O processo decisório em Charles Edward Lindblom e a vontade geral em Jean-Jacques Rousseau: reflexões acerca da participação política e da necessidade de educação para essa participação

In The Policy-Making Process, Charles Edward Lindblom reflects upon such process, highlighting the relevance of the political participation of the general citizens. Nevertheless, the author warns the reader about the necessity of the existence of a kind of education that commits to the formation of men and women for social participation since, only because of this kind of education, such participation will be carried out. Likewise, in The Social Contract, Jean-Jacques Rousseau presents considerations about the importance of a people’s participation in the elaboration process of such contract, which shall happen through “general will”. Nonetheless, such participation entails a kind of education towards the formation of men as individuals and citizens in order for them to participate actively in society, as he exposes in his pedagogical treatise – Emile or On Education. This paper aims to foreground that, in both reflections, the authors discuss about the relevance of the political participation of the citizens, which, according to their point of view, shall fully happen only through the existence of a kind of education that values formation for participation.En el libro El Proceso de Decisión de Política, Charles Edward Lindblom teje reflexiones sobre este proceso, haciendo hincapié en la importancia de la participación política de los ciudadanos en general. Sin embargo, el autor advierte la necesidad de la existencia de una educación que se ha comprometido a la formación de hombres y mujeres para la participación social, porque sólo de la enseñanza recibida dicha participación puede ser eficaz. Del mismo modo, en la obra El contrato social, Jean-Jacques Rousseau presenta consideraciones acerca de la importancia de la participación popular en la elaboración del proceso de contratación, que se llevará a cabo a través de la "voluntad general". Pero esta participación implica la creación de una educación para la formación del hombre como individuo y ciudadano para que participe activamente en la sociedad, tal como se expone en su tratado pedagógico - Emilio o la educación. El propósito de este trabajo es mostrar que en estas dos reflexiones autores discuten esta importancia de la participación política de los ciudadanos, que, en su opinión, sólo se logrará por la existencia de una educación que valore la formación para la participación.Na obra O Processo de Decisão Política, Charles Edward Lindblom tece reflexões acerca desse processo, destacando a relevância da participação política dos cidadãos em geral. Entretanto, esse autor alerta a necessidade da existência de uma educação que tenha como compromisso a formação de homens e mulheres para a participação social, pois somente a partir dessa educação tal participação poderá se efetivar. Do mesmo modo, na obra O Contrato Social, Jean-Jacques Rousseau apresenta considerações acerca da importância da participação do povo no processo de elaboração desse contrato, a qual ocorrerá por intermédio da “vontade geral”. Mas essa participação implica a criação de uma educação voltada para a formação do homem como indivíduo e cidadão, para que este participe de forma ativa da sociedade, tal como expõe em seu tratado pedagógico – Emílio ou Da Educação. O intuito desse trabalho é evidenciar que em ambas as reflexões esses autores discutem sobre essa relevância da participação política dos cidadãos, a qual, segundo sua visão, será concretizada apenas pela existência de uma educação que valorize a formação para a participação

Time-to-effect guided pulmonary vein isolation utilizing the third-generation versus second generation cryoballoon: One year clinical success

Background: The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging and reproducible clinical outcome data. The latest- -generation cryoballoon (CB3) incorporates a 40% shorter distal tip, thus allowing for an increased rate of PVI real-time signal recording and facilitating individualized ablation strategies taking the time-to- -effect (TTE) into account. However, whether this characteristic translates into favorable clinical success has not been evaluated yet. Herein was investigated 1-year clinical success after CB3 in comparison to CB2 based-PVI. Methods: One hundred and ten consecutive patients with paroxysmal or short-standing persistent atrial fibrillation (AF) underwent CB2 (n = 55 patients) -or CB3 (n = 55 patients) -based PVI. The freeze-cycle duration was set to TTE + 120 s if TTE could be recorded, otherwise a fixed freeze-cycle duration of 180 s was applied. Results: A total of 217/218 (99%, CB3) and 217/217 (100%, CB2) pulmonary veins (PV) were successfully isolated. The real-time PVI visualization rate was 69.2% (CB3) and 54.8% (CB2; p = 0.0392). The mean freeze-cycle duration was 194 ± 77 s (CB3) and 206 ± 85 s (CB2; p = 0.132), respectively. During a median follow-up of 409 days (interquartile range [IQR] 378–421, CB3) and 432 days (IQR 394–455, CB2) 73.6% (CB3) and 73.1% of patients (CB2) remained in stable sinus rhythm after a single procedure (p = 0.806). Conclusions: A higher rate of real-time electrical PV recordings was seen using the CB3 as compared to CB2. There was no difference in 1-year clinical follow-up

Clinical outcomes of cryoballoon ablation for pulmonary vein isolation: Impact of intraprocedural heart rhythm

Background: The current study sought to assess the impact of the intraprocedural heart rhythm (sinus rhythm [SR] vs. atrial fibrillation [AF]) on acute procedural characteristics, durability of pulmonary vein isolation (PVI) and long-term clinical outcomes of cryoballoon (CB) ablation. Methods: A total of 195 patients with symptomatic paroxysmal (n = 136) or persistent AF (n = 59) underwent CB-based PVI. Ablation procedures were either performed in SR (SR group; n = 147) or during AF (AF group; n = 48). Persistent AF was more frequent in the AF group than in the SR group (62% vs. 20%). All other patient baseline characteristics did not differ between the two groups. Results: The nadir temperature during the CB applications was significantly lower in the AF group than in patients in the SR group (–49 [interquartile range, –44; –54]°C vs. –47 [-42; –52]°C, p = 0.002). Median procedure and fluoroscopy times as well as the rate of real-time recordings were not different between the two groups. Repeat ablation for the treatment of atrial arrhythmia recurrence was performed in 60 patients (SR: 44 [30%] patients; AF: 16 [33%] patients), with a trend towards a lower rate of PV reconnections in the AF group (p = 0.07). There was no difference in 3-year arrhythmia-free survival (p = 0.8). Conclusions: Cryoballoon-based PVI during AF results in lower nadir balloon temperatures and a trend towards a higher durability of PVI as compared to procedures performed in SR. The rate of real-time PVI recordings was not affected by the intraprocedural heart rhythm

Noninvasive epicardial and endocardial mapping of premature ventricular contractions

AIMS: The aim of the present study was to estimate the accuracy of a novel non-invasive epicardial and endocardial electrophysiology system (NEEES) for mapping ectopic ventricular depolarizations. METHODS AND RESULTS: The study enrolled 20 patients with monomorphic premature ventricular contractions (PVCs) or ventricular tachycardia (VT). All patients underwent pre-procedural computed tomography or magnetic resonance imaging of the heart and torso. Radiographic data were semi-automatically processed by the NEEES to reconstruct a realistic 3D model of the heart and torso. In the electrophysiology laboratory, body-surface electrodes were connected to the NEEES followed by unipolar EKG recordings during episodes of PVC/VT. The body-surface EKG data were processed by the NEEES using its inverse-problem solution software in combination with anatomical data from the heart and torso. The earliest site of activation as denoted on the NEEES 3D heart model was compared with the PVC/VT origin using a 3D electroanatomical mapping system. The site of successful catheter ablation served as final confirmation. A total of 21 PVC/VT morphologies were analysed and ablated. The chamber of interest was correctly diagnosed non-invasively in 20 of 21 (95%) PVC/VT cases. In 18 of the 21 (86%) cases, the correct ventricular segment was diagnosed. Catheter ablation resulted in acute success in 19 of the 20 (95%) patients, whereas 1 patient underwent successful surgical ablation. During 6 months of follow-up, 19 of the 20 (95%) patients were free from recurrence off antiarrhythmic drugs. CONCLUSION: The NEEES accurately identified the site of PVC/VT origin. Knowledge of the potential site of the PVC/VT origin may aid the physician in planning a successful ablation strategy

Pace Mapping for the Identification of Focal Atrial Tachycardia Origin: A Novel Technique to Map and Ablate Difficult-to-Induce and Nonsustained Focal Atrial Tachycardia

Background - Focal atrial tachycardia (FAT) is extremely difficult to map and ablate when it is difficult to induce and nonsustained. The objective of this study is to evaluate the efficacy of pace mapping in identifying the FAT origin. Methods and Results - The study included 7 patients with drug-refractory FAT who experienced daily multiple episodes before ablation and presented with difficult-to-induce and nonsustained FAT and a distinct P wave morphology. Pace mapping was systematically performed in the areas of interest using 3-dimensional mapping to match the P wave morphology and paced intracardiac activation sequence recorded from multiple catheters. The anatomic origins of FAT were the right pulmonary vein (PV) in 3 patients, mitral annulus, crista terminalis, tricuspid annulus, and right-sided PV via a posterior conduction of previous PV isolation. In all patients, pace mapping obtained best-matched P wave morphology in â\u89¥11/12 leads of surface ECG at the successful ablation site, and paced intracardiac activation sequence was identical to that of induced FAT. Focal ablation was delivered in 4 patients, including non-PV FAT in 3 and FAT in 1, via posterior gap along the previous right-sided PV isolation, and circumferential right-sided PV isolation was performed in the other 3 patients. No FAT was induced at the end of the procedure. All patients were free of arrhythmias without antiarrhythmic drugs during the 8.4±5.6-month follow-up. Conclusions - The combination of paced P wave morphology and intracardiac activation sequence can be used for the identification of FAT origin in patients with difficult-to-induce and nonsustained FAT

EL PROCESO DE TOMA DE DECISIONES EN CHARLES EDWARD LINDBLOM Y LA VOLUNTAD GENERAL EN JEAN-JACQUES ROUSSEAU: REFLEXIONES SOBRE LA PARTICIPACIÓN POLÍTICA Y LA NECESIDAD DE EDUCACIÓN PARA ESA PARTICIPACIÓN

Na obra O Processo de Decisão Política, Charles Edward Lindblom tece reflexões acerca desse processo, destacando a relevância da participação política dos cidadãos em geral. Entretanto, esse autor alerta a necessidade da existência de uma educação que tenha como compromisso a formação de homens e mulheres para a participação social, pois somente a partir dessa educação tal participação poderá se efetivar. Do mesmo modo, na obra O Contrato Social, Jean-Jacques Rousseau apresenta considerações acerca da importância da participação do povo no processo de elaboração desse contrato, a qual ocorrerá por intermédio da “vontade geral”. Mas essa participação implica a criação de uma educação voltada para a formação do homem como indivíduo e cidadão, para que este participe de forma ativa da sociedade, tal como expõe em seu tratado pedagógico – Emílio ou Da Educação. O intuito desse trabalho é evidenciar que em ambas as reflexões esses autores discutem sobre essa relevância da participação política dos cidadãos, a qual, segundo sua visão, será concretizada apenas pela existência de uma educação que valorize a formação para a participação.In The Policy-Making Process, Charles Edward Lindblom reflects upon such process, highlighting the relevance of the political participation of the general citizens. Nevertheless, the author warns the reader about the necessity of the existence of a kind of education that commits to the formation of men and women for social participation since, only because of this kind of education, such participation will be carried out. Likewise, in The Social Contract, Jean-Jacques Rousseau presents considerations about the importance of a people’s participation in the elaboration process of such contract, which shall happen through “general will”. Nonetheless, such participation entails a kind of education towards the formation of men as individuals and citizens in order for them to participate actively in society, as he exposes in his pedagogical treatise – Emile or On Education. This paper aims to foreground that, in both reflections, the authors discuss about the relevance of the political participation of the citizens, which, according to their point of view, shall fully happen only through the existence of a kind of education that values formation for participation.En el libro El Proceso de Decisión de Política, Charles Edward Lindblom teje reflexiones sobre este proceso, haciendo hincapié en la importancia de la participación política de los ciudadanos en general. Sin embargo, el autor advierte la necesidad de la existencia de una educación que se ha comprometido a la formación de hombres y mujeres para la participación social, porque sólo de la enseñanza recibida dicha participación puede ser eficaz. Del mismo modo, en la obra El contrato social, Jean-Jacques Rousseau presenta consideraciones acerca de la importancia de la participación popular en la elaboración del proceso de contratación, que se llevará a cabo a través de la "voluntad general". Pero esta participación implica la creación de una educación para la formación del hombre como individuo y ciudadano para que participe activamente en la sociedad, tal como se expone en su tratado pedagógico - Emilio o la educación. El propósito de este trabajo es mostrar que en estas dos reflexiones autores discuten esta importancia de la participación política de los ciudadanos, que, en su opinión, sólo se logrará por la existencia de una educación que valore la formación para la participación

Epicardial access for VT ablation: analysis of two different puncture techniques, incidence of adhesions and complication management

Introduction!#!Pericardial access for ablation of ventricular arrhythmias (VA) can be gained either by an anterior-oriented or inferior-oriented epicardial puncture under fluoroscopical guidance. We retrospectively sought to assess the safety of these two puncture techniques and the incidence of epicardial adhesions and introduce our algorithm for management of pericardial tamponade.!##!Methods and results!#!In 211 patients (61.4 ± 15.6 years, 179 males; 84.8%) 271 epicardial ablation procedures of VA were performed using either an anterior- or inferior-oriented approach for epicardial access. Puncture-related complications were systematically analyzed. Furthermore, the incidence of adhesions was evaluated during first and repeated procedures. A total of 34/271 (12.5%) major complications occurred and 23/271 (8.5%) were directly related to epicardial puncture. The incidence of puncture-related major complications in the anterior and inferior group was 4/82 (4.9%) and 19/189 (10.1%), respectively. Pericardial tamponade was the most common major complication (15/271; 5.5%). Collateral damages of adjacent structures such as liver, colon, gastric vessels and coronary arteries occurred in 6/189 (3.2%) patients and only within the inferior epicardial access group. Adhesions were documented in 19/211 (9%) patients during the first procedure and in 47.1% if patients had 2 or more procedures involving epicardial access.!##!Conclusion!#!Anterior-oriented epicardial puncture shows an observed association to a reduced incidence of pericardial tamponades and overall puncture-related complications in epicardial ablation of VA. In cases of repeated epicardial access adhesions increase significantly and may lead to ablation failure