Updated results on catheter ablation of ventricular arrhythmias arising from the papillary muscles of the left ventricle

BACKGROUND

Catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricle`s (LV) papillary muscles (PM) is challenging. In this study we present results of catheter ablation using multiple energy sources and image-based approaches.

METHODS

Fifty-three patients (49 ± 17 years old; 34% females; median LV ejection fraction 53 ± 11%) underwent catheter cryoablation or radiofrequency (RF) ablation with non-contact force sensing (Non-CFS) catheters and cardiac computed tomography integration (CTII) into the electroanatomical mapping system or contact force sensing RF (CFS RF) ablation catheters and intracardiac echo-facilitated 3D electroanatomical mapping. Ventricular arrhythmias foci were mapped at either the anterolateral (ALPM) or posteromedial papillary muscles (PMPM). Ablation was performed using an 8-mm cryoablation catheter (CRYO); a Non-CFS 4-mm open-irrigated RF catheter; or a CFS RF 3.5-mm open-irrigated tip catheter, via transmitral or transaortic approach.

RESULTS

Acute success rate was 83% for Non-CFS RF/CTII; 100% for CRYO/CTII (n = 16) and CFS RF/ICE3D (n = 14) (P = 0.03). Catheter stability was achieved in all patients treated with Cryo/CTII. VA recurrence at 12 months follow-up was 48% (n = 11) for Non-CFS RF/CTII; 19% (n = 3) for CRYO/CTII; and 7% (n = 1) for CFS RF/ICE3D (P = 0.02).

CONCLUSIONS

Non-CFS/CTII was associated with an increased risk of recurrence of the clinical arrhythmia. Ablation with either CFS RF/ICE3D or CRYO/CTII showed high acute success rates and low recurrence rates during follow-up. Cryoablation provided stable contact and was less arrhythmogenic.

Results of Cryoenergy and Radiofrequency-Based Catheter Ablation for Treating Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle, Guided by Intracardiac Echocardiography and Image Integration

BACKGROUND

Catheter radiofrequency ablation of ventricular arrhythmias (VAs) arising from the left ventricle's papillary muscles has been associated with inconsistent results. The use of cryoenergy versus radiofrequency has not been compared yet. This study compares outcomes and complications of catheter ablation of VA from the papillary muscles of the left ventricle with either cryoenergy or radiofrequency.

METHODS AND RESULTS

Twenty-one patients (40±12 years old; 47% males; median ejection fraction 59±7.3%) with drug refractory premature ventricular contractions or ventricular tachycardia underwent catheter cryoablation or radiofrequency ablation. VAs were localized using 3-dimensional mapping, multidetector computed tomography, and intracardiac echocardiography, with arrhythmia foci being mapped at either the anterolateral papillary muscle or posteromedial papillary muscles of the left ventricle. Focal ablation was performed using an 8-mm cryoablation catheter or a 4-mm open-irrigated radiofrequency catheter, via transmitral approach. Acute success rate was 100% for cryoenergy (n=12) and 78% for radiofrequency (n=9; P=0.08). Catheter stability was achieved in all patients (100%) treated with cryoenergy, and only in 2 (25%) patients treated with radiofrequency (P=0.001). Incidence of multiple VA morphologies was observed in 7 patients treated with radiofrequency (77.7%), whereas none was observed in those treated with cryoenergy (P=0.001). VA recurrence at 6 months follow-up was 0% for cryoablation and 44% for radiofrequency (P=0.03).

CONCLUSIONS

Cryoablation was associated with higher success rates and lower recurrence rates than radiofrequency catheter ablation, better catheter stability, and lesser incidence of polymorphic arrhythmias.

X-ray diffraction and Raman spectroscopy study of white decorations on tricolored ceramics from Northwestern Argentina

White virgules, commas, and dot designs on tricolored ceramics are sporadically found in different archaeological sites located in Northwestern Argentina area, as Puna and Quebrada de Humahuaca. This decorating style has been reported in several articles, but few previous archaeometric studies have been carried out on the pigment composition. Fragments from Puna and Quebrada archaeological sites, belonging to Regional Development Period (900-1430 AD), were analyzed by X-ray diffraction and Raman spectroscopy in order to characterize the pigments employed. Red and black pigments are based on iron and manganese oxides, as it has been extensively reported for the NW Argentina area. White pigments from white virgules, comma, and dot designs have shown different composition. Hydroxyapatite was found in samples from Doncellas site (North Puna region), and calcium and calcium-magnesium containing compounds, as vaterite and dolomite, along with titanium containing compounds were detected on samples from Abralaite (Central Puna region) and Gasoducto (Quebrada de Humahuaca region). It has been concluded that pigment composition is not characteristic of a unique region.

Microaerobic digestion of sewage sludge on an industrial-pilot scale: the efficiency of biogas desulphurisation under different configurations and the impact of O2 on the microbial communities

Biogas produced in an industrial-pilot scale sewage sludge reactor (5m(3)) was desulphurised by imposing microaerobic conditions. The H2S concentration removal efficiency was evaluated under various configurations: different mixing methods and O2 injection points. Biogas was entirely desulphurised under all the configurations set, while the O2 demand of the digester decreased over time. Although the H2S removal seemed to occur in the headspace, S(0) (which was found to be the main oxidation product) was scarcely deposited there in the headspace. O2 did not have a significant impact on the digestion performance; the VS removal remained around 47%. Conversely, DGGE revealed that the higher O2 transfer rate to the sludge maintained by biogas recirculation increased the microbial richness and evenness, and caused an important shift in the structure of the bacterial and the archaeal communities in the long term. All the archaeal genera identified (Methanosaeta, Methanospirillum and Methanoculleus) were present under both anaerobic and microaerobic conditions.

[Internationally adopted children's psychosocial adjustment in internationally adopted children: personal and parental perceptions]

OBJECTIVE

To assess psychosocial adjustment in middle childhood in internationally adopted children in Spain.

MATERIAL AND METHODS

One hundred and one internationally adopted children (67% girls), aged 8 to 12, and their adoptive parents (97 mothers and 67 fathers) completed the Behaviour Assessment System for Children (BASC). Descriptive analyses and mean comparisons (Student's t test and ANOVA) were conducted to test for gender, age at adoption, current age and area of origin differences for each informant on the scales and composite-scales of the BASC. Multiple linear regression analyses were then performed. Agreement between mothers and fathers was calculated using intra-class correlation coefficients (ICC). Percentages of children in the normal and symptomatic range in composite-scales were compared to the theoretical ones using chi square tests.

RESULTS

The results showed that children were generally well-adjusted, regardless of the informant. Differences were found in children's adjustment by area of origin, gender and current age, although values remained within the normal range. The ICC ranged from 0.46 (satisfactory) to 0.84 (excellent). Compared to the normal-group, more children showed difficulties in adapting to school (24.8%; as reported by children), externalising problems, (27.8% and 28.3%; as reported by mothers and fathers, respectively), and behavioural and adaptive difficulties (28.4% and 29.9%, respectively; as reported by fathers).

CONCLUSIONS

About 25% of the internationally adopted children showed adaptive difficulties in basic areas, clearly identified using the BASC, which need psychological and paedological support.

Vanadium Oxide Nanotubes with Diamine Templates

Diamine vanadium oxide nanotubes (DA-VOx-NTs) have been prepared in high yields applying two different synthesis routes, namely either a sol-gel reaction followed by a hydrothermal treatment or an exchange reaction. The first route is analogous to the well-known preparation of VOx-NTs containing monoamines: a vanadium(V) alkoxide is mixed with an α, ω- diamine (H2N[CH2]nNH2 with 12≤n≤20), the resulting adduct is hydrolyzed, and, after aging, a hydrothermal treatment leads to the nanotubes in pure form. The exchange of the monoamine template in VOx-NTs against diamines represents an alternative access to DA-VOx-NTs. This reaction occurs readily and is also applicable for diamines with short CH 2 chains like, e.g., in ethylene diamine. The TEM characterization of the DA-VOx-NTs confirms the tubular morphology which is widely preserved in the products of the exchange reactions. The characteristic feature of as-synthesized DA-VOx-NTs is a thick tube wall with many VO, layers while the exchange products are tubes comprising thin walls or bent packs of layers.