A New Formula for Estimating the True QT Interval in Left Bundle Branch Block.

INTRODUCTION: QT prolongation is an independent risk factor for cardiac mortality. Left bundle branch block (LBBB) is more common in patients as they age. Widening of the QRS in LBBB causes false QT prolongation and thus makes true QT assessment difficult. We aimed to develop a simple formula to achieve a good estimate of the QT interval in the presence of LBBB. METHODS AND RESULTS: To determine the effect of QRS duration on the QT interval, QRS and QT were measured in sinus rhythm and during right ventricular apical pacing in 62 patients (age 55 ± 11 years, 60% male) undergoing electrophysiology studies. A QT formula for LBBB (QT-LBBB) was derived based on the effect of increased QRSLBBB on QTLBBB . The predictive accuracy of the QT-LBBB formula was then tested in 22 patients (age 66 ± 13 years, 64% male) with intermittent LBBB with comparisons to prior QT formulae and JT index. On average, the net increase in QRSLBBB constituted 92% of the net increase in QTLBBB . A new formula, QT-LBBB = QTLBBB - (0.86 * QRSLBBB - 71), which takes the net increase in QRSLBBB into account, best predicted the QT interval with heart rate corrected QTc in the test set of LBBB ECGs when compared to the baseline value and prior formulae. CONCLUSION: The QT-LBBB formula developed in this study best estimates the true QT interval in the presence of LBBB. It is simple and therefore can be easily utilized in clinical practice.

Denervation as a common mechanism underlying different pulmonary vein isolation strategies for paroxysmal atrial fibrillation: evidenced by heart rate variability after ablation.

BACKGROUNDS: Segmental and circumferential pulmonary vein isolations (SPVI and CPVI) have been demonstrated to be effective therapies for paroxysmal atrial fibrillation (PAF). PVI is well established as the endpoint of different ablation techniques, whereas it may not completely account for the long-term success. METHODS: 181 drug-refractory symptomatic PAF patients were referred for segmental or circumferential PVI (SPVI = 67; CPVI = 114). Heart rate variability (HRV) was assessed before and after the final ablation. RESULTS: After following up for 62.23 ± 12.75 months, patients underwent 1.41 ± 0.68 procedures in average, and the success rates in SPVI and CPVI groups were comparable. 119 patients were free from AF recurrence (SPVI-S, n = 43; CPVI-S, n = 76). 56 patients had recurrent episodes (SPVI-R, n = 21; CPVI-R, n = 35). Either ablation technique decreased HRV significantly. Postablation SDNN and rMSSD were significantly lower in SPVI-S and CPVI-S subgroups than in SPVI-R and CPVI-R subgroups (SPVI-S versus SPVI-R: SDNN 91.8 ± 32.6 versus 111.5 ± 36.2 ms, rMSSD 47.4 ± 32.3 versus 55.2 ± 35.2 ms; CPVI-S versus CPVI-R: SDNN 83.0 ± 35.6 versus 101.0 ± 40.7 ms, rMSSD 41.1 ± 22.9 versus 59.2 ± 44.8 ms; all P < 0.05). Attenuation of SDNN and rMSSD remained for 12 months in SPVI-S and CPVI-S subgroups, whereas it recovered earlier in SPVI-R and CPVI-R subgroups. Multivariate logistic regression analysis identified SDNN as the only predictor of long-term success. CONCLUSIONS: Beyond PVI, denervation may be a common mechanism underlying different ablation strategies for PAF.

[Long term outcome of atrial fibrillation patients with KCNA5 and NPPA mutations post circumferential pulmonary vein ablation].

OBJECTIVE: The outcome of atrial fibrillation patients with genetic mutations post ablation was not well evaluated. METHODS AND RESULTS: Three atrial fibrillation patients with evidence of mutations in KCNA5 and NPPA post successful circumferential pulmonary vein ablation were included. Mutation in KCNA5 was found in one male patient with paroxysmal atrial fibrillation. He was free of atrial fibrillation post ablation after 46 months follow-up. Mutations in NPPA were found in two male patients with persistent atrial fibrillation and they were free from atrial fibrillation after 64 months and 38 months follow-up post circumferential pulmonary vein ablation, roof line and mitral isthmus line ablation. CONCLUSION: Satisfactory long term results are observed in atrial fibrillation patients with KCNA5 and NPPA mutations post circumferential pulmonary vein ablation.

Effect of epicardial fat pad ablation on acute atrial electrical remodeling and inducibility of atrial fibrillation.

BACKGROUND: Atrial electrical remodeling (AER) is the underlying mechanism of atrial fibrillation (AF). The present study investigated the impact of epicardial fat pad (FP) ablation on acute AER (AAER) and inducibility of AF. METHODS AND RESULTS: AAER was performed in 28 mongrel dogs through 4-h rapid atrial pacing (RAP). Before RAP, 14 dogs (ablation group) underwent FP ablation, and the other 14 (control group) underwent a sham procedure. The atrial effective refractory period (ERP) and vulnerability window (VW) of AF were measured with and without bilateral cervical vagosympathetic nerve stimulation (VNS) at the high right atrium, ostium of the coronary sinus (CS) and distal CS before and after every hour of RAP. In the control group, ERP was markedly shortened in the first 2 h of RAP and then stabilized. AF was only slightly induced. After RAP, the time course of ERP with and without VNS was similar. VNS significantly shortened ERP and increased VW before and after RAP. In the ablation group, ERP was significantly prolonged after FP ablation. Moreover, neither VNS nor RAP shortened the ERP or increased the VW. AF could not be induced (VW=0). CONCLUSIONS: RAP resulted in AAER, which may be mediated and aggravated by autonomic activity. Epicardial FP ablation generated denervation, which not only abolishes AF inducibility but also prevents RAP-mediated AAER.

Wavelet and principal component analysis of electromyographic activity and slow component of oxygen uptake during heavy and severe cycling exercise.

The aim of the study was to investigate whether the slow component of oxygen uptake was concurrent with the recruitment of large α-motoneuron muscle fibres by using wavelet and principal component analysis (PCA) of electromyography (EMG) during heavy and severe cycling exercise. Eleven male subjects participated in the study. After establishing each subject's maximum value of oxygen uptake through an incremental test on the cycle ergometer, the subjects performed 6-min cycling tests at heavy and severe intensity. EMG signals were collected from rectus femoris, biceps femoris long head, tibialis anterior, and medial gastrocnemius and processed by combined use of wavelet and PCA analysis. The time delays to the onset of slow component occurred significantly earlier during severe (105.22 ± 5.45 s) compared with during heavy (138.78 ± 15.09 s) exercise. ANOVA with repeated measures showed that for all muscles tested, the angle θ formed by the first and second principal components decreased significantly between time windows during heavy and severe exercise. However, significant increases of EMG mean power frequency (MPF) were found only during heavy exercise. Our results show the concurrence of the oxygen uptake slow component with the additional recruitment of muscle fibres, presumably less efficient large α-motoneuron fibres. Novelty The expected rise in MPF may be offset by muscle fatigue occurring in the later time windows of the slow component during severe exercise. The gradual shift to higher EMG frequencies throughout the slow-component phase was reflected in the progressive and significant decrease of angle θ.

[Chronic outcome of patients with paroxysmal atrial fibrillation post catheter ablation].

OBJECTIVE: High short-term successful rate was reported for catheter ablation in patients with paroxysmal atrial fibrillation (AF), we analyzed the long-term outcome (success rate, anticoagulation therapy and embolism event, anti-arrhythmic therapy and death post procedure) of catheter ablation for paroxysmal AF in this study. METHODS: From January 2000 to December 2004, 106 consecutive patients with drug-refractory paroxysmal AF underwent catheter ablation and were followed-up for (60.7 + or - 11.8) months. Segmental pulmonary vein isolation (SPVI) was routinely performed by radiofrequency energy under the guidance of circular mapping catheter. The patients were followed up with 24 h-holter, ECG, telephone or letter. Data on recurrence of AF, the anticoagulation medication and the incidence of embolism, anti-arrhythmic therapy were obtained. RESULTS: There were 9 patients lost to follow up. In the remaining 97 patients [65 males, (54.8 + or - 11.2) years old], 3 cases died from cancer, sinus rhythm was maintained in 68 patients (Group S, 72.3%) and AF recurrence evidenced in 26 patients (Group R, 27.7%). In Group S, 56 patients (82.4%) discontinued anticoagulation medication, and 12 patients continued to take aspirin. There was no embolism event in Group S during follow-up. In Group R, 1 patient continued to take warfarin; 11 patients continued to take aspirin and 2 patients suffered from cerebral embolism. Anticoagulation medication was discontinued in 14 patients (53.8%) and 1 patient suffered form cerebral embolism. The incidence of embolism event in Group R is significantly higher than in Group S (P < 0.01). More patients discontinued anti-arrhythmic medication in Group S than in Group R (80.9% vs. 56.0%, P < 0.05). CONCLUSION: Catheter ablation is associated with satisfactory long-term success rate, reduced anti-arrhythmia medication, improved quality of life in patients with paroxysmal AF.

Review of the genus Prays Hübner, 1825 (Lepidoptera: Praydidae) from China, with descriptions of twelve new species.

The genus Prays Hübner, 1825 from China is reviewed. Nineteen species are treated, including twelve species described as new: P. orthacantha sp. nov., P. spiniprocessa sp. nov., P. erromera sp. nov., P. rectangula sp. nov., P. tauricornis sp. nov., P. longisaccula sp. nov., P. bisechinata sp. nov., P. semilunata sp. nov., P. semicircularis sp. nov., P. dorsiprotrusa sp. nov., P. helanshana sp. nov., and P. acinacea sp. nov. The female of P. inconspicua Yu et Li, 2004 is described for the first time. Images of adults and genitalia are provided, along with a key to separate all the Chinese species.

Taxonomic study of the genus Lycophantis Meyrick from China (Lepidoptera: Yponomeutidae) with descriptions of three new species.

Six Chinese species of the genus Lycophantis Meyrick, 1914 are reviewed, including three new species: Lycophantis mucronata Li, sp. nov. from Zhejiang and Hubei, L. stenopetala Li, sp. nov. and L. incurvula Li, sp. nov., both from Xizang (Tibet). Lycophantis leviaurata Sohn & Park, 2010 is newly recorded from China. Images of adults and genitalia are provided, along with key to all the Chinese species of Lycophantis.

Review of the genus Anthonympha Moriuti, 1971 (Lepidoptera: Plutellidae) from China, with descriptions of four new species.

Chinese species of Anthonmypha Moriuti are reviewd. Five species are recognized, four of which are described as new: Anthonympha truncata sp. nov., A. trapezia sp. nov., A. ligulacea sp. nov. and A. reniforma sp. nov. Images of adults and genitalia are provided, along with a key to distinguishing all the Chinese species.