Functional electrographic flow patterns in patients with persistent atrial fibrillation predict outcome of catheter ablation.

AIMS: Electrographic flow (EGF) mapping is a method to detect action potential sources within the atria. In a double-blinded retrospective study we evaluated whether sources detected by EGF are related to procedural outcome. METHODS: EGF maps were retrospectively generated using the Ablamap® software from unipolar data recorded with a 64-pole basket catheter from patients who previously underwent focal impulse and rotor modulation-guided ablation. We analyzed patient outcomes based on source activity (SAC) and variability. Freedom from atrial fibrillation (AF) was defined as no recurrence of AF, atypical flutter or atrial tachycardia at the follow-up visits. RESULTS: EGF maps were from 123 atria in 64 patients with persistent or long-standing persistent AF. Procedural outcome correlation with SAC peaked at >26%. S-type EGF signature (source-dependent AF) is characterized by stable sources with SAC > 26% and C-type (source-independent AF) is characterized by sources with SAC ≤ 26%. Cases with AF recurrence at 3-, 6-, or 12-month follow-up showed a median final SAC 34%; while AF-free patients had sources with significantly lower median final SAC 21% (p = .0006). Patients with final SAC and Variability above both thresholds had 94% recurrence, while recurrence was only 36% for patients with leading source SAC and variability below threshold (p = .0001). S-type EGF signature post-ablation was associated with an AF recurrence rate 88.5% versus 38.1% with C-type EGF signature. CONCLUSIONS: EGF mapping enables the visualization of active AF sources. Sources with SAC > 26% appear relevant and their presence post-ablation correlates with high rates of AF recurrence.

[Schizophrenic disorders in adolescence]. / Troubles schizophréniques de l'adolescence.

This article provides a brief overview of Early Onset Schizophrenia (EOS). Schizophrenia is a severe, devastating and common psychiatric disorder (around 1% of general population). EOS is defined as onset before 18 years with a Childhood Onset Schizophrenia (COS) sub-category beginning before 13. COS is rare representing 1% of all schizophrenia, with a prevalence of 1 in 10000 births. Prevalence increases remarkably during adolescence with 4% of all schizophrenic disorders before 10 and 12-34% before 18. DSM-IV criteria for EOS are the same as for adult onset schizophrenia. Interestingly, compared to cases with adult onset, EOS shows the following characteristics: 1) it is more frequent in males; 2) onset is more often insidious; 3) minor neurological signs, negative symptoms and catatonia are more frequent; 3) a history of developmental problems (ranging from minor motor coordination disorder to autism spectrum disorders) occurs in up to 50% of the cases; 4) the disease process has a greater impact on cognition and brain anatomic markers; 5) comorbid organic and genetic risk factors, including mental retardation, are more prevalent. Gold standard treatments are antipsychotic medications, which are approved by administration until 13 years old in France. It is of particular importance to search for side effects which may have different profile in pediatric populations.