Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Fluxless flip-chip bonding using a lead-free solder bumping technique

With the LHC exceeding the nominal instantaneous luminosity, the current barrel pixel detector (BPIX) of the CMS experiment at CERN will reach its performance limits and undergo significant radiation damage. In order to improve detector performance in high luminosity conditions, the entire BPIX is replaced with an upgraded version containing an additional detection layer. Half of the modules comprising this additional layer are produced at DESY using fluxless and lead-free bumping and bonding techniques. Sequential solder-jetting technique is utilized to wet 40-μm SAC305 solder spheres on the silicon-sensor pads with electroless Ni, Pd and immersion Au (ENEPIG) under-bump metallization (UBM). The bumped sensors are flip-chip assembled with readout chips (ROCs) and then reflowed using a flux-less bonding facility. The challenges for jetting low solder volume have been analyzed and will be presented in this paper. An average speed of 3.4 balls per second is obtained to jet about 67 thousand solder balls on a single chip. On average, 7 modules have been produced per week. The bump-bond quality is evaluated in terms of electrical and mechanical properties. The peak-bump resistance is about 17.5 mΩ. The cross-section study revealed different types of intermetallic compounds (IMC) as a result of interfacial reactions between UBM and solder material. The effect of crystalline phases on the mechanical properties of the joint is discussed. The mean shear strength per bump after the final module reflow is about 16 cN. The results and sources of yield loss of module production are reported. The achieved yield is 95%