Adenosine-guided pulmonary vein isolation versus conventional pulmonary vein isolation in patients undergoing atrial fibrillation ablation: An updated meta-analysis

BACKGROUND: Recurrent atrial fibrillation episodes following pulmonary vein isolation (PVI) are frequently due to reconnection of PVs. Adenosine can unmask dormant conduction, leading to additional ablation to improve AF-free survival. We performed a meta-analysis of the literature to assess the role of adenosine testing in patients undergoing atrial fibrillation (AF) ablation. METHODS: PubMed, EMBASE, and Cochrane databases were searched through until December 2015 for studies reporting on the role of adenosine guided-PVI versus conventional PVI in AF ablation. RESULTS: Eleven studies including 4099 patients undergoing AF ablation were identified to assess the impact of adenosine testing. Mean age of the population was 61 ± 3 years: 25% female, 70% with paroxysmal AF. Follow up period of 12.5 ± 5.1 months. A significant benefit was observed in the studies published before 2013 (OR = 1.75; 95%CI 1.32–2.33, p < 0.001, I2 = 11%), retrospective (OR = 2.05; 95%CI 1.47–2.86, p < 0.001, I2 = 0%) and single-centre studies (OR = 1.58; 95%CI 1.19–2.10, p = 0.002, I2 = 30%). However, analysis of studies published since 2013 (OR = 1.41; 95% CI 0.87–2.29, p = 0.17, I2 = 75%) does not support any benefit from an adenosine-guided strategy. Similar findings were observed by pooling prospective case-control (OR = 1.39; 95%CI 0.93–2.07, p = 0.11, I2 = 75%), and prospective randomized controlled studies (OR = 1.62; 95%CI 0.81–3.24, p = 0.17, I2 = 86%). Part of the observed high heterogeneity can be explained by parameters such as dormant PVs percentage, use of new technology, improvement of center/operator experience, patients' characteristics including gender, age, and AF type. CONCLUSIONS: Pooling of contemporary data from high quality prospective case–control & prospective randomized controlled studies fails to show the benefit of adenosine-guided strategy to improve AF ablation outcomes

Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: a systematic review and meta-analysis

Objective: Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) and is associated with a high risk of stroke. The efficacy and safety of catheter ablation in this setting is poorly characterised. We aimed to systematically review the existing literature and to perform a meta-analysis to determine the efficacy and safety of catheter ablation of AF in patients with HCM. // Methods: Random-effects meta-analysis of studies comparing HCM versus non-HCM controls. The outcomes of freedom from AF/atrial tachycardia, and acute procedure-related complications were assessed. Studies were searched on MEDLINE, EMBASE, COCHRANE and clinicaltrials.gov. // Results: Fourteen studies were considered eligible for the systematic review, of which five were included in the meta-analysis. Freedom from AF/atrial tachycardia relapse was higher in patients without HCM (after a single procedure: 38.7% HCM vs 49.8% controls, OR=2.25, 95% CI 1.09 to 4.64, p=0.03; after ≥1 procedure: 51.8% HCM vs 71.2% controls, OR=2.62, 95% CI 1.52 to 4.51, p=0.0006; I2=33% and 26%, respectively). Risk of procedure-related adverse events was low. Repeat procedures (mean difference=0.16, 95% CI 0.0 to 0.32, p=0.05, I2=53%) and antiarrhythmic drugs (OR=4.70, 95% CI 2.31 to 9.55, p<0.0001, I2=0%) are more frequently needed in patients with HCM to prevent arrhythmia relapse. Sensitivity analyses suggested that the outcome in patients with HCM with less dilated atria and paroxysmal AF may be more comparable to the general population. // Conclusions: The observed complication rate of catheter ablation of AF in patients with HCM was low. Even though the risk of relapse is twofold higher, catheter ablation can be effective in patients with HCM and AF, particularly in patients with paroxysmal AF and smaller atria

The altered expression of α1 and β3 subunits of the gamma-aminobutyric acid A receptor is related to the hepatitis C virus infection

The modulation of the gamma-aminobutyric acid type A (GABA A) receptors activity was observed in several chronic hepatitis failures, including hepatitis C. The expression of GABA A receptor subunits α1 and β3 was detected in peripheral blood mononuclear cells (PBMCs) originated from healthy donors. The aim of the study was to evaluate if GABA A α1 and β3 expression can also be observed in PBMCs from chronic hepatitis C (CHC) patients and to evaluate a possible association between their expression and the course of hepatitis C virus (HCV) infection. GABA A α1- and β3-specific mRNAs presence and a protein expression in PBMCs from healthy donors and CHC patients were screened by reverse transcription polymerase chain reaction (RT-PCR) and Western blot, respectively. In patients, HCV RNA was determined in sera and PBMCs. It was shown that GABA A α1 and β3 expression was significantly different in PBMCs from CHC patients and healthy donors. In comparison to healthy donors, CHC patients were found to present an increase in the expression of GABA A α1 subunit and a decrease in the expression of β3 subunit in their PBMCs. The modulation of α1 and β3 GABA A receptors subunits expression in PBMCs may be associated with ongoing or past HCV infection

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.

Peer reviewe

First observation of a shape isomer and a low-lying strongly-coupled prolate band in neutron-deficient semi-magic 187Pb

Prompt and delayed γ-ray spectroscopy of the neutron-deficient, semi-magic isotope 187Pb has been performed using the recoil-decay and isomer-decay tagging techniques at the Argonne Gas-Filled Analyzer. A new 5.15(15)-μs isomeric state at only 308 keV above the spherical 3/2− ground state is identified and classified as a shape isomer. A strongly-coupled band is observed on top of the isomer, which is nearly identical to the one built on the prolate 7/2−[514] Nilsson state in the isotone 185Hg. Based on this similarity and on the result of the potential-energy surface calculations, the new isomer in 187Pb is proposed to originate from the same configuration. The retarded character of the 308-keV (7/2−)→3/2gs− transition with a deduced B(E2)=5.6(2)×10−4 W.u. can be well explained by the significant difference between the prolate parent and spherical daughter configurations, leading to the shape isomerism. The excitation energy of the isomer is surprisingly low, being roughly half of the excitation energies of the known 0+ intruder bandheads in the neighboring 186,188Pb isotopes. The combined results of the present work and the previous α-decay and laser spectroscopy studies present evidence for triple shape coexistence at low energy in the negative-parity configurations of 187Pb, which is well reproduced by the potential-energy surface calculations

An approach to performance prediction for parallel applications

Abstract. Accurately modeling and predicting performance for largescale applications becomes increasingly difficult as system complexity scales dramatically. Analytic predictive models are useful, but are difficult to construct, usually limited in scope, and often fail to capture subtle interactions between architecture and software. In contrast, we employ multilayer neural networks trained on input data from executions on the target platform. This approach is useful for predicting many aspects of performance, and it captures full system complexity. Our models are developed automatically from the training input set, avoiding the difficult and potentially error-prone process required to develop analytic models. This study focuses on the high-performance, parallel application SMG2000, a much studied code whose variations in execution times are still not well understood. Our model predicts performance on two large-scale parallel platforms within 5%-7 % error across a large, multidimensional parameter space.

Partial Data Traces: Efficient Generation and Representation

Binary manipulation techniques are increasing in popularity. They support program transformations tailored toward certain program inputs, and these transformations have been shown to yield performance gains beyond the scope of static code optimizations without prole-directed feedback. They even deliver moderate gains in the presence of prole-guided optimizations. In addition, transformations can be performed on the entire executable, including library routines. This work focuses on program instrumentation, yet another application of binary manipulation. This paper reports preliminary results on generating partial data traces through dynamic binary rewriting. The contributions are threefold. First, a portable method for extracting precise data traces for partial executions of arbitrary applications is developed. Second, a set of hierarchical structures for compactly representing these accesses is developed. Third, an e- cient online algorithm to detect regular accesses is introduced. These eorts are part of a larger project to counter the increasing gap between processor and main memory speeds by means of software optimization and hardware enhancements. 1

METRIC: Tracking Down Inefficiencies in the Memory Hierarchy via Binary Rewriting

In this paper, we present METRIC, an environment for determining memory inefficiencies by examining data traces. METRIC is designed to alter the performance behavior of applications that are mostly constrained by their latency to resolve memory references. We make four primary contributions in this paper. First, we present methods to extract partial data traces from running applications by observing their memory behavior via dynamic binary rewriting. Second, we present a methodology to represent partial data traces in constant space for regular references through a novel technique for online compression of reference streams. Third, we employ offline cache simulation to derive indications about memory performance bottlenecks from partial data traces. By exploiting summarized memory metrics, by-reference metrics as well as cache evictor information, we can pin-point the sources of performance problems. Fourth, we demonstrate the ability to derive opportunities for optimizations and assess their benefits in several experiments resulting in up to 40% lower miss ratios