His-Purkinje conduction system pacing combined with atrioventricular node ablation improves quality of life in older patients with persistent atrial fibrillation refractory to multiple ablation procedures.

BACKGROUND: Recurrence of atrial fibrillation (AF) is common in patients with persistent AF even after multiple ablation procedures. His-Purkinje conduction system pacing (HPCSP) combined with atrioventricular node ablation (AVNA) is effective in managing patients with AF and heart failure. This study aimed to determine whether HPCSP combined with AVNA can improve quality of life and alleviate symptoms in older patients with symptomatic persistent AF refractory to multiple ablation procedures, as well as evaluate the feasibility and safety of this therapy. METHODS: Older patients (≥ 65 years) with symptomatic persistent AF refractory to at least two ablation procedures were treated with combined HPCSP and AVNA. The success rates and complications were recorded. Pacing parameters, European Heart Rhythm Association (EHRA) scores, and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) scores obtained perioperatively were compared with those recorded at the 6-month follow-up examination. RESULTS: Thirty-one patients were enrolled; of those, only thirty patients were eventually treated with AVNA because one patient developed a complete atrioventricular block following the withdrawal of the His bundle pacing lead. The success rates were 100% for HPCSP (22 cases with His bundle pacing, and 9 cases with left bundle branch pacing) and 93.3% (28/30) for AVNA, respectively. By the 6-month follow-up examination, EHRA scores improved significantly (3.00 ± 0.73 vs. 2.44 ± 0.63, P = 0.014) and AFEQT scores increased markedly (49.6 ± 20.6 vs. 70.9 ± 14.0, P = 0.001). No severe complications developed. CONCLUSIONS: When used in older patients with symptomatic persistent AF refractory to multiple ablation procedures, HPCSP combined with AVNA significantly alleviated symptoms and improved quality of life during short-term follow-up. This therapy was proved to be safe and effective in this patient population.

Auditory cortical neurons in the mouse have salient best azimuths.

Azimuth sensitivity of the primary auditory cortex in mammals is not well understood, and there is a debate as to whether the primary auditory cortex plays role in spatial hearing. We show for the first time, using single-unit recordings in the mouse primary auditory cortex, that auditory cortical neurons demonstrate a variety of azimuth-tuning functions and there are a majority of neurons showing salient best azimuths. The findings differ from those in the cat, ferret and monkey, and imply that there is some representation of auditory space in the mouse primary auditory cortex.

Columnar and layer-specific representation of spatial sensitivity in mouse primary auditory cortex.

The primary auditory cortex (AI) is implicated in coding sound location, as revealed by behavior-lesion experiments, but our knowledge about the functional organization and laminar specificity of neural spatial sensitivity is still very limited. Using single-unit recordings in mouse AI, we show that (i) an inverse relationship between onset latency and spike count is consistently observed when all the azimuthal points are taken; (ii) a substantial proportion of penetrations perpendicular to the AI surface showed columnar organization of best azimuths; (iii) the preferred azimuth range of AI neurons demonstrated layer-specific distribution pattern. Our findings suggest that similar to other response properties, the manner of sound space information processing in the auditory cortex is also layer dependent.