A new interpretation of nonpulmonary vein substrates of the left atrium in patients with atrial fibrillation.

BACKGROUND: Substrate analysis of the left atrium in patients undergoing atrial fibrillation ablation has limitations when performed by means of simple bipolar acquisition. OBJECTIVE: To evaluate the incidence of low-voltage zones (LVZs) through maps constructed by means of various catheters: multipolar (MC), omnipolar (OC), and circular catheters (CMCs) with the 3D electro-anatomical systems (3d-S) CARTO3 and EnSite Precision. METHODS: To assess LVZs, we acquired maps by means of CMC and MC in the voltage range 0.05-0.5 mV in 70 consecutive patients in sinus rhythm. In the case of OC only, we made an intra-patient comparison of bipolar maps constructed by means of the along and across, and HD-Wave configurations of the EnSite 3d-S in the ranges of 0.05-0.5 and 0.5-1.0 mV. On the basis of this comparison, we chose the range that best identified LVZs as a set of different colors (SDC) compatible with patchy fibrosis (qualitative analysis). Subsequently, we detected the voltage values corresponding to purple and gray points, close to SDC, and the value inside corresponding to blue, green, and red colors, and we evaluated the color change in other voltage ranges. Finally, we performed a quantitative analysis of LVZs by applying the qualitative characteristics described above. RESULTS: On the basis of our settings, for OC, the optimal range identifying LVZs was 0.3-0.6 mV. OC revealed smaller LVZs than MC (P < .05 or P < .001), except in the lateral wall. No significant differences were observed between CMCs. CONCLUSIONS: In our experience, OC does not present the limits of bipolar HD maps, though further studies are needed in order to confirm that 0.3-0.6 mV is the optimal voltage range within which to identify LVZs.

Adhesion mechanisms at the interface between Y-TZP and veneering ceramic with and without modifier.

OBJECTIVE: This study investigated the mechanism of action at the interface between a commercially available Y-TZP and its veneering ceramic after final firing. Particular attention was paid, from a microstructural point of view, to evaluating the effects of different surface treatments carried out on the zirconia. METHODS: In total, 32 specimens of presintered zirconia Y-TZP (LavaFrame, 3M ESPE, Germany) were cut with a low-speed diamond blade. The specimens were divided in two major groups, for testing after fracture or after mirror finishing, and were sintered following the manufacturer's instructions. Each major group was then randomly divided into four subgroups, according to using or not using the dedicated framework modifier, with or without a preliminary silica coating (CoJet, 3M ESPE). A suitable veneering ceramic was used for each group (Lava Ceram Overlay Porcelain, 3M ESPE). A detailed microstructural study of the interfaces of the zirconia-veneering ceramic was performed using a scanning electron microscope equipped with an energy-dispersive X-ray spectrometer to evaluate chemical variation at the interfaces. RESULTS: When the framework modifier was not applied on the Y-TZP surface, microdetachments, porosities, and openings in the ceramic layer were observed at the interlayers. A degree of diffusion of different elements through the interfaces from both the zirconia and veneering layers was detected. CONCLUSIONS: Application of the framework modifier can increase the wettability of the zirconia surfaces, allowing a continuous contact with the veneering layer. The micro-analysis performed showed the presence of a reaction area at the interface between the different materials. CLINICAL SIGNIFICANCE: the increase of the wettability of the zirconia surface could improve the adhesion at interface with the veneering ceramic and reduce the clinical failure as chipping or delamination.

Microstructural changes produced by abrading Y-TZP in presintered and sintered conditions.

OBJECTIVE: To evaluate the effect of abrading before and after sintering using alumina-based abrasives on the surface of yttria-tetragonal zirconia polycrystals. Particular attention was paid to the amount of surface stress-assisted phase transformation (tetragonal→monoclinic) and the presence of microcracks. METHODS: Pre-sintered zirconia ceramic specimens (ZirCAD; Ivoclar Vivadent) were first surface-ground flat with #600-800-1000-grit SiC paper. They were then surface-treated with different grain size abrasives before and after the sintering step. Samples that underwent no surface treatment were used as controls. For each condition, eight specimens were prepared. The physical/mechanical characteristics of zirconia material were determined by measuring density, porosity, grain size, hardness, and fracture toughness. The effects of surface treatments were assessed by surface roughness measurements, quantitative X-ray diffraction analysis, and scanning electron microscopy. RESULTS: With increased dimensions of the abrasive particles, the abraded surfaces of zirconia specimens exhibited a widespread system of microcracks and an increased monoclinic zirconia quantity. These structural changes likely affect the aging of the material during its clinical service.