Ventricular tachycardia (VT) storm after cryoballoon-based pulmonary vein isolation

Objective: Unusual clinical course. Background: Following catheter ablation of atrial fibrillation, increased incidence of ventricular arrhythmia has been observed. We report a case of sustained ventricular arrhythmia in a patient who underwent cryoballoon-based pulmonary vein isolation for symptomatic persistent atrial fibrillation. Case Report: A 57-year-old patient with dilated cardiomyopathy underwent CB-based pulmonary vein isolation for symptomatic persistent AF. On the day following an uneventful procedure, the patient for the first time experienced a sustained ventricular tachycardia that exacerbated into VT storm. Each arrhythmia was terminated by the ICD that had been implanted for primary prevention. Antiarrhythmic treatment with amiodarone was initiated immediately. The patient remained free from sustained ventricular arrhythmia during follow-up. Conclusions: After pulmonary vein isolation, physicians should be vigilant for ventricular arrhythmia. The influence of atrial autonomic innervation on ventricular electrophysiology is largely unknown

Implantable loop recorders in patients with unexplained syncope: Clinical predictors of pacemaker implantation

Background: Implantable loop recorders (ILR) are a valuable tool for the investigation of unexplained syncopal episodes. The aim of this retrospective single center study was to identify predictive factors for pacemaker implantation in patients with unexplained syncope who underwent ILR insertion. Methods: One hundred six patients were retrospectively analyzed (mean age 59.1 years; 47.2% male) with unexplained syncope and negative conventional testing who underwent ILR implantation. The pri- mary study endpoint was detection of symptomatic or asymptomatic bradycardia requiring pacemaker implantation.  Results: The average follow-up period after ILR implantation was 20 ± 15 months. Pacemaker im- plantation according to current guidelines was necessary in 22 (20.8%) patients, mean duration until index bradycardia was 81 ± 88 (2–350) days. Ten (45.5%) patients received a pacemaker due to sinus arrest, 7 (31.8%) patients due to third-degree atrioventricular block, 2 (9.1%) patients due to second- degree atrioventricular block and 1 (4.5%) patient due to atrial fibrillation with a slow ventricular rate. Three factors remained significant in multivariate analysis: obesity, which defined by a body mass index above 30 kg/m2 (OR: 7.39, p = 0.014), a right bundle branch block (OR: 9.40, p = 0.023) and chronic renal failure as defined by a glomerular filtration rate of less than 60 mL/min (OR: 6.42, p = 0.035). Conclusions: Bradycardia is a frequent finding in patients undergoing ILR implantation due to un- explained syncope. Obesity, right bundle branch block and chronic renal failure are independent clinical predictors of pacemaker implantation

Observational evidence for gravitationally trapped massive axion(-like) particles

Unexpected astrophysical observations can be explained by gravitationally captured massive particles, which are produced inside the Sun or other Stars and are accumulated over cosmic times. Their radiative decay in solar outer space would give rise to a `self-irradiation' of the whole star, providing the time-independent component of the corona heating source. In analogy with the Sun-irradiated Earth atmosphere, the temperature and density gradient in the corona - chromosphere transition region is suggestive for an omnipresent irradiation of the Sun. The same scenario fits other astrophysical X-ray observations. The radiative decay of a population of such elusive particles mimics a hot gas. X-ray observatories, with an unrivalled sensitivity below ~10 keV, can search for such particles. The elongation angle relative to the Sun is the relevant new parameter.Comment: 35 pages, LaTeX, 9 figures. Accepted by Astroparticle Physic

Robotic ablation of atrial fibrillation

BACKGROUND: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). During PVI an electrical conduction block between pulmonary vein (PV) and left atrium (LA) is created. This conduction block prevents AF, which is triggered by irregular electric activity originating from the PV. However, transmural atrial lesions are required which can be challenging. Re-conduction and AF recurrence occur in 20 - 40% of the cases. Robotic catheter systems aim to improve catheter steerability. Here, a procedure with a new remote catheter system (RCS), is presented. Objective of this article is to show feasibility of robotic AF ablation with a novel system. MATERIALS AND METHODS: After interatrial trans-septal puncture is performed using a long sheath and needle under fluoroscopic guidance. The needle is removed and a guide wire is placed in the left superior PV. Then an ablation catheter is positioned in the LA, using the sheath and wire as guide to the LA. LA angiography is performed over the sheath. A circular mapping catheter is positioned via the long sheath into the LA and a three-dimensional (3-D) anatomical reconstruction of the LA is performed. The handle of the ablation catheter is positioned in the robotic arm of the Amigo system and the ablation procedure begins. During the ablation procedure, the operator manipulates the ablation catheter via the robotic arm with the use of a remote control. The ablation is performed by creating point-by-point lesions around the left and right PV ostia. Contact force is measured at the catheter tip to provide feedback of catheter-tissue contact. Conduction block is confirmed by recording the PV potentials on the circular mapping catheter and by pacing maneuvers. The operator stays out of the radiationfield during ablation. CONCLUSION: The novel catheter system allows ablation with high stability on low operator fluoroscopy exposure

Melt-spun poly(D,l-lactic acid) monofilaments containing N,N-diethyl-3-methylbenzamide as mosquito repellent

Malaria is still a major tropical disease, with Africa particularly burdened. It has been proposed that outdoor protection could aid substantially in reducing the malaria incidence rate in rural African communities. Recently, melt-spun polyolefin fibers containing mosquito repellents have been shown to be promising materials to this end. In this study, the incorporation of N,N-Diethyl-3-methylbenzamide (DEET)—a popular and widely available mosquito repellent—in commercially available, amorphous poly(D,L-lactic acid) (PDLLA) is investigated with the aim of producing biodegradable mosquito-repelling filaments with a reduced environmental impact. It is shown to be possible to produce macroscopically stable PDLLA-DEET compounds containing up to 20 wt.-% DEET that can be melt-spun to produce filaments, albeit at relatively low take-up speeds. A critical DEET content allows for stress-induced crystallization during the spinning of the otherwise amorphous PDLLA, resulting in the formation of -crystals. Although the mechanical integrity of the filaments is notably impacted by the incorporation of DEET, these filaments show potential as materials that can be used for Malaria vector control.The Deutsche Forschungsgemeinschaft (DFG)https://www.mdpi.com/journal/materialsam2022Chemical Engineerin