CMR of LV non-compaction cardiomyopathy: association of clinical presentation and prognosis with cardiac phenotype

Left ventricular non-compaction (LVNC) is a rare congenital disorder characterized by two layered myocardium; trabeculated (non-compacted) and a non-trabeculated (compacted). LVNC is increasingly being recognized due to better imaging technology as a cause for heart failure and sudden cardiac death; however, data on clinical and imaging characteristics remains limited

Endo-Epicardial Homogenization of the Scar Versus Limited Substrate Ablation for the Treatment of Electrical Storms in Patients With Ischemic Cardiomyopathy

ObjectivesThis study investigated the impact on recurrences of 2 different substrate approaches for the treatment of these arrhythmias.BackgroundCatheter ablation of electrical storms (ES) for ventricular arrhythmias (VAs) has shown moderate long-term efficacy in patients with ischemic cardiomyopathy.MethodsNinety-two consecutive patients (81% male, age 62 ± 13 years) with ischemic cardiomyopathy and ES underwent catheter ablation. Patients were treated either by confining the radiofrequency lesions to the endocardial surface with limited substrate ablation (Group 1, n = 49) or underwent endocardial and epicardial ablation of abnormal potentials within the scar (homogenization of the scar, Group 2, n = 43). Epicardial access was obtained in all Group 2 patients, whereas epicardial ablation was performed in 33% (14) of these patients.ResultsMean ejection fraction was 27 ± 5. During a mean follow-up of 25 ± 10 months, the VAs recurrence rate of any ventricular tachycardia (VTs) was 47% (23 of 49 patients) in Group 1 and 19% (8 of 43 patients) in Group 2 (log-rank p = 0.006). One patient in Group 1 and 1 patient in Group 2 died at follow-up for noncardiac reasons.ConclusionsOur study demonstrates that ablation using endo-epicardial homogenization of the scar significantly increases freedom from VAs in ischemic cardiomyopathy patients

Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review

BackgroundAblation of long-standing persistent atrial fibrillation (AF) is highly variable, with differing techniques and outcomes.ObjectiveThe purpose of this study was to undertake a systematic review of the literature with regard to the impact of ablation technique on the outcomes of long-standing persistent AF ablation.MethodsA systematic search of the contemporary English scientific literature (from January 1, 1990 to June 1, 2009) in the PubMed database identified 32 studies on persistent/long-standing persistent or long-standing persistent AF ablation (including four randomized controlled trials). Data on single-procedure, drug-free success, multiple procedure success, and pharmaceutically assisted success at longest follow-up were collated.ResultsFour studies performed pulmonary vein isolation alone (21%-22% success). Four studies performed pulmonary vein antrum ablation with isolation (PVAI; n = 2; 38%-40% success) or without confirmed isolation (PVA; n = 2; 37%-56% success). Ten studies performed linear ablation in addition to PVA (n = 5; 11%-74% success) or PVAI (n = 5; 38%-57% success). Three studies performed posterior wall box isolation (n = 3; 44%-50% success). Five studies performed complex fractionated atrial electrogram ablation (n = 5; 24%-63% success). Six studies performed complex fractionated atrial electrogram ablation as an adjunct to PVA (n = 2; 50%-51% success), PVAI (n = 3; 36%-61% success), or PVAI and linear (n = 1; 68% success) ablation. Five studies performed the stepwise ablation approach (38%-62% success).ConclusionThe variation in success within and between techniques suggests that the optimal ablation technique for long-standing persistent AF is unclear. Nevertheless, long-standing persistent AF can be effectively treated with a composite of extensive index catheter ablation, repeat procedures, and/or pharmaceuticals.Anthony G. Brooks, Martin K. Stiles, Julien Laborderie, Dennis H. Lau, Pawel Kuklik, Nicholas J. Shipp, Li-Fern Hsu, and Prashanthan Sandershttp://www.elsevier.com/wps/find/journaldescription.cws_home/702333/description#descriptio

Minimizing discordances in automated classification of fractionated electrograms in human persistent atrial fibrillation

Ablation of persistent atrial fibrillation (persAF) targeting complex fractionated atrial electrograms (CFAEs) detected by automated algorithms has produced conflicting outcomes in previous electrophysiological studies. We hypothesize that the differences in these algorithms could lead to discordant CFAE classifications by the available mapping systems, giving rise to potential disparities in CFAE-guided ablation. This study reports the results of a head-to-head comparison of CFAE detection performed by NavX (St. Jude Medical) versus CARTO (Biosense Webster) on the same bipolar electrogram data (797 electrograms) from 18 persAF patients. We propose revised thresholds for both primary and complementary indices to minimize the differences in CFAE classification performed by either system. Using the default thresholds [NavX: CFEMean ≤ 120 ms; CARTO: ICL ≥ 7], NavX classified 70 % of the electrograms as CFAEs, while CARTO detected 36 % (Cohen’s kappa κ ≈ 0.3, P < 0.0001). Using revised thresholds found using receiver operating characteristic curves [NavX: CFE-Mean ≤ 84 ms, CFE-SD ≤ 47 ms; CARTO: ICL ≥ 4, ACI ≤ 82 ms, SCI ≤ 58 ms], NavX classified 45 %, while CARTO detected 42 % (κ ≈ 0.5, P < 0.0001). Our results show that CFAE target identification is dependent on the system and thresholds used by the electrophysiological study. The thresholds found in this work counterbalance the differences in automated CFAE classification performed by each system. This could facilitate comparisons of CFAE ablation outcomes guided by either NavX or CARTO in future works

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.

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2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.

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withdrawn 2017 hrs ehra ecas aphrs solaece expert consensus statement on catheter and surgical ablation of atrial fibrillation

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Découvertes gallo-romaines du Luc (Saint-Girons, Ariège)

This article presents the results of an emergency excavation made by the authors in 1963, during the digging of a public swimming-pool at Saint-Girons, in the eastern part of the Luc, an ancient lucus, a sacred wood in Gallo-Roman time. A pit was excavated and unstratified finds were collected in the spoil earth removed from the digging of the pool. This pit contained in particular about twenty unbroken vessels, one coin, animal bones, ashes and fragments of a gold inscribed leaf ; it may have been dug in the IV th cent., with a filling of older sherds and objects, but its function remains unclear. The inscription, engraved on an exceptional support, is the first Iberian inscription found in the Pyrenean area. The discovery of particular architectural remains, complemented by other indications, lead to suppose the presence of a Gallo-Roman temple in this sacred area, located at the junction of Lez and Salat rivers ; other discoveries have enlightened some aspects of local handicraft and trade. Far from being isolated, the finds of the Luc take place among other finds of Saint-Girons, most of them unpublished, beginning to furnish some information on an important Gallo-Roman site.J. Elayi et J. -P. Bareille présentent les découvertes d’une fouille de sauvetage effectuée en 1963, lors du creusement de la piscine municipale de Saint-Girons dans la partie orientale du quartier du Luc, ancien lucus, bois sacré gallo-romain ; une fosse a pu être fouillée et un ramassage effectué dans les déblais de construction de la piscine. La fosse contenait notamment une vingtaine de vases intacts, une monnaie, des ossements d’animaux, des cendres et les fragments d'une lamelle d’or inscrite ; elle pourrait avoir été creusée au IVe siècle, avec un remplissage plus ancien, mais sa fonction n’est pas claire. L’inscription, dont le support est exceptionnel, est la première inscription ibérique qui provienne de la région pyrénéenne. La découverte de certains fragments architecturaux, complétée par d’autres indices, a conduit à envisager l’hypothèse de l’existence d’un temple gallo-romain, dans un espace sacré situé au confluent du Lez et du Salat ; d’autres objets ont éclairé quelques aspects de l’artisanat local et des échanges commerciaux. Loin d’être isolées, les découvertes du Luc se situent dans l’ensemble des découvertes saint-gironnaises, inédites pour la plupart, et permettent de faire sortir de 1'ombre une importante localité gallo-romaine de confluent.Elayi Josette, Bareille Jean-Pierre. Découvertes gallo-romaines du Luc (Saint-Girons, Ariège). In: Aquitania : une revue inter-régionale d'archéologie, tome 10, 1992. pp. 75-107