Atrial Flutter Ablation Using a Three-Dimensional Electroanatomical Mapping System

Typical atrial flutter ablation is usually performed conventionally, by creating a line across the cavotricuspid isthmus under fluoroscopic guidance. In this article, we present the case of a middle-aged male who was submitted to flutter ablation through use of a three-dimensional electroanatomical mapping system, yielding highly accurate and pedantic images.

Cardiac Resynchronisation Therapy and Cellular Bioenergetics: Effects Beyond Chamber Mechanics

Cardiac resynchronisation therapy is a cornerstone in the treatment of advanced dyssynchronous heart failure. However, despite its widespread clinical application, precise mechanisms through which it exerts its beneficial effects remain elusive. Several studies have pointed to a metabolic component suggesting that, both in concert with alterations in chamber mechanics and independently of them, resynchronisation reverses detrimental changes to cellular metabolism, increasing energy efficiency and metabolic reserve. These actions could partially account for the existence of responders that improve functionally but not echocardiographically. This article will attempt to summarise key components of cardiomyocyte metabolism in health and heart failure, with a focus on the dyssynchronous variant. Both chamber mechanics-related and -unrelated pathways of resynchronisation effects on bioenergetics – stemming from the ultramicroscopic level – and a possible common underlying mechanism relating mechanosensing to metabolism through the cytoskeleton will be presented. Improved insights regarding the cellular and molecular effects of resynchronisation on bioenergetics will promote our understanding of non-response, optimal device programming and lead to better patient care

Late Onset of Severe Symptoms in a Patient with Wolff-Parkinson-White Syndrome with Misleading ECG Pattern of the Accessory Pathway Origin Undergoing Successful Ablation

The case of a female patient with symptomatic Wolff-Parkinson-White syndrome is presented with very late onset of symptoms at the age of 65 years, who had an apparent left-sided posteroseptal accessory pathway, which was ablated via a right-sided approach. A subepicardial location was strongly suspected within the coronary sinus ostium at the origin of the middle cardiac vein by applying both ECG and fluoroscopic criteria. Rhythmos 2016;11(3):73-75.

Shipborne vertical profiles of dust aerosols obtained with Unmanned Aerial Vehicles in the Mediterranean and the Middle East: First results ofthe AQABA campaign

International audienceAtmospheric aerosols have a large role in the earth climate through direct or indirect effects on the radiative energy budget. As the aerosol characteristics are highly variable spatially and in time, observations of these characteristics are needed in regions, where the climate change effects are the most severe. One of these types of hotspots is the East Mediterranean and Middle East (EMME region) (Lelieveld et al., 2012), however, high quality in-situ observations in the Middle East and Arabian Peninsula region are still missing. To gain such a high quality observations in this region, the "Air Quality and climate change in the Arabian Basin" (AQABA) oceanographic campaign was organized during summer 2017, shipping from France, through the Suez Canal and around the Arabian Peninsula to Kuwait and back to France. The total length of the campaign was more than 2 months. A wide spectrum of environmental conditions was encountered during the campaign, ranging from pristine conditions over the Indian Ocean, to dusty (low polluted) atmosphere in the Red Sea affected by the Saharan dust and the highly dusty and polluted Gulf. To add on the remote sensing data of aerosol characteristics above the sea surface collected on the ship, the Cyprus Institute's Unmanned Systems Research Laboratory (USRL) team deployed Unmanned Aerial Vehicles (UAVs) to gain in-situ observations of aerosol properties inside and above the marine boundary layer. A small, fixed wing UAV was hand launched from the ship, which then climbed up to 2000 m (a.s.l.) and then returned to the ship and landed on a net. A modified AlphaSense N-2 Optical Particle Counter (OPC) was used on board the UAV to observe the number size distribution of aerosol particles (range: 0.38-17.5 µm, with 16 channels). Meteorological parameters (T, RH and P), as well as a video was recorded also. A total of 16 Successful flights were made, mostly in the Mediterranean and in the Persian Gulf, with few flights in the Red Sea and the Arabian Sea. The presentation will show data acquired on board the UAVs and comparison with ceilometer data obtained on the ship to identify possible dust layers and other interesting events. The differences in aerosol size distributions inside and above the boundary layer will be discussed, as well as any interesting case studies or events during the measurements

Effects of dopamine - furosemide coadministration on renal function indices, diastolic function indices and clinical course of patients with acute decompensated systolic heart failure

Despite considerable advances regarding treatment of chronic heart failure, acute decompensation continues to portend high morbidity and mortality, especially in the peri-hospitalization period. Worsening renal function is one of the major prognostic factors in acutely decompensated heart failure, associated with significantly increased mortality. It should be noted that many of our current mainstream therapies, especially loop diuretics, are thought to be associated with further activation of maladaptive mechanisms that exacerbate renal dysfunction. Recently, non-invasive calculation of ventriculoarterial coupling has been achieved, it being a parameter that expresses the balance between the components of the cardiovascular system (heart and vessels) and denotes the degree to which maximal stroke work for the given contractility is being achieved.AIM: To study the effect of co-administering dopamine and furosemide on renal function, diastolic function of the heart and ventriculoarterial coupling in patients hospitalized with acute decompensated systolic heart failure.METHODS: 42 patients with acute decompensation of reduced ejection fraction heart failure were enrolled and randomized in three groups, receiving the following continuous infusions: high dose furosemide (20mg/hr), low dose furosemide (5mg/hr) and combination of low dose furosemide (5mg/hr) and dopamine (5μg/kg/min). Echocardiographic assessment of diastolic function indices and ventriculoarterial coupling occurred at 0 and 24 hours post randomization. Renal function was evaluated using serum creatinine and creatinine clearance levels as surrogate markers.RESULTS: Ventriculoarterial coupling and percent external stroke work were found to have improved significantly more in the dopamine arm of the trial, along with a trend (p level 0.10) for improvement of parameters expressing myocardial energy efficiency. Important findings were the statistically significant correlations between coupling improvement and renal function improvement, as assessed by means of serum creatinine, percent external stroke work, and efficiency improvement. Furthermore, left ventricular diastolic function indices were found to have significantly improved in the combination arm, as compared with the low and high furosemide dose groups.CONCLUSIONS: These data, combined with the fact that the aforementioned correlations remained significant even when stratifying per heart failure etiology, suggest that, during episodes of acute decompensation, it is advisable to seek optimization of ventriculoarterial coupling and thus maximization of stroke work, that determines, being the product of pressure and volume, tissue blood supply and consequently impacts on the function of all organ systems.Παρά τις προόδους αναφορικά με την αντιμετώπιση της χρονίας καρδιακής ανεπάρκειας, η οξεία απορρύθμιση της νόσου εξακολουθεί να συνοδεύεται από υψηλή νοσηρότητα και θνητότητα ιδίως στην περινοσοκομειακή περίοδο. Κύριο προγνωστικό παράγοντα στην έκβαση της απορρύθμισης αποτελεί η επιδείνωση της νεφρικής λειτουργίας, που συνοδεύεται από ιδιαίτερα αυξημένη θνητότητα. Συγχρόνως, υπάρχει η αντίληψη ότι οι τρέχουσες θεραπείες, ιδίως τα διουρητικά, ίσως να επιδεινώνουν την παθοφυσιολογία της νόσου πυροδοτώντας δυσπροσαρμοστικούς μηχανισμούς που επιτείνουν την νεφρική δυσλειτουργία. Επίσης, τα τελευταία χρόνια έχει επιτευχθεί ο μη επεμβατικός, με την χρήση υπερήχων, υπολογισμός της κοιλιοαρτηριακής σύζευξης, μεγέθους που εκφράζει την ισορροπία των συνιστωσών του καρδιαγγειακού συστήματος (καρδιά και αγγεία) και μπορεί να προσδιορίσει κατά πόσον επιτυγχάνεται το μέγιστο έργο παλμού για την δεδομένη καρδιακή συσπαστικότητα. ΣΤΟΧΟΣ: Μελέτη της επίδρασης της συγχορήγησης ντοπαμίνης – φουροσεμίδης στην νεφρική λειτουργία, στην διαστολική λειτουργία της καρδιάς και στην κοιλιοαρτηριακή σύζευξη ασθενών νοσηλευόμενων με οξεία απορρυθμισθείσα συστολική καρδιακή ανεπάρκεια. ΜΕΘΟΔΟΛΟΓΙΑ: 42 ασθενείς με οξεία απορρύθμιση καρδιακής ανεπάρκειας με χαμηλό κλάσμα εξώθησης τυχαιοποιήθηκαν σε τρεις άξονες και έλαβαν, σε συνεχή έγχυση, υψηλή δόση φουροσεμίδης (20mg/hr), χαμηλή δόση φουροσεμίδης (5mg/hr) ή συνδυασμό χαμηλής δόσης φουροσεμίδης (5mg/hr) και ντοπαμίνης (5μg/kg/min) αντίστοιχα. Έγινε ηχωκαρδιογραφική εκτίμηση των δεικτών διαστολικής λειτουργίας και της κοιλιοαρτηριακής σύζευξης στις 0 και 24 ώρες από την τυχαιοποίησή τους. Η νεφρική λειτουργία μελετήθηκε με την χρήση της κρεατινίνης ορού και της κάθαρσης αυτής. ΑΠΟΤΕΛΕΣΜΑΤΑ: Φάνηκε ότι η κοιλιοαρτηριακή σύζευξη και το ποσοστιαίο εξωτερικό έργο παλμού βελτιώθηκαν σημαντικά περισσότερο στην ομάδα της ντοπαμίνης, μαζί με τάση βελτίωσης (ενδεικτικό επίπεδο σημαντικότητας) παραμέτρων που εκφράζουν την ενεργειακή απόδοση του μυοκαρδίου. Σημαντικό είναι το εύρημα ότι η βελτίωση της σύζευξης συνεσχετίζετο στατιστικώς σημαντικώς με την βελτίωση της νεφρικής λειτουργίας, όπως εξετιμάτο δια της κρεατινίνης ορού, με το ποσοστιαίο εξωτερικό έργο παλμού, αλλά και με την βελτίωση της ενεργειακής απόδοσης. Επίσης, οι δείκτες διαστολικής λειτουργίας της αριστεράς κοιλίας βελτιώθηκαν σε στατιστικά σημαντικό βαθμό περισσότερο στην ομάδα του συνδυασμού ντοπαμίνης - φουροσεμίδης. ΣΥΜΠΕΡΑΣΜΑΤΑ: Τα ευρήματα αυτά, σε συνδυασμό με την παραμονή των σημαντικών συσχετίσεων και κατά την ανάλυση των υποομάδων αναφορικά με την αιτία της καρδιακής ανεπάρκειας, δυνατόν να υποδηλώνουν ότι, κατά την οξεία απορρύθμιση, πρέπει να επιζητείται η βελτιστοποίηση της σύζευξης και άρα του έργου παλμού, που καθορίζει, ως γινόμενο όγκου επί πίεση, την άρδευση και συνεπώς και την λειτουργία όλων των οργανικών συστημάτων

T wave axis deviation and QRS-T angle - Controversial indicators of incident coronary heart events

Abnormal orientation of the T-wave axis and increased angle between the QRS complex (depolarization) and the T-wave (repolarization) have long been assumed to provide a global measure of repolarization abnormality, and have been used to assess ventricular repolarization. The ability of the T-wave axis deviation and the QRS-T angle to predict incident coronary heart events was examined in several studies. However, conflicting results have led to significant controversy in the literature concerning their purported ability. Potential explanations involve true variation between study populations, non-standardized cut-off values, different baseline cardiovascular risk levels or different patterns of confounding by other concomitant cardiovascular risk factors. In the present article we will attempt to briefly present the rationale and pathophysiology behind these indices, summarize existing knowledge regarding their prognostic significance and their correlation with established cardiovascular disease risk factors. Further prospective studies are necessary to confirm or refute whether T-wave axis deviation, QRS-T angle and ventricular gradient may in the future serve as indicators of incident coronary heart events and mortality, both in populations with higher prevalence of subclinical advanced atherosclerotic heart disease and in apparently healthy subjects. (C) 2017 Elsevier Inc. All rights reserved