Sinus node sparing novel hybrid approach for treatment of inappropriate sinus tachycardia/postural sinus tachycardia: multicenter experience.

BACKGROUND: The ideal treatment of inappropriate sinus tachycardia (IST) and postural orthostatic tachycardia syndrome (POTS) still needs to be defined. Medical treatments yield suboptimal results. Endocardial catheter ablation of the sinus node (SN) may risk phrenic nerve damage and open-heart surgery may be accompanied by unjustified invasive risks. METHODS: We describe our first multicenter experience of 255 consecutive patients (235 females, 25.94 ± 3.84 years) having undergone a novel SN sparing hybrid thoracoscopic ablation for drug-resistant IST (n = 204, 80%) or POTS (n = 51, 20%). As previously described, the SN was identified with 3D mapping. Surgery was performed through three 5-mm ports from the right side. A minimally invasive approach with a bipolar radiofrequency clamp was used to ablate targeted areas while sparing the SN region. The targeted areas included isolation of the superior and the inferior caval veins, and a crista terminalis line was made. All lines were interconnected. RESULTS: Normal sinus rhythm (SR) was restored in all patients at the end of the procedure. All patients discontinued medication during the follow-up. After a blanking period of 6 months, all patients presented stable SR. At a mean of 4.07 ± 1.8 years, normal SN reduction and chronotropic response to exercise were present. In the 51 patients initially diagnosed with POTS, no syncope occurred. During follow-up, pericarditis was the most common complication (121 patients: 47%), with complete resolution in all cases. Pneumothorax was observed in 5 patients (1.9%), only 3 (1.1%) required surgical drainage. Five patients (1.9%) required a dual-chamber pacemaker due to sinus arrest > 5 s. CONCLUSIONS: Preliminary results of this multicenter experience with a novel SN sparing hybrid ablation of IST/POTS, using surgical thoracoscopic video-assisted epicardial ablation combined with simultaneous endocardial 3D mapping may prove to be an efficient and safe therapeutic option in patients with symptomatic drug-resistant IST and POTS. Importantly, in our study, all patients had a complete resolution of the symptoms and restored normal SN activity.

Social approval of the community assessment model for odor dispersal: results from a citizen survey.

Odors emitted from US Midwest hog production facilities present farmers, residents, and state regulatory agencies with a set of complex challenges. To predict odor exposure from multiple swine production sources simultaneously, and to determine siting recommendations for proposed new or enlarged hog facilities, researchers at Iowa State University designed the community assessment model for odor dispersion (CAM). A three-county citizen survey conducted in Iowa examined the level of hypothetical social acceptance of the modeling process, and level of trust in CAM results. While 69 % of respondents approved of modeling as a way to determine the most socially appropriate location for production sites, only 35 % would trust the results if potential odor exposure from a new facility were proposed to be built near their home. We analyzed approval of the CAM model, and level of trust, across a number of demographic, attitudinal, and belief factors regarding environmental quality and the hog industry. Overall, trust in CAM was uneven and varied across respondents. Those residents who would not trust CAM tended to be more concerned with environmental quality and less inclined to believe that the hog industry is critically important economically. Those who would not trust CAM results also had significantly more direct experience with odors. Findings point to predominantly positive, yet equivocal acceptance of CAM results among the citizenry, which is not unexpected given conflict typical of siting decisions in industry and waste disposal arenas. Recommendations are offered regarding the interaction of trust, beliefs and attitudes and the utility of CAM.

Effect of temperature and relative humidity on the stability of infectious porcine reproductive and respiratory syndrome virus in aerosols.

The objective of this experiment was to describe the stability of airborne infectious porcine reproductive and respiratory syndrome virus (PRRSV) as a function of temperature and relative humidity. A cloud of infectious PRRSV was aerosolized using 24-jet Collison nebulizer into a dynamic aerosol toroid (DAT) maintained at a specific temperature and relative humidity. The PRRSV cloud within the DAT was sampled repeatedly over time using SKC BioSampler impingers and the total viral RNA (RT-PCR) and concentration of infectious PRRSV (TCID50) in the air samples was determined. As measured by quantitative RT-PCR, PRRSV RNA was stable under the conditions evaluated in this study. Thus, a comparison of viral RNA and Rhodamine B dye, a physical tracer, found no significant difference in the slopes of the lines. Titers of infectious virus were plotted by time and the half-life (T1/2) of infectious PRRSV was calculated using linear regression analysis. An analysis of the results showed that aerosolized PRRSV was more stable at lower temperatures and/or lower relative humidity, but temperature had a greater effect on the T1/2 of PRRSV than relative humidity. Based on these results, an equation was derived to predict the T1/2 of infectious airborne PRRSV for any combination of environmental temperature and relative humidity.