Felsic crust development in the Kaapvaal Craton, South Africa: A reference sample collection to investigate a billion years of geological history

The crust of the Kaapvaal craton accreted throughout the Archaean over nearly 1 billion years. It provides a unique example of the various geological processes that shape Earth's continental crust, and is illustrated by a reference collection of granitoids and mafic rocks (SWASA collection). This sample collection is fully characterised in term of age, major and trace elements, and documents the following multistage history of the craton. In the Barberton area, the initial stages of accretion (stage B·I, > 3.33 Ga and B.II, 3.28—3.21 Ga) correspond to the formation of a sodic (TTG) crust extracted from a near-chondritic reservoir. Stage B.III (ca. 3.1 Ga) corresponds to reworking of this crust, either through intracrustal melting, or via recycling of some material into the mantle and melting of this enriched mantle. Stage B.IV (2.85—2.7 Ga) corresponds to the emplacement of small, discrete plutons involving limited intracrustal reworking. The Northern Kaapvaal craton corresponds to a mobile belt flanking the Barberton cratonic core to the North. Stage NK·I (> 3.1 Ga) resembles stages B·I and B.II: formation of a TTG crust from a chondritic reservoir. In contrast, stage NK.II. (2.97–2.88 Ga) witnesses probable rifting of a cratonic fragment and formation of greenstone basins as well as a new generation of TTGs with both the mafic and felsic magmatism extracted from an isotopically depleted mantle (super-chondritic) reservoir. Intra-crustal reworking dominates stage NK.III (2.88–2.71 Ga), whereas sanukitoids and related granites, involving a mantle contaminated by recycled crustal material, are common during stage NK.IV (ca. 2.67 Ga)

The Ca isotope composition of mare basalts as a probe into the heterogeneous lunar mantle

The Ca isotope compositions of mare basalts offer a novel insight into the heterogeneous nature of the lunar mantle. We present new high-precision Ca isotope data for a suite of low-Ti and high-Ti mare basalts obtained using our collision cell MC-ICP-MS/MS instrument, Proteus. Mare basalts were found to have a Ca isotope composition resembling terrestrial basalts (δ44/40CaSRM915a=0.78–0.89‰) even though they are derived from a differentiated, refractory cumulate mantle source. Modelling of Ca isotope fractionation during crystallisation of a lunar magma ocean (LMO) indicates that the dominantly harzburgitic cumulates of the lunar interior should be isotopically heavier than Earth’s mantle (δ44/40CaSRM915a=1.1–1.2‰versus 0.93‰, respectively). These are balanced by an isotopically light lunar anorthosite crust, consistent with data for lunar anorthosite and feldspathic breccia meteorites. We investigate the major element and Ca isotope composition of partial melts of various cumulate reservoirs by combining pMELTS models with equilibrium isotope fractionation mass balance calculations. The principal finding is that harzburgite cumulates alone are too refractory a source to produce low-Ti magmas. Partial melts of harzburgite cumulates have too low CaO contents, too high Al2O3/CaO and too high δ44/40CaSRM915ato resemble low-Ti magmas. From Ca isotope constraints, we find that the addition of 10–15% of late-stage, clinopyroxenite cumulates crystallising at 95% LMO solidification is required to produce a suitable source that can generate low-Ti basalt compositions. Despite the addition of such late-stage cumulates pMELTS finds that these hybrid sources are undersaturated in clinopyroxene and are thus consistent with experimental constraints that the mantle sources of the lunar magmas are clinopyroxene-free. High-Ti basalts have slightly lower δ44/40CaSRM915a(0.80–0.86‰) than low-Ti magmas (0.85–0.89‰) and clearly elevated TiO2/CaO. No suitable hybrid source involving ilmenite-bearing cumulates (IBC) was found that could reproduce melts with appropriate δ44/40Ca and major element systematics. Instead, we suggest that metasomatism of low-Ti mantle sources by IBC melts is the most plausible way to generate high-Ti magma sources and the rich diversity in TiO2contents of lunar basalts and pyroclastic glasses

Ultralow temperature cryoablation using near-critical nitrogen for cavotricuspid isthmus-ablation, first-in-human results

Introduction: Cryoablation has evolved as a safe alternative to radiofrequency ablation in the treatment of several supraventricular arrhythmias and has potential advantages, yet is limited by the properties of the cryogen used. We investigated a novel ultralow temperature cryoablation (ULTC) system using nitrogen near its liquid-vapor critical point as a freezing source, achieving temperatures as low as -196 degrees Celsius in a long linear catheter with a continuous energy release. Initial safety, procedural and efficacy outcomes of ULTC are described in patients undergoing cavotricuspid isthmus (CTI) ablation. Methods and Results: The Cryocure studies (NCT02355106, NCT02839304) are prospective, single-arm, multi-center, first-in-human clinical studies in 17 patients with atrial flutter (AFL) and 13 patients with atrial fibrillation (AF). A total of 30 patients, mean age 65 ± 8 years old and 67% male, were enrolled and underwent ablation of the CTI. Acute success, defined as the confirmation of stable bidirectional conduction block across the CTI, was achieved in all 30 patients. After 12 months of follow-up, 14 out of 17 AFL patients remained free from any AFL. One (3.3%) procedure-related but not device-related serious adverse event was reported, involving transient inferolateral ST-elevation associated with temporary AV conduction block. Conclusion: In this first-in-human clinical study the safety and performance results demonstrate the capabilities of ultralow temperature near-critical nitrogen as an effective energy source for CTI ablation. Ongoing, larger, studies should confirm our findings and evaluate the capabilities to create linear and focal transmural lesions in other arrhythmias

2-year outcomes of phased radiofrequency ablation for atrial fibrillation with the second-generation PVAC Gold ablation catheter

Purpose: The second-generation multi-electrode catheter, PVAC Gold, was designed to improve the safe delivery of phased radiofrequency energy using a “single shot” approach for pulmonary vein isolation (PVI), while retaining efficacy. This large registry presents long-term performance in a daily practice setting. Methods: A total of 1011 patients undergoing first time ablation for atrial fibrillation (AF) using PVAC Gold were included, 639 patients with PVI for paroxysmal AF (PAF PVI) and 372 patients with persistent or long-standing persistent AF, divided into 175 patients receiving PVI only (PersAF PVI) and 197 patients receiving PVI with additional substrate ablation (PersAF PVI +). Results: At 24-month follow-up, single procedure freedom from atrial tachyarrhythmia (ATA) was 58% (368/639) in the PAF PVI group, 44% (77/175) in the PersAF PVI group, and 29% (57/197) in the PersAF PVI + group. Allowing one repeat procedure in 33% of patients, 76%, 65%, and 54% were free from ATA at 24 months, respectively. Pulmonary vein reconnection was observed in 98% of patients with recurrent arrhythmia after PVI. Conclusions: Although phased RF ablation with PVAC Gold is quick and safe, the efficacy outcomes are modest compared to current mainstream ablation strategies

Left atrial catheter ablation in patients with previously implanted left atrial appendage closure devices

Aims Left atrial appendage closure (LAAC) is increasingly used as an alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) patients. Feasibility and safety of left atrial (LA) catheter ablation (CA) in patients with previously implanted LAAC devices have not been well studied. We report on the feasibility, safety, and efficacy of LA CA in the presence of a previously implanted LAAC device. Methods and results In this prospective cohort study consecutive patients that underwent LA CA with a previously implanted Watchman device were included. Periprocedural characteristics and long-term clinical follow-up were evaluated. Twenty-three LA CA procedures were performed in 19/162 AF patients with previously implanted Watchman devices [47% male, age 63.9 ± 6.2 years, CHA 2 DS 2 -VASc 4.0 (3.0-5.0); HASBLED 3.0 (2.0-4.0); 63% paroxysmal]. Left atrial CA was performed with irrigated radiofrequency (RF; n = 20, 87%) or phased RF (n = 3, 13%) in a mean of 18 months after LAAC implantation (range 4-80 months). Targets of CA consisted of pulmonary vein isolation (n = 19, 83%), superior vena cava isolation (n = 13, 57%), and additional linear lesions (n = 8, 35%). Procedures were carried out under vitamin K antagonist (VKA; n = 6, 26%), non-VKA OAC (NOAC; n = 8, 35%), or single antiplatelet therapy alone (n = 9, 39%). Left atrial CA was successful without any signs of interference from the device. Procedure-related complications were not observed. During a mean follow-up of 28 months, 11 patients (58%) had AF recurrence. Conclusion Left atrial CA after LAAC appears to be feasible, effective, and safe in this single centre cohort. Previously implanted Watchman device should not be a reason to relinquish CA in symptomatic AF patients, even in patients on single antiplatelet therapy alone

Efficacy and safety of the GOLD FORCE multicentre randomized clinical trial: Multielectrode phased radiofrequency vs. irrigated radiofrequency single-tip catheter with contact force ablation for treatment of symptomatic paroxysmal atrial fibrillation

Aims: Pulmonary vein isolation (PVI) for atrial fibrillation (AF) has become increasingly safe and effective with the evolution of single-tip ablation catheters aided by contact force sensing (ST-CF) and single-shot devices such as the second-generation pulmonary vein ablation catheter (PVAC) Gold multi-electrode array. The multicentre randomized GOLD FORCE trial was conducted to evaluate non-inferiority of safety and efficacy of PVAC Gold PVI compared to ST-CF ablation for paroxysmal AF. Methods and results: The primary efficacy endpoint documented AF recurrence ≥30 s was assessed by time-to-first-event analysis after a 90-day blanking period using repeated 7-day Holters. Secondary endpoints include acute success and procedural characteristics. Safety endpoints included procedural complications, stroke/transient ischaemic attack (TIA), tamponade, bleeding, and access site complications. Two hundred and eight patients underwent randomization and PVI (103 assigned to PVAC Gold, 105 to ST-CF). Acute success rates were 95% and 97% for PVAC Gold and ST-CF, respectively. At 12 months, AF recurrence was observed in 46.6% of the PVAC Gold group and in 26.2% of the ST-CF group [absolute efficacy difference 20.4% (95% confidence interval, CI 7.5-33.2%), hazard ratio 2.05 (95% CI 1.28-3.29), P = 0.003]. PVAC Gold had significantly shorter procedure and ablation times. Complication rates were 5.7% and 4.9% for PVAC Gold and ST-CF, respectively (P = 0.782). Conclusion: In this multicentre randomized clinical trial, ablation with ST-CF and PVAC Gold ablation catheters non-inferiority for efficacy was not met. AF recurrence was significantly more frequent in the PVAC Gold group compared to single-tip contact force group. Both groups had similarly low rates of adverse events. PVAC Gold ablation had significantly shorter procedure and ablation times

A Prospective Multicenter Comparison Study of Risk-adapted Ultrasound-directed and Magnetic Resonance Imaging–directed Diagnostic Pathways for Suspected Prostate Cancer in Biopsy-naïve Men

Background: European Association of Urology guidelines recommend a risk-adjusted biopsy strategy for early detection of prostate cancer in biopsy-naïve men. It remains unclear which strategy is most effective. Therefore, we evaluated two risk assessment pathways commonly used in clinical practice. Objective: To compare the diagnostic performance of a risk-based ultrasound (US)-directed pathway (Rotterdam Prostate Cancer Risk Calculator [RPCRC] #3; US volume assessment) and a magnetic resonance imaging (MRI)-directed pathway. Design, setting, and participants: This was a prospective multicenter study (MR-PROPER) with 1:1 allocation among 21 centers (US arm in 11 centers, MRI arm in ten). Biopsy-naïve men with suspicion of prostate cancer (age ≥50 yr, prostate-specific antigen 3.0–50 ng/ml, ± abnormal digital rectal examination) were included. Intervention: Biopsy-naïve men with elevated risk of prostate cancer, determined using RPCRC#3 in the US arm and Prostate Imaging Reporting and Data System scores of 3–5 in the MRI arm, underwent systematic biopsies (US arm) or targeted biopsies (MRI arm). Outcome measurements and statistical analysis: The primary outcome was the proportion of men with grade group (GG) ≥2 cancer. Secondary outcomes were the proportions of biopsies avoided and GG 1 cancers detected. Categorical (nonparametric) data were assessed using the Mann-Whitney U test and χ2 tests. Results and limitations: A total of 1965 men were included in the intention-to-treat population (US arm n = 950, MRI arm n = 1015). The US and MRI pathways detected GG ≥2 cancers equally well (235/950, 25% vs 239/1015, 24%; difference 1.2%, 95% confidence interval [CI] −2.6% to 5.0%; p = 0.5). The US pathway detected more GG 1 cancers than the MRI pathway (121/950, 13% vs 84/1015, 8.3%; difference 4.5%, 95% CI 1.8–7.2%; p < 0.01). The US pathway avoided fewer biopsies than the MRI pathway (403/950, 42% vs 559/1015, 55%; difference −13%, 95% CI −17% to −8.3%; p < 0.01). Among men with elevated risk, more GG ≥2 cancers were detected in the MRI group than in the US group (52% vs 43%; difference 9.2%, 95% CI 3.0–15%; p < 0.01). Conclusions: Risk-adapted US-directed and MRI-directed pathways detected GG ≥2 cancers equally well. The risk-adapted US-directed pathway performs well for prostate cancer diagnosis if prostate MRI capacity and expertise are not available. If prostate MRI availability is sufficient, risk assessment should preferably be performed using MRI, as this avoids more biopsies and detects fewer cases of GG 1 cancer. Patient summary: Among men with suspected prostate cancer, relevant cancers were equally well detected by risk-based pathways using either ultrasound or magnetic resonance imaging (MRI) to guide biopsy of the prostate. If prostate MRI availability is sufficient, risk assessment should be performed with MRI to reduce unnecessary biopsies and detect fewer irrelevant cancers