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Contains fulltext : 252137.pdf (Publisher’s version ) (Open Access) BACKGROUND: Left atrial appendage occlusion (LAAO) provides an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). In patients with a long-term or permanent contraindication for OAC randomized controlled trial (RCT) data is lacking. STUDY OBJECTIVES: To assess the efficacy and safety of LAAO in AF patients who are ineligible to use OAC. The co-primary efficacy endpoint is (1) time to first occurrence of stroke (ischemic, hemorrhagic, or undetermined) and (2) time to first occurrence of the composite of stroke, transient ischemic attack (TIA), and systemic embolism (SE). The primary safety endpoint is the 30-day rate of peri-procedural complications. STUDY DESIGN: This is a multicenter, investigator-initiated, open-label, blinded endpoint (PROBE), superiority-driven RCT. Patients with AF, a CHA₂DS₂-VASc score ≥2 for men and ≥3 for women and a long-term or permanent contraindication for OAC will be randomized in a 2:1 fashion to the device- or control arm. Patients in the device arm will undergo percutaneous LAAO and will receive post-procedural dual antiplatelet therapy (DAPT) per protocol, while those in the control arm will continue their current treatment consisting of no antithrombotic therapy or (D)APT as deemed appropriate by the primary responsible physician. In this endpoint-driven trial design, assuming a 50% lower stroke risk of LAAO compared to conservative treatment, 609 patients will be followed for a minimum of 1 and a maximum of 5 years. Cost-effectiveness and budget impact analyses will be performed to allow decision-making on reimbursement of LAAO for the target population in the Netherlands. SUMMARY: The COMPARE LAAO trial will investigate the clinical superiority in preventing thromboembolic events and cost-effectiveness of LAAO in AF patients with a high thromboembolic risk and a contraindication for OAC use. NCT TRIAL NUMBER: NCT04676880.

Implantable cardioverter-defibrillators have become an established therapy for the prevention of sudden cardiac death due to life-threatening ventricular arrhythmias in the last decades. In all those years, the use of transvenous leads has proven to be the most vulnerable part of the system. The development of the completely subcutaneous implantable cardioverter-defibrillator opened a new era of device therapy outside of the vascular system. The next step, enabling extravascular devices with the option of antitachycardia pacing, is just around the corner. This may become an important option for all patients without a bradycardia pacing indication that are in need for antitachycardia pacing because of monomorphic ventricular tachycardia.

We present the case of a 75-year-old patient with a single-chamber St. Jude Medical internal cardioverter defibrillator (ICD; St. Jude Medical, St. Paul, MN, USA) for primary prevention, who was admitted with 39 inappropriate ICD shocks because of atrial fibrillation with rapid ventricular frequention, despite magnet placement. Review of the device manual and literature revealed that apart from different responses to magnet placement programmed for the various manufacturers, the type of magnet and the positioning can be of specific interest. In the case presented, the donut-shaped magnet should have been placed off-center instead of directly over the device.

A computationally efficient Immersed Boundary Method (IBM) based on penalized direct forcing was employed to determine the permeability of a real porous medium. The porous medium was composed of about 9000 glass beads with an average particle diameter of 1.93 mm and a porosity of 0.367. The forcing of the IBM depends on the local solid volume fraction within a computational grid cell. The latter could be obtained from a high-resolution X-ray Computed Tomography (CT) scan of the packing. An experimental facility was built to determine the permeability of the packing experimentally. Numerical simulations were performed for the same packing based on the data from the CT scan. For a scan resolution of 0.1 mm the numerical value for the permeability was nearly 70% larger than the experimental value. An error analysis indicated that the scan resolution of 0.1 mm was too coarse for this packing.Copyright © 2012 by ASME

It is often stated that the Gibbs ‘‘paradox’’ is resolved or at least alleviated in quantum mechanics because the value of the quantum mechanical entropy of mixing continuously approaches zero if the difference between the particles that are being mixed is made to vanish (i.e., if the value of the inproduct of the respective quantum states goes to one). In this article, the justification of that claim is discussed. It is pointed out that, strictly speaking, an entropy of mixing is not defined if the quantum states of the particles are no longer orthogonal. It seems, therefore, that from a fundamental point of view the Gibbs ‘‘paradox’’ is there no less in quantum mechanics than in classical statistical mechanics.