Initial Independent Outcomes from Focal Impulse and Rotor Modulation Ablation for Atrial Fibrillation: Multicenter FIRM Registry

Introduction The success of pulmonary vein isolation (PVI) for atrial fibrillation (AF) may be improved if stable AF sources identified by Focal Impulse and Rotor Mapping (FIRM) are also eliminated. The long-term results of this approach are unclear outside the centers where FIRM was developed; thus, we assessed outcomes of FIRM-guided AF ablation in the first cases at 10 experienced centers. Methods We prospectively enrolled n = 78 consecutive patients (61 ± 10 years) undergoing FIRM guided ablation for persistent (n = 48), longstanding persistent (n = 7), or paroxysmal (n = 23) AF. AF recordings from both atria with a 64-pole basket catheter were analyzed using a novel mapping system (Rhythm View™; Topera Inc., CA, USA). Identified rotors/focal sources were ablated, followed by PVI. Results Each institution recruited a median of 6 patients, each of whom showed 2.3 ± 0.9 AF rotors/focal sources in diverse locations. 25.3% of all sources were right atrial (RA), and 50.0% of patients had ≥1 RA source. Ablation of all sources required a total of 16.6 ± 11.7 minutes, followed by PVI. On >1 year follow-up with a 3-month blanking period, 1 patient lost to follow-up (median time to 1st recurrence: 245 days, IQR 145–354), single-procedure freedom from AF was 87.5% (patients without prior ablation; 35/40) and 80.5% (all patients; 62/77) and similar for persistent and paroxysmal AF (P = 0.89). Conclusions Elimination of patient-specific AF rotors/focal sources produced freedom-from-AF of ≈80% at 1 year at centers new to FIRM. FIRM-guided ablation has a rapid learning curve, yielding similar results to original FIRM reports in each center’s first cases

Abnormal ECG Findings in Athletes: Clinical Evaluation and Considerations.

PURPOSE OF REVIEW: Pre-participation cardiovascular evaluation with electrocardiography is normal practice for most sporting bodies. Awareness about sudden cardiac death in athletes and recognizing how screening can help identify vulnerable athletes have empowered different sporting disciplines to invest in the wellbeing of their athletes. RECENT FINDINGS: Discerning physiological electrical alterations due to athletic training from those representing cardiac pathology may be challenging. The mode of investigation of affected athletes is dependent on the electrical anomaly and the disease(s) in question. This review will highlight specific pathological ECG patterns that warrant assessment and surveillance, together with an in-depth review of the recommended algorithm for evaluation

Linking personality to larval energy reserves in rainbow trout (Oncorhynchus mykiss).

There is a surging interest in the evolution, ecology and physiology of personality differences. However, most of the studies in this research area have been performed in adult animals. Trait variations expressed early in development and how they are related to the ontogeny of an animal's personality are far less studied. Genetic differences as well as environmental factors causing functional variability of the central serotonergic system have been related to personality differences in vertebrates, including humans. Such gene-environment interplay suggests that the central serotonergic system plays an important role in the ontogeny of personality traits. In salmonid fishes, the timing of emergence from spawning nests is related to energy reserves, aggression, and social dominance. However, it is currently unknown how the size of the yolk reserve is reflected on aggression and dominance, or if these traits are linked to differences in serotonergic transmission in newly emerged larvae. In this study we investigated the relationship between yolk reserves, social dominance, and serotonergic transmission in newly emerged rainbow trout (Oncorhynchus mykiss) larvae. This was conducted by allowing larvae with the same emergence time, but with different yolk sizes, to interact in pairs for 24 h. The results show that individuals with larger yolks performed more aggressive acts, resulting in a suppression of aggression in individuals with smaller yolks. A higher brain serotonergic activity confirmed subordination in larvae with small yolks. The relationship between social dominance and yolk size was present in siblings, demonstrating a link between interfamily variation in energy reserves and aggression, and suggests that larger yolk reserves fuel a more aggressive personality during the initial territorial establishment in salmonid fishes. Furthermore, socially naïve larvae with big yolks had lower serotonin levels, suggesting that other factors than the social environment causes variation in serotonergic transmission, underlying individual variation in aggressive behavior