Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation.

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach. This protocol describes the use of a commercially available esophageal temperature management device to cool or warm the esophagus to reduce esophageal injury during left atrial ablation. The temperature management device is powered by standard water-blanket heat exchangers, and is shaped like a standard orogastric tube placed for gastric suctioning and decompression. Water circulates through the device in a closed-loop circuit, transferring heat across the silicone walls of the device, through the esophageal wall. Placement of the device is analogous to the placement of a typical orogastric tube, and temperature is adjusted via the external heat-exchanger console

Does periprocedural anticoagulation management of atrial fibrillation affect the prevalence of silent thromboembolic lesion detected by diffusion cerebral magnetic resonance imaging in patients undergoing radiofrequency atrial fibrillation ablation with open irrigated catheters? Results from a prospective multicenter study

BackgroundSilent cerebral ischemia (SCI) has been reported in 14% of cases after catheter ablation of atrial fibrillation (AF) with radiofrequency (RF) energy and discontinuation of warfarin before AF ablation procedures.ObjectiveThe purpose of this study was to determine whether periprocedural anticoagulation management affects the incidence of SCI after RF ablation using an open irrigated catheter.MethodsConsecutive patients undergoing RF ablation for AF without warfarin discontinuation and receiving heparin bolus before transseptal catheterization (group I, n = 146) were compared with a group of patients who had protocol deviation in terms of maintaining the therapeutic preprocedural international normalized ratio (patients with subtherapeutic INR) and/or failure to receive pretransseptal heparin bolus infusion and/or ≥2 consecutive ACT measurements <300 seconds (noncompliant population, group II, n = 134) and with a group of patients undergoing RF ablation with warfarin discontinuation bridged with low molecular weight heparin (group III, n = 148). All patients underwent preablation and postablation (within 48 hours) diffusion magnetic resonance imaging.ResultsSCI was detected in 2% of patients (3/146) in group I, 7% (10/134) in group II, and 14% (21/148) in group III (P <.001). “Therapeutic INR” was strongly associated with a lower prevalence of postprocedural silent cerebral ischemia (SCI). Multivariable analysis demonstrated nonparoxysmal AF (odds ratio 3.8, 95% confidence interval 1.5–9.7, P = .005) and noncompliance to protocol (odds ratio 2.8, 95% confidence interval 1.5–5.1, P <.001] to be significant predictors of ischemic events.ConclusionStrict adherence to an anticoagulation protocol significantly reduces the prevalence of SCI after catheter ablation of AF with RF energy

Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation

BACKGROUND: Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed. OBJECTIVES: The authors aimed to compare AEF rates before and after the adoption of active esophageal cooling. METHODS: This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. RESULTS: A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals. In the time frames before adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In the preadoption cohort, a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates for procedures using LET monitoring. In the postadoption cohort, no AEFs were found in the prespecified sites, yielding an AEF rate of 0% (P \u3c 0.0001). CONCLUSIONS: Adoption of active esophageal cooling during RF ablation of the left atrium for the treatment of atrial fibrillation was associated with a significant reduction in AEF rate

Actuality of Art Education at the Beginning of XX Century in East Europe. Graphic Constructions Through Gestaltung and Formenlehre in Figurative Creativities Teaching Pathways

The great innovations in the field of the elaboration of forms and figures in the last century have often sometimes accompanied the amazement and optimism of the discovery, a methodological uncertainty shared with other fields of Knowledge. It is undeniable that the advent of information technology and representation\u2014together with the socio-economic changes that have taken place\u2014has laid the foundations for an irreversible ontological leap in the process of form processing, and yet very often there are references historians that can somehow inspire current theories and practices. In this sense, some interpretations considered to be classical, from Val\ue9ry to Benjamin, from Arnheim to Waburg, provide not a few substantial points for understanding contemporaneity. In this regard, the well-known pedagogical sketches by Paul Klee (1925), like the whole compendium of the notes that the Swiss artist wrote and cataloged from the first day of teaching at the Bauhaus (1921\u201331), contain ideas and practices that can be declined in the world of graphic informatics, parametric modeling software, but also in areas where the goal is not the control of the form as such, to the advantage of the control of the creative process. And a renewed interest in the work of Klee pedagogue is also due to the open source accessibility guaranteed by the Zentrum Paul Klee of Bremen, which allows a direct study of the sources. Another extraordinarily interesting idea is El Lisintskij\u2019s cross-media production, which with his Proun anticipates\u2014or inspires\u2014the work of some of the greatest architects of the late twentieth century. El Lisintskij\u2019s work is also characterized by the free overflow of visual arts\u2014graphics, painting, sculpture and architecture\u2014of compositional methods, production of stylistic elements and figurative innovations, laying the foundations for a vision of art that we could define as \u201ctotal\u201d. Other authors of the first two decades of the twentieth century have explored the potential of the renewed figurative arts: from the lucky \u201cPoint, line, surface\u201d. Kandinsky\u2019s Theory of form and composition of Itten, the pedagogy of the arts of the Bauhaus is, evidently, still valid as a cultural substratum for research in the architectural field, but perhaps more generally, in the figurative arts. But if the pedagogical structure of the Bauhaus and the developments of Russian constructivism are well traceable in literature, just from the exchange with these two great avant-garde experiences, all a graphic-artistic-performative production in the East-European area seems to have developed and hybridize compositional themes permuted by Bauhaus and Russian Constructivism