Left-sided phrenic nerve injury during redo pulmonary vein isolation long after a previous contralateral self-limiting phrenic nerve palsy

We present a unique case of a left-sided phrenic nerve injury (PNI) long after a previous contralateral PNI following pulmonary vein isolation (PVI) procedures. Firstly, right-sided PNI after cryoballoon ablation, and secondly a left-sided PNI was observed following a redo PVI extended with box-lesion and left atrial appendage isolation (LAAI)

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

Valproate treatment normalizes EEG functional connectivity in successfully treated idiopathic generalized epilepsy patients

Aim: To investigate the effect of chronic VPA treatment of EEG functional connectivity insuccessfully treated idiopathic generalized epilepsy (IGE) patients.Patients and methods: 19-channel waking, resting-state EEG records of 26 IGE patients wereanalyzed before treatment (IGE) and after the 90th day of treatment (VPA), in seizure-free condition.Three minutes of artifact-free EEG background activity (without epileptiform potentials)was analyzed for each patient in both conditions. A group of 26 age-matched healthy normativecontrol persons (NC) was analyzed in the same way. All the EEG samples were processed toLORETA (Low Resolution Electromagnetic Tomography) to localize multiple distributed sourcesof EEG activity. Current source density time series were generated for 33 regions of interest(ROI)in each hemisphere for four frequency bands. Pearson correlation coefficients (R) were computedbetween all ROIs in each hemisphere, for four bands across the investigated samples. Rvalues corresponded to intrahemispheric, cortico-cortical functional EEG connectivity (EEGfC).Group and condition differences were analyzed by statistical parametric network method.Main results: p < 0.05, corrected for multiple comparisons: (1) The untreated IGE group showedincreased EEGfC in the delta and theta bands, and decreased EEGfC in the alpha band (as comparedto the NC group); (2) VPA treatment normalized EEGfC in the delta, theta and alpha bands;and (3) degree of normalization depended on frequency band and cortical region.Conclusions: VPA treatment normalizes EEGfC in IGE patients

Extensive scar modification for the treatment of intra-atrial re-entrant tachycardia in patients after congenital heart surgery

Background:Catheter ablation is an important therapeutic option for atrial tachycardias in patients with CHD. As a result of extensive scarring and surgical repair, multiple intra-atrial re-entrant tachycardia circuits develop and serve as a substrate for arrhythmias. The best ablation approach for patients with multiple intra-atrial re-entrant tachycardias has not been investigated. Here, we compared substrate-based ablation using extensive scar modification to conventional ablation.Methods:The present study included patients with surgically corrected CHD that underwent intra-atrial re-entrant tachycardia ablation. Extensive scar modification was defined as substrate ablation based on a dense voltage map, aimed to eliminate all potentials in the scar region. The control group had activation mapping-based ablation. A clinical composite endpoint was assessed. Points were given for type, number, and treatment of intra

Functional electrographic flow patterns in patients with persistent atrial fibrillation predict outcome of catheter ablation

Aims: Electrographic flow (EGF) mapping is a method to detect action potential sources within the atria. In a double-blinded retrospective study we evaluated whether sources detected by EGF are related to procedural outcome. Methods: EGF maps were retrospectively generated using the Ablamap® software from unipolar data recorded with a 64-pole basket catheter from patients who previously underwent focal impulse and rotor modulation-guided ablation. We analyzed patient outcomes based on source activity (SAC) and variability. Freedom from atrial fibrillation (AF) was defined as no recurrence of AF, atypical flutter or atrial tachycardia at the follow-up visits. Results: EGF maps were from 123 atria in 64 patients with persistent or long-standing persistent AF. Procedural outcome correlation with SAC peaked at &gt;26%. S-type EGF signature (source-dependent AF) is characterized by stable sources with SAC &gt; 26% and C-type (source-independent AF) is characterized by sources with SAC ≤ 26%. Cases with AF recurrence at 3-, 6-, or 12-month follow-up showed a median final SAC 34%; while AF-free patients had sources with significantly lower median final SAC 21% (p =.0006). Patients with final SAC and Variability above both thresholds had 94% recurrence, while recurrence was only 36% for patients with leading source SAC and variability below threshold (p =.0001). S-type EGF signature post-ablation was associated with an AF recurrence rate 88.5% versus 38.1% with C-type EGF signature. Conclusions: EGF mapping enables the visualization of active AF sources. Sources with SAC &gt; 26% appear relevant and their presence post-ablation correlates with high rates of AF recurrence.</p

Aligned carbon nanotube reinforced high performance polymer composites with low erosive wear

The erosive wear behaviour of epoxy composites reinforced with aligned, as-produced carbon nanotube (CNT) films was investigated. The CNT film composites were fabricated in two different configurations, where the unidirectional (0°) and bi-directional (0°/90°) aligned CNT films were exposed to the particle stream. Results have shown that the unidirectional (0°) CNT film/epoxy composite exhibit superior erosive wear resistance compared to the unidirectional (0°) carbon fibre reinforced epoxy composite. Furthermore, the bi-directional (0°/90°) CNT film/epoxy composite shows even better resistance to erosion compared to the unidirectional (0°) CNT film/epoxy composite due to additional impact energy absorption resulted from CNT networks. Scanning Electron Microscopy (SEM) provides further insight into the erosive wear mechanisms of CNT film composites at different impingement angles. This work has successfully introduced aligned as-produced CNT films fabricating epoxy composites using traditional composite manufacturing processes with low erosive wear and high electrical performance which deliver potential for engineering applications