Characteristics of P wave in Patients with Sinus Rhythm after Maze Operation

Maze operation could alter P wave morphology in electrocardiogram (ECG), which might prevent exact diagnosis of the cardiac rhythm of patients. However, characteristics of P wave in patients with sinus rhythm after the operation have not been elucidated systematically. Consecutive patients who underwent the modified Cox Maze operation from January to December 2007 were enrolled. The standard 12-lead ECG and echocardiography were evaluated in patients who had sinus rhythm at 6 months after the operation. The average axis of P wave was 65±30 degrees. The average amplitude of P wave was less than 0.1 mV in all 12-leads, with highest amplitude in V1. The most common morphology of P wave was monophasic with positive polarity (49%), except aVR lead, which was different from those in patients with enlarged left atrium, characterized by large P-terminal force in the lead V1. There were no significant differences in P-wave characteristics and echocardiographic parameters between patients with LA activity (30.6%) versus without LA activity (69.4%) at 6 months after the operation. In conclusion, the morphology of P wave in patients after Maze operation shows loss of typical ECG pattern of P mitrale: P wave morphology is small in amplitude, monophasic and with positive polarity

Clinical characteristics of apixaban prescription in AF patients with single dose-reduction criterion: the ASPIRE (efficAcy and safety of aPixaban in rEal-world practice in Korean frail patients with atrial fibrillation) study

BackgroundData on off-label reduced dose risk among patients with atrial fibrillation (AF) who qualify for a single-dose reduction of apixaban is scarce.ObjectivesWe prospectively assessed apixaban dosing and clinical characteristics in AF patients meeting a dose reduction criterion.MethodsThe multicentre, prospective cohort study, the efficAcy and Safety of aPixaban In REal-world practice in Korean frail patients with AF (ASPIRE), encompasses patients with AF who met the criteria for a single-dose reduction of apixaban and were given varying doses of apixaban, either the on-label standard dose or the off-label reduced dose.ResultsOf 2,000 patients (mean age 74.3 ± 7.9 years, 55.8% women), 29.7% were ≥80 years, 62.6% weighed ≤60 kg, and 7.8% had serum creatinine ≥1.5 mg/dL. Of these, 51.3% were prescribed an off-label reduced dose of apixaban. The off-label group was characterized with older age, more comorbidities, and antiplatelet agents, while the on-label group had more prior strokes. Physicians preferred off-label reduced dose in the “marginal zone,” defined as age 75–80 years, weight 60–65 kg, and creatinine levels 1.2–1.5 mg/dL.ConclusionsIn real-world clinical setting of the Korean population, off-label reduced dose apixaban was administered to nearly half of the patients who qualified for a single dose reduction. This reduced dosage was more commonly prescribed to patients with frail characteristics, while patients with a history of stroke were more often given the standard dose as per the label. A future study is planned to contrast the safety and effectiveness of the standard dose against the reduced dose of apixaban in this population

Effect of the Flow Rate on the Relative Permeability Curve in the CO₂ and Brine System for CO₂ Sequestration

The relative permeabilities of CO2 and brine are important parameters that account for two-phase flow behavior, CO2 saturation distribution, and injectivity. CO2/brine relative permeability curves from the literature show low endpoint CO2 permeability values and high residual brine saturation values. These are the most distinguishing aspects of the CO2/brine relative permeability from oil/water and gas/oil. In this study, this aspect is investigated experimentally by employing a wide range of CO2 injection flow rates. As a result, all the measurements align with previous studies, having low endpoint relative permeability and high residual brine saturation values. They have obvious relationships with the changes in CO2 flow rates. As the CO2 flow rate increases, the endpoint relative permeability increases, the residual brine saturation decreases, and they converge to specific values. These imply that a high CO2 injection flow rate results in high displacement efficiency, but the improvement in efficiency decreases as the flow rate increases. The reasons are identified with the concept of the viscous and capillary forces, and their significance in the CO2 injection into a reservoir is analyzed

Directional Hydraulic Characteristics of Reservoir Rocks for CO2 Geological Storage in the Pohang Basin, Southeast Korea

This study conducted core sampling of an offshore borehole for geological reservoir characterization of a potential CO2 storage site in southeast Korea. From this, two promising geological formations at ~739 and ~779 m were identified as prospective CO2 storage reservoirs. Injection efficiency and CO2 migration were evaluated based on directional measurements of permeabilities from core plugs. The directional transport properties were determined using both a portable probe permeameter and a pressure cell capable of applying different in situ confining pressures. Both steady state and unsteady state measurements were used to determine permeability—the method selected according to the expected permeability range of the specific sample. This expected range was based on rapid screening measurements acquired using a portable probe permeameter (PPP). Anticipated performance of the prototypical CO2 injection site was evaluated based on flow modeling of the CO2 plume migration pathway including CO2 transport through the overlying formations based on the measured directional hydraulic properties. These analyses revealed that the injection efficiency at a depth of 739 m was double that at 779 m. These correlations among and distributions of the directional permeabilities of the potential CO2 geological storage site can be utilized for the assessment of CO2 storage capacity, injectivity, and leakage risk

Synergistic protective effects of a statin and an angiotensin receptor blocker for initiation and progression of atherosclerosis.

AimAlthough the atheroprotective effects of statins and angiotensin II receptor blockers (ARBs) are well-established, little is known about their additive effects, especially during the early period of atherosclerosis. The aim of this study was to investigate whether combination of a statin and an ARB exerts synergistic anti-atherosclerotic effects, and to elucidate the mechanisms of combined effects.MethodsAtherosclerotic plaques were developed in arteries of 23 rabbits using a high-cholesterol diet (HCD) and intra-arterial balloon inflation. Rabbits received one of five different treatment strategies for 4 weeks: positive control [n = 5, HCD]; negative control [n = 3, regular chow diet]; statin [n = 5, HCD and rosuvastatin 10 mg]; ARB [n = 5, HCD and olmesartan 20 mg]; and combination [n = 5, HCD and statin+ARB].ResultsHistological analysis demonstrated that development of atherosclerotic plaques was inhibited more in combination group than in statin group (P = 0.001). Although macrophage infiltration identified by RAM11 staining was not significantly different between combination and individual treatment groups (31.76±4.84% [combination] vs. 38.11±6.53% [statin; P = 0.35] or 35.14±2.87% [ARB; P = 0.62]), the relative proportion of pro-inflammatory M1-macrophages was significantly lower in combination group than in ARB group (3.20±0.47% vs. 5.20±0.78%, P = 0.02). Furthermore, M2-macrophage polarization was higher in combination group than in statin group (17.70±3.04% vs. 7.86±0.68%, P = 0.001).ConclusionCombination treatment with a statin and an ARB produced synergistic protective effects for atherosclerosis initiation and progression, which may be attributed to modulation of macrophage characteristics in the early period of atherosclerosis

Prevalence and Characteristics of Atrial Tachycardia from Noncoronary Aortic Cusp during Atrial Fibrillation Catheter Ablation

© 2022.Background and Objectives: Atrial tachycardias (ATs) from noncoronary aortic cusp (NCC) uncovered after radiofrequency ablation for atrial fibrillation (AF) are rarely reported. This study was conducted to investigate the prevalence and clinical characteristics of NCC ATs detected during AF ablation and compare their characteristics with de novo NCC ATs without AF. Methods: Consecutive patients who underwent radiofrequency catheter ablation for AF were reviewed from the multicenter AF ablation registry of 11 tertiary hospitals. The clinical and electrophysiological characteristics of NCC AT newly detected during AF ablation were compared with its comparators (de novo NCC AT ablation cases without AF). Results: Among 10,178 AF cases, including 1,301 redo ablation cases, 8 (0.08%) NCC AT cases were discovered after pulmonary vein isolation (PVI; 0.07% in first ablation and 0.15% in redo ablation cases). All ATs were reproducibly inducible spontaneously or with programmed atrial stimulation without isoproterenol infusion. The P-wave morphological features of tachycardia were variable depending on the case, and most cases exhibited 1:1 atrioventricular conduction. AF recurrence rate after PVI and NCC AT successful ablation was 12.5% (1 of 8). Tachycardia cycle length was shorter than that of 17 de novo ATs from NCC (303 versus 378, p=0.012). No AV block occurred during and after successful AT ablation. Conclusions: Uncommon NCC ATs (0.08% in AF ablation cases) uncovered after PVI, showing different characteristics compared to de-novo NCC ATs, should be suspected irrespective of P-wave morphologies when AT shows broad propagation from the anterior interatrial septum.N