A Recyclable Polypropylene Multilayer Film Maintaining the Quality and the Aroma of Coffee Pods during Their Shelf Life.

Films for coffee-pod packaging usually contain aluminium as an impermeable foil that is not recyclable and has to be discharged as waste. In this study, a recyclable polypropylene multilayer film is proposed as an alternative. The performance on the chemical composition of coffee was evaluated and compared to that of film containing aluminium (standard). The oxygen in the headspace, moisture, lipidic oxidation, and volatile organic compounds were studied in coffee pods during storage for 12 months at 25 and 40 °C. In addition, the acidity and acceptability of extracted coffee were evaluated. In the polypropylene-packaged pods, the percentage of oxygen during storage at 25 °C was lower than that in the standard. Moisture was not affected by the type of packaging materials. No differences were found between the peroxide values, except in pods stored for 3, 10, and 11 months at 25 °C, where they were even lower than the standard. Furans and pyrazines were the main volatile organic compounds detected. No differences were found in the pH and titratable acidity of the coffee brew either. All samples were well accepted by consumers without any perceived difference related to the packaging film. The polypropylene multilayer film is a sustainable recyclable material with high performance, in particular, against oxygen permeation.

MR guided cardiac ablation: how to build an interventional magnetic resonance suite and what's the role of the imaging.

Magnetic resonance (MR) represents a new interesting imaging approach for guiding electrophysiology (EP)-based ablation procedures of atrial flutter and typical atrial fibrillation. This new approach permits to reach good results if compared with conventional EP ablation. Tissue characterization by MR permits to detect cardiac anatomy and pathological substrate like myocardial scars well visualized with late gadolinium enhancement (LGE) sequences. Intra-procedural imaging is useful to real-time follow the catheter during the ablation procedure and at the same time to visualize cardiac anatomy in addition to understanding if the ablation is correctly performed using oedema sequences. Performing cardiac ablations inside an MR room permits to reduce radiation exposure and occupational illnesses.

Atrial fibrillation and sympatho-vagal imbalance: from the choice of the antiarrhythmic treatment to patients with syncope and ganglionated plexi ablation.

For several years, the autonomic nervous system has played a central role in the pathophysiological mechanism of atrial fibrillation (AF), so much so that it has been considered one of the cornerstones of Coumel's triangle. The clinical and therapeutic management of AF secondary to sympatho-vagal imbalance represents one of the most important examples of how precision medicine should be applied. Increasing knowledge of this kind of arrhythmias has made it possible to select specific antiarrhythmic drugs and to diversify their use according to vagal or adrenergic AF forms. Ablative strategies, such as cardioneuroablation and non-direct cardiac neuromodulation methods (such as renal denervation and peripheral vagal stimulation), have gradually emerged. In the possibly near future, there will be a development of new acquisitions regarding new pharmacological therapeutic strategies and gene therapy. Finally, finding an AF in patients experiencing syncopal episodes opens a whole chapter regarding interesting, but also complex, diagnostic and therapeutic strategies, ranging from neurally mediated forms to convulsive seizure that could also increase the risk of sudden death.

Cardiac magnetic resonance in Fabry disease.

Fabry disease (FD) is a rare X-linked inherited lysosomal storage disorder caused by deficient a-galactosidase A activity that leads to an accumulation of glycolipids, mainly globotriaosylceramide (Gb3) and globotriaosylsphingosine, in affected tissues, including the heart. Cardiovascular involvement usually manifests as left ventricular hypertrophy (LVH), myocardial fibrosis, heart failure, and arrhythmias, which limit the quality of life and represent the most common causes of death. Following the introduction of enzyme replacement therapy, early diagnosis and treatment have become essential in slowing down the disease progression and preventing major cardiac complications. Recent advances in the understanding of FD pathophysiology suggest that in addition to Gb3 accumulation, other mechanisms contribute to the development of cardiac damage. FD cardiomyopathy is characterized by an earlier stage of glycosphingolipid accumulation and a later one of hypertrophy. Morphological and functional aspects are not specific in the echocardiographic evaluation of Anderson-Fabry disease. Cardiac magnetic resonance with tissue characterization capability is an accurate technique for the differential diagnosis of LVH. Progress in imaging techniques has improved the diagnosis and staging of FD-related cardiac disease: a decreased myocardial T1 value is specific of FD. Late gadolinium enhancement is typical of the later stage of cardiac involvement but as in other cardiomyopathy is also valuable to predict the outcome and cardiac response to therapy.

Tissue thickness measured with dielectric-based technology during radiofrequency catheter ablation.

Radiofrequency catheter ablation of the cavotricuspid isthmus is the standard treatment for patients suffering from typical atrial flutter. The aim of this study was to test the feasibility of tissue thickness and lesion transmurality measurement by a novel dielectric system. This was a retrospective multicentric non-randomized open-label, single-arm study. The atrial wall thickness was significantly higher close to the tricuspid annulus than close to the inferior vena cava and a trend towards a progressive decrease of atrial wall thickness was observed moving the mapping catheter from the tricuspid valve to the inferior vena cava. The possibility to visualize the tissue thickness could modify the way to deliver radiofrequency energy, allowing a tailored approach in cardiac ablation procedures.

Contact-force monitoring increases accuracy of right ventricular voltage mapping avoiding "false scar" detection in patients with no evidence of structural heart disease.

PURPOSE: Electroanatomical mapping (EAM) could increase cardiac magnetic resonance imaging (CMR) sensitivity in detecting ventricular scar. Possible bias may be scar over-estimation due to inadequate tissue contact. Aim of the study is to evaluate contact-force monitoring influence during EAM, in patients with idiopathic right ventricular arrhythmias. METHODS: 20 pts (13 M; 43 ± 12 y) with idiopathic right ventricular outflow tract (RVOT) arrhythmias and no structural abnormalities were submitted to Smarttouch catheter Carto3 EAM. Native maps included points collected without considering contact-force. EAM scar was defined as area ≥1 cm2 including at least 3 adjacent points with signal amplitude (bipolar <0.5 mV, unipolar 3,5 mV), surrounded by low-voltage border zone. EAM were re-evaluated offline, removing points collected with contact force <5 g. Finally, contact force-corrected maps were compared to the native ones. RESULTS: An EAM was created for each patient (345 ± 85 points). After removing poor contact points, a mean of 149 ± 60 points was collected. The percentage of false scar, collected during contact force blinded mapping compared to total volume, was 6.0 ± 5.2% for bipolar scar and 7.1 ± 5.9% for unipolar scar, respectively. No EAM scar was present after poor contact points removal. Right ventricular areas analysis revealed a greater number of points with contact force < 5 g acquired in free wall, where reduced mean bipolar and unipolar voltage were recorded. CONCLUSIONS: To date this is the first work conducted on structurally normal hearts in which contact-force significantly increases EAM accuracy, avoiding "false scar" related to non-adequate contact between catheter and tissue.

Volatile Organic Compound and Fatty Acid Profile of Milk from Cows and Buffaloes Fed Mycorrhizal or Nonmycorrhizal Ensiled Forage.

Seed inoculation of forage crops by arbuscular mycorrhizal fungi (AMF) generally results in higher profitability, but also modifies the chemical composition of silage in terms of increased biomass, protein, and dry matter. Raw milk aroma is affected by the type of feed. This work investigated the influence of ensiled forage obtained by seed inoculation with AMF on the volatile fractions and fatty acid composition of milk. Two experiments were carried out: in the first, buffaloes were fed maize silage, and in the second, cows were fed sorghum silage. The volatile fractions of milk were quantified by headspace solid-phase micro-extraction (HS-SPME), combined with gas chromatography-mass spectrometry (GC-MS), and fatty acids by gas chromatography (GC). The ensiled forage obtained with AMF increased saturated fatty acids (SFAs), and decreased monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) in both experiments. The volatile fraction in milk samples obtained from bovines fed mycorrhizal ensiled forage showed an increase of free fatty acids and ketones, responsible for cheesy and fruity odors. Aldehydes, responsible for green and grassy notes, increased only in the milk from buffaloes fed ensiled maize. Our results suggest that inoculation of maize and sorghum seed with AMF, combined with a low rate of fertilizers, leads to ensiled forage that could slightly affect the FA profile and odor quality of milk.

Patients with left bundle branch block and left axis deviation show a specific left ventricular asynchrony pattern: Implications for left ventricular lead placement during CRT implantation.

BACKGROUND: Left bundle branch block (LBBB) and left axis deviation (LAD) patients may have poor response to resynchronization therapy (CRT). We sought to assess if LBBB and LAD patients show a specific pattern of mechanical asynchrony. METHODS: CRT candidates with non-ischemic cardiomyopathy and LBBB were categorized as having normal QRS axis (within -30° and +90°) or LAD (within -30° and -90°). Patients underwent tissue Doppler imaging (TDI) to measure time interval between onset of QRS complex and peak systolic velocity in ejection period (Q-peak) at basal segments of septal, inferior, lateral and anterior walls, as expression of local timing of mechanical activation. RESULTS: Thirty patients (mean age 70.6years; 19 males) were included. Mean left ventricular ejection fraction was 0.28±0.06. Mean QRS duration was 172.5±13.9ms. Fifteen patients showed LBBB with LAD (QRS duration 173±14; EF 0.27±0.06). The other 15 patients had LBBB with a normal QRS axis (QRS duration 172±14; EF 0.29±0.05). Among patients with LAD, Q-peak interval was significantly longer at the anterior wall in comparison to each other walls (septal 201±46ms, inferior 242±58ms, lateral 267±45ms, anterior 302±50ms; p<0.0001). Conversely, in patients without LAD Q-peak interval was longer at lateral wall, when compared to each other (septal 228±65ms, inferior 250±64ms, lateral 328±98ms, anterior 291±86ms; p<0.0001). CONCLUSIONS: Patients with heart failure, presenting LBBB and LAD, show a specific pattern of ventricular asynchrony, with latest activation at anterior wall. This finding could affect target vessel selection during CRT procedures in these patients.

Safety and feasibility of atrial fibrillation ablation using Amigo® system versus manual approach: A pilot study.

BACKGROUND: The Amigo® Remote Catheter System is a relatively new robotic system for catheter navigation. This study compared feasibility and safety using Amigo (RCM) versus manual catheter manipulation (MCM) to treat paroxysmal atrial fibrillation (PAF). Contact force (CF) and force-time integral (FTI) values obtained during pulmonary vein isolation (PVI) ablation were compared. METHODS: Forty patients were randomly selected for either RCM (20) or MCM (20). All were studied with the Thermocool® SmartTouch® force-sensing catheter (STc). Contact Force (CF), Force Time Integral (FTI) and procedure-related data, were measured/stored in the CARTO®3. RESULTS: All cases achieved complete PVI without major complications. Mean CF was significantly higher in the RCM group (13.3 ± 7.7 g in RCM vs. 12.04 ± 7.42 g in MCM p < 0.001), as was overall mean FTI (425.6 gs ± 199.6 gs with RCM and 407.5 gs ± 288.0 gs in MCM (p = 0.007) and was more likely to fall into the optimal FTI range (400-1000) using RCM (66.1% versus 49.1%, p < 0.001). FTI was significantly more likely to fall within the optimal range in each PV, as was CF within its optimal range in the right PVs, but trended higher in the left PVs. Freedom from atrial tachyarrhythmia was 90.0% for the RCM and 70.0% for the MCM group (p = 0,12) at 540 days follow-up. CONCLUSIONS: This pilot study suggests that use of the Amigo RCM system, with STc catheter, seems to be safe and effective for PVI ablation in paroxysmal AF patients. A not statistically significant favorable trend was observed for RCM in term of AF-free survival.

Impact of the third generation cryoballoon on atrial fibrillation ablation: An useful tool?

BACKGROUND: Third-generation cryoballoon (CB3) is characterized by a 40% shorter distal tip designed to increase the rate of pulmonary veins real-time signal recording in order to measure time necessary to isolate veins, the "Time to effect" (TTE). Few data are currently available on clinical follow up of CB3 treated patients. METHODS: Sixtyeight consecutive patients (mean age 57.8 ±â€¯9.6 years, 48 male) with paroxysmal or persistent atrial fibrillation (AF) were enrolled. Thirthyfour (25 paroxysmal AF) underwent to a 28 mmCB3 pulmonary veins isolation and were compared to 34 treated (21 paroxysmal AF) with 28 mmCB2. RESULTS: CB3 use was correlated to significant increase of the possibility to measure TTE in every treated veins (left superior 82,35% vs 23,53%, left inferior 70,59% vs 38,24%, right superior 58,82% vs 14,71%, right inferior 52,94% vs 17,65%). When it is measured, TTE wasn't different between two groups. Higher nadir temperature was observed in CB3 patients (-39.4 ±â€¯5.2 °C vs -43.0 ±â€¯7.2 °C, p = 0.03). CB3 procedures were shorter (91.4 ±â€¯21.7 vs 110.9 ±â€¯31.8 min, p = 0.018), with a significant reduction in cryoenergy delivery time (24.2 ±â€¯8.5 vs 20.3 ±â€¯6.7 min, p < 0.05), and a significant reduction in left atrium dwell time (59.3 ±â€¯9.8 vs 69.3 ±â€¯10.8 min, p = 0.02, p < 0.05). At one year follow up period the Kaplan-Meier curve didn't show any significant difference in AF-free survival (Log p = 0,49). CONCLUSIONS: Novel CB3 is a useful tool in order to simplify AF cryoballoon ablation when compared to second generation cryoballoon, as observed in our experience. Follow up data seem confirm a clinical CB3 efficacy at least comparable CB2.

Acute echocardiographic optimization of multiple stimulation configurations of cardiac resynchronization therapy through quadripolar left ventricular pacing: a tailored approach.

BACKGROUND: Cardiac resynchronization therapy (CRT) is ineffective in approximately 30% of recipients, in part due to sub-optimal left ventricular (LV) pacing location. The Quartet LV lead, with 2 additional electrodes proximal to conventional bipolar lead electrodes, enables 10 different pacing configurations at four independent LV locations. In a CRT patient cohort, we sought to evaluate the spectrum of echocardiographic and electrocardiographic response over these 10 configurations, to select the optimal one in each patient. Moreover, we sought to evaluate the 6-months clinical and echocardiographic response to a "tailored approach" in which the optimal LV pacing configuration for CRT was determined by echocardiographic measures, QRSd and pacing capture thresholds. METHODS: Twenty-two consecutive CRT indicated patients were implanted with a quadripolar CRT system (St. Jude Medical). Optimal LV pacing configuration was determined by echocardiographic measures, including velocity time integral (VTI), myocardial performance index (MPI) and mitral regurgitation (MR), and an electrocardiographic measure (QRS duration) during pacing from each of the configurations at pre-discharge. The optimal LV pacing vector was chosen for every patient. Clinical and echocardiographic assessment was repeated after 6 months. RESULTS: Various configurations provided different VTI, MPI, MR and QRSd values. Conventional bipolar vectors (ie, D1-M2, D1-RVc, M2-RVc) were rarely associated with the best echocardiographic improvements and provided significantly worse VTI, MR, MPI, and QRSd values than the best configuration for every patient (P = .005, P = .05 and P = .03 for VTI; P = .01, P = .005 and P = .001 for MPI; P = .003, P = .01 and P = .005 for MR, P > .5, P = .01 and P = .05 for QRSd) Conversely, "unconventional" proximal configurations (ie, making use of P4 and M3 electrodes) were generally characterized by higher acute VTI, MR and MPI improvements. CRT devices were reprogrammed with an "unconventional" LV pacing configuration in 50% of patients. A significant improvement in New York Heart Association class (81%), LV ejection fraction (76%), end-diastolic and end-systolic volumes was observed after 6 months (P = .02, P < .001, P = .02 and P = .003, respectively). CONCLUSIONS: In this study, conventional bipolar vectors of quadripolar-CRT were rarely associated with the best echocardiographic improvements. Quadripolar CRT utilizing optimal LV pacing configuration was associated with a significant improvement in New York Heart Association class and LV ejection fraction after 6 months.

Effects of germination time on the structure, functionality, flavour attributes, and in vitro digestibility of green Altamura lentils (Lens culinaris Medik.) flour.

There has been an increase in the use of adoptable bioprocessing methods for the development of high-quality leguminous ingredients. The potential use of germinated green Altamura lentils as a food ingredient is closely related to the resulting properties. The objective of this study was to evaluate the impact of three germination times - 0 (C), 24 (G) and 48 (H) hours - on the physicochemical, microstructural, flavour, functional, and nutritional features of lentil flour samples (CF, GF and HF). Lentil flour samples were obtained by grinding both whole green seeds (C) and germinated seeds (G and H), and then sifting them to obtain a particle size < 300 µm. The germinated samples - GF (24 h) and HF (48 h) - exhibited differences (P < 0.05) in the physicochemical and bioactive properties of CF (control). Similarly, compared with those in the control sample, the total starch, amylose and total phenolic contents in the GF and HF samples decreased, while the protein content increased (p < 0.05). A decrease in the presence of intact starch granules was observed via SEM in the germinated samples. The germination time had a significant (P < 0.05) effect on the colour indices, L*, a*, and b* of the samples. Flavour attributes were significantly influenced by the germination time. Overall, a total of 14 (CF) and 17 (GF and HF) aromatic compounds were identified. The technological characteristics of the CF, GF and HF dough samples were studied using a Brabender farinograph. Germination time affects the flour properties, leading to a significant decrease in farinographic parameters such as water absorption (WA), dough development time (DT), and dough stability (DS) and an increase in the degree of dough weakening (DOS). Differential scanning calorimetry was employed to examine the gelatinization transition of the samples. Germination strongly influenced all the thermal properties of the samples. It also had a significant impact on the in vitro starch digestibility, starch fraction and glycaemic index (eGI) of the samples. In particular, the eGI of germinated lentils was lower than that of the CF. In conclusion, the germination time could be a key factor modulating some crucial lentil flour properties.

The Lipidic and Volatile Components of Coffee Pods and Capsules Packaged in an Alternative Multilayer Film.

Coffee pods and capsules require packaging that guarantees the optimal coffee preservation. The chemical composition of coffee can undergo quality decay phenomena during storage, especially in terms of lipidic and volatile components. Amongst coffee packaging, aluminum multilayer materials are particularly widely diffused. However, aluminum is a negative component because it is not recoverable in a mixed plastic structure and its specific weight gives significant weight to packaging. In this study, a multilayer film with a reduced content of aluminum was used to package coffe pods and capsules and compared to a standard film with an aluminum layer. Their influence on the peroxides and volatile organic compounds of two coffee blends, 100% Coffea arabica L., 50% Coffea arabica L., and 50% Coffea canephora var. robusta L., were studied during their 180-day shelf life. The predominant volatile organic compounds detected belonged to the class of furans and pyrazines. Both packaging materials used for both coffee blends in the pods and capsules showed no significant differences during storage. Thus, the alternative packaging with less aluminum had the same performance as the standard with the advantage of being more sustainable, reducing the packaging weight, with benefits for transportation, and preserving the coffee aroma during the shelf life.

Green technologies for extracting plant waste functional ingredients and new food formulation: A review.

Nowadays, there is a growing interest in food waste recovery by both consumers and companies. Food waste of plant origin is a source of bioactive compounds, such as phenolic acids, anthocyanins, flavonoids, phytosterols, carotenoids, and tocopherols, with well-known antioxidant, anti-glycemic, and antimicrobial properties. The use of green and sustainable technologies to recover bioactive compounds from food waste is a possible solution to valorize waste following the principles of green chemistry. Furthermore, today's consumers are more attracted, informed, and aware of the benefits associated with the consumption of functional foods, and with this in mind, the use of extracts rich in beneficial compounds obtained by green technologies from food waste can be a valid alternative to prepare functional foods. In this review, the recovery of polyphenols and fibers with green technologies from food waste for the formulation of functional foods was presented.

Exploring the Untapped Potential of Pine Nut Skin By-Products: A Holistic Characterization and Recycling Approach.

The increasing population, food demand, waste management concerns, and the search for sustainable alternatives to plastic polymers have led researchers to explore the potential of waste materials. This study focused on a waste of pine nut processing referred to in this paper as pine nut skin. For the first time, its nutritional profile, potential bioactive peptide, contaminants, and morphological structure were assessed. Pine nut skin was composed mainly of carbohydrates (56.2%) and fiber (27.5%). The fat (9.8%) was about 45%, 35%, and 20% saturated, monounsaturated, and polyunsaturated fatty acid, respectively, and Omega-9,-6, and -3 were detected. Notably, oleic acid, known for its health benefits, was found in significant quantities, resembling its presence in pine nut oil. The presence of bioactive compounds such as eicosapentaenoic acid (EPA) and phytosterols further adds to its nutritional value. Some essential elements were reported, whereas most of the contaminants such as heavy metals, polycyclic aromatic hydrocarbons, rare earth elements, and pesticides were below the limit of quantification. Furthermore, the in silico analysis showed the occurrence of potential precursor peptides of bioactive compounds, indicating health-promoting attributes. Lastly, the morphological structural characterization of the pine nut skin was followed by Fourier Transform Infrared and solid-state NMR spectroscopy to identify the major components, such as lignin, cellulose, and hemicellulose. The thermostability of the pine nut skin was monitored via thermogravimetric analysis, and the surface of the integument was analyzed via scanning electron microscopy and volumetric nitrogen adsorption. This information provides a more comprehensive view of the potential uses of pine nut skin as a filler material for biocomposite materials. A full characterization of the by-products of the food chain is essential for their more appropriate reuse.

Minor Variety of Campania Olive Germplasm ("Racioppella"): Effects of Kaolin on Production and Bioactive Components of Drupes and Oil.

The effects of climate change have a great impact on the Mediterranean regions which are experiencing an increase in drought periods with extreme temperatures. Among the various solutions reported to reduce the damage caused by extreme environmental conditions on olive plants, the application of anti-transpirant products is widespread. In an increasingly current scenario of climate change, this study was designed to evaluate the effect of kaolin on the quantitative and qualitative parameters of drupes and oil in a little-known olive cultivar known as "Racioppella", belonging to the autochthonous germplasm of Campania (Southern Italy). To this purpose, the determination of maturation index, olive yield/plant, and bioactive components analysis (anthocyanins, carotenoids, total polyphenols, antioxidant activity, and fatty acids) were carried out. Kaolin applications showed no statistically significant differences in terms of production/plant while a significant increase in the drupe oil content was observed. Kaolin treatments resulted in increased anthocyanins (+24%) and total polyphenols (+60%) content and at the same time a significant increase in the antioxidant activity (+41%) of drupes was recorded. As far as oil is concerned, the results showed an increase in monounsaturated fatty acids, oleic and linoleic acids, and total polyphenols (+11%). On the basis of the results obtained, we can conclude that kaolin treatment can be considered as a sustainable solution to improve qualitative parameters in olive drupes and oil.

The Use of Carbon Dioxide as a Green Approach to Recover Bioactive Compounds from Spent Coffee Grounds.

Spent coffee grounds (SCG) contain bioactive compounds. In this work, given the increasing demand to valorize waste and use green technologies, SCG were submitted to extraction by carbon dioxide (CO2) in supercritical and liquid conditions. The extraction parameters were varied to obtain the maximum yield with the maximum antioxidant activity. The use of supercritical and liquid CO2 with 5% ethanol for 1 h provided yields (15 and 16%, respectively) comparable to those obtained by control methods for 5 h and extracts with high total polyphenolic contents (970 and 857 mg GAE/100 g oil, respectively). It also provided extracts with DPPH (3089 and 3136 µmol TE/100 g oil, respectively) and FRAP (4383 and 4324 µmol TE/100 g oil, respectively) antioxidant activity levels higher than those of hexane extracts (372 and 2758 µmol TE/100 g oil, respectively) and comparable to those of ethanol (3492 and 4408 µmol TE/100 g oil, respectively). The SCG extracts exhibited linoleic, palmitic, oleic, and stearic acids (predominant fatty acids) and furans and phenols (predominant volatile organic compounds). They were also characterized by caffeine and individual phenolic acids (chlorogenic, caffeic, ferulic, and 3,4-dihydroxybenzoic acids) with well-known antioxidant and antimicrobial properties; therefore, they could be used in the cosmetic, pharmaceutical, and food sectors.

Low fluoroscopy permanent His bundle pacing using a new electroanatomic mapping system (KODEX EPD). A multicenter experience.

Background: His bundle pacing (HBP) may be a challenging procedure, often involving a long fluoroscopic time (FT) and a long procedural time (PT). We sought to evaluate whether the use of a new nonfluroscopic mapping (NFM) system, the KODEX-EPD, is able to reduce FT and PT when mapping is performed by the pacing catheter rather than an electrophysiological mapping catheter. Methods and Results: We included 46 consecutive patients (77 ± 8 years; 63% male) who underwent HBP; in 22 a NFM-guided procedure with the KODEX-EPD system was performed (group 1), whereas in 24 a conventional fluoroscopy-guided approach was used (group 2). Pacing indications were sick sinus syndrome in 13, atrioventricular block in 21, and cardiac resynchronization therapy in 12 cases. Both a lumen-less fixed helix lead and a stylet-driven extendable helix lead were used, respectively, in 24% and 76% of patients. HBP was successful in 22 patients (100%) in group 1 and 23 patients (96%) in group 2. The FT was significantly reduced in group 1 (183 ± 117 s vs 464.1 ± 352 s in group 2, p = .012). There were no significant differences between groups in PT and other procedural outcomes. Conclusions: The KODEX-EPD system may be safely used in HBP procedures. It is effective in reducing ionizing radiation exposure, as evidenced by the significant drop in FT, without increasing PT.

Cardiac implantable electronic devices (CIEDs) and allergy.

Advances in cardiac implantable electronic devices (CIEDs) have prolonged life expectancy in various medical settings. However, the issue of hypersensitivity to components of CIEDs is still a concern. Since 1970, allergic reactions to metallic and nonmetallic components of CIEDs have been reported. Hypersensitivity reactions to medical devices are rare and not fully understood. In some cases, diagnosis and treatment are difficult. Cardiologists should always keep in mind pacemaker allergy when a patient appears with wound complications and no signs of infection. Patch testing should be tailored toward the specific biomaterials used in a device, in addition to testing with standard screening allergens in select cases.

The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System.

Arrhythmogenic substrate, modulating factors, and triggering factors (the so-called Coumel's triangle concept) play a primary role in atrial fibrillation (AF) pathophysiology. Several years have elapsed since Coumel and co-workers advanced the concept of the relevance of autonomic nervous system (ANS) influences on atrial cells' electrophysiological characteristics. The ANS is not only associated with cardiac rhythm regulation but also exerts an important role in the triggering and maintenance of atrial fibrillation. This review aims to describe in detail the autonomic mechanisms involved in the pathophysiology of atrial fibrillation (AF), starting from the hypothesis of an "Autonomic Coumel Triangle" that stems from the condition of the fundamental role played by the ANS in all phases of the pathophysiology of AF. In this article, we provide updated information on the biomolecular mechanisms of the ANS role in Coumel's triangle, with the molecular pathways of cardiac autonomic neurotransmission, both adrenergic and cholinergic, and the interplay between the ANS and cardiomyocytes' action potential. The heterogeneity of the clinical spectrum of the ANS and AF, with the ANS playing a relevant role in situations that may promote the initiation and maintenance of AF, is highlighted. We also report on drug, biological, and gene therapy as well as interventional therapy. On the basis of the evidence reviewed, we propose that one should speak of an "Autonomic Coumel's Triangle" instead of simply "Coumel's Triangle".