Longitudinal exposure to neighborhood poverty and obesity risk in emerging adulthood.

This study uses data from the longitudinal Panel Study of Income Dynamics data and its Transition to Adulthood (TA) Study (2005-2017), in conjunction with decades of neighborhood-level data from the U.S. decennial census and American Community Survey, to examine the relationship between individuals' neighborhood poverty exposure trajectories in childhood and the likelihood of obesity in emerging adulthood. Latent growth mixture models reveal that exposure to neighborhood poverty differs considerably for white and nonwhite individuals over their childhood life course. Durable exposure to neighborhood poverty confers greater subsequent obesity risks in emerging adulthood than transitory experiences of neighborhood poverty. Racial differences in the changing and persistent trajectories of neighborhood poverty help explain part of the racial differences in obesity risks. Among nonwhites, and compared to consistent nonpoor neighborhood conditions, both durable and transitory neighborhood poverty exposures are significantly associated with higher obesity risks. This study suggests that a theoretical framework that integrates key elements of the life-course perspective is helpful to uncover the individual and structural pathways through which neighborhood histories in poverty shape population health in general.

Mentoring in neuropsychology: Sage advice compilation from our field.

As part of the special issue on mentoring in neuropsychology in collaboration between the Journal of Clinical and Experimental Neuropsychology (JCEN) and American Psychological Association (APA) Society for Clinical Neuropsychology (SCN; Division 40)'s Women in Neuropsychology Committee (WIN), we are excited to present a compilation of sage advice in regards to best practices in mentoring from a diverse range of well-respected clinical neuropsychologists in field. This amazing group of neuropsychologists, including: Drs. Heather G. Belanger, Erin D. Bigler, Cady Block, Mark Bondi, Greg Brown, Sandra Brown, Daryl Fujii, Robert Heilbronner, Robin C. Hilsabeck, Amy Jak, Michelle R. Madore, Luis D. Medina, Neil H. Pliskin, George Prigatano, Yakeel T. Quiroz, Lisa Jane Rapport, Maureen Schmitter-Edgecombe, Anthony Y. Stringer, Julie Suhr, Daniel Tranel, Elizabeth W. Twamley, Steven Paul Woods, and Keith Owen Yeates discuss their first-hand experiences and practical advice related to formal/informal mentoring and supervising, with a particular focus on women and underrepresented peoples.

Mentorship in clinical neuropsychology: Survey of current practices, cultural responsiveness, and untapped potential.

INTRODUCTION: Neuropsychology trainees have identified mentorship as an important factor in their training. Limited past work has been conducted on mentorship within neuropsychology, and there is a need to better understand the experiences and perspectives of neuropsychology mentors. METHOD: Self-identified mentors in clinical neuropsychology completed a survey about their mentorship practices, including culturally responsive mentorship, as well as perceived barriers and challenges to providing effective mentorship. Themes were derived using qualitative analyses for free response questions, and descriptive statistics were calculated for quantitative variables. RESULTS: Mentors identified assessment, professionalism, and ethics as top priorities in mentorship, which may reflect the overlap within neuropsychology of assessment supervision and mentoring. Reported best practices included being self-aware and engaging in a personalized approach to mentorship relationships that varies depending upon the needs of the mentee. A majority reported that their training program is not diverse and they themselves do not mentor trainees from diverse backgrounds which provides a clear area for targeted efforts to recruit and retain diversity in the discipline. Mentors described practices related to discussing diversity-related differences with their trainees including self-disclosure, creating a safe space for conversations, and tailoring discussions to the individual trainee. They reported an interest in more training on how to engage in culturally competent mentorship. Two barriers to providing effective mentorship identified most by mentors were time constraints and a lack of training. CONCLUSIONS: These results highlight a variety of perspectives and approaches to mentorship, which may be beneficial for mentors to consider as they reflect on their mentorship practices and/or for trainees as part of their professional development toward becoming future mentors themselves. These results also highlight the need for a greater emphasis on mentorship training within neuropsychology, including training in culturally responsive mentorship practices.

Mentoring in neuropsychology: How theory and practice can support diverse mentees.

The academic literature on mentoring is well established, with a large body of published "best practices" regarding mentoring outside of neuropsychology. Specific attention is given to the need to diversify mentors, mentoring practices, and giving voice to a new generation of academics and practitioners through the mentoring process. Still, the field of neuropsychology has much to learn and implement consistently in practice from this well-established literature base and trove of resources and best practices. Existing literature in mentoring argues for compassionate mentoring and moving away from a mentee deficit model, to a model of having clear expectations of mentors to address the needs of all their mentees (National Academies of Sciences & Medicine, 2019), but with particular attention given to women, historically marginalized racial/ethnic groups, first-generation college students, mentees with disabilities, sexual and/or gender minority individuals, and mentees with intersecting identities. Evidence-based practices and programs with a focus on culturally responsive mentoring are a new area of interest both in terms of program development based on theory and measurement of mentee-mentor outcomes. Women in Neuropsychology (WIN) is a special committee of the American Psychological Association, Society for Clinical Neuropsychology (SCN; Division 40), dedicated to facilitating success and well-being among women and gender non-binary individuals in neuropsychology (https://scn40.org/win/). This article serves as an introduction to the WIN/JCEN special issue on mentoring in neuropsychology. Articles included in this special issue are focused on this specific topic relative to the discipline of clinical neuropsychology to develop, operationalize, and highlight best practices in mentoring with attention to the need to end racist/sexist treatment of women and historically marginalized racial/ethnic individuals; develop culturally humble mentoring approaches and clinical practices; and fix the leaky pipeline limiting access to marginalized individuals to contribute to the field of research and practice.

Barriers to Health Care Among Adults With Minoritized Identities in the United States, 2013-2017.

Objectives. To examine the relationship between minoritized identity and barriers to health care in the United States.Methods. Nationally representative data collected from the 2013 to 2017 waves of the National Health Interview Survey were used to conduct descriptive and logistic regression analyses. Men and women were placed in 1 of 4 categories: no minoritized identities, minoritized identities of race/ethnicity (MIoRE), minoritized identities of sexuality (MIoS), or minoritized identities of both race/ethnicity and sexuality (MIoRES). Five barriers to health care were considered.Results. Relative to heterosexual White adults and after controlling for socioeconomic status, adults with MIoRE were less likely to report barriers, adults with MIoS were more likely to report barriers, and adults with MIoRES were more likely to report barriers across 2 of the study measures.Conclusions. Barriers to care varied according to gender, minoritized identity, and the measure of access to health care itself.Public Health Implications. Approaching health disparities research using an intersectional lens moves the discussion from examining individual differences to examining the role of social structures such as the health care system in maintaining and reproducing inequality.

Disparities in injury morbidity among young adults in the USA: individual and contextual determinants.

BACKGROUND: Injuries have been recognised as important public health concerns, particularly among adolescents and young adults. Few studies have examined injuries using a multilevel perspective that addresses individual socioeconomic status (SES) and health behaviours and local socioeconomic conditions in early adolescence. We offer a conceptual framework incorporating these various components. METHODS: We test our conceptual framework using population data from the National Longitudinal Study of Adolescent Health Wave 4 when respondents were young adults and linked them to contextual level data from when they were middle-schoolers. We use logistic and multilevel regression models to examine self-reported injury risk in young adults by sex (n=14 356). RESULTS: Logistic regression models showed that men were more likely to experience serious injuries than women (OR 1.75, P<0.0001), but SES and health behaviours operated differently by sex. In stratified models, men with lower education had consistently higher injury risk, while only women with some college had increased injury risk (OR 1.40, P=0.0089) than college graduates. Low household income (OR 1.54, P=0.0011) and unemployment (OR 1.50, P=0.0008) increased female injury risk, but was non-significant for men. Alcohol consumption increased injury risk for both sexes, while only female smokers had elevated injury risk (OR 1.38, P=0.0154). In multilevel models, significant county-level variation was only observed for women. Women living in disadvantaged neighbourhoods during adolescence had increased injury risk (OR 1.001, P<0.0001). CONCLUSIONS: These findings highlight the importance of investigating mechanisms that link early-life contextual conditions to early adult SES and health behaviours and their linkage to injury risk, particularly for women.

Proscriptive vs. Prescriptive Health Recommendations to Drink Alcohol Within Recommended Limits: Effects on Moral Norms, Reactance, Attitudes, Intentions and Behaviour Change.

AIMS: Health advice can be framed in terms of prescriptive rules (what people should do, e.g. you should drink alcohol within recommended limits) or proscriptive rules (what people should not do, e.g. you should not drink alcohol above recommended limits). The current research examines the differing effect that these two types of injunction have on participants' moral norms, reactance, attitudes and intentions to consume alcohol within moderation, and their subsequent alcohol consumption. METHODS: Participants (N = 529) completed an online questionnaire which asked them to report their previous 7 days' alcohol consumption. They then read either a proscriptive or a prescriptive health message and completed measures of moral norms, reactance, attitudes and intentions to drink alcohol only within recommended limits. Subsequent alcohol consumption was reported 7 days later. RESULTS: The results showed that across all participants, the proscriptive message elicited stronger moral norms than did the prescriptive message, which in turn were associated with more positive attitudes and intentions to drink within recommended limits. For male participants who reported drinking more alcohol than recommended at baseline, the proscriptive message elicited more reported alcohol consumption over the subsequent 7 days. CONCLUSIONS: Proscriptive messages may be effective at eliciting stronger moral norms to drink within government recommended guidelines. However, reactance may occur for high relevance groups. Practical and theoretical implications are discussed.

Does allostatic load calculation method matter? Evaluation of different methods and individual biomarkers functioning by race/ethnicity and educational level.

OBJECTIVES: Using nationally representative data for adults of age 25 years and older from four waves of the National Health and Nutrition Examination Survey (NHANES), collected from 2003 through 2010, this study examines differences in individual health markers used to calculate allostatic load, with particular attention given to stratification by race/ethnicity and educational level. METHODS: Factor analysis with maximum likelihood estimation was used. Fisher's r to z transformation test was used to determine whether or not observed differences in factor loadings were statistically significant. RESULTS: The findings reveal the unidimensionality of the concept of allostatic load and the underlying differences in associations between individual biomarkers and summary measures of allostatic load. Additionally, metabolic processes tend to be the most important predictor of allostatic load for all adults; however, inflammatory measures are more important in determining allostatic load scores for non-Hispanic blacks compared to non-Hispanic whites and for adults with less than a college education compared to adults with some college or a college degree. CONCLUSIONS: These findings highlight the continued importance of studying the concept of "weathering" or allostatic load at the population level and need to better understand how population groups facing exclusion from economic, social, and political power may internalize this position which may cause early health deterioration and ultimate mortality chance through different expression of health insults and premature aging. Am. J. Hum. Biol. 28:627-635, 2016. © 2016 Wiley Periodicals, Inc.

The role of education in explaining racial/ethnic allostatic load differentials in the United States.

This study expands on earlier findings of racial/ethnic and education-allostatic load associations by assessing whether racial/ethnic differences in allostatic load persist across all levels of educational attainment. This study used data from four recent waves of the National Health and Nutrition Survey (NHANES). Results from this study suggest that allostatic load differs significantly by race/ethnicity and educational attainment overall, but that the race/ethnicity association is not consistent across education level. Analysis of interactions and education-stratified models suggest that allostatic load levels do not differ by race/ethnicity for individuals with low education; rather, the largest allostatic load differentials for Mexican Americans (p < .01) and non-Hispanic blacks (p < .001) are observed for individuals with a college degree or more. These findings add to the growing evidence that differences in socioeconomic opportunities by race/ethnicity are likely a consequence of differential returns to education, which contribute to higher stress burdens among minorities compared to non-Hispanic whites.

Pulmonary vein antral isolation for paroxysmal atrial fibrillation: results from long-term follow-up.

INTRODUCTION: Pulmonary veins play an important role in triggering atrial fibrillation (AF). Pulmonary vein isolation (PVI) is an effective treatment for patients with paroxysmal AF. However, the late AF recurrence rate in long-term follow-up of circumferential PV antral isolation (PVAI) is not well documented. We sought to determine the time to recurrence of arrhythmia after PVAI, and long-term rates of sinus rhythm after circumferential PVAI. METHODS: One hundred consecutive patients with a mean age of 54 ± 10 years, with paroxysmal AF who underwent PVAI procedure were analyzed. Isolation of pulmonary veins was based on an electrophysiological and anatomical approach, with a nonfluoroscopic navigation mapping system to guide antral PVI. Ablation endpoint was vein isolation confirmed with a circular mapping catheter at first and subsequent procedures. Clinical, ECG, and Holter follow-up was undertaken every 3 months in the first year postablation, every 6 months thereafter, with additional prolonged monitoring if symptoms were reported. Time to arrhythmia recurrence, and representing arrhythmias, were documented. RESULTS: Isolation of all 4 veins was successful in 97% patients with 3.9 ± 0.3 veins isolated/patient. Follow-up after the last RF procedure was at a mean of 39 ± 10 months (range 21-66 months). After a single procedure, sinus rhythm was maintained at long-term follow-up in 49% patients without use of antiarrhythmic drugs (AADs). After repeat procedure, sinus rhythm was maintained in 57% patients without the use of AADs, and in 82% patients including patients with AADs. A total of 18 of 100 patients had 2 procedures and 4 of 100 patients had 3 procedures for recurrent AF/AT. Most (86%) AF/AT recurrences occurred ≤ 1 year after the first procedure. Mean time to recurrence was 6 ± 10 months. Kaplan-Meier analysis on antiarrhythmics showed AF free rate of 87% at 1 year and 80% at 4 years. There were no major complications. CONCLUSION: PVAI is an effective strategy for the prevention of AF in the majority of patients with PAF. Maintenance of SR requires repeat procedure or continuation of AADs in a significant proportion of patients. After maintenance of sinus rhythm 1-year post-PVAI, a minority of patients will subsequently develop late recurrence of AF.

Rural-urban differences in breastfeeding initiation in the United States.

Research has noted a rural disadvantage in breastfeeding initiation; however, most previous research has been based on nonrepresentative samples and has been limited in its ability to compare racial/ethnic differences in breastfeeding initiation based on residential location. This research fills this gap by examining a nationally representative sample of births using the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) to explore associations between rural-urban residence and maternal race/ethnicity on breastfeeding initiation. Results indicate that associations observed for rural-urban breastfeeding initiation differ based on maternal race/ethnicity and poverty status. These patterns likely reflect differences in economic resources, work environments, and social support among rural minority postpartum women.

Differential neonatal and postneonatal infant mortality rates across US counties: the role of socioeconomic conditions and rurality.

PURPOSE: To examine differences in correlates of neonatal and postneonatal infant mortality rates, across counties, by degree of rurality. METHODS: Neonatal and postneonatal mortality rates were calculated from the 1998 to 2002 Compressed Mortality Files from the National Center for Health Statistics. Bivariate analyses assessed the relationship between neonatal and postneonatal mortality by Urban Influence (UI) codes. Multivariable, weighted least-squares regression models included measures of county socioeconomic conditions, health services and environmental risks. FINDINGS: The bivariate analysis indicated neonatal and postneonatal mortality was significantly higher in the most nonmetropolitan counties compared to the most metropolitan counties. However the relationship was not linear across the Urban Influence codes. In the multivariable models, a nonmetropolitan advantage was observed for counties not adjacent to metropolitan areas for neonatal mortality. However, postneonatal mortality rates were higher in the most rural nonmetropolitan counties. CONCLUSIONS: Certain characteristics of nonmetropolitan counties not adjacent to metropolitan counties and with an urban area of 2,500 population or more are protective against neonatal mortality (UI = 7, UI = 8). This may indicate that just having access to health services is more important to creating a protective effect for these nonmetropolitan counties than having a high concentration of medical facilities. The nonmetropolitan, not adjacent (UI = 9) disadvantage observed for postneonatal mortality supports the idea that the isolation of these areas combined with the combination of risk factors across the most nonmetropolitan counties leads to poorer postneonatal health outcomes in these areas.

One size does not fit all: an examination of low birthweight disparities among a diverse set of racial/ethnic groups.

To examine disparities in low birthweight using a diverse set of racial/ethnic categories and a nationally representative sample. This research explored the degree to which sociodemographic characteristics, health care access, maternal health status, and health behaviors influence birthweight disparities among seven racial/ethnic groups. Binary logistic regression models were estimated using a nationally representative sample of singleton, normal for gestational age births from 2001 using the ECLS-B, which has an approximate sample size of 7,800 infants. The multiple variable models examine disparities in low birthweight (LBW) for seven racial/ethnic groups, including non-Hispanic white, non-Hispanic black, U.S.-born Mexican-origin Hispanic, foreign-born Mexican-origin Hispanic, other Hispanic, Native American, and Asian mothers. Race-stratified logistic regression models were also examined. In the full sample models, only non-Hispanic black mothers have a LBW disadvantage compared to non-Hispanic white mothers. Maternal WIC usage was protective against LBW in the full models. No prenatal care and adequate plus prenatal care increase the odds of LBW. In the race-stratified models, prenatal care adequacy and high maternal health risks are the only variables that influence LBW for all racial/ethnic groups. The race-stratified models highlight the different mechanism important across the racial/ethnic groups in determining LBW. Differences in the distribution of maternal sociodemographic, health care access, health status, and behavior characteristics by race/ethnicity demonstrate that a single empirical framework may distort associations with LBW for certain racial and ethnic groups. More attention must be given to the specific mechanisms linking maternal risk factors to poor birth outcomes for specific racial/ethnic groups.

Do biological, sociodemographic, and behavioral characteristics explain racial/ethnic disparities in preterm births?

Many studies find racial/ethnic disparities in a diverse set of birth outcomes. However few empirical studies have examined the existence and possible explanations for racial/ethnic disparities in preterm births using a diverse set of racial/ethnic categories and a nationally representative sample of births. This research fills that gap. Using data from the US Early Childhood Longitudinal Study - Birth Cohort (ECLS-B), this research first explores the distribution of biological, sociodemographic, and behavioral characteristics of mothers and infants based on seven categories of maternal race/ethnicity. Next, multivariable logistic regression models are estimated in a nested manner to test for possible explanations for racial/ethnic disparities in preterm births. Lastly, race-stratified models are estimated to better elucidate the mechanism leading to racial/ethnic disparities in preterm births. Results from the chi-square tests of significance for racial/ethnic differences indicate that all variables used in this analysis, except for infant's gender, differ significantly based on maternal race/ethnicity. Results from the full multivariable logistic regression model finds that the only racial/ethnic disparity found in preterm births is observed for infants born to Native American mothers compared to non-Hispanic white mothers, once all variables are controlled for in the model. Race-stratified models indicate that maternal health complications and prenatal care adequacy offer the most potential in explaining remaining racial/ethnic disparities in preterm births. Results from this research support the need to increase access to appropriate and timely prenatal care for women of all races/ethnicities in an effort to reduce racial/ethnic disparities in preterm births.

Motivational and behavioural consequences of self-affirmation interventions: a study of sunscreen use among women.

The reported study compared the efficacy of three self-affirmation manipulations in reducing defensive processing and instigating behaviour change in response to personally relevant information about the health risks of sunbathing. White female sunbathers (N = 162) were recruited on a beach in the south of England. Participants were randomly allocated to a 'values affirmation' condition, a 'kindness affirmation' condition, a 'positive traits affirmation' condition, or a no affirmation 'control' condition. In the 'positive traits affirmation' condition the self-affirmation task was incorporated into a leaflet presenting the health risk information. Findings supported the hypothesis that participants in the three self-affirmation conditions would engage in less-defensive processing of the health-risk information than those in the 'control' condition. For the behavioural measure, however, only those participants in the 'positive traits affirmation' condition were more likely to request a free sample of sunscreen than those in the control condition. The implications of these findings for self-affirmation theory and the development of effective health promotion campaigns are discussed.

Blockade of alpha1 adrenoreceptors in the dorsal raphe nucleus prevents enhanced conditioned fear and impaired escape performance following uncontrollable stressor exposure in rats.

Previous research has shown that the effect of exposure to uncontrollable stressors on conditioned fear responding and escape behavior in rats is dependent on serotonergic neural activity in the dorsal raphe nucleus (DRN). The role that norepinephrine released in the DRN plays in producing the behavioral consequences of exposure to inescapable tail shock in rats was investigated in the present study. The selective alpha1 adrenoreceptor antagonist benoxathian was injected into the DRN before exposure to inescapable tail shock or before behavioral testing conducted 24 h later. Benoxathian prevented the impairment of escape responding produced by inescapable shock, but did not reverse this effect when given before testing. The enhancement of conditioned fear produced by prior inescapable shock was attenuated by benoxathian administered before inescapable shock or before behavioral testing. These results support the view that noradrenergic input to the DRN is necessary to produce the behavioral effects of inescapable tail shock.

Immediate and long-term results of radiofrequency ablation of pulmonary vein ectopy for cure of paroxysmal atrial fibrillation using a focal approach.

BACKGROUND: Atrial fibrillation (AF) is frequently initiated by focal activity originating in the pulmonary veins. We present the early and long-term results of a focal approach to pulmonary-vein ablation for cure of paroxysmal AF. AIMS: The aim of this study was to establish the effectiveness of focal pulmonary vein radiofrequency ablation (RFA) for cure of paroxysmal AF. METHODS: Fifty-one consecutive patients (35 male; 45+/-11.4 years) were considered for RFA on the following criteria: (i) symptomatic drug refractory AF, (ii) high-density atrial ectopy, bursts of atrial tachycardia or AF, (iii) absence of structural heart disease and (iv) provision of informed consent. Pulmonary vein mapping and RFA were by single trans-septal puncture, which was only performed in patients with adequate focal activity at the time of procedure. Focal activity was present spontaneously or was elicited by isoprenaline, burst pacing or AF induction and cardioversion. RESULTS: One patient was excluded from the analysis due to non-pulmonary vein triggers. Trans-septal mapping and RFA were not performed in 22 patients (44%) due to: (i) inadequate ectopy (17), (ii) recurrent AF (1), (iii) inability to cross septum (2) and (iv) multiple foci (2). Of 28 patients, RFA was attempted with procedural success in 23 patients (82%), with no acute complications. Mean fluoroscopy time for patients having RFA was 29+/-11.5 mins. Pulmonary vein stenosis occurred in one case. Ten patients had symptomatic recurrence and, of those, two had further RFA. At a mean follow up of 11+/-8 months, 15 patients (54% ablated, 30% of the total cohort) remained free of AF without antiarrhythmics. CONCLUSION: This series highlights the low long-term success rate of RFA to cure AF by targeting pulmonary vein initiators using a focal approach. Electrical pulmonary vein isolation may provide better long-term results.

The role of the habenular complex in the elevation of dorsal raphe nucleus serotonin and the changes in the behavioral responses produced by uncontrollable stress.

Previous research indicates that the serotonergic neurons of the caudal dorsal raphe nucleus (DRN) are activated to a greater degree by inescapable shock (IS) as compared to escapable shock (ES), causing a greater release of serotonin (5-HT) in the DRN and in target regions. This differential activation is necessary for the behavioral changes that occur after exposure to IS, but not to ES (i.e. learned helplessness/behavioral depression). Although the critical role of the DRN in learned helplessness is clear, the neural inputs to the caudal DRN which result in this selective activation are unknown. One structure that may be involved in the activation of the DRN and the induction of learned helplessness/behavioral depression is the habenular complex. In experiment 1, habenula lesions eliminated the differential rise in DRN extracellular 5-HT levels in response to IS and ES exposure by severely attenuating the rise in 5-HT for both groups. In experiment 2, sham operated and habenula lesioned rats were exposed to either ES, IS or no stress (home cage control; HCC). Twenty-four hours later, sham rats previously exposed to IS exhibited longer escape latencies as compared to both ES and HCC rats (i.e. learned helplessness). The habenular lesion eliminated the differences in escape latency between groups, thus eliminating the induction of learned helplessness/behavioral depression. These results suggest that the habenula is necessary for the differential activation of the DRN and the escape deficits produced by IS.

Clinical outcome after radiofrequency catheter ablation of focal atrial fibrillation triggers.

INTRODUCTION: Ablative therapy for atrial fibrillation (AF) by targeting initiating triggers, usually in or around the pulmonary veins, has been reported by several centers. Evidence for an overall improvement in quality of life (QOL) and amelioration of symptoms is lacking. METHODS AND RESULTS: Seventy-one patients undergoing attempted ablation of focal AF were followed for 60+/-33 weeks. QOL and symptom questionnaires were completed 1 month before and 6 months after electrophysiologic study. Twenty-three patients (32%) underwent electrophysiologic mapping but no ablation because of either insufficient or multifocal ectopy; the other 48 patients (68%) underwent attempted ablation. Sixteen of 48 patients (33%) undergoing ablation, or 16 (23%) of 71 on an intention-to-treat basis, were found at last follow-up to have persistent sinus rhythm without antiarrhythmic drugs. Patients who underwent mapping without ablation reported no improvements in any QOL or symptom score, whereas patients who had long-term successful ablation had significant improvements in all six QOL measures. Interestingly, patients who developed AF recurrence after ablation still reported significant improvements in 4 of 6 QOL measures. Four of 48 patients (8.3%) undergoing ablation developed pulmonary vein stenosis. CONCLUSION: Paroxysmal AF can be treated successfully in some patients by ablating initiating triggers in the pulmonary veins; however, in our experience the recurrence rate (32/48 [68%]) and risk of pulmonary vein stenosis (8%) after ablation are high. Patients with recurrent AF after ablation of focal AF triggers have significant improvement in QOL and symptoms compared with before ablation. Patients and their physicians should carefully balance the risks and benefits before considering ablation.