Impact of ablation index settings on pulmonary vein reconnection

PURPOSE

Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated the incidence of acute and late PV reconnection (PVR) with different AI settings and its predictors.

METHODS

The Ablation Index Registry is a multicenter study that included patients with paroxysmal/persistent atrial fibrillation (AF) who underwent first-time ablation. Each operator performed the ablation using his preferred ablation catheter (ThermoCool® SmartTouch or Surround Flow) and AI setting (380 posterior-500 anterior and 330 posterior-450 anterior). We divided the study population into two groups according to the AI setting used: group 1 (330-450) and group 2 (380-500). Incidence of acute PVR was validated within 30 min after PVI, whereas the incidence of late PVR was evaluated at repeat procedure.

RESULTS

Overall, 490 patients were divided into groups 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of the first-pass PVI between the two study groups. Acute PVR was observed in 5.6% PVs. The rate of acute PVR was slightly higher in group 2 (64/943, 6.8%, PVs) than in group 1 (48/1045, 4.6% PVs, p = 0.04). Thirty patients (6%) underwent a repeat procedure and late PVR was observed in 57/116 (49%) PVs (number of reconnected PV per patient of 1.9 ± 1.6). A similar rate of late PVR was found in the two study groups. No predictors of acute and late PVR were found.

CONCLUSION

Ablation with a lower range of AI is highly effective and is not associated with a higher rate of acute and late PVR. No predictors of PV reconnection were found.

Optoelectrochemical biorecognition by optically transparent highly conductive graphene-modified fluorine-doped tin oxide substrates

Both optical and electrochemical graphene-based sensors have gone through rapid development, reaching high sensitivity at low cost and with fast response time. However, the complex validating biochemical operations, needed for their consistent use, currently limits their effective application. We propose an integration strategy for optoelectrochemical detection that overcomes previous limitations of these sensors used separately. We develop an optoelectrochemical sensor for aptamer-mediated protein detection based on few-layer graphene immobilization on selectively modified fluorine-doped tin oxide (FTO) substrates. Our results show that the electrochemical properties of graphene-modified FTO samples are suitable for complex biological detection due to the stability and inertness of the engineered electrodic interface. In addition, few-layer immobilization of graphene sheets through electrostatic linkage with an electrochemically grafted FTO surface allows obtaining an optically accessible and highly conductive platform. As a proof of concept, we used insulin as the target molecule to reveal in solution. Because of its transparency and low sampling volume (a few microliters), our sensing unit can be easily integrated in lab-on-a-chip cell culture systems for effectively monitoring subnanomolar concentrations of proteins relevant for biomedical applications.

Surface functionalization of fluorine-doped tin oxide samples through electrochemical grafting

Transparent conductive oxides are emerging materials in several fields, such as photovoltaics, photoelectrochemistry, and optical biosensing. Their high chemical inertia, which ensured long-term stability on one side, makes challenging the surface modification of transparent conductive oxides; long-term robust modification, high yields, and selective surface modifications are essential prerequisite for any further developments. In this work, we aim at inducing chemical functionality on fluorine-doped tin oxide surfaces (one of the most inexpensive transparent conductive oxide) by means of electrochemical grafting of aryl diazonium cations. The grafted layers are fully characterized by photoemission spectroscopy, cyclic voltammetry, and atomic force microscopy showing linear correlation between surface coverage and degree of modification. The electrochemical barrier effect of modified surfaces was studied at different pH to characterize the chemical nature of the coating. We showed immuno recognition of biotin complex built onto grafted fluorine-doped tin oxides, which opens the perspective of integrating FTO samples with biological-based devices.

The meningococcal ABC-Type L-glutamate transporter GltT is necessary for the development of experimental meningitis in mice

Experimental animal models of bacterial meningitis are useful to study the host-pathogen interactions occurring at the cerebral level and to analyze the pathogenetic mechanisms behind this life-threatening disease. In this study, we have developed a mouse model of meningococcal meningitis based on the intracisternal inoculation of bacteria. Experiments were performed with mouse-passaged serogroup C Neisseria meningitidis. Survival and clinical parameters of infected mice and microbiological and histological analysis of the brain demonstrated the establishment of meningitis with features comparable to those of the disease in humans. When using low bacterial inocula, meningococcal replication in the brain was very efficient, with a 1,000-fold increase of viable counts in 18 h. Meningococci were also found in the blood, spleens, and livers of infected mice, and bacterial loads in different organs were dependent on the infectious dose. As glutamate uptake from the host has been implicated in meningococcal virulence, mice were infected intracisternally with an isogenic strain deficient in the ABC-type L-glutamate transporter GltT. Noticeably, the mutant was attenuated in virulence in mixed infections, indicating that wild-type bacteria outcompeted the GltT-deficient meningococci. The data show that the GltT transporter plays a role in meningitis and concomitant systemic infection, suggesting that meningococci may use L-glutamate as a nutrient source and as a precursor to synthesize the antioxidant glutathione.

[Effectiveness of daptomycin in the treatment of patients on hemodialysis affected by CVC infection]

The use of tunneled central venous catheters (CVCs) has grown exponentially in recent years. It has increased particularly for elderly patients, patients with severe heart failure, and patients on chronic hemodialysis. In such patients there is a great risk of infection. This led us to search for a new-generation antibiotic able to resolve infection rapidly and effectively. In our experience, administration of daptomycin resulted in rapid resolution of infection without the necessity of CVC removal or its replacement by another system.

RecB-dependent mutator phenotype in Neisseria meningitidis strains naturally defective in mismatch repair

Several invasive serogroup B meningococcal strains phylogenetically related to the lineage III (ET-24) exhibited a mutator phenotype as shown by mutagenicity assay using rifampicin-resistance as a selection marker. Hypermutation was associated to the presence of defective mutL alleles that were genetically characterized. Interestingly, the mutator phenotype was suppressed when a non-functional recB(ET-37) allele, derived from ET-37 meningococcal strains, replaced the functional recB allele in a lineage III strain. In contrast, the same gene replacement did not affect mutation frequencies in a mismatch repair-proficient strain. These results suggested that in MutL-deficient strains spontaneous mutations mostly arise from post-replicative DNA synthesis associated to the activity of the RecBCD recombination pathway.

Role of repulsive factors in vascularization dynamics

Capillary networks are essential in vertebrates to supply tissues with nutrients. Experiments of in vitro capillary formation show that endothelial cells randomly spread on a gel matrix autonomously organize to form vascular networks with a characteristic length independent of the initial cell density. A mathematical model based on free cell migration and on cell cross-talk mediated by soluble chemical factors has been recently proposed and explains the main dynamical and geometrical properties of the networks. We extend this model introducing the action of repulsive factors and we show that their activity results in a larger degree of reorganization of cellular matter and in more robust control over the size of the growing vascular network.

[Sustained low-efficiency dialysis (SLED) in patients with prevalent systolic heart failure refractory to medical treatment and with chronic renal failure]

Systolic heart failure refractory to conventional medical therapy is the principal cause of the high hospitalization rates and of high mortality risks. When this condition is associated with chronic renal failure it is necessary to treat the body liquid composition alterations, and the alterations in the hemodynamic state without creating low flow conditions, trying to achieve an electrolytic and an acid-base balance to reduce the plasmatic volume and permit refilling between the interstitium and plasm. Sustained low-efficiency dialysis (SLED) is a dialysis technique allowing the maintenance of hemodynamic stability through a reduced ultrafiltration rate, it allows an adequate clearance of small solutes, and with sustained treatment it maximizes the dialysis dose and determines a clinical improvement through the removal of the hydric overload. Our experience suggests that SLED is a substitutive treatment for acute dialysis in patients with systolic heart failure refractory to conventional medical treatment.

[Quality of life in patients with combined treatments for heart failure]

The low quality of life in patients with end-stage heart failure is correlated, above all, to frequent hospitalization and to the awareness of having an illness that limits survival. The quality of life in these patients with heart failure using treatment with sustained low efficiency dialysis (SLED) is determined through the Minnesota Living with Heart Failure (MLHF) Questionnaire. The reliability of this evaluation system has been examined through consultation with international trials. After 1 yr of this treatment, we observed an improvement in quality of life.

The Mitochondrial Genome of Xiphinema americanum sensu stricto (Nematoda: Enoplea): Considerable Economization in the Length and Structural Features of Encoded Genes

The complete sequence of the mitochondrial genome of the plant parasitic nematode Xiphinema americanum sensu stricto has been determined. At 12626bp it is the smallest metazoan mitochondrial genome reported to date. Genes are transcribed from both strands. Genes coding for 12 proteins, 2 rRNAs and 17 putative tRNAs (with the tRNA-C, I, N, S1, S2 missing) are predicted from the sequence. The arrangement of genes within the X. americanum mitochondrial genome is unique and includes gene overlaps. Comparisons with the mtDNA of other nematodes show that the small size of the X. americanum mtDNA is due to a combination of factors. The two mitochondrial rRNA genes are considerably smaller than those of other nematodes, with most of the protein encoding and tRNA genes also slightly smaller. In addition, five tRNAs genes are absent, lengthy noncoding regions are not present in the mtDNA, and several gene overlaps are present.

Characterization and Sequence Variation in the rDNA Region of Six Nematode Species of the Genus Longidorus (Nematoda)

Total DNA was isolated from individual nematodes of the species Longidorus helveticus, L. macrosoma, L. arthensis, L. profundorum, L. elongatus, and L. raskii collected in Switzerland. The ITS region and D1-D2 expansion segments of the 26S rDNA were amplified and cloned. The sequences obtained were aligned in order to investigate sequence diversity and to infer the phylogenetic relationships among the six Longidorus species. D1-D2 sequences were more conserved than the ITS sequences that varied widely in primary structure and length, and no consensus was observed. Phylogenetic analyses using the neighbor-joining, maximum parsimony and maximum likelihood methods were performed with three different sequence data sets: ITS1-ITS2, 5.8S-D1-D2, and combining ITS1-ITS2+5.8S-D1-D2 sequences. All multiple alignments yielded similar basic trees supporting the existence of the six species established using morphological characters. These sequence data also provided evidence that the different regions of the rDNA are characterized by different evolution rates and by different factors associated with the generation of extreme size variation.

Efficacy of the liquid formulation of some nematicides

Bunches of 25 g of tomato galled roots containing ca. 270 eggs and juveniles/g of Meloidogyne incognita were buried on 29 September 2001 in gauze bags at the depth of 15, 30 and 45 cm in a sandy loam. The liquid formulation of the nematicides 1,3 dichloropropene (at the rate of 100, 200 and 300 l/ha), metam sodium (at the rate of 500, 1000, and 1500 l/ha), oxamyl (at the rate of 50, 100 and 150 l/ha) and fenamiphos (at the rate of 30, 60, and 90 l/ha) were then applied in 10, 20 or 40 l/m2 of water. Control plots received only plain water. One month later all bags were recovered and the roots mixed with steamed soil and filled in plastic pots in which two tomato seeds were planted. Fifty days later plants were uprooted and aliquots of roots were macerated in blender to determine the number of eggs and juveniles. 1,3 dichloropropene, metam sodium and oxamyl were equally effective in controlling root-knot nematodes; fenamiphos was less effective. For all chemicals degree of control increased with the increase of rate of application and the volume of water of application, but decreased in the increase of depth of nematode burial.

Control of Pratylenchus vulnus in stone fruit nurseries

Almond, peach and olive nurseries were prepared in sandy soil infested by Pratylenchus vulnus in southern Italy. Soil treatments before or at sowing included methyl bromide at the rate of 40 g/m2; 1.3 D at the rate of 15 ml/m2; dazomet at the rate of 100 g/m2 without plastic tarping, or at the rate of either 100 or 50 g/m2 with tarping, and fenamiphos Gr 5 at the rate of 100 g/m2 or 240 CS at the rate of 40 g/m2 as single application; fenamiphos Gr 10 and 240 CS were also applied at planting and two, four and six months after sowing, each time at the rate of 10 g/m2. The experiment was discontinued ten and thirteen months after sowing, respectively for olive and peach and almond. Methyl bromide, 1.3 D or fenamiphos, or dazomet, under certain circumstances, produced agronomically suitable plants, but none of the treatments eradicated the nematode.

The use of olive mill wastes for the control of root-knot nematodes

The suppressive effect of olive mill wastes was tested in a field experiment in sandy soil, infested by Meloidogyne incognita, in the Province of Lecce, southern Italy. The field was subdivided in 12 m2 plots distributed at random in four blocks. Treatment consisted of different dosages (10, 20 and 40 t/ha) of two composts prepared with either exhausted or fresh olive pomace or raw extraction sewage at rate of 40 or 80 m3/ha. There were four untreated control plots and four plots on which the granular 5% formulation of fenamiphos had been broadcast incorporated into the soil at the rate of 300 Kg/ha, one week before planting the tomato cv. Tondino di Zagaria. All treatments statistically increased tomato yields with respect to the control. Conversely, the root gall index, assessed according to a scale from 0 (no gall at all) to 5 (root system of reduced size and deformed by large galls), was significantly reduced in all treated plots. Also soil populations of the root-knot nematode declined, significantly compared to the control, except in the soil treated with the lowest doses of raw sewage or exhausted pomace compost.

First Record of Xiphinema pacificum from a Peach Orchard in Georgia

In April 2000, a Xiphinema sp. was found in a peach (Prunus persica (L.) Batsch) orchard during a longidorid nematode survey in Concord, GA. The nematode was recovered from the rhizosphere of healthy and dying peach trees established on Lovell rootstock. Following a comparative microscope study, the species was identified as X. pacificum Ebsary, Vrain, & Graham, a putative species of the X. americanum group (2). All morphometric measurements coincided with the original description (1). In North America, this group of nematodes are natural vectors of four economically important nepoviruses that are responsible for causing substantial damage to a wide variety of crops. In spring 1999, tree death from bacterial canker (Pseudomonas syringae pv. syringae) occurred within this then 2-year-old orchard. Samples showed that populations of X. pacificum and Pratylenchus sp. were greater under dying trees (34 and 143/100 cm³ of soil) than under healthy trees (19 and 30/100 cm³ of soil), respectively. Samples taken during the 2000 survey contained 10 X. pacificum per 100 cm³ soil under apparently healthy trees. This nematode was originally described from British Columbia, Canada, where it seemed to be restricted in its distribution to vineyards in the south Okanagan Valley. To our knowledge, this is the first report of X. pacificum in the United States. References: (1) B. A. Ebsary et al. Can. J. Zool. 67:801, 1989. (2) F. Lamberti et al. Russian J. Nematol. 8:65, 2000.

Facilitation of atrioventricular reentrant tachycardia by iatrogenic right bundle branch block

The present case report describes the diagnosis of a concealed bypass tract in the right lateral wall revealed by electrophysiologic evaluation performed in a patient with rare palpitations. A iatrogenic right bundle branch block (RBBB) caused the occurrence of an incessant atrioventricular reentrant tachycardia. The disappearance of the RBBB determined a very difficult induction of the tachycardia that, when induced, showed a shorter cycle length and ventriculoatrial interval than those observed during RBBB tachycardia. The presence of a RBBB ipsilateral to the right free wall accessory pathway provided a critical delay within the circuit thus allowing the bypass tract to recover excitability. This relevant delay also allows the sinus beat to initiate and stabilize the tachycardia thus rendering it incessant.

Radiofrequency catheter ablation of idiopathic left ventricular outflow tract tachycardia: utility of intracardiac echocardiography

INTRODUCTION

The site of origin of idiopathic ventricular tachycardia (VT) arising from the left ventricular outflow tract (LVOT) may be closely related to the aortic valve leaflets, and radiofrequency (RF) delivery potentially can damage them. Intracardiac echocardiography (ICE) can identify accurately the ablation electrode and anatomic landmarks, and contact with the endocardium can be easily assessed. The aim of this study was to define the utility and the accuracy of ICE in guiding RF ablation of idiopathic VT of the LVOT.

METHODS AND RESULTS

Five consecutive patients (all men; mean age 20.4 years, range 16 to 25) symptomatic for idiopathic VT underwent RF ablation. A 9-French, in-sheath catheter with a 9-MHz ultrasound transducer was inserted through the femoral vein and positioned in the His-bundle region or right ventricular outflow tract to provide a clear view of the aortic root. Local earliest ventricular activation during tachycardia and pace mapping were used to identify the ablation site. Idiopathic VT was ablated successfully in all patients using a median of two RF pulses, delivered during tachycardia. High-resolution images of the aortic valve and ablation electrode were achievable in all cases. Direct vision of ablation electrode-endocardial contact in the outflow tract was assessed easily in all patients.

CONCLUSION

Idiopathic VT of the LVOT can be treated successfully with RF ablation. ICE can accurately guide catheter ablation and identify anatomic landmarks, endocardial contact, and ablation electrode movement.

Postcardioversion atrial electrophysiologic changes induced by oral verapamil in patients with persistent atrial fibrillation

OBJECTIVES

The aim of our study was to verify the effect of oral administration of verapamil on atrial electrophysiologic characteristics after cardioversion of persistent atrial fibrillation (AF) in humans.

BACKGROUND

Discordant findings have been reported regarding the efficacy of verapamil in preventing the electrical remodeling induced by AF.

METHODS

We determined the effective refractory periods (ERPs) at five pacing cycle lengths (300 to 700 ms) and in five right atrial sites after internal cardioversion of persistent AF (mean duration 238.1+/-305.9 days) in 19 patients. Nine patients received oral verapamil (240 mg/day) starting four weeks before the electrophysiologic study, whereas the other 10 patients were in pharmacologic washout.

RESULTS

The mean ERPs were 202.0+/-22.7 ms in the washout group and 189.3+/-18.5 ms in the verapamil group (p < 0.0001). The degree of adaptation of refractoriness to rate was similar in the two groups (mean slope value in the washout group and verapamil group: 0.07+/-0.03 and 0.08+/-0.05, respectively), showing a normal or nearly normal adaptation to rate in the majority of the paced sites in both groups. The mean ERP was slightly longer in the septum than in the lateral wall and in the roof, both in the washout and verapamil groups.

CONCLUSIONS

In patients with persistent AF, long-term administration of verapamil before internal cardioversion resulted in 1) shortening of atrial ERPs; 2) no change in refractoriness dispersion within the right atrium; and 3) no change in atrial ERP adaptation to rate.

Electrophysiology of atrial fibrillation: evolving insights

In the last few years many studies have been performed to better understand the pathophysiological nature of atrial fibrillation (AF). These recent observations provide new insights into the initiation and perpetuation of AF, underlying the importance of the pulmonary veins as major sources of atrial triggers and introducing new concepts such as atrial electrical remodeling and spatial heterogeneity of the electrophysiologic characteristics of this arrhythmia. The purpose of this review was to provide current knowledge about AF electrophysiology in an effort to unite old models and new concepts.

Transoesophageal low-energy cardioversion of atrial fibrillation. Results with the oesophageal-right atrial lead configuration

BACKGROUND

Low energy internal cardioversion is a safe and effective procedure to restore sinus rhythm in patients with atrial fibrillation refractory to external cardioversion. However the procedure is invasive and fluoroscopy is mandatory. Aim of the study To assess the efficacy, safety and tolerability of a new simplified procedure of low energy internal cardioversion.

METHODS

Twenty-five consecutive patients (19 males and 6 females) with persistent atrial fibrillation were submitted to low energy internal cardioversion using a step-up protocol (in steps of 50 V, starting from 300 V). A large surface area lead (cathode) was positioned in the oesophagus, 45 cm from the nasal orifice. A second large surface area lead (anode) was positioned in the right atrium. A quadripolar lead was positioned at the right ventricular apex to achieve ventricular synchronization and back-up pacing. Oesophageal endoscopy was performed within 24 h of the end of the procedure and repeated after 48 h, if injury to the oesophageal mucosa had occurred.

RESULTS

Sinus rhythm was restored in 23 patients (92%) with a mean delivered energy of 15.74 J (range 5-27) and a mean impedance of 48 Omega. In two patients, endoscopy revealed that small burns had occurred in the oesophageal mucosa. Such lesions spontaneously healed after 48 h.

CONCLUSIONS

This new technique of performing low energy internal cardioversion is effective and safe and avoids the positioning of a lead in the coronary sinus or in the left pulmonary artery, thereby simplifying the procedure.

Typical atrial flutter ablation: conduction across the posterior region of the inferior vena cava orifice may mimic unidirectional isthmus block

INTRODUCTION

The aim of this study was to map the low right atrium before and after radiofrequency ablation of the inferior vena cava-tricuspid annulus (IVC-TA) isthmus in patients with typical atrial flutter (AFI) to better understand the electrophysiologic meaning of incomplete or unidirectional block following the ablation procedure and its relationship with AFI recurrence.

METHODS AND RESULTS

We performed atrial mapping in 12 patients using a "basket" catheter in the IVC orifice, Halo catheter in the right atrium, and multipolar catheters in the coronary sinus (CS) and His region. In patients in sinus rhythm, atrial activation was analyzed during pacing from the CS and low lateral right atrium (LLRA) before and after ablation. Atrial activation propagated across the isthmus and posterior region of the IVC orifice simultaneously before ablation. Mapping during AF1 in four patients showed that the crista terminalis was a site of functional block. After ablation, evaluation of Halo catheter recordings in three patients showed apparent unidirectional counterclockwise block, whereas analysis of basket catheter recordings demonstrated complete bidirectional block. The apparent conduction over the isthmus during pacing from proximal CS was due to conduction along the posterior part of the IVC orifice, which activated the LLRA despite complete isthmus block.

CONCLUSION

Our results demonstrate that limited endocardial mapping may yield a pattern compatible with unidirectional block in the IVC-TA isthmus, although bidirectional block is present at this anatomic level.

Catheter ablation of paroxysmal atrial fibrillation using a 3D mapping system

BACKGROUND

We treated paroxysmal recurrent atrial fibrillation (AF) with radiofrequency (RF) catheter ablation by creating long linear lesions in the atria. To achieve line continuity, a 3D electroanatomic nonfluoroscopic mapping system was used.

METHODS AND RESULTS

In 27 patients with recurrent AF, a catheter incorporating a passive magnetic field sensor was navigated in both atria to construct a 3D activation map. RF energy was delivered to create continuous linear lesions: 3 lines (intercaval, isthmic, and anteroseptal) in the right atrium and a long line encircling the pulmonary veins in the left atrium. After RF application, the atria were remapped to validate completeness of the block lines, demonstrated by late activation of the areas circumscribed by the lines. The mean procedure duration was 312+/-103 minutes (range, 187 to 495), with mean fluoroscopy time of 107+/-44 minutes (range, 32 to 185 minutes). No acute complications occurred, but 1 patient experienced early prolonged sinus pauses and received a pacemaker. During the first day, 17 patients (63%) had AF episodes, but at discharge, 25 patients were in sinus rhythm. After a follow-up of 6. 0 to 15.3 months (average, 10.5+/-3.0 months), 16 patients are asymptomatic, 3 have an almost complete disappearance of symptoms, 1 patient is improved, and 7 patients have their AF attacks unchanged.

CONCLUSIONS

Paroxysmal recurrent drug-refractory AF can be treated by RF catheter ablation. Creation of long continuous linear lesions necessary to compartmentalize the atria is facilitated by a nonfluoroscopic electroanatomic mapping system.

Reproducibility of spontaneous initiations of atrial fibrillation

INTRODUCTION

It has been suggested that some atrial regions may play a role in the maintenance of atrial fibrillation (AF), whereas little is known about the presence of critical areas for the initiation of AF. It is conceivable that the identification of such critical areas may lead to more localized and selective strategies of ablative therapy.

METHODS AND RESULTS

A patient suffering from paroxysmal AF was extensively mapped in both the atria with a multielectrode basket catheter in right atrium and two decapolar catheters placed in the coronary sinus and along the left septum. During the mapping, seven identical patterns of initiation of AF were recorded. AF was initiated by an atrial premature beat (APB) arising from the superior right septum, followed by a reentrant beat originating from the same area that slowly propagated through the atria and resulted in late activation of the right lateral wall. During sinus rhythm, the majority of the electrograms were single potentials, whereas during the APB, and particularly during the first atrial reentrant beat, a high percentage of fragmented complexes was present, mainly located in the right superior septum. These fragmented complexes were present in the same sites in each initiating episode and remarkably, they showed an almost identical morphology.

CONCLUSION

This case suggests that in some patients the initiation of AF could be caused by reentrant circuits localized in specific atrial regions and the reentrant circuits could be identical in the different episodes of AF. This highlights the importance of increasing our understanding of the mechanisms of the initiation of AF so that we can identify any critical area involved in the genesis of AF where selective RF lesions may be effective in curing this arrhythmia.

Catheter ablation in a patient with a congenital giant right atrial diverticulum presented as Wolff-Parkinson-White syndrome

A young woman symptomatic for tachycardia showed right ventricular preexcitation on the surface ECG with a pattern during induced atrial fibrillation suggestive of multiple APs. Noninvasive imaging techniques performed prior to catheter ablation demonstrated the presence of a giant right atrial diverticulum confirmed by hemodynamic procedure. This structure functioned as an enormous accessory AP. We performed catheter ablation of this pathway using a special 4-mm multipolar catheter inside the diverticulum. This is the first case of such as anomaly being successfully treated with catheter ablation.

Early dialysis in heart insufficiency of patients with chronic renal failure

In patients with severe heart failure life expectancy is short, the quality of life is affected, and the service costs are very high. Drug therapies remain restricted despite continuous clinical research. Therefore new therapeutic approaches have been attempted to improve the signs and symptoms of the disorder. In our study we followed patients suffering from class-IV cardiac failure concomitant with chronic renal failure. The patients were initially treated by means of hemofiltration, and subsequently they underwent a personalized dialysis program. The survival rate after 2 years was 62.5%. In 7 of the 8 patients the results revealed a drop to a class-III condition. The hospitalization period was limited to a few days. Early dialytic therapy represents a reality for such patients.

Electrophysiological characteristics of the human atria after cardioversion of persistent atrial fibrillation

BACKGROUND

In animal models, induced atrial fibrillation shortens the atrial effective refractory period (ERP) and reverses its physiological adaptation to rate. It is not clear whether this process, known as "electrical remodeling," occurs in humans.

METHODS AND RESULTS

We determined the ERPs, at 5 pacing cycle lengths (300 to 700 ms) and in 5 right atrial sites, after internal cardioversion of chronic atrial fibrillation in 25 patients (14 in pharmacological washout and 11 on amiodarone). The ERPs were 195.5+/-18.8 ms in the washout and 206.3+/-17.9 ms in the amiodarone patients (P<0.0001). ERPs were closely correlated with the stimulation rates (r=0.95 in the washout and r=0.94 in the amiodarone group), and slope values indicating a normal (>/=0.07) or nearly normal (0.05 to 0.06) adaptation of ERP to rate were found in 77% of the 84 paced sites. The mean ERP was shorter in the lateral wall (198.1+/-17.9 ms) than in the atrial roof (203.3+/-21.5 ms) and in the septum (210.5+/-20.0 ms) (P<0.03). After 4 weeks of sinus rhythm, the mean ERP, determined again in 8 patients (4 in wash-out and 4 on amiodarone), was significantly increased compared with the basal study (221. 4+/-21.4 versus 197.8+/-18.3 ms, P<0.0001).

CONCLUSIONS

After cardioversion of chronic atrial fibrillation, (1) atrial ERP adaptation to rate was normal or nearly normal in the majority of the cases, (2) a significant dispersion of refractoriness between different right atrial sites was present, and (3) ERPs were significantly increased after 4 weeks of sinus rhythm in both washout and amiodarone patients.

Atrial mapping and radiofrequency catheter ablation in patients with idiopathic atrial fibrillation. Electrophysiological findings and ablation results

BACKGROUND

Knowledge of the electrophysiological substrates and the cure of atrial fibrillation (AF) is still unsatisfactory. The goal of this study was to evaluate the electrophysiological features of idiopathic AF and their relationship to the results of radiofrequency (RF) catheter ablation of AF and the safety and effectiveness of this procedure.

METHODS AND RESULTS

Sixteen patients with idiopathic AF underwent atrial mapping during AF and then RF ablation in the right atrium. The atrial activation was simultaneously recorded in four regions in the right atrium: high lateral wall (HL), low lateral wall (LL), high septum (HS), and low septum (LS) and in the left atrium through the coronary sinus (CS). In these regions, we evaluated the atrial fibrillation intervals (FF) and the morphological features of AF recordings by Wells' classification. No complications occurred during RF ablation. Of the 16 patients, 9 (56%) without AF recurrences during the follow-up (11 +/- 4 months) were considered successfully ablated. These patients showed a significantly shorter mean FF interval in the HS and the LS (122 +/- 32 and 126 +/- 28 ms, respectively), than in the HL and LL (159 +/- 24 and 156 +/- 28 ms, respectively). Moreover, the septum had more irregular electrical activity with greater beat-to-beat changes in FF and a higher prevalence of type III AF than the lateral region. The CS had similar behavior to the septum. Conversely, patients with unsuccessful ablation had an irregular atrial activity in the lateral wall, septum, and CS with no significant differences between the different sites.

CONCLUSIONS

Right atrial endocardial catheter ablation of AF is a safe procedure and may be effective in some patients with idiopathic AF. The atrial mapping during AF showed a more disorganized right atrial activation in the septum than in the lateral wall in patients with successful ablation.

Modulation of expression at the level of splicing of cut-1 RNA in the infective second-stage juvenile of the plant parasitic nematode Meloidogyne artiellia

The cut-1 gene coding for cuticlin-1 has been isolated from the plant parasitic nematode Meloidogyne artiellia. The sequence of the cut-1 gene was compared with the corresponding sequence from the free-living nematode Caenorhabditis elegans. The high degree of similarity between the amino acid sequences, together with the occurrence of characteristic sequence motifs, indicates that the cuticlin-1 is a non-collagenous component of the cuticle also in plant parasitic nematodes. Studies on the expression pattern during the development of M. artiellia indicate that there is a burst of expression of this gene during moulting. Then, the expression rate is reduced in the infective juveniles, which migrate in the soil. In the sedentary females, in contrast, no expression is detected, while in the males which move freely through the soil, the gene is expressed and the transcript fully processed. These data strongly suggest that the gene is developmentally regulated. It is proposed that the production of cuticlin plays an important role in determining the mechanical properties of the cuticle. Furthermore, evidence is provided to indicate that the modulation of cut-1 expression is achieved by regulation of the cis-splicing mechanism in the infective second-stage juvenile.

A silent trans-splicing signal in the cuticlin-encoding gene of the plant-parasitic nematode Meloidogyne artiellia

A gene (cut-1) coding for a cuticular protein, cuticlin-1, has been isolated and sequenced in the plant parasitic nematode, Meloidogyne artiellia. The nucleotide sequence revealed a typical eukaryotic-like organization, exons and introns bordered by canonical sequences. The 5' flanking region presents nematode-specific sequence motifis, including a trans-splicing signal. Studies on the expression of this gene demonstrated that, while in the adult females cut-1 is not expressed, the removal of the introns occurs in the eggs. These experiments also indicate that cis-splicing precedes the processing of the 5' untranslated region. In no case has a trans-spliced transcript been detected.

[Idiopathic ventricular tachycardia with onset in the verapamil-sensitive left ventricle: the clinical characteristics and long-term follow-up of 37 patients]

BACKGROUND

Idiopathic verapamil-responsive left ventricular tachycardia (IVRLVT) is a rare, well known form of ventricular tachycardia. Issues concerning long-term prognosis, drug prophylaxis and non-pharmacological therapy are rarely reported in the literature. We report the long-term follow-up, the efficacy of various drugs in the prophylaxis and the role of catheter ablation in a large group of patients with IVRLVT.

METHODS AND RESULTS

This retrospective study involves 37 patients with a mean age of 28.3 +/- 14.8 years at first IVRLVT episode. The tachycardia morphology was typically with a right bundle-branch block configuration in all cases, with left axis deviation in 33 and right axis deviation in 5 (one patient had the 2 morphologies). Four patients had a mitral valve prolapse; the remaining 33 patients had neither clinical nor echocardiographic signs of heart disease. Only sporadic ventricular extrasystoles were detected at Holter monitoring in 73% of cases; 30% of patients had positive criteria for the presence of late potentials at signal averaged ECG. During electrophysiologic study, the tachycardia could be easily induced in 91% of patients. Mean follow-up is 7.3 +/- 4.7 years; all patients are alive at the end of follow-up. A mean of 2.3 +/- 1.2 drugs was prescribed in 35 patients (94.6%); betablockers were effective in 66% of the cases, verapamil in 20%, class I drugs in 22%, class III drugs in 15%. Both the 2 patients, who never received prophylaxis, and the 4 who stopped medication, utilize verapamil in case of recurrences. Eight patients were submitted to catheter ablation, with DC shock the first 2 patients, with RF energy from the third on; all but one (with DC shock) were successfully cured.

CONCLUSIONS

Long-term follow-up confirmed the good prognosis of this form of ventricular tachycardia; a new insight that has been addressed about prophylaxis is the high efficacy of betablockers in preventing relapse and the poor efficacy of verapamil per os in chronic prophylaxis. Radiofrequency catheter ablation is effective and safe, using the earliest ventricular potential and the pace-mapping reproducing the same morphology of the tachycardia in all the 12 leads as a marker to identify the site of RF application, and may be proposed to all patients suffering from frequent episodes of IVRLVT.

Catheter ablation of permanent junctional reciprocating tachycardia with radiofrequency current

OBJECTIVES

This study evaluated accessory pathway location, its relation to retrograde P wave polarity on the surface electrocardiogram and radiofrequency ablation efficacy and safety in a large group of patients with permanent junctional reciprocating tachycardia.

BACKGROUND

Permanent junctional reciprocating tachycardia is an uncommon form of reciprocating tachycardia, almost incessant from infancy and usually refractory to drug therapy. It is characterized by RP > PR interval and usually by negative P waves in leads II, III, aVF and V4 to V6. Retrograde conduction occurs through an accessory pathway with slow and decremental properties. Although this accessory pathway has been classically located in the posteroseptal zone, other locations have been recently reported.

METHODS

The study included 32 patients (20 men, 12 women, mean [+/- SD] age 29 +/- 15 years) with a diagnosis of permanent junctional reciprocating tachycardia confirmed at electrophysiologic study. Seven patients had depressed left ventricular function. Radiofrequency energy was applied at the site of the earliest retrograde atrial activation during tachycardia.

RESULTS

There were 33 accessory pathways. The site of the earliest retrograde atrial activation was posteroseptal in 25 patients (76%), midseptal in 4 (12%), right posterior in 1 (3%), right lateral in 1 (3%), left posterior in 1 (3%) and left lateral in 1 (3%). Thirty pathways were ablated with a right approach; in 11 patients with posteroseptal pathway the ablation was performed through the coronary sinus. Three pathways were ablated with a left approach. Positive retrograde P wave in lead I suggested that ablation could be performed from the right side; if negative, it did not exclude ablation from this approach. All the accessory pathways were successfully ablated, with a median of 3 and a mean of 5.6 +/- 5 radiofrequency applications of 70 +/- 26 s in duration. In two patients with the accessory pathway in the midseptal zone, a transient second- and third-degree atrioventricular block, respectively, was observed after ablation. At a mean follow-up of 18 +/- 12 months, 31 patients (97%) are asymptomatic without antiarrhythmic therapy (95% confidence interval [CI] 84% to 99%). Recurrences were observed in four patients (13%) (95% CI 4% to 29%), three of whom had the accessory pathway ablated successfully at a second session. All patients with depressed left ventricular function showed a marked improvement after successful ablation.

CONCLUSIONS

In our experience, most of the patients with permanent junctional reciprocating tachycardia had posteroseptal pathways; all these pathways were ablated from the right side. P wave configuration may be helpful in suggesting the approach to the site of ablation. Catheter ablation using radiofrequency energy is an effective therapy for permanent junctional reciprocating tachycardia.

Formalin-induced infidelity in PCR-amplified DNA fragments

A 643-nucleotide-long fragment of rDNA gene was amplified by PCR in the nematode worm Caenorhabditis elegans. When the experiments were performed by using samples fixed in formalin, artefacts were detected. While the size of the amplified fragment resulted unaffected, very striking differences were seen in the nucleotide sequences of the amplified fragments. Furthermore, in many cases, the PCR reaction failed completely. The results obtained might warn of potential problems, especially when the amount of DNA to be amplified is scarce.

[Atrioventricular conduction before and after the radiofrequency catheter ablation of a nodal reentry tachycardia circuit]

Aim of our study was to retrospectively evaluate atrioventricular conduction 24 hours after selective radiofrequency catheter ablation of the fast pathway or after selective ablation of the slow pathway of the atrioventricular nodal reentrant tachycardia circuit. Electrophysiologic modifications were retrospectively analyzed in 47/48 patients successfully submitted to fast pathway ablation and in 90/93 patients successfully submitted to slow pathway ablation. The atrioventricular conduction intervals (P-Q and A-H), both anterograde and retrograde Wenckebach point, the effective refractory period of atrioventricular node and the atrioventricular node function curve were evaluated before and after selective radiofrequency catheter ablation of slow and fast pathway. We identified the fast pathway ablation potential as: A:V ratio > or = 2:1, His electrogram < or = 150 microV. The slow pathway potential was identified as the widest, sharpest and latest atrial electrogram recorded during sinus rhythm in the posteroseptal region of the atrioventricular junction or as the widest, sharpest and earliest observed during retrograde conduction. We observed a significant increase in the P-Q and A-H intervals in patients submitted to fast pathway ablation, while no significant modification of these parameters was appreciated in patients submitted to slow pathway ablation. No significant modification of anterograde Wenckebach point (NS) was observed in patients submitted to successfully ablation of fast pathway while a statistically significant increase in anterograde Wenckebach point (p = 0.03) was observed in patients submitted to slow pathway ablation. After selective fast pathway ablation, retrograde conduction was absent in 82.9% of patients submitted to ablation; in the remaining 17.1% a significant increase of retrograde Wenckebach point was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ablation of paroxysmal tachycardia in Wolff-Parkinson-White syndrome]

Surgical or catheter ablation of accessory pathways by means of high energy shock has been substantial associated with morbidity and mortality. On the contrary radiofrequency current, an alternative energy source for ablation, has a low incidence of complications and a very high success rate. Aim of this study was to relate about the results using catheter ablation of accessory pathways by radiofrequency current in our Electrophysiologic laboratory. Radiofrequency current (20-40 W) was delivered between a large-tip catheter electrode positioned against the mitral or tricuspid anulus and a standard adhesive electrosurgical dispersive pad applied to the left chest wall. When possible radiofrequency delivery was guided by catheter recordings of accessory pathway activation. Ablation was attempted in 181 patients with 191 accessory pathways. We obtained successful ablation of 187/191 accessory pathways and accessory pathway conduction was eliminated in 177/181 patients. During a mean follow-up of 14 +/- 10 months preexcitation returned in 7 patients (3.9%). All underwent a second successful ablation. In 1 patient, during the procedure, we observed a transient ischemic attack, with no complications. In accordance to other reports we conclude that radiofrequency ablation is highly effective in ablating accessory pathways, with low morbidity and no mortality.

[A methodological approach to the transcatheter radiofrequency ablation of anomalous Kent-type pathways]

Aim of this study is to suggest our methodological approach for transcatheter ablation of Kent bundles by radiofrequency energy as to the potential ablation sites, the need in unipolar or bipolar recording mode, single catheter or multiple catheters mapping of anomalous pathways, the vascular approach for both left sited and right sited anomalous pathways, and finally the duration and power to supply. The recording of Kent potential and/or a Va-QRS interval > or = 0 ms have been considered significant predictors of success (respectively p < 0.001 and p < 0.05). The unipolar recording mode has been considered critical in the choice of ablation site in 47 (29.9%) patients. A 6-catheter approach for both diagnostic electrophysiologic studies and mapping allowed us to easily localize accessory pathways and to record either a probable or possible Kent potential in a high percentage of patients and to reduce the permanence of the ablation catheter in the left ventricle. By transaortic retrograde approach in ablating left sited anomalous pathways, we obtained a high success rate, while right sited accessory pathway were approached from the inferior vena cava. In right sited anomalous pathway we delivered radiofrequency energy for a longer time in order to avoid a relapse soon after the procedure. We performed ablation of 174/178 (97.7%) anomalous pathways in 165/169 (97.6%) patients. We observed a 3.8% relapse during a mean follow up of 13 +/- 9 months.

Diversity of Xiphinema americanum-group Species and Hierarchical Cluster Analysis of Morphometrics

Of the 39 species composing the Xiphinema americanum group, 14 were described originally from North America and two others have been reported from this region. Many species are very similar morphologically and can be distinguished only by a difficult comparison of various combinations of some morphometric characters. Study of morphometrics of 49 populations, including the type populations of the 39 species attributed to this group, by principal component analysis and hierarchical cluster analysis placed the populations into five subgroups, proposed here as the X. brevicolle subgroup (seven species), the X. americanum subgroup (17 species), the X. taylori subgroup (two species), the X. pachtaicum subgroup (eight species), and the X. lambertii subgroup (five species).

Description of Afenestrata koreana n. sp. (Nematoda: Heteroderinae), a Parasite, of Bamboo in Korea

Afenestrata koreana n. sp. collected from roots of bamboo (Phyllostachys pubescens) in Gyeongnam Province in the southern part of the Korean peninsula is described and illustrated. Its primary differentiating characteristics are a globose to subspherical body in adults with a prominent neck and terminal cone, thick cuticle, terminal vulva, and deep vagina. Fenestra, bullae, and underbridge are absent. The anus is on the immediate posterior side of the cone. Superficial small tubercules cover all the terminal cone area. The new species differs markedly from the other two known species in the genus, specifically in having three incisures in the lateral field of juveniles and a shorter stylet length in juveniles and adults. The male is unknown.