Recovery of upland acid grasslands after successful Pteridium aquilinum control: Long-term effectiveness of cutting, repeated herbicide treatment and bruising.

There is a clear need for the development of management strategies to control dominant, perennial weeds and restore semi-natural communities and an important part of this is to know how long control treatments take to be effective and how long they last after treatments stop. Here, we report the results from a 17-year long experiment where we compared the effects of five control treatments on dense Pteridium aquilinum (L. Kuhn) relative to an untreated experimental-control in Derbyshire, UK. The experiment was run in two phases. In Phase 1 (2005-2012) we controlled the P. aquilinum by cutting and bruising, both twice and thrice annually, and a herbicide treatment (asulam in year 1, followed by annual spot-re-treatment of all emergent fronds). In Phase 2 (2012-2021) all treatments were stopped, and the vegetation was allowed to develop naturally. Between 2005 and 2021 we monitored P. aquilinum performance annually and full plant species composition at intervals. Here, we concentrate on analysing the Phase 2 data where we used regression approaches to model individual species responses through time and unconstrained ordination to compare treatment effects on the entire species composition over both Phases. Remote sensing was also used to assess edge invasion in 2018. At the end of Phase 1, a good reduction of P. aquilinum and restoration of acid-grassland was achieved for the asulam and cutting treatments, but not for bruising. In Phase 2, P. aquilinum increased through time in all treated plots but the asulam and cutting ones maintained a much lower P. aquilinum performance for nine years on all measures assessed. There was a reduction in species richness and richness fluctuations, especially in graminoid species. However, multivariate analysis showed that the asulam and cutting treatments were stationed some distance from the untreated and bruising treatments with no apparent sign of reversions suggesting an Alternative Stable State had been created, at least over this nine-year period. P. aquilinum reinvasion was mainly from plot edges. The use of repeated P. aquilinum control treatments, either through an initial asulam spray with annual follow-up spot-spraying or cutting twice or thrice annually for eight years gave good P. aquilinum control and helped restore an acid-grassland community. Edge reinvasion was detected, and it is recommended that either whole-patch control be implemented or treatments should be continued around patch edges.

The role of coupled DNRA-Anammox during nitrate removal in a highly saline lake.

Nitrate (NO3-) removal from aquatic ecosystems involves several microbially mediated processes, including denitrification, dissimilatory nitrate reduction to ammonium (DNRA), and anaerobic ammonium oxidation (anammox), controlled by slight changes in environmental gradients. In addition, some of these processes (i.e. denitrification) may involve the production of undesirable compounds such as nitrous oxide (N2O), an important greenhouse gas. Saline lakes are prone to the accumulation of anthropogenic contaminants, making them highly vulnerable environments to NO3- pollution. The aim of this paper was to investigate the effect of light and oxygen on the different NO3- removal pathways under highly saline conditions. For this purpose, mesocosm experiments were performed using lacustrine, undisturbed, organic-rich sediments from the Pétrola Lake (Spain), a highly saline waterbody subject to anthropogenic NO3- pollution. The revised 15N-isotope pairing technique (15N-IPT) was used to determine NO3- sink processes. Our results demonstrate for the first time the coexistence of denitrification, DNRA, and anammox processes in a highly saline lake, and how their contribution was determined by environmental conditions (oxygen and light). DNRA, and especially denitrification to N2O, were the dominant nitrogen (N) removal pathways when oxygen and/or light were present (up to 82%). In contrast, anoxia and darkness promoted NO3- reduction by DNRA (52%), combined with N loss by anammox (28%). Our results highlight the role of coupled DNRA-anammox, which has not yet been investigated in lacustrine sediments. We conclude that anoxia and darkness favored DNRA and anammox processes over denitrification and therefore to restrict N2O emissions to the atmosphere.

Global Variations in Water Vapor and Saturation State Throughout the Mars Year 34 Dusty Season.

To understand the evolving martian water cycle, a global perspective of the combined vertical and horizontal distribution of water is needed in relation to supersaturation and water loss and how it varies spatially and temporally. The global vertical water vapor distribution is investigated through an analysis that unifies water, temperature and dust retrievals from several instruments on multiple spacecraft throughout Mars Year (MY) 34 with a global circulation model. During the dusty season of MY 34, northern polar latitudes are largely absent of water vapor below 20 km with variations above this altitude due to transport from mid-latitudes during a global dust storm, the downwelling branch of circulation during perihelion season and the intense MY 34 southern summer regional dust storm. Evidence is found of supersaturated water vapor breaking into the northern winter polar vortex. Supersaturation above around 60 km is found for most of the time period, with lower altitudes showing more diurnal variation in the saturation state of the atmosphere. Discrete layers of supersaturated water are found across all latitudes. The global dust storm and southern summer regional dust storm forced water vapor at all latitudes in a supersaturated state to 60-90 km where it is more likely to escape from the atmosphere. The reanalysis data set provides a constrained global perspective of the water cycle in which to investigate the horizontal and vertical transport of water throughout the atmosphere, of critical importance to understand how water is exchanged between different reservoirs and escapes the atmosphere.

A multi-isotopic approach to investigate the influence of land use on nitrate removal in a highly saline lake-aquifer system.

Endorheic or closed drainage basins in arid and semi-arid regions are vulnerable to pollution. Nonetheless, in the freshwater-saltwater interface of endorheic saline lakes, oxidation-reduction (redox) reactions can attenuate pollutants such as nitrate (NO3-). This study traces the ways of nitrogen (N) removal in the Pétrola lake-aquifer system (central Spain), an endorheic basin contaminated with NO3- (up to 99.2mg/L in groundwater). This basin was declared vulnerable to NO3- pollution in 1998 due to the high anthropogenic pressures (mainly agriculture and wastewaters). Hydrochemical, multi-isotopic (δ18ONO3, δ15NNO3, δ13CDIC, δ18OH2O, and δ2HH2O) and geophysical techniques (electrical resistivity tomography) were applied to identify the main redox processes at the freshwater-saltwater interface. The results showed that the geometry of this interface is influenced by land use, causing spatial variability of nitrogen biogeochemical processes over the basin. In the underlying aquifer, NO3- showed an average concentration of 38.5mg/L (n=73) and was mainly derived from agricultural inputs. Natural attenuation of NO3- was observed in dryland farming areas (up to 72%) and in irrigation areas (up to 66%). In the Pétrola Lake, mineralization and organic matter degradation in lake sediment play an important role in NO3- reduction. Our findings are a major step forward in understanding freshwater-saltwater interfaces as reactive zones for NO3- attenuation. We further emphasize the importance of including a land use perspective when studying water quality-environmental relationships in hydrogeological systems dominated by density-driven circulation.

The role of Pteridium arachnoideum(Kaulf) on the seed bank of the endangered Brazilian Cerrado.

The native bracken (Pteridium arachnoideum) often occurs in mono-specific stands in the Brazilian Cerrado, and this dominance can impact on both the above-ground vegetation and soil seed bank. This study investigated how invasion by this species over a 20-year period changed the seed bank and the relationship between the seed bank and litter mass. We extracted soil samples from three replicated invaded and uninvaded sites, and followed seedling emergence for six months. We collected the above-ground biomass and litter of P. arachnoideum in ten 1m2 plots from three invaded sites. There was no difference between invaded and uninvaded areas in seed bank richness, diversity or overall abundance. The most abundant family was the Melastomataceae, followed by the Poaceae. The Melastomataceae was more abundant in uninvaded sites, but the most common species of this family (Tibouchinastenocarpa) was not affected. The grasses were more common in invaded sites in the rainy season and were affected by heterogeneity in the litter layer. The seed bank could play a role in the recovery of these invaded areas, but the presence of weeds and invasive grasses could constrain their use as a management strategy.

The role of Pteridium arachnoideum(Kaulf) on the seed bank of the endangered Brazilian Cerrado / Impacto de Pteridium arachnoideum(Kaulf) no banco de sementes do Cerrado

Abstract The native bracken (Pteridium arachnoideum) often occurs in mono-specific stands in the Brazilian Cerrado, and this dominance can impact on both the above-ground vegetation and soil seed bank. This study investigated how invasion by this species over a 20-year period changed the seed bank and the relationship between the seed bank and litter mass. We extracted soil samples from three replicated invaded and uninvaded sites, and followed seedling emergence for six months. We collected the above-ground biomass and litter of P. arachnoideum in ten 1m2 plots from three invaded sites. There was no difference between invaded and uninvaded areas in seed bank richness, diversity or overall abundance. The most abundant family was the Melastomataceae, followed by the Poaceae. The Melastomataceae was more abundant in uninvaded sites, but the most common species of this family (Tibouchinastenocarpa) was not affected. The grasses were more common in invaded sites in the rainy season and were affected by heterogeneity in the litter layer. The seed bank could play a role in the recovery of these invaded areas, but the presence of weeds and invasive grasses could constrain their use as a management strategy.

Resumo O samambaião (Pteridium arachnoideum) frequentemente domina áreas de cerrado, e pode alterar tanto a vegetação estabelecida quanto o banco de sementes do solo. Nesse estudo investigamos como áreas de cerrado invadidas por essa espécie a mais de 20 anos alteraram o banco de sementes, e também a relação entre banco de sementes e quantidade de serapilheira. Extraímos amostras de solo em três invadidas e em áreas controle adjacentes, e monitoramos a emergência de plântulas por seis meses. Coletamos a biomassa aérea e a serapilheira de P. arachnoideum em dez parcelas de 1m2 nas áreas invadidas. Ariqueza, diversidade e abundância totalnão diferiram entre áreas invadidas e controle. A família mais abundante foi Melastomataceae, seguida por Poaceae. Melastomataceae foi mais comum em áreas controle, mas não a espécie mais comum nessa família (Tibouchina stenocarpa). Gramíneas foram predominantes em áreas invadidas durante a estação chuvosa, e foram afetadas pela heterogeneidade da camada de serapilheira. O banco de sementes pode ser importante para a recuperação dessas áreas invadidas, mas esse uso pode ser prejudicado pela presença de ervas daninhas e gramíneas invasoras.

Denitrification in a hypersaline lake-aquifer system (Pétrola Basin, Central Spain): the role of recent organic matter and Cretaceous organic rich sediments.

Agricultural regions in semi-arid to arid climates with associated saline wetlands are one of the most vulnerable environments to nitrate pollution. The Pétrola Basin was declared vulnerable to NO3(-) pollution by the Regional Government in 1998, and the hypersaline lake was classified as a heavily modified body of water. The study assessed groundwater NO3(-) through the use of multi-isotopic tracers (δ(15)N, δ(34)S, δ(13)C, δ(18)O) coupled to hydrochemistry in the aquifer connected to the eutrophic lake. Hydrogeologically, the basin shows two main flow components: regional groundwater flow from recharge areas (Zone 1) to the lake (Zone 2), and a density-driven flow from surface water to the underlying aquifer (Zone 3). In Zones 1 and 2, δ(15)NNO3 and δ(18)ONO3 suggest that NO3(-) from slightly volatilized ammonium synthetic fertilizers is only partially denitrified. The natural attenuation of NO3(-) can occur by heterotrophic reactions. However, autotrophic reactions cannot be ruled out. In Zone 3, the freshwater-saltwater interface (down to 12-16 m below the ground surface) is a reactive zone for NO3(-) attenuation. Tritium data suggest that the absence of NO3(-) in the deepest zones of the aquifer under the lake can be attributed to a regional groundwater flow with long residence time. In hypersaline lakes the geometry of the density-driven flow can play an important role in the transport of chemical species that can be related to denitrification processes.

Nitrate attenuation potential of hypersaline lake sediments in central Spain: flow-through and batch experiments.

Complex lacustrine systems, such as hypersaline lakes located in endorheic basins, are exposed to nitrate (NO3(-)) pollution. An excellent example of these lakes is the hypersaline lake located in the Pétrola basin (central Spain), where the lake acts as a sink for NO3(-) from agricultural activities and from sewage from the surrounding area. To better understand the role of the organic carbon (Corg) deposited in the bottom sediment in promoting denitrification, a four-stage flow-through experiment (FTR) and batch experiments using lake bottom sediment were performed. The chemical, multi-isotopic and kinetic characterization of the outflow showed that the intrinsic NO3(-) attenuation potential of the lake bottom sediment was able to remove 95% of the NO3(-) input over 296days under different flow conditions. The NO3(-) attenuation was mainly linked with denitrification but some dissimilatory nitrate reduction to ammonium was observed at early days favored by the high C/N ratio and salinity. Sulfate reduction could be neither confirmed nor discarded during the experiments because the sediment leaching masked the chemical and isotopic signatures of this reaction. The average nitrogen reduction rate (NRR) obtained was 1.25mmold(-1)kg(-1) and was independent of the flow rate employed. The amount of reactive Corg from the bottom sediment consumed during denitrification was 28.8mmol, representing approximately 10% of the total Corg of the sediment (1.2%). Denitrification was produced coupled with an increase in the isotopic composition of both δ(15)N and δ(18)O. The isotopic fractionations (ε of (15)N-NO3(-) and (18)O-NO3(-)) produced during denitrification were calculated using batch and vertical profile samples. The results were -14.7‰ for εN and -14.5‰ for εO.

Addressing the tobacco epidemic in the Philippines: progress since ratification of the WHO FCTC.

Tobacco use is the leading cause of preventable death, and is estimated to kill more than 5 million persons each year worldwide. Tobacco use and exposure to second-hand smoke pose a major public health problem in the Philippines. Effective tobacco control policies are enshrined in the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), a legally binding international treaty that was ratified by the Philippines in 2005. Since 2007, Bloomberg Philanthropies has supported the accelerated reduction of tobacco use in many countries, including the Philippines. Progress in the Philippines is discussed with particular emphasis on the period since ratification of the WHO FCTC, and with particular focus on the grants programme funded by the Bloomberg Initiative. Despite considerable progress, significant challenges are identified that must be addressed in future if the social, health and economic burden from the tobacco epidemic is to be alleviated.

L'emploi de tabac est la principale cause évitable de décès et on estime qu'il tue chaque année plus de 5 millions de personnes au niveau mondial. L'utilisation de tabac et l'exposition à la fumée secondaire posent un problème majeur de santé publique aux Philippines. Les politiques efficientes de lutte contre le tabagisme sont garanties dans la Convention Cadre de Lutte contre la Tabagisme (FCTC) de l'Organisation Mondiale de la Santé (OMS), un traité international d'application légale obligatoire qui a été ratifié par les Philippines en 2005. Depuis 2007, Bloomberg Philanthropies a soutenu l'accélération de la réduction de l'utilisation de tabac dans beaucoup de pays, notamment les Philippines. On discute les progrès observés aux Philippines en insistant particulièrement sur la période faisant suite à la ratification de la FCTC de l'OMS et en se focalisant particulièrement sur le programme de dons financé par l'Initiative Bloomberg. En dépit de progrès significatifs, on identifie des défis majeurs auxquels il faut répondre à l'avenir, si l'on veut alléger le fardeau social économique et sanitaire provenant de l'épidémie de tabagisme.

El consumo de tabaco representa la principal causa prevenible de mortalidad y se calcula que provoca la muerte de más de 5 millones de personas cada año en todo el mundo. El tabaquismo y la exposición pasiva al humo del tabaco plantean un problema mayor de salud pública en las Filipinas. El Convenio Marco para el Control del Tabaco (FCTC) de la Organización Mundial de la Salud (OMS) consagra las políticas eficaces de control del tabaquismo; este tratado internacional jurídicamente vinculante fue ratificado por las Filipinas en el 2005. Desde el 2007, la iniciativa Bloomberg Philanthropies ha apoyado una disminución acelerada del tabaquismo en muchos países, incluidas las Filipinas. En el presente artículo se examinan los progresos alcanzados en este país, con especial interés en el período posterior a la ratificación del FCTC de la OMS y se hace hincapié en el programa de subsidios financiado por la Iniciativa Bloomberg. Pese a los considerables progresos alcanzados, se destacan retos importantes que exigen una respuesta en el futuro, si se busca aliviar la carga social, sanitaria y económica que representa la epidemia de tabaquismo.

Catecholaminergic polymorphic ventricular tachycardia detected by an insertable loop recorder in a pediatric patient with exercise syncopal episodes.

Syncope is a common clinical problem that occurs at all ages and is particularly prevalent in childhood and adolescence. The evaluation of syncope is best approached using the history and physical examination, electrocardiogram and risk stratification to guide further diagnostic tests. Syncope associated with exercise or exertion must be considered dangerous, it can be a predictor of sudden cardiac death and therefore it must be taken seriously. The insertable loop recorder has been proven to be useful in the diagnosis of recurrent syncope in adult patients in whom the cause of the syncope cannot be found by other noninvasive means. We report the first known case of cathecolaminergic polymorphic ventricular tachycardia detected by an insertable loop recorder in a 5-year-old boy with a syncopal history and no structural heart disease.

Guías para el manejo de la fibrilación auricular en los servicios de urgencias hospitalarios / Guidelines for the managment of atrial fibrillation in hospital emergency services

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Trastorno psicótico en el síndrome de Prader-Willi: a propósito de un caso / Psychotic disorder in Prader Willi syndrome: a case report

En el Síndrome de Prader-Willi los principales síntomas psiquiátricos son las alteraciones conductuales y la clínica obsesivo-compulsiva relacionada con la alimentación, lo cual está ampliamente recogido en la literatura. Sin embargo, las manifestaciones psicóticas en este síndrome son hallazgos infrecuentes. En el caso clínico que se presenta se produce esta asociación. Con relación a esto se realiza una revisión bibliográfica (Medline, EmBase, Cochrane) de los últimos años sobre el SPW y su comorbilidad con patología psiquiátrica (AU)

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Sensitivity and specificity of the indicators of sincere effort of the EPIC lift capacity test on a previously injured population.

STUDY DESIGN: Randomized control post-test only. OBJECTIVES: To investigate the reliability and validity of the EPIC Lift Capacity test's indicators of sincere effort. SUMMARY OF BACKGROUND DATA: The EPIC Lift Capacity test (ELC) (Employment Potential Improvement Corp., Santa Ana, CA) is a functional evaluation tool used to identify physical limitations involved in lifting and manual materials handling. Identification of insincere effort is an integral component of such functional testing because of the potential secondary gain issues surrounding the various populations typically involved in this form of testing. The purpose of this study was to determine the sensitivity and specificity of the "indicators of sincere effort" of the EPIC Lift Capacity test when used on a previously injured population typical of subjects for which the test is designed. METHODS: Subjects consisted of 41 volunteers (age 22 to 58 years) with a previously diagnosed musculoskeletal pathology of the spine or extremities. Volunteers were randomized into either the control group, instructed to give a sincere maximum effort, or the experimental group, instructed to give an insincere effort at 50% of their perceived maximum effort. All tests were administered by certified clinical evaluators according to the standardized EPIC Lift Capacity test protocol.- RESULTS: Overall accuracy in identifying participants' level of effort was 86.84%. The indicators of valid effort exhibited both high positive (94.44%) and negative (80.00%) predictive values. The indicators of valid effort accounted for 94.9% of the total variance in the determination of the subjects' overall effort level. Interrater reliability for agreement of subjects' overall effort was good (interclass correlation coefficient = 0.82). CONCLUSIONS: Through use of standardized indicators of sincere effort, certified EPIC Lift Capacity test evaluators were able to predict sincerity of effort with a high degree of reliability and validity. The rater's systematicobservational evaluation of effort was shown to be the single best indicator of sincere effort.

Rate-dependent conduction block of the crista terminalis in patients with typical atrial flutter: influence on evaluation of cavotricuspid isthmus conduction block.

BACKGROUND: The crista terminalis (CT) has been identified as the posterior boundary of typical atrial flutter (AFL) in the lateral wall (LW) of the right atrium (RA). To study conduction properties across the CT, rapid pacing was performed at both sides of the CT after bidirectional conduction block was achieved in the cavotricuspid isthmus by radiofrequency catheter ablation. METHODS AND RESULTS: In 22 patients (aged 61+/-7 years) with AFL (cycle length, 234+/-23 ms), CT was identified during AFL by double electrograms recorded between the LW and posterior wall (PW). After the ablation procedure, decremental pacing trains were delivered from 600 ms to 2-to-1 local capture at the LW and PW or coronary sinus ostium (CSO). At least 5 bipolar electrograms were recorded along the CT from the high to the low atrium next to the inferior vena cava. No double electrograms were recorded during sinus rhythm in that area. Complete transversal conduction block all along the CT (detected by the appearance of double electrograms at all recording sites and craniocaudal activation sequence on the side opposite to the pacing site) was observed in all patients during pacing from the PW or CSO (cycle length, 334+/-136 ms), but it was fixed in only 4 patients. During pacing from the LW, complete block appeared at a shorter pacing cycle length (281+/-125 ms; P<0.01) and was fixed in 2 patients. In 3 patients, complete block was not achieved. CONCLUSIONS: These data suggest the presence of rate-dependent transversal conduction block at the crista terminalis in patients with typical AFL. Block is usually observed at longer pacing cycle lengths with PW pacing than with LW pacing. This difference may be a critical determinant of the counterclockwise rotation of typical AFL.

Randomized, prospective comparison of four burst pacing algorithms for spontaneous ventricular tachycardia.

"Less aggressive" burst stimulation is more effective in terminating spontaneous monomorphic ventricular tachycardia with a lesser acceleration rate. Higher ventricular tachycardia cycle length and use of 91% coupling interval were independent predictors for pacing termination.

Analysis of the degree of QRS fusion necessary for its visual detection: importance for the recognition of transient entrainment.

BACKGROUND: Fixed fusion is the hallmark for the demonstration of transient entrainment. However, the degree of accuracy of its recognition on the surface ECG is unknown. The purpose of the present study was to evaluate the ability to detect fusion in the QRS complex. METHODS AND RESULTS: While pacing the ventricles at a fixed rate, a model of ventricular fusion was created by introducing late extra stimuli at a second site. In this model, the presence and degree of fusion are known. Pacing sites were the RV apex, outflow tract, and left ventricle in various configurations. We analyzed 433 QRS complexes with different degrees of fusion (or no fusion) in 21 patients. Each QRS was "read" by three investigators blinded to intracardiac recordings but having a reference QRS with no fusion. There was a statistically significant correlation between the degree of fusion and its recognition. Fusion was detected with a sensitivity of 75% and a specificity of 87%. Fusion was accurately detected in all configurations only when >22% of the QRS was fused. In patients with organic left ventricular disease, fusion was better recognized when the driving pacing site was the left ventricle than when it was a right ventricular site. The interobserver agreement was moderate between two pairs of observers and only fair between the remaining pair. CONCLUSIONS: Our results suggest that an accurate detection of ventricular fusion can only be accomplished when fusion occurs during a significant proportion of the QRS duration. The potential lack of recognition of minor degrees of fusion may produce underdetection of transient entrainment.

"Pseudodisappearance" of atrial electrogram during orthodromic tachycardia: new criteria for successful ablation of concealed left-sided accessory pathways.

OBJECTIVES: This study sought to analyze two new criteria along with other known predictors of success of radiofrequency ablation. Background. Although the overall success rate of radiofrequency ablation of accessory pathways is high, the individual predictive value of each of the established criteria is low. METHODS: We prospectively studied the local electrograms obtained before the application of radiofrequency energy in 33 patients with a left-sided concealed accessory pathway successfully ablated. Two new criteria ("pseudodisappearance" during tachycardia of a bipolar atrial electrogram visible during sinus rhythm and the presence of an "atrial notch" in the ascending limb of the unipolar ventricular electrogram during tachycardia) were studied along with other known predictors. Electrograms recorded at a total of 157 sites were analyzed (33 successful applications, 124 failures). RESULTS: Electrogram characteristics that were predictive of success during ablation on the basis of univariate analyses were a pseudodisappearance criterion (p<0.001), the presence of a Kent potential (p<0.005) and the presence of an "atrial notch" (p<0.005). After adjustment for between-patient differences, logistic regression analysis showed that only the "pseudodisappearance" criterion (odds ratio [OR] 7.2, 95% confidence interval [CI] 1.2 to 42.5, p<0.03) and the presence of a Kent potential (OR 2.4, 95% CI 1.01 to 5.79, p<0.05) had independent predictive value. CONCLUSIONS: The pseudodisappearance during tachycardia or ventricular pacing of a bipolar atrial electrogram present during sinus rhythm is associated with a good outcome during radiofrequency ablation of concealed accessory pathways. These observations may help to ablate accessory pathways and to avoid missing appropriate sites for ablation when the atrial activation is not clearly visible at the local electrogram.

[Radiofrequency catheter ablation of ventricular tachycardia in patients without apparent structural cardiopathy]. / Ablación con catéter mediante radiofrecuencia de taquicardias ventriculares en pacientes sin cardiopatía estructural aparente.

BACKGROUND AND PURPOSE: It has been suggested that the efficacy of radiofrequency ablation of idiopathic ventricular tachycardia (VT) is dependent on the site of VT origin, with the efficacy being greater for VTs originating from right ventricle. The electrophysiologic characteristic and the results of radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease are reported. Special emphasis was focused to the differences observed in the pace and activating mapping between VTs originating in the right ventricle and those originating from the left ventricle and its possible implications for radiofrequency efficacy. METHODS AND RESULTS: 14 consecutive patients with idiopathic VT (7 women and 7 men, mean age 35 +/- 16 years), 8 originating in the right ventricle (RV) and 6 in the left ventricle (LTV), underwent catheter ablation using radiofrequency energy. The observation of entrainment with fusion in all LV VT suggested that the electrophysiologic mechanism was a reentry, meanwhile the RV VT were due to focal non-reentrant mechanisms. Sites for radiofrequency energy delivery were selected on the basis of pace and activation mapping in all patients less in two patients with incessant VT in whom only activation mapping was performed. 14 VT were mapped. The activation mapping demonstrated isolated presystolic electrograms in the point of origin in all VT arising from the LV. However in RV tachycardias there was continuous activity between presystolic and systolic electrograms, although the prematurity of these electrograms was similar (31 +/- 16 ms vs 33 +/- 9 ms; p = 0.77). Radiofrequency was successful in eliminating 93% of TV (100% RV TV vs 83% LV TV; p = 0.23). No complications were observed. CONCLUSIONS: The results of this study suggest that radiofrequency ablation is highly successful either in right and left ventricles idiopathic tachycardias when pace and activation mapping are used complementary.

Identification of concealed posteroseptal Kent pathways by comparison of ventriculoatrial intervals from apical and posterobasal right ventricular sites.

BACKGROUND: The differential diagnosis of supraventricular tachycardia with concentric atrial activation usually requires the inducibility of sustained tachycardia and needs a complex and time-consuming electrophysiological evaluation. To develop a simple test to establish if ventriculoatrial conduction uses a posteroseptal accessory pathway or the normal conduction system, we compared the ventriculoatrial intervals during right ventricular pacing from apical and posterobasal sites. METHODS AND RESULTS: Continuous pacing was performed from an apical and a posterobasal right ventricular site in 34 patients with retrograde conduction over the normal conduction system (group A) and in 22 patients with conduction over a posteroseptal accessory pathway (group B). During apical pacing, ventriculoatrial intervals in group A (176 +/- 40 milliseconds) were not significantly different than those in group B (197 +/- 47 milliseconds, P = NS). During posterobasal pacing, group B patients had significantly shorter ventriculoatrial intervals than group A patients (158 +/- 46 versus 197 +/- 39 milliseconds, P < .01). The difference between the ventriculoatrial interval obtained during apical pacing and that obtained during posterobasal pacing (ventriculoatrial index) discriminated between the two groups without overlapping: It was positive in all group B patients (39 +/- 19; range, +10 to +70 milliseconds) and negative in all except two group A patients (-21 +/- 13; range, -50 to +5 milliseconds; P < .001). CONCLUSIONS: This ventriculoatrial index can identify accurately and in the absence of tachycardia whether concentric retrograde conduction is proceeding over a posteroseptal accessory pathway or over the normal conduction system.