Characteristics and long-term ablation outcomes of supraventricular arrhythmias in hypertrophic cardiomyopathy: a 10-year, single-center experience

Background

A variety of supraventricular arrhythmias (SVAs) may occur in patients with hypertrophic cardiomyopathy (HCM). The characteristics and long-term ablation outcomes of different types of SVAs in HCM have not been comprehensively investigated.

Methods

We retrospectively enrolled 101 consecutive symptomatic HCM patients with suspected arrhythmia from May 2010 to October 2020. The clinical features and ablation outcomes of patients with SVAs were further analyzed.

Results

Seventy-eight patients had SVAs, consisting of 50 (64.1%) atrial fibrillation (AF), 16 (20.5%) atrial flutter (AFL), 15 (19.2%) atrioventricular reentrant tachycardia (AVRT), 11 (14.1%) atrial arrhythmia (AT), and 3 (3.8%) atrioventricular nodal reentrant tachycardia (AVNRT). Thirty-four patients underwent catheter ablation including 14 for AF, 9 for AVRT, 6 for AFL, 3 for AVNRT, 1 for both AF and AFL, and 1 for both AF and AVRT. They were followed up for a median (interquartile range) of 58.5 (82.9) months. There were no recurrences for patients with non-AF SVAs. For patients with AF, the 1- and 7-year AF-free survival were 87.5% and 49.5%, respectively. A ROC analysis revealed that a greater left ventricular end-diastolic dimension (LVEDD) was associated with higher recurrence of AF with an optimum cutoff value of 47mm (c-statistic = 0.91, p=0.011, sensitivity = 1.00, specificity = 0.82). In Kaplan-Meier analysis, patients with LVEDD ≥47mm had worse AF-free survival (log-rank p=0.014).

Conclusions

AF is the most common SVA in HCM, with AFL, AVRT, AT, and AVNRT ranking the second to the last according to the prevalence. The long-term catheter ablation outcome for non-AF SVAs in HCM is satisfying. A greater LVEDD predicts AF recurrence after catheter ablation in patients with HCM.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): National Natural Science Foundation of China Figure 1Figure 2

A remote gain controlled and polarization angle tunable Doppler backward scattering reflectometer

Remote control of the diagnostic systems is the basic requirement for the high performance plasma operation in a fusion device. This work presents the development of the remote control system for the multichannel Doppler backward scattering (DBS) reflectometers. It includes a remote controlled quasi-optical system and a remote intermediate frequency (IF) amplifier gain control system. The quasi-optical system contains a rotational polarizer, its polarization angle is tunable through a remote controlled motor, and it could combine the microwave beams with a wide frequency range into one focused beam. The remote IF gain control system utilizes the digital microcontroller (MCU) technique to regulate the signal amplitude for each signal channel. The gain parameters of amplifiers are adjustable, and the feedback of working status in the IF system will be sent to MCU in real time for safe operation. The gain parameters could be controlled either by the Ethernet remote way or directly through the local control interface on the system. Preliminary experimental results show the effectiveness of the remote controlled multichannel DBS system.

An eight-channel correlation electron cyclotron emission diagnostic for turbulent electron temperature fluctuation measurement in HL-2A tokamak

A new correlation electron cyclotron emission (CECE) diagnostic has recently been installed on the HL-2A tokamak in order to study electron temperature fluctuations. Eight radial locations are measured simultaneously through eight pairs of correlated channels. Multiplexers are employed in the intermediate frequency section instead of the conventional separated filter banks to meet strict cross-isolation specifications and lower insertion loss. Relative electron temperature fluctuations are observed by CECE for the first time on the HL-2A by using the spectral decorrelation method. The achieved minimum detectable fluctuation level is up to (T̃_e/T_e)_min∼0.5%. When studying electron temperature fluctuations in the core region with gas puffing, the cross-power spectra show that the amplitude of the electron temperature fluctuation increases in a high temperature and low density plasma. Further analysis demonstrates that the electron temperature gradient ∇T_e drives the electron temperature fluctuations together with electron heat transport.

Initial beam emission spectroscopy diagnostic system on HL-2A tokamak

A beam emission spectroscopy system is being developed and deployed on the HL-2A tokamak to measure local low wavenumber (k _⊥ ρ _i < 1) density fluctuations by measuring the Doppler-shifted emission from a 50 kV deuterium heating neutral beam. High spatial resolution (Δr ≤ 1 cm, Δz ≤ 1.5 cm) measurements are achieved with customized in-vacuum optics. High frequency, high-gain preamplifiers sample the light intensity at a Nyquist frequency of 1 MHz and achieve a high S/N ratio via high optical throughput, low-noise preamplifiers, and high quantum efficiency photodiodes. A first set of 16 detector channels [configured in an 8 (radial) × 2 (poloidal) array] has been installed and tested at HL-2A, covering the radial range r/a = 0.8-1.1. The frequency and wavenumber spectra have been measured under different plasma conditions. Initial measurements have demonstrated the capability of measuring edge plasma density fluctuation spectra and the poloidal flow velocity fields with a high S/N ratio.

Synchronization of Geodesic Acoustic Modes and Magnetic Fluctuations in Toroidal Plasmas

The synchronization of geodesic acoustic modes (GAMs) and magnetic fluctuations is identified in the edge plasmas of the HL-2A tokamak. Mesoscale electric fluctuations (MSEFs) having components of a dominant GAM, and m/n=6/2 potential fluctuations are found at the same frequency as that of the magnetic fluctuations of m/n=6/2 (m and n are poloidal and toroidal mode numbers, respectively). The temporal evolutions of the MSEFs and the magnetic fluctuations clearly show the frequency entrainment and the phase lock between the GAM and the m/n=6/2 magnetic fluctuations. The results indicate that GAMs and magnetic fluctuations can transfer energy through nonlinear synchronization. Such nonlinear synchronization may also contribute to low-frequency zonal flow formation, reduction of turbulence level, and thus confinement regime transitions.

Observation of Double Impurity Critical Gradients for Electromagnetic Turbulence Excitation in Tokamak Plasmas

The impact of impurity ions on a pedestal has been investigated in the HL-2A Tokamak, at the Southwestern Institute of Physics, Chengdu, China. Experimental results have clearly shown that during the H-mode phase, an electromagnetic turbulence was excited in the edge plasma region, where the impurity ions exhibited a peaked profile. It has been found that double impurity critical gradients are responsible for triggering the turbulence. Strong stiffness of the impurity profile has been observed during cyclic transitions between the I-phase and H-mode regime. The results suggest that the underlying physics of the self-regulated edge impurity profile offers the possibility for an active control of the pedestal dynamics via pedestal turbulence.

Note: Upgrade of electron cyclotron emission imaging system and preliminary results on HL-2A tokamak

The electron cyclotron emission imaging system on the HL-2A tokamak has been upgraded to 24 (poloidally) × 16 (radially) channels based on the previous 24 × 8 array. The measurement region can be flexibly shifted due to the independence of the two local oscillator sources, and the field of view can be adjusted easily by changing the position of the zoom lenses. The temporal resolution is about 2.5 μs and the achievable spatial resolution is 1 cm. After laboratory calibration, it was installed on HL-2A tokamak in 2014, and the local 2D mode structures of MHD activities were obtained for the first time.

Diagnostics for energetic particle studies on the HL-2A tokamak

About 13 kinds of diagnostics for energetic particle physics studied on the HuanLiuqi-2A (commonly referred to as HL-2A) tokamak are described in this paper. Their measurement ranges, resolutions, and arrangement are presented. Three under-construction diagnostics including imaging fast ion D-alpha, scintillator matrix (for hard X-ray detection), and bundle fission chamber are described in detail.

Calibration of a 32 channel electron cyclotron emission radiometer on the HL-2A tokamak

A novel 32-channel electron cyclotron emission radiometer has been designed and tested for the measurement of electron temperature profiles on the HL-2A tokamak. This system is based on the intermediate frequency filter detection technique, and has the features of wide working frequency range and high spatial resolution. Two relative calibration methods have been investigated: sweeping the toroidal magnetic field and hopping the output frequency of the local oscillator. Preliminary results show that both methods can ensure reasonable profiles.

Development of frequency modulated continuous wave reflectometer for electron density profile measurement on the HL-2A tokamak

The frequency modulated continuous wave reflectometer was developed for the first time on the HL-2A tokamak. The system utilizes a voltage controlled oscillator and an active multiplier for broadband coverage and detects as heterodyne mode. Three reflectometers have been installed and operated in extraordinary mode polarization on HL-2A to measure density profiles at low field side, covering the Q-band (33-50 GHz), V-band (50-75 GHz), and W-band (75-110 GHz). For density profile reconstruction from the phase shift of the probing wave, a corrected phase unwrapping method is introduced in this article. The effectiveness of the method is demonstrated. The density profile behavior of a fast plasma event is presented and it demonstrates the capability of the reflectometer. These diagnostics will be contributed to the routine density profile measurements and the plasma physics study on HL-2A.

Development of electron cyclotron emission imaging system on the HL-2A tokamak

A 2D electron cyclotron emission imaging (ECEI) system has been developed for measurement of electron temperature fluctuations in the HL-2A tokamak. It is comprised of a front-end 24 channel heterodyne imaging array with a tunable RF range spanning 75-110 GHz, and a set of back-end ECEI electronics that together generate 24 × 8 = 192 channel images of the 2nd harmonic X-mode electron cyclotron emission from the HL-2A plasma. The simulated performance of the local oscillator (LO) optics and radio frequency (RF) optics is presented, together with the laboratory characterization results. The Gaussian beams from the LO optics are observed to properly cover the entire detector array. The ECE signals from the plasma are mixed with the LO signal in the array box, then delivered to the electronics system by low-loss microwave cables, and finally to the digitizers. The ECEI system can achieve temporal resolutions of ~μs, and spatial resolutions of 1 cm (radially) and 2 cm (poloidally).

Dynamics of low-intermediate-high-confinement transitions in toroidal plasmas

The dynamic features of the low-intermediate-high-(L-I-H) confinement transitions on HL-2A tokamak are presented. Here we report the discovery of two types of limit cycles (dubbed type-Y and type-J), which show opposite temporal ordering between the radial electric field and turbulence intensity. In type-Y, which appears first after an L-I transition, the turbulence grows first, followed by the localized electric field. In contrast, the electric field leads type-J. The turbulence-induced zonal flow and pressure-gradient-induced drift play essential roles in the two types of limit cycles, respectively. The condition of transition between types-Y and -J is studied in terms of the normalized radial electric field. An I-H transition is demonstrated to occur only from type-J.

A new neutral particle analyzer diagnostic and its first commissioning on HL-2A

A new neutral particle analyzer diagnostic has been developed for HuanLiuqi-2A (commonly referred to as HL-2A), which can provide the neutral particle flux measurement along 11 separate sightlines, simultaneously, within a wider energy range (1-70 keV). It is an electrostatic type analyzer with a removable pinhole and special-shape condenser. The energy analysis can be flexibly achieved by controlling a preset stepwise high voltage on the condenser. It is compact and its field of view covers HL-2A cross section from -33 cm to 33 cm without "cross-talk." The energy spectra and ion temperature profile have been obtained during its commissioning.

Frequency-resolved nonlinear turbulent energy transfer into zonal flows in strongly heated L-mode plasmas in the HL-2A tokamak

The absolute rate of nonlinear energy transfer among broadband turbulence, low-frequency zonal flows (ZFs) and geodesic acoustic modes (GAMs) was measured for the first time in fusion-grade plasmas using two independent methods across a range of heating powers. The results show that turbulent kinetic energy from intermediate frequencies (20-80 kHz) was transferred into ZFs and GAMs, as well as into fluctuations at higher frequencies (>80  kHz). As the heating power was increased, the energy transfer from turbulence into GAMs and the GAM amplitudes increased, peaked and then decreased, while the energy transfer into the ZFs and the ZFs themselves increased monotonically with heating power. Thus there exists a competition between ZFs and GAMs for the transfer of turbulent energy, and the transfer into ZFs becomes dominant as the heating power is increased. The poloidal-radial Reynolds stress and the mean radial electric field profiles were also measured at different heating powers and found to be consistent with the energy transfer measurement. The results suggest that ZFs play an important role in the low-to-high (L-H) plasma confinement transition.

Time-frequency analysis for microwave reflectometry data processing in the HL-2A tokamak

The Choi-Williams distribution (CWD) technique is introduced as a time-frequency tool for processing data measured from the new developed homodyne and the fixed frequency reflectometry in the HL-2A tokamak. The comparison between spectrogram and CWD for the simulated signal is presented. It indicates that the CWD can greatly improve the representation of the time-frequency content of the multi-components signal. Its effectiveness is demonstrated through two applications in HL-2A, which are the extraction of beat frequencies from the frequency modulated-continuous wave reflectometry (FM-CW) and the characterizing of the fluctuations. The density profile inversed from the group delay of the FM-CW and the density fluctuations deduced from the fixed-frequency reflectometry would be more reliable and accurate by using the CWD technique.

Observation of turbulence suppression after electron-cyclotron-resonance-heating switch-off on the HL-2A tokamak

The formation of a transient internal transport barrier (ITB) is observed after the electron-cyclotron-resonance-heating (ECRH) switch-off in the HL-2A plasmas, characterized by transient increase of central electron temperature. The newly developed correlation reflectometer provided direct measurements showing reduction of turbulence in the region of steepened gradients for the period of ITB formation triggered by the ECRH switch-off. Furthermore, the reduction of core turbulence is correlated in time with the appearance of a low-frequency mode with a spectrally broad poloidal structure that peaks near zero frequency in the core region. These structures have low poloidal mode number, high poloidal correlation, and short radial correlation and are strongly coupled with high-frequency ambient turbulence. Observation indicates that these structures play important roles in the reduction of the core turbulence and in improvements of the core transport after the off-axis ECRH is turned off.

β-induced Alfvén eigenmodes destabilized by energetic electrons in a Tokamak plasma

The β-induced Alfvén eigenmode (BAE) excited by energetic electrons has been identified for the first time both in the Ohmic and electron cyclotron resonance heating plasma in HL-2A. The features of the instability, including its frequency, mode number, and propagation direction, can be observed by magnetic pickup probes. The mode frequency is comparable to that of the continuum accumulation point of the lowest frequency gap induced by the shear Alfvén continuous spectrum due to finite β effect, and it is proportional to Alfvén velocity at thermal ion β held constant. The experimental results show that the BAE is related not only with the population of the energetic electrons, but also their energy and pitch angles. The results indicate that the barely circulating and deeply trapped electrons play an important role in the mode excitation.

Measurements of the fast electron bremsstrahlung emission during electron cyclotron resonance heating in the HL-2A tokamak

A fast electron bremsstrahlung (FEB) diagnostic technique based on cadmium telluride (CdTe) detector has been developed recently in the HL-2A tokamak for measurements of the temporal evolution of FEB emission in the energy range of 10-200 keV. With a perpendicular viewing into the plasma on the equatorial plane, the hard x-ray spectra with eight different energy channels are measured. The discrimination of the spectra is implemented by an accurate spectrometry. The system also makes use of fast digitization and software signal processing technology. An ambient environment of neutrons, gammas, and magnetic disturbance requires careful shielding. During electron cyclotron resonance heating, the generation of fast electrons and the oscillations of electron fishbone (e-fishbone) have been found. Using the FEB measurement system, it has been experimentally identified that the mode strongly correlates with the electron cyclotron resonance heating produced fast electrons with 30-70 keV.

Observation of a spontaneous particle-transport barrier in the HL-2A tokamak

Using the profile analysis, the density perturbation transport analysis, and the Doppler reflectometry measurement, for the first time a spontaneous and steady-state particle-transport barrier has been evidenced in the Ohmic plasmas in the HL-2A tokamak with no externally applied momentum or particle input except the gas puffing. A threshold in density has been found for the observation of the barrier. The particle diffusivity is well-like, and the convection is found to be inward outside the well and outward inside the well. The formation of the barrier coincides with the transition between the trapped electron mode and the ion temperature gradient driven mode.

A method of particle transport study using supersonic molecular beam injection and microwave reflectometry on HL-2A tokamak

A method of the particle transport study using supersonic molecular beam injection (SMBI) and microwave reflectometry is reported in this paper. Experimental results confirm that pulsed SMBI is a good perturbation source with deeper penetration and better localization than the standard gas puffing. The local density modulation is induced using the pulsed SMBI and the perturbation density is measured by the microwave reflectometry. Using Fourier transform analysis for the local density perturbation, radial profiles of the amplitude and phase of the density modulation can be obtained. The experimental results in HL-2A show that the particle injected by SMBI is located at about r/a=0.65-0.75. The position of the main particle source can be determined through three aspects: the minimum of the phase of the first harmonic of the Fourier transform of the modulated density measured by microwave reflectometry; the H(a) intensity profile and the local density increase ratio. The maximum of the amplitude of the first harmonic shifts often inward relative to the particle source location, which indicates clearly there is an inward particle pinch in this area. Good agreement has been found between the experimental results and the simulation using analytical transport model. The particle diffusivity D and the particle convection velocity V have been obtained by doing this simulation. The sensitivity in the transport coefficients of the amplitude and the phase of the density modulation has been discussed.

The development of Thomson scattering system on HL-2A tokamak

A new Thomson scattering diagnostic system is successfully developed to measure core plasma electron temperature (Te) and density (ne) of HL-2A tokamak (major radius R=165 cm, minor radius a=40 cm). In this system, a standard lamp-monochromator combination is utilized for the calibration of spectral responses. By sweeping in the range of 750-1200 nm with a step of 2 nm, the work can be done automatically for one-point calibration and then for other. Electronic gain calibration and gain monitoring are done by pulsed light emitting diode light. By utilizing an intense Nd:YAG laser of pulse energy up to 4 J and employing good quality interference filters in the five-channel filter polychromator to surpress greatly the stray light, the TS system can be routinely used to make measurements with good quality data. After each HL-2A plasma discharge, the measured Te and ne data are transferred to HL-2A database for lookup and analyses.

A new multichannel interferometer system on HL-2A

A new multichannel HCN interferometer has been developed on HL-2A tokamak, which is characterized by two techniques: (1) the wave-guide HCN laser with cavity length of 6 m to increase the optical resource power and (2) high response room temperature waveguide Schottky diode detectors to obtain good beat signal. The space resolution is 7 cm by the use of focusing metal mirrors mounted on the vacuum chamber and a compensated optical system. In the 2006 experiment campaign, this new interferometer has been applied for plasma density profile and density sawtooth measurement.

Toroidal symmetry of the geodesic acoustic mode zonal flow in a tokamak plasma

The toroidal symmetry of the geodesic acoustic mode (GAM) zonal flows is identified with toroidally distributed three step Langmuir probes at the edge of the HuanLiuqi-2A (commonly referred to as HL-2A) tokamak plasmas for the first time. High coherence of both the GAM and the ambient turbulence for the toroidally displaced measurements along a magnetic field line is observed, in contrast with the high coherence of the GAM but low coherence of the ambient turbulence when the toroidally displaced measurements are not along the same field line. The radial and poloidal features of the flows are also simultaneously determined. The nonlinear three wave coupling between the high frequency turbulent fluctuations and the flows is demonstrated to be a plausible formation mechanism of the flows.

Immunologic abnormalities in children with acute Kawasaki disease

Spontaneous release of IgG, production of IgG, IgM and IgG subclasses induced by PWM in vitro, serum IgG, IgM, IgA and IgG subclasses were measured in 23 patients with acute Kawasaki disease (KD). The results showed that there was polyclonal B cell activation with significantly increased IgG1 and IgG3. As compared with 21 healthy controls, the mean activities of B cell growth factors (BCGFs), B cell differentiation factors (BCDFs) and interleukin 6 (IL-6) were significantly elevated. IL-6 activity was correlated with the production of IgG, IgG1, IgG3 and IgM, while BCGFs and BCDFs were also correlated with IgG1. The serum level of circulating tumor necrosis factor (TNF) determined in 16 patients with acute KD using double antibody ELISA was 1.86-8.83 micrograms/ml, but it was less than 1 microgram/L in normal controls. The clinical value of increased TNF in serum is discussed.