Selective proximal left anterior fascicle pacemapping for guiding narrow QRS premature ventricular complex ablation from the right coronary cusp.

A 38-year-old woman with a structurally normal heart was referred for catheter ablation due to symptomatic, monomorphic, high burden (12%) premature ventricular complexes (PVC) refractory to medical therapy. The PVC's ECG morphology suggested an origin in the proximal left anterior fascicle (LAF). During procedure PVCs were mechanically suppressed. Consequently, selection of the ablation target site was based on pace-mapping. This case illustrates how ablation from the right coronary cusp (RCC) for PVC arising from the proximal LAF could be accurately guided by pace-mapping. At this location, pacing can result in both a selective and a non-selective capture of the proximal LAF.

Synthesis of UV-11 MOF and Its Characterization by Cyclic Voltammetry.

In this work a Metal-Organic Framework (MOF) was prepared using a solvothermal method, taking as precursors 1. 2-di-(4-pyridyl)-ethylene, 1.2.4.5-benzenetetracarboxylic acid and Co(No3)2-6H2O. This MOF was called UV-11 and was evaluated using microscopic, spectroscopic and electrochemical techniques. According to the obtained results, the melting point of the compound is located in a higher interval than its precursors. Stereoscopic microscopy analysis shows the presence of pink crystals in the form of needles. MEB technique displays a laminar morphology as well as crystals with approximate sizes (36 mm wide and 150 mm long). EDS analysis corroborated the presence of precursor elements such as cobalt, carbon and oxygen. Furthermore, the XRD technique shows the cobalt-related phases in the sample, which is cobalt bis (pyridine-6-carboxylic-2-carboxylate). A modified carbon paste electrode was prepared using MOF UV-11 and by cyclic voltammetry electrochemical technique, semi-reversible redox processes are identified, as well as thermodynamic and kinetic parameters were obtained with the Laviron equation, and electrochemical performance properties from the cyclic voltammetry experimental data.

A simple method to detect leaks after left atrial appendage occlusion with Watchman.

BACKGROUND: We evaluated the efficacy of a new method in identifying peri-device leak (PDL) using morphology of the thrombus formed inside the left atrial appendage (LAA) as seen on follow-up transesophageal echo (TEE). METHOD: A total of 291 consecutive patients undergoing Watchman procedure were included in this analysis. TEE was performed at 45 days postprocedure. Based on the presence of the thrombus inside the LAA behind the device, patients were grouped as (1) white (W) group: LAA completely filled with thrombus (n = 101), 2) nonwhite (NW) group: LAA completely black or mixed (part black and part white; n = 190). Follow-up TEE was repeated at 6 and 12 months. RESULTS: Baseline characteristics were comparable between groups except the device size, number of patients with chicken-wing morphology, and prevalence of left atrial "smoke" that were significantly higher in the NW group. Detection of black appearance was comparable between the pre-coil closure image and the NW population (26/36 [72.2%] vs 99/154 [64.3%], p = .37). After adjusting for clinically relevant covariates, NW appearance of the LAA was associated with the presence of significant leak (odds ratio: 47.96, 95% confidence interval: 2.91-790.2, p < .001). The 11 patients with mixed appearance at the 6-month TEE remained unchanged (part black and part white) at the 12-month TEE. LAA appearance was white in all 36 patients following coil closure. CONCLUSION: Our findings demonstrated white and nonwhite appearance of the appendage on TEE to be reliable markers of complete closure and leak respectively, following LAA occlusion with the Watchman device.

Simple electrocardiographic criteria for rapid identification of wide QRS complex tachycardia: The new limb lead algorithm.

BACKGROUND: The electrocardiogram (ECG) is essential for the differential diagnosis of wide QRS complex tachycardia (WCT). OBJECTIVE: The purpose of this study was to evaluate the diagnostic value of a novel ECG algorithm on the basis of the morphological characteristics of the QRS on the limb leads. METHODS: The limb lead algorithm (LLA) was evaluated by analyzing 528 monomorphic WCTs with electrophysiology-confirmed diagnoses. In the LLA, ventricular tachycardia (VT) is diagnosed in the presence of at least 1 of the following: (1) monophasic R wave in lead aVR; (2) predominantly negative QRS in leads I, II, and III; and (3) opposing QRS complex in the limb leads: concordant monophasic QRS in all 3 inferior leads and concordant monophasic QRS in 2 or 3 of the remaining limb leads with a polarity opposite to that of the inferior leads. The diagnostic performance of the LLA was compared with that of the Brugada, Vereckei, and R-wave peak time (RWPT) algorithms. RESULTS: Of 528 WCT cases, 397 were VT and 131 supraventricular tachycardia. The interobserver agreement for the LLA was excellent (κ = 0.98), better than that for the other algorithms. The overall accuracy of the LLA (88.1%) was similar to that of Brugada (85.4%) and Vereckei (88.1%) algorithms but was higher than that of the RWPT algorithm (70.8%). The LLA had a lower sensitivity (87.2%) than did Brugada (94.0%) and Vereckei (92.4%) algorithms, but not the RWPT algorithm (67.8%). Furthermore, the LLA showed a higher specificity (90.8%) than did Brugada (59.5%), Vereckei (76.3%), and RWPT (80.2%) algorithms. CONCLUSION: The LLA is a simple yet accurate method to diagnose VT when approaching WCTs on the ECG.

The Value of Baseline and Arrhythmic ECG in the Interpretation of Arrhythmic Mechanisms.

Owing to the rapid development of new electrophysiologic techniques, our understanding of arrhythmias and their underlying mechanisms has reached unprecedented levels. In some cases, baseline ECG alterations can be identified before arrhythmia development; early recognition of these alterations is of utmost importance to start appropriate preventive therapies and stratify the risk according to patients' outcomes. Hereby, we report a systematic revision of main baseline ECG abnormalities and their implications on clinical outcomes.

Crystal structure of catena-poly[[[tri-aqua-(4-cyano-benzoato-κO)nickel(II)]-µ-4,4'-bi-pyridine-κ(2) N:N'] 4-cyano-benzoate].

In the title polymeric complex salt, {[Ni(C8H4NO2)(C10H8N2)(H2O)3](C8H4NO2)} n , the Ni(II) cation is coordinated by a 4-cyano-benzoate anion, two 4,4'-bi-pyridine ligands and three water mol-ecules in a distorted N2O4 octa-hedral geometry. The 4,4'-bi-pyridine ligands bridge the Ni(II) cations to form polymeric chains of the title complex cations, propagating along the c-axis direction. The dihedral angle between the pyridine rings of the 4,4'-bi-pyridine ligand is 24.9 (6)°. In the crystal, the uncoordinating 4-cyano-benzoate anions link with the complex cations via O-H⋯O hydrogen bonds into a three-dimensional supra-molecular architecture. Weak C-H⋯O, C-H⋯N inter-actions and π-π stacking [centroid-to-centroid distances = 3.566 (4) and 3.885 (4) Å] are also observed in the crystal.

Tuberculosis renal / Renal tuberculosis

En estudio de 10 años retrospectivos (1973-82), encontramos diez casos de Tuberculósis Renal, en el Hóspital Infantil "Robert Read Cabral", e indagamos algunas características clínicas y variables epidemiológicas, cada caso de Tuberculósis Renal fué confirmado por la presencia del Bacilo de Koch (B. K.) en orina almacenada de 24 horas. Otras pruebas coadyubantes fueron realizadas tales como: PPD, Baciloscopía, Radiografía de Torax, y Pielografía

Recuperacion de potencia de motores diesel operando a gran altitud

Existen muchas situaciones en que el aire aspirado por un motor diesel de aspiracion natural sufre alteraciones de sus condiciones normales, tal es el caso que se da en paises situados a grandes altitudes como el nuestro o con climas tropicales donde existe la necesidad de compensar la disminucion de la densidad del aire como consecuencia de una disminucion de la presion atmosferica ocasionada por la altitud y una disminucion de las moleculas de oxigeno por el aumento de la temperaturam, respectivamente.En ambos casos no es tan importante conseguir un aumento de potencia a traves de una dosificacion mayor de combustible, sino conseguir la misma potencia nominal del motor recuperando la potencia perdida por los factores indicados. El metodo mas conocido y recomendable es el de la sobrealimentacion mediante un turbocompresor, el cual debe ser adecuado y especifico a los requerimientos del motor. El acople entre dos elementos motor-turbocompresor se lo realiza de manera tal que interactuan termodinamicamente para mejorar el rendimiento energetico del sistema y alcanzar la potencia deseada. El proceso de recuperacion de potencia de motores diesel de aspiracion natural operando a grandes altitudes mediante este procedimiento es muy ventajoso, considerando sobre todo desde el punto de vista economico.