Mechanisms of functional improvement through cognitive rehabilitation in schizophrenia.

Whereas the efficacy of cognitive rehabilitation in schizophrenia is widely known, studies examining mechanisms for functional improvement are still scarce. The aim of the study was to examine the mediational mechanisms through which cognitive rehabilitation improves functioning in schizophrenia. One hundred and eleven schizophrenia patients were randomly assigned to either a 4-month cognitive rehabilitation group or an active control group. Patients underwent a neurocognitive battery (including processing speed, verbal memory, working memory and executive functioning) and social cognition assessment (emotion perception, theory of mind and social perception). Functioning was assessed by the combined use of a performance-based instrument, the UCSD Performance-based Skills Assessment (UPSA) and an observer-rated instrument, the Global Assessment of Functioning (GAF). The trial was registered in clinicaltrials.gov (NCT02796417). Multiple mediational analyses revealed that the effect of cognitive rehabilitation on functional improvement was partially mediated by changes in processing speed and verbal memory, but not by the domains of social cognition and negative symptoms. More specifically, verbal memory partially mediated the treatment's effect on performance-based functioning (UPSA), whereas processing speed acted as a partial mediator for observer-rated functioning (GAF). The effect of rehabilitation on functioning did not take place through all the domains that showed significant improvement. Verbal memory and processing speed emerged as the most crucial factors. However, these complex interactions need further research.

Cardiac allograft vasculopathy in Dutch heart transplant recipients.

BACKGROUND: Cardiac allograft vasculopathy (CAV) is a multifactorial disease and a major cause of graft failure after heart transplantation. However, the impact of CAV may vary according to the definition and the regional differences in transplantation settings. OBJECTIVES: We sought to assess CAV prevalence, predictors and prognosis in Dutch heart transplant recipients based on coronary angiography, following the 2010 standard nomenclature of the International Society for Heart and Lung Transplantation. METHODS: Patients ≥18 years who underwent heart transplantation at our centre with at least one coronary angiography during follow-up were included in the analysis. Clinical variables were collected prospectively. RESULTS: Among 495 analysed recipients, there were 238 (48 %) with CAV. The prevalence of CAV was 18, 47 and 70 % at 4, 12 and 20 years, respectively. In the multivariable proportional hazards regression analysis, only male donor gender and increasing donor age were significantly associated with the risk of CAV. The long-term prognosis of the patients with CAV at fourth-year angiography was significantly worse as compared with that of CAV-free patients, independently of the severity of CAV (p < 0.001). CONCLUSION: The prevalence of CAV increased gradually over time, with a similar trend as in other registries. Post-transplant survival is decreased in patients with any degree of early CAV, indicating that management strategies should start with donor selection and preventive measures immediately after transplantation.

Variability of the egg hatch assay to survey benzimidazole resistance in nematodes of small ruminants under field conditions.

The egg hatch assay (EHA) is one of the main in vitro methods for detection of benzimidazole resistance in nematode parasites of small ruminants. However, although the EHA has been standardised at the laboratory level, the diagnostic performance of this method has not been fully characterised for field screenings. In the present work, monthly variation of benzimidazole resistance estimated by EHA was surveyed over two years in three sheep flocks and in one goat and an additional sheep flock sharing the same pastures. Resistance was measured by calculating both the effective dose of thiabendazole (TBZ) that inhibited hatching of ≥50% of parasite eggs (ED50) and the proportion (Pdd) of eggs hatching at a discriminating dose of 0.1 µg/ml TBZ. Pdd exhibited higher variability than ED50, in agreement with the higher sensitivity of Pdd to changes in resistance levels. Both resistance parameters, however, were highly correlated, and their variation was similarly related to the same factors. Resistance levels differed among sheep flocks, and the resistance level of the goat flock was higher than that measured for the sheep flock sharing the same pasture. Moreover, monthly variation of resistance in goats did not mirror that recorded in sheep. Resistance levels varied seasonally, with the highest values recorded in the spring, and they were inversely related to the number of days that samples were stored under anaerobic conditions. In addition, they were directly associated with the relative abundance of Teladorsagia spp. but inversely related to the relative abundance of Haemonchus spp. After controlling for the effects of these identified factors for variation, inter-monthly sampling variation due to unknown factors was the main source of variability, accounting for more than 60-70% of variance for both resistance parameters and yielding absolute estimation errors higher than 0.06 for ED50 or 0.2 for Pdd when resistance was estimated from a single sampling. Optimum sample size, estimated from variance components, suggested that at least 4-5 samplings would be needed to halve this absolute error, whereas additional samplings would slightly increase precision but at the cost of substantially increasing sampling effort. More research is needed to identify the main factors involved in this inter-sampling variation to standardise the implementation of EHA under field conditions.

Management and environmental factors related to benzimidazole resistance in sheep nematodes in Northeast Spain.

A survey to determine the level of parasite resistance to benzimidazoles (BZ) under field conditions was performed on 107 commercial sheep farms located in the Aragon region of northeast Spain. Resistance was measured using the discriminant dose, a simplified form of the in vitro egg hatch assay (EHA). Taking into account the spatial structure of the data, a multivariate approach was applied to management and environmental variables as well as to their relationships with BZ resistance levels compiled from each flock. Results estimated that 11% of flocks had resistant parasite populations, although we suspected the presence of BZ-resistant parasite strains in 98% of the sample. Resistance levels were more similar among the nearest flocks, suggesting a contagious spatial distribution of resistance (i.e., resistance at neighbouring farms was not independent from one another). Management variables such as frequency of deworming, grazing in private pastures and underdosing were positively related to resistance levels, whereas only the use of BZ was negatively related to resistance levels, likely because BZ were replaced by other anthelmintics in flocks where reduced BZ efficacy was suspected. In addition to climatic conditions and seasonality, land use was an environmental variable associated with observed BZ resistance levels. Generally, resistance was highest in cooler and wetter areas but was lower in flocks sampled during January-March compared to flocks sampled in April-June or October-December. Variation partitioning procedures showed that the variation of resistance explained by the effect of environmental variables was higher than management variables. The effects of both variable groups, however, highly overlapped with the spatial structure of resistant levels, which suggests that a considerable amount of the effects attributable to both variable groups may be actually due to the spatial distribution of resistance. The resistance variation explained by the spatial component suggested that other uncontrolled factors acting at short spatial scale (e.g., common management and environmental variables; the importation of resistant strains and their posterior spread across neighbouring flocks; the selection history of the worms carried out by historical management events previous to this survey; and genetic, physiological or both types of parasite population variation) could yield this contagious spatial structure of BZ resistance. Although further research is needed, both seasonal variation and the dependence of resistance levels among neighbouring flocks should be taken into account in the design of future research or observational resistance programmes to minimise spatial and temporal pseudo-replication. Thus, research would avoid biased estimations of resistance prevalence or of its relationship with putative factors.

Structural and functional characterisation of the ovine interferon gamma (IFNG) gene: its role in nematode resistance in Rasa Aragonesa ewes.

The ovine interferon gamma (IFNG) gene was structurally and functionally characterised, and the association between its variants and the response to Haemonchus contortus infection was examined in resistant and susceptible Rasa Aragonesa ewes in different physiological conditions. Sequential faecal egg counts (FECs) were performed on a naturally infected flock of 400 Rasa Aragonesa ewes and two groups of ewes selected for high (n=38) or low (n=33) FEC, which were subsequently challenged with H. contortus in the spring and autumn. The second challenge infection was performed to explore the extent to which the previously established resistance or susceptibility to H. contortus based on FEC reflected the worm burdens of ewes in different physiological states. The ovine IFNG gene was partially isolated and characterised, including the promoter and other regulatory regions. In addition, DNA sequencing of the resistant and susceptible Rasa Aragonesa ewes revealed 13 polymorphisms (12 SNPs and 1 microsatellite) in the IFNG gene. Association studies showed that a haplotype composed of C (SNP -641) and (GTTT)5 (microsatellite) was linked to the FEC and worm burden recorded in spring and autumn challenges, respectively, and thus to susceptibility to H. contortus in adult Rasa Aragonesa ewes. Our results also suggested that the IFNG gene was not responsible for the phenotypic variation in susceptibility to H. contortus but was linked to a QTL segregating near the IFNG gene. No significant differences in IFNG gene expression were found between either resistant and susceptible or pregnant and non-pregnant ewes. Finally, we studied the effects of the polymorphisms on IFNG gene expression, finding that the C/T SNP at -641 and the microsatellite showed significant effects in spleen. The C/T SNP at -641 was located within a possible trans-acting factor binding site. Further work is needed to elucidate the function of this SNP.

Effect of feeding bioactive forages on infection and subsequent development of Haemonchus contortus in lamb faeces.

Contrasting dried herbage diets were offered to lambs to evaluate their effects on Haemonchus contortus infection and on subsequent development of larvae in faeces. Artificially infected lambs (n=24, 4 months old) were allocated to one of four treatment groups (n=6) and fed on hay of lucerne (Medicago sativa; Lu), sulla (Hedysarum coronarium; Su), sainfoin (Onobrychis viciifolia; Sa) or wormwood (Artemisia absinthium; Wo) included as 20% in ground lucerne pellets. While voluntary intake was similar, lamb growth rates were notably affected by diet. Additionally, necropsies carried out 30 days post-infection showed that worm burden was reduced by 8 (Su), 13 (Sa) and 49% (Wo) with respect to that found in lambs fed on lucerne, though only the difference with wormwood was significant. Faecal egg excretion expressed on a dry matter basis was also reduced by 22 (Su), 54 (Sa) and 73% (Wo), but differences were significant only for wormwood and sainfoin, which was associated with a decrease in female fecundity. Sulla and sainfoin diets significantly reduced egg hatching rates but increased the percentage of L(3) in the faeces of the host animal, particularly in the case of sulla hay compared to other forages. Consequently, the potential risk of infection derived from faecal excretion could be notably altered. Further work is needed to validate these findings and their implications in an applied farming system.

Management of hepatocellular carcinoma recurrence after liver transplantation.

UNLABELLED: Management of patients with hepatocellular carcinoma (HCC) recurrence after liver transplantation (OLT) is not well established. We conducted a retrospective analysis of our results in the treatment of HCC recurrence after OLT Patients. The 23 HCC recurrences developed after 182 OLT performed for HCC within Milan criteria, had an average follow-up of 60 months. RESULTS: The median time to recurrence was 23.4 months. Surgical resection of the recurrence was possible in 11 patients, but an R-0 resection was obtained in 8 patients. Four of these 8 patients developed another recurrence, with 3 succumbing due to tumor recurrence and 1 alive at 12 months with recurrence. The other 4 patients without recurrences, include 3 who are alive at 19, 31, and 86 months and 1 who died at 32.6 months due to hepatitis C recurrence. The 3 patients with palliative resections developed recurrences. Twelve patients were rejected for surgery: 8 were treated symptomatically, 2 with systemic chemotherapy, and 2 with everolimus and sorafenib. This last treatment was also prescribed for 2 patients after R-0 surgery who are alive at 19 and 31 months and for 1 patient after R-1 surgery who is alive at 19 months. Of 15 patients who died, 13 succumbed to HCC recurrence. The average survival from transplantation was 61.7 +/- 37.5 and 48 +/- 34.3 months for patients without and with recurrence, respectively (P < .001). The survival from the recurrence was significantly higher among patients with R-0 surgery: 32.3 +/- 21.5 versus 11.9 +/- 6.9 months (P = .006). CONCLUSIONS: HCC recurrence after OLT of patients within Milan criteria was low but had a great impact on survival. Few cases are amenable to R-0 resection, but when possible it was associated with a significantly increased survival, although with an high incidence of a new recurrence. There is a rationale for the use of sorafenib and mammalian target of rapamycin based immunosuppression, which warrants randomized studies.

Silvopastoralism and autochthonous equine livestock: analysis of the infection by endoparasites.

Two groups of autochthonous Pura Raza Galega (PRG) horses, one comprising 483 animals under a silvopasturing regime, and the other comprising 72 PRG horses managed in farms, were used to analyse the effect of silvopasture on infection by endoparasites. Results were considered according to the age and the sex of the horses. Faecal samples were individually collected from each animal and analysed by the coprological flotation, sedimentation and migration techniques. Coprocultures were also done to identify the main strongylid genera affecting the horses. Eggs from the gastrointestinal nematoda Parascaris equorum, strongyles and Oxyuris equi were the only endoparasites observed in the faeces of the horses. Larvae of Trichonema and Cyalocephalus spp. (small strongyles) and Strongylus and Triodontophorus (large strongyles) were identified in the coprocultures. The silvopasturing horses had the highest prevalence of the helminth parasites. The percentage of horses passing ascarid eggs was significantly higher in pasturing horses younger than 3 years. The prevalence of strongyles was statistically greater in the oldest grazing equines. Mares reached the highest prevalence of helminth egg output. Our results showed that native horses kept under silvopasture had the highest prevalence of the ascarids, strongyles and oxyurids, possibly due to their exposure to contaminated grazing areas, lack of appropriate feeding and control of their health status. We conclude that silvopasture increases the presence of infection by gastrointestinal nematoda in wild horses, especially by strongyles. Suitable measures to control parasitic diseases affecting horses in silvopasture should be considered in those systems.

Intrinsic Factors Influencing the Infection by Helminth Parasites in Horses under an Oceanic Climate Area (NW Spain).

A coprological survey to determine the influence of some intrinsic factors (breed, age, and sex) on the infection by helminth parasites in equine livestock (n = 418) under an oceanic climate area (NW Spain) was conducted. Faecal samples were individually collected and analyzed by the coprological techniques. The main strongylid genera identified were Trichonema and Cyalocephalus spp (small strongyles) and Strongylus and Triodontophorus (large strongyles). The prevalence of gastrointestinal nematode was 89% (95% CI 86, 92) and 1% cestoda (0, 2). The percentage of horses with strongyloid parasites was 89% (86, 92), 11% (8, 14) for Parascaris, and 3% (1, 5) for Oxyuris. The highest prevalence for ascariosis was observed in the youngest horses (<3 years), for oxyurosis in the >10 years animals, and for strongylosis in the 3-10 years ones. Females were significantly more parasitized than males. A negative correlation between the age and the egg-excretion of ascarids and strongyles was recorded. The autochthonous and the English Pure Blood horses were the most parasitized. We concluded that the infections by helminths, especially the strongyloids, are significantly common in the region, so that greater importance should be given to this situation.

Dynamics of infestation of cattle and pasture by gastrointestinal nematodes in an Atlantic temperate environment.

The objective of the present study was to determine the dynamics of infestation of cattle and pasture by gastrointestinal nematodes in a mild humid environment in northwestern Spain. For this, infestation of pasture by free-living stages (L3), dynamics of faecal egg output, blood pepsinogen levels and worm burden in slaughtered animals were quantified. The results showed a high degree of annual variability, which was dependent on weather conditions. The seasons were clearly defined in the study area, with mild humid winters and relatively dry summers registered throughout the years of the study. Infestation of pasture by larvae varied from year to year, peaking during August in the first year, between August and December in the second year, and during October in the third year. The annual variation was mainly due to weather conditions, particularly the amount of rain in summer. The patterns of faecal egg output were similar in the first and third grazing seasons, with maximum levels observed in May/June; however, in the second year, the peak was reached in October. Blood pepsinogen levels increased from pasture turnout (March/April) until the end of the grazing season (November/December), reaching maximum values from August/September onwards. The nematode parasite species identified at necropsy were Ostertagia osteragi, O. lyrata, Cooperia oncophora, C. macmasteri, C. punctata and Trichuris ovis, with O. ostertagi and C. oncophora predominating. In faecal cultures, the following genera were also identified: Haemonchus, Trichostrongylus, Nematodirus, Bunostomum, Oesophagostomum and Strongyloides. There was a significant correlation (r=0.97, P<0.01) between worm burden (Ostertagia spp.) and pasture infestation (Ostertagia L3) 3 weeks prior to slaughter of the calves, and also between blood pepsinogen levels and pasture infestation by Ostertagia L3 (r=0.33, P<0.02). Correlations between worm burden and faecal egg output and between blood pepsinogen level and faecal egg output were not significant. The results obtained in the present study confirm that there is annual variability in the time-course of nematodosis in cattle, and demonstrate the importance of weather, particularly summer rainfall, in an Atlantic temperate environment.

Effect of nutritional status and fat reserves on the periparturient immune response to Haemonchus contortus infection in sheep.

A study was made of the effect of body fat stored by ewes in early pregnancy on the subsequent immune response to gastrointestinal parasites around parturition. Pregnant ewes were given access to a lucerne pelleted diet either ad libitum (H) or at approximately 0.70 of their maintenance requirements (L) from the 42nd day of pregnancy in order to achieve a clearly differentiated level of body reserves by the 90th day of pregnancy. Then, all animals were put on the same plane of nutrition till 3 weeks after parturition. All ewes in both groups received 7,000 infective larvae of Haemonchus contortus per week for 7 weeks prior to lambing. The dietary treatments led to large differences between both groups of ewes in back-fat thickness that had a high correlation with mean plasma concentrations of leptin. In spite of the fact that animals were on the same plane of nutrition at infection time, host resistance, as measured by faecal egg counts, was significantly affected by the nutritional treatment established during early pregnancy. This effect produced noticeable differences in worm size and in worm burden at lambing. The response was accompanied by a marked increase in circulating eosinophils in better-fed ewes than in those maintained on a restricted diet in early pregnancy. Serum pepsinogen concentration, however, was inversely affected by the nutritional treatment till lambing, showing a maximum difference as early as 2 weeks after infection. The results support the view that higher levels of nutrition during early pregnancy enhance the expression of immunity against gastrointestinal parasites around parturition. Furthermore, the differences in the immune response appeared associated with serum leptin levels suggesting that leptin may be a key link between nutritional status and the protective immune reactivity against GI nematode infection.

Efficiency of Duddingtonia flagrans against Trichostrongyle infections of sheep on mountain pastures.

The control of sheep nematode parasites in extensive mountain/transhumant management systems using the nematophagous fungus Duddingtonia flagrans was assessed in this study. Two groups of Churra Tensina ewes were allowed to graze for 8 weeks in autumn on two separate paddocks of infected pasture near their winter sheds in the valley. At lambing, ewes and their twin lambs were turned out into the same paddocks for the following 12 weeks. One group of ewes received a daily dose of 5 x 10(5) chlamydospores of Duddingtonia flagrans/kg live weight per day both in autumn and in spring, while the other group was used as a non-treated control. Daily dosing of grazing ewes with the fungus D. flagrans had a clear effect on reducing autumn pasture contamination. This had a subsequent effect on the over-wintering larvae population that was confirmed by a 20% lower worm burden of tracer lambs kept in early spring on the paddock previously grazed by fungus treated ewes. In spring, pasture contamination was also significantly reduced in the paddock grazed by fungi-treated ewes and their lambs showed a 61% lower worm burden and a better performance than the control lambs. Results herein show that fungal spores fed to sheep at critical times with regard to the epidemiology of parasite infection, can have a significant effect on the infective larvae present on pasture, which could further improve lambs performance. This novel approach to parasite control would be of interest amongst both organic and conventional sheep farmers operating in mountain regions.

STR data for 11 autosomal STR markers from Costa Rica, Central America.

Allele frequencies for 11 STR autosomal loci (F13A01, F13B, FESFPS, LPL, CSF1PO, TH01, TPOX, VWA, D16S539, D7S820 and D13S317) were obtained from a sample of 200 unrelated individuals from Costa Rica, Central America.

Seasonal changes of gastrointestinal nematode burden in sheep under an intensive grazing system.

A study was conducted of the monthly fluctuations of worm burdens and arrested development of gastrointestinal (GI) nematodes in sheep from a commercial farm of the Ebro valley (Spain). Twenty-four previously helminth-free female lambs (permanent lambs) grazed together with a flock of 500 resident ewes for 12 months following a three lambing/2-year reproductive management system. Two helminth-free lambs (tracer lambs) were added to the flock each month and allowed to graze for 4 weeks. Measurements were made of the population of infective larvae on the pasture, and of levels of serum pepsinogen and faecal worm eggs in ewes and lambs. Additionally, post-mortem worm counts from two tracer and two permanent lambs were used to establish the level of infection at monthly intervals. Three generations of parasites were identified in the experiment. The generation derived from eggs deposited the previous autumn gave rise to the first infection of the animals in January and May. This infection had low consequences for the animals, but it signified the initiation of infection and the resumption of the annual cycle of pasture contamination. The second generation, appearing between June and July, was the year's most important source of infection and gave rise to an outbreak of parasitism in permanent lambs. This was indicated by an increase in levels of serum pepsinogen, the appearance of diarrhoea, and an important decrease in lamb growth rates. The third wave of infection, occurring in October and November, there was less impact than the previous one with respect to the level of infection, but it was the origin of the future over-wintering population. Teladorsagia circumcincta was the predominant species, followed by Haemonchus contortus and Trichostrongylus colubriformis. The highest numbers of worm recovered from both the tracer and permanent lambs were observed in July, with average numbers of 7900 and 19,200, respectively. The inhibition phenomenon was more evident in permanent than in tracer lambs, and mainly affected H. contortus as evidenced by populations exhibiting arrested larvae values of over 70% in January and February. Results obtained in this study confirm the epidemiological importance of the over-wintering L(3) generation as the initial source of the animal's infection and the origin of the annual resumption of pasture contamination cycles.

Liver transplantation for hepatocellular carcinoma in cirrhotic patients.

A consecutive series of 88 patients underwent transplantation for hepatocellular carcinoma with cirrhosis over a 7-year period. Liver transplantation was indicated because of the tumor in 75 cases (85.2%); tumor was an incidental finding in 13 cases (14.8%). One patient was retransplanted due to primary nonfunction. The perioperative mortality was 4.5%. Tumor recurrence was observed in seven patients (7.95%) with incidental tumor recurrence in one case. As in patients with known primary liver tumors pretransplant, a thorough follow-up is advisable to establish an early diagnosis of recurrence. The actuarial survival for nonincidental hepatocellular carcinoma at 1, 3, and 5 year was 92%, 77%, and 75%, respectively. The differences in actuarial survival between hepatitis C negative and positive hepatocellular carcinoma were not significant (log-rank test P=.27), though there was a clear improvement in results (94%, 85%, and 78% vs 90%, 71%, and 71%), at 1, 3, and 5 years meaning that HCV infection is an important prognostic factor. Although transplantation for HCC has the advantages of removing the tumor and the cirrhotic liver, it remains a controversial topic. In our experience patients showing lesions less than 5 cm or three or fewer lesions experience an equivalent survival to transplanted patients who do not have cancer.

Bystander cavo-tricuspid isthmus activation during post-incisional intra-atrial reentrant tachycardia.

We describe a case of post-incisional atrial tachycardia resembling typical atrial flutter on the surface ECG. Typical atrial flutter reentry was ruled out by the results of activation and entrainment mapping. Nevertheless, overdrive pacing from the lateral edge of the cavo-tricuspid isthmus produced tachycardia entrainment with concealed fusion associated with post-pacing and stimulus-to-P wave onset intervals exactly matching the tachycardia cycle length duration and the electrogram-to-P wave onset interval, respectively. Therefore, that site was firstly severed by sequential radiofrequency pulses. However, a transformation of the tachycardia P wave morphology and endocardial activation sequence, not associated with tachycardia termination or cycle length modification occurred. After additional mapping manoeuvres, a relatively small reentrant circuit was identified in the low and mid aspect of the lateral right atrium with the critical isthmus located between the lower border of a cannulation atriotomy and the crista terminalis, close to the inferior vena cava orifice. A single radiofrequency pulse at that site terminated the tachycardia. Both the electrocardiographic pattern and the endocardial mapping data obtained in our case might be explained by a split of the reentrant wavefront into a secondary wavelet which freely propagated through the cavo-tricuspid isthmus without completing the peritricuspid loop. In conclusion, bystander cavo-tricuspid isthmus activation during atrial tachycardia may simulate a typical atrial flutter pattern on the surface ECG. Further studies should evaluate the prevalence of this propagation pattern in post-incisional atrial reentry and atypical atrial flutters, and identify its implications for ablation strategy.

Catheter ablation and antiarrhythmic drugs for haemodynamically tolerated post-infarction ventricular tachycardia; long-term outcome in relation to acute electrophysiological findings.

AIMS: Radiofrequency catheter ablation is effective at terminating ventricular tachycardia, but the overall clinical role of the technique in patients with a prior myocardial infarction is still debated, due to the uncertainties of the long-term reliability of the procedure. The purpose of this study was to prospectively investigate the relationship between acute results obtained by catheter ablation and long-term outcome in a homogeneous population of patients with post-myocardial infarction ventricular tachycardia. METHODS AND RESULTS: One hundred and twenty-four consecutive patients with recurrent, drug-refractory, haemodynamically tolerated ventricular tachycardia were included in the study. This population accounted for 30% of the patients with post-myocardial infarction ventricular tachycardia admitted between April 1992 and September 1997 to the investigating centres. The ablation was successful in eliminating sustained ventricular tachycardia in 91 of them (73%); a partial result was obtained in 21 (17%) and failure in 12 (10%). Low dose amiodarone and/or beta-blockers were maintained in 86% of the patients. Over a median follow-up of 41.5 months (interquartile range 30.5-59.5 months), there were 15 deaths (12%), three of which were sudden (2.4%); the 12 remaining patients died of heart failure. Event-free survival analysis showed a significantly lower ventricular tachycardia recurrence rate in patients with a successful procedure as compared to those with failure or a partial result (19% vs 53% at one year and 27% vs 60% at 3 years, P=0.003). A repeat procedure was performed in 15 patients with early recurrences and was followed in all by long-term success. Of those who submitted to a second procedure, 93/124 patients (75%) are free of ventricular tachycardia recurrences. An implantable cardioverter-defibrillator (ICD), following procedure failure, was implanted in 13 patients (11%) of the study population. CONCLUSIONS: Radiofrequency catheter ablation is effective in a wide population of patients with recurrent tolerated ventricular tachycardia, with very low sudden death and cardiac mortality rates over the long-term. Persistent ventricular tachycardia inducibility after catheter ablation requires an ICD implant and/or repeat ablation.