Buried RF Sensors for Smart Road Infrastructure: Empirical Communication Range Testing, Propagation by Line of Sight, Diffraction and Reflection Model and Technology Comparison for 868 MHz-2.4 GHz.

Updating the road infrastructure requires the potential mass adoption of the road studs currently used in car detection, speed monitoring, and path marking. Road studs commonly include RF transceivers connecting the buried sensors to an offsite base station for centralized data management. Since traffic monitoring experiments through buried sensors are resource expensive and difficult, the literature detailing it is insufficient and inaccessible due to various strategic reasons. Moreover, as the main RF frequencies adopted for stud communication are either 868/915 MHz or 2.4 GHz, the radio coverage differs, and it is not readily predictable due to the low-power communication in the near proximity of the ground. This work delivers a reference study on low-power RF communication ranging for the two above frequencies up to 60 m. The experimental setup employs successive measurements and repositioning of a base station at three different heights of 0.5, 1 and 1.5 m, and is accompanied by an extensive theoretical analysis of propagation, including line of sight, diffraction, and wall reflection. Enhancing the tutorial value of this work, a correlation analysis using Pearson's coefficient and root mean square error is performed between the field test and simulation results.

Impact of Li-Ion Battery on System's Overall Impedance and Received Signal Strength for Power Line Communication (PLC).

In anticipation of the hybrid utilisation of the radio frequency (RF) wireless transceiver technology embedded in future smart Li-ion battery cells to deliver hybrid links based on power line communication (PLC) and wireless connections, herein we present an empirical high-frequency investigation of the direct current (DC) bus. The focus is to determine, via statistical tools including correlation coefficient (CC), root mean squared error (RMSE) and feature selective validation (FSV) method, the impedance and signal change impact on a possible communication link when fully charged cells are present or completely missing from the bus. Moreover, to establish if technological differences may be accounted for during the empirical experiments, Li-ion cells from two different manufacturers were selected and connected via three subsequent capacitive couplings of 1 µF, 1 nF and 1 pF. According to a methodical comparison by employing CC, RMSE, and FSV over the measured impedance and signal attenuation, this study has shown that the physical DC network is the dominant impedance at high frequencies and that the signal attenuation on the DC line supports communication in the investigated spectrum. The reported findings are critical for in situ hybrid PLC and wireless communication implementation of BMS for Li-ion systems supported through only one RF transceiver.

Wireless Communication Test on 868 MHz and 2.4 GHz from inside the 18650 Li-Ion Enclosed Metal Shell.

As the RF communication on 18650 Li-ion cell level has not been reported due to its challenges and constrains, in this work, a valid wireless data link is demonstrated in an enclosed empty metal shell at 868 MHz and 2.4 GHz based on the IEEE 802.15.4 standard. The experimental tests are carried out using two generic unturned radiative structures, a wire loop fitted inside a cell shell, and an open terminal sub miniature version A (SMA), subsequently oriented vertically and horizontally relative to the ground plane. Based on signal strength indicator, bit error rate, and packet error rate, the test characterized a payload of 120 bytes at the highest speed of 150 kbps and 250 kbps supported by the IEEE 802.15.4 for the two communication frequencies. A MATLAB simulation is used in parallel to determine the three-dimensional radiative pattern of the two structures, whereas a three-ray model for multipath range propagation is implemented to complete the empirical experiments. It was demonstrated through testing communication of up to 10 m for both operating frequencies, proving the concept of wireless cell communication within short ranges, an essential feature for monitoring the health of each cell inside future electric vehicles (EVs).

DC Power Line Communication (PLC) on 868 MHz and 2.4 GHz Wired RF Transceivers.

Efficient management through monitoring of Li-ion batteries is critical to the progress of electro-mobility and energy storage globally, since the technology can be hazardous if pushed beyond its safety boundaries. Battery management systems (BMSs) are being actively improved to reduce size, weight, and cost while increasing their capabilities. Using power line communication, wireless monitoring, or hybrid data links are one of the most advanced research directions today. In this work, we propose the use of radio frequency (RF) transceivers as a communication unit that can deliver both wired and wireless services, through their superior analog and digital signal processing capability compared to PLC technology. To validate our approach computational simulation and empirical evaluation was conducted to examine the possibility of using RF transceivers on a direct current (DC) bus for wired BMS. A key advantage of this study is that it proposes a flexible and tested system for communication across a variety of network scenarios, where wireless data links over disrupted connections may be enabled by using this technology in short-range wired modes. This investigation demonstrates that the IEEE 802.15.4-compliant transceivers with operating frequencies of 868 MHz and 2.4 GHz can establish stable data links on a DC bus via capacitive coupling at high data rates.

Characteristics of cavotricuspid isthmus-dependent atrial flutter after left atrial ablation of atrial fibrillation.

BACKGROUND: Patients who have previously undergone ablation of atrial fibrillation may experience cavotricuspid isthmus (CTI)-dependent atrial flutter during follow-up. The effects of left atrial (LA) ablation on the characteristics of CTI-dependent flutter have not been described. METHODS AND RESULTS: Fifteen patients underwent ablation of CTI-dependent flutter late after LA ablation of AF. The ECG, biatrial activation patterns, and LA voltage maps during flutter were analyzed. Thirty age- and gender-matched patients who underwent ablation of CTI-dependent flutter without prior LA ablation served as control subjects. Among the patients with prior LA ablation, mapping revealed counterclockwise activation around the tricuspid annulus in 12 of 15 patients (80%) and clockwise activation in 3 of 15 patients (20%). The flutter waves in the inferior leads were upright in 9 of the 15 patients (60%) with prior LA ablation and in none of the control subjects (P<0.001). The upright flutter waves in the inferior leads in patients with counterclockwise flutter corresponded to craniocaudal activation of the right atrial free wall. LA activation contributed little to the genesis of the flutter waves in these patients because of a significant reduction in bipolar LA voltage (0.44+/-0.20 versus 1.54+/-0.19 mV in patients with biphasic/negative flutter waves; P<0.001). CONCLUSIONS: CTI-dependent flutter that occurs after LA ablation of atrial fibrillation often has atypical ECG characteristics because of altered LA activation. In patients presenting with atrial flutter after LA ablation, entrainment mapping should be performed at the CTI even if the ECG is uncharacteristic of CTI-dependent flutter.

A tailored approach to catheter ablation of paroxysmal atrial fibrillation.

BACKGROUND: Because the genesis of atrial fibrillation (AF) is multifactorial and variable, an ablation strategy that involves pulmonary vein isolation and/or a particular set of ablation lines may not be equally effective or efficient in all patients with AF. A tailored strategy that targets initiators and drivers of AF is a possible alternative to a standardized lesion set. METHODS AND RESULTS: Catheter ablation was performed in 153 consecutive patients (mean age, 56+/-11 years) with symptomatic paroxysmal AF with the use of an 8-mm tip radiofrequency ablation catheter. The esophagus was visualized with barium. The pulmonary veins and left atrium were mapped during spontaneous or induced AF. Arrhythmogenic pulmonary veins were isolated or encircled. If AF was still present or inducible, complex electrograms in the left atrium, coronary sinus, and superior vena cava were targeted for ablation. The end point of ablation was absence of frequent atrial ectopy and spontaneous AF during isoproterenol infusion and noninducibility of AF. Routine energy applications near the esophagus were avoided. During follow-up, left atrial flutter developed in 19% of patients and was still present in 10% at >12 weeks of follow-up. A repeat ablation procedure was performed in 18% of patients. During a mean follow-up of 11+/-4 months, 77% of patients were free from AF and/or atrial flutter without antiarrhythmic drug therapy. Pericardial tamponade or transient neurological events occurred in 2% of procedures. CONCLUSIONS: A tailored ablation strategy that only targets triggers and drivers of AF is feasible and eliminates paroxysmal AF in approximately 80% of patients.

Risk of thromboembolic events after percutaneous left atrial radiofrequency ablation of atrial fibrillation.

BACKGROUND: In patients with atrial fibrillation (AF), the risk of thromboembolic events (TEs) is variable and is influenced by the presence and number of comorbid conditions. The effect of percutaneous left atrial radiofrequency ablation (LARFA) of AF on the risk of TEs is unclear. METHODS AND RESULTS: LARFA was performed in 755 consecutive patients with paroxysmal (n = 490) or chronic (n = 265) AF. Four hundred eleven patients (56%) had > or = 1 risk factor for stroke. All patients were anticoagulated with warfarin for > or = 3 months after LARFA. A TE occurred in 7 patients (0.9%) within 2 weeks of LARFA. A late TE occurred 6 to 10 months after ablation in 2 patients (0.2%), 1 of whom still had AF, despite therapeutic anticoagulation in both. Among 522 patients who remained in sinus rhythm after LARFA, warfarin was discontinued in 79% of 256 patients without risk factors and in 68% of 266 patients with > or = 1 risk factor. Patients older than 65 years or with a history of stroke were more likely to remain anticoagulated despite a successful outcome from LARFA. None of the patients in whom anticoagulation was discontinued had a TE during 25 +/- 8 months of follow-up. CONCLUSIONS: The risk of a TE after LARFA is 1.1%, with most events occurring within 2 weeks after the procedure. Discontinuation of anticoagulant therapy appears to be safe after successful LARFA, both in patients without risk factors for stroke and in patients with risk factors other than age > 65 years and history of stroke. Sufficient safety data are as yet unavailable to support discontinuation of anticoagulation in patients older than 65 years or with a history of stroke.

Catheter ablation of atypical atrial flutter and atrial tachycardia within the coronary sinus after left atrial ablation for atrial fibrillation.

OBJECTIVES: The goal of this study was to describe the prevalence and ablation of coronary sinus (CS) arrhythmias after left atrial ablation for atrial fibrillation (AF). BACKGROUND: The CS has been implicated in a variety of supraventricular arrhythmias. METHODS: Thirty-eight patients underwent mapping and ablation of atypical flutter that developed during (n = 5) or after (n = 33) ablation for AF. Also included were two patients with focal CS arrhythmias that occurred during an AF ablation procedure. A tachycardia was considered to be originating from the CS if the post-pacing interval in the CS matched the tachycardia cycle length and/or if it terminated during ablation in the CS. RESULTS: Among the 33 patients who developed atypical flutter late after AF ablation, 9 (27%) were found to have a CS origin. Overall, 16 of the 40 patients in this study had a CS arrhythmia. The tachycardia was macro-re-entrant in 14 patients (88%) and focal in two patients. Radiofrequency ablation with an 8-mm-tip catheter was successful in 15 patients (94%) without complication. In eight patients (50%), > or = 45 W was required for successful ablation. Thirteen of the 15 patients (87%) with a successful ablation acutely remained arrhythmia-free during 5 +/- 5 months of follow-up. CONCLUSIONS: The musculature of the CS serves as a critical component of the re-entry circuit in approximately 25% of patients with atypical flutter after ablation for AF. The CS may also generate focal atrial arrhythmias that may play a role in triggering and/or maintaining AF. Catheter ablation of these arrhythmias in the CS can be performed safely.

Comparison of mapping criteria for hemodynamically tolerated, postinfarction ventricular tachycardia.

BACKGROUND: Mapping criteria for hemodynamically tolerated, postinfarction ventricular tachycardia (VT) have been evaluated in only small series of patients. OBJECTIVES: The purpose of this study was to evaluate the utility of various mapping criteria for identifying a critical VT circuit isthmus in a post hoc analysis. METHODS: Ninety VTs (cycle length 491 +/- 84 ms) were mapped in 48 patients with a prior myocardial infarction. The mapping catheter was positioned within a protected area of the reentrant circuit of the targeted VTs at 176 sites. All sites showed concealed entrainment. The predictive values of the following mapping criteria for a successful ablation site were compared: discrete isolated potential during VT, inability to dissociate the isolated potential from the VT, endocardial activation time >70 ms, matching electrogram-QRS and stimulus-QRS intervals, VT termination without global capture during pacing, stimulus-QRS/VT cycle length ratio

Nondestructive Method for Mapping Metal Contact Diffusion in In2O3 Thin-Film Transistors.

The channel width-to-length ratio is an important transistor parameter for integrated circuit design. Contact diffusion into the channel during fabrication or operation alters the channel width and this important parameter. A novel methodology combining atomic force microscopy and scanning Kelvin probe microscopy (SKPM) with self-consistent modeling is developed for the nondestructive detection of contact diffusion on active devices. Scans of the surface potential are modeled using physically based Technology Computer Aided Design (TCAD) simulations when the transistor terminals are grounded and under biased conditions. The simulations also incorporate the tip geometry to investigate its effect on the measurements due to electrostatic tip-sample interactions. The method is particularly useful for semiconductor- and metal-semiconductor interfaces where the potential contrast resulting from dopant diffusion is below that usually detectable with scanning probe microscopy.

Randomized comparison of encircling and nonencircling left atrial ablation for chronic atrial fibrillation.

BACKGROUND: Left atrial (LA) circumferential ablation has been reported to eliminate atrial fibrillation (AF). Whether an ablation without encirclement of the pulmonary veins (PVs) is as effective as LA circumferential ablation is not clear. OBJECTIVES: The purpose of this study was to compare the efficacy of LA circumferential ablation and nonencircling linear ablation in patients with chronic AF. METHODS: Eighty patients with chronic AF were randomized to undergo LA circumferential ablation (n = 40) or nonencircling linear ablation (n = 40). In LA circumferential ablation, the PVs were encircled, with additional lines made in the mitral isthmus and posterior wall or roof. In nonencircling linear ablation, 4 +/- 1 ablation lines were created through areas of complex electrograms, with lines in the roof (38), anterior wall (36), septum (40), mitral isthmus (32), and posterior annulus (6). The endpoint of LA circumferential ablation and nonencircling linear ablation was voltage abatement. RESULTS: LA flutter occurred in 15% after LA circumferential ablation and in 18% after nonencircling linear ablation (P = .8). A repeat ablation procedure was performed for recurrent AF in 7 and 11 patients or for atrial flutter in 6 and 4 patients after LA circumferential ablation and nonencircling linear ablation, respectively (P = .8). At 9 +/- 4 months, the prevalence of AF was 28% in the LA circumferential ablation and 25% in the nonencircling linear ablation group (P = .8). Sixty-eight percent and 60% of patients were in sinus rhythm and free of AF and atrial flutter in the absence of antiarrhythmic drug therapy after LA circumferential ablation and nonencircling linear ablation, respectively (P = .5). There were no complications. CONCLUSION: Nonencircling linear ablation and LA circumferential ablation are equally efficacious in eliminating chronic AF. However, the advantage of nonencircling linear ablation is that it eliminates the need for ablation along the posterior wall of the LA. Therefore, nonencircling linear ablation may avoid the small but real risk of atrioesophageal fistula formation associated with LA circumferential ablation.

Mechanical interruption of postinfarction ventricular tachycardia as a guide for catheter ablation.

BACKGROUND: Mechanical trauma has been described as a helpful guide for ablation of atrial tachycardias and accessory pathways. In postinfarction ventricular tachycardia (VT), the reentrant circuit is partly endocardial and therefore may be susceptible to catheter trauma. OBJECTIVES: The purpose of this study was to determine the prevalence and significance of VT termination resulting from catheter trauma. METHODS: A consecutive series of 39 patients (mean age 68 +/- 7 years, ejection fraction 0.25 +/- 0.02) underwent left ventricular mapping for postinfarction VT. Mapping was performed during 62 hemodynamically tolerated VTs (mean cycle length 451 +/- 88 ms). Only hemodynamically tolerated VTs that did not terminate spontaneously and VTs that were reproducibly inducible were included in the study. VT termination was considered mechanical only if it was not caused by a premature depolarization. RESULTS: In 13 of 62 VTs (21%) in 8 of 39 patients (21%), either VT terminated during catheter placement at a particular site (n = 7) or a previously reproducibly inducible VT became no longer inducible with the mapping catheter located at a particular site (n = 6). The stimulus-QRS interval was significantly shorter at sites where mechanical trauma affected the reentrant circuit compared with sites having concealed entrainment (102 +/- 56 ms vs 253 +/- 134 ms, P = .003). At the site that was susceptible to mechanical trauma, the pace map was identical or highly similar in 13 of 13 VTs. After radiofrequency ablation at these sites, the targeted VTs were no longer inducible. No patient had recurrence of the targeted VT during a mean follow-up of 15 +/- 11 months. CONCLUSIONS: Catheter contact at a critical endocardial site can interrupt postinfarction VT or prevent its induction. Radiofrequency ablation at sites of mechanical termination of VT has a high probability of success.

Topographic analysis of the coronary sinus and major cardiac veins by computed tomography.

BACKGROUND: The coronary sinus (CS) and its branches may play a role in the genesis of various arrhythmias. Applications of radiofrequency energy within the CS may be necessary. Atrio-esophageal fistula has been recognized as a complication of ablation along the posterior left atrial wall. OBJECTIVES: The purpose of this study was to describe the in vivo topographic anatomy of the CS, esophagus, and coronary arteries using computed tomography (CT). METHODS: Helical contrast CT of the heart with three-dimensional and endoscopic reconstructions was performed in 50 patients (28 men and 22 women; mean age 54 +/- 10 years). The images were reformatted to determine the relationships among the CS, adjacent blood vessels, and esophagus and to determine the nature and thickness of surrounding tissue layers. RESULTS: Mean CS ostium diameter was 12 +/- 4 mm, and mean thickness of the periosteal fat layer was 3 +/- 2 mm. In 40 of the 50 patients (80%), the esophagus was adjacent to the CS, starting 24 +/- 9 mm from the ostium, and remained in contact for a mean length of 7 +/- 5 mm. Mean thickness of the fat layer between the esophagus and CS was 1 +/- 1 mm, and mean thickness of the anterior wall of the esophagus was 3 +/- 2 mm. In 10 patients (20%), there was no contact between the esophagus and CS. In 40 patients (80%), the right coronary artery was less than 5 mm from the CS (minimum distance 1 +/- 1 mm) over a mean length of 17 +/- 11 mm. In all patients, the circumflex artery was less than 5 mm from the CS (minimum distance 1 +/- 0.4 mm) over a mean length of 16 +/- 9 mm in patients with right-dominant coronary circulation and over a mean length of 86 +/- 11 mm in patients with left-dominant coronary circulation. CONCLUSION: The CS often lies very close to the esophagus and coronary arteries. During radiofrequency energy ablation in the CS, caution should be exercised to prevent injury to surrounding structures.

Effect of left atrial circumferential ablation for atrial fibrillation on left atrial transport function.

BACKGROUND: The effects of left atrial (LA) circumferential ablation on LA function in patients with atrial fibrillation (AF) have not been well described. OBJECTIVES: The purpose of this study was to determine the effect of LA circumferential ablation on LA function. METHODS: Gated, multiphase, dynamic contrast-enhanced computed tomographic (CT) scans of the chest with three-dimensional reconstructions of the heart were used to calculate the LA ejection fraction (EF) in 36 patients with paroxysmal (n = 27) or chronic (n = 9) AF (mean age 55 +/- 11 years) and in 10 control subjects with no history of AF. Because CT scans had to be acquired during sinus rhythm, a CT scan was available both before and after (mean 5 +/- 1 months) LA circumferential ablation (LACA) in only 10 patients. A single CT scan was acquired in 8 patients before and in 18 patients after LACA ablation. Radiofrequency catheter ablation was performed using an 8-mm-tip catheter to encircle the pulmonary veins, with additional lines along the mitral isthmus and the roof. RESULTS: In patients with paroxysmal AF, LA EF was lower after than before LACA (21% +/- 8% vs 32 +/- 13%, P = .003). LA EF after LA catheter ablation was similar among patients with paroxysmal AF and those with chronic AF (21% +/- 8% vs 23 +/- 13%, P = .7). However, LA EF after LA catheter ablation was lower in all patients with AF than in control subjects (21% +/- 10% vs 47% +/- 5%, P < .001). CONCLUSION: During medium-term follow-up, restoration of sinus rhythm by LACA results in partial return of LA function in patients with chronic AF. However, in patients with paroxysmal AF, LA catheter ablation results in decreased LA function. Whether the impairment in LA function is severe enough to predispose to LA thrombi despite elimination of AF remains to be determined.

Toxic effects associated with consumption of zinc.

A 27-year-old man with a history of acne presented to his primary care physician because of fatigue and dyspnea on exertion of 4 weeks' duration. He was remarkably pale, orthostatic pulse changes were noted, and a systolic ejection murmur was heard. The patient had profound anemia (hemoglobin concentration, 5.0 g/dL) and neutropenia (neutrophil count, 0.06 x 10(9)/L); he was admitted for further evaluation. A detailed inquiry into his medication history revealed that he was taking several vitamins and zinc gluconate, 850 to 1000 mg/d for 1 year (US recommended daily allowance, 15 mg), as therapy for acne. A zinc toxic and copper-deficient state was confirmed by laboratory studies. The patient was treated with intravenous copper sulfate, followed by 3 months of oral therapy. The complete blood cell count, serum copper level, and serum zinc level returned to normal.

The middle ear of gekkonoid lizards: interspecific variation of structure in relation to body size and to auditory sensitivity.

Wishing to assess the effects of the dimensions of the middle ear on the auditory sensitivity of gekkonoid lizards, we measured middle ear components in preserved geckos, which in life had yielded 'cochlear microphonics' audiograms. We examined two to seven specimens of 14 species. The measures of middle ear elements varied relative to head or body length similarly within species and among species. The areas of the external ear opening, tympanic membrane, and columellar footplate, and the ratio between the last two ('hydraulic lever'), were correlated with animal length. The hydraulic and mechanical (extracolumellar) lever ratios appeared to complement each other, the former being emphasized in large animals, the latter in small animals. The apparent auditory sensitivity correlated with the sizes of the animal, head and external ear opening, and negatively (insignificantly) correlated with the mechanical lever ratio. The correlation of sensitivity with the hydraulic lever was insignificant, perhaps due to a 'tympanic membrane lever' (catenary effect). The most sensitive frequency negatively correlated with the area of the external ear opening, the area of the tympanic membrane, and with the level of greatest sensitivity. It was positively correlated with the relative length of the cartilaginous portion of the ossicular chain. However, the number of hair cells in the basilar papilla, too, is known to correlate with animal size. Moreover, the least sensitive species were not only the smallest species, they were also the species known to lack a zone of unidirectional hair cells in the basilar papilla. Hence the apparent sensitivity hypothetically depends on both middle ear dimensions and summation of inner ear output. This hypothesis requires verification by other methods.

Role of Purkinje fibers in post-infarction ventricular tachycardia.

OBJECTIVES: The objective of this study was to assess the role of Purkinje fibers in monomorphic, post-infarction ventricular tachycardia (VT). BACKGROUND: Ventricular fibrillation and polymorphic VT in the setting of acute myocardial infarction (MI) may be triggered by ectopy arising from Purkinje fibers. METHODS: From among a group of 81 consecutive patients with post-infarction monomorphic VT referred for catheter ablation, 9 patients were identified in whom the clinical VT had a QRS duration < or =145 ms. Mapping was performed focusing on areas with Purkinje potentials. RESULTS: A total of 11 VTs with a QRS duration < or =145 ms were induced and mapped in the 9 patients; 9 of the 11 VTs had a right bundle branch block/left-axis morphology that mimicked left posterior fascicular VT. The mean VT cycle length was 402 +/- 82 ms. Eight of 9 patients had a history of inferior MI involving the left ventricular septum. One patient had an anterior wall MI with septal involvement. Mapping during VT demonstrated re-entry involving the inferior left ventricular wall. In each of the VTs, a Purkinje potential was present at the exit site of the VT re-entry circuit. Single radiofrequency catheter ablation lesions were successful in eliminating these VTs in all patients. CONCLUSIONS: The Purkinje system may be part of the re-entry circuit in patients with post-infarction monomorphic VT, resulting in a type of VT with a relatively narrow QRS complex that mimics fascicular VT.

Isolated potentials during sinus rhythm and pace-mapping within scars as guides for ablation of post-infarction ventricular tachycardia.

OBJECTIVES: The purpose of this study was to identify ventricular tachycardia (VT) isthmus sites by pace-mapping within scar tissue and to identify electrogram characteristics that are helpful in identifying VT isthmus sites during sinus rhythm (SR). BACKGROUND: Pace-mapping has been used in the scar border zone to identify the exit site of post-infarction VT. METHODS: In 19 consecutive patients (18 men, mean age 66 +/- 9 years, mean ejection fraction 0.24 +/- 0.12) with post-infarction VT, a left ventricular voltage map was generated during SR. Pace-mapping was performed at sites with abnormal electrograms or isolated potentials. Radiofrequency ablation was performed at isthmus sites as defined by pace-mapping (perfect pace-map = 12/12 matching electrocardiogram leads; good pace-map = 10/12 to 11/12 matching electrocardiogram leads) and/or entrainment mapping. RESULTS: A total of 81 VTs (mean cycle length 396 +/- 124 ms) were inducible. In 16 of the 19 patients, a total of 41 distinct isthmus areas of 41 distinct VTs were identified and successfully ablated. All but one displayed isolated potentials during SR. Furthermore, 22 of the 81 VTs (27%) for which no isthmus was identified became noninducible after ablation of a targeted VT. The 16 patients in whom > or =1 isthmus was identified and ablated were free of arrhythmic events during a mean follow-up of 10 months. CONCLUSIONS: During SR, excellent or good pace-maps at sites of isolated potentials within areas of scar identify areas of fixed block that are protected and part of the critical isthmus of post-infarction VT. Shared common pathways might explain why non-targeted VTs might become noninducible after ablation of other VTs.

Effects of two different catheter ablation techniques on spectral characteristics of atrial fibrillation.

OBJECTIVES: The aim of this study was to determine the effects of circumferential pulmonary vein ablation (CPVA) and electrogram-guided ablation (EGA) on the spectral characteristics of atrial fibrillation (AF) and the relationship between changes in dominant frequency (DF) and clinical outcome. BACKGROUND: Circumferential pulmonary vein ablation and EGA have been used to eliminate AF. Spectral analysis may identify high-frequency sources. METHODS: In 84 consecutive patients, CPVA (n = 42) or EGA (n = 42) was performed for paroxysmal (n = 49) or persistent (n = 35) AF. During EGA, complex electrograms were targeted. Lead V1 and electrograms from the left atrium and coronary sinus were analyzed to determine the DF of AF before and after ablation. RESULTS: The left atrial DF was higher in persistent (5.83 +/- 0.86 Hz) than paroxysmal AF (5.33 +/- 0.76 Hz, p = 0.03). There was a frequency gradient from the left atrium to the coronary sinus (p = 0.02). Circumferential pulmonary vein ablation and EGA resulted in a similar decrease in DF (18 +/- 17% vs. 17 +/- 15%, p = 0.8). During a mean follow-up of 9 +/- 6 months, the change in DF after CPVA was similar among patients with and without recurrent AF. An acute decrease in DF after EGA was associated with freedom from recurrent AF only in patients with persistent AF (19 +/- 14% vs. 3 +/- 6%, p = 0.02). CONCLUSIONS: Both CPVA and EGA decrease the DF of AF, consistent with elimination of high-frequency sources. Whereas the efficacy of EGA is associated with a decrease in DF in patients with persistent AF, the efficacy of CPVA is independent of changes in DF. This suggests that CPVA and EGA eliminate different mechanisms in the genesis of persistent AF.