First-line treatment of persistent and long-standing persistent atrial fibrillation with single-stage hybrid ablation:a 2-year follow-up study

AIMS: This study evaluates the efficacy and safety of first-line single-stage hybrid ablation of (long-standing) persistent atrial fibrillation (AF), over a follow-up period of 2 years, and provides additional information on arrhythmia recurrences and electrophysiological findings at repeat ablation. METHODS AND RESULTS: This is a prospective cohort study that included 49 patients (65% persistent AF; 35% long-standing persistent AF) who underwent hybrid ablation as first-line ablation treatment (no previous endocardial ablation). Patients were relatively young (57.0 ± 8.5 years) and predominantly male (89.8%). Median CHA2DS2-VASc score was 1.0 (0.5; 2.0) and mean left atrium volume index was 43.7 ± 10.9 mL/m2. Efficacy was assessed by 12-lead electrocardiography and 72-h Holter monitoring after 3, 6, 12, and 24 months. Recurrence was defined as AF/atrial flutter (AFL)/tachycardia (AT) recorded by electrocardiography or Holter monitoring lasting >30 s during 2-year follow-up. At 2-year follow-up, single and multiple procedure success rates were 67% and 82%, respectively. Two (4%) patients experienced a major complication (bleeding) requiring intervention following hybrid ablation. Among the 16 (33%) patients who experienced an AF/AFL/AT recurrence, 13 (81%) were ATs/AFLs and only 3 (19%) were AF. Repeat ablation was performed in 10 (20%) patients and resulted in sinus rhythm in 7 (70%) at 2-year follow-up. CONCLUSION: First-line single-stage hybrid AF ablation is an effective treatment strategy for patients with persistent and long-standing persistent AF with an acceptable rate of major complications. Recurrences are predominantly AFL/AT that can be successfully ablated percutaneously. Hybrid ablation seems a feasible approach for first-line ablation of (long-standing) persistent AF

Variations in the amount of water ice on Ceres' surface suggest a seasonal water cycle.

The dwarf planet Ceres is known to host a considerable amount of water in its interior, and areas of water ice were detected by the Dawn spacecraft on its surface. Moreover, sporadic water and hydroxyl emissions have been observed from space telescopes. We report the detection of water ice in a mid-latitude crater and its unexpected variation with time. The Dawn spectrometer data show a change of water ice signatures over a period of 6 months, which is well modeled as ~2-km2 increase of water ice. The observed increase, coupled with Ceres' orbital parameters, points to an ongoing process that seems correlated with solar flux. The reported variation on Ceres' surface indicates that this body is chemically and physically active at the present time

Assessment of sex-related differences and outcome in patients who underwent cryoballoon pulmonary vein isolation for atrial fibrillation:an observational cohort study

OBJECTIVES: Pulmonary vein isolation (PVI) is widely accepted as an effective and safe treatment for symptomatic atrial fibrillation (AF). However, data on sex-related differences and associations with clinical outcome and safety of PVI with cryoballoon ablation are limited. We sought to compare sexrelated efficacy and safety of cryoballoon ablation and identify sex-related associations with clinical outcomes. METHODS AND RESULTS: We included 650 consecutive patients with AF undergoing PVI with cryoballoon ablation at our institution between 2013 and 2017. The efficacy outcome was the first documented recurrence (>30 s) of AF, atrial flutter or atrial tachycardia (AF/AT) or repeat ablation during follow-up, after a 90-day blanking period. The safety outcome was the incidence of periprocedural complications. Mean age of the population was 58±10, and 210 (32.3%) patients were women. Women were older, had a higher body mass index, had more renal dysfunction and less coronary artery disease as compared with men. The rate of AF/AT recurrence was similar between women and men at 12-month follow-up (27.6% vs 24.8%, p=0.445). The incidence of periprocedural complications was higher in women (12.9% vs 4.6%; p<0.001), specifically groin haematomas and phrenic nerve palsy. On multivariate analysis, left atrial volume index (adjusted OR 1.05, 95% CI 1.00 to 1.10; p=0.032) was associated with the incidence of procedural complications in women. For men, no relation with complications could be found. CONCLUSION: The efficacy of cryoballoon ablation was similar between women and men; however, women had a higher risk of procedural complications

Identifying patients with atrial fibrillation recurrences after two pulmonary vein isolation procedures

INTRODUCTION: Pulmonary vein isolation (PVI) is an important treatment for atrial fibrillation (AF). However, many patients need more than one procedure to maintain long-term sinus rhythm. Even after two PVIs some may suffer from AF recurrences. We aimed to identify characteristics of patients who fail after two PVI procedures. METHODS AND RESULTS: We included 557 consecutive patients undergoing a first PVI procedure with a second-generation 28 mm cryoballoon. Follow-up procedures were performed using radiofrequency ablation targeting reconnected PVs only. Recurrent AF was defined as any episode of AF lasting >30 s on ECG or 24 hour Holter monitoring performed at 3, 6 and 12 months post procedure. Mean age was 59.1±10.2 years, 383 (68.8%) were male, 448 (80.4%) had paroxysmal AF and the most common underlying condition was hypertension (36.6%). A total of 140/557 (25.1%) patients underwent redo procedure with PVI only. Of these patients 45 (32.4%) had recurrence of AF. These patients were comparable regarding age and sex to those in sinus rhythm after one or two procedures. Multivariate logistic regression showed that non-paroxysmal AF (OR 1.08 (95% CI 1.01 to 1.15), estimated glomerular filtration rate (OR 0.96, 95% CI 0.94 to 0.99), bundle branch block (OR 4.17, 95% CI 1.38 to 12.58), heart failure (OR 4.17, 95% CI 1.38 to 12.58) and Left Atrium Volume Index (OR 1.04, 95% CI 1.01 to 1.08) were associated with AF recurrence after two PVIs. The area under the curve for the identified risk factors was 0.74. CONCLUSIONS: Using a PVI-only approach, recurrence of AF after two AF ablation procedures is associated with more advanced underlying disease and persistent types of AF

Nature, formation, and distribution of carbonates on Ceres

Different carbonates have been detected on Ceres, and their abundance and spatial distribution have been mapped using a visible and infrared mapping spectrometer (VIR), the Dawn imaging spectrometer. Carbonates are abundant and ubiquitous across the surface, but variations in the strength and position of infrared spectral absorptions indicate variations in the composition and amount of these minerals. Mg-Ca carbonates are detected all over the surface, but localized areas show Na carbonates, such as natrite (Na_2CO_3) and hydrated Na carbonates (for example, Na_2CO_3·H_2O). Their geological settings and accessory NH_4-bearing phases suggest the upwelling, excavation, and exposure of salts formed from Na-CO_3-NH_4-Cl brine solutions at multiple locations across the planet. The presence of the hydrated carbonates indicates that their formation/exposure on Ceres’ surface is geologically recent and dehydration to the anhydrous form (Na_2CO_3) is ongoing, implying a still-evolving body

Ceres photometric properties from VIR on Dawn

Dawn spacecraft [1] entered orbit around Ceres on 6 March 2015. During the approach phase to this dwarf planet and later, through the Survey, High Altitude Mapping (HAMO) and Low Altitude Mapping Orbits (LAMO), the Visible and Infrared Mapping Spectrometer (VIR) will perform detailed observations of the surface of the body. VIR [2] is an imaging spectrometer onboard the Dawn mission and it is composed of two spectral channels: the visible (VIS) covering the 0.25 μm - 1.0 μm wavelength range and the infrared (IR) for the 0.95 μm - 5.0 μm interval. During the various phases of the mission, the surface of Ceres will be observed under different observation geometries. The measured signal is then affected by photometric issues that need to be minimized in order to exploit the intrinsic spectral variability of the surface, thus allowing the direct comparison between acquisitions taken under different observation conditions. In order to accomplish this task we perform a photometric reduction of the dataset by means of a simplified Hapke model, following the approach of [3]

DETECTION OF WIDESPREAD HYDRATED MATERIALS ON VESTA BY THE VIR IMAGING SPECTROMETER ON BOARD THE DAWN MISSION

Water plays a key role in the evolution of terrestrial planets, and notably in the occurrence of Earth's oceans. However, the mechanism by which water has been incorporated into these bodies—including Earth—is still extensively debated. Here we report the detection of widespread 2.8 μm OH absorption bands on the surface of the asteroid Vesta by the VIR imaging spectrometer on board Dawn. These observations are surprising as Vesta is fully differentiated with a basaltic surface. The 2.8 μm OH absorption is distributed across Vesta's surface and shows areas enriched and depleted in hydrated materials. The uneven distribution of hydrated mineral phases is unexpected and indicates ancient processes that differ from those believed to be responsible for OH on other airless bodies, like the Moon. The origin of Vestan OH provides new insight into the delivery of hydrous materials in the main belt and may offer new scenarios on the delivery of hydrous minerals in the inner solar system, suggesting processes that may have played a role in the formation of terrestrial planets