Therapeutic end points for the treatment of atrioventricular node reentrant tachycardia by catheter-guided radiofrequency current

AbstractObjectives. The purpose off this prospective study was to test the hypothesis that the elimination of inducible repetitive atrioventricular (AV) node reentry the persistence of slow AV pathway conduction is a valid end point for radiofrequency catheter ablation procedures in patients with supraventricular tachycardia due to AV node reentry.Background. Although modification of AV node physiology by radiofrequency current can eliminate AV node reentrant tachycardia, therapeutic end points that are definitive of a satisfactory result in patients undergoing modification of the slow AV pathway have not been established. Applications of radiofrequency current at selected sites may eliminate all evidence of slow pathway conduction or sufficiently modify the refractory properties of the slow pathway to preclude sustained arrhythmias. Accordingly, total abolition of dual AV node physiology may not be necessary to prevent arrhythmia recurrence.Methods. Radiofrequency catheter ablation of the slow AV pathway was attempted in 59 patients with typical AV node reentry. Tissue ablation was performed with a continuous wave of 500-kHz radiofrequency current. Twenty-five to 35 W was applied for 60 s at the site selected for destruction.Results. Dual AV node physiology was eliminated completely in 35 patients (59%), persisted without inducible AV node reentry in 13 patients (22%) and persisted with inducible single AV reentrant beats in 11 patients (19%). In patients with persistent dual AV node physiology, the maximal difference between the effective refractory period of the fast and slow pathways was reduced from 104 ± 62 ms before the procedure to 37 ± 37 ms after AV conduction had been modified (p < 0.001). During a mean follow-up interval of 15 months (range 4 to 28), only one patient (2%) had a recurrence of the tachycardia.Conclusions. Resulte demonstrate that when complete elimination of dial AV node physiology is difficult, modification of slow pathway conduction to the extent that repetitive AV node reentry cannot be induced is a definitive end point that portends a good prognosis

Long-term effectiveness of surgical treatment of ectopic atrial tachycardia

AbstractObjectives. The purpose of this study was to determine the long-term clinical outcome of patients with ectopic atrial tachycardias treated surgically.Background. Ectopic atriai tachycardia is an uncommon arrhythmia that can be symptomatic and is associated with the development of a cardiomyopathy. Management strategies are not well defined because of the paucity of data on the long-term effectiveness of pharmacologic and nonpharmacologic therapies.Methods. The long-term clinical impact of medical and surgical therapy was determined in 15 consecutive patients with ectopic atrial tachycardia. All 15 patients were initially treated with antiarrhythmic drugs (mean 5.7 ± 2.2 drugs/patient). An effective drug regimen was identified in only 5 (33%) of the 15 patients; the remaining 10 patients were treated surgically. In each, individualized surgical procedures were guided by computer-assisted intraoperative mapping, with atrial plaques comprising up to 156 electrodes. Focal ablation was performed in four patients and artial isolation procedures in six.Results. The 10 patients treated surgically were followed up a mean of 4 ± 3.2 years. Ectopic atrial tachycardia recurred in one patients, A permanent pacemaker was implanted in two patients, one of whom also required reoperation for constrictive pericarditis. There were no operative deatlis. Ectopic atrial tachycardia recurred in three (60%) of the five patients discharged on antiarrhythmic drug therapy during a mean follow-up interval of 6.4 ± 4.3 years. There was one nonarrhythmic death.Conclusions. Map-guided surgery demonstrated long-term efficacy in abolishing symptoms in 9 of the 10 patients with ectopic atrial tachycardia. Results demonstrate surgery is effective for patients with ectopic atrial tachycardias who are not easily treated with antiarrhythmic drugs

Assessing persistent organic pollutant (POP) transfer from female killer whales (Orcinus orca) to calves during gestation and lactation

Persistent organic pollutants (POPs) pose a health risk for southern resident killer whales (SRKWs). Data on maternal contaminant transfer to calves are needed to inform models that estimate future contaminant loads as well as assess risk to newborn killer whale calves exposed to POPs. We conducted a study on trained female killer whales and their calves to fill these data gaps. POPs and lipid content were quantified in blood serum (POP levels in serum and blubber are highly correlated) collected during gestation and in milk and serum collected post-partum from female killer whales. Serum samples were also collected from calves during the lactation period. POP concentrations in milk collected over 15 months post-partum from the primiparous female decreased by 47-65%, depending on the contaminant class. The highest influx of contaminants to calves tended to occur soon after birth. Greater contaminant transfer rates during early lactation were also reflected in maternal serum POP levels. POP levels in maternal serum decreased significantly during the first 144-158 days post-partum, depending on contaminant class, and then leveled off through the remaining lactation period. This resulted in 67-81% reductions in POP levels in maternal serum over 15 months. By 15 months post-partum, serum POP levels from the primiparous female had dropped to levels measured in the multiparous female during pregnancy. Dissimilar to the multiparous female, body mass and blubber thickness in the primiparous female also declined significantly during the first 3-5 months post-partum, demonstrating linkages between lipid and POP transfer from blubber stores to milk in early lactation. By the end of lactation, lipid-corrected POP concentrations in serum from the first-born calf were 5-8 times greater than the corresponding POP levels from her primiparous mother. These results demonstrate that very young neonatal SRKW calves, particularly first-born calves, are at high risk from contaminant exposure

Getting Better Hospital Alarm Sounds Into a Global Standard

The reserved set of audible alarm signals embodied within the global medical device safety standard, IEC 60601-1-8, is known to be problematic and in need of updating. The current alarm signals are not only suboptimal, but there is also little evidence beyond learnability (which is known to be poor) that demonstrates their performance in realistic and representative clinical environments. In this article, we describe the process of first designing and then testing potential replacement audible alarm signals for IEC 60601-1-8, starting with the design of several sets of candidate sounds and initial tests on learnability and localizability, followed by testing in simulated clinical environments. We demonstrate that in all tests, the alarm signals selected for further development significantly outperform the current alarm signals. We describe the process of collecting considerably more data on the performance of the new sounds than exists for the current sounds, which ultimately will be of use to end users. We also reflect on the process and practice of working with the relevant committees and other practical issues beyond the science, which also need constant attention if the alarms we have developed are to be included successfully in an updated version of the standard