The Importance of a Distance between the Lines Encircling Pulmonary Veins in Atrial Fibrillation Ablation on First-Pass Isolation Ratio and Clinical Outcomes.

INTRODUCTION: How wide the encircling line is made may influence the outcomes of pulmonary vein isolation (PVI). In the present study we hypothesised that the distance between the lines encircling the pulmonary veins may correspond with the extent of wide antral circumferential ablation (WACA). The aim of the study was to assess the impact of the distance and the area between the lines on the posterior wall of the left atrium on first-pass isolation rate and 12-month freedom from atrial arrhythmia in patients undergoing PVI ablation. METHODS AND RESULTS: One hundred sixteen patients underwent circumferential ablation index (AI)-guided PVI. The distance between the encircling ablation lines was measured off-line between the uppermost points (right and left) and the lowest points and as the area between the encircling lines on the posterior wall. The first-pass isolation rate and 12-month freedom from atrial arrhythmia were 59% and 73%, respectively. Distance between the encircling lines measured linearly or as the area of the posterior wall, assessed as direct values or indexed to left atrial dimensions, did not differ between patients with and without first-pass isolation or between patients with and without recurrences of atrial arrhythmia. CONCLUSIONS: The distance between the ablation lines did not influence the rate of first-pass isolation and arrhythmia recurrence in the long-term follow-up after PVI procedures incorporating the ablation index protocol.

The value of the ablation index in patients undergoing ablation for atrial fibrillation.

BACKGROUND: Data on the results of ablation for atrial fibrillation (AF) in Poland are scarce. AIMS: The aim of the study was to compare the efficacy of ablation index (AI)-guided pulmonary vein isolation (PVI) with that of conventional contact force-based PVI. METHODS: Consecutive patients undergoing PVI for the first time were included in the study. A nonrandomized retrospective comparison was made between patients ablated with contact force before AI was introduced (non -AI group) and patients ablated with the use of AI (AI group). The AI threshold for the anterior wall / roof of left veins was 500 and 380 elsewhere. The maximal interlesion distance was 6 mm. The follow -up included outpatient visits and 7-day Holter monitoring 6 and 12 months after ablation. RESULTS: A total of 275 patients were included in the analysis: 133 in the AI group and 142 in the non--AI group. The duration of AF ablation was slightly longer in the AI group, but the fluoroscopy time and the radiofrequency ablation time were shorter in the same group. During the 12-month follow -up period, 25.8% and 40.6% of patients from the AI and non -AI groups, respectively, experienced recurrences (P = 0.02). The log -rank test with an extended follow -up period of up to 18 months confirmed the difference between the AI and non -AI groups, both in the whole group and in the paroxysmal AF and nonparoxysmal AF subgroups (P = 0.001, P = 0.04, and P = 0.006, respectively). CONCLUSION: The AI -based protocol provides a significant advantage over traditional contact force-based radiofrequency ablation in nonselected patients undergoing PVI.

Total reflection X-ray fluorescence analysis of elemental composition of herbal infusions and teas.

BACKGROUND: The elemental composition of herbal infusions and teas has not been sufficiently investigated. It could potentially be used for defining fingerprints for individual herbal / tea infusions, differentiation of botanical families, detecting the influence of packaging, and other purposes. The objective of this study was to determine the elemental composition, including the trace element content, of various herbal infusions and teas by means of total reflection X-ray fluorescence analysis (TXRF), with a chemometrics approach using principal component analysis (PCA). RESULTS: This study determined the elemental composition of various herbal infusions and teas, including trace elements, using total reflection X-ray fluorescence (TXRF). The methodology for the sample preparation was established, including the multiple-steepings procedure for the two tea samples (Oolong and Pu-erh). Data from 29 samples were collected. We hypothesized that the elemental content of infusions could reflect certain features, such as the influence of processing and the type of tea. CONCLUSION: A chemometric approach (PCA) was applied, and differences between teas and herbal infusions were found. This was further corroborated by explicit differentiation of one botanical family, Theaceae. The influence of packaging (tea bags) on herbal material was identified. The three types of tea (Camellia sinensis) appeared to be separated with PCA, and elemental concentrations in Pu-erh changed with multiple steepings.

Predictors of appropriate interventions and mortality in patients with implantable cardioverter-defibrillators.

INTRODUCTION: Additional risk assessment in patients with heart failure referred for implantable cardioverter­defibrillator (ICD) implantation as primary prevention is needed. A reduction in left ventricular ejection fraction (LVEF) seems to lack sufficient sensitivity and specificity to be used for identification of patients at the highest risk of sudden cardiac death. OBJECTIVES: The aim of this study was to identify short- and long­term predictors of appropriate implantable cardioverter­defibrillator therapy as well as predictors of long­term mortality in patients with an ICD or cardiac resynchronization therapy defibrillator (CRT­D). PATIENTS AND METHODS: In this retrospective study, data from 457 patients who had an ICD or CRT­D implanted between 2011 and 2017 were analyzed. RESULTS: During the median follow­up of 31 months (interquartile range, 17-52 months), 153 patients died (33.9%) and 140 had appropriate interventions (31%). In a multivariate Cox regression analysis, implantation for secondary prevention (hazard ratio [HR], 2.49; P <0.001), severe mitral valve disease (HR, 2.17; P <0.001), and previous myocardial infarction (HR, 1.68; P = 0.009) were predictors of appropriate intervention. Resynchronization therapy (HR, 0.59; P = 0.025) and severe mitral valve disease (HR, 2.42; P <0.001) were predictors of appropriate intervention in primary prevention. Body mass index, hemoglobin concentrations, LVEF, diabetes, and left atrial diameter were significant predictors of death. CONCLUSIONS: Implantation of ICD or CRT­D as secondary prevention was a potent predictor of appropriate intervention, while resynchronization therapy and severe mitral regurgitation predicted ICD therapy in primary prevention. In patients with ICD or CRT-D, independent predictors of mortality included: body mass index, hemoglobin concentrations, LVEF, diabetes, and left atrial diameter.

Altered gene expression pattern in peripheral blood mononuclear cells in patients with acute myocardial infarction.

BACKGROUND: Despite a substantial progress in diagnosis and therapy, acute myocardial infarction (MI) is a major cause of mortality in the general population. A novel insight into the pathophysiology of myocardial infarction obtained by studying gene expression should help to discover novel biomarkers of MI and to suggest novel strategies of therapy. The aim of our study was to establish gene expression patterns in leukocytes from acute myocardial infarction patients. METHODS AND RESULTS: Twenty-eight patients with ST-segment elevation myocardial infarction (STEMI) were included. The blood was collected on the 1(st) day of myocardial infarction, after 4-6 days, and after 6 months. Control group comprised 14 patients with stable coronary artery disease, without history of myocardial infarction. Gene expression analysis was performed with Affymetrix Human Gene 1.0 ST microarrays and GCS3000 TG system. Lists of genes showing altered expression levels (fold change >1.5, p<0.05) were submitted to Ingenuity Pathway Analysis. Gene lists from each group were examined for canonical pathways and molecular and cellular functions. Comparing acute phase of MI with the same patients after 6 months (stable phase) and with control group we found 24 genes with changed expression. In canonical analysis three pathways were highlighted: signaling of PPAR (peroxisome proliferator-activated receptor), IL-10 and IL-6 (interleukin 10 and 6). CONCLUSIONS: In the acute phase of STEMI, dozens of genes from several pathways linked with lipid/glucose metabolism, platelet function and atherosclerotic plaque stability show altered expression. Up-regulation of SOCS3 and FAM20 genes in the first days of myocardial infarction is observed in the vast majority of patients.

The LocaLisa system as the key to shortening the procedure duration and fluoroscopy time during ablation of atrial fibrillation.

BACKGROUND: Ablation of atrial fibrillation (AF) can be difficult and time-consuming. Systems facilitating catheter navigation may be helpful. AIM: To compare the efficacy of the LocaLisa system with the conventional mapping/ablation approach to radiofrequency (RF) ablation of AF. METHODS: Group 1, consisting of 64 patients (48 male; aged 51.5+/-10.6 years), underwent segmental isolation of the pulmonary veins with the Lasso catheter and the LocaLisa system. Group 2, consisting of 64 patients (44 male, aged 51.4+/-11.0 years), had RF ablation guided by means of a conventional fluoroscopy-based approach. Clinical and procedural data were analysed. RESULTS: Nine patients from group 1 and three patients from group 2 had persistent AF. In group 1 the mean number of isolated veins was 3.98+/-0.96, while in group 2 - 4.0+/-0.95 (NS). In group 1 cavotricuspid isthmus lines were created in four patients and lines in the roof of the left atrium in two patients. One patient needed slow pathway ablation. In group 2 six patients had ablation of the cavotricuspid isthmus and a line was created at the roof of the left atrium in one patient. Two patients had ectopic activity ablated in the crista terminalis. Procedure times were 131.6+/-40.3 and 170.0+/-56.5 min (p <0.0001) and fluoroscopy times were 16.93+/-9.7 and 35.66+/-12.7 min (p <0.0001) for groups 1 and 2, respectively. Long-term efficacy of RF ablation was similar in both groups (for example, complete success was achieved in 59% of patients using LocaLisa and 50% without using this system, NS). CONCLUSIONS: The LocaLisa navigation system makes it possible to shorten both the duration of the procedure and the total fluoroscopy time during ablation of AF.