Pulmonary vein isolation in atrial fibrillation patients guided by a novel local impedance algorithm: 1-year outcome from the CHARISMA study.

BACKGROUND: Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have recently emerged as a viable real-time indicator of tissue characteristics and durability of the lesions created. We report the outcomes of acute and long-term clinical evaluation of the new DirectSense algorithm in AF ablation. METHODS: Consecutive patients undergoing AF ablation were included in the CHARISMA registry. RF delivery was guided by the DirectSense algorithm, which records the magnitude and time-course of the impedance drop. The ablation endpoint was pulmonary vein isolation (PVI), as assessed by the entrance and exit block. RESULTS: 3556 point-by-point first-pass RF applications of >10 s duration were analyzed in 153 patients (mean age=59 ± 10 years, 70% men, 61% paroxysmal AF, 39% persistent AF). The mean baseline LI was 105 ± 15 Ω before ablation and 92 ± 12 Ω after ablation (p < .0001). Both absolute drops in LI and the time to LI drop (LI drop/τ) were greater at successful ablation sites (n = 3122, 88%) than at ineffective ablation sites (n = 434, 12%) (14 ± 8 Ω vs 6 ± 4 Ω, p < .0001 for LI; 0.73 [0.41-1.25] Ω/s vs. 0.35[0.22-0.59 Ω/s, p < .0001 for LI drop/τ). No major complications occurred during or after the procedures. All PVs had been successfully isolated. During a mean follow-up of 366 ± 130 days, 18 patients (11.8%) suffered an AF/atrial tachycardia recurrence after the 90-day blanking period. CONCLUSION: The magnitude and time-course of the LI drop during RF delivery were associated with effective lesion formation. This ablation strategy for PVI guided by LI technology proved safe and effective and resulted in a very low rate of AF recurrence over 1-year follow-up.

Experiences of Racial and Ethnic Discrimination Are Associated with Food Insecurity and Poor Health.

This study examines the associations of mothers' experiences of discrimination (EODs) with household food insecurity (HFI), physical health, and depressive symptoms, while taking into account the influence of mothers' Adverse Childhood Experiences (ACEs) and public assistance participation. Mothers (N = 1372) of young children under age 4 who self-identified as Latinx, Non-Latinx Black/African American and Non-Latinx white answered questions for a cross-sectional survey in an emergency room in a large children's hospital in Philadelphia between 2016 and 2018. Logistic regression was used to model associations of EODs in specific settings with HFI, depressive symptoms, and physical health. Compared to those without EODs, mothers with EODs from police/courts and in workplaces had higher odds of HFI, AOR =2.04 (95% CI: 1.44-2.89) and AOR = 1.57 (95% CI: 1.18-2.11), respectively. Among Latinx mothers, EODs in school were associated with nearly 60% higher odds of HFI and nearly 80% higher odds of depressive symptoms. Latinx and Black mothers with EODs in workplaces had higher odds of HFI (AOR = 1.76, 95% CI: 1.21-2.56 and AOR = 1.46, 95% CI: 1.05-2.36, respectively), compared to mothers without EODs. Discrimination is associated with HFI, depressive symptoms, and poor health. Public health interventions intended to improve food security and health may be only partially effective without simultaneously addressing racism and discrimination.

Left ventricular functional recovery during cardiac resynchronization therapy: predictive role of asynchrony measured by strain rate analysis.

Cardiac resynchronization therapy (CRT) improves myocardial performance in patients with heart failure (HF) and left bundle-branch block (LBBB). Tissue Doppler echocardiography (TDE) has already been used to guide the selection of candidates for CRT. The objective of this study is to correlate the effects of CRT on left ventricular (LV) systolic function with wall motion synchrony assessed by TDE. High frame TDE data were obtained in 15 patients (mean age = 68.9 years, 11 men) with LBBB (QRS = 163 +/- 13 ms) to derive temporal intraventricular horizontal asynchrony indexes, expressed as the time difference at the onset of shortening between the septum and the lateral (S-L) and antero-inferior (A-I) walls, and measure the amount of delayed longitudinal contraction (DLC) within the LV. All measurements were made at baseline, 24 hours after implantation, and at 1 year of follow-up. The results show that LV ejection fraction (EF) increased from 25 +/- 6.2% at baseline to 36.9 +/- 7.9% at 1 year, and was strongly related to DLC, expressed either by time duration (DLCd, r =-0.51; P < 0.0001) or percent of the basal segments (%DLC, r =-0.50; P < 0.001). New York Heart Association functional class, which decreased from 3.6 +/- 0.5 to 2.3 +/- 0.8, was correlated with %DLC (r = 0.50) and DLCd (r = 0.48, P < 0.001). Weaker correlations were found between LVEF and S-Li (r =-0.40) and between NYHA and S-Li (r = 0.40). It is concluded that DLC was the best among intraventricular asynchrony indexes in predicting increases in LVEF after CRT. DLC may be useful to identify responders to CRT.

Sequential biventricular resynchronization optimized by myocardial strain rate analysis: a case report.

We report the case of a patient with severe left ventricular systolic dysfunction and left bundle branch block in whom cardiac resynchronization therapy (CRT) was optimized by tissue Doppler imaging. A horizontal mechanical asynchrony index was derived from tissue Doppler regional longitudinal strain rate profiles as the time difference at the onset of shortening between septum, lateral, anterior and inferior walls. The interventricular delay was modulated in order to achieve the smallest asynchrony index; on the basis of this parameter a sequential (S)-CRT with a left ventricular pre-excitation of 20 ms was definitively programmed. This optimized S-CRT was followed by an acute improvement in systolic cardiac performance and by a long-term (12 months) clinical benefit as well as by a documented decrease in LV chamber size due to a true reverse remodeling effect. Thus, in some patients S-CRT may be more effective than conventional CRT. Tissue Doppler-derived strain rate analysis can provide information on the degree of left intraventricular asynchrony allowing the modulation of a tailored interventricular delay.