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The rapid development of coastal aquaculture in recent decades has led to excessive discharge of organic matter and nutrients into surrounding waters, which could result in eutrophication and potentially affect metal cycling. In our study, the influence of algal organic matter on metal accumulation was examined in three coastal sediment cores taken from a tropical region, Hainan Island, China. Overall, metal pollution adjacent to aquaculture ponds remained at low levels on the coast, except Zn, Cd, and Sn were moderately to highly enriched in the Dongjiao sediments. The δ

Seagrass beds are considered to be substantial sinks of “blue carbon”. However, differentiation in the carbon sink capacities of seagrass beds in different regions with distinct nutrient conditions remains unclear. In this study, sediment carbon stocks, seagrass biomass, and microbial community structures and potential functions of seagrass beds in eutrophic seawater adjacent to Hainan Island and oligotrophic seawater around the Xisha Islands were compared. Our results showed that sediment mineralizable organic carbon and dry bulk density were substantially higher on Hainan Island than on the Xisha Islands (t-test, p < 0.05), while sediment carbon stocks and the total organic carbon were comparable between the two regions (p > 0.05). Similarly, seagrass biomass was much higher on Hainan Island (p < 0.05). Sediment carbon stocks positively correlated with sediment nitrogen and negatively correlated to sediment pH and grain size (p < 0.05). Bacterial diversities were similar in the two regions, while fungi were more diverse on Hainan Island (p < 0.05). Proteobacteria, Desulfobacterota, Ascomycota and Basidiomycota could account for degrading organic carbon on Hainan Island. Proteobacteria and Bacteroidota may contribute primarily to carbon loss in the seagrass beds of the Xisha Islands. This study strengthens our understanding of the effects of human activities on carbon sequestration in seagrass bed ecosystems.

Background Vasovagal syncope (VVS) is one of the most common causes of syncope. Traditional treatment has not achieved satisfactory results. The purpose of this study was to assess the feasibility and efficacy of selective anatomical catheter ablation of left atrial ganglionated plexus (GP) as a therapeutic strategy for the patients of symptomatic VVS. Methods A total of 70 patients with at least once recurrent syncopal episodes of VVS with positive head-up tilt test were enrolled. They were divided into GP ablation group and control group. Patients in GP ablation group were received anatomical catheter ablation of left superior ganglionated plexus (LSGP) and right anterior ganglionated plexus (RAGP). Patients in control group were guideline-direted conventional therapy. The primary endpoint was VVS recurrences. The secondary endpoint was recurrence of syncope and prodrome events. Results There were no statistical differences in clinical characteristics between the ablation group (n = 35) and control group (n = 35). Over a follow-up of 12 months, ablation group had significantly lower syncope recurrence compared with control group (5.7% vs. 25.7%, P = 0.02), and ablation group had significantly lower syncope and prodrome recurrence compared with control group (11.4% vs. 51.4%, P

This study presents the first record of the overall distribution of the seagrass Halophila beccarii Ascherson on the island of Hainan. Statistical and ecological methods were used to analyze the distribution of the species and the influence of environmental factors. Halophila beccarii was mainly distributed in the northwest and southeast of Hainan, in lagoons with a total area of 20.981 km2, including the largest H. beccarii area in China covering approximately 9.58 km2 in Xiaohai, Wanning; there were also 4.89 km2 in Xinying Bay, Danzhou, approximately 2.20 km2 in Huachang Bay, Chengmai, 1.88 km2 in Dongzhai Port, Haikou, 0.95 km2 in Xinying Port, Lingao, approximately 0.668 km2 in Laoyehai, Wanning, approximately 0.363 km2 in Hongpai, approximately 0.23 km2 in Maniao, and approximately 0.22 km2 in Huanglong Port, Lingao. The average coverage of H. beccarii measured at 7.08–56.33%, the density of stem and branch was 487.47–20,167.1 ind/m2, and the biomass measured at 1.57–112.94 gDW/m2. The growth distribution was mainly influenced by habitat type and, to a lesser extent, by tidal branching channels, heavy metal content (Cu, Pb, Cr, Zn) in the marine environment, and human activities in adjacent coastal areas.

Intracardiac echocardiography (ICE) technology has been increasingly accepted as an integral part of atrial fibrillation (AF) ablation procedures. It is still unknown whether ICE can routinely replace transesophageal echocardiography (TEE) for routine thrombus screening in non-selective AF patients.To assess whether ICE can routinely replace TEE in screening for left atrial (LA)/left atrial appendage (LAA) thrombus in general patients undergoing catheter ablation for AF.A total of 2003 consecutive patients undergoing AF ablation were included. 1155 patients (ICE group) received intra-procedural ICE examination for LA/LAA thrombus screening, while 848 patients (TEE group) received pre-procedure TEE examination. The incidence of thrombus, peri-procedure complications, and hospital efficiency were assessed.The LA and LAA were adequately visualized in all patients. Five patients in the ICE group and 15 patients in the TEE group were found to have LAA thrombus. The incidence of major periprocedural thrombo-embolic events was comparable between two groups (0.2% vs. 0.1%, p = .76), none were due to undetected LA/LAA thrombus. Other major periprocedural complications occurred at similar rates in both groups, while post-procedure fever was less common in the ICE group (12.7% vs. 17.4%, p .001). Procedure times and hospital length of stay were both shorter in the ICE group (142 min [87-197 min] vs. 150 min [95-205 min], and 3[2-4] day vs. 4[3-5] day, respectively, both p .001).ICE can replace TEE for atrial thrombus screening in AF patients undergoing ablation without increased complications. An "ICE replacing TEE" workflow can also reduce the incidence of postoperative fever and improve hospital efficiency.

Background: Patients with typical atrial flutter (AFL) undergoing successful cavotricuspid isthmus ablation remain at risk for future development of new-onset atrial fibrillation (AF). Conventional monitoring (CM) techniques have shown AF incidence rates of 18%–50% in these patients. Objectives: To evaluate whether continuous monitoring using implantable loop recorders (ILRs) would enhance AF detection in this patient population. Methods: Veteran patients undergoing AFL ablation between 2002 and 2019 who completed at least 6 months of follow-up after the ablation procedure were included. We compared new-onset AF detection between those who underwent CM and those who received ILRs immediately following AFL ablation. Results: A total of 217 patients (age: 66 ± 9 years; all male) participated. CM was used in 172 (79%) and ILR in 45 (21%) patients. Median follow-up duration after ablation was 4.1 years. Seventy-nine patients (36%) developed new-onset AF, which was detected by CM in 51 and ILR in 28 (30% vs 62%, respectively, P < .001). AF detection occurred at 7.7 months (IQR: 4.7–17.5) after AFL ablation in the ILR group vs 41 months (IQR: 23–72) in the CM group (P < .001). Eleven patients (5%) experienced cerebrovascular events (all in the CM group) and only 4 of these patients (36%) were on long-term anticoagulation. Conclusion: Patients undergoing AFL ablation remain at an increased risk of developing new-onset AF, which is detected sooner and more frequently by ILR than by CM. Improving AF detection may allow optimization of rhythm management strategies and anticoagulation in this patient population.

Tachycardia-induced cardiomyopathy is poorly recognized pre-ablation. It remains unclear of better patient selection and timing for catheter ablation in persistent atrial fibrillation (PerAF) with heart failure (HF).Consecutive patients with PerAF and left ventricular ejection fraction (LVEF) 50% referred for AF ablation were retrospectively included. The impact of LV size, heart rate (HR), and LVEF pre-ablation were analyzed for assessing LV systolic function recovery, defined as LVEF increase of ≥20% or to a value ≥55% after ablation.A total of 120 patients (2017-2020) were included. After 19 ±14 months post ablation, LVEF improvement was similar in patients with normal or dilated LV (18.3 ± 9.4% vs. 16.1 ± 10.8%, P = .25), rapid or controlled HR (19.5 ± 10% vs. 16.1 ± 10%, P = .09), but higher in HFrEF (HF with reduced EF) than HFmrEF (HF with midrange EF) (21.6 ± 10.3% vs. 14.9 ± 9.3%, P .01). There was more LV systolic function recovery in those with normal to moderate LV dilation (80%, odds ratio [OR] 15.22, P .01), HR ≥80 bpm (79%, OR 5.38, P .01) and HFmrEF (80%, OR 4.03, P .01). The overall AF freedom was similar between normal and dilated LV (59% vs. 62%, P = .95), rapid and controlled HR (67% vs. 56%, P = .18), and HFmrEF and HFrEF (65% vs. 50%, P = .19).Catheter ablation is effective independent of LV dilation, rate control or HFrEF. Patients with normal to moderate LV dilation, resting HR ≥80 bpm and HFmrEF may be candidates for early PerAF ablation to achieve LVEF normalization.

Nitrogen is an essential nutrient in aquaculture. It is also an important factor in coastal and river eutrophication. We present an island-scale model to study the nitrogen flows in different aquaculture systems in Hainan Island during 1998–2018. The result indicated that nitrogen losses associated with pond sludge, wastewater discharge and gaseous emission increased by a factor of 1.4, 4.6 and 3.2, respectively. Sludge and wastewater account for 84% of the total losses to the environment. During the past 20 years, aquacultural yields and the nitrogen use efficiency (NUE) improved considerably in Hainan Island. Nevertheless, nitrogen losses to the environment increased significantly as well, with negative effects for local ecosystems. In the future, sustainable aquacultural practices are needed to improve NUE and to reduce nitrogen losses to the environment.

Multifunctional textiles based on cotton have attracted wide attentions recently. In this study, the cotton fabrics were synergistically modified by surface micro-dissolution and cationization to enrich the adsorption of negatively charged graphene oxide (GO) on it. Subsequently, the bound GO was chemically reduced to rGO by using L-Ascorbic acid to endow cotton with high UV resistance and conductivity. By XRD, FTIR and zeta potential analysis, it was concluded that the synergistic modification could alter the structure of cotton and at the same time facilitate the reactions between cotton molecules and cationic agent EPTAC. This would shield more negative charges in cotton to decrease its absolute zeta potential, enhancing the uptake of negatively charged GO on the surface of cotton significantly. In addition, SEM, FTIR and Raman spectroscopy were utilized to confirm the presence of rGO on the surface of cotton fabrics. The result from resistance measurement disclosed that the synergistic modification could significantly reduce the electrical surface resistance of cotton to 3.89 × 103 Ω/sq. Moreover, the synergistic modification could greatly improve the UV protection factor (UPF) of cotton from 24.18 to 487.91, far beyond the excellent UPF rating (50+). The high UV resistance and conductivity of this rGO coated cotton fabrics suggests that they can be used as functional textiles for various applications.

Objectives This study sought to address whether technological innovations such as contact force sensing (CFS) can improve acute and long-term ablation outcomes of left ventricular papillar...

Seagrass meadows provide important ecosystem services, but are among the least conserved marine ecosystems. The Southern bioregion of China has the nation’s largest seagrass distribution. However, lack of information on the distribution of seagrasses and the threats they face pose a significant obstacle to their conservation and restoration. Accordingly, a framework for prioritizing conservation and restoration objectives was proposed in the present study. First, we modeled the suitable habitats with MaxEnt, random forest (RF), and ensemble models to obtain a reliable basis map of seagrass distribution. A potentially suitable area of approximately 3,536–4,852 km2 was mapped in the coastal sea of South China, with the greatest area occurring between 18 °N and 22 °N. The anthropogenic pressures on the seagrass habitat were then estimated using an integrated exposure index consisting of four indicators, namely, population density, fishery economy, aquaculture, and shipping. The results indicated 48% of the coastal seas were under intensive anthropogenic pressures, with a higher exposure in the north than the south. The current conservation status suggests that there is a large seagrass conservation gap. By coupling the two dimensions of habitat suitability and integrated exposure, priority sites for seagrass management in South China were identified for the first time. Our work will not only provide basic information for coastal ecosystem management, but also serve as a tool to support the conservation and restoration planning of seagrass, thus, ultimately promoting the sustainability of seagrasses habitats.

Introduction: Septal mass reduction is beneficial for hypertrophic obstructive cardiomyopathy (HOCM) patients with severe left ventricular outflow (LVOT) gradient and symptoms, with surgical myectomy or alcohol septal ablation (ASA) currently recommended in selected patients. Radiofrequency (RF) ablation of hypertrophied septum has been published as a novel method to alleviate LVOT obstruction in small populations. This study aims to investigate factors influencing clinical outcomes of radiofrequency septum ablation.Methods and Results: In this study, 20 patients with HOCM who underwent endocardial ablation were included. Echocardiography and cardiac MRI (CMR) data was collected and analyzed pre- and (or) post- procedure. Nineteen patients underwent ablation successfully, while ablation was aborted in one patient with prior RBBB due to transient complete atrioventricular block (AVB). After 6 months of follow-up, NYHA heart functional class improved from III (2 - 3) to II (1 - 2) (p < 0.001), and resting LVOT gradient was significantly reduced (87.6 ± 29.5 mmHg vs. 48.1 ± 29.7, p < 0.001). LVOT gradient reduction was significantly higher in patients with limited basal septal hypertrophy (60.9 ± 8.3 vs. 27.9 ± 7.1, p = 0.01), shorter anterior mitral leaflet (56.1 ± 6.4 vs. 20.4 ± 5.0, p < 0.01), and normally positioned papillary muscle (36.9 ± 7.1 vs. 75.0 ± 6.3, p < 0.05).Conclusions: Endocardial septal ablation appears to be a safe and effective procedure for alleviating LVOT gradient in patients with HOCM, especially in those with limited basal septal hypertrophy, shorter anterior mitral leaflet, and normal positioned papillary muscle.

Outbreaks of the crown-of-thorns starfish Acanthaster planci have received increasing attention due to their negative impacts on coral reefs. However, outbreaks of A. planci in Chinese seas are still poorly understood. Coral reefs in the Xisha Islands (Paracel Islands), South China Sea, have been monitored during 2005 and 2019, including hard coral coverage, larval recruitment rates, density of coral reef fish and the populations of A. planci . This study aims to analyse the regular pattern regarding outbreaks of A. planci in the main islands of Xisha Islands, the causes of outbreaks of the crown-of-thorns starfish Acanthaster planci , and the solutions for controlling the outbreaks of the crown-of-thorns starfish Acanthaster planci . Monitoring coral reef ecosystems on the main islands of Xisha Islands from 2005 to 2019 showed that the cycle of Acanthaster planci outbreaks in Xisha Islands is about 15 years. These 15 years can be divided into two phases, in which the period of A. planci outbreak is about 5 years, and the recovery period of coral reefs is about 10 years. When A. planci outbreak from 2006 to 2010, the coral reef cover rate decreased from more than 60% to less than 5%. During the recovery period from 2011 to 2019, the coverage of coral reefs gradually increased to around 15%, at the same time the coral recruitment and coral reef fish increased. Further analysis showed that the occurrence of A. planci in Xisha Islands is mainly related to typhoon weather, reduction of coral reef fish, global warming and human activities. The passage of the typhoon brought a large number of nutrients, which led to the increase of plankton, leading to the survival rate of larvae of A. planci . Global warming and a decline in coral reef fish could lead to a greater percentage of the eggs of A. planci hatching and surviving. Based on 15-years monitoring data, it is highly possible that Xisha Islands are entering the next outbreak cycle of A. planci , and therefore measures should be taken to prevent the coral reef ecosystem from being destroyed again. Outbreaks of the crown-of-thorns starfish A. planci should be controlled in several ways. Direct control methods including physical removal of individual starfish and cutting individuals into multiple pieces were most often used methods to kill starfish. The most effective methods to control A. planci require injecting individual starfish with lethal chemicals, including sodium bisulfate, powdered citric acid, vinegar and thiosulfate-citrate-bile-sucrose agar (TCBS). Releasing the predator of A. planci of their different life cycle was also an effective way to control A. planci . The Giant Triton Shells ( Charonia tritonis ), the Napoleon Maori Wrasse ( Cheilinus undulatus ), Starry Puffer ( Arathron stellatus ) and Titan Trigger Fish ( Ballistoides viridescens ) were the main predator of the crown-of-thorns starfish A. planci . Moreover, regular monitoring of the starfish A. planci should be conducted in the Xisha Islands for early warning of outbreaks.

Complete chloroplast genome of Enhalus acodoides was obtained in this work. Circular mapping revealed that the complete chloroplast sequences of E. acodoides was 176,748 bp in length and had an overall GC content of 38.3%, encoded 132 genes which contained 86 protein-coding genes (PCGs), 38 transfer RNA genes (tRNA) and 8 ribosomal RNA genes (rRNA). The phylogenetic tree shows that E. acodoides had a closer relationship with Thalassia hemprichii in Hydrocharitaceae and its analysis will help better understand the evolution of Alismatales species.

Microplastics are emerging as widespread pollutants in coral reef ecosystems worldwide; however, there is limited knowledge regarding their impact on giant clams, which are important reef builders. In the present study, the cytological, physiological, and molecular response of the giant clam Tridacna crocea to a 5 d exposure of microplastics was investigated. The concentration of microplastics in the intestine and outer mantle increased significantly and gradually after the exposure to microplastics. There were no significant changes in the density of symbiotic Symbiodiniaceae throughout the exposure period, but symbiont chlorophyll content increased significantly after 1 d of exposure. There was a significant increase in symbiont superoxide dismutase (SOD) activity, but a decrease in giant clam SOD activity and symbiont glutathione S-transferase (GST) activity. No significant changes in catalase (CAT) activity and caspase3 activation level were observed in the two symbiotic partners. Transcriptomic analysis of the giant clam revealed 138 significantly upregulated and 1390 significantly downregulated genes after 5 d of microplastic exposure. The top 20 GO terms overrepresented by these significantly downregulated genes were related to primary metabolic processes and cellular metabolic processes. No significantly upregulated genes were observed in symbionts, but 28 genes were significantly downregulated, including chloroplast oxygen-evolving enhancer, photosystem I reaction center subunit II, peptide/nitrate transporter, sodium-coupled neutral amino acid transporter, beta-glucosidase, and TPA: lipase. These results suggest that T. crocea ingests microplastics through the outer mantle and intestine, and these microplastics can suppress the photosynthesis, organic nutrient transportation, and detoxification ability of the symbionts, as well as the primary metabolism of the giant clam. This eventually could threaten their metabolic relationship and long-term survival.

Introduction: Septal mass reduction is beneficial for hypertrophic obstructive cardiomyopathy (HOCM) patients with severe left ventricular outflow (LVOT) gradient and symptoms, with surgical myectomy or alcohol septal ablation (ASA) currently recommended in selected patients. Radiofrequency (RF) ablation of hypertrophied septum has been published as a novel method to alleviate LVOT obstruction in small populations. This study aims to investigate factors influencing clinical outcomes of radiofrequency septum ablation. Methods and results: In this study, twenty patients with HOCM who underwent endocardial ablation were included. Echocardiography and cardiac MRI (CMR) data was collected and analyzed pre- and (or) post- procedure. Nineteen patients underwent ablation successfully, while ablation was aborted in one patient with prior RBBB due to transient complete atrioventricular block (AVB). After six months of follow-up, NYHA heart functional class improved from III (2 - 3) to II (1 - 2) (p < 0.001), and resting LVOT gradient was significantly reduced (87.6 ± 29.5 mmHg vs. 48.1 ± 29.7, p < 0.001). LVOT gradient reduction was significantly higher in patients with limited basal septal hypertrophy (60.9 ± 8.3 vs. 27.9 ± 7.1, p = 0.01), shorter anterior mitral leaflet (56.1 ± 6.4 vs. 20.4 ± 5.0, p

Background: Sickle seagrass ( Thalassia hemprichii ) is one of the most important marine plants living in the tropical climate, mainly distributed in Southeast Asian waters. It is an important food source for marine herbivores and plays important roles in nitrogen fixation, water purification and maintaining the balance of marine ecology. In recent years, the area of aquatic plants has declined rapidly, affecting the ecological balance. However, the molecular mechanism of aquatic plants has been poorly studied.Results: In this study, all transcriptional information of T. hemprichii was obtained by using high-throughput sequencing technology, and 32,097 unigenes were identified by annotation. In addition, 119 MYB transcription factors were screened, and 61 genes with complete ORF were sequenced. Furthermore, 17 clays were identified according to the information of Arabidopsis .Conclusions: This study provides useful information for enriching the genetic information of T. hemprichii , and further exploring the molecular mechanisms of the evolution, development, and physiological functions of Sickle seagrass.

Background During ablation for atrial fibrillation (AF), energy delivery toward the left atrial posterior wall may cause esophageal injury (EI). Ablation index (AI) was introduced to estimate ablation lesion size, however, the impact of AI technology on the risk of EI has not been explored. Method From March 2019 to December 2019, 60 patients with paroxysmal AF undergoing first-time ablation were prospectively enrolled. The first 30 consecutive patients were ablated with the AI target value of 400 (AI-400 group), and the later 30 consecutive patients were ablated with the AI target value of 350 at the posterior wall (AI-350 group). Endoscopic ultrasonography was used to evaluate EI postablation. EI was classified as a category 1 (erythema or erosion) or a category 2 (hematoma or ulceration). Results Compared with the AI-400 group (59.9 ± 8.4 years; male, 60%), the AI-350 group (59.1 ± 9.9 years; male, 50%) had a lower incidence of EI (3.3% vs 26.7%, P = .03). There was no significant difference in the percentage of first-pass PVI between the AI-400 group and the AI-350 group (left PVI: 80% vs 73.4%, P = .54; right PVI: 80% vs 60%, P = .1). Neither ablation time nor fluoroscopy time was significantly different between the AI-400 group and the AI-350 group. Conclusions AF ablation guide by AI target value of 350 may reduce esophageal thermal injury and has a similar efficiency on the acute success rate of first-pass PVI compared with an AI target value of 400 at the posterior wall.

This study sought to address whether technological innovations such as contact force sensing (CFS) can improve acute and long-term ablation outcomes of left ventricular papillary muscle (LV PAP) ventricular arrhythmias (VAs).Catheter ablation of LV PAP VAs has been less efficacious than another focal VAs. It remains unclear whether technological innovations such as CFS can improve acute and long-term ablation outcomes of LV PAP VA.From January 2015 to December 2019, a total of 137 patients underwent LV PAP VA ablation. VA site of origin (SOO) was identified using activation and pace-mapping guided by intracardiac echocardiography. Radiofrequency energy (20 to 50 W for 60 to 90 s) was delivered by irrigated catheter with or without CFS. We defined acute success as complete suppression of targeted VA ≥30 min post ablation and clinical success as ≥80% VA burden reduction at outpatient follow-up.VA manifested as premature ventricular complexes in 98 (71%), nonsustained ventricular tachycardia in 18 (13%), sustained ventricular tachycardia in 12 (9%) and premature ventricular complexes induced ventricular fibrillation in 9 (7%). VA SOO was anterolateral PAP in 51 (37%), posteromedial PAP in 73 (53%), and both PAPs in 13 (10%). VAs were targeted using CFS in 97 (71%) and non-CFS in 40 (29%). After a single procedure, acute success was achieved in 130 (95%) and clinical success was achieved in 112 (82%); neither was impacted by VA SOO and/or CFS. Complications occurred in 5 patients (3.6%).Independent of CFS technology, intracardiac echocardiography-guided catheter ablation is highly efficacious and may be considered as first-line therapy in the management of LV PAP VA.

BACKGROUND Contraction of the esophagus was observed during cryoablation for paroxysmal atrial fibrillation (PAF). The purpose of this study is to investigate the mechanism of esophageal contraction and the correlation between the contraction and esophageal thermal lesions. METHODS This prospective study enrolled 64 patients with PAF undergoing second-generation cryoballoon (CB2) ablation for pulmonary vein isolation (PVI). During PVI for the left inferior pulmonary vein, contrast esophagography was performed before and during cryoablation. The sample population was divided into two groups: A (31 patients) and B (33 patients). Group A consisted of patients in whom the distal half of the CB was in proximity to the esophagus, while for group B the esophagus was away from the distal half of the CB. Esophageal contraction was recorded as a variation in the width of the esophageal lumen during PVI. Postablation esophageal endoscopy was done on all patients. RESULTS The reduction in the width of the esophageal lumen in group A was greater than in group B during freezing (40.12 ± 23.24% vs 8.14 ± 10.35%, P

Right ventricular pacing (RVP) is associated with an increased incidence of heart failure and may impair cardiac function. Permanent His bundle pacing (HBP) has the potential to physiologically preserve and prevent cardiac dysfunction. This study was to evaluate the feasibility and intermediate follow-up results of upgrade to HBP implantation in patients referred for pulse generator change with long term RVP.Twelve of 14 pacing dependent patients who were referred for pulse generator exchange underwent upgrade into HBP successfully in our center. QRS duration, New York Heart Association (NYHA) functional class, echocardiography, use of diuretics and lead parameters were measured at baseline and during the follow-up.Among the 12 patients attempted (mean age, 70.8 ± 8.9 years, 75% males) successfully, the average ejection fraction (EF) was 52.2 ± 11.2%. Nine of 12 patients underwent upgrade to HBP, and three patients with EF 40% underwent HBP and biventricular pacing (BVP) as well. A significant reduction in mean QRS duration was observed compared with pre-implantation, from 157.8 ± 13.3 ms to 109.3 ± 16.9 ms (p 0.001). After 6 months follow-up period, median NYHA functional class was improved from 2.7 ± 0.6 to 1.8 ± 0.6 (p = 0.007) and left ventricular internal diastolic diameter (LVIDd) was reduced from 5.5 ± 0.4 cm to 5.3 ± 0.3 cm (p = 0.03).HBP improves heart failure symptoms with preserved EF by long term RVP. Permanent HBP is feasible and safe for upgrade in patients with long term RVP irrespective of LVEF.

Yu et al. ([1][1]) reported the electrographic characteristics of the fossa ovalis (FO) and successful transseptal puncture (TSP) by 3-dimensional (3D) electroanatomic mappings (EAM) of the right atrium (RA) and the FO with a fluoroscopy-free and echocardiography-free method in 276 patients

Catheter ablation of atrial fibrillation (AF) is an effective and relatively safe procedure. Cheng et al. ([1][1]) reported an early post-ablation mortality of 0.46% in 60,203 patients between 2010 and 2015. They suggest that prompt management of post-procedure complications and congestive heart

Background Catheter ablation in the right ventricular outflow tract (RVOT) may modify the electrophysiologic substrate for recurrent ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with Brugada syndrome (BrS). Objective The purpose of this study was to investigate the mechanism and arrhythmogenic substrate of VT/VF and to evaluate the long-term outcomes of catheter ablation in patients with BrS. Methods Eleven consecutive patients with BrS referred to 2 academic medical centers underwent combined epicardial–endocardial electroanatomic mapping. Catheter ablation was performed in regions of localized conduction slowing. Transmural dispersion of late activation was calculated as the difference between the latest activation between epicardium and endocardium, and low-voltage areas were analyzed. Results Eleven patients met diagnostic criteria for BrS (spontaneous type 1, n=9; Na channel provocation=2). All patients were found to have a localized region in the anterior epicardial RVOT with conduction slowing evidenced by prolonged electrogram duration (78.79 ± 19.87 ms vs 58.93 ± 10.11 ms in epicardial right ventricle, and 59.87 ± 12.61 ms in endocardial RVOT, P 2 ). Epicardial ablation resulted in normalization of spontaneous type 1 Brugada ECG pattern in all patients, and 73% were free from VT/VF at 25 ± 11 months. Conclusion Prolonged electrograms localized to epicardial RVOT with variable low voltage were identified in all patients with BrS. J-point and ST-segment elevation correlated with greater transmural dispersion of late activation and was independent of total low-voltage area. Despite normalization of spontaneous type 1 pattern in all patients after ablation, recurrence was still observed, suggesting the implantable cardioverter–defibrillator as the cornerstone therapy for BrS.

Georgiev et al. ([1][1]) reported that long-term follow-up in 226 patients who underwent transcatheter pulmonary valve replacement (TPVR) showed excellent outcomes. However, of the 17 patients (7.2%) requiring valve replacement during the study, 10 had known infectious endocarditis (IE), and

Introduction Repeat ablation strategy for atrial fibrillation (AF) recurrence after multiple ablation procedures is known to be challenging. This study evaluated the insights of adjunctive ablation for epicardial arrhythmogenic substrates in those patients via a percutaneous epicardial approach. Methods and results Thirty-five consecutive patients with AF/atrial tachycardia (AT) recurrence, who had two or more prior ablation procedures, were enrolled from September 2016 to December 2018. In addition to a standard endocardial approach, epicardial mapping and ablation were performed via a percutaneous subxiphoid access in the electrophysiology lab. Adjunctive epicardial ablations for left lateral ridge (LLR) were performed in 31 of 35 patients (88.6%) for efficient transmural lesions with pacing capture loss. Marshall Bundle (MB) potentials were documented on epicardial LLR in three patients and abolished by direct epicardial ablation. Bachmann's bundle (BB) was ablated as an epicardial conduction gap in four patients with a refractory anterior wall line. Two epicardial AT/AF triggers were detected followed by successful termination with epicardial ablation. No periprocedural complications occurred. About 23 of 35 patients (65.7%) remained free from AF/AT after 23.2 ± 9 months of the procedure. Conclusions Patients with multiple failed prior AF procedures refractory to antiarrhythmic therapy might warrant a percutaneous epicardial mapping and ablation strategy, with adjunctive therapy for targeting LLR/MB, BB, and underlying epicardial triggers in addition to a standard endocardial approach.

Aims The optimal procedural endpoint to achieve permanent pulmonary vein isolation (PVI) during ablation of atrial fibrillation (AF) remains unknown. We aimed to compare the impact of prolonged waiting periods and adenosine triphosphate (ATP) testing after PVI on long-term freedom from AF. Methods and results In total, 538 patients (median age 61 years, 62% male) undergoing first-time radiofrequency ablation for paroxysmal AF were randomized into four groups: Group 1 [PVI (no testing), n = 121], Group 2 (PVI + 30min waiting phase, n = 151), Group 3 (PVI+ATP, n = 131), and Group 4 (PVI + 30min+ATP, n = 135). The primary endpoint was freedom from AF. Repeat mapping to assess for late pulmonary vein (PV) reconnection was performed in patients who remained AF-free for >3 years (n = 46) and in those who had repeat ablation for AF recurrence (n = 82). During initial procedure, acute PV reconnection was observed in 33%, 26%, and 42% of patients in Groups 2, 3, and 4, respectively. At 36 months, no significant differences in freedom from AF recurrence were observed among all four groups (55%, 61%, 50%, and 62% for Groups 1, 2, 3, and 4, respectively; P = 0.258). Late PV reconnection was commonly observed, with a similar incidence between patients with and without AF recurrence (74% vs. 83%; P = 0.224). Conclusion Although PVI remains the cornerstone for AF ablation, intraprocedural techniques to assess for PV reconnection did not improve long-term success. Patients without AF recurrence after 3 years exhibited similarly high rates of PV reconnection as those that underwent repeat ablation for AF recurrence. The therapeutic mechanisms of AF ablation may not be solely predicated upon durable PVI.