Efficient CsPbBr3 Quantum-Dot Light-Emitting Diodes Using Sputtered NiO Films as Hole Injection Layers

Perovskite quantum dots (QDs) have showed excellent optoelectronic properties to extend the application range of novel solid-state lighting, such as perovskite QD based LEDs (QD-LEDs). However, the traditional device structure of perovskite QD-LEDs employed PEDOT:PSS as a hole inject layer (HIL), which impairs stability due to acidic surface characteristics. This study proposes the sputtered NiO films as an HIL to replace acidic PEDOT:PSS. The NiO films with significantly different characteristics were prepared by controlling the sputtering parameters to investigate the devices' performance of NiO-based CsPbBr3 QD-LEDs. The optimized device showed an excellent performance with maxima luminescence of 20,118 cd/m2 and an external quantum efficiency (EQE) up to 3.63%.

Facile and Unplugged Surface Plasmon Resonance Biosensor with NIR-Emitting Perovskite Nanocomposites for Fast Detection of SARS-CoV-2

The emergence of the coronavirus disease 2019 (COVID-19) pandemic prompted researchers to develop portable biosensing platforms, anticipating to detect the analyte in a label-free, direct, and simple manner, for deploying on site to prevent the spread of the infectious disease. Herein, we developed a facile wavelength-based SPR sensor built with the aid of a 3D printing technology and synthesized air-stable NIR-emitting perovskite nanocomposites as the light source. The simple synthesis processes for the perovskite quantum dots enabled low-cost and large-area production and good emission stability. The integration of the two technologies enabled the proposed SPR sensor to exhibit the characteristics of lightweight, compactness, and being without a plug, just fitting the requirements of on-site detection. Experimentally, the detection limit of the proposed NIR SPR biosensor for refractive index change reached the 10-6 RIU level, comparable with that of state-of-the-art portable SPR sensors. In addition, the bio-applicability of the platform was validated by incorporating a homemade high-affinity polyclonal antibody toward the SARS-CoV-2 spike protein. The results demonstrated that the proposed system was capable of discriminating between clinical swab samples collected from COVID-19 patients and healthy subjects because the used polyclonal antibody exhibited high specificity against SARS-CoV-2. Most importantly, the whole measurement process not only took less than 15 min but also needed no complex procedures or multiple reagents. We believe that the findings disclosed in this work can open an avenue in the field of on-site detection for highly pathogenic viruses.

Planar Perovskite Solar Cells Using Perovskite CsPbI3 Quantum Dots as Efficient Hole Transporting Layers

Perovskite CsPbI₃ quantum dots (QDs) were synthesized as a hole-transporting layer (HTL) of a planar perovskite solar cell (PSC). By using the Octam solution during the ligand engineering, CsPbI₃ QDs exhibits a denser grain and a larger grain size due to the short-chain ligands of Octam. In addition, CsPbI₃ QDs with the Octam solution showed a smooth and uniform surface on MAPbI₃ film, indicating the QDs improved the microstructure of the MAPbI₃ perovskite film. As a result, the PSC with CsPbI₃ QDs as an HTL has the optimal open-circuit voltage as 1.09 V, the short-circuit current as 20.5 mA/cm², and the fill factor (FF) as 75.7%, and the power conversion efficiency (PCE) as 17.0%. Hence, it is inferred that introducing QDs as a HTL via the ligand engineering can effectively improve the device performance of the PSC.

Anion-Exchange Blue Perovskite Quantum Dots for Efficient Light-Emitting Devices

In this study, blue perovskite quantum dots (PQDs) were prepared using didodecyldimethylammonium bromide (DDAB), which can passivate surface defects caused by the loss of surface ligands and reduce particle size distribution. After the passivation of DDAB, blue CsPbCl_xBr_3-x PQDs dispersed in n-octane produced a more compact and uniform PQD thin film than the non-passivated ones. The resulting device showed a stabile lifetime, and an EL peak of 470 nm and a maximum EQE of 1.63% were obtained at an operating voltage of 2.6 V and a current density of 0.34 mA/cm². This work aims to provide a simple method to prepare blue-emitting PQDs and high-performance PQD-based light-emitting devices.

Should we initiate oral anticoagulants for patients with atrial fibrillation staying well without oral anticoagulants for years?

Background

Although non-vitamin K antagonist oral anticoagulants (NOACs) were more and more commonly prescribed for stroke prevention for patients with atrial fibrillation (AF), underuse of OACs is still not uncommon. Data about the initiations of OACs in AF patients who did not experience ischemic stroke without any OACs for years since incident AF was diagnosed were limited. We aimed to investigate the associations between the initiations of warfarin or NOACs and clinical outcomes among this population.

Methods

From January 1st, 2007 to December 31st, 2010, a total of 167,176 newly-diagnosed AF patients aged ≥20 years were identified from the Taiwan National Health Insurance Research Database as the study population. Among the study population, 32,917 patients with a CHA2DS2-VASc score >1 for males or >2 for females who did not receive warfarin or NOACs and survived for at least 90 days after June 1st, 2015 were defined as the “original non-OAC cohort”. These patients were then categorized into 3 groups according to the stroke prevention strategies they received after June 1st, 2015; that is, without OACs (n=31,195), warfarin (n=230) and NOACs (n=1,492).

Results

Compared to patients staying on non-OACs, the risk of ischemic stroke was lower for patients who initiated NOACs (aHR 0.867; p=0.043). The risk of all-cause mortality was lower for patients who started to receive warfarin (aHR 0.876; p=0.036) or NOACs (aHR 0.798; p=0.047). The composite risk of ischemic stroke or major bleeding was also lower for patients who initiated warfarin (0.849; p<0.001) or NOACs (0.789; p<0.001) (Figure 1). Compared to warfarin, NOACs use was associated with a lower risk of ischemic stroke (aHR 0.819; p<0.001), ischemic stroke or intracranial hemorrhage (aHR 0.927; p=0.042) or ischemic stroke or major bleeding (aHR 0.912; p<0.001).

Conclusions

Initiations of OACs, especially NOACs, should still be considered for AF patients who stayed well without OACs for years since incident AF was diagnosed.

Funding Acknowledgement

Type of funding sources: None.

P4793Comparing the effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in the elderly Asian patients with atrial fibrillation

Background

Stroke prevention in elderly patients with atrial fibrillation (AF) can be challenging. Comparisons of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in the elderly, at different age strata (age 65–74, 75–89, ≥90) in the daily practice have not been well described, particularly in Asians. We aimed to assess the clinical outcomes of NOACs compared warfarin for stroke prevention in elderly patients with AF.

Methods

A total of 64,169 AF patients aged ≥65 years receiving NOACs or warfarin prescription were identified from the Taiwan National Health Insurance Research Database. The risks of adverse events were compared between NOACs and warfarin in all patients age ≥65 and specifically, with different age strata; that is 65–74 years, 75–89 years and >90 years.

Results

Overall NOACs were associated with a significantly lower risk of ischemic stroke (adjusted hazard ratio [aHR] 0.869, 95% confidence interval [CI] 0.812–0.931), ICH (aHR 0.524, 95% CI 0.456–0.601), major bleeding (aHR 0,824, 95% CI 0.776–0.875), mortality (aHR 0.511, 95% CI 0.491–0.532) and composite adverse events (aHR 0.646, 95% CI 0.625–0.667) compared to warfarin. There was heterogeneity in treatment effect for NOACs versus warfarin in different age strata, but the results still favored NOACs even among the very elderly (>90 years). The absolute risk difference and reductions in ICH and composite adverse events with NOAC use were even greater among the elderly compared to warfarin (Figure).

Conclusions

Compared to warfarin, NOACs were associated with a significantly lower risk of adverse events, with heterogeneity in treatment effects among different age strata. Overall, the clear safety signal in favor of NOACs over warfarin was evident irrespective of age strata, being most marked in the most elderly.

P3775Income level is associated with risk of adverse events in patients with atrial fibrillation

Background

Atrial fibrillation (AF) increases the risk of cardiovascular events, major bleeding, and all-cause mortality. Risk factors for adverse events in AF patients have been identified, but data regarding the effect of income level were limited.

Methods

From the year 2010 to 2015, a total of 185,052 patients with AF aged ≥20 years were identified from the “National Health Insurance Research Database” in Taiwan and 169,450 of them had a CHA2DS2-VASc score ≥1 (for males) or ≥2 (for female). Among them, income data were available in149,489 patients and these subjects constituted our study population. Patients were classified into low-, intermediate- and high-income group. The baseline characteristics were analyzed. Subgroup analysis (low income versus high income; intermediate versus high income) was done using matched populations. The end-points include all-cause mortality, ischemic stroke, intracerebral hemorrhage (ICH), major bleeding and composite outcomes (any of mortality, ischemic stroke or ICH)

Results

Compared to the low-income group, patients in intermediate- and high-income groups were younger and had less underlying diseases. Besides, the percentage of anticoagulant use increased with income levels. The annual incidences of mortality, stroke, ICH, major bleeding and composite outcome increase with the decrease of income. Multi-variate Cox regression analysis showed that higher income was significantly associated with a lower risk of adverse events. The observations that high income conveys a lower risk remained consistent after matched subgroup analysis. (Figure) Compared to low-income group, the high-income group had a decreased risk of ischemic stroke by 18%, ICH by 22.5%, major bleeding by 16.4%, mortality by 44.4%, and composite outcome by 33.7%.

Incidence and hazard ratio

Conclusions

Income levels were associated with the risk of adverse events in AF patients and should be taken into account when taking care of AF patients.

P5667A clinical risk score for predicting incident atrial fibrillation in Asians: derivation in 7,220,654 Taiwan subjects with 438,930 incident atrial fibrillation

Background

The patient number of atrial fibrillation (AF) is continuously increasing all over the world. No risk score for predicting incident AF has been specifically developed using a nationwide dataset for Asians. Our aim was to investigate risk factors for incident AF in Asians and to combine them to develop a clinical risk scheme.

Method

From January 1st 2000 to December 31st 2000, 7,220,654 subjects aged >40 years without past history of cardiac arrhythmia were identified from the Taiwan National Health Insurance Research Database. Cox regression analysis was performed to identify significant clinical predictors of incident AF which were then incorporated together to develop a scoring scheme.

Results

During a follow up of 16 years, 438,930 patients experienced incident AF. The significant predictors and the calculation rule of the scoring scheme are shown in Figure A. The score ranged from −3 to 25, and the risk of incident AF ranged from 0.06%/year for patients with a score −3 to 7.99%/year for those with a score >19. The AUC in the prediction of 1-year risk of incident AF was 0.86 and was 0.75 for 16-year risk of AF (Figure B), which was higher than that of CHADS2, CHA2DS2-VASc and C2HEST scores.

Conclusion

A clinical risk score has been developed based on a large nationwide database which could be used to identify patients at a high risk of incident AF.

P4789Comparisons of direct oral anticoagulants and warfarin in patients with atrial fibrillation and liver cirrhosis

Background

Patients with atrial fibrillation (AF) and severe liver cirrhosis were excluded from the pivotal randomized trials comparing direct oral anticoagulants (DOACs) and warfarin. In the present study, we compared the effectiveness and safety of DOACs and warfarin among AF patients with liver cirrhosis.

Method

A total of 3,691 AF patients with liver cirrhosis having a CHA2DS2-VASc score ≥1 for males and ≥2 for females and received oral anticoagulants (DOACs in 2,548 and warfarin in 1,143) were identified from the Taiwan National Health Insurance Research Database. The effectiveness and safety were compared between DOACs and warfarin groups.

Results

There was a trend suggesting a lower risk of ischemic stroke with DOACs compared to warfarin (2.91%/yr vs 3.41%/yr; HR 0.743, p=0.060). The risks of bleeding events were lower with DOACs compared to warfarin with a HR (95% CI) of 0.718 (0.573–0.899, p=0.004) for major bleeding and 0.509 (0.292–0.889, p=0.018) for ICH. The risk of mortality was also lower in patients treated with DOACs (HR=0.483; 95% CI: 0.424–0.551, p<0.001). The cumulative incidence curves of each events for 2 groups are shown in Figure. The results were essentially similar after the propensity matching analysis of 2 groups.

Conclusion

Compared to warfarin, DOACs were associated with a lower risk of ICH, major bleeding and mortality among AF patient with liver cirrhosis.

P4773Oral anticoagulants in patients with atrial fibrillation having an intermediate risk of ischemic stroke but a high risk of bleeding

Background

The use of oral anticoagulants (OACs) for patients with atrial fibrillation (AF) for stroke prevention should be balanced between the reduction on stroke risk and the increase in bleeding. Our aim was to investigate net clinical benefits of OACs among AF patients with a CHA2DS2-VASc score of 1 (males) or 2 (females) who had a HAS-BLED score ≥3.

Method

A total of 404,949 newly diagnosed AF patients were identified from the Taiwan National Health Insurance Research Database. The stroke risk was assessed using the CHA2DS2-VASc score and patients were classified as low (score 0 for males, 1 for females), intermediate (1 for males and 2 for females) and high risk (≥2 for males and ≥3 for females). A high risk of bleeding was defined as a HAS-BLED score ≥3.

Results

The CHA2DS2-VASc and HAS-BLED scores were significantly correlated (r=0.70). Around 72.7% of patients with a high-risk of stroke had a HAS-BLED score ≥3 (Figure A). Among patients with a CHA2DS2-VASc score of 1 (males) or 2 (females) who had a HAS-BLED score ≥3, the use of OACs was associated with a lower risk of adverse events (ischemic stroke, intra-cranial hemorrhage or mortality) with an adjusted hazard ratio of 0.781 (p=0.037) (Figure B).

Conclusion

Even among patients with an intermediate risk of ischemic stroke (CHA2DS2-VASc score 1 for males, 2 for females) having a high risk for bleeding (HAS-BLED score ≥3), use of OACs was associated with a better clinical outcome and should still be considered.

D-Phe-Pro-Arg-Chloromethylketone: Its Potential Use in Inhibiting the Formation of In Vitro Artifacts in Blood Collected During Tissue-Type Plasminogen Activator Thrombolytic Therapy

In vitro artifacts due to proteolysis may occur in blood samples containing recombinant tissue-type plasminogen activator (rt-PA) due to continued activation of plasminogen to plasmin by rt-PA. The aim of this study was to identify a rapid inhibitor of rt-PA that would not interfere in assays designed to monitor thrombolytic events.

When rt-PA was added at 5 μg/ml to whole blood and incubated at 25° C, fibrinogen decreased 50 percent, plasminogen levels decreased 90 percent and α2-antiplasmin decreased below detectable levels. If D-Phe-Pro-Arg-chloromethylketone (PPACK) or aprotinin were added before the addition of rt-PA there was no significant loss of fibrinogen. Only PPACK completely inhibited changes in fibrin degradation products, plasminogen and α2-antiplasmin. PPACK was also found to inhibit the binding of rt-PA to plasma protease inhibitors in vitro.

Rhesus monkeys were infused with rt-PA and blood samples were taken with either PPACK or aprotinin in the collection syringe. There was a significant increase in the recovery of immunoreactive rt-PA and consistent measures of fibrinogen, FDPs, plasminogen, and α2-antiplasmin in the PPACK group as compared to the aprotinin group which indicates that PPACK will prevent the in vitro formation of artifacts due to the presence of active rt-PA

Screening for Atrial Fibrillation

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.

Electronic structure and characteristics of Fe 3d valence states of Fe(1.01)Se superconductors under pressure probed by x-ray absorption spectroscopy and resonant x-ray emission spectroscopy

The electronic structure and characteristics of Fe 3d valence states of iron-chalcogenide Fe(1.01)Se superconductors under pressure were probed with x-ray absorption spectroscopy and resonant x-ray emission spectroscopy (RXES). The intensity of the pre-edge peak at ~7112.7 eV of the Fe K-edge x-ray absorption spectrum of Fe(1.01)Se decreases for pressure from 0.5 GPa increased to 6.9 GPa. The satellite line Kβ' was reduced in intensity upon applying pressure and became absent for pressure 52 GPa. Fe(1.01)Se shows a small net magnetic moment of Fe(2+), likely arising from strong Fe-Fe spin fluctuations. The 1s3p-RXES spectra of Fe(1.01)Se at pressures 0.5, 6.9, and 52 GPa recorded at the Fe K-edge reveal that unoccupied Fe 3d states exhibit a delocalized character, stemming from hybridization of Fe 3d and 4p orbitals arising from a local distortion around the Fe atom in a tetrahedral site. Application of pressure causes suppression of this on-site Fe 3d-Fe 4p hybridization, and thereby decreases the intensity of the pre-edge feature in the Fe K-edge absorption spectrum of Fe(1.01)Se. Compression enhances spin fluctuations at Fe sites in Fe(1.01)Se and increases the corresponding T(c), through a competition between nearest-neighbor ferromagnetic and next-nearest-neighbor antiferromagnetic superexchange interactions. This result aids our understanding of the physics underlying iron-based superconductors.

Swelling activated chloride currents in the electrical activity of pulmonary vein cardiomyocytes

BACKGROUND

Pulmonary veins (PVs) contain cardiomyocytes with a high arrhythmogenicity for inducing atrial fibrillation. The swelling-activated outwardly rectifying Cl(-) currents (I(Cl,swell)) are important in the electrical activity of cardiomyocytes. This study was to investigate whether I(Cl,swell) play a role in the PV electrophysiological characteristics.

MATERIALS AND METHODS

A whole-cell patch clamp was used to investigate the action potentials and I(Cl,swell) in isolated rabbit single PV and atrial cardiomyocytes during immersion in isotonic (290-300 mosm L(-1)) and hypotonic (220-230 mosm L(-1)) solutions. The cell length and cell width were measured using confocal microscopy.

RESULTS

Hypotonic solution induced larger I(Cl,swell) in the PV cardiomyocytes with pacemaker activity than those in the PV cardiomyocytes without pacemaker activity or atrial cardiomyocytes. Hypotonic solution shortened the action potential duration and increased the cell width to a greater extent in the PV cardiomyocytes than in the atrial cardiomyocytes. Moreover, hypotonic solution decreased the PV firing with a decrease in the transient inward currents and delayed after depolarizations.

CONCLUSIONS

These findings suggest that the I(Cl,swell) plays an important role in the electrical activity of the PV cardiomyocytes.

A computerized apparatus designed to automatically dispense, measure, and record alcohol consumption by individual members of a rhesus macaque social group: trait-like drinking across social- and single-cage conditions

BACKGROUND

The present study tested the validity of an automated ethanol dispensing apparatus that is capable of identifying individual monkeys and precisely measuring their levels of ethanol consumption while living in a social group, and assessed individual subjects' level of consumption when alone and in social groups.

METHODS

In Experiment 1, 21 rhesus macaques (Macaca mulatta) were given access for 1-h each day to the dispensing apparatus, which contained an aspartame-sweetened 8.4% (v/v) ethanol solution. Measurements of blood ethanol concentrations were taken for each subject and compared with the level of consumption recorded by the apparatus for those subjects. To examine the possibility that competition among the animals limited their access to the dispensing unit, in Experiment 2, 10 of the subjects used in Experiment 1 were singly housed to allow them to drink without interference from other monkeys. A correlation was then performed to assess the interindividual relationship between the amount of ethanol consumed in these two housing conditions.

RESULTS

In Experiment 1, the volume of solution measured and recorded by the apparatus correlated positively with the true volume dispensed. Furthermore, the volume of solution reported by the computer to have been consumed by an individual subject correlated positively with blood ethanol concentrations. In Experiment 2, the volume of ethanol consumed by individual subjects in single cages correlated positively with their consumption in the social group.

CONCLUSIONS

The apparatus accurately identified and measured individual patterns of ethanol consumption among socially housed animals. Additionally, individual differences in ethanol consumption remained stable across settings, as shown by the strong positive correlation between drinking in a social setting versus drinking alone. This finding may thus reflect an individual's constitutional proclivity to consume alcohol.

Phase Behavior of Poly(9,9-di-n-hexyl-2,7-fluorene)

Here we report the phase behavior of poly(9,9-di-n-hexyl-2,7-fluorene) (PFH), which previously received little attention as compared to its homologues poly(9,9-di-n-octyl-2,7-fluorene) (PFO) and poly(9,9-di-(2'-ethylhexyl)-2,7-fluorene) (PFEH). By means of differential scanning calorimetry, X-ray diffraction, and electron microscopy, we show that there exist four different phases in PFH. The as-cast film is mainly composed of a mesomorphic beta phase with layer spacing of ca. 1.4 nm. This beta phase is inherently metastable and, upon heating above 175 degrees C, transforms into a crystalline (alpha) form that melts into a nematic (N) liquid above 250 degrees C. Upon stepwise cooling, the nematic melt crystallizes into the alpha phase first, followed by solid-solid transformation into another crystalline (alpha') form. Unit cell structure of the alpha form is monoclinic whereas that of the alpha' form is triclinic, but departures from strict orthogonality are slight (by ca. 6 degrees). These observations not only support our previous assignment of two crystalline forms (both orthorhombic in structure) in PFO but also provide insights to the crystalline nature of the polyfluorene series.

Noncrystalline Phases in Poly(9,9-di-n-octyl-2,7-fluorene)

Selective formation of amorphous, nematic (N), and beta phases in poly(9,9-di-n-octyl-2,7-fluorene) (PFO) films was achieved via judicious choice of process parameters. Phase structure and film morphology were carefully examined by means of X-ray diffraction as well as electron microscopy. "Amorphous" thin films were obtained by quick evaporation of solvent. Slow solvent removal during film formation or extended treatment of the amorphous film with solvent vapor resulted in predominantly the beta phase, which corresponds to a frozen (due to decreased segmental mobility upon solvent removal) and intrinsically metastable state of transformation midway between a solvent-induced clathrate phase and the equilibrium crystalline order in the undiluted state. The frozen transformation process is reactivated upon an increase in temperature beyond 100 degrees C. Compared to the amorphous film, extended backbone conjugation in the beta phase is evidenced from the emergence of a characteristic absorption peak around 430 nm near the absorption edge. For films of frozen nematic order (obtained by quenching from the nematic state), the conjugation length is also greater than the amorphous films as revealed by an absorption shoulder around 420 nm. Well-behaved single-chromophore emission with single-mode phonon coupling was observed for the beta phase; in the case of nematic films, dual-mode phonon coupling must exist if single-chromophore emission is assumed. In comparison, the emission spectrum of the amorphous film of generally shorter conjugation lengths exhibited mixed characteristics of nematic and beta phases, implying the presence of minor populations of extended conjugation similar to those in nematic and beta phases, which are of biased weightings in the emission spectra. All these films consist of nanograins (ca. 10 nm in size) of collapsed chains; the films are therefore inherently inhomogeneous in this length scale. In combination with previous observations on the crystalline (alpha and alpha') forms, the phase behavior of PFO is then generally summarized in terms of relative thermodynamic stability.

Aging of poly(2-methoxy-5-(2'-ethylhexyloxy)-1,4-phenylenevinylene)/toluene solutions and subsequent effects on luminescence behavior of cast films

Morphological effects in luminescence properties of a representative semiconducting polymer, poly(2-methoxy-5-(2'-ethylhexyloxy)-1,4-phenylenevinylene) (MEH-PPV), has recently attracted much attention. Previous studies indicated that short-term heat treatment of solution-cast MEH-PPV films may result in the formation of mesomorphic order that is responsible for the "red" emission around 640 nm, in contrast to the single-chromophore "yellow" emission near 590 nm from the disordered matrix. On the basis of microscopic and spectroscopic evidence for films cast from freshly prepared and aged solutions, here we show that prolonged storage of MEHyellowPPV solutions at room temperature or lower may result in retardation of the thermally induced mesophase formation in the subsequently cast films. According to small-angle neutron scattering and differential scanning calorimetric observations over aged MEH-PPV/toluene solutions, we propose that the suppressed transformation into mesomorphic order is due to further development of nanocrystalline aggregates that serve as physical cross-links among MEH-PPV chains in the solution state upon long-term storage. These solvent-induced nanocrystalline aggregates, however, do not exhibit new spectroscopic features beyond the suppression of "red" emission at 640 nm from the mesomorphic phase.

Triplet-to-singlet exciton formation in poly(p-phenylene-vinylene) light-emitting diodes

The triplet to singlet exciton formation ratio in a MEH-PPV light-emitting diode is measured by comparing the triplet-induced absorptions with optical and electric excitations at the same singlet exciton density. The ratio is a strong universal decreasing function of the averaged electric field. Using 4 ns for singlet to triplet intersystem crossing time, the ratio is significantly larger than the spin-independent value 3 at intermediate field but is reduced to about 2 for higher field.

Clinical and electrophysiological characteristics in children with atrioventricular nodal reentrant tachycardia

Atrioventricular (AV) nodal reentrant tachycardia is one of the most common supraventricular tachycardias in childhood. However, information about AV nodal reentrant tachycardia in childhood is limited, especially about the variant and multiple forms. The purpose of this retrospective study was to investigate the clinical and electrophysiological characteristics in pediatric patients with AV nodal reentrant tachycardia. Forty-eight pediatric patients with AV nodal reentrant tachycardia were included (ages 11-18 years; 25 males and 23 females). The age of onset and duration of symptoms were significantly younger and shorter in pediatric patients, respectively. A higher incidence of antegrade dual AV nodal pathways was found in adult patients than pediatric patients (72.9 vs 52.1% p = 0.003). Both antegrade and retrograde slow pathway functions were better in pediatric than adult patients. There was no significant difference between children and adults in the occurrence of variant and multiple forms of AV nodal reentrant tachycardia. This study demonstrated that pediatric patients have different electrophysiologic characteristics from those of adult patients.

Heterogeneity of myocardial sleeve morphology and gap junctions in canine superior vena cava

BACKGROUND

The myocardial sleeve of the superior vena cava (SVC) has been identified as a potential initiating focus in atrial fibrillation, but information on cell-to-cell linkage at this site is lacking.

METHODS AND RESULTS

We examined the SVC in 8 dogs by immunoconfocal and electron microscopy. Cardiomyocytes outlined with vinculin and bearing striations positive for alpha-actinin are found in the proximal segment of the SVC. These cells, grouped in bundles of various orientations according to location, extend cephalically as far as 3 cm from the right atrium (RA)-SVC junction. Comparison between the junctional level and the level 2 cm distal shows that the myocardial layer in the latter is thinner and not as compact and is composed of longer cells (87.3+/-15.7 versus 71.6+/-14.4 micrometer, P<0.01). Gap junctions made of connexin43 (Cx43), Cx40, and Cx45 are aggregated mainly at the intercalated disks, and colocalization of connexins is a common feature throughout the myocardial sleeve. Areas of atypical expression exist, however, characterized by a center of abundant Cx43 labels surrounded by a periphery of scattered tiny Cx40-labeled spots. Although in the ventral subluminal compact myocardial layer, individual cells at both levels are surrounded by similar numbers of cells, the number of aggregation of labeled gap junctions at the distal level is less (2.3+/-0.6 versus 3.7+/-0.9, P<0.01). In addition, electron-microscopic examination demonstrates that the gap junctions at the distal level are smaller in size (0.37+/-0.30 versus 0.55+/-0.34 micrometer, P<0.01).

CONCLUSIONS

The myocardial sleeve in the canine SVC is a heterogeneous structure, which could potentially form a substrate for heterogeneity of electrical coupling.

Effects of rapid atrial pacing on the arrhythmogenic activity of single cardiomyocytes from pulmonary veins: implication in initiation of atrial fibrillation

BACKGROUND

Pulmonary veins (PVs) are important sources of paroxysmal atrial fibrillation. Long-term rapid atrial pacing (RAP) changes atrial electrophysiology and facilitates the maintenance of atrial fibrillation. It is not clear whether RAP alters the arrhythmogenic activity of PVs. The purpose of this study was to isolate single PV cardiomyocytes from control and RAP dogs and evaluate their electrophysiological characteristics.

METHODS AND RESULTS

The action potential and ionic currents were investigated in PV cardiomyocytes from control and long-term (6 to 8 weeks) RAP (780 bpm) dogs by use of the whole-cell clamp technique. Dissociation of PVs yielded rod-shaped single cardiomyocytes without (n=91, 60%) or with (n=60, 40%) pacemaker activity. Compared with the control group, the RAP dog PV cardiomyocytes had faster beating rates (0.86+/-0.28 versus 0.45+/-0.07 Hz, P<0.05) and shorter action potential duration. The RAP dog PV cardiomyocytes with pacemaker activity have a higher incidence of delayed (59% versus 7%, P<0.001) or early (24% versus 0%, P<0.005) after depolarization. The RAP dog PV cardiomyocytes with pacemaker activity had smaller slow inward and transient outward but larger transient inward (0.017+/-0.004 versus 0.009+/-0.002 pA/pF, P<0.05) and pacemaker (0.111+/-0.019 versus 0.028+/-0.008 pA/pF, P<0.001) currents. The RAP dog PV cardiomyocytes without pacemaker activity had only smaller slow inward and transient outward and larger pacemaker currents.

CONCLUSIONS

PVs contain multiple cardiomyocytes with distinct electrophysiological characteristics. RAP changes the electrophysiological characteristics and arrhythmogenic activity of PVs.

Role of right middle pulmonary vein in patients with paroxysmal atrial fibrillation

INTRODUCTION

Elimination of the ectopic foci from pulmonary veins (PVs) has proved to be a curative therapy for focal atrial fibrillation (AF). However, information about the importance of the right middle PV (RMPV) in initiation of AF and radiofrequency ablation of AF is limited.

METHOD AND RESULTS

Forty-three patients (34 men and 9 women; age 65+/-12 years) with drug-refractory paroxysmal AF underwent electrophysiologic study and catheter ablation for treatment of AF. Three-dimensional magnetic resonance angiography (MRA) of the PVs and left atrium (LA) was performed to determine the anatomic patterns of RMPV. Diameter of PV ostium was measured at the junction of the LA and each PV. MRA findings showed the following: (1) 36 (84%) of 43 patients had a discrete RMPV; (2) there are three drainage patterns of RMPV, including joining the proximal part (<1 cm from the ostium) of the right superior PV (RSPV), joining the right inferior PV (RIPV), and a separate RMPV ostium in the LA wall; and (3) the ostial diameter of RMPV was significantly smaller than RSPV and RIPV (P < 0.01). Electrophysiologic studies demonstrated that five AF foci arose from RMPV. The coupling interval between the ectopic beat of AF and sinus beat was longer in RMPV than RSPV (262+/-45 msec vs 212+/-47 msec; P = 0.043). All AFs from RMPV were ablated successfully. PV stenosis or AF recurrence from RMPV was not found during follow-up of 10+/-4 months.

CONCLUSION

RMPV was detected by MRA in >80% of paroxysmal AF patients. Ectopy from RMPV can initiate AF, and radiofrequency ablation of RMPV foci is feasible and safe.

Mechanisms of transition between double paroxysmal supraventricular tachycardias

INTRODUCTION

Coexistence of double tachycardias in one patient has been infrequently reported. Furthermore, the mechanisms of transition between double paroxysmal supraventricular tachycardias have not been well studied.

METHODS AND RESULTS

Thirty-five patients with two paroxysmal supraventricular tachycardias were studied. Group IA consisted of 3 patients with spontaneous transition between AV reciprocating tachycardia (AVRT) and AV nodal reentrant tachycardia (AVNRT). Group IB consisted of 13 patients without spontaneous transition between AVRT and AVNRT. Group IIA consisted of 5 patients with spontaneous transition between AVNRT and atrial tachycardia (AT). Group IIB consisted of 14 patients without spontaneous transition between AVNRT and AT. The absolute values of differences between the two tachycardia cycle lengths were significantly smaller in patients with than in those without transition between the two tachycardias (25+/-8 msec vs 90+/-46 msec, P < 0.05, IA vs IB; 21+/-25 msec vs 99+/-57 msec, P < 0.01, IIA vs IIB). The cutoff point of 25 msec had 80% positive predictive value for transition between the two tachycardias. Transition between two tachycardias occurred due to a spontaneous premature atrial complex (30%), conduction block at one limb of tachycardia (20%), or tachycardia-induced tachycardia (50%). Absence of transition between two tachycardias might be explained by the absence of a spontaneous premature atrial complex, longer cycle length of the first tachycardia, larger difference between two tachycardia cycle lengths, or induction of each tachycardia under different situations.

CONCLUSION

Double supraventricular tachycardias with similar tachycardia cycle lengths are vulnerable to transition between different tachycardias.

Efficient light harvesting by sequential energy transfer across aggregates in polymers of finite conjugational segments with short aliphatic linkages

Interactions between lumophores have a critical influence on the photophysical properties of conjugated polymers. We synthesized a new series of light-harvesting polymers (poly-DSBs, I-IV) of dialkyloxy- or dialkyl-substituted distyrylbenzene (the substituents being methoxy, 2-ethylhexyloxy, and cyclohexyl) with short aliphatic linkage (methylene or ethylene) and examined the effects of interactions between lumophores and of chemical structures on the absorption, emission, and excitation spectra. The proximity between distyrylbenzene lumophores was shown to be critical to the interactions between lumophores and to the energy-transfer processes. In concentrated solutions and solid films, intermolecular aggregates exist resulting from different extents of interactions between lumophores and are found to involve at least three species: loose, compact, and the most aligned aggregates as observed by photoluminescence and excitation spectroscopies. We also found, for the first time, sequential energy transfer from individual lumophores to the most compact, aligned aggregates via the looser intermolecular aggregates, as observed directly by time-resolved fluorescence spectroscopy. Such a process mimics energy transfer in photosynthesis units and is so efficient such that the fluorescence color can be red-shifted drastically by the presence of comparatively few aggregates and that the light evolved from concentrated solutions and films of poly-DSBs I-IV is entirely or almost the aggregation emission. Although the sequential energy-transfer process in fully conjugated electro-/photoluminescent polymers due to inhomogenity other than distributed conjugation lengths has never been directly observed at room temperature, we suggest that events similar to those observed in poly-DSBs in conjugated polymers could occur but on a much shorter time scale, i.e., a few picoseconds.

Hyperventilation facilitates induction of supraventricular tachycardia: a novel method and the possible mechanism

INTRODUCTION

Hyperventilation has been demonstrated to alter autonomic function. Sympathomimetic drugs (isoproterenol) and parasympatholytic drugs (atropine) may be needed to facilitate induction of supraventricular tachycardia (SVT). The aim of this study was to test the clinical utility and mechanisms of hyperventilation to facilitate SVT initiation.

METHODS AND RESULTS

Fourteen patients with clinically documented SVT (9 AV nodal reentrant tachycardia and 5 AV reciprocating tachycardia) but noninducible during baseline electrophysiologic study were included. Immediately after hyperventilation test (at least 30 respirations/min) for 2 minutes, systolic blood pressure, sinus cycle length, anterograde and retrograde 1:1 conduction, and induced SVT were measured. Arterial blood gas, pH, and heart rate variability before and after hyperventilation were measured. Seven of nine patients with AV nodal reentrant tachycardia and 3 of 5 patients with AV reciprocating tachycardia could be induced immediately after the hyperventilation test. After hyperventilation, anterograde AV and retrograde VA 1:1 conduction were improved, sinus cycle length was decreased, and heart rate variability were decreased in both groups.

CONCLUSION

Hyperventilation can facilitate induction of SVT. Improvement of conduction properties and changes of autonomic function are the possible mechanisms.

Linkage and mutation analysis in two Taiwanese families with long QT syndrome

Long QT syndrome (LQT) is a cardiovascular disorder causing syncope and sudden death from arrhythmias. Mutations in KCNQ1, KCNH2, KCNE1, KCNE2, and SCN5A genes encoding cardiac potassium and sodium ion channels cause LQT. Two Taiwanese LQT families were screened for mutations in these ion channel genes. In family H87, the diagnosis was made in the 25-year-old female proband and six family members based on recurrent syncope and/or a prolonged QT interval. Genotyping revealed a novel nonsense mutation, R744X (C to T transition in codon 744), in the KCNH2 potassium channel gene, resulting in truncation of the putative cyclic nucleotide-binding domain and C-terminal region of the HERG K(+)-channel in all affected family members. The mutation was confirmed by DdeI endonuclease digestion of the DNA from each family member. The 26-year-old female proband in family L89 developed repeated syncope with QTc of 0.61 seconds. After linkage and mutation analysis, the syndrome in this family was associated with a novel KCNQ1 missense mutation, T309I, causing the substitution of a threonine residue at position 309, in the pore region of the KvLQT1 K(+)-channel, with an isoleucine. By Tsp45I restriction analysis, the mutation was noted in the proband and the proband's asymptomatic brother, but was not detected in 100 unrelated normal individuals. Identification of a mutation has clinical implications for presymptomatic diagnosis and therapy.

Effects of cavotricuspid isthmus ablation on atrioventricular node electrophysiology in patients with typical atrial flutter

BACKGROUND

The atrial musculature in the cavotricuspid isthmus is a part of posterior inputs to the AV node. In patients with typical atrial flutter, effects of radiofrequency ablation of this isthmus on AV node conduction are still unknown.

METHODS AND RESULTS

This study included 16 patients with clinically documented typical atrial flutter. Group 1 had 8 patients without and group 2 had 8 patients with dual AV nodal pathway physiology. Electrical pacing from the interatrial septum and low right atrium was performed to evaluate antegrade AV node function before and after ablation of the cavotricuspid isthmus. In group 1, the AV node conduction properties were similar before and after ablation. In group 2, the AV node Wenckebach cycle length and maximal AH interval during low right atrium (356+/-58 versus 399+/-49 ms, P=0.008; 303+/-57 versus 376+/-50 ms, P=0.008) and interatrial septum (365+/-62 versus 393+/-59 ms, P=0.008; 324+/-52 versus 390+/-60 ms, P=0.008) pacing were significantly longer after ablation. Elimination of the slow pathway after ablation was noted in 2 patients, including 1 with AV nodal reentrant echo beats.

CONCLUSIONS

Radiofrequency ablation of the cavotricuspid isthmus was effective in eliminating typical atrial flutter without injury of antegrade fast AV node conduction. The atrial musculature in the cavotricuspid isthmus significantly contributed to the slow AV node conduction.

Acquired pulmonary vein stenosis after radiofrequency catheter ablation of paroxysmal atrial fibrillation

INTRODUCTION

Elimination of the initiating focus within the pulmonary vein (PV) using radiofrequency (RF) catheter ablation is a new treatment modality for treatment of drug-refractory atrial fibrillation. However, information on the long-term safety of RF ablation within the PV is limited.

METHODS AND RESULTS

In 102 patients with drug-refractory atrial fibrillation and at least one initiating focus from the PV, series transesophageal echocardiography was performed to monitor the effect of RF ablation on the PV. There were 66 foci in the right upper PV and 65 foci in the left upper PV. Within 3 days of ablation, 26 of the ablated right upper PVs (39%) had increased peak Doppler flow velocity (mean 130+/-28 cm/sec, range 106 to 220), and 15 of the ablated left upper PVs (23%) had increased peak Doppler flow velocity (mean 140+/-39 cm/sec, range 105 to 219). Seven patients had increased peak Doppler flow velocity in both upper PVs. No factor (including age, sex, site of ablation, number of RF pulses, pulse duration, and temperature) could predict PV stenosis after RF ablation. Three patients with stenosis of both upper PVs experienced mild dyspnea on exertion, but only one had mild increase of pulmonary pressure. There was no significant change of peak and mean flow velocity and of PV diameter in sequential follow-up studies up to 16 (209+/-94 days) months.

CONCLUSION

Focal PV stenosis is observed frequently after RF catheter ablation applied within the vein, but usually is without clinical significance. However, ablation within multiple PVs might cause pulmonary hypertension and should be considered a limiting factor in this procedure.

Effect of nitric oxide on strophanthidin-induced ventricular tachycardia

Nitric oxide (NO) has been demonstrated to have several effects on the heart. Through the stimulation of guanylate cyclase, NO increases cyclic GMP and decreases intracellular calcium. The purpose of this study was to evaluate the effects of NO on ventricular arrhythmia induced by strophanthidin in guinea pigs and dogs. In experiment 1, after strophanthidin-induced ventricular tachycardia, guinea pigs received different doses of L-arginine (0, 25, 50, 100, 200, and 400 mg/kg; n = 10 for each dose), 200 mg/kg L-arginine combined with 100 mg/kg N(G)-nitro-L-arginine methylester (L-NAME, n = 10), or 200 mg/kg D-arginine (n = 10). In experiment 2, after strophanthidin-induced ventricular tachycardia, dogs (n = 7) received 200 mg/kg L-arginine. By 12-lead ECG, monophasic action potentials in left and right ventricles were recorded throughout the study. In experiment 1, guinea pigs which received 200 mg/kg or 400 mg/kg L-arginine had greater incidences of ventricular tachycardia termination (60 and 80%, respectively) than those which received 0, 25, 50, and 100 mg/kg L-arginine (0, 0, 20, and 30%, respectively), those which received L-arginine with L-NAME (0%), and those which received D-arginine (0%). In experiment 2, 5 (71%) of the dogs had successful termination of ventricular tachycardia. These findings suggest that L-arginine was effective in treating strophanthidin-induced ventricular tachycardia in vivo and that the underlying mechanism is through a NO pathway.

Classification of atrial flutter and regular atrial tachycardia according to electrophysiologic mechanism and anatomic bases: a statement from a joint expert group from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology

Regular atrial tachycardias classically are classified into flutter or tachycardia, depending on the rate and presence of a stable baseline on the ECG. However, current understanding of electrophysiology atrial tachycardias makes this classification obsolete, because it does not correlate with mechanisms. The proposed classification is based on electrophysiologic mechanisms, defined by mapping and entrainment. Radiofrequency ablation of a critical focus or isthmus can afford proof. Focal tachycardias are characterized by radial spread of activation and endocardial activation not covering the whole cycle. Ablation of the focus of origin interrupts the tachycardia. The mechanism of focal firing is difficult to ascertain by clinical methods. Macroreentrant tachycardias are characterized by circular patterns of activation that cover the whole cycle. Fusion can be shown during entrainment on the ECG or by multiple endocardial recordings. Ablation of a critical isthmus interrupts the tachycardia. Macroreentry can occur around normal structures (terminal crest, eustachian ridge) or around atrial lesions. The anatomic bases of these tachycardias must be defined, to guide appropriate treatment. Atrial flutter is a mere description of continuous undulation on the ECG, and only some strictly defined typical flutter patterns correlate with right atrial macroreentry bounded by the tricuspid valve, terminal crest, and caval vein orifices. This classification should be considered open, as some classically described tachycardias, such as reentrant sinus tachycardia, inappropriate sinus tachycardia, and type II atrial flutter, cannot be classified accurately. Furthermore, the possibility of fibrillatory conduction makes the limits with atrial fibrillation still ill defined.

Pulmonary vein dilation in patients with atrial fibrillation: detection by magnetic resonance imaging

INTRODUCTION

The positive relationship between left atrial (LA) size and atrial fibrillation (AF) is well recognized; however, there is little information on the association of pulmonary vein (PV) diameter and AF. The purpose of this study was to investigate by magnetic resonance angiography the change of PV and LA size in patients with no history of AF, patients with paroxysmal AF (PAF), and patients with chronic AF (CAF).

METHODS AND RESULTS

The study included 47 patients. Group I included 15 patients with normal sinus rhythm and no history of documented AF. Group II included 24 patients with drug-refractory PAF who underwent electrophysiologic study and radiofrequency ablation of PV foci. Group III included 8 patients with CAF who were converted to sinus rhythm by external electrical cardioversion. Age and concomitant heart diseases were similar among the three groups. We measured the diameter of each PV at its junction with the LA in addition to LA dimensions by gadolinium-enhanced magnetic resonance angiography with three-dimensional reconstruction. Significant dilation of both superior PVs (P < 0.01) and transverse diameter of LA (P < 0.01) was seen in the three groups. There were no significant changes of both inferior PVs, corrected PV (PV/LA) diameter, or longitudinal diameter of LA among the three groups. Only 28% patients showed arrhythmogenic foci from the largest PV.

CONCLUSION

Significant dilation of both superior PVs with simultaneous LA enlargement was demonstrated i

Prolonged fractionation of paced right atrial electrograms in patients with atrial flutter and fibrillation

OBJECTIVES

This study investigated the extent of fractionation of paced right atrial electrograms in patients with and without paroxysmal atrial flutter (AFL) or atrial fibrillation (AF).

BACKGROUND

Slow conduction through nonuniform anisotropic atrial muscles, represented by fractionated electrograms, may favor the generation of atrial tachyarrhythmias.

METHODS

This study included 10 control patients (Group 1), 8 patients with documented paroxysmal AFL (Group 2) and 10 patients with documented paroxysmal AF (Group 3). Five electrode catheters were placed in the different sites of the right atrium and one catheter was positioned at the coronary sinus ostium. Atrial pacing from one site was done by a constant drive train with an extrastimulus inserted every fourth beat while recording at the other five sites was performed. The delay of each fractionated potential in the high-pass filtered atrial electrogram in response to extrastimulation was determined and used to construct conduction curves of delay versus the S1S2 interval.

RESULTS

The mean increase in electrogram duration between a coupling interval of 350 ms and 10 ms above atrial refractoriness was significantly greater in Groups 2 and 3 compared with that in Group 1 (8.5 +/- 2.5 vs. 11.0 +/- 2.7 vs. 5.9 +/- 2.3 ms, respectively, p < 0.001). The mean S1S2 interval at which delay increased suddenly was also longer in Groups 2 and 3 compared with Group 1 (326 +/- 9 vs. 343 +/- 12 vs. 307 +/- 17 ms, respectively, p < 0.001).

CONCLUSIONS

Increased delays in the individual potential of the fractionated atrial electrograms may be related to the development of AFL and AF.

Electrophysiologic characteristics in initiation of paroxysmal atrial fibrillation from a focal area

OBJECTIVES

We investigated the electrophysiologic characteristics in the initiation of paroxysmal atrial fibrillation (PAF) from a focal area.

BACKGROUND

The electrophysiologic characteristics in the initiation of PAF are still not clear.

METHODS

The study group consisted of 77 patients (M/F = 65/12, age 66 +/- 12 years) with frequent episodes of PAF; we analyzed: 1) 15 cycle lengths of electrical activity before the onset of atrial fibrillation (AF); 2) coupling interval (CI) of the first ectopic beat just before the initiation of AF; and 3) the prematurity of an ectopic beat (prematurity index [PI] = CI/mean of preceding 15 cycle lengths).

RESULTS

A total of 111 episodes of sustained AF were identified. Two patterns of AF initiation were observed: group I (59/111, 53%) included the episodes preceded by cycle length oscillation, and group II (52/111, 47%) included the episodes initiated by a single ectopic beat with preceding cycle length relatively constant. The PI of group I episodes was significantly greater than that of group II (0.41 +/- 0.12 vs. 0.34 +/- 0.10, p < 0.01). The CI (267 +/- 54 ms vs. 217 +/- 55 ms, p < 0.05), AF1 (194 +/- 36 ms vs. 153 +/- 37 ms, p < 0.05) and PI (0.49 +/- 0.13 vs. 0.37 +/- 0.11, p < 0.01) of the AF episodes from the superior vena cava (SVC) were significantly longer and greater than those of AF episodes from pulmonary veins (PVs).

CONCLUSIONS

In patients with PAF originating from PVs or the SVC, two major initiating patterns were found. Moreover, the electrophysiologic characteristics in the initiation of AF originating from the SVC were also different from those of AF initiating from the PVs.

Mechanisms of antiarrhythmic drug action on termination of atrial flutter

Atrial flutter is an important arrhythmia in clinical practice. Although the reentrant circuit of human typical atrial flutter is well characterized, the action of antiarrhythmic drugs on this tachycardia is less understood. Based on the recent clinical trials, pure Class III drugs like ibutilide or dofetilide are more effective in acute termination of human atrial flutter than Class I drugs like procainamide or flecainide. The mechanisms of drug induced termination of atrial flutter include refractory block due to cycle length oscillation, fixed block due to a reduced safety factor for conduction, or a collision of opposing wavefronts due to loss of the lateral boundaries or return reexcitation. Because ventricular proarrhythmia is a major concern with ibutilide or dofetilide therapy, development of new drugs with more specific target profiles is a future direction for treatment of human atrial flutter.

Soluble electroluminescent poly(phenylene vinylene)s with balanced electron- and hole injections

We report a new route for the design of efficient soluble electroluminescent PPV-based copolymers bearing electron-deficient oxadiazole (OXD) moieties on side chains. The introduction of OXD through a long alkylene spacer with PPV backbone provides a molecular dispersion of OXD in the film; both the side chain OXD and the main chain PPV do retain their own electron-transport and emissive properties, respectively. The use of phenylene vinylene derivatives with asymmetric and branched substituents and a long spacer provides solubility for ease of device fabrication as well as amorphous structure to allow a well-mixing of OXD groups with the main chains. By properly adjusting the OXD content through copolymerization, we can tailor the chemical structure of electroluminescent material to give a balance of hole- and electron injections for various metal cathodes, such that the quantum efficiency is significantly improved and the turn-on voltage is reduced for the devices with aluminum and calcium. For the device with calcium fabricated in open air, a maximum brightness of 15000 cd/m(2) at 15 V/100 nm and a maximum luminance efficiency of 2.27 cd/A can be obtained, respectively, about 30 times brighter and 9.4 times more efficient than those with the corresponding homopolymer, poly[2-methoxy-5-(2'-ethylhexyloxy)-p-phenylenevinylene] (MEH-PPV). The use of physical blends to simulate the copolymers provides no significant improvement, since phase-separation structures appear, causing an inefficient utilization of OXD and sometimes voltage-dependent emission spectra. The present route permits a fabrication of single layer PLED with high brightness, high efficiency, and low turn-on voltage.

Atypical atrial flutter involving the isthmus between the right pulmonary veins and fossa ovalis

Typical atrial flutter, counterclockwise or clockwise movement around the tricuspid annulus, has been well studied. However, the reentrant circuits in atypical atrial flutter are not well defined. A patient without a prior history of cardiac surgery who presented with incessant atypical atrial flutter is described. Activation mapping demonstrated a circular movement around the fossa ovalis in the interatrial septum. Entrainment mapping demonstrated a protected isthmus between the right pulmonary veins and the fossa ovalis. Radiofrequency ablation of this isthmus terminated atrial flutter without recurrence during the follow-up period.

Acute and long-term effects of atrioventricular junction ablation and VVIR pacemaker in symptomatic patients with chronic lone atrial fibrillation and normal ventricular response

INTRODUCTION

The precise role of irregular ventricular response in atrial fibrillation (AF) has not been fully elucidated. This study examined the independent effects of rhythm regularity in patients with chronic AF.

METHODS AND RESULTS

This study included 50 patients who had chronic lone AF and a normal ventricular rate. Among these patients, 21 who underwent AV junction ablation and implantation of a VVIR pacemaker constituted the ablation group; the other 29 patients were the medical group. Acute hemodynamic findings were measured in 21 ablation patients before ablation (during AF, baseline) and 15 minutes after ablation (during right ventricular pacing). Compared with baseline data, ablation and pacing therapy increased cardiac output (4.7 +/- 0.8 vs 5.2 +/- 0.9 L/min; P = 0.05), decreased pulmonary capillary wedge pressure (16 +/- 5 vs 13 +/- 4 mmHg; P = 0.001), and decreased left ventricular end-diastolic pressure (14 +/- 4 vs 11 +/- 3 mmHg; P < 0.05). After 12 months, the ablation group patients showed lower scores in general quality of life (-20%; P < 0.001), overall symptoms (-24%; P < 0.001), overall activity scale (-23%; P = 0.004), and significant increase of left ventricular ejection fraction (44% +/- 6% vs 49% +/- 5%; P = 0.02) by echocardiographic examination.

CONCLUSION

AV junction ablation and pacing in patients with chronic AF and normal ventricular response may confer acute and long-term benefits beyond rate control by eliminating rhythm irregularity.

Sudden changes in heart rate variability during the 1999 Taiwan earthquake

Sympathovagal imbalance resulting from reactions to an earthquake was not prominent in patients who were taking beta-blockers.

Mechanism of spontaneous transition from typical atrial flutter to atrial fibrillation: role of ectopic atrial fibrillation foci

Paroxysmal AF has been known to be initiated by ectopic beats, especially in the pulmonary veins (PVs), and radiofrequency catheter ablation could cure it. We considered that the spontaneous transition from typical atrial flutter to AF also could be initiated by ectopic beats. Twenty patients (18 men, mean age 66 +/- 14 years) with episodes of spontaneous transition from typical atrial flutter to AF were included in this study. They underwent detailed mapping of both atria. All the patients had spontaneous AF initiated by ectopic beats, and all of them had typical atrial flutter and spontaneous transition from typical atrial flutter (12 patients with counterclockwise atrial flutter and 8 patients with clockwise atrial flutter) to AF. The transition was initiated by ectopic beats from the PVs (17 foci, 85%), crista terminalis (2 foci, 10%), and superior vena cava (1 focus, 5%). After successful ablation of AF foci, typical atrial flutter was induced again, but no spontaneous transition was found after at least 10 minutes of observation. We concluded that paroxysmal AF and spontaneous transition from typical atrial flutter to AF were initiated by ectopic beats, and successful catheter ablation of the ectopic foci can eliminate paroxysmal AF and spontaneous transition from typical atrial flutter to AF.