Forward and hybrid path-integral methods in photoelectron holography: Sub-barrier corrections, initial sampling, and momentum mapping

We construct two strong-field path integral methods with full Coulomb distortion, in which the quantum pathways are mimicked by interfering electron orbits: the rate-based CQSFA (R-CQSFA) and the hybrid forward-boundary CQSFA (H-CQSFA). The methods have the same starting point as the standard Coulomb quantum-orbit strong-field approximation (CQSFA), but their implementation does not require preknowledge of the orbits' dynamics. These methods are applied to ultrafast photoelectron holography. In the rate-based method, electron orbits are forward propagated and we derive a nonadiabatic ionization rate from the CQSFA, which includes sub-barrier Coulomb corrections and is used to weight the initial orbit ensemble. In the H-CQSFA, the initial ensemble provides initial guesses for a subsequent boundary problem and serves to include or exclude specific momentum regions, but the ionization probabilities associated with individual trajectories are computed from sub-barrier complex integrals. We perform comparisons with the standard CQSFA and ab initio methods, which show that the standard, purely boundary-type implementation of the CQSFA leaves out whole sets of trajectories. We show that the sub-barrier Coulomb corrections broaden the resulting photoelectron momentum distributions (PMDs) and improve the agreement of the R-CQSFA with the H-CQSFA and other approaches. We probe different initial sampling distributions, uniform and otherwise, and their influence on the PMDs. We find that initial biased sampling emphasizes rescattering ridges and interference patterns in high-energy ranges, while an initial uniform sampling guarantees accurate modeling of the holographic patterns near the ionization threshold or polarization axis. Our results are explained using the initial to final momentum mapping for different types of interfering trajectories

Left Atrial Appendage Volume As a New Predictor of Atrial Fibrillation Recurrence After Catheter Ablation

PURPOSE: Recurrence of atrial fibrillation (AF) after catheter ablation is common, being clinically relevant to identify predictors of recurrence. The left atrial appendage (LAA) role as an AF trigger is scarcely explored. Our aim was to identify if LAA volume is an independent predictor of AF recurrence after catheter ablation. METHODS: We analysed 52 patients (aged 54 ± 10 years, 58% male) with paroxysmal and persistent AF who underwent a first AF catheter ablation and had performed contrast-enhanced cardiac computed tomography (CT) prior to the procedure. RESULTS: The mean left atrial and LAA volumes measured by cardiac CT were 98.9 ± 31.8 and 9.3 ± 3.5 mL, respectively. All patients received successful pulmonary vein isolation and were followed up for 24 months. AF recurrence occurred in 17 patients (33%). LAA volume was significantly greater in patients with AF recurrence than in those without recurrence (11.3 ± 2.9 vs. 8.2 ± 3.4 mL; p = 0.002). Multivariable analysis using Cox regression revealed that LAA volume (hazard ratio 1.32; 95% confidence interval 1.12-1.55; p = 0.001) and persistent AF (hazard ratio 4.22; 95% confidence interval 1.48-12.07; p = 0.007) were independent predictors for AF recurrence. An LAA volume greater than 8.825 mL predicted AF recurrence with 94% sensitivity and 66% specificity. The Kaplan-Meier analysis showed a lower rate free from AF recurrence in the group with an LAA volume >8.825 mL (p < 0.001). CONCLUSIONS: Larger LAA volume was associated with AF recurrence after catheter ablation in patients with paroxysmal and persistent AF.info:eu-repo/semantics/publishedVersio

VIH e Doença Coronária - Quando a Prevenção Secundária É Insuficiente

Highly active antiretroviral therapy (HAART) has created a new paradigm for human immunodeficiency virus (HIV)-infected patients, but their increased risk for coronary disease is well documented. We present the case of a 57-year-old man, co-infected with HIV-2 and hepatitis B virus, adequately controlled and with insulin-treated type 2 diabetes and dyslipidemia, who was admitted with non-ST elevation acute myocardial infarction. Coronary angiography performed on day four of hospital stay documented two-vessel disease (mid segment of the right coronary artery [RCA, 90% stenosis] and the first marginal). Two drug-eluting stents were successfully implanted. The patient was discharged under dual antiplatelet therapy (aspirin 100 mg/day and clopidogrel 75 mg/day) and standard coronary artery disease medication. He was admitted to the emergency room four hours after discharge with chest pain radiating to the left arm and inferior ST-segment elevation myocardial infarction was diagnosed. Coronary angiography was performed within one hour and documented thrombosis of both stents. Optical coherence tomography revealed good apposition of the stent in the RCA, with intrastent thrombus. Angioplasty was performed, with a good outcome. The acute stent thrombosis might be explained by the thrombotic potential of HIV infection and diabetes. There are no specific guidelines regarding HAART in secondary prevention of acute coronary syndromes. A multidisciplinary approach is essential for optimal management of these patients.info:eu-repo/semantics/publishedVersio

Seguimento a Longo Prazo da Ablação de Arritmias Ventriculares com Origem na Câmara de Saída Ventricular Baseada em Mapeamento Não Contacto por Balão Multi-Elétrodos

Introduction: The outflow tract (OT) regions of the ventricles are a common location of origin for idiopathic ventricular arrhythmias (VA). Non-contact mapping (NCM) with a multi-electrode balloon catheter Ensite-Array enables three-dimensional reconstruction of the geometry of the cardiac chambers and accurate mapping of the propagation map, based on a single beat analysis, facilitating the ablation and contributing procedure success. Objective: Assessment of the feasibility and long-term outcomes following NCM-guided OT VA ablation. Methods: Single center retrospective analysis of patients admitted for symptomatic OT VA ablation. Demographic and clinical characteristics of patients, procedure data and long-term outcomes were assessed. Results: Fifty-eight patients (79.3% female, age 43.9±17.6 years) were considered, 89.7% without structural heart disease. In 85.7% of the cases left ventricle ejection fraction (LVEF) was preserved (LVEF≥50%), 8.6% had mild systolic dysfunction (LVEF 40%-49%) and 5.7% had moderate systolic dysfunction (LVEF 30%-39%). Twenty-four-hour Holter recording documented sustained VA episodes in 12.1% of the patients, non-sustained VA in 31.0%, and >10 000 premature ventricular complex (PVC)/24 h in 56.9%, with an ECG suggesting right ventricular OT origin in 84.5%. There was total elimination of PVC in 87.9% cases and a significant reduction in 3.4%. During a mean follow-up of 5.5 years, 87.9% patients remained asymptomatic without medication, 12.1% underwent re-ablation due to symptomatic PVC recurrence, and two cases underwent a third successful intervention. Conclusion: Non-contact mapping-guided multi-electrode balloon catheter VA ablation is a highly effective and safe procedure, with a low rate of long-term recurrence.info:eu-repo/semantics/publishedVersio

O Efeito da Monitorização Remota em Eventos Cardíacos Adversos numa Amostra Emparelhada por Propensity-Score Matching

AIMS: There are conflicting data regarding the clinical benefits of device-based remote monitoring (RM). We sought to assess the effect of device-based RM on long-term clinical outcomes in recipients of implantable cardioverter-defibrillators (ICDs). METHODS: We assessed the incidence of adverse cardiac events, overall mortality and device therapy efficacy and safety in a propensity score-matched cohort of patients under RM compared to patients under conventional follow-up. Data on hospitalizations, mortality and cause of death were systematically assessed using a nationwide healthcare platform. The primary outcome was time to a composite outcome of first hospital admission for heart failure or cardiovascular death. RESULTS: Of a total of 923 implantable device recipients, 164 matched patients were identified (84 under RM, 84 under conventional follow-up). The mean follow-up was 44 months (range 1-123). There were no significant differences regarding baseline characteristics in the matched cohorts. Patients under RM had a significantly lower incidence of the primary outcome (hazard ratio [HR] 0.42, confidence interval [CI] 0.20-0.88, p=0.022); there was a non-significant trend towards lower overall mortality (HR 0.53, CI 0.27-1.04, p=0.066). No significant differences between cohorts were found regarding appropriate therapies (RM vs. conventional follow-up, 8.1 vs. 8.2%, p=NS) or inappropriate therapies (6.8 vs. 5.0%, p=NS). CONCLUSION: In a propensity score-matched cohort of ICD recipients with long-term follow-up, RM was associated with a lower rate of a combined endpoint of hospital admission for heart failure or cardiovascular death.info:eu-repo/semantics/publishedVersio

Influence of Remote Monitoring on Long-Term Cardiovascular Outcomes after Cardioverter-Defibrillator Implantation

AIMS: Device-based remote monitoring (RM) has been linked to improved clinical outcomes at short to medium-term follow-up. Whether this benefit extends to long-term follow-up is unknown. We sought to assess the effect of device-based RM on long-term clinical outcomes in recipients of implantable cardioverter-defibrillators (ICD). METHODS: We performed a retrospective cohort study of consecutive patients who underwent ICD implantation for primary prevention. RM was initiated with patient consent according to availability of RM hardware at implantation. Patients with concomitant cardiac resynchronization therapy were excluded. Data on hospitalizations, mortality and cause of death were systematically assessed using a nationwide healthcare platform. A Cox proportional hazards model was employed to estimate the effect of RM on mortality and a composite endpoint of cardiovascular mortality and hospital admission due to heart failure (HF). RESULTS: 312 patients were included with a median follow-up of 37.7months (range 1 to 146). 121 patients (38.2%) were under RM since the first outpatient visit post-ICD and 191 were in conventional follow-up. No differences were found regarding age, left ventricular ejection fraction, heart failure etiology or NYHA class at implantation. Patients under RM had higher long-term survival (hazard ratio [HR] 0.50, CI 0.27-0.93, p=0.029) and lower incidence of the composite outcome (HR 0.47, CI 0.27-0.82, p=0.008). After multivariate survival analysis, overall survival was independently associated with younger age, higher LVEF, NYHA class lower than 3 and RM. CONCLUSION: RM was independently associated with increased long-term survival and a lower incidence of a composite endpoint of hospitalization for HF or cardiovascular mortality

Tempo para a Remodelagem Inversa do Ventrículo Esquerdo: Mais Vale Tarde do que Nunca

INTRODUCTION: Left ventricular reverse remodeling (LVRR), defined as reduction of end-diastolic and end-systolic dimensions and improvement of ejection fraction, is associated with the prognostic implications of cardiac resynchronization therapy (CRT). The time course of LVRR remains poorly characterized. Nevertheless, it has been suggested that it occurs ≤6 months after CRT. OBJECTIVE: To characterize the long-term echocardiographic and clinical evolution of patients with LVRR occurring >6 months after CRT and to identify predictors of a delayed LVRR response. METHODS: A total of 127 consecutive patients after successful CRT implantation were divided into three groups according to LVRR response: Group A, 19 patients (15%) with LVRR after >6 months (late LVRR); Group B, 58 patients (46%) with LVRR before 6 months (early LVRR); and Group C, 50 patients (39%) without LVRR during follow-up (no LVRR). RESULTS: The late LVRR group was older, more often had ischemic etiology and fewer patients were in NYHA class ≤II. Overall, group A presented LVRR between group B and C. This was also the case with the percentage of clinical response (68.4% vs. 94.8% vs. 38.3%, respectively, p<0.001), and hospital readmissions due to decompensated heart failure (31.6% vs. 12.1% vs. 57.1%, respectively, p<0.001). Ischemic etiology (OR 0.044; p=0.013) and NYHA functional class <III (OR 0.056; p=0.063) were the variables with the highest predictive value for late LVRR. CONCLUSIONS: Late LVRR has better clinical and echocardiographic outcomes than no LVRR, although with a suboptimal response compared to the early LVRR population. Ischemic etiology and NYHA functional class <III are predictors of late LVRR