High-density Mapping Guided Pulmonary Vein Isolation for Treatment of Atrial Fibrillation - Two-year clinical outcome of a single center experience.

Pulmonary vein isolation (PVI) as interventional treatment for atrial fibrillation (AF) aims to eliminate arrhythmogenic triggers from the PVs. Improved signal detection facilitating a more robust electrical isolation might be associated with a better outcome. This retrospective cohort study compared PVI procedures using a novel high-density mapping system (HDM) with improved signal detection vs. age- and sex-matched PVIs using a conventional 3D mapping system (COM). Endpoints comprised freedom from AF and procedural parameters. In total, 108 patients (mean age 63.9 ± 11.2 years, 56.5% male, 50.9% paroxysmal AF) were included (n = 54 patients/group). Our analysis revealed that HDM was not superior regarding freedom from AF (mean follow-up of 494.7 ± 26.2 days), with one- and two-year AF recurrence rates of 38.9%/46.5% (HDM) and 38.9%/42.2% (COM), respectively. HDM was associated with reduction in fluoroscopy times (18.8 ± 10.6 vs. 29.8 ± 13.4 min; p < 0.01) and total radiation dose (866.0 ± 1003.3 vs. 1731.2 ± 1978.4 cGy; p < 0.01) compared to the COM group. HDM was equivalent but not superior to COM with respect to clinical outcome after PVI and resulted in reduced fluoroscopy time and radiation exposure. These results suggest that HDM-guided PVI is effective and safe for AF ablation. Potential benefits in comparison to conventional mapping systems, e.g. arrhythmia recurrence rates, have to be addressed in randomized trials.

Postmortem interrogation of cardiac implantable electrical devices may clarify time and cause of death.

BACKGROUND: Postmortem interrogation of cardiac implantable electrical devices (CIED) in autopsy is not routinely performed. Thus, it remains unclear whether an interrogation might clarify time and cause of death. METHODS: Seventy of 4401 patients (1.6%) undergoing autopsy in 2014 and 2015 presented with a CIED. The explanted CIED were interrogated with respect to time and possible cause of death. Battery and lead parameters, clinical and technical alerts, and arrhythmia episodes were reviewed and afterwards correlated with the results of autopsy and clinical data. RESULTS: Twenty-five implantable cardioverter defibrillators (ICD) and 45 pacemaker (PM) devices were analyzed. Death was classified as cardiac by autopsy in 17 of 70 patients. Accordingly, presumably lethal ventricular arrhythmias were documented in six patients (8.6%; 5 ICD, 1 PM). In two of 30 patients with unknown cause of death after autopsy (6.7%), interrogation revealed ventricular tachycardia as potential reason for decease (1 ICD, 1 PM). Postmortem CIED interrogation additionally allowed to make a statement regarding the day of death in 36 patients (51%; 13 ICD, 23 PM). This was in accordance with clinical data or the results of autopsy in nine patients (25%; 3 ICD, 6 PM) or could even clarify the time of death in six patients (16.7%; 4 ICD, 2 PM). CONCLUSION: Interrogation of CIED revealed potentially lethal ventricular arrhythmias in 9 of 70 patients investigated and enabled valid estimation of the day of death in 15 patients. We therefore conclude that routinely performed postmortem CIED interrogation may clarify time and cause of death.

Safety and efficacy in ablation of premature ventricular contraction: data from the German ablation registry.

BACKGROUND: Patients with frequent premature ventricular contractions (PVCs) are often highly symptomatic with significantly reduced quality-of-life. We evaluated the outcome and success of PVC ablation in patients in the German Ablation Registry. METHODS: The German Ablation Registry is a nationwide prospective multicenter database of patients who underwent an ablation procedure, initiated by the "Stiftung Institut für Herzinfarktforschung" (IHF), Ludwigshafen, Germany. Data were acquired from March 2007 to May 2011. Patients underwent PVC ablation in the enrolling ablation centers. RESULTS: A total of 408 patients (age 53.5 ± 15 years, 55 % female) undergoing ablation for PVCs were included. 32 % of patients showed a co-existing structural heart disease. Acute ablation success of the procedure was 82 % in the overall patient group. In patients without structural heart disease, acute success was significantly higher compared with patients with structural heart disease (86 vs. 74 %, p = 0.002). All patients were discharged alive after a median of 3 days. No patient suffered an acute myocardial infarction, stroke, or major bleeding. After 12 months' follow-up, 99 % of patients were still alive showing a significant different mortality between patients with structural heart disease compared with those without (2.3 vs. 0 %, p = 0.012). In addition, 76 % of patients showed significantly improved symptoms after 12 months of follow-up. CONCLUSION: Based on the data from this registry, ablation of PVCs is a safe and efficient procedure with an excellent outcome and improved symptoms after 12 months.

[Completely subcutaneous implantable cardioverter defibrillator: Care of S-ICD wearers during childbirth]. / Komplett subkutaner implantierbarer Kardioverter-Defibrillator: Betreuung von Patientinnen mit S-ICD® unter Entbindung.

Inappropriate shock delivery is a problem that has been described for subcutaneous implantable cardioverter defibrillators (S-ICDs). Situations which predispose inappropriate shock delivery, such as childbirth, must be identified and the best treatment strategies selected. Inactivation of the S-ICD is the safest approach to avoiding inappropriate shock delivery. Inactivation of the S-ICD requires adequate patient monitoring and facilities for manual shock delivery.

Decomposition of 2-chloroethylethylsulfide on copper oxides to detoxify polymer-based spherical activated carbons from chemical warfare agents.

For the decomposition of chemical warfare agents, a hybrid material concept was applied. This consists of a copper oxide-containing phase as a component with reactive functionality supported on polymer-based spherical activated carbon (PBSAC) as a component with adsorptive functionality. A corresponding hybrid material was prepared by impregnation of PBSAC with copper(II)nitrate and subsequent calcination at 673K. The copper phase exists predominantly as copper(I)oxide which is homogeneously distributed over the PBSAC particles. The hybrid material containing 16 wt.% copper on PBSAC is capable of self-detoxifying the mustard gas surrogate 2-chloroethylethylsulfide (CEES) at room temperature. The decomposition is related to the breakthrough behavior of the reactant CEES, which displaces the reaction product ethylvinylsulfide (EVS). This leads to a combined breakthrough of CEES and EVS. The decomposition of CEES is shown to occur catalytically over the copper-containing PBSAC material. Thus, the hybrid material can even be considered to be self-cleaning.

Forces on cardiac implantable electronic devices during remote magnetic navigation.

BACKGROUND: Remote magnetic navigation systems are used for catheter navigation in cardiac electrophysiological ablation procedures. In this setting, ferromagnetic particles will be moved by changes in the magnetic field. It is unknown to what extent cardiac implantable electronic devices (CIED) are affected by the magnetic field when using magnetic navigation, and whether these forces may exceed the limit of 5 N that is set forth by German and European norms for implanted electrodes. METHODS: A total of 121 rhythm devices were examined in a magnetic field of 0.1 T using the NIOBE II(®) Magnetic Navigation System (Stereotaxis, St. Louis, USA). Forces acting on the devices were measured with the force measurement tool Futek LRF 400 (Futek Advanced Sensor Technology Inc., Irvine, CA, USA). A standardized protocol of different movements of the magnetic field including all three dimensions was performed and maximal forces on the CIED were assessed. RESULTS: Out of 121 devices, 78 different pacemakers (54 different model families from 11 manufacturers) and 43 different cardioverter-defibrillators (26 different model families from 6) were examined. The mean force that could be observed was 0.33 ± 0.13 N for pacemakers (range 0.16-1.12 N) and 1.05 ± 0.11 N for cardioverter-defibrillators (range 0.86-1.38 N) when exposed to the magnetic field. CONCLUSION: Exposure of pacemakers or implantable cardioverter-defibrillators to a magnetic field of 0.1 T does not result in a force exceeding the regulatory demanded 5 N that could damage the connected leads.

Visualization of multiple catheters in left atrial ablation procedures. Comparison of two different 3D mapping systems.

BACKGROUND: Visualization of intracardiac catheters placed in predefined anatomic locations is a cornerstone for successful atrial fibrillation (AF) ablation. The 3D mapping system Carto3™ (Biosense Webster, Diamond Bar, CA, USA) released in 2009 provides the possibility to visualize more than one intracardiac catheter at a time. The aim of the study was to evaluate the feasibility and safety of the system, to show the learning curve, and to compare it to the established Ensite NavX™ system regarding procedural handling parameters. METHODS: A total of 100 patients were enrolled in the study. The Carto3™ system was used by a team of four specialized operators in 50 patients (mean age 62±9 years, paroxysmal AF n=28, persistent AF n=17, left atrial flutter n=5). Patients were consecutively enrolled and matched (regarding type of ablated arrhythmias, ablation strategy, left atrial size, age, and gender) with patients ablated during the same time period with the EnSite NavX™ system. In patients with paroxysmal AF, ostial pulmonary vein isolation (PVI) was performed. Patients with persistent AF underwent PVI plus additional ablation of complex fractionated atrial electrograms (CFAE) and patients with left atrial flutter were treated with specific lines. RESULTS: In 50 case-control pairs, all procedures were performed as planned without complications in both groups except one cardiac tamponade in 1 patient in the Ensite NavX™ control group. The learning curve using the Carto3™ system was fast regarding x-ray time and procedural duration and reached the level of the EnSite NavX™ system after 15 and 25 patients, respectively. CONCLUSION: The Carto3™ system with its feature of visualizing several catheters is feasible and safe compared to an established system, e.g., Ensite NavX™. The learning curve is steep regarding reduction of x-ray time and procedural duration.

Determination of "extractables" on polymer materials by means of HPLC-MS.

In biopharmaceutical processes, in the area of food and medical technology a variety of devices is used. These devices consist of various polymers. The detection and identification of potential extractables from these polymers during application are requested by the regulatory bodies. For risk and toxicity assessment, both identification and quantification of extractables are necessary. This article describes the development of a LS-MS methodology transfered from an established HPLC-UV-VIS method for full extractables analysis of sterile-grade filtration cartridges.

Evaluation of Several Approaches to Manage Meloidogyne incognita and Cotton Seedling Disease Complexes in the High Plains of Texas.

Field experiments were conducted for control of the southern root-knot nematode (Meloidogyne incognita) and cotton seedling disease fungi (primarily Thielaviopsis basicola) in one naturally infested field during 1999 and 2000 and in three additional fields in 2000. Treatments included: seed-applied fungicides (triadimenol + mefenoxam + thiram and carboxin + PCNB + mefenoxam), cultivars (Paymaster [PM] 2326 RR and PM 2200 RR), and a nematicide (aldicarb at 0.83 kg a.i/ha). Plant stands were higher (P = 0.02) in the presence of aldicarb (77% emergence) than in its absence (74% emergence). Hypocotyl disease symptom ratings were lower (P = 0.0001) following triadimenol + mefenoxam + thiram seed treatment (0.53) as compared with carboxin + PCNB + mefenoxam (0.93). Root necrosis was lower (P = 0.002) following triadimenol + mefenoxam + thiram seed treatment (27%) as compared with carboxin + PCNB + mefenoxam (34%). In one field, in both years, aldicarb was associated with more root necrosis (58%) than in its absence (46%) (P = 0.004). At three other sites aldicarb did not affect root necrosis. Population densities of Meloidogyne incognita eggs and juveniles at midseason were greater (P = 0.005, P = 0.003, respectively) on PM 2200 RR (less resistant) than on PM 2326 RR (more resistant). Yield was affected by the plant genotype by aldicarb interaction (P = 0.02) but not by seed treatments. Aldicarb effect on yield was dependent on cultivar, whereas affect of seed treatment on root health was consistent and independent of cultivar and aldicarb. No conditions were identified when use of triadimenol + mefenoxam was detrimental.

[Energy metabolism of the rat renal cortex, as measured by incubation in various substrates]. / Energiestoffwechsel der Rattennierenrinde, gemessen in Schnitten bei Inkubation in verschiedenen Substraten.

Different substrate mixtures were investigated for their effect on energy metabolism using sections of the rat renal cortex. Simultaneous determination of adenine nucleotide concentrations and determination of the damage quotient of oxidative phosphorylation proved to be appropriate parameters for selecting substrate mixtures that have a favorable effect on energy metabolism. A mixture of albumin (1 mM) and octanoate (5.6 mM) with electrolytes proved to be adequate. The extent of oxygen consumption (60%) and 14CO2 formation (75%) argues in favor of the metabolization of this mixture; a damage quotient of 23% and general constancy of the concentration of high-energy compounds render prospective their testing in animal experiments. Addition of dicarbosylic acids increase the antimycin A resistant oxygen consumption without any energy conservation being demonstrable. Therefore, these substrates should not be used for conservation.