Left atrial voltage, circulating biomarkers of fibrosis, and atrial fibrillation ablation. A prospective cohort study.

Aims To test the ability of four circulating biomarkers of fibrosis, and of low left atrial voltage, to predict recurrence of atrial fibrillation after catheter ablation. Background Circulating biomarkers potentially may be used to improve patient selection for atrial fibrillation ablation. Low voltage areas in the left atrium predict arrhythmia recurrence when mapped in sinus rhythm. This study tested type III procollagen N terminal peptide (PIIINP), galectin-3 (gal-3), fibroblast growth factor 23 (FGF-23), and type I collagen C terminal telopeptide (ICTP), and whether low voltage areas in the left atrium predicted atrial fibrillation recurrence, irrespective of the rhythm during mapping. Methods 92 atrial fibrillation ablation patients were studied. Biomarker levels in peripheral and intra-cardiac blood were measured with enzyme-linked immunosorbent assay. Low voltage (<0.5mV) was expressed as a proportion of the mapped left atrial surface area. Follow-up was one year. The primary endpoint was recurrence of arrhythmia. The secondary endpoint was a composite of recurrence despite two procedures, or after one procedure if no second procedure was undertaken. Results The biomarkers were not predictive of either endpoint. After multivariate Cox regression analysis, high proportion of low voltage area in the left atrium was found to predict the primary endpoint in sinus rhythm mapping (hazard ratio 4.323, 95% confidence interval 1.337–13.982, p = 0.014) and atrial fibrillation mapping (hazard ratio 5.195, 95% confidence interval 1.032–26.141, p = 0.046). This effect was also apparent for the secondary endpoint. Conclusion The studied biomarkers do not predict arrhythmia recurrence after catheter ablation. Left atrial voltage is an independent predictor of recurrence, whether the left atrium is mapped in atrial fibrillation or sinus rhythm

Experimental Observations of Active Invariance Striations in a Tank Environment

The waveguide invariant in shallow water environments has been widely studied in the context of passive sonar. The invariant provides a relationship between the frequency content of a moving broadband source and the distance to the receiver, and this relationship is not strongly affected by small perturbations in environment parameters such as sound speed or bottom features. Recent experiments in shallow water suggest that a similar range-frequency structure manifested as striations in the spectrogram exists for active sonar, and this property has the potential to enhance the performance of target tracking algorithms. Nevertheless, field experiments with active sonar have not been conclusive on how the invariant is affected by the scattering kernel of the target and the sonar configuration monostatic vs bistatic . The experimental work presented in this paper addresses those issues by showing the active invariance for known scatterers under controlled conditions of bathymetry, sound speed profile and high SNR. Quantification of the results is achieved by introducing an automatic image processing approach inspired on the Hough transform for extraction of the invariant from spectrograms. Normal mode simulations are shown to be in agreement with the experimental results