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The head-up/-down tilt test acutely modifies the autonomic nervous system balance throughout a deactivation of the cardiopulmonary reflexes. The present study examines the influence of head-up/-down tilt on a number of ECG segments. A total of 20 healthy subjects underwent a 5 min ECG and noninvasive hemodynamic bio-impedance recording, during free and controlled breathing, lying at (a) 0°; (b) −45°, tilting up at 45°, and tilting up at 90°. Heart rate variability power spectral analysis was obtained throughout some ECG intervals: P-P (P), P-Q (PQ), PeQ (from the end of P to Q wave), Q-R peak (QR intervals), Q-R-S (QRS), Q-T peak (QTp), Q-T end (QTe), STp, STe, T peak-T end (Te), and, eventually, the TeP segments (from the end of T to the next P waves). Results: In all study conditions, the Low Frequency/High FrequencyPP and LFPP normalized units (nu) were significantly lower than the LF/HFRR and LFRRnu, respectively. Conversely, the HFPP and HFPPnu were significantly higher in all study conditions. STe, QTp, and QTe were significantly related to the PP and RR intervals, whereas the T wave amplitude was inversely related to the standard deviations of all the myocardial repolarization variables and to the left ventricular end-systolic volume (LVEDV). The T wave amplitude diminished during head-up tilt and significantly correlated with the LVEDV.

Background Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of patients with symptomatic atrial fibrillation (AF). AF symptoms are highly subjective; however, they are important outcomes for the patient. The aim is to describe the use and impact of a web-based App to collect AF-related symptoms in a population of patients who underwent PVI-C in seven Italian centers. Methods A patient App to collect AF-related symptoms and general health status was proposed to all patients who underwent an index PVI-C. Patients were divided into two groups according to the utilization of the App or the non-usage. Results Out of 865 patients, 353 (41%) subjects composed the App group, and 512 (59%) composed the No-App group. Baseline characteristics were comparable between the two cohorts except for age, sex, type of AF, and body mass index. During a mean follow-up of 7.9±13.8 months, AF recurrence was found in 57/865 (7%) subjects with an annual rate of 7.36% (95% CI:5.67-9.55%) in the No-App versus 10.99% (95% CI:9.67-12.48%) in the App group, p=0.007. In total, 14,458 diaries were sent by the 353 subjects in the App group and 77.1% reported a good health status and no symptoms. In only 518 diaries (3.6%), the patients reported a bad health status, and bad health status was an independent parameter of AF recurrence during follow-up. Conclusions The use of a web App to record AF-related symptoms was feasible and effective. Additionally, a bad health status reporting in the App was associated with AF recurrence during follow-up.

Radiofrequency (RF) lesion creation is related to the heat propagation induced by RF application on tissues. Thermocouple embedded in the RF antenna are not able to predict deep tissue temperature at various level.This study aims to investigate the influence of power delivered on radiofrequency catheter ablation (RFCA) effects by means of high resolved 2D temperature maps.Three trials of four ablations (12 applications) were executed on each specimen of healthy excised swine myocardium in different application points at four RF power values (30 W, 40 W, 50 W, and 60 W) for a fixed treatment time. All the data provided by the fiber Bragg gratings (FBGs) were analyzed. Temperature variations (ΔT) in time recorded in the 28 sites of measurements were reported. Also, temperature maps showing the ΔT spatial distribution reached within the tissue at the end of the RFCA were produced and displayed, together with the representation of the lethal isotherm. Moreover, the time of achievement of the lethal isotherm at different tissue depths (from 1 to 8 mm) was evaluated for the four power settings.Temperature trends reported comparable profiles across the different power settings. ΔT values and ΔT rising times showed dependence on the sensors' proximity to the RF energy source and on the set RF power. Temperature maps confirmed that heat propagation occurs preferentially along the width of the tissue than in the depth. Also, for the adjusted treatment time, no power setting guarantees lesions thicker than 6 mm.ΔT maximal values and ΔT rising time strongly depends on the proximity of the tissues to RF energy source, as well as on the RF power setting. A plateau is reached in lesion size, regardless of the power setting. A first correlation between lesion size, power setting, and time to achieve lethal isotherms has been established.

Background Spatial differences in conduction velocity (CV) are critical for cardiac arrhythmias induction. We propose a method for an automated CV calculation to identify areas of slower conduction during cardiac arrhythmias and sinus rhythm. Methods Color-coded representations of the isochronal activation map using data coming from the RHYTHMIA™ Mapping System were reproduced by applying a temporal isochronal window at 20 ms. Geodesic distances of the 3D mesh were calculated using an algorithm selecting the minimum distance pathway (MDP). The CV estimation was performed considering points on the boundary of two spatially and temporally adjacent isochrones. For each of the boundary points of a given isochrone, the nearest boundary point of the consecutive isochrone was chosen, the MDP was evaluated, and a map of CV was created. The proposed method has been applied to a population of 29 patients. Results In all cases of perimitral atrial flutter (16 pts out of 29 (55%)), areas with significantly low CV ( Conclusions The proposed software for automated CV estimation allows the identification of low CV areas, potentially helping electrophysiologists to plan the ablation strategy.

Background Pulsed Field Ablation (PFA) is a new and promising non-thermal ablation modality for Pulmonary Vein Isolation (PVI) for the treatment of patients with Atrial Fibrillation (AF). It preferentially ablates myocardial tissue via electroporation leading to minimal effects on surrounding structures. We sought to evaluate safety and efficacy of PFA in our single center experience. Methods PFA was performed at optimized bipolar biphasic waveform using Farapulse system. A protocol of 8 pulses per vein, 4 in the basket configuration and 4 in the flower configuration was followed. The procedure was performed under general anesthesia. Fluoroscopy was used to guide single transseptal puncture. 1 mg of atropine was administered before starting applications. One third of patients underwent CTI ablation using radiofrequency during the same procedure. In one patient we mapped the left atrium before and after ablation using a high-density mapping catheter. Results We prospectively enrolled 21 patients (76% men, age 58,6 ± 9) who underwent PVI using PFA from July to September 2022 for the treatment of Paroxysmal AF (81%) or Persistent AF (19%). Acute pulmonary veins isolation was achieved in the totality of patients. Median skin-to-skin procedure time and catheter dwell time were 56 minutes and 29 minutes respectively. Median fluoroscopy time was 12 minutes. The average number of total applications was 34 ± 4. No adverse events were observed. After a median follow-up of 77 days, we observed early AF recurrence in two patients. Conclusion Preliminary results of our singe center experience confirm that PFA is a safe and effective ablation modality. Pulmonary vein isolation can be achieved very rapidly with short procedural time, catheter dwell time and fluoroscopy time. Further studies are needed to assess durability of the technique.

Introduction Atrial fibrillation (AF) is the most common sustained arrhythmia and an important risk factor for stroke and heart. Recent technology advances have allowed for heart rhythm monitoring using smart gadgets/wearable devices which can be used for early AF diagnosis. Hypothesis We performed a systemic review and meta-analysis to assess the accuracy of AF diagnosis by smart gadgets/wearable devices. Methods We systematically searched Medline, Embase and Cochrane electronic databases up to April 15th, 2022 for observational studies of the diagnostic accuracy of smartphone application, wrist-worn wearables and external devices in detecting AF. We calculated the area under the curve (AUC) of the summary receiver operating characteristic curves (SROC) and pooled sensitivities and specificities. Results A total of 79 studies were included enrolling 36903 patients, 66.3% male with average age of 68.3±8 years. In the overall analysis of all devices, the AUC was 0.99 (95% CI: 0.98-1.00), the sensitivity 95%(95% CI: 94–96%), the specificity 96%(95% CI: 96–97%). Wrist-worn wearables had AUC of 0.99 (95% CI: 0.98-1.00), the sensitivity 95%(9% CI: 92–97%), the specificity 97%(95% CI: 96–98%)(Figure 1A). Smartphone applications had AUC of 0.98 (95% CI: 0.96-0.99), the sensitivity 96%(9% CI: 94–97%), the specificity 96%(95% CI: 93–98%)(Figure 1B). External devices had AUC of 0.99 (95% CI: 0.98-1.00), the sensitivity 95%(9% CI: 93–97%), the specificity 96%(95% CI: 95–97%)(Figure 1C). Single-lead ECG had AUC of 0.99 (95% CI: 0.98- 1.00), the sensitivity 95%(9% CI: 92–96%), the specificity 96%(95% CI: 95–97%). PPG had AUC of 0.99 (95% CI: 0.98-1.00), the sensitivity 96%(9% CI: 95–97%), the specificity 97%(95% CI: 95–98%). Conclusions Smartphone application, wrist-worn devices and external devices with PPG and single-lead ECG have excellent diagnostic accuracy in atrial fibrillation diagnosis. Figure 1. Summary Receiver Operating Characteristic curves and Areas Under The Curve of Wrist-worn wearables (A), Smartphone applications (B) and External devices (C).

Background Atrial fibrillation (AF) and heart failure (HF) often coexist and syner-gistically contribute to an increased risk of hospitalization, stroke, and mortality. Objective: To compare the efficacy of catheter ablation (CA) versus medical therapy (MT) in HF patients with AF. Methods Electronic databases were queried for randomized controlled trials (RCTs) of CA versus MT of AF in patients with HF. Risk ratios (RRs), mean differences (MDs), and 95% confidence in-tervals (CIs) were measured using the Mantel–Haenszel method. Results A total of nine RCTs enrolling 2155 patients met the inclusion criteria. Compared to MT, CA led to a significant reduction in the composite of all-cause mortality and HF hospitalization (24.6% vs. 37.1%; RR: 0.65 (95% CI: 0.53–0.80); p < 0.0001) (Figure 1), all-cause mortality (8.8% vs. 13.6%; RR: 0.65 (95% CI: 0.51–0.82); p = 0.0005), HF hospitalization (15.4% vs. 22.4%; (RR: 0.67 (95% CI: 0.54–0.82); p = 0.0001), AF re-currence (31.8% vs. 77.0%; RR: 0.36 (95% CI: 0.24–0.54); p < 0.0001), and cardiovascular (CV) death (4.9% vs. 8.4%; RR: 0.58 (95% CI: 0.39–0.86); p = 0.007). CA improved the left ventricular ejection fraction (MD:4.76% (95% CI: 2.35–7.18); p = 0.0001), 6 min walk test (MD: 20.48 m (95% CI: 10.83–30.14); p < 0.0001), peak oxygen consumption (MD: 3.1 2mL/kg/min (95% CI: 1.01–5.22); p = 0.004), Minnesota Living with Heart Failure Questionnaire score (MD: −6.98 (95% CI: −12–03, −1.93); p = 0.007), and brain natriuretic peptide levels (MD:−133.94 pg/mL (95% CI: −197.33, −70.55); p < 0.0001). Conclusions In HF patients, AF catheter ablation was superior to MT in re-ducing CV and all-cause mortality. Further significant benefits occurred within the ablation group in terms of HF hospitalizations, AF recurrences, the systolic function, exercise capacity, and quality of life. Figure 1: Forest plot displaying a decrease in the composite endpoint in patients with AF and HF undergoing CA versus MT.

Introduction The Implantable Cardioverter Defibrillator (ICD) has been demonstrated to successfully prevent sudden cardiac death in children and young adults. A wide range of device-related complications/malfunctions have been described, which depend on the intrinsic design of the defibrillation system [Transvenous (TV-ICD) vs Subcutaneous (S-ICD)]. Objective To compare the device-related complications and inappropriate shocks with TV-ICD vs S-ICD. Methods Electronic databases were queried for studies focusing on the prevention of SCD in children and young adults with TV-ICD or S-ICD. The effect size was estimated using a random-effect model as Odds Ratio (OR) and relative 95% Confidence Interval (CI). The primary endpoint was a composite of any device-related complications and inappropriate shocks. Results We identified a total of 5 studied including 236 patients (Group S-ICD: 76 patients; Group TV-ICD: 160 patients) with a mean follow-up time of 54.2 ± 24.9 months. S-ICD implantation contributed to a significant reduction in the risk of the primary endpoint of any device-related complications and inappropriate shock (OR:0.18; 95% CI: 0.05 - 0.73; p=0.02)(Figure 1). S-ICD was also associated with a significantly lower incidence of inappropriate shocks (OR:0.28; 95% CI: 0.11 - 0.74; p=0.01) and lead-related complications (OR:0.18; 95% IC: 0.05 - 0.66; p=0.01). Otherwise, a trend towards a higher risk of pocket complications (OR:5.91; 95% CI: 0.98 - 35.63; p=0.05) was recorded in patients with S-ICD. Conclusion Children and young adults undergoing S-ICD implantation may have a lower risk of a composite of device-related complications and inappropriate shocks, compared to TV-ICD patients.

Background The diagnostic value of the β-angle in the diagnosis of patients with Brugada Syndrome (BrS) is still unclear. Objective to evaluate the diagnostic accuracy of the β-angle and establish its best cut-off value. Methods We searched databases for studies evaluating sensitivity and specificity of the β-angle in patients with suspected BrS undergoing Sodium Channel Blocker Provocation Test (SCBPT). The pooled sensitivity and specificity were calculated, and the Summary Receiver Operating Characteristic curve was constructed. The effect size was estimated using a random-effect model as Odds Ratio. Results we included 4 studies enrolling 1471 patients (Positive SCBPT: 382 patients; Negative SCBPT: 1089 patients). Patients with positive SCBPT had a higher mean β-angle value than those with negative SCBPT (39.25° vs 22.52°; p Conclusion A β-angle ≥58° represents the best diagnostic predictor for patients with suspected BrS.

INTRODUCTION: The implantable cardioverter defibrillator (ICD) has been demonstrated to successfully prevent sudden cardiac death (SCD) in children and young adults. A wide range of device-related complications/malfunctions have been described, which depend on the intrinsic design of the defibrillation system (transvenous-implantable cardioverter defibrillator [TV-ICD] vs. subcutaneous-implantable cardioverter defibrillator [S-ICD]). OBJECTIVE: To compare the device-related complications and inappropriate shocks with TV-ICD versus S-ICD. METHODS AND RESULTS: Electronic databases were queried for studies focusing on the prevention of SCD in children and young adults with TV-ICD or S-ICD. The effect size was estimated using a random-effect model as odds ratio (OR) and relative 95% confidence interval (CI). The primary endpoint was a composite of any device-related complications and inappropriate shocks. We identified a total of five studies including 236 patients (Group S-ICD: 76 patients; Group TV-ICD: 160 patients) with a mean follow-up time of 54.2 ± 24.9 months. S-ICD implantation contributed to a significant reduction in the risk of the primary endpoint of any device-related complications and inappropriate shocks (OR: 0.18; 95% CI: 0.05-0.73; p = .02). S-ICD was also associated with a significantly lower incidence of inappropriate shocks (OR: 0.28; 95% CI: 0.11-0.74; p = .01) and lead-related complications (OR: 0.18; 95% CI: 0.05-0.66; p = .01). A trend toward a higher risk of pocket complications (OR: 5.91; 95% CI: 0.98-35.63; p = .05) was recorded in patients with S-ICD. CONCLUSION: Children and young adults undergoing S-ICD implantation may have a lower risk of a composite of device-related complications and inappropriate shocks, compared to TV-ICD patients.

This case report describes a third successful attempt to ablate a focal atrial tachycardia originating from the left atrial appendage in a highly symptomatic 49-year-old woman using a combined endocardial-epicardial approach, which could be taken into consideration as a safe and effective alternative method for treating similar arrhythmias originating from complex sites.

The goal of this paper is to investigate the method outlined by one of us (PR) in Cherubini et al. (2009) to compute option prices. We name it the SINC approach. While the COS method by Fang and Osterlee (2009) leverages the Fourier-cosine expansion of truncated densities, the SINC approach builds on the Shannon Sampling Theorem revisited for functions with bounded support. We provide several results which were missing in the early derivation: i) a rigorous proof of the convergence of the SINC formula to the correct option price when the support grows and the number of Fourier frequencies increases; ii) ready to implement formulas for put, Cash-or-Nothing, and Asset-or-Nothing options; iii) a systematic comparison with the COS formula for several log-price models; iv) a numerical challenge against alternative Fast Fourier specifications, such as Carr and Madan (1999) and Lewis (2000); v) an extensive pricing exercise under the rough Heston model of Jaisson and Rosenbaum (2015); vi) formulas to evaluate numerically the moments of a truncated density. The advantages of the SINC approach are numerous. When compared to benchmark methodologies, SINC provides the most accurate and fast pricing computation. The method naturally lends itself to price all options in a smile concurrently by means of Fast Fourier techniques, boosting fast calibration. Pricing requires to resort only to odd moments in the Fourier space. A previous version of this manuscript circulated with the title `Rough Heston: The SINC way'., Comment: 49 pages, 4 figures, 13 tables

Aging and chronic heart failure (CHF) are responsible for the temporal inhomogeneity of electrocardiogram (ECG) repolarization phase. In the past, short period repolarization-dispersion parameters were used as makers of mortality risk in different heart diseases, yet. Aim of this work was to evaluate risk of mortality or worsening condition in CHF elderly subjects by mean of these repo-larization variables.An observational, prospective cohort study was performed, collecting 5 minutes ECG recordings to assess the mean and standard deviation (SD) of the following variables: QT end (QTe), QT peak (QTp) and T peak to T end (Te) in 117 decompensated CHF (age range: from 49 to 103 years). 30-day mortality and high levels of NT-pro BNP (75 percentile) were considered markers of decompensated CHF.A total of 27 patients (23%) died during the 30-day follow-up (overall mortality rate 23%). Te mean (odd ratio (OR): 1.04, 95% confidence limit (Cl 7u): 1.02-1.09, p0.01), NT-pro BNP (OR: 1.00, 95% cl: 1.00-1.00, p0.01) and LVMI (OR : 0.98, 95% cl: 0.96-0.10, p0.05) were associated to risk of mortality at the multivariable logistic analysis. On the contrary, the same statistical analysis selected TeSD (OR: 1.36, 95% cl: 1.16-1.59, p0.001) and LVEF (OR: 0.91, 95% cl: 0.87-0.95, p0.001) as marker of decompensated CHF.In decompensated CHF elderly subjects, Te mean seem be associated to mortality and TeSD could be considered a risk factor for CHF worsening and complications. These evidences could provide useful tools for telemonitoring CHF elderly patients, amelio-rating treatments and outcomes.

Background Optimal pulmonary vein (PV) occlusion, usually verified with selective contrast injection, is mandatory to obtain an effective PV isolation during cryoballoon (CB) ablation. Aim of the study The purpose of this study was to verify the feasibility and the accuracy of a new dielectric sensing system in assessing PV occlusion during CB ablation in patients with atrial fibrillation (AF). Methods We enrolled 28 consecutive patients with paroxysmal or persistent AF. After transseptal access, a detailed image reconstruction of left atrium and PVs was achieved with an octapolar or decapolar mapping catheter (Achieve catheter, Medtronic Inc.) and KODEX-EPD system (EPD Solutions, a Philips company). The degree of PV occlusion with the inflated Arctic Front Advance Cryoballoon (Medtronic Inc.) was verified using the new "occlusion tool" software module (EPD Solutions, a Philips company) and compared to an angiogram obtained with contrast medium injection in each PV. Results A total of 105 PV CB occlusion were tested. The new occlusion tool software module showed a 91% sensitivity and 76% specificity in assessing a complete PV occlusion verified with contrast medium injection. The positive predictive value was 80%, and the negative predictive value was 88.6%. Mean procedure time was 81 ± 17 minutes. Mean fluoroscopy time was 6 ± 2 minutes. No 30-day complications were observed. Conclusion The new dielectric imaging system was able to assess the degree of PV occlusion during a CB ablation with good sensitivity and specificity.

Low-voltage activity beyond pulmonary veins (PVs) may contribute to the failure of ablation of atrial fibrillation (AF) in the long term. We aimed to assess the presence of gaps (PVG) and residual potential (residual antral potential [RAP]) within the antral scar by means of an ultra-high-density mapping (UHDM) system.We studied consecutive patients from the CHARISMA registry who were undergoing AF ablation and had complete characterization of residual PV antral activity. The Lumipoint™ (Boston Scientific) map-analysis tool was used sequentially on each PV component. The ablation endpoint was PV isolation (PVI) and electrical quiescence in the antral region.Fifty-eight cases of AF ablation were analyzed. A total of 86 PVGs in 34 (58.6%) patients and 44 RAPs in 34 patients (58.6%) were found. In 16 (27.6%) cases, we found at least one RAP in patients with complete absence of PV conduction. RAPs showed a lower mean voltage than PVG (0.3 ± 0.2 mV vs. 0.7 ± 0.5 mV, p .0001), whereas the mean number of electrogram peaks was higher (8.4 ± 1.4 vs. 3.2 ± 1.5, p .0001). The percentage of patients in whom RAPs were detected through Lumipoint™ was higher than through propagation map analysis (58.6% vs. 36.2%, p = .025). Acute procedural success was 100%, with all PVs successfully isolated and RAPs completely abolished in all study patients. During a mean follow-up of 453 ± 133 days, 6 patients (10.3%) suffered an AF/AT recurrence.Local vulnerabilities in antral lesion sets were easily discernible by means of the UHDM system in both de novo and redo patients when no PV conduction was present.

As recently reported, elevated fasting glucose plasma level constitutes a risk factor for 30-day total mortality in acutely decompensated chronic heart failure (CHF). Aim of this study was to evaluate the 30-day mortality risk in decompensated CHF patients by fasting glucose plasma level and some repolarization ECG markers.A total of 164 decompensated CHF patients (M/F: 94/71; mean age, 83 ± 10 years) were studied; Tend (Te), QT interval (QT) and 5 min of ECG recordings were obtained, studying mean, SD and normalized index of the abovementioned ECG intervals. These repolarization variables and fasting glucose were analyzed to assess the 30-day mortality risk among these patients.Thirty-day mortality rate was 21%, deceased subjects showed a significant increase in N terminal-pro-brain natriuretic peptide (Data suggest that two simple, inexpensive, noninvasive markers, as fasting glucose and Te, were capable to stratify the short-term total and cardiovascular mortality risk in acutely decompensated CHF.

Purpose Electrophysiological studies and ablation procedures expose both physicians and patients to a significant amount of radiation. Most 3-D mapping systems provide improved tracking of catheters and enable radiation exposure to be reduced or even eliminated. However, there are no data on the ability of the Rhythmia ™ mapping system (Boston Scientific) to minimize fluoroscopy time and dose. Methods Here, we report on the feasibility and safety of a novel non-fluoroscopic approach (NFA) that uses the Rhythmia ™ mapping system and a novel navigation-enabled ablation catheter in SVT and atrial flutter procedures, and describe in detail our modified procedural work-flow. A total of 20 consecutive patients who were referred to our center for RF ablation of SVT arrhythmias were included in this analysis to test our procedural work flow. Results In our preliminary experience of the NFA work-flow, fluoroscopy times and radiological exposure were significantly reduced in comparison with the conventional approach. Conclusion In our preliminary experience, arrhythmia ablation through a near-zero fluoroscopy approach involving the use of a novel ablation technology and the Rhythmia™ mapping system proved to be safe, feasible and effective in common atrial arrhythmias.

Edible electronics will facilitate point-of-care testing through safe and cheap devices that are digested or degraded in the body or environment after performing a specific function. Its thrive depends on creating a library of materials that are the basic building blocks for eatable technologies. Edible electrical conductors fabricated with green methods that allow production at a large scale and composed of food derivatives, ingestible in large amounts without risk for human health are needed. Here, conductive pastes made with materials with a high tolerable upper intake limit (major of mg/kg body weight /day) are proposed. Conductive oleogel paste composites, made with biodegradable and food-grade materials like natural waxes, oils, and activated carbon conductive fillers, are presented. The proposed pastes are compatible with manufacturing processes such as direct ink writing and thus are suitable for an industrial scale-up. These conductors are built without the use of solvents, and with tunable electromechanical features and adhesion depending on the composition. They have antibacterial and hydrophobic properties, so that they can be used in contact with food preventing contamination and preserving its organoleptic properties. As a proof-of-principle application, the edible conductive pastes are demonstrated to be effective edible contacts for food impedance analysis, to be integrated for example in smart fruit labels for ripening monitoring.

As previously reported, an increased repolarization temporal imbalance induces a higher risk of total/cardiovascular mortality.The aim of this study was to assess if the electrocardiographic short period markers of repolarization temporal dispersion could be predictive of the hospital stay length and mortality in patients with acutely decompensated chronic heart failure (CHF).Mean, standard deviation (SD), and normalized variance (VN) of QT (QT) and Tpeak-Tend (Te) were obtained on 5-min ECG recording in 139 patients hospitalized for acutely decompensated CHF, subgrouping the patients for hospital length of stay (LoS): less or equal 1 week (≤1 W) and those with more than 1 week (1 W).We observed an increase of short-period repolarization variables (TeSD and TeVN, p .05), a decrease of blood pressure (p .05), lower ejection fraction (p .05), and higher plasma level of biomarkers (NT-proBNP, p .001; Troponin, p .05) in1 W LoS subjects. 30-day deceased subjects reported significantly higher levels of QTSD (p .05), Te mean (p .001), TeSD (p .05), QTVN (p .05) in comparison to the survivors. Multivariable Cox regression analysis reported that TeVN was a risk factor for longer hospital stay (hazard ratio: 1.04, 95% confidence limit: 1.01-1.08, p .05); whereas, a longer Te mean was associated with higher mortality risk (hazard ratio: 1.02, 95% confidence limit: 1.01-1.03, p .05).A longer hospital stay is considered a clinical surrogate of CHF severity, we confirmed this finding. Therefore, these electrical and simple parameters could be used as noninvasive, transmissible, inexpensive markers of CHF severity and mortality.

OBJECTIVES This study aimed to evaluate the progression of electrophysiotogicat phenomena in a cohort of patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PsAF). BACKGROUND Electrical remodeling has been conjectured to determine atrial fibrillation (AF) progression. METHODS High-density electroanatomic maps during sinus rhythm of 20 patients with AF (10 PAF, 10 PsAF) were compared with 5 healthy control subjects (subjects undergoing ablation of a left-sided accessory pathway). A computational postprocessing of electroanatomic maps was performed to identify specific electrophysiological phenomena: stow conductions corridors, defined as discrete areas of conduction velocity 2.5 1/s. RESULTS A progressive decrease of mean conduction velocity was recorded across the groups (111.6 +/- 55.5 cm/s control subjects, 97.1 +/- 56.3 cm/s PAF, and 84.7 +/- 55.7 cm/s PsAF). The number and density of slow conduction corridors increase in parallel with the progression of AF (8.6 +/- 2.2 control subjects, 13.3 +/- 3.2 PAF, and 20.5 +/- 4.5 PsAF). In PsAF the atrial substrate is characterized by a higher curvature of wave-front propagation (0.86 +/- 0.71 1/s PsAF vs 0.74 +/- 0.63 1/s PAF; P = 0.003) and higher number of pivot points (25.1 +/- 13.8 PsAF vs 9.5 +/- 6.7 PAF; P < 0.0001). Slow conductions: corridors were mostly associated with pivot sites tending to cluster around pulmonary veins antra. CONCLUSIONS The electrical remodeling hinges mainly on corridors of slow conduction and higher curvature of wave-front propagation. Pivot points associated to SC corridors may be the major determinants for functional localized re-entrant circuits creating the substrate for maintenance of AF. (C) 2022 by the American College of Cardiology Foundation.

Building the future profit and loss distribution of a portfolio holding highly nonlinear and path-dependent derivatives, among other assets, is a challenging task. Giacomo Bormetti, Flavio Cocco and Pietro Rossi provide a simple machinery where an increasing number of assets may be accounted for in a simple and semi-automatic fashion. They resort to a variation of the least squares Monte Carlo algorithm in which the continuation value of the portfolio is interpolated with a feed-forward neural network. They account for the profit and loss distribution of a whole portfolio even when the dependence structure between different assets is very strong, eg, for contingent claims written on the same underlying.

Background Atrial fibrillation (AF) is the most frequent sustained arrhythmia worldwide and Cryoballoon ablation (CB) has become a consolidated alternative to the radiofrequency pulmonary vein (PV) isolation. However, CB requires fluoroscopy and dye injections to verify the occlusion grade. The accuracy of the earlier version of the Kodex Occlusion Tool software has been studied. Purpose The purpose of this study was to verify the accuracy of the second generation Kodex Occlusion Tool Software of a new dielectric system imaging compared to its first generation to detect PV occlusion during CB ablation in patients with AF. Methods 15 consecutive patients with paroxysmal AF were enrolled in the study and underwent the procedure with the guidance of the first generation version (1.4.6) of the Kodex Occlusion Tool software. The Kodex recorded procedural data were used to replay the case using the Kodex second generation version (1.4.7) of the Occlusion Tool software when clinically available. After transseptal access, a detailed image reconstruction of left atrium and PVs was achieved with an octa-polar circular mapping catheter, PV occlusion was assessed with the Occlusion Tool Software and compared with standard dye injection and angiography, the cryoablation was then performed with a cryoballoon catheter. Results A total of 74 PVs CB occlusions were tested. The old version showed 90.7% sensitivity and 74.2% specificity in assessing a complete PV occlusion verified with contrast medium injection. The positive predictive value was 82.9%, and the negative predictive value was 85.2%. The new version showed 94.8% sensitivity and 93.7% specificity in assessing a complete PV occlusion verified with same contrast medium injection data. The positive predictive value was 98.2%, and the negative predictive value was 93.7%. Acute isolation was achieved in all PVs and no 30-day complication was observed. Conclusion This study demonstrates an increased accuracy of new Occlusion Tool software of the Kodex dielectric imaging system to assess the degree of PV occlusion during a CB ablation. Funding Acknowledgement Type of funding sources: None.