Outcome of ACHD patients with non-inducible versus inducible IART undergoing cavo-tricuspid isthmus ablation: the role of empiric ablation

Purpose: Catheter ablation for supraventricular tachycardia (SVT) in adults with congenital heart disease (ACHD) is an important therapeutic option. Cavo-tricuspid isthmus (CTI)-dependent intraatrial re-entrant tachycardia (IART) is common. However, induction of sustained tachycardia at the time of ablation is not always possible. We hypothesised that performing an empiric CTI line in case of non-inducibility leads to good outcomes. Long-term outcomes of empiric versus entrained CTI ablation in ACHD patients were examined. / Methods: Retrospective, single-centre, case-control study over 7 years. Arrhythmia-free survival after empiric versus entrained CTI ablation was compared. / Results: Eighty-seven CTI ablations were performed in 85 ACHD patients between 2010 and 2017. The mean age of the cohort was 43 years and 48% were male. Underlying aetiology included ASD (31%), VSD (11.4%), AVSD (9.1%), AVR (4.8%), Fallot’s (18.4%), Ebstein’s (2.3%), Fontan’s palliation (9.2%) and atrial switch (13.8%). CTI-dependent IART was entrained in 59 patients whereas it was non-inducible in 28. The latter had an empiric CTI ablation. Forty-three percent of procedures were performed under general anaesthesia. There were no reported procedural complications. There was no significant difference in the mean procedure or fluoroscopy times between the groups (empiric vs entrained CTI; 169.1 vs 183.3 and 28.1 vs 19.9 min). Arrhythmia-free survival was 64.3% versus 72.8% (p value 0.44) in the empiric and entrained groups at 21 months follow-up. / Conclusions: Long-term outcomes after empiric and entrained CTI ablation for IART in ACHD patients are comparable. This is a safe and effective therapeutic option. In the case of non-inducibility of IART, an empiric CTI line should be considered in this cohort

Exploring the key drivers behind the adoption of mobile banking services

This research examines the main drivers behind the adoption of mobile banking, a concept that has revolutionized the day-to-day activities of humans. A review of relevant literature on the topic, leads us toward testing the following key hypotheses: consumers are adopting mobile banking due to the perceived usefulness and benefits associated with the concept; and consumers are adopting mobile banking due to technological advances meaning increased access to the mobile phone devices. We published an online questionnaire on Amazon Mechanical Turk to obtain responses from Internet users. A dominating proportion of participants highlighted how mobile banking is a concept that they adopted between three and 5 years ago, showing just how recently mobile banking took off. The results also showed a number of links between the study’s research hypotheses and the adoption of mobile banking. The overall result of the study shows online banking as a concept that is influenced by a number of both internal and external factors. No single factor plays a dominating force in pushing retail bankers to adopt mobile banking, with it instead being a culmination of numerous different factors. The recent introduction of mobile banking is made seemingly apparent, as is the increasing susceptibility to change in the near future. Subsequently, countless opportunities for further academic research are likely to arise

Switching costs, experience goods and dynamic price competition

Dynamic price competition, Experience goods, Markov-perfect equilibrium, Switching costs, C73, D21, D43, L13, L14, L15,

Joint strategic planning between health and local authorities

This paper describes an approach to joint consideration of strategic planning problems between Health Authorities and Local Authorities. It is currently being pilot tested in the UK by two Area Health Authorities and their corresponding County Councils. The approach is most effective in planning the provision of health and social services for periods between three and ten years ahead and has been particularly designed for planning the non-acute services. These are the services for which joint planning between the health and social services is most important. Depending on local needs and planning priorities the approach may be used for one or more 'client groups' (the Elderly, Mentally Ill, Mentally Handicapped, Physically Handicapped etc.). In the pilot applications the approach is being used in planning for the Elderly client group only. The model now used relies on very simple assumptions, arithmetic calculations, and a heuristic optimisation algorithm, in place of a previous mathematical programming model originally aimed at national planning needs and then adapted to local planning. The revised model has achieved these simplifications, while extending the power of the model to fit local needs, by separating out different parts of the problem corresponding to different stages in the planning process, and developing techniques appropriate to each. In a companion paper2 in this issue authors from the participating Authorities put their views on the pilot applications of the approach.