Facets of mindfulness among video game players: A latent profile analysis.

OBJECTIVE: This study explores the presence of different profiles of video game players across five mindfulness facets (i.e., describing, observing, nonreacting, nonjudging, and acting with awareness) and nonattachment (i.e., the ability to relate to experiences without clinging onto them). METHOD: Adults who play video games (N = 629) were recruited from Amazon's Mechanical Turk. Participants completed an online survey, assessing their dispositional mindfulness and nonattachment, problem video gaming, emotion-based impulsivity, psychological inflexibility, and mental health. RESULTS: The latent profile analysis identified four profiles, representing those who were highly mindful (n = 131; 20.8%), moderately mindful (n = 289; 46.0%), reactive and attached (n = 132; 21.0%), and judgmental and unaware (n = 77; 12.2%). Subsequent comparisons revealed that the judgmental and unaware profile reported the highest level of problem gaming, followed by the reactive and attached profile. The judgmental and unaware profile evidenced stronger general gaming motivations and higher emotion-based impulsivity; in contrast, the reactive and attached profile demonstrated greater psychological inflexibility and escapism motivation relative to the other profiles. Both the judgmental and unaware and the reactive and attached profiles had elevated levels of anxiety and depression. CONCLUSION: These findings provide a more nuanced assessment of the protective role of mindfulness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Hypnosis Versus Placebo During Atrial Flutter Ablation: The PAINLESS Study: A Randomized Controlled Trial.

OBJECTIVES: The aim of this study was to assess the superiority of hypnosis versus placebo on pain perception and morphine consumption during typical atrial flutter (AFL) ablation. BACKGROUND: AFL ablation commonly requires intravenous opioid for analgesia, which can be associated with adverse outcomes. Hypnosis is an alternative technique with rising interest, but robust data in electrophysiological procedures are lacking. METHODS: This single center, randomized controlled trial compared hypnosis and placebo during AFl ablation. In addition to the randomized intervention, all patients were treated according to the institution's standard of care analgesia protocol (administration of 1 mg of intravenous morphine in case of self-reported pain ≥5 on an 11-point numeric rating scale or on demand). The primary endpoint was perceived pain quantified by patients using a visual analog scale. RESULTS: Between October 2017 and September 2019, 113 patients (mean age 70 ± 12 years, 21% women) were randomized to hypnosis (n = 56) or placebo (n = 57). Mean pain score was 4.0 ± 2.2 in the hypnosis group versus 5.5 ± 1.8 in the placebo group (p < 0.001). Pain perception, assessed every 5 min during the whole procedure, was consistently lower in the hypnosis group. Patients' sedation scores were also better in the hypnosis group than in the placebo group (8.3 ± 2.2 vs. 5.4 ± 2.5; p < 0.001). Finally, morphine requirements were significantly lower in the hypnosis group (1.3 ± 1.3 mg) compared with the placebo group (3.6 ± 1.8 mg; p < 0.001). CONCLUSIONS: In this first randomized trial, hypnosis during AFL ablation was superior to placebo for alleviating pain and reducing morphine consumption.

Proof of concept study of a novel pacemapping algorithm as a basis to guide ablation of ventricular arrhythmias.

Aims: To determine if a software algorithm can use an individualized distance-morphology difference model, built from three initial pacemaps, to prospectively locate the exit site (ES) of ventricular arrhythmias (VA). Methods and results: Consecutive patients undergoing ablation of VA from a single centre were recruited. During mapping, three initial pacing points were collected in the chamber of interest and the navigation algorithm applied to predict the ES, which was corroborated by conventional mapping techniques. Thirty-two patients underwent ES prediction over 35 procedures. Structural heart disease was present in 16 (7 ischaemic cardiomyopathy, 9 non-ischaemic cardiomyopathy), median ejection fraction 45% [Interquartile range (IQR) 26]. The remainder had normal hearts. The navigation algorithm was applied to 46 VA (24 left ventricle, 11 right ventricular outflow tract, 5 left ventricular outflow tract, 4 right ventricle, 2 epicardial) and successfully located the site of best pacemap match in 45 within a median area of 196.5 mm2 (IQR 161.3, range 46.6-1288.2 mm2). Conclusions: In a diverse population of patients with and without structural heart disease, the ES of VA can be accurately and reliably identified to within a clinically useful target area using a simple software navigation algorithm based on pacemapping.

Relationship Between Distance and Change in Surface ECG Morphology During Pacemapping as a Guide to Ablation of Ventricular Arrhythmias: Implications for the Spatial Resolution of Pacemapping.

BACKGROUND: Pacemapping is used to localize the exit site of ventricular arrhythmia. Although the relationship between distance and change in QRS morphology is its basis, this relationship has not been systematically quantified. METHODS AND RESULTS: Patients (n=68) undergoing ventricular arrhythmia ablation between March 2012 and July 2013 were recruited. Pacemapping was targeted to areas of voltage >0.5 mV. Linear mixed-effects models were constructed of distance against morphology difference measured by the root mean square error sum across all 12 ECG leads (E12). Forty of 68 (58%) patients had structural heart disease, and 21/40 (53%) patients were ischemic. Nine hundred thirty-five pacing points were collected, generating 6219 pacing site pair combinations (3087 [50%] ventricular bodies, 756 [12%] outflow tract, and 162 [3%] epicardial). In multivariable analysis, increase in E12 was predicted by increasing distance (0.07 per mm; 95% confidence interval 0.07-0.08; P<0.001). Compared with the left ventricle, E12 values were lower in the right ventricle (P=0.037) and left ventricular outflow tract (P<0.001) and higher in left ventricle-right ventricle pairs (P=0.021) and left ventricular epicardium (P=0.08). There was no difference in E12 in the right ventricular outflow tract compared with the right-left ventricular outflow tract (P=0.75) pairs. Structural heart disease or inadvertent pacing in scar was not associated with changes in E12; however, the presence of latency and split potentials were associated with higher and lower E12 values, respectively (P<0.001). CONCLUSIONS: A robust positive relationship exists between distance and QRS morphological change when restricting pacing points to areas of voltage >0.5 mV. Significant differences in the spatial resolution of pacemapping exist within the heart.

Brugada syndrome: an update.

More than 20 years have passed since the description of Brugada syndrome as a clinical entity. The original case series depicted patients who all had coved ST-segment elevation in the right precordial leads, associated with a high risk of sudden death and no apparent structural heart disease. As subsequent registry data were published, it became apparent that the spectrum of risk is wide, with the majority of patients classified as low risk. Two consensus documents have been published that will continue to be updated. Despite intense research efforts, many controversies still exist over its pathophysiology and the risk stratification for sudden death. Management continues to be challenging with a lack of drug therapy and high complication rates from implantable cardioverter defibrillators. In this review, we highlight the current state-of-the-art therapies and their controversies.

Intra-isthmus reentry associated with uncorrected double inlet left ventricle and transposition of the great arteries.

A 62-year-old man with uncorrected cyanotic congenital heart disease involving double inlet left ventricle with visceral and atrial situs solitus, L-looped ventricles, L-transposed great vessels, and pulmonary stenosis, presented with recurrent atrial tachycardia. Entrainment mapping revealed the arrhythmia mechanism to be an uncommon micro-reentrant cavotricuspid isthmus-dependent circuit (intra-isthmus reentry), which was amenable to radiofrequency ablation. This uncommon right atrial arrhythmia is yet to be reported in patients with complex congenital heart disease and was amenable to radiofrequency ablation.