Access to and clinical use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology Countries: 2016 Report from the European Heart Rhythm Association.

AIMS: The aim of this analysis was to provide comprehensive information on the access to and use of cardiac implantable electronic device (CIED) and catheter ablation therapy in the European Society of Cardiology (ESC) area. METHODS AND RESULTS: The European Heart Rhythm Association (EHRA) has been collecting descriptive and quantitative data on invasive arrhythmia therapies since 2008. This year 50 of the 56 ESC member countries provided data for the EHRA White Book. Up-to-date information on procedure rates for the last 5 years together with information on demographics, economy, vital statistics, local healthcare systems, and training activities is presented for each country and the 5 geographical ESC regions. Our analysis indicated that considerable heterogeneity in the access to arrhythmia therapies still exists across the ESC area. In 2015, the CIED implantation rates per million population were highest in the Western followed by the Southern and Northern European countries. The catheter ablation activity was largest in the Western followed by the Northern and Southern areas. Overall, the procedure rates were 3-10 times higher in the European than in the non-European ESC countries. Economic resources were not the only driver for utilization of arrhythmia therapies as in some Eastern European countries with relative low gross domestic product the procedure rates exceeded the average values. CONCLUSION: These data will help the healthcare professionals and stakeholders to identify and to understand in more depth the trends, disparities, and gaps in cardiac arrhythmia care and thereby promote harmonization of cardiac arrhythmias therapies in the ESC area

Voltage Stability Analysis of Grid-Connected Wind Farms with FACTS: Static and Dynamic Analysis

Recently, analysis of some major blackouts and failures of power system shows that voltage instability problem has been one of the main reasons of these disturbances and networks collapse. In this paper, a systematic approach to voltage stability analysis using various techniques for the IEEE 14-bus case study, is presented. Static analysis is used to analyze the voltage stability of the system under study, whilst the dynamic analysis is used to evaluate the performance of compensators. The static techniques used are Power Flow, V–P curve analysis, and Q–V modal analysis. In this study, Flexible Alternating Current Transmission system (FACTS) devices- namely, Static Synchronous Compensators (STATCOMs) and Static Var Compensators (SVCs) - are used as reactive power compensators, taking into account maintaining the violated voltage magnitudes of the weak buses within the acceptable limits defined in ANSI C84.1. Simulation results validate that both the STATCOMs and the SVCs can be effectively used to enhance the static voltage stability and increasing network loadability margin. Additionally, based on the dynamic analysis results, it has been shown that STATCOMs have superior performance, in dynamic voltage stability enhancement, compared to SVCs

Long-range gravitational-like interaction in a neutral atomic cold gas

A quasi-resonant laser induces a long-range attractive force within a cloud of cold atoms. We take advantage of this force to build in the laboratory a system of particles with a one-dimensional gravitational-like interaction, at a fluid level of modeling. We give experimental evidences of such an interaction in a cold Strontium gas, studying the density profile of the cloud, its size as a function of the number of atoms, and its breathing oscillations.Comment: 4 pages, 4 figures. Published in PRA 87, 013401 (2013

Impact of stable angina on health status and quality of life perception of currently treated patients. The BRIDGE 2 survey.

OBJECTIVE: to explore 1) the perception of stable angina (SA) - impact on quality of life (QoL) and current condition related to SA; 2) SA burden - symptoms and frequency of anginal episodes; 3) impairment attributable to SA - limitations in daily activities and impact on work; 4) characteristics that might affect the patients' perception." METHOD: a proprietary questionnaire was administered on-line to SA patients selected using a purpose-built screening program from general population panels collaborating with IQVIA in Italy, Germany, Spain, and the UK. Exploratory analyses were performed: descriptive statistics on the total sample and different stratifications (gender, age class, time since diagnosis) were provided; we used Chi-square tests to compare subgroups. RESULTS: of more than 25,000 subjects who accessed the survey, 268 were eligible and completed the questionnaire: mean age was 61 years and women accounted for 30%. Despite being treated, about 40% of patients reported that SA impacted "completely" or "very much" their QoL, 10% rated their condition as "not good", and 45.1% stated that they felt "Fair". The majority of patients were still symptomatic and many of them perceived that SA had a major impact on their working life. Women, younger patients and those with a more recent diagnosis reported a worse self-assessment of their condition, QoL and symptom burden. CONCLUSIONS: the results of our survey provide new insights on how patients with SA perceived their own health status and suggest that any patient with SA deserves a more detailed and accurate evaluation by their physicians

Catheter ablation vs. antiarrhythmic drug therapy in patients with symptomatic atrioventricular nodal re-entrant tachycardia: a randomized, controlled trial.

Aims: To conduct a randomized trial in order to guide the optimum therapy of symptomatic atrioventricular nodal re-entrant tachycardia (AVNRT). Methods and Results: Patients with at least one symptomatic episode of tachycardia per month and an electrophysiologic diagnosis of AVNRT were randomly assigned to catheter ablation or chronic antiarrhythmic drug (AAD) therapy with bisoprolol (5 mg od) and/or diltiazem (120-300 mg od). All patients were properly educated to treat subsequent tachycardia episodes with autonomic manoeuvres or a 'pill in the pocket' approach. The primary endpoint of the study was hospital admission for persistent tachycardia cardioversion, during a follow-up period of 5 years. Sixty-one patients were included in the study. In the ablation group, 1 patient was lost to follow-up, and 29 were free of arrhythmia or conduction disturbances at a 5-year follow-up. In the AAD group, three patients were lost to follow-up. Of the remainder, 10 patients (35.7%) continued with initial therapy, 11 patients (39.2%) remained on diltiazem alone, and 7 patients (25%) interrupted their therapy within the first 3 months following randomization, and subsequently developed an episode requiring cardioversion. During a follow-up of 5 years, 21 patients in the AAD group required hospital admission for cardioversion. Survival free from the study endpoint was significantly higher in the ablation group compared with the AAD group (log-rank test, P < 0.001). Conclusions: Catheter ablation is the therapy of choice for symptomatic AVNRT. Antiarrhythmic drug therapy is ineffective and not well tolerated

Causes of death in patients with atrial fibrillation anticoagulated with rivaroxaban:a pooled analysis of XANTUS

Aims: Anticoagulation can prevent stroke and prolong lives in patients with atrial fibrillation (AF). However, anticoagulated patients with AF remain at risk of death. The aim of this study was to investigate the causes of death and factors associated with all-cause and cardiovascular death in the XANTUS population. Methods and results: Causes of death occurring within a year after rivaroxaban initiation in patients in the XANTUS programme studies were adjudicated by a central adjudication committee and classified following international guidance. Baseline characteristics associated with all-cause or cardiovascular death were identified. Of 11 040 patients, 187 (1.7%) died. Almost half of these deaths were due to cardiovascular causes other than bleeding (n = 82, 43.9%), particularly heart failure (n = 38, 20.3%) and sudden or unwitnessed death (n = 24, 12.8%). Fatal stroke (n = 8, 4.3%), which was classified as a type of cardiovascular death, and fatal bleeding (n = 17, 9.1%) were less common causes of death. Independent factors associated with all-cause or cardiovascular death included age, AF type, body mass index, left ventricular ejection fraction, hospitalization at baseline, rivaroxaban dose, and anaemia. Conclusion: The overall risk of death due to stroke or bleeding was low in XANTUS. Anticoagulated patients with AF remain at risk of death due to heart failure and sudden death. Potential interventions to reduce cardiovascular deaths in anticoagulated patients with AF require further investigation, e.g. early rhythm control therapy and AF ablation. Trial registration numbers: NCT01606995, NCT01750788, NCT0180000