Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation.

INTRODUCTION: Ablation with second-generation cryoballoon technology evolves as an effective and safe alternative to radiofrequency for atrial fibrillation ablation procedures. Nevertheless, the optimal freezing strategy remains unknown. Our objective was to identify the procedural cryoablation parameters predicting successful peri-pulmonary vein (PV) lesions by directly analyzing Postablation gaps in late-gadolinium-enhanced cardiac magnetic resonance (LGE-CMR). METHODS AND RESULTS: Forty-nine consecutive patients (196 PVs) undergoing ablation with second-generation cryoballoon at our center were included. The number and duration of cryoballoon application to achieve PV isolation were left to operator discretion. Gap number and length were quantified in all patients with a LGE-CMR performed 3 months postablation. Application time (420 ± 217 seconds), number of applications (2.1 ± 1.2), application time after electrical isolation (311 ± 194 seconds) and minimum temperature (-45.8 ± 6.5°C) were similar in the 4 PVs. Gaps were observed in 148 PVs (76%), averaging 1.3 ± 1 gaps per vein. Gaps were longer and more frequent in the right PVs (91% vs 59% in left PVs, P < .001). Neither the number, total duration of applications, nor postisolation application time predicted relative length or number of gaps. CONCLUSIONS: After successful PV isolation was achieved in patients undergoing cryoablation, increasing the number of applications, the total application time or application time postisolation did not result in a reduction in the number or the relative length of gaps.

Cryoballoon vs. radiofrequency lesions as detected by late-enhancement cardiac magnetic resonance after ablation of paroxysmal atrial fibrillation: a case-control study.

AIMS: Cryoballoon (CB) ablation has emerged as a reliable modality to isolate pulmonary veins (PVs) in atrial fibrillation. Ablation lesions and the long-term effects of energy delivery can be assessed by delayed-enhancement cardiac magnetic resonance (DE-CMR). The aim of the study was to compare the number, extension, and localization of gaps in CB and radiofrequency (RF) techniques in pulmonary vein isolation (PVI). METHODS AND RESULTS: Consecutive patients submitted to PVI with CB in whom DE-CMR images were available (n = 30) were matched (1:1) to patients who underwent PVI with RF (n = 30), considering age, sex, hypertension, and diabetes. Delayed-enhancement cardiac magnetic resonance was obtained at 3 months post-procedure, and images were processed to assess the mean number of gaps around PV ostia, their localization, and the normalized gap length (NGL), calculated as the difference between total gap length and total PV perimeter. Patients were followed up for 12 months. The CB and RF procedures did not differ in the mean number of gaps per patient (4.40 vs. 5.13 gaps, respectively; P = 0.21) nor NGL (0.35 vs. 0.32, P = 0.59). For both techniques, a higher mean number of gaps were detected in right vs. left PVs (3.18 vs. 1.58, respectively; P = 0.01). The incidence of recurrences did not differ between techniques (odds ratio 1.87, 95% confidence interval 0.66-4.97; P = 0.29). CONCLUSION: Location and extension of ablation gaps in PVI did not differ between CB and RF groups in DE-CMR image analysis.

Diagnosis-to-ablation time in atrial fibrillation: A modifiable factor relevant to clinical outcome.

INTRODUCTION: Recurrences after atrial fibrillation (AF) ablation are still common. Among the reported clinical and imaging predictors of recurrences, diagnosis-to-ablation time (DAT) has been defined as a predictor of ablation outcome in single-center studies. We aimed to validate DAT in a multicenter real-life cohort. METHODS: This was a multicenter study including consecutive patients undergoing first paroxysmal and persistent AF ablation with radiofrequency or cryoballoon catheters during 2013. Cox proportional hazard regression models were performed to identify predictors of recurrence. RESULTS: In total, 309 patients were included across nine centers (71% men, 57 ± 10 years old, 46% with hypertension, and 66% with CHA2 DS2 -VASc ≤ 1). Most patients had paroxysmal AF (67%) and underwent radiofrequency ablation (68%) with a median DAT of 51 (43) months. Patients with DAT ≤ 1 year (16.6%) were less likely to have repeat procedures (4% vs 18%; P = .017). The adjusted proportional hazards Cox model identified hypertension (P = .005), heart failure (P = .011), nonparoxysmal AF (P = .038), DAT > 1 year (P = .007), and LA diameter (P = .026) as independent predictors for AF recurrence. DAT > 1 year was the only modifiable factor independently associated with recurrence (HR 4.2 [95% CI, 1.5-11.9]) CONCLUSION: Diagnosis-to-ablation time is a modifiable factor independently associated with recurrent arrhythmia and repeat ablation after first AF ablation. An early intervention strategy during the first year from AF diagnosis might improve outcomes.

Analysis of late reconnections after pulmonary vein isolation: Impact of interlesion contiguity and ablation index.

BACKGROUND: Interlesion distance and ablation index (AI) have been proposed as parameters of radiofrequency (RF) lesion durability. This study analyzes the relationship between RF parameters of automatically acquired lesion tags and late reconnections in repeat pulmonary vein isolation (PVI) procedures. METHODS: One hundred fifty-seven patients underwent contact force (CF)-guided PVI with automatic acquisition of RF lesions. During follow-up, 21 patients underwent a repeat PVI procedure. The relationship between RF parameters (power, CF, impedance drop, and AI) of the initial PVI procedure and reconnections observed at repeat PVI was analyzed. Visual gap was defined as the existence of a discontinuity between two RF lesions automatically acquired in the initial PVI procedure. Regional values of AI associated with lesion durability were identified. RESULTS: Twenty-one patients were included. Three hundred thirty-six segments and 2507 RF lesions were analyzed. The median interval between the initial and repeat PVI procedures was 17 (11-24) months. All patients showed ≥1 reconnected segment. Sixty-three segments (18.7%) were reconnected. Reconnected segments showed visual gaps more frequently than non-reconnected segments (66.6% vs 17.6%; P < .001; negative predictive value 91.4%). The mean distance of visual gaps was 8 ± 2.8 mm. No differences were observed in power (31.4 ± 4.7 W vs 31 ± 4.1 W; P = .573), CF (14.4 ± 5.3 g vs 15.4 ± 5.4 g; P = .315), and impedance drop (6.9 ± 5.2 ohms vs 6.5 ± 3.8 ohms; P = .576) between reconnected and non-reconnected segments. Among segments without visual gap, the minimum AI value was significantly higher in the non-reconnected segments (325 ± 96.1 vs 204.7 ± 78.5; P < .001). No reconnections were observed in segments without visual gap and minimum AI ≥ 330/220 in anterior/posterior wall, respectively. CONCLUSIONS: Contiguity between automatically acquired RF lesions and minimum AI value are the main determinants of long-term PVI durability.

Parto diferido o asincrónico del segundo gemelo: un caso clínico con buen desenlace neonatal / Delayed interval delivery or asynchronous birth of the second twin: a case report with a good outcome neonatal

Resumen ANTECEDENTES: El parto diferido o asincrónico ocurre cuando los fetos de un embarazo múltiple nacen con una diferencia de días o semanas. La finalidad es incrementar la edad gestacional del segundo gemelo y aumentar la tasa de supervivencia. CASO CLÍNICO: Paciente primigesta de 39 años, con embarazo gemelar bicorial, biamniótico logrado mediante fertilización in vitro. En la semana 23 + 2 acudió a urgencias por sangrado vaginal y dolor abdominal. En la especuloscopia se observó líquido amniótico claro y dilatación cervical de 4-5 cm. El registro cardiotocográfico reportó dinámica uterina franca. En la ecografía se visualizaron dos fetos: el primero en presentación podálica sin latido cardiaco y el segundo en transversa con latido cardiaco. Después del nacimiento del primer gemelo se observó la retracción del cuello uterino y desaparición de la dinámica uterina. El estudio ecográfico mostró la bolsa amniótica íntegra, sin signos de desprendimiento placentario ni pérdida del bienestar fetal. Se propuso a la pareja la posibilidad de realizar un cerclaje cervical y diferir el parto del segundo gemelo, hecho que fue aceptado. Se consiguió prolongar la gestación del segundo gemelo 77 días, que nació mediante parto, sin morbilidad materna ni fetal. CONCLUSIONES: El parto diferido es una práctica adecuada para incrementar la tasa de supervivencia del feto o fetos retenidos. Los protocolos asociados con este tipo de partos son variados. Se requieren estudios adicionales para establecer los criterios de tratamiento de este tipo de partos.

Abstract BACKGROUND: Delayed Interval delivery or asynchronous birth is when a multiple pregnancy`s fetuses are not born simultaneously, and with several day´s difference between their births. This practice´s objective is to increase the second twin´s gestational age and, as such, improve its survival rate. CLINICAL CASE: A 39 years-old patient with bicorial biamniotic twin pregnancy achieved by in vitro fertilization. At 23 + 2 weeks of pregnancy assisted to Emergency service for vaginal bleeding and abdominal pain. In the speculoscopy a clear amniotic fluid and cervical dilation of 4-5 cm was observed. The cardiotocographic record reported frank uterine dynamics. In the ultrasound, two files are displayed: the first in the syntax presentation in the heartbeat and the second in the transversal with heartbeat. After the birth of the first twin, retraction of the cervix and the disappearance of uterine dynamics were observed. The ecological study showed the amniotic bag intact, without signs of placental detachment or loss of fetal well-being. It was proposed to the couple the possibility of performing the cervical fence and the other part of the second day, which was accepted. It was possible to prolong the gestation of the second year to 77 days, which was born through childbirth, without registering maternal or fetal morbidity. CONCLUSIONS: Delayed Interval delivery is a good practice to increase the survival rate of a retained fetus or retained fetuses. The protocols associated with this type of births are varied. Additional studies are required to establish treatment criteria for this type of births.

Stearidonic acid combined with alpha-linolenic acid improves lipemic and neurological markers in a rat model subject to a hypercaloric diet.

In this study, we hypothesized that terrestrial plant oils, rich in alpha linolenic acid (ALA) and stearidonic acid (SDA) relative to fish oil, rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), prevent negative effects on cardiovascular and neurological function using a rat model fed a hypercaloric diet. Results showed effects on the FA profile, namely, eicosapentaenoic, EPA, and docosahexaenoic, DHA, levels. There were also effects on neural aspects (cAMP response element-binding protein, CREB, gene expression, at least, doubled) and the pro-inflammatory/anti-inflammatory balance (TNF-α, tumor necrosis factor alpha reduced by 30-50%). The most positive impact of ALA and SDA was the beneficial reduction of total lipids (from 395 ±â€¯3 to 352-361 mg/dL), VLDL-cholesterol (from 21.8 ±â€¯0.2 to 14.1-17.8 mg/dL), and triacylglycerols (from 109 ±â€¯1 to 71-89 mg/dL) in both LIN (diet enriched in linseed oil) and BUG (diet enriched in Buglossoides oil) groups. Overall, data indicate that ALA- and SDA-rich lipid sources may counteract the undesirable cardiovascular effects of a hypercaloric diet based on milk fat.

Postprocedural LGE-CMR comparison of laser and radiofrequency ablation lesions after pulmonary vein isolation.

INTRODUCTION: The purpose of this study was to compare the anatomical characteristics of scar formation achieved by visual-guided laser balloon (Laser) and radiofrequency (RF) pulmonary vein isolation (PVI), using late-gadolinium-enhanced cardiac magnetic resonance imaging (LGE-CMR). METHODS AND RESULTS: We included 17 patients with paroxysmal or early persistent drug resistant AF who underwent Laser ablation; 2 were excluded due to procedure-related complications. The sample was matched with a historical group of 15 patients who underwent PVI using RF. LGE-CMR sequences were acquired before and 3 months post-PVI. Ablation gaps were defined as pulmonary vein (PV) perimeter sections showing no gadolinium enhancement. The number of ablation gaps was lower in Laser versus RF ablations (median 7 vs. 14, P  =  0.015). Complete anatomical PVI (circumferential scar around PV, without gaps) was more frequently achieved with Laser than with RF (39% vs. 19% of PVs, P  =  0.025). Fewer gaps were present at the superior and anterior left PV and posterior right PV antral regions in the Laser group, compared to RF. Scar extension into the PVs was similar in both groups, although RF produced more extensive ablation scar toward the LA body. AF recurrences at 1 year were similar in both groups (Laser 36% vs. RF 27%, P  =  1.00). CONCLUSIONS: Compared to RF, Laser ablation achieved more complete anatomical PVI, with less LA scar extension. However, AF recurrence appears to be similar after Laser compared to RF ablation. Further studies are needed to assess whether the anatomical advantages of Laser ablation translate into clinical benefit in patients with AF.

[WebSurvCa: web-based estimation of death and survival probabilities in a cohort]. / WebSurvCa: estimación vía web de las probabilidades de fallecimiento y de supervivencia de una cohorte.

Relative survival has been used as a measure of the temporal evolution of the excess risk of death of a cohort of patients diagnosed with cancer, taking into account the mortality of a reference population. Once the excess risk of death has been estimated, three probabilities can be computed at time T: 1) the crude probability of death associated with the cause of initial diagnosis (disease under study), 2) the crude probability of death associated with other causes, and 3) the probability of absolute survival in the cohort at time T. This paper presents the WebSurvCa application (https://shiny.snpstats.net/WebSurvCa/), whereby hospital-based and population-based cancer registries and registries of other diseases can estimate such probabilities in their cohorts by selecting the mortality of the relevant region (reference population).

Multielectrode vs. point-by-point mapping for ventricular tachycardia substrate ablation: a randomized study.

Aims: Ventricular tachycardia (VT) substrate ablation is based on detailed electroanatomical maps (EAM). This study analyses whether high-density multielectrode mapping (MEM) is superior to conventional point-by-point mapping (PPM) in guiding VT substrate ablation procedures. Methods and results: This was a randomized controlled study (NCT02083016). Twenty consecutive ischemic patients undergoing VT substrate ablation were randomized to either group A [n = 10; substrate mapping performed first by PPM (Navistar) and secondly by MEM (PentaRay) ablation guided by PPM] or group B [n = 10; substrate mapping performed first by MEM and second by PPM ablation guided by MEM]. Ablation was performed according to the scar-dechanneling technique. Late potential (LP) pairs were defined as a Navistar-LP and a PentaRay-LP located within a three-dimensional distance of ≤ 3 mm. Data obtained from EAM, procedure time, radiofrequency time, and post-ablation VT inducibility were compared between groups. Larger bipolar scar areas were obtained with MEM (55.7±31.7 vs. 50.5±26.6 cm2; P = 0.017). Substrate mapping time was similar with MEM (19.7±7.9 minutes) and PPM (25±9.2 minutes); P = 0.222. No differences were observed in the number of LPs identified within the scar by MEM vs. PPM (73±50 vs. 76±52 LPs per patient, respectively; P = 0.965). A total of 1104 LP pairs were analysed. Using PentaRay, far-field/LP ratio was significantly lower (0.58±0.4 vs. 1.64±1.1; P = 0.01) and radiofrequency time was shorter [median (interquartile range) 12 (7-20) vs. 22 (17-33) minutes; P = 0.023]. No differences were observed in VT inducibility after procedure. Conclusion: MEM with PentaRay catheter provided better discrimination of LPs due to a lower sensitivity for far-field signals. Ablation guided by MEM was associated with a shorter radiofrequency time.

El terremoto 19S en Morelos: la experiencia operativa del INEEL en la evaluación del riesgo estructural / The S19 earthquake in Morelos: the operational experience of INEEL in the evaluation of structural risk

Resumen El sismo del 19 de septiembre de 2017 en México causó daños catastróficos en el estado de Morelos que afectaron a más de 23 000 inmuebles en prácticamente todos los municipios del estado. Después de un sismo, resultan de gran importancia las acciones de emergencia existentes en la región para dar apoyo a la sociedad, tanto en el rescate de personas atrapadas como en la evaluación de la condición estructural que presentan los inmuebles, y de esta manera, mitigar sus efectos. Las acciones de emergencia requieren de planeación, organización, recursos económicos y materiales y, sobre todo, de trabajo en equipo. Desafortunadamente muchas sociedades no están preparadas para contener grandes desastres, por lo que puede resultar muy difícil hacer frente a una gran emergencia sin las condiciones adecuadas. Durante la emergencia del 19 de septiembre se vivió una situación jamás esperada en el estado de Morelos por los daños provocados por el sismo de magnitud 7.1, con epicentro a menos de 75 km de distancia, que puso a prueba al sistema de emergencia del estado. De manera particular, investigadores del Instituto Nacional de Electricidad y Energías Limpias (INEEL) iniciaron acciones de inspección en los inmuebles de su propio instituto, y posteriormente se pusieron a las órdenes de Protección Civil del Estado de Morelos para realizar inspecciones post-sísmicas de los inmuebles de gobierno, escuelas y, en general, de las viviendas de Morelos. La tarea principal del apoyo del INEEL consistió en dictaminar si los inmuebles debían continuar operando o ser habitables, si debían ser desalojados para hacer una revisión detallada o incluso si debían ser demolidos debido al alto riesgo de colapso que presentaban. El apoyo proporcionado por el INEEL no sólo se concentró en la evaluación post-sísmica de los inmuebles, sino que ha sido el inicio de una mayor colaboración con las autoridades del Estado, que resultará en el mejoramiento de los planes de emergencia y, sobre todo, en la actualización de las normas de diseño.

Abstract The earthquake of September 19, 2017 in Mexico caused catastrophic damage in the state of Morelos to more than 23 thousand structures in almost all municipalities. After an earthquake, emergency actions in the area are of great importance to support society, rescue trapped people as well as to assess the structural condition of the structures, and in this way, mitigate the negative effects. Unfortunately, society is not prepared to contain major disasters, and it can be very difficult to face a major emergency without the right conditions. The earthquake of September 19, with magnitude 7.1 and epicenter less than 75 km away, caused an emergency never expected in the state of Morelos, because of the damage it produced, which put Morelos' emergency system to the test. In particular, researchers from the National Institute of Electricity and Clean Energies (INEEL) initiated inspection actions in the buildings of their own institute, and subsequently placed themselves under the orders of the Civil Protection office of the State of Morelos to carry out post-seismic inspections of government buildings, schools and, in general, the homes of Morelos. The main task was to decide if the buildings were able to be inhabited again, if they should be evicted for a detailed review or if they should be demolished due to their high risk of collapse. The support was not only oriented to the post-seismic evaluation of the buildings, but was the beginning of working days with the State authorities, which will result in the improvement of the emergency plans and, above all, in the update of the design standards.

Hiperostosis asociada a prostaglandinas: Reporte de tres casos / Hyperostosis associated with prostaglandins: Report of three cases

Se expone una serie de casos de pacientes con hiperostosis reactiva secundaria a la utilización prolongada de prostaglandinas en el contexto de cardiopatías congénitas complejas, que por su condición hemodinámica requirieron mantener el cortocircuito vascular de izquierda a derecha para su supervivencia. Se muestran las características imaginológicas típicas en radiografía convencional y se analizan los detalles fisiopatológicos y los diagnósticos diferenciales.

We present a series of cases of patients with reactive hyperostosis secondary to prolonged use of prostaglandins in the context of complex congenital heart disease, which due to its hemodynamic condition required to maintain the left to right vascular shunt for their survival. We show the typical imaginological characteristics in conventional radiography and discuss the pathophysiological details and the differential diagnoses.

Fibrodisplasia osificante progresiva: reporte de caso / Fibrodysplasia ossificans progressiva: case report

La fibrodisplasia osificante progresiva (FOP) es una entidad poco común, caracterizada por la aparición de focos extraesqueléticos de osificación heterotópica, asociados a limitación física progresiva. En este artículo se describe el caso de una paciente evaluada en la Fundación Cardioinfantil, con diagnóstico de FOP, así como los principales hallazgos imaginológicos encontrados. Seguidamente se revisan la historia natural y las características radiológicas de esta enfermedad descritas en la literatura.

Fibrodysplasia ossificans progressiva is a rare entity characterized by progressive heterotopic ossification of the soft tissues and subsequent severe disability. We present a case of fibrodysplasia ossificans progressive in a young female evaluated in our institution. The clinical presentation and imaging characteristics of this disease are reviewed.

Complicaciones abdominales consecutivas a derivación cardiopulmonar / Abdominal complications resulting from cardiopulmonary derivation

Objetivo. Conocer la frecuencia de complicaciones intraabdominales y su impacto en la supervivencia de pacientes sujetos a DCP para procedimientos quirúrgicos comunes a corazón abierto. Antecedentes. Las complicaciones gastrointestinales después de cirugía cardiaca con derivación cardiopulmonar, tienen incidencia del 0.3 al 3 por ciento, pero la mortalidad puede sobrepasar 60 por ciento. Pese a las mejorías en el cuidado pre, trans, y posoperatorio, la impresión general ha sido que las complicaciones abdominales permanecen como un problema significativo. Tipo de Estudio. Retrospectivo de casos y controles. Material y métodos. Pacientes consecutivos sometidos a cirugía cardiaca con derivación cardiopulmonar, entre marzo de 1995 y marzo de 1997. Se identificó cualquier complicación abdominal, su diagnóstico, manejo médico o quirúrgico y mortalidad. Resultados. Se estudiaron 1,352 pacientes de los cuales 516 fueron operados por revascularización coronaria (38 por ciento), 502 (37 por ciento) por reemplazo valvular, 68 (5.2 por ciento) una combinación de reemplazo valvular y revascularización, 144 (10.6 por ciento) corrección de defectos congénitos, y 122 (9.6 por ciento) tratados por padecimientos diversos. Desarrollaron complicaciones 44 pacientes (3.3 por ciento) y éstas fueron íleo intestinal posoperatorio en 14 casos (32 por ciento), la mitad de ellos tuvo hiperamilasemia. Las complicaciones hepatobiliares representaron 29.5 por ciento (13 casos). Diez pacientes (22.7 por ciento) tuvieron enfermedad ulceropéptica complicada con hemorragia o perforación. La pandreatitis aguda grave se observó en 4.5 por ciento de los casos al igual en dos pacientes con necrosis intestinal. Tres casos presentaron complicaciones quirúrgicas no relacionadas con DCP y fueron traumatismo hepático grado I, apendicitis aguda y colitis amibiana. La mortalidad fue de 11/44 (25 por ciento). Como grupo control, se analizaron 73 pacientes operados el día o alrededor de los días como los del grupo de estudio y que no desarrollaron complicaciones gastrointestinales. La mortalidad en este grupo fue de 5/73 (6.8 por ciento). ...

Acreditación de la calidad: Bases para flexibilizar el reconocimiento de títulos y liberalizar el ejercicio de profesiones universitarias en Centroamérica / Quality accreditation: basic to facilitate the recognition of degrees and liberalize professional practices of graduates in Central America

Para comenzar se hace una breve reseña sobre el Consejo Superior Universitario Centroamericano (CSUCA) y su segundo Plan Regional de Integración de la Educación Superior en Centroamérica (PIRESC II), Plan estratégico conjunto de las universidades estatales de la región. Seguidamente se hace referencia a los convenios vigentes para el reconocimiento de títulos y estudios universitarios en la región y el papel y posición conjunta de las universidades estatales al respecto. Luego se explica brevemente la propuesta de Sistema Centroamericano de Evaluación y Acreditación de la Educación Superior (SICEVAES) que hoy diseñan y promueven las universidades miembros del CSUCA. Finalmente, de manera muy breve, se relaciona lo anterior con los compromisos internacionales de la región en materia de comercio de servicios profesionales.

Características de los procesos en la planta; desinfección

Trata de la metodología de desinfección que se lleva a cabo en la planta de tratamiento de agua San Antonio del Río Cali, en la ciudad de Cali, por medio de la aplicación y control del cloro en forma de pre y post-cloración, cuya dosis es invariable e independiente de los valores de la demanda de cloro. La pre-cloración se realiza antes del proceso de coagulación y floculación y la post-cloración se realiza al agua filtrada. Presenta observaciones generales para esta planta. Concluye que el pH es una variable que incide en la eficiencia de la cloración y que hay buena disponibilidad de recursos para el control