Temperature-controlled high-power short-duration ablation with 90 W for 4 s: outcome, safety, biophysical characteristics and cranial MRI findings in patients undergoing pulmonary vein isolation.

BACKGROUND: High-power short-duration (HPSD) radiofrequency ablation (RFA) is highly efficient and safe while reducing procedure and RF time in pulmonary vein isolation (PVI). The QDot™ catheter is a novel contact force ablation catheter that allows automated flow and power adjustments depending on the local tissue temperature to maintain a target temperature during 90 W/4 s lesions. We analysed intraprocedural data and periprocedural safety using the QDot-catheter in patients undergoing PVI for paroxysmal atrial fibrillation (PAF). METHODS: We included n = 48 patients undergoing PVI with the QDot-catheter with a temperature-controlled HPSD ablation mode with 90 W/4 s (TC-HPSD). If focal reconnection occurred besides repeat ablation, the ablation mode was changed to 50 W/15 s (QMode). N = 23 patients underwent cerebral MRI to detect silent cerebral lesions. RESULTS: Mean RF time was 8.1 ± 2.8 min, and procedure duration was 84.5 ± 30 min. The overall maximal measured catheter tip temperature was 52.0 °C ± 4.6 °C, mean overall applied current was 871 mA ± 44 mA and overall applied energy was 316 J ± 47 J. The mean local impedance drop was 12.1 ± 2.4 Ohms. During adenosine challenge, n = 14 (29%) patients showed dormant conduction. A total of n = 24 steam pops were detected in n = 18 patients (39.1%), while no pericardial tamponade occurred. No periprocedural thromboembolic complications occurred, while n = 4 patients (17.4%) showed silent cerebral lesion. CONCLUSIONS: TC-HPSD ablation with 90 W/4 s using the QDot-catheter led to a reduction of procedure and RF time, while no major complications occurred. Despite optimized temperature control and power adjustment, steam pops occurred in a rather high number of patients, while none of them leads to tamponade or to clinical or neurological deficits.

[Importance of trauma and emergency surgery for German metropolitan emergency departments-an analysis of 524,716 emergency patients]. / Stellenwert der Unfallchirurgie für die Notaufnahmen einer deutschen Millionenstadt ­ Eine Auswertung von 524.716 Notfallpatienten.

BACKGROUND: The future of emergency departments in Germany is influenced by increasing numbers of patients, demographic changes, new therapeutic concepts, current legislation and expert opinions. There is a lack of reliable data concerning the quantity and the type of injuries and diseases presenting in emergency departments. MATERIAL AND METHODS: This descriptive, epidemiological study included 14 emergency departments in Munich (1.41 million inhabitants in 2014), where 524,716 patients were treated from 1 July 2013 to 30 June 2014. 393,587 were included in this prospectively planned subgroup analysis. Patients presenting in special departments, such as gynecology or ophthalmology (59,523) or cases without a documented diagnosis (71,606) were excluded. Cases were assigned to the discipline trauma surgery or orthopedics according to the ICD-10 diagnosis chapters "injuries, poisoning and certain other consequences of external causes" and "diseases of the musculoskeletal system and connective tissue". RESULTS: Of the 393,587 cases included, 169,208 were treated due to trauma or orthopedic diseases (43%). 134,507 underwent outpatient treatment (79%) and 34,701 were admitted on the same day (21%). 29,920 patients suffered from head injuries (18%), 31,143 fractures (20%) and 24,367 deep wounds (14%) were recorded. On workdays between 8am and 10am, up to 47 patients per hour were treated and between 1pm and 3pm, up to 36 patients per hour. On weekends, most patients presented between 11am and 7pm. CONCLUSION: The present study analyzed the frequency of major diagnoses corresponding to the various medical disciplines including more than 500,000 patients. Of the emergency cases included, 43% were allocated to trauma surgery or orthopedics. These patients presented in the emergency departments around the clock and necessitate the permanent attendance of a trauma and emergency surgeon. Thereby, timely surgical care and decisions regarding indications for surgery and admission are ensured. Competence in trauma and emergency surgery is therefore essential for emergency departments.