Sustained intraatrial reentrant tachycardia: Clinical, electrocardiographic and electrophysiologic characteristics and long-term follow-up

Although intraatrial reentry has been traditionally listed as a mechanism for supraventricular tachycardia, few reports describing the clinical features of this arrhythmia exist. Nineteen patients with a clinical history of sustained supraventricular tachycardia were diagnosed as having intraatrial reentrant tachycardia. Seventeen (89%) patients of the 19 had underlying structural heart disease and 17 had echocardiographic evidence of atrial enlargement; the mean left ventricular ejection fraction was 51 ± 16%. A history of concomitant atrial fibrillation or flutter was present in 13 patients (68%). The mean atrial cycle length during tachycardia was 326 ± 57 ms (range 260 to 460). Fourteen patients had 1:1 atrioventricular (AV) conduction during tachycardia, of whom 50% had an RP7RR' ratio >0.5.Intravenous adenosine (dose range 37.5 to 150 µg/kg) and verapamil (dose range 5 to 10 mg) had no effect on atrial tachycardia cycle length in 13 of 14 and 9 of 9 patients, respectively, despite induction of second degree AV block. Type la antiarrhythmic drugs achieved longterm suppression of intraatrial reentrant tachycardia in only 6 patients, whereas amiodarone (326 ± 145 mg/day) was successful in 11 patients during a 32 ± 20 month follow-up period. The remaining two patients and one patient who later developed amiodarone toxicity either progressed to (n = 1) or had (n = 2) catheter-induced high grade AV block and were treated with long-term ventricular pacing.It is concluded that intraatrial reentrant tachycardia is often associated with structural heart disease, particularly of types that cause atrial abnormalities, but left ventricular dysfunction is not a requisite finding. Other arrhythmias are frequently observed in these patients. This arrhythmia responds poorly to type la antiarrhythmic drugs, but is effectively treated with amiodarone. Catheter ablation of the AV junction offers a therapeutic option for patients who are refractory to medical therapy

A placebo-controlled, double-blind, randomized, multicenter study to assess the effects of dronedarone 400 mg twice daily for 12 weeks on atrial fibrillation burden in subjects with permanent pacemakers

Purpose Dronedarone is a benzofuran derivative with a pharmacological profile similar to amiodarone but has a more rapid onset of action and a much shorter half-life (13–19 h). Our goal was to evaluate the efficacy of dronedarone in atrial fibrillation (AF) patients using dual-chamber pacemakers capable of quantifying atrial fibrillation burden. Methods Pacemakers were adjusted to optimize AF detection. Patients with AF burden \u3e1 % were randomized to dronedarone 400 mg twice daily (BID) or placebo. Pacemakers were interrogated after 4 and 12 weeks of treatment. The primary endpoint was the change in AF burden from baseline over the 12-week treatment period. Patients with permanent AF, severe/recently decompensated heart failure, and current use of antiarrhythmic drugs were excluded. AF burden was assessed by a core laboratory blinded to treatment assignment. Results From 285 patients screened, 112 were randomized (mean age 76 years, 60 % male, 84 % hypertensive, 65 % with sick sinus syndrome, 26 % with diabetes mellitus type II, 15 % with heart failure). Baseline mean (SEM) AF burden was 8.77 % (0.16) for placebo and 10.14 % (0.17) for dronedarone. Over the 12-week study period, AF burden compared to baseline decreased by 54.4 % (0.22) (P = 0.0009) with dronedarone and trended higher by 12.8 % (0.16) (P = 0.450) with placebo. The absolute change in burden was decreased by 5.5 % in the dronedarone group and increased by 1.1 % in the placebo group. Heart rate during AF was reduced to approximately 4 beats/min with dronedarone (P = 0.285). Adverse events were higher with dronedarone compared to placebo (65 vs 56 %). Conclusions Dronedarone reduced pacemaker-assessed the relative AF burden compared to baseline and placebo by over 50 % during the 12-week observation period

Use of a regional wall motion score to enhance risk stratification of patients receiving an implantable cardioverter-defibrillator

AbstractObjectives. We postulated that preoperative assessment of both regional wall motion and left ventricular ejection fraction would serve as an accurate prognostic indicator of long-term cardiac mortality and functional outcome in patients treated with an implantable cardioverter-defibrillator.Background. Long-term cardiac mortality has remained high in patients receiving an implantable cardioverter-defibrillator. The ability to risk stratify patients before defibrillator implantation is becoming increasingly important from a medical and economic standpoint.Methods. The hypothesis was retrospectively tested in 74 patients who had received an implantable cardioverterdefibrillator. Left ventricular ejection fraction and regional wall motion score, derived from centerline chord motion analysis, were calculated for each patient from the preoperative right anterior oblique contrast ventriculogram. Wall motion score was the only significant independent predictor of long-term cardiac mortality and functional status by multivariate analysis because of its enhanced prognostic capability in patients with an ejection fraction in the critical range of 30% to 40%.Results. Patients with an ejection fraction >40% had a 3-year cardiac mortality rate of 0% compared with 25% for those with an ejection fraction of 30% to 40% and 48% for those with an ejection fraction <30% (p < 0.05). Similarly, 75% of patients with an ejection fraction >40% were in New York Heart Association functional class I or II during long-term follow-up compared with 59% of those with an ejection fraction 30% to 40% and 29% of those with an ejection fraction <30%. Among patients with an ejection fraction of 30% to 40%, those with a wall motion score >16% had a 3-year cardiac mortality rate of 0% compared with 71% of those with a wall motion score ≤ 16% (p = 0.002). In addition, 86% of patients with a wall motion score >16% were in functional class I or II during long-term follow-up compared with 13% of those with a wall motion score ≤16% (p = 0.001).Conclusions. Long-term cardiac mortality and functional outcome in patients receiving an implantable cardioverterdefibrillator can be predicted if the left ventricular ejection fraction and regional wall motion score are measured preoperatively

Characterizing the weather band variability of the Texas shelf current

Considering the benefits of understanding the circulation patterns of the shelf, it is not surprising that there are numerous studies of the Texas Shelf circulation patterns. Given that previous studies were focused on the low-frequency variability of the circulation which is upcoast (northeast flow) in the summer and downcoast (southwest flow) especially on the inner shelf in the non-summer seasons, this study investigates the weather band (2–15 days) variability of the Texas Shelf near-surface circulation pattern. Current meter data at 1.5 m below the sea surface from the inner, mid, and outer shelves were analyzed. This study demonstrated that there are high-frequency current reversals within the weather band in each season. From the estimated persistence of the currents during reversals, the inner and mid shelf currents are predominantly downcoast in the non-summer seasons and upcoast in the summer season whereas the outer shelf currents are mostly upcoast all year round. The Wavelets analysis of the currents revealed that most of the variabilities on the inner and mid shelf regions were within the 4-12-day band whereas on the outer shelf the dominant variability was within the 3–8-day band. From the cross-spectra analysis of both the currents and wind data, it was determined that the influence of the wind was more dominant on the inner and mid shelf regions at the 8–15-day band than on the outer shelf where the contribution of the wind is prevalent at the 2–4-day band

The Disconnect Between the Guidelines, the Appropriate Use Criteria, and Reimbursement Coverage Decisions The Ultimate Dilemma

Recently, the American College of Cardiology Foundation in collaboration with the Heart Rhythm Society published appropriate use criteria (AUC) for implantable cardioverter-defibrillators and cardiac resynchronization therapy. These criteria were developed to critically review clinical situations that may warrant implantation of an implantable cardioverter-defibrillator or cardiac resynchronization therapy device, and were based on a synthesis of practice guidelines and practical experience from a diverse group of clinicians. When the AUC was drafted, the writing committee recognized that some of the scenarios that were deemed “appropriate” or “may be appropriate” were discordant with the clinical requirements of many payers, including the Medicare National Coverage Determination (NCD). To charge Medicare for a procedure that is not covered by the NCD may be construed as fraud. Discordance between the guidelines, the AUC, and the NCD places clinicians in the difficult dilemma of trying to do the “right thing” for their patients, while recognizing that the “right thing” may not be covered by the payer or insurer. This commentary addresses these issues. Options for reconciling this disconnect are discussed, and recommendations to help clinicians provide the best care for their patients are offered

A slowly rotating coil system for AC field measurements of Fermilab booster correctors

A method for measurement of rapidly changing magnetic fields has been developed and applied to the testing of new room temperature corrector packages designed for the Fermilab Booster Synchrotron. The method is based on fast digitization of a slowly rotating tangential coil probe, with analysis combining the measured coil voltages across a set of successive magnet current cycles. This paper presents results on the field quality measured for the normal and skew dipole, quadrupole, and sextupole elements in several of these corrector packages

Autonomous and Lagrangian ocean observations for Atlantic tropical cyclone studies and forecasts

Author Posting. © The Oceanography Society, 2017. This article is posted here by permission of The Oceanography Society for personal use, not for redistribution. The definitive version was published in Oceanography 30, no. 2 (2017): 92–103, doi:10.5670/oceanog.2017.227.The tropical Atlantic basin is one of seven global regions where tropical cyclones (TCs) commonly originate, intensify, and affect highly populated coastal areas. Under appropriate atmospheric conditions, TC intensification can be linked to upper-ocean properties. Errors in Atlantic TC intensification forecasts have not been significantly reduced during the last 25 years. The combined use of in situ and satellite observations, particularly of temperature and salinity ahead of TCs, has the potential to improve the representation of the ocean, more accurately initialize hurricane intensity forecast models, and identify areas where TCs may intensify. However, a sustained in situ ocean observing system in the tropical North Atlantic Ocean and Caribbean Sea dedicated to measuring subsurface temperature, salinity, and density fields in support of TC intensity studies and forecasts has yet to be designed and implemented. Autonomous and Lagrangian platforms and sensors offer cost-effective opportunities to accomplish this objective. Here, we highlight recent efforts to use autonomous platforms and sensors, including surface drifters, profiling floats, underwater gliders, and dropsondes, to better understand air-sea processes during high-wind events, particularly those geared toward improving hurricane intensity forecasts. Real-time data availability is key for assimilation into numerical weather forecast models.The NOAA/AOML component of this work was originally funded by the Disaster Relief Appropriations Act of 2013, also known as the Sandy Supplemental, and is currently funded through NOAA research grant NA14OAR4830103 by AOML and CARICOOS, as well as NOAA’s Integrated Ocean Observing System (IOOS). The TEMPESTS component of this work is supported by NOAA through the Cooperative Institute for the North Atlantic Region (NA13OAR4830233) with additional analysis support from the WHOI Summer Student Fellowship Program, Nortek Student Equipment Grant, and the Rutgers University Teledyne Webb Graduate Student Fellowship Program. The drifter component of this work is funded through NOAA grant NA15OAR4320071(11.432) in support of the Global Drifter Program

Ocean observations in support of studies and forecasts of tropical and extratropical cyclones

© The Author(s), 2019. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Domingues, R., Kuwano-Yoshida, A., Chardon-Maldonado, P., Todd, R. E., Halliwell, G., Kim, H., Lin, I., Sato, K., Narazaki, T., Shay, L. K., Miles, T., Glenn, S., Zhang, J. A., Jayne, S. R., Centurioni, L., Le Henaff, M., Foltz, G. R., Bringas, F., Ali, M. M., DiMarco, S. F., Hosoda, S., Fukuoka, T., LaCour, B., Mehra, A., Sanabia, E. R., Gyakum, J. R., Dong, J., Knaff, J. A., & Goni, G. Ocean observations in support of studies and forecasts of tropical and extratropical cyclones. Frontiers in Marine Science, 6, (2019): 446, doi:10.3389/fmars.2019.00446.Over the past decade, measurements from the climate-oriented ocean observing system have been key to advancing the understanding of extreme weather events that originate and intensify over the ocean, such as tropical cyclones (TCs) and extratropical bomb cyclones (ECs). In order to foster further advancements to predict and better understand these extreme weather events, a need for a dedicated observing system component specifically to support studies and forecasts of TCs and ECs has been identified, but such a system has not yet been implemented. New technologies, pilot networks, targeted deployments of instruments, and state-of-the art coupled numerical models have enabled advances in research and forecast capabilities and illustrate a potential framework for future development. Here, applications and key results made possible by the different ocean observing efforts in support of studies and forecasts of TCs and ECs, as well as recent advances in observing technologies and strategies are reviewed. Then a vision and specific recommendations for the next decade are discussed.This study was supported by the National Oceanic and Atmospheric Administration and JSPS KAKENHI (Grant Numbers: JP17K19093, JP16K12591, and JP16H01846)

Development of a Kemp\u27s Ridley Sea Turtle Stock Assessment Model

We developed a Kemp’s ridley (Lepidochelys kempii) stock assessment model to evaluate the relative contributions of conservation efforts and other factors toward this critically endangered species’ recovery. The Kemp’s ridley demographic model developed by the Turtle Expert Working Group (TEWG) in 1998 and 2000 and updated for the binational recovery plan in 2011 was modified for use as our base model. The TEWG model uses indices of the annual reproductive population (number of nests) and hatchling recruitment to predict future annual numbers of nests on the basis of a series of assumptions regarding age and maturity, remigration interval, sex ratios, nests per female, juvenile mortality, and a putative ‘‘turtle excluder device effect’’ multiplier starting in 1990. This multiplier was necessary to fit the number of nests observed in 1990 and later. We added the effects of shrimping effort directly, modified by habitat weightings, as a proxy for all sources of anthropogenic mortality. Additional data included in our model were incremental growth of Kemp’s ridleys marked and recaptured in the Gulf of Mexico, and the length frequency of stranded Kemp’s ridleys. We also added a 2010 mortality factor that was necessary to fit the number of nests for 2010 and later (2011 and 2012). Last, we used an empirical basis for estimating natural mortality, on the basis of a Lorenzen mortality curve and growth estimates. Although our model generated reasonable estimates of annual total turtle deaths attributable to shrimp trawling, as well as additional deaths due to undetermined anthropogenic causes in 2010, we were unable to provide a clear explanation for the observed increase in the number of stranded Kemp’s ridleys in recent years, and subsequent disruption of the species’ exponential growth since the 2009 nesting season. Our consensus is that expanded data collection at the nesting beaches is needed and of high priority, and that 2015 be targeted for the next stock assessment to evaluate the 2010 event using more recent nesting and in-water data

Think globally, measure locally: The MIREN standardized protocol for monitoring plant species distributions along elevation gradients

Climate change and other global change drivers threaten plant diversity in mountains worldwide. A widely documented response to such environmental modifications is for plant species to change their elevational ranges. Range shifts are often idiosyncratic and difficult to generalize, partly due to variation in sampling methods. There is thus a need for a standardized monitoring strategy that can be applied across mountain regions to assess distribution changes and community turnover of native and non-native plant species over space and time. Here, we present a conceptually intuitive and standardized protocol developed by the Mountain Invasion Research Network (MIREN) to systematically quantify global patterns of native and non-native species distributions along elevation gradients and shifts arising from interactive effects of climate change and human disturbance. Usually repeated every five years, surveys consist of 20 sample sites located at equal elevation increments along three replicate roads per sampling region. At each site, three plots extend from the side of a mountain road into surrounding natural vegetation. The protocol has been successfully used in 18 regions worldwide from 2007 to present. Analyses of one point in time already generated some salient results, and revealed region-specific elevational patterns of native plant species richness, but a globally consistent elevational decline in non-native species richness. Non-native plants were also more abundant directly adjacent to road edges, suggesting that disturbed roadsides serve as a vector for invasions into mountains. From the upcoming analyses of time series, even more exciting results can be expected, especially about range shifts. Implementing the protocol in more mountain regions globally would help to generate a more complete picture of how global change alters species distributions. This would inform conservation policy in mountain ecosystems, where some conservation policies remain poorly implemented