a predictive model by multivariate logistic regression analysis including the following ECG variables associated with a right origin of the ventricular focus in previous studies: Transitional Zone (TZ) index, V2 transition ratio, V2S / V3R index, R-wave duration index, R/S-wave amplitude index in V2, variable coupling interval, and the presence of QS morphology in lead I. Results Two independent predictive ECG variables were identified: the V2S / V3R index (odds ratio 1.223; 95% CI, 1.024–1.460; p=0.026) and a coupling interval variability >60 ms (odds ratio 0.307; 95% CI, 0.129 - 0.731; p=0.008). The area under the curve of this model was 0.733 (Picture 1). Arrhythmias with transition in V3 present a greater electroanatomic overlap and, therefore, a higher probability of right failure (59.3% vs 73.5% in arrhythmias with transitions after V3). In these, the V2 transition ratio is useful to predict the origin of the ectopy. Conclusion Two easily identifiable ECG variables (the V2S / V3R index and coupling interval variability >60 ms) predict the acute success of a right-sided approach in the ablation of focal ventricular arrhythmias with predominantly negative QRS complexes in V1 and V2. Funding Acknowledgement Type of funding sources: None. Predictive accuracy of the ECG model

Simple Summary Atrial fibrillation is a type of arrhythmia that occurs when the electrical activity of the heart in the atrium is not coordinated, and its consequences can be lethal. The driving source that initiates this chaotic activity can be located anywhere in the atrium, but most frequently appears in certain areas such as the pulmonary veins. In this study, we developed a new estimation method to evaluate possible source location and complexity of the arrhythmia using computer simulations. This method represents mathematical descriptions of natural processes that can be used to mimic a real scenario, including specific information such as the atrial anatomy. Here, we identified a specific biomarker the enabled obtaining a foci distribution map and found that elimination of pulmonary vein drivers was associated with a successful long-term ablation outcome. This study could, therefore, help to identify and characterize patients in order to better plan the ablation procedure. Abstract Current clinical guidelines establish Pulmonary Vein (PV) isolation as the indicated treatment for Atrial Fibrillation (AF). However, AF can also be triggered or sustained due to atrial drivers located elsewhere in the atria. We designed a new simulation workflow based on personalized computer simulations to characterize AF complexity of patients undergoing PV ablation, validated with non-invasive electrocardiographic imaging and evaluated at one year after ablation. We included 30 patients using atrial anatomies segmented from MRI and simulated an automata model for the electrical modelling, consisting of three states (resting, excited and refractory). In total, 100 different scenarios were simulated per anatomy varying rotor number and location. The 3 states were calibrated with Koivumaki action potential, entropy maps were obtained from the electrograms and compared with ECGi for each patient to analyze PV isolation outcome. The completion of the workflow indicated that successful AF ablation occurred in patients with rotors mainly located at the PV antrum, while unsuccessful procedures presented greater number of driving sites outside the PV area. The number of rotors attached to the PV was significantly higher in patients with favorable long-term ablation outcome (1-year freedom from AF: 1.61 ± 0.21 vs. AF recurrence: 1.40 ± 0.20; p-value = 0.018). The presented workflow could improve patient stratification for PV ablation by screening the complexity of the atria.

We describe two consecutive adult males with incessant dual atrioventricular nodal nonreentrant tachycardia and associated severe cardiomyopathy. After invasive diagnosis, this is the first published report showing the successful outcome of this rare tachycardia with effective cryoablation. Cryothermal lesions in the roof of the proximal coronary sinus and right midseptal area lead to complete resolution of the tachycardia-mediated cardiomyopathy in the mid-term follow-up of our patients.

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Supported in part by the Instituto de Salud Carlos III (PI16/01123, DTS16/0160, PI17/010559, PI17/01106 and PI20/01618); Spanish Ministry of Science and Innovation (CIRBER CV); and cofound by FEDER: Fondo Europeo de Desarrollo Regional. EITHealth 19600 AFFINE. Background Pulmonary veins (PV) electrical isolation is the cornerstone of atrial fibrillation (AF treatment), but other proarrhythmic areas of the atria may trigger or sustain AF. Objective We used computer simulations to analyze AF complexity measured using non-invasive electrocardiographic imaging (ECGi). Methods We included 30 patients that underwent PVI. Personalized simulations using biatrial anatomies segmented from MRI images and an automata model for modeling the electrical activity were compared with ECGi results to evaluate the long-term outcome of AF ablation. Results Simulation maps closely correlated with the rotors histogram obtained from patients´ ECGi: high entropy areas from simulations matched the areas with higher density of rotor presence on the ECGi. Simulations revealed that successful ablations occurred in patients with rotors mainly located at the PV area, while unsuccessful ablations presented an increased number of high entropy foci, greater distribution of rotors along the atria and lower number of PV rotors. The number of rotors attached to the PV was significantly higher in patients with favorable long-term ablation outcome (1-year AF Freedom: 1.61 ± 0.21 vs. AF: 1.40 ± 0.20; p-value = 0.018). Conclusion This simulation approach could improve patient screening and ablation design prior to the intervention providing information of the complexity of the atria. Abstract Figure. Rotor maps, ACM and ACB for 3 patients

The increasing prevalence of AF in a growing population of adults with congenital heart disease (CHD) poses new challenges to clinicians involved in the management of these patients. Distinctive underlying anatomies, unique physiological aspects, a high diversity of corrective surgeries and associated comorbidities can complicate clinical decision-making. In this review, the authors provide an overview of the current knowledge on epidemiology and pathophysiology, with a special focus on the differences to the non-CHD population and the clinical impact of AF in adults with CHD. Acute and long-term management strategies are summarised, including the use of antiarrhythmic drugs, catheter or surgical ablation and prophylaxis of thromboembolism. Finally, gaps of knowledge and potential areas of future research are highlighted.

La tormenta eléctrica (TE) se caracteriza por episodios repetidos de taquicardia ventricular o fibrilación ventricular relacionados con mal pronóstico a corto y largo plazos. El objetivo fue evaluar la prevalencia, resultados y supervivencia de los pacientes sometidos a tratamiento intervencionista por TE en un centro de referencia.Estudio unicéntrico, observacional y retrospectivo. Se revisaron los procedimientos de ablación por TE y se evaluaron las características basales de los pacientes, tipo de procedimiento, mortalidad total, recurrencia de arritmia, mortalidad cardiovascular y necesidad de trasplante.Desde enero de 2009 hasta diciembre de 2016 se realizaron 67 procedimientos (38% de complejos: 19% de ablación endoepicárdica, 7.5% de crioablación epicárdica quirúrgica, 3% de simpatectomía, 3% de inyección coronaria con alcohol; 6% de apoyo con oxigenación con membrana extracorpórea) en 41 pacientes (61% de causa isquémica) por TE. La mortalidad intraprocedimiento fue del 1.5%. La mediana de seguimiento fue de 23.5 meses (RIQ, 14.2-52.7). Tras el primer ingreso por TE (uno o varios procedimientos), la mortalidad a un año fue de 9.8%. La incidencia acumulada de trasplante cardiaco por TE fue de 2.4%. En el análisis multivariado, el riesgo de recurrencias arrítmicas o muerte por cualquier causa fue significativamente mayor en pacientes con arritmias clínicas inducibles (HR, 9.03; p = 0.017).El tratamiento de pacientes con TE, instituido en un centro de referencia y con experiencia, se relacionó con una tasa baja de recurrencia y supervivencia elevada, con una tasa de trasplante cardiaco por TE muy baja. Ante una recurrencia temprana es recomendable practicar un nuevo procedimiento durante el ingreso.Electrical storm (ES) is characterized by repeated episodes of ventricular tachycardia or ventricular fibrillation, with poor short and long term prognosis. Our objective was to evaluate the prevalence, results of interventional treatment and survival of patients undergoing interventional treatment for ES in our center.Retrospective, unicentric and observational study. ES ablation procedures were revised and data regarding baseline characteristics of the patients, type of procedure, total mortality, recurrence of arrhythmia, cardiovascular mortality and the need for transplantation were evaluated.From January 2009 to December 2016, 67 procedures (38% complex procedures: 19% epicardial ablation, 7.5% surgical epicardial crioablation, 3% simpatectomy, 3% coronary alcohol injection, 6% extracorporeal membrane oxygenation support) were performed in 41 patients (61% Ischemic etiology) due to ES. Intraprocedural mortality was 1.5%. The median follow-up was 23.5 months (IQR [14.2-52.7]). After the first admission for ES (one or several procedures), 1-year mortality was 9.8%. The cumulative incidence of cardiac transplantation was 2.4%. The risk of arrhythmic recurrences or death was significantly higher in patients with inducible clinical arrhythmias after ablation (HR: 9.03, p = 0.017).The treatment of patients with ES, performed in a reference center, allows obtaining good rates of recurrence and survival, with very low rates of cardiac transplantation for ES. In the presence of an early recurrence, it is advisable to perform a new procedure during admission.

Introduction and objectives: The development of complete AV block and the need for pacemaker implantation (PM) is the most frequent complication after Transaortic valve replacement (TAVR). In other PM clinical contexts, a higher percentage of ventricular stimulation has been associated with worse prognosis. The objective was to study the existence of predictors of PM dependence. Methods: We identified 96 consecutive patients who had received a PM post-TAVR (all Core-Valve). We retrospectively analyzed this cohort with the aim of identifying predictors of a high and very high percentage of ventricular pacing (VP), PM dependency and survival. Results: The mean age was 82.3 years, with a mean logistic EuroSCORE of 17.1, 53% were women and 12% of patients had LVEF 50%, VP > 85% or PM dependence. In 73 patients PM rhythm was documented at the end of follow-up. Of these, 14 (19.2%) were considered dependent, and 37 (50.7%) presented VP > 50%. The post-TAVR complete AV block recovery rate was 67.8%. In multivariate analysis, female sex (HR = 5.6, p = 0.005), and indication of complete AV block vs. LBBB (HR = 15.7, p = 0.017) were independently associated with PM dependency. Conclusions: Female sex and indication due to complete AV block were independent predictors of PM dependency during follow up. In our series of patients with mostly normal LVEF, a high percentage of stimulation does not influence prognosis.

Introduction Chronic Atrial stretch is an important determinant for atrial fibrillation (AF) in patients with rheumatic mitral stenosis (RMS). Purpose We analysed the effect of balloon mitral commissurotomy (BMC) plus atrial fibrillation ablation on the long-term occurrence of AF as compared to isolated BMC. Methods We prospectively included 20 patients with severe RMS undergoing BMC+AF ablation (Intervention) and compared it with a retrospective sample of 53 RMS patients that underwent BMC (Control). AF ablation consisted in pulmonary vein isolation and driver ablation identified using intracardiac basket mapping. We followed patients for 1 year after the procedure in both groups. Clinical values were evaluated in both groups. Propensity score matching was computed in order to evaluate the effect of the intervention and to analyse the impact of clinical properties of each group. Results At baseline, there were no statistical differences in gender (90% vs. 85%) and mitral valve area (1.2±0.18 vs. 1.17±0.18 cm2) between intervention and control groups, respectively. In contrast, there were differences in age (65±12 vs. 72±12; p=0.01) and AF incidence prior to the procedure (90% vs. 62%; p=0.001) between intervention and control groups, respectively. Patients undergoing AF ablation underwent successful pulmonary vein isolation in all cases and driver ablation at sites located in the right atrium (RA) in 7 (35%) patients. Median dominant frequency was significantly higher in the right atrium (DF RA 4.9±0.6 vs. DF LA 3.9±0.7 Hz; p=0.003) prior the intervention. After the intervention, it was significantly reduced only in the left atrium (LA) (DF RA 4.5±1 vs. DF LA 3.2±0.6 Hz; p=0.02 for Pre vs. Post DF LA). Three (15%) patients converted to sinus rhythm during ablation, the remaining were cardioverted. After 1-year follow-up, the proportion of patients in sinus rhythm was significantly higher in patients undergoing BMC+AF (90%) vs. isolated BMC (45%; p Conclusion This observational study demonstrates that the combination of BMC+AF ablation significantly increses the proportion of patients in sinus rhythm at 1-year as compared to isolated BMC. Reverse remodelling of the atrial substrate following isolated BMC also converted to sinus rhythm a small proportion of patients with persistent AF at baseline. Thus, although reversal of atrial stretch changes by BMC could potentially terminate AF in some patients, the combined intervention with catheter ablation will successfully maintain sinus rhythm in the majority of patients in the study. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): FIS by Instituto de Salud Carlos III

Enzyme subunit interfaces have remarkable potential in drug design as both target and scaffold for their own inhibitors. We show an evolution-driven strategy for the de novo design of peptide inhibitors targeting interfaces of the Escherichia coli FoF1-ATP synthase as a case study. The evolutionary algorithm ROSE was applied to generate diversity-oriented peptide libraries by engineering peptide fragments from ATP synthase interfaces. The resulting peptides were scored with PPI-Detect, a sequence-based predictor of protein-protein interactions. Two selected peptides were confirmed by in vitro inhibition and binding tests. The proposed methodology can be widely applied to design peptides targeting relevant interfaces of enzymatic complexes.

Antimicrobial resistance due to carbapenemase production in Enterobacteriaceaeclinical isolates is a global threat. Klebsiella pneumoniae harboring the blaKPCgene is one ofthe major concerns in hospital settings in Latin America.The aim of this study was to characterize the antibiotic resistance mechanisms and to typifyfour carbapenem-resistant K. pneumoniae clinical isolates from the city of Manizales, Colombia.We identified blaKPC-3in all four isolates by polymerase chain reaction and subsequentsequencing. The plasmid-mediated quinolone resistance genes qnrB19-like and aac(6)Ib-cr;fosfomycin resistance gene fosA and an insertion sequence IS5-like in mgrB (colistin resistance)were also detected. Sequence types ST11 with capsular type wzi75, and ST258 with wzi154,were characterized. The blaKPC-3gene was mobilized in a 100-kb IncFIB conjugative plasmidwith vagCD toxin-antitoxin system.This work reports multiple resistance genes in blaKPC-producing K. pneumoniae and the firstoccurrence of ST11 clinical isolates harboring blaKPC-3in Latin America. Resumen La resistencia a antibióticos mediada por la producción de carbapenemasas en aislamientos clínicos de Enterobacteriaceae es una amenaza mundial. Klebsiella pneumoniae portador de blaKPC es uno de los mayores problemas a nivel hospitalario en Latinoamérica. El objetivo de este estudio fue caracterizar los mecanismos de resistencia antibiótica y tipificar cuatro aislamientos clínicos de K. pneumoniae resistentes a carbapenems obtenidos en la ciudad de Manizales, Colombia. Se identificó blaKPC-3 en todos los aislamientos mediante reacción en cadena de polimerasa y secuenciación. También se detectaron los genes de resistencia transferible a quinolonas qnrB19-like y aac(6’)Ib-cr y a fosfomicina fosA, y la secuencia de inserción \S5-like en mgrB (asociada a la resistencia a colistina). Se caracterizaron los secuenciotipos ST11 (cápsula wzi75) y ST258 (cápsula wzi154). Se comprobó que blaKPC-3 fue movilizado por un plásmido conjugativo IncFIB-vagCD de 100kb. En este trabajo se reportan múltiples genes de resistencia en K. pneumoniae productor de blaKPC y se describen por primera vez aislamientos clínicos ST11 productores de blaKPC-3 en Latinoamérica.