Zero-fluoroscopy ablation with multielectrode pulse field ablation system: Case series.

Pulse field ablation (PFA) is a novel nonthermal ablation modality for treatment of atrial fibrillation. While mostly lacking 3D electroanatomical mapping integration, reported radiation doses in procedures using multielectrode PFA catheters are relatively high. We report a first case series of three patients where a zero-fluoroscopy approach by intracardiac echocardiography was utilized and present a possible workflow for zero-fluoroscopy ablation with the Farapulse PFA system.

Ablation of residual potentials along the circumferential line reduces acute pulmonary vein reconnection.

INTRODUCTION: Acute pulmonary vein (PV) reconnection is frequently encountered in patients undergoing PV isolation (PVI) procedure for the treatment of atrial fibrillation. In this study, we investigated whether the identification and ablation of residual potentials (RPs), after the initial achievement of PVI, reduces acute PV reconnection rate. METHODS: Following PVI in 160 patients, mapping along the ablation line was performed to identify RPs, defined as bipolar amplitude ≥0.2 mV or 0.1-0.19 mV combined with a negative component of the unipolar electrogram. Ipsilateral PV sets with RPs were randomized to either no further ablation (Group B) or to additional ablation of the identified RPs (Group C). The primary study endpoint was spontaneous or adenosine-mediated acute PV reconnection after a 30-min waiting period and was also evaluated in ipsilateral PV sets without RPs (Group A). RESULTS: After isolation of 287 PV pairs, 135 had no RPs (Group A), whereas the remaining PV pairs were randomized to either Group B (n = 75) or Group C (n = 77). Ablation of RPs resulted in a reduction of spontaneous or adenosine-mediated PV reconnection rate (16.9% in Group C vs 48.0% in Group B; p < 0.001). Group A was associated with a significantly lower percentage of acute PV reconnection as compared to Group B (5.9% vs 48.0%; p < 0.001) and Group C (5.9% vs 16.9%; p = 0.016). CONCLUSION: After PVI achievement, the absence of RPs along the circumferential line is associated with a low likelihood of acute PV reconnection rate. Ablation of RPs significantly reduces spontaneous or adenosine-mediated acute PV reconnection rate.

Carbon-14 release and speciation during corrosion of irradiated steel under radioactive waste disposal conditions.

Carbon-14 is a key radionuclide in the safety assessment of deep geological repositories (DGR) for low- and intermediate-level radioactive waste (L/ILW). Irradiated metallic wastes generated during the decommissioning of nuclear power plants are an important source of 14C after their disposal in a DGR. The chemical form of 14C released from the irradiated metallic wastes determines the pathway of migration from the DGR into the environment. In a long-term corrosion experiment with irradiated steel simulating the hyper-alkaline, anoxic conditions of a cement-based DGR, total inorganic (TI14C2) and organic 14C contents (TO14C) in the liquid and gas phases (TG14C), as well as individual 14C-bearing carbon compounds by compound-specific radiocarbon analysis (CSRA), were quantified using accelerator mass spectrometry (AMS). The AMS-based quantification allows the determination of 14C in the pico- to femtomolar concentration range. An initial increase in TO14C was observed, which could be attributed partially to the release of 14C-bearing oxygenated carbon compounds. In the long term, TO14C and the TI14C remain constant, while TG14C increases over time according to a corrosion rate of steel of 1 nm/yr. In solution, 14C-bearing carboxylic acids (CAs) contribute ~40% to TO14C, and they are the main 14C carriers along with 14C-bearing carbonate (14CO32-). The remaining fraction of TO14C (~ 60%) is likely due to the presence of as yet non-identified polymeric or colloidal organic material. In the gas phase, 14CH4 accounts for more than 80% of the TG14C, while only trace amounts of 14CO, and other small 14C-bearing hydrocarbons have been detected. In a DGR, the release of 14C will be mainly in gaseous form and migrate via the gas pathway from the repository near field to the surrounding host rock and eventually to the environment.

Minimising radiation exposure in catheter ablation of ventricular arrhythmias.

BACKGROUND: Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). METHODS: Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. RESULTS: Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. CONCLUSIONS: Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.