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Portero V, Deng S, Boink GJJ, Zhang GQ, de Vries A, Pijnappels DA. Optoelectronic control of cardiac rhythm: Toward shock-free ambulatory cardioversion of atrial fibrillation. J Intern Med 2024; 295:126-145. [PMID: 37964404 DOI: 10.1111/joim.13744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, progressive in nature, and known to have a negative impact on mortality, morbidity, and quality of life. Patients requiring acute termination of AF to restore sinus rhythm are subjected to electrical cardioversion, which requires sedation and therefore hospitalization due to pain resulting from the electrical shocks. However, considering the progressive nature of AF and its detrimental effects, there is a clear need for acute out-of-hospital (i.e., ambulatory) cardioversion of AF. In the search for shock-free cardioversion methods to realize such ambulatory therapy, a method referred to as optogenetics has been put forward. Optogenetics enables optical control over the electrical activity of cardiomyocytes by targeted expression of light-activated ion channels or pumps and may therefore serve as a means for cardioversion. First proof-of-principle for such light-induced cardioversion came from in vitro studies, proving optogenetic AF termination to be very effective. Later, these results were confirmed in various rodent models of AF using different transgenes, illumination methods, and protocols, whereas computational studies in the human heart provided additional translational insight. Based on these results and fueled by recent advances in molecular biology, gene therapy, and optoelectronic engineering, a basis is now being formed to explore clinical translations of optoelectronic control of cardiac rhythm. In this review, we discuss the current literature regarding optogenetic cardioversion of AF to restore normal rhythm in a shock-free manner. Moreover, key translational steps will be discussed, both from a biological and technological point of view, to outline a path toward realizing acute shock-free ambulatory termination of AF.
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Affiliation(s)
- Vincent Portero
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Shanliang Deng
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Microelectronics, Delft University of Technology, Delft, The Netherlands
| | - Gerard J J Boink
- Department of Medical Biology, Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Guo Qi Zhang
- Department of Microelectronics, Delft University of Technology, Delft, The Netherlands
| | - Antoine de Vries
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Daniël A Pijnappels
- Laboratory of Experimental Cardiology, Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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2
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Traykov V, Marchov D, Martinov E, El Abbady A, Gelev V, Dichtl W. Ongoing substrate-driven atrial fibrillation "boxed" in the left atrial posterior wall with ablation: a case report. Front Cardiovasc Med 2023; 10:1251874. [PMID: 37790595 PMCID: PMC10542893 DOI: 10.3389/fcvm.2023.1251874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Patients undergoing valve surgery for rheumatic heart disease are expected to develop significant atrial arrhythmogenic substrates outside of the pulmonary veins, which sometimes require complex ablation techniques for the treatment of symptomatic arrhythmias. We describe, herein, the case of a 76-year-old male undergoing endocardial ablation for the treatment of symptomatic persistent atrial fibrillation which developed after aortic and mitral valve replacement with a simultaneous tricuspid ring annuloplasty. Following pulmonary vein isolation, the patient's atrial fibrillation was converted into cavotricuspid isthmus-dependent atrial flutter. After a successful cavotricuspid isthmus ablation, the arrhythmia reverted back to a left atrial tachyarrhythmia originating from the posterior wall. A linear left atrial lesion led to the electrical isolation of a large area, which included the posterior wall, as well as the containment of the ongoing fibrillatory activity, while sinus rhythm was restored in the rest of the atria. In conclusion, successful left atrial posterior wall isolation can be achieved in the setting of severe scarring due to previous atriotomy by creating a linear lesion on the atrial roof, in conjunction with pulmonary vein isolation, sparing the patient from requiring bottom-line ablation, and avoiding possible esophageal injury. Such compartmentalization of the left atrium may effectively contain local fibrillatory activity, while allowing for the restoration of sinus rhythm.
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Affiliation(s)
- Vassil Traykov
- Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Daniel Marchov
- Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Emiliyan Martinov
- Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Asmaa El Abbady
- Cardiac Electrophysiology Department, National Heart Institute, Giza, Egypt
| | - Valeri Gelev
- Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Innsbruck, Austria
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Jing M, Li D, Xi H, Zhang Y, Zhou J. Value of Imaging in the Non-Invasive Prediction of Recurrence after Catheter Ablation in Patients with Atrial Fibrillation: An Up-to-Date Review. Rev Cardiovasc Med 2023; 24:241. [PMID: 39076720 PMCID: PMC11266785 DOI: 10.31083/j.rcm2408241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 07/31/2024] Open
Abstract
Catheter ablation (CA) is the first-line treatment for atrial fibrillation (AF) patients. However, the risk of recurrence associated with CA treatment should not be ignored. Therefore, the preoperative identification of patients at risk of recurrence is essential for identifying patients who will benefit from non-invasive surgery. Echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI) are essential for the preoperative non-invasive prediction of AF recurrence after CA. Compared to laboratory examinations and other examination methods, these modalities can identify structural changes in the heart and assess functional variations. Accordingly, in past studies, morphological features, quantitative parameters, and imaging information of the heart, as assessed by echocardiography, CT, and MRI, have been used to predict AF recurrence after CA noninvasively. This review summarizes and discusses the current research on echocardiography, CT, MRI, and machine learning for predicting AF recurrence following CA. Recommendations for future research are also presented.
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Affiliation(s)
- Mengyuan Jing
- Department of Radiology, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
- Second Clinical School, Lanzhou University, 730030 Lanzhou, Gansu, China
- Key Laboratory of Medical Imaging of Gansu Province, 730030 Lanzhou, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, Gansu, China
| | - Dong Li
- Department of Cardiovascular Medicine, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
| | - Huaze Xi
- Department of Radiology, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
- Second Clinical School, Lanzhou University, 730030 Lanzhou, Gansu, China
- Key Laboratory of Medical Imaging of Gansu Province, 730030 Lanzhou, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, Gansu, China
| | - Yuting Zhang
- Department of Radiology, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
- Second Clinical School, Lanzhou University, 730030 Lanzhou, Gansu, China
- Key Laboratory of Medical Imaging of Gansu Province, 730030 Lanzhou, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, Gansu, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China
- Second Clinical School, Lanzhou University, 730030 Lanzhou, Gansu, China
- Key Laboratory of Medical Imaging of Gansu Province, 730030 Lanzhou, Gansu, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, 730030 Lanzhou, Gansu, China
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Fujito T, Mochizuki A, Kamiyama N, Koyama M, Nagahara D, Miura T. Is Incomplete Left Atrial Posterior Wall Isolation Associated With Recurrence of Atrial Fibrillation After Radiofrequency Catheter Ablation? Circ Rep 2020; 2:648-656. [PMID: 33693191 PMCID: PMC7937498 DOI: 10.1253/circrep.cr-20-0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Complete left atrial posterior wall isolation (LAPI) is not always achieved. We examined whether incomplete LAPI has an effect on outcomes after catheter ablation (CA). Methods and Results: This study enrolled 75 consecutive patients (mean [±SD] age 62.6±8.9 years, 74.7% male) who underwent LAPI by radiofrequency CA for persistent atrial fibrillation (AF). The median follow-up period was 541 days (interquartile range 338-840 days). Incomplete LAPI was defined as the presence of a successfully created roof or floor linear lesion. The rate of complete LAPI was 41.3% (31/75). Either a roof or floor linear lesion was created in 38 patients, whereas neither was created in 6. Multivariate Cox proportional hazards regression analysis revealed that female sex (hazard ratio [HR] 5.29; 95% confidence interval [CI] 1.81-16.8; P=0.002) and complete or incomplete LAPI (HR 0.17; 95% CI 0.03-0.79; P=0.027) were independent predictors of AF recurrence. Kaplan-Meier curves indicated that better outcome was associated with at least one rather than no successful linear lesion (86.5% vs. 50.0% at 1 year; P=0.043). There were no significant differences in outcomes between the complete LAPI and incomplete LAPI groups. Conclusions: Complete LAPI is unachievable in a significant percentage of patients with persistent AF. However, incomplete LAPI, as a result of aiming for complete LAPI, may have a benefit comparable to that of complete LAPI.
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Affiliation(s)
- Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine Sapporo Japan
| | - Atsushi Mochizuki
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine Sapporo Japan
| | - Naoyuki Kamiyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine Sapporo Japan
| | - Masayuki Koyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine Sapporo Japan
| | - Daigo Nagahara
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine Sapporo Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine Sapporo Japan
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Sun T, Xie T, Zhang A, Fan L, Xu Z, Chen X, Fan Z, Wang C. Relation between left atrial structure and lacunar infarction in patients with hypertension. Aging (Albany NY) 2020; 12:17295-17304. [PMID: 32915163 PMCID: PMC7521509 DOI: 10.18632/aging.103697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 07/06/2020] [Indexed: 01/24/2023]
Abstract
A lacunar infarction (LACI) can cause damage to the surrounding brain tissue and place an individual at greater risk for future major stroke. LACI is associated with hypertension and hypertension is associated with left atrial enlargement. It is important to identify a high-risk patient who is more vulnerable to suffering a LACI in hypertensive group. So, we studied whether left atrium size is an independent risk predictor for LACI in hypertensive patients. We performed cross-sectional analysis of 365 patients with hypertension at Shanghai Ninth People's Hospital from January 2016 to January 2017. The results showed that left atrial diameter(LAD), left atrial volume (LAV) and the ratio of left atrial diameter to left ventricular diameter (LAD/LVD) were significantly associated with LACI in hypertensive patients. Based on the ROC curve analysis, the area under the ROC curve (AUC) of LAV used to predict LACI was 0.737 (95% CI: 0.686 - 0.788), and the AUC of LAD/LVD was 0.784 (95% CI: 0.737 - 0.830). The optimal cut-off value for LAV was 30.14, and the sensitivity and specificity were 72% and 63%, respectively. The optimal cut-off value for LAD/LVD was 0.757, and the sensitivity and specificity were 77% and 70%, respectively. LAV or LAD/LVD played an important role in LACI with hypertension and could be an independent risk factor in hypertensive patients.
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Affiliation(s)
- Ting Sun
- Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Tong Xie
- Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China,Department of Intensive Care Unit, Shanghai Xuhui District Central Hospital, Shanghai 200031, China
| | - Alian Zhang
- Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Li Fan
- Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Zuojun Xu
- Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Xin Chen
- Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Zhicheng Fan
- Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Changqian Wang
- Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
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Williams SE, O'Neill L, Roney CH, Julia J, Metzner A, Reißmann B, Mukherjee RK, Sim I, Whitaker J, Wright M, Niederer S, Sohns C, O'Neill M. Left atrial effective conducting size predicts atrial fibrillation vulnerability in persistent but not paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:1416-1427. [PMID: 31111557 PMCID: PMC6746623 DOI: 10.1111/jce.13990] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/01/2019] [Accepted: 05/17/2019] [Indexed: 11/30/2022]
Abstract
Background The multiple wavelets and functional re‐entry hypotheses are mechanistic theories to explain atrial fibrillation (AF). If valid, a chamber's ability to support AF should depend upon the left atrial size, conduction velocity (CV), and refractoriness. Measurement of these parameters could provide a new therapeutic target for AF. We investigated the relationship between left atrial effective conducting size (LAECS), a function of area, CV and refractoriness, and AF vulnerability in patients undergoing AF ablation. Methods and Results Activation mapping was performed in patients with paroxysmal (n = 21) and persistent AF (n = 18) undergoing pulmonary vein isolation. Parameters used for calculating LAECS were: (a) left atrial body area (A); (b) effective refractory period (ERP); and (c) total activation time (T). Global CV was estimated as √A/T. Effective atrial conducting size was calculated as LAECS=A/(CV×ERP). Post ablation, AF inducibility testing was performed. The critical LAECS required for multiple wavelet termination was determined from computational modeling. LAECS was greater in patients with persistent vs paroxysmal AF (4.4 ± 2.0 cm vs 3.2 ± 1.4 cm; P = .049). AF was inducible in 14/39 patients. LAECS was greater in AF‐inducible patients (4.4 ± 1.8 cm vs 3.3 ± 1.7 cm; P = .035, respectively). The difference in LAECS between inducible and noninducible patients was significant in patients with persistent (P = .0046) but not paroxysmal AF (P = .6359). Computational modeling confirmed that LAECS > 4 cm was required for continuation of AF. Conclusions LAECS measured post ablation was associated with AF inducibility in patients with persistent, but not paroxysmal AF. These data support a role for this method in electrical substrate assessment in AF patients.
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Affiliation(s)
- Steven E Williams
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Louisa O'Neill
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Caroline H Roney
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Justo Julia
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Bruno Reißmann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Rahul K Mukherjee
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Iain Sim
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - John Whitaker
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Matthew Wright
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Steven Niederer
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Christian Sohns
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.,Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Mark O'Neill
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
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Keçe F, Scholte AJ, de Riva M, Naruse Y, Watanabe M, Alizadeh Dehnavi R, Schalij MJ, Zeppenfeld K, Trines SA. Impact of left atrial box surface ratio on the recurrence after ablation for persistent atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 42:208-215. [PMID: 30520059 PMCID: PMC6850488 DOI: 10.1111/pace.13570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 01/19/2023]
Abstract
Background The posterior wall of the left atrium (LA) is a well‐known substrate for atrial fibrillation (AF) maintenance. Isolation of the posterior wall between the pulmonary veins (box lesion) may improve ablation success. Box lesion surface area size varies depending on the individual anatomy. This retrospective study evaluates the influence of box lesion surface area as a ratio of total LA surface area (box surface ratio) on arrhythmia recurrence. Methods Seventy consecutive patients with persistent AF (63 ± 11 years, 53 men) undergoing computed tomography (CT) imaging and ablation procedure consisting of a first box lesion were included in this study. Box lesion surface area was measured on electroanatomical maps and total LA surface area was derived from CT. Patients were followed with 24‐h electrocardiography and exercise tests at 3, 6, and 12 months after AF ablation. Arrhythmia recurrence was defined as any AF/atrial tachycardia (AT) beyond 3 months without antiarrhythmic drugs. Results During a median follow‐up of 13 (interquartile range = 10‐17) months, 42 (60%) patients had AF/AT recurrence. Multivariate Cox proportional regression analysis showed that a larger box surface ratio protected against recurrence (hazard ratio [HR] = 0.81; 95% confidence interval [CI] = 0.690‐0.955; P = 0.012). Left atrial volume index (HR = 1.01 [0.990‐1.024, P = 0.427] and a history of mitral valve surgery (HR = 2.90; 95% CI = 0.970‐8.693; P = 0.057) were not associated with AF recurrence in multivariate analysis. Conclusion A larger box lesion surface area as a ratio of total LA surface area is protective for AF/AT recurrence after ablation for persistent AF.
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Affiliation(s)
- Fehmi Keçe
- Department of Cardiology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| | - Marta de Riva
- Department of Cardiology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| | - Yoshihisa Naruse
- Department of Cardiology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| | - Masaya Watanabe
- Department of Cardiology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| | - Reza Alizadeh Dehnavi
- Department of Cardiology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| | - Serge A Trines
- Department of Cardiology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
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