Impact of ablation index settings on pulmonary vein reconnection.

PURPOSE: Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated the incidence of acute and late PV reconnection (PVR) with different AI settings and its predictors. METHODS: The Ablation Index Registry is a multicenter study that included patients with paroxysmal/persistent atrial fibrillation (AF) who underwent first-time ablation. Each operator performed the ablation using his preferred ablation catheter (ThermoCool® SmartTouch or Surround Flow) and AI setting (380 posterior-500 anterior and 330 posterior-450 anterior). We divided the study population into two groups according to the AI setting used: group 1 (330-450) and group 2 (380-500). Incidence of acute PVR was validated within 30 min after PVI, whereas the incidence of late PVR was evaluated at repeat procedure. RESULTS: Overall, 490 patients were divided into groups 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of the first-pass PVI between the two study groups. Acute PVR was observed in 5.6% PVs. The rate of acute PVR was slightly higher in group 2 (64/943, 6.8%, PVs) than in group 1 (48/1045, 4.6% PVs, p = 0.04). Thirty patients (6%) underwent a repeat procedure and late PVR was observed in 57/116 (49%) PVs (number of reconnected PV per patient of 1.9 ± 1.6). A similar rate of late PVR was found in the two study groups. No predictors of acute and late PVR were found. CONCLUSION: Ablation with a lower range of AI is highly effective and is not associated with a higher rate of acute and late PVR. No predictors of PV reconnection were found.

Operative treatment of refractory superior vena cava syndrome.

Left sapheno-axillary vein bypass is effective in relieving the signs and symptoms of superior vena cava obstruction. As the operation can be performed easily under local anesthesia, it should probably be used more often than indicated by a review of the literature. The authors present a patient with bronchogenic carcinoma who experienced excellent results.

Effects of postpneumonectomy distention on pulmonary compliance and vascular resistance.

Postpneumonectomy pulmonary distention has been considered harmful by many clinicians. We measured changes in pulmonary compliance and vascular resistance with distention in five dogs. There was no significant change in compliance and vascular resistance in the range of pulmonary distention seen following pneumonectomy.

[Evaluation of arachidonic acid in amniotic fluid before and during labor]. / Valutazione dell'acido arachidonico nel liquido amniotico prima e dura il travaglio di parto.

Arachidonic acid is considered to be one of the precursors in prostaglandin synthesis. For this reason, arachidonic acid was measured in a series of amniotic fluid. Samples in order to rest the hypothesis that the beginning of uterine activity is accompanied by a rise of its concentration. In fact, it could be shown that in amniotic fluid from patients in labor arachidonic acid levels are much higher than in amniotic fluid from patients without uterine activity.

Technetium-99m pertechnetate as an indicator of gastric mucosal proliferation.

Gastric mucosa was removed from five dogs and allowed to regenerate. Serial scintiscans after administration of 99mTc pertechnetate revealed gradual increase in gastric radioactivity, so that by 4 weeks it appeared as intense as preoperatively. By this means it was possible to follow the progress of gastric mucosal regeneration. The authors suggest that serial 99mTc scintiscanning might prove useful in evaluating the hypothesis that Barrett esophagus is due to replacement of esophageal squamous epithelium by gastric columnar epithelium.