Minimal fluoroscopy approach for right-sided supraventricular tachycardia ablation with a novel ablation technology: Insights from the multicenter CHARISMA clinical registry

Background No data exist on the ability of the novel Rhythmia 3-D mapping system to minimize fluoroscopy exposure during transcatheter ablation of arrhythmias. We report data on the feasibility and safety of a minimal fluoroscopic approach using this system in supraventricular tachycardia (SVT) procedures.Methods Consecutive patients were enrolled in the CHARISMA registry at 12 centers. All right-sided procedures performed with the Rhythmia mapping system were analyzed. The acquired electroanatomic information was used to reconstruct 3-D cardiac geometry; fluoroscopic confirmation was used whenever deemed necessary.Results Three hundred twenty-five patients (mean age = 56 +/- 17 years, 57% male) were included: 152 atrioventricular nodal reentrant tachycardia, 116 atrial flutter, 41 and 16 right-sided accessory pathway and atrial tachycardia, respectively. Overall, 27 481 s of fluoroscopy were used (84.6 +/- 224 s per procedure, equivalent effective dose = 1.1 +/- 3.7 mSv per patient). One hundred ninety-two procedures (59.1%) were completed without the use of fluoroscopy (zero fluoroscopy, ZF). In multivariate analysis, the presence of a fellow in training (OR = 0.15, 95% CI: 0.05-0.46; p = .0008), radiofrequency application (0.99, 0.99-1.00; p = .0002), and mapping times (0.99, 0.99-1.00; p = .042) were all inversely associated with ZF approach. Acute procedural success was achieved in 97.8% of the cases (98.4 vs. 97% in the ZF vs. non-ZF group; p = .4503). During a mean of 290.7 +/- 169.6 days follow-up, no major adverse events were reported, and recurrence of the primary arrhythmia was 2.5% (2.1 vs. 3% in the ZF vs. non-ZF group; p = .7206).Conclusions The Rhythmia mapping system permits transcatheter ablation of right-sided SVT with minimal fluoroscopy exposure. Even more, in most cases, the system enables a ZF approach, without affecting safety and efficacy

Targeted ablation of residual pulmonary vein potentials in atrial fibrillation ablation through ultra-high-density mapping: Insights from the CHARISMA registry

Introduction Low-voltage activity beyond pulmonary veins (PVs) may contribute to the failure of ablation of atrial fibrillation (AF) in the long term. We aimed to assess the presence of gaps (PVG) and residual potential (residual antral potential [RAP]) within the antral scar by means of an ultra-high-density mapping (UHDM) system.Methods We studied consecutive patients from the CHARISMA registry who were undergoing AF ablation and had complete characterization of residual PV antral activity. The Lumipoint (TM) (Boston Scientific) map-analysis tool was used sequentially on each PV component. The ablation endpoint was PV isolation (PVI) and electrical quiescence in the antral region.Results Fifty-eight cases of AF ablation were analyzed. A total of 86 PVGs in 34 (58.6%) patients and 44 RAPs in 34 patients (58.6%) were found. In 16 (27.6%) cases, we found at least one RAP in patients with complete absence of PV conduction. RAPs showed a lower mean voltage than PVG (0.3 +/- 0.2 mV vs. 0.7 +/- 0.5 mV, p < .0001), whereas the mean number of electrogram peaks was higher (8.4 +/- 1.4 vs. 3.2 +/- 1.5, p < .0001). The percentage of patients in whom RAPs were detected through Lumipoint (TM) was higher than through propagation map analysis (58.6% vs. 36.2%, p = .025). Acute procedural success was 100%, with all PVs successfully isolated and RAPs completely abolished in all study patients. During a mean follow-up of 453 +/- 133 days, 6 patients (10.3%) suffered an AF/AT recurrence.Conclusion Local vulnerabilities in antral lesion sets were easily discernible by means of the UHDM system in both de novo and redo patients when no PV conduction was present

O ensino de história da enfermagem nos cursos de graduação de Santa Catarina Nursing history education on graduation courses in Santa Catarina

Partindo da idéia de que o ensino da história da enfermagem é fundamental para a formação dos alunos do curso de graduação e de que a forma como se ministra o seu conteúdo proporciona ou não a aderência a este conhecimento, esta pesquisa pretende estabelecer uma rede de contatos com todas as escolas de enfermagem de Santa Catarina para traçar um diagnóstico do ensino de história da enfermagem. Este poderá subsidiar a criação de uma política para nortear a reformulação curricular da disciplina, face às necessidades do Estado. A metodologia é qualitativa e a coleta de dados inicial identificou, a partir de 15 escolas de enfermagem do Estado, o modus operandi do desenvolvimento da disciplina ao longo do curso. Uma análise inicial indica que as estratégias educacionais e curriculares são variadas, havendo interfaces entre elas. Percebe-se um avanço relativo à carga horária e às estratégias de ensino-aprendizagem, porém a inserção do conteúdo em questão ainda carece de reflexão coletiva sobre a sua importância no currículo dos cursos.<br>Concerning to the idea that the nursing history education is fundamental to the development of students of graduation course and that the way this instruction is given determines if its content provides or not the adherence to this information, this research aims to establish a network with all Nursing Schools of Santa Catarina to determine a education diagnosis of nursing history education. This may be a subsidy for a policy creation to guide the curricular reformulation of this subject, in view of the State needs. The methodology is qualitative and the initial data collection identified, from 15 nursing schools of the State, the modus operandi of the subject development along the course. An initial analysis indicates that the educational and curricular strategies are varied, and there are interfaces between them. We note an advance related to the grade hours and to learning-education strategies, however the insertion of said content still needs a collective reflection about its importance on the courses curriculum

Recommendations from a health impact assessment in viggiano and grumento nova (basilicata region, Southern Italy)

In Europe, Health Impact Assessment (HIA) is a consolidated practice aimed at predicting health impacts supporting the predisposition of plans and projects subjected to authorization procedures. In Italy, further developments are needed to harmonize the practice and consolidate methodologies in order to extend the HIA application in different fields. The recent HIA conducted in Val d'Agri (Basilicata) on the impacts of a first crude oil treatment plant represents an opportunity to illustrate its tools, methods and fields of application. In this experience, participation methods in impact assessment have been adapted to the context, emphasizing aspects of ethics, equity and democracy. Environmental and epidemiological studies were included in the HIA Val d'Agri in order to characterize the environment and assess the health status of the resident population. On the basis of the results public health recommendations have been elaborated, shared with the stakeholders and shared with local and regional administrators. The experience in Val d'Agri introduces elements of reflection on the potential of HIA at local level in order to support the public health and the environmental control systems in the area, as well as planning based on preventive environment and HIA