Aveir VR real-world performance and chronic pacing threshold prediction using mapping and fixation electrical data

AIMS

Aveir VR performance and predictors for its pacing threshold (PCT) in a real-world cohort were investigated.

METHODS

Electrical measurements at various stages of an Aveir VR implant were prospectively collected. Predictors for 3-month PCT were studied. A retrospective cohort of consecutive 139 Micra implants was used to compare the PCT evolution. High PCT was defined as ≥1.5 V, using a pulse width of 0.4 ms for Aveir and 0.24 ms for Micra. Excellent PCT was defined as ≤0.5 V at the respective pulse width.

RESULTS

Among the 123 consecutive Aveir VR implant attempts, 122 (99.2%) were successful. The majority were of advanced age (mean 79.7) and small body size (mean BSA 1.60). Two patients (1.6%) experienced complications, including one pericardial effusion after device reposition and one intraoperative device dislodgement. Eighty-eight patients reached a 3-month follow-up. Aveir 3-month PCT was correlated with impedance at mapping (P = 0.015), tether mode (P < 0.001), end-of-procedure (P < 0.001), and mapping PCT (P = 0.035), but not with PCTs after fixation (P > 0.05). Tether mode impedance >470 ohms had 88% sensitivity and 71% specificity in predicting excellent 3-month PCT. Although it is more common for Aveir to have high PCT at end of procedure (11.5% for Aveir and 2.2% for Micra, P = 0.004), the rate at 3 months was similar (2.3% for Aveir and 3.1% for Micra, P = 1.000).

CONCLUSION

Aveir VR demonstrated satisfactory performance in this high-risk cohort. Pacing thresholds tend to improve to a greater extent than Micra after implantation. The PCT after fixation, even after a waiting period, has limited predictive value for the chronic threshold. Low-mapping PCT and high intraoperative impedance predict chronic low PCT.

Molecular basis for the photosynthetic primary process

In this paper, the molecular details for the primary reaction in photosynthesis are deduced from several recent critical experimental observations. A symmetrical structure is proposed for the basic unit of the reaction center in plant photosynthesis. A mathematical consequence of the symmetrical arrangement is the creation of an anomalously long-lived trap state, which makes possible the summation of a reaction-center triplet excitation and an antenna chlorophyll singlet excitation to bring the photoactive chlorophylls to a charge-transfer state prior to entering into a primary photochemical reaction.

Non-cyclic photoreductive carbon fixation in photosynthesis. Light and dark transients of the glycerate-3-P special pair

It is demonstrated that carbon fixation in photosynthesis is regulated in two kinetically coupled pathways involving the specialized pair of non-equivalent, enzyme-bound glycerate-3-P (3-PGA) molecules obtained from ribulose 1,5-bisphosphate (RuBP) carboxylation in the light. A non-cyclic pathway is suggested (reaction 2) for the direct biosynthesis of sucrose from the 3-PGA obtained from C-3, C-4 and C-5 of the six-carbon carboxylation adduct. Concomitant to the appearance of sucrose as the principal product, the Mg2+-bound 3-PGA molecule formed from C-1, C-2 and C-2' of the C6 intermediate is released and subsequently reduced in regenerating the RuBP. It is proposed that the nocturnal inhibitor, 2-carboxyarabinitol-1-phosphate (1-PCA) is obtained from a condensation of 3-PGA and glyceraldehyde.

Photoreductive path of carbon fixation in green plant photosynthesis. Reaction pathway of six-carbon ribulose 1,5-bisphosphate carboxylation adduct intermediate

In this paper we examine the six-carbon intermediate pathway of ribulose 1,5-bisphosphate (RuBP) carboxylation reaction in photosynthesis. Based on the observed reactions of purified RuBP carboxylase, mechanisms are described for carbon dioxide assimilation leading to the hydrolytic splitting of the six-carbon intermediate to two enzyme-bound glycerate-3-P (3-PGA) molecules. It is concluded that, under photosynthetic conditions, the reduction of enzyme-bound NADP+ by the chlorophyll is responsible for the rapid carboxylase turnover rate given by the lifetime, tau L = 0.4 s, which is nearly two orders of magnitude shorter than the corresponding value, tau D = 11 +/- 3 s, for the dark decay of enzyme-bound RuBP. The nocturnal inhibition and photoactivation of RuBP carboxylation are described in terms of the reversible light-dark cycles of the NADP+/NADPH redox couple and endogenous changes that accompany the 2-carboxy-D-arabinitol-1-phosphate binding to the enzyme active site.

Superoxide photogeneration by chlorophyll a in water/acetone. Electron spin resonance studies of radical intermediates in chlorophyll a photoreaction in vitro

In this paper we report the use of DMPO (5,5-dimethyl-1-pyrroline-1-oxide) as spin trap in the ESR observation of O2-. photogeneration by in vitro Ch1 a in oxygen-saturated 50:50% (v/v) water/acetone. The observed hyperfine parameters for the spin adducts of DMPO are identical to those obtained from H2O2 decomposition, and to those reported by earlier workers for the formation of 02-. in oxygen-saturated preparations of spinach chloroplasts.

In vitro preparation and characterization of a 700 nm absorbing chlorophyll-water adduct according to the proposed primary molecular unit in photosynthesis

1. This study characterized chlorophyll a-H2O adducts in vitro in order to establish their generic relationship to the recently proposed [15, 18-20, 31] primary molecular adduct in photosynthesis. The effects of water titration and temperature on the absorption, fluorescence, excitation, and redox properties of the various in vitro chlorophyll a aggregate species are investigated. 2. From fluorescence measurements, we conclude that the driest chlorophyll a sample contains an equimolar amount of water. This conclusion is consistent with earlier experimental work [2, 3, 14, 17, 31], and clarifies the origin of the controversial [15] Katz model [14] of chlorophyll a-H2O interactions. 3. With increasing water concentration or as the temperature is lowered below room temperature, the A-663 monohydrate chlorophyll a-H2O (species absorbing at 663 nm) is favored at the expense of the A-678 anhydrous aggregate according to the equilibrium 2H2O+chlorophyll a2in equilibrium2 chlorophyll a-H2O. Under excess water conditions, A-663 is converted to A-743 (chlorophyll a-2H2O)n. 4. On slow sample cooling to T less than or approximately 200 degrees K, we observe the growth of A-700 at the expense of A-663. There is a direct correspondence between the increasing (decreasing) absorption by A-700 (A-633) and increasing (decreasing) fluorescence at 720 nm (664 nm). 5. It is concluded that A-700 is most probably the dimer participating in the equilibrium 2 chlorophyll a-H2O in equilibrium (chlorophyll a-H2O)2. The A-700 band consists of two exciton components (separated by approximately 280 cm1) that are interpretable in terms of the dimeric origin of A-700. 6. The deconvoluted A-700 absorption spectrum and the excitation spectrum of the 720 nm fluorescence are compared with the light-minus-dark spectra of P-700. 7. It is found that A-700 is reversibly bleached by I2 (E0 equals 0.54 V). The significance of this observation is discussed in terms of the redox properties of monomeric chlorophyll a and P-700.