High power continuous laser at 461 nm based on a compact and high-efficiency frequency-doubling linear cavity

A Watt-level continuous and single frequency blue laser at 461 nm is obtained by frequency-doubling an amplified diode laser operating at 922 nm via a LBO crystal in a resonant Fabry-Pérot cavity. We achieved a best optical conversion efficiency equal to 87% with more than 1 W output power in the blue, and limited by the available input power. The frequency-converted beam is characterized in terms of long term power stability, residual intensity noise, and geometrical shape. The blue beam has a linewidth of the order of 1 MHz, and we used it to magneto-optically trap ⁸⁸Sr atoms on the 5s^2 1S₀ - 5s5p ¹P₁ transition. The low-finesse, linear-cavity doubling system is very robust, maintains the lock for several days, and is compatible with a tenfold increase of the power levels which could be obtained with fully-fibered amplifiers and large mode area fibers.

Fast Control of Atom-Light Interaction in a Narrow Linewidth Cavity

We propose a method to exploit high-finesse optical resonators for light-assisted coherent manipulation of atomic ensembles, overcoming the limit imposed by the finite response time of the cavity. The key element of our scheme is to rapidly switch the interaction between the atoms and the cavity field with an auxiliary control process as, for example, the light shift induced by an optical beam. The scheme is applicable to other atomic species, both in trapped and free fall configurations, and can be adopted to control the internal and/or external atomic degrees of freedom. Our method will open new possibilities in cavity-aided atom interferometry and in the preparation of highly nonclassical atomic states.

A control hardware based on a field programmable gate array for experiments in atomic physics

Experiments in Atomic, Molecular, and Optical (AMO) physics require precise and accurate control of digital, analog, and radio frequency (RF) signals. We present control hardware based on a field programmable gate array core that drives various modules via a simple interface bus. The system supports an operating frequency of 10 MHz and a memory depth of 8 M (2²³) instructions, both easily scalable. Successive experimental sequences can be stacked with no dead time and synchronized with external events at any instructions. Two or more units can be cascaded and synchronized to a common clock, a feature useful to operate large experimental setups in a modular way.

A fibered laser system for the MIGA large scale atom interferometer

We describe the realization and characterization of a compact, autonomous fiber laser system that produces the optical frequencies required for laser cooling, trapping, manipulation, and detection of 87Rb atoms - a typical atomic species for emerging quantum technologies. This device, a customized laser system from the Muquans company, is designed for use in the challenging operating environment of the Laboratoire Souterrain à Bas Bruit (LSBB) in France, where a new large scale atom interferometer is being constructed underground - the MIGA antenna. The mobile bench comprises four frequency-agile C-band Telecom diode lasers that are frequency doubled to 780 nm after passing through high-power fiber amplifiers. The first laser is frequency stabilized on a saturated absorption signal via lock-in amplification, which serves as an optical frequency reference for the other three lasers via optical phase-locked loops. Power and polarization stability are maintained through a series of custom, flexible micro-optic splitter/combiners that contain polarization optics, acousto-optic modulators, and shutters. Here, we show how the laser system is designed, showcasing qualities such as reliability, stability, remote control, and flexibility, while maintaining the qualities of laboratory equipment. We characterize the laser system by measuring the power, polarization, and frequency stability. We conclude with a demonstration using a cold atom source from the MIGA project and show that this laser system fulfills all requirements for the realization of the antenna.

All-Optical Bose-Einstein Condensates in Microgravity

We report on the all-optical production of Bose-Einstein condensates in microgravity using a combination of grey molasses cooling, light-shift engineering and optical trapping in a painted potential. Forced evaporative cooling in a 3-m high Einstein elevator results in 4×10^{4} condensed atoms every 13.5 s, with a temperature as low as 35 nK. In this system, the atomic cloud can expand in weightlessness for up to 400 ms, paving the way for atom interferometry experiments with extended interrogation times and studies of ultracold matter physics at low energies on ground or in Space.

HIDRAdisk: validation of an innovative visual tool to assess the burden of hidradenitis suppurativa

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin disease characterized by painful inflamed nodules, recurrent abscesses and fistulas located in apocrine gland-bearing body sites. The negative impact of HS on patient's quality of life (QoL) has been reported to be greater than other dermatologic conditions as psoriasis and atopic eczema, and its improvement is an important goal in disease management. Nowadays, there are no specific validated QoL instruments available for HS and generic dermatologic questionnaires are used.

OBJECTIVE

The objective of this study was to demonstrate the validity, reliability and responsiveness of HIDRAdisk, a new innovative tool designed for rapid assessment of HS burden and, at the same time, an intuitive graphic visualization of the measurement outcome.

METHODS

A multicentre, longitudinal, observational study was conducted to validate the HIDRAdisk compared with other validated questionnaires [Skindex-16, Dermatology Life Quality Index (DLQI), Work Productivity and Activity Impairment-General Health (WPAI:GH)] and to evaluate its correlation with disease severity in Italian patients with any degree of HS severity, as measured by Hurley stage and HS Physician Global Assessment (HS-PGA).

RESULTS

A total of 140 patients (59% women; mean age 34.9 ± 11.0 years) were enrolled in 27 dermatologic centres. HIDRAdisk showed a strong correlation with Skindex-16 and DLQI, and a good one with WPAI:GH (correlation coefficient: 0.7568, 0.6651 and 0.5947, respectively) and a statistically significant correlation with both Hurley stage and HS-PGA. Very good internal consistency (Cronbach coefficient >0.80; intraclass correlation coefficient >0.6), with correlation between the 10 items, good test-retest reliability (Spearman correlation coefficient, 0.8331; P < 0.0001) and responsiveness to changes were demonstrated.

CONCLUSION

Our study shows that HIDRAdisk, a short and innovative visual HS QoL instrument, has been psychometrically validated in Italian language and it may help improve the management of HS once implemented in routine clinical practice.

Exploring gravity with the MIGA large scale atom interferometer

We present the MIGA experiment, an underground long baseline atom interferometer to study gravity at large scale. The hybrid atom-laser antenna will use several atom interferometers simultaneously interrogated by the resonant mode of an optical cavity. The instrument will be a demonstrator for gravitational wave detection in a frequency band (100 mHz–1 Hz) not explored by classical ground and space-based observatories, and interesting for potential astrophysical sources. In the initial instrument configuration, standard atom interferometry techniques will be adopted, which will bring to a peak strain sensitivity of \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\bf{2}}\cdot {\bf{1}}{{\bf{0}}}^{-{\bf{13}}}/\sqrt{{\bf{H}}{\bf{z}}}$$\end{document}2⋅10−13/Hz at 2 Hz. This demonstrator will enable to study the techniques to push further the sensitivity for the future development of gravitational wave detectors based on large scale atom interferometers. The experiment will be realized at the underground facility of the Laboratoire Souterrain à Bas Bruit (LSBB) in Rustrel–France, an exceptional site located away from major anthropogenic disturbances and showing very low background noise. In the following, we present the measurement principle of an in-cavity atom interferometer, derive the method for Gravitational Wave signal extraction from the antenna and determine the expected strain sensitivity. We then detail the functioning of the different systems of the antenna and describe the properties of the installation site.

Watt-level single-frequency tunable neodymium MOPA fiber laser operating at 915-937 nm

We have developed a Watt-level single-frequency tunable fiber laser in the 915-937 nm spectral window. The laser is based on a neodymium-doped fiber master oscillator power amplifier architecture, with two amplification stages using a 20 mW extended cavity diode laser as seed. The system output power is higher than 2 W from 921 to 933 nm, with a stability better than 1.4% and a low relative intensity noise.

Feedback control of trapped coherent atomic ensembles

We demonstrate how to use feedback to control the internal states of trapped coherent ensembles of two-level atoms, and to protect a superposition state against the decoherence induced by a collective noise. Our feedback scheme is based on weak optical measurements with negligible backaction followed by coherent microwave manipulations. The efficiency of the feedback system is studied for a simple binary noise model and characterized in terms of the trade-off between information retrieval and destructivity from the optical probe. We also demonstrate the correction of more general types of collective noise. This technique can be used for the operation of atomic interferometers beyond the standard Ramsey scheme, opening the way towards improved atomic sensors.

In situ characterization of an optical cavity using atomic light shift

We report the precise characterization of the optical potential obtained by injecting a distributed-feedback erbium-doped fiber laser at 1560 nm to the transverse modes of a folded optical cavity. The optical potential was mapped in situ using cold rubidium atoms, whose potential energy was spectrally resolved thanks to the strong differential light shift induced by the 1560 nm laser on the two levels of the probe transition. The optical potential obtained in the cavity is suitable for trapping rubidium atoms and eventually to achieve all-optical Bose-Einstein condensation directly in the resonator.

Determination of the newtonian gravitational constant using atom interferometry

We present a new measurement of the Newtonian gravitational constant G based on cold-atom interferometry. Freely falling samples of laser-cooled rubidium atoms are used in a gravity gradiometer to probe the field generated by nearby source masses. In addition to its potential sensitivity, this method is intriguing as gravity is explored by a quantum system. We report a value of G = 6.667 x 10(-11) m(3) kg(-1) s(-2), estimating a statistical uncertainty of +/-0.011 x 10(-11) m(3) kg(-1) s(-2) and a systematic uncertainty of +/-0.003 x 10(-11) m(3) kg(-1) s(-2). The long-term stability of the instrument and the signal-to-noise ratio demonstrated here open interesting perspectives for pushing the measurement accuracy below the 100 ppm level.

Source mass and positioning system for an accurate measurement of G

We report on a system of well-characterized source masses and their precision positioning system for a measurement of the Newtonian gravitational constant G using atoms as probes. The masses are 24 cylinders of 50 mm nominal radius, 150.2 mm nominal height, and mass of about 21.5 kg, sintered starting from a mixture of 95.3% W, 3.2% Ni, and 1.5% Cu. Density homogeneity and cylindrical geometry have been carefully investigated. The positioning system independently moves two groups of 12 cylinders along the vertical direction by tens of centimeters with a reproducibility of a few microns. The whole system is compatible with a resolution DeltaG/G<10(-4).

Incidence of cancer after a first episode of idiopathic venous thromboembolism treated with 3 months or 1 year of oral anticoagulation

BACKGROUND

A prolonged treatment with oral anticoagulants has been claimed to reduce the incidence of newly diagnosed cancer in the long-term follow-up of patients with venous thromboembolism.

OBJECTIVES

In a multicenter prospective study we assessed the incidence of newly diagnosed clinically overt cancer in patients with a first episode of idiopathic venous thromboembolism (VTE) treated with oral anticoagulants for 3 months or 1 year.

PATIENTS AND METHODS

Consecutive patients with an idiopathic venous thromboembolism who had completed 3 months of oral anticoagulant therapy without having a recurrence, bleeding or newly diagnosed cancer were randomized to discontinue oral anticoagulant therapy or to continue it for nine additional months. Idiopathic venous thromboembolism was defined as thrombosis occurring in the absence of known cancer, known thrombophilia, or temporary risk factors for venous thromboembolism. All patients were followed up for at least 1 year after randomization.

RESULTS

A total of 429 patients, 265 patients with DVT and 164 with PE, were followed up for an average of 43.7 months after randomization. A newly diagnosed cancer occurred in 32 patients (7.5%), 13 (6.2%) of the 210 patients treated for 3 months and 19 (8.7%) of the 219 patients treated for 1 year (RR = 0.71, 95% confidence interval 0.36-1.41).

CONCLUSIONS

The incidence of newly diagnosed clinically overt cancer is not reduced in patients with idiopathic venous thromboembolism treated with 1-year anticoagulant treatment compared with patients treated for 3 months.

Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. Warfarin Optimal Duration Italian Trial Investigators

BACKGROUND

In patients with idiopathic deep venous thrombosis, continuing anticoagulant therapy beyond three months is associated with a reduced incidence of recurrent thrombosis during the period of therapy. Whether this benefit persists after anticoagulant therapy is discontinued is controversial.

METHODS

Patients with a first episode of idiopathic proximal deep venous thrombosis who had completed three months of oral anticoagulant therapy (with warfarin, in 97 percent of the cases and acenocoumarol in 3 percent) were randomly assigned to the discontinuation of oral anticoagulants or to their continuation for nine additional months. The primary study outcome was recurrence of symptomatic, objectively confirmed venous thromboembolism during at least two years of follow-up.

RESULTS

The primary intention-to-treat analysis showed that of 134 patients assigned to continued oral anticoagulant therapy, 21 had a recurrence of venous thromboembolism (15.7 percent; average follow-up, 37.8 months), as compared with 21 of 133 patients assigned to the discontinuation of oral anticoagulant therapy (15.8 percent; average follow-up, 37.2 months), resulting in a relative risk of 0.99 (95 percent confidence interval, 0.57 to 1.73). During the initial nine months after randomization (after all patients received three months of therapy), 1 patient had a recurrence while receiving oral anticoagulant therapy (0.7 percent), as compared with 11 of the patients assigned to the discontinuation of oral anticoagulant therapy (8.3 percent; P=0.003). The incidence of recurrence after the discontinuation of treatment was 5.1 percent per patient-year in patients in whom oral anticoagulant therapy was discontinued after 3 months (95 percent confidence interval, 3.2 to 7.5 percent; average interval since discontinuation, 37.2 months) and 5.0 percent per patient-year in patients who received an additional 9 months of oral anticoagulant therapy (95 percent confidence interval, 3.1 to 7.8 percent; average interval since discontinuation, 29.4 months). None of the recurrences were fatal. Four patients had non-fatal major bleeding during the extended period of anticoagulant therapy (3.0 percent).

CONCLUSIONS

In patients with idiopathic deep venous thrombosis, the clinical benefit associated with extending the duration of anticoagulant therapy to one year is not maintained after the therapy is discontinued.

Atrial fibrillation in elite athletes

INTRODUCTION

Atrial fibrillation (AF) is a rare event in people younger than 25 years of age, but is probably more frequent in competitive athletes. We analyzed the presence of AF, paroxysmal or chronic, in a population of young elite athletes, including previous Olympic and World champions, who were studied for arrhythmias that endangered their athletic careers.

METHODS AND RESULTS

From 1974 to June 1977, 1,772 athletes identified with arrhythmias (1,464 males and 308 females; mean age 21 years) underwent individualized work-ups. Among these, 146 (122 males and 24 females; mean age 24 years) were young elite athletes. They were studied from 1985 to 1997, with a mean follow-up of 62 months. Of the 146 young elite athletes, 13 (9%) had AF (paroxysmal in 11 and chronic in 2); all were male. The paroxysmal AF occurred during effort (n = 7), after effort (n = 1), or at rest (n = 3) and was reinduced by transesophageal pacing or endocavitary electrophysiologic testing under the same clinical circumstances. AF was the cause of symptoms in 13 (40%) of 22 young elite athletes with long-lasting palpitations. Five young elite athletes had a substrate for AF: Wolff-Parkinson-White syndrome (WPW) in 3, arrhythmogenic right ventricular dysplasia (ARVD) in 1, healed myocarditis in 1, and was considered idiopathic in 8. All elite athletes are alive with a mean follow-up of 62 months and 7 continue in their sports: 3 after radiofrequency catheter ablation (of WPW in 2 and AF with maze-type nonfluoroscopic approach in 1) and 4 after a period of de-training.

CONCLUSIONS

AF, occurring in young elite athletes and affecting only males, is one of the most frequent causes of prolonged palpitations and is reproduced easily by transesophageal atrial pacing or electrophysiologic testing. AF may be a cause of disqualification from sports eligibility, but may disappear if the athletic activity is stopped for an adequate period of time, if trigger mechanisms are corrected (i.e., WPW), or if the substrate is modified.

Cardiac arrest and sudden death in competitive athletes with arrhythmogenic right ventricular dysplasia

Arrhythmogenic right ventricular dysplasia (ARVD) is a predisposing factor for sport-related cardiac arrest (CA), sudden cardiac death (SD), and life-threatening ventricular tachyarrhythmias (VT). The aim of this study was the assessment of athletes with ARVD, particularly the CA survivors. From 1974 to January 1996, 1642 competitive athletes (aver. 25.5 yr.), 136 of whom were top level athletes (TLA), were studied for important arrhythmic manifestations. All athletes underwent an individualised study protocol including a series of non invasive and invasive diagnostic techniques. One hundred and one athletes (90 males, 11 females, aver. 25.9 yr.) were diagnosed as being affected by ARVD on the basis of the WHO/ISFC criteria. The same percentage (about 6%) of ARVD is present in both the general arrhythmic athletes population and in the subgroup of TLA. Prevalence of ARVD among athletes with CA or SD is high (respectively 23% and 25%), confirming the observation that ARVD is one of the major causes of SD in Italian athletes. All CA were athletic activity related, indicating the potentiality of exercise as a cause of electrical destabilisation in subjects with ARVD. In athletes with documented ARVD intense sport activity has to be proscribed. In athletes at risk of CA or SD an aggressive treatment, ICD implantation and RF catheter ablation must be taken into consideration.

Catheter ablation in competitive athletes: indication

Some supraventricular tachyarrhythmias (SVT), particularly if paroxysmal and/or related to Wolff-Parkinson-White syndrome (WPW), may in some cases endanger an athlete's professional career due to hemodynamic consequences during athletic activity, which in some instances may be life-threatening. One must also take into account that in Italy the law makes antiarrhythmic drug treatment (AAD) incompatible with sport eligibility. For these reasons, the utilization of radiofrequency ablation (RFA) in athletes has different indications as opposed to the normal population, since the primary goal is "the eligibility of the athlete." In our study, we discuss the criteria for indication of RFA in athletes with SVT on the basis of the data obtained from our population of athletes, studied over a 20-year period, from 1974 to the 31st of December 1993. These athletes were evaluated for arrhythmic events, utilizing a standardized cardioarrhythmological protocol: 1,325 athletes (1,125 men, 200 women, mean age 20.7 years). One subgroup included 380 athletes with WPW (28.7%), 22 athletes with aborted sudden death (1.6%), 6 of whom had WPW, 13 athletes with sudden death (0.98%), and 2 of whom had WPW. Another subgroup was formed by 116 top level elite professional athletes (TLA) (mean age 22.9 years), of which 10 of 116 (8.6%) had WPW and 12 of 116 (10.3%) had paroxysmal SVT. The most important indications for RFA in athletes are represented by: WPW asymptomatic at risk, symptomatic during athletic activity, and/or requiring AAD treatment: paroxysmal junctional reentrant tachycardia: when this condition is disabling and related to exercise and therefore compromising an athlete's performance and sports career. Paroxysmal junctional reentrant tachycardia is easily reproduced via transesophageal atrial pacing (TAP) during exercise (bicycle ergometer), common in athletes but normally the recurrences are concentrated only during the period in which the athlete is engaged in sport. Rare indications for RFA are focal or reentry, permanent SVT, and particularly junctional reentrant tachycardia. For each individual athlete, we have to consider the possible side-effects of RFA, the possible recurrences with psychobiological traumatic consequences, the effective recovery period, and the natural history of the tachyarrhythmias, which frequently disappear after interruption of the sports career.

Flavin adenine dinucleotide synthesis in isolated rat liver mitochondria caused by imported flavin mononucleotide

Evidence is given in this paper that externally added flavin mononucleotide (FMN) induces flavin adenine dinucleotide synthesis in isolated rat liver mitochondria, as shown by fluorimetric, chromatographic, and enzymatic assays. FMN association with mitochondria is a process with hyperbolic features that is sensitive to externally added mersalyl.

Life-threatening tachyarrhythmias in athletes

The arrhythmias in competitive athletes may be classified as "benign," "paraphysiological" due to prolonged athletic training, or "pathological" due to hemodynamic effects on the athletic performance-risk-arrhythmogenic substratum. Pathological arrhythmias include life-threatening forms that are severe enough to produce symptoms (presyncope, syncope, cardiac arrest) during athletic activity. These forms are in particular rapid VT, VF, torsades de pointes, preexcited atrial fibrillation, sinus atrial and AV block. Our study population includes 766 competitive athletes, mean age 21.1 years (74 top international level), investigated with a cardioarrhythmological work-up for symptoms and for arrhythmias from 1974 to June 30, 1991. Three leading categories, represented by 16 aborted sudden death, 8 sudden death, and 7 induced VF (by EES or TAP) athletes, are described. All athletes with life-threatening arrhythmias, previously as asymptomatic or with minor symptoms had an arrhythmogenic substratum due to underlying silent cardiopathy or primary arrhythmic disorders. Athletic activity can be regarded as a trigger of electrical destabilization.

Long-term follow-up of patients with inducible supraventricular tachycardia treated with flecainide or propafenone: therapy guided by transesophageal electropharmacologic testing

We report our experience with flecainide and propafenone therapy for inducible supraventricular tachycardias and paroxysmal supraventricular tachycardias due to atrioventricular (AV) nodal reentry or the Wolff-Parkinson-White syndrome. We performed an electropharmacologic test (ET) that consisted of first inducing a clinical arrhythmia by transesophageal atrial pacing (TAP) protocol. This was followed by intravenous drug administration and TAP reevaluation, either after acute intravenous administration or in oral steady-state. We used ET with flecainide and/or propafenone to study 2 groups of patients at least 3 years before the long-term clinical observation period. The first group was comprised of 58 patients with reciprocating tachycardias--due to AV node reentry in 17 (29.3%) and anomalous pathway in 41 (70.7%). Twelve (29.3%) of the latter had reciprocating tachycardias, 15 (36.6%) had atrial fibrillation, and 14 (34.2%) had both arrhythmias. During ET, flecainide was administered to 42 patients, and the ET was considered positive in 28 (66.7%). Propafenone was administered to 32 patients, with positive results in 15 (46.9%). In 15 patients, both flecainide and propafenone were tested, 8 receiving flecainide after a negative ET with propafenone, and 7 receiving propafenone after a negative ET with flecainide. In the first group, the ET was positive in 7 (87.5%), and in the second group, it was positive in 3 (42.9%). In a follow-up of 40.1 +/- 11 months, 38 (65.5%) patients had positive outcomes, 5 (8.6%) had to stop receiving the drugs because of side effects, 3 (5.2%) stopped because of inefficacy, and 12 (20.7%) dropped out.(ABSTRACT TRUNCATED AT 250 WORDS)

[Supraventricular reentry tachycardia and athletic fitness]

Paroxysmal supraventricular reciprocating tachycardias (PSRT) which are due to a different type of reentry including the atrioventricular reentry circuit of Wolff-Parkinson-White (WPW) syndrome, may disturb the professional career of an athlete. Moreover even severe episodes of preexcited atrial fibrillation of WPW may occur. PSRT in athletes may present various clinical consequences: unimportant symptoms, or severe hemodynamic effects on the athletic performance particularly during sports activity at intrinsic high risk. The athletes are evaluated by clinical protocol which includes Holter monitoring ergometric test, echocardiography study, thyroid check and transesophageal electrophysiologic study at rest and during exercise. The arrhythmological study should be carefully performed in order to exclude an underlying heart disease, to study electrophysiological mechanisms and possible hemodynamic effect sports activity relate of the inducible and clinical tachyarrhythmias. Sometimes, these PSRT may disappear after interruption of athletic activity because of modifications of electrophysiological conditions related to the sports activity.

[Stable ventricular tachycardia in arrhythmogenic dysplasia of the right ventricle in sportsmen]

Right ventricular arrhythmogenic dysplasia (RVAD) is a typical asymptomatic arrhythmogenic cardiopathy in athletes, which is occasionally concurrent with normal ventricular function and life-threatening arrhythmias. A total of 32 athletes (28 males and 4 females, mean age, 23 years, mean follow-up, 6.7 years) were examined for severe cardiac arrhythmias with left bundle branch block. The conclusive diagnosis of RVAD was established from clinical, echocardio-, and angiographic evidence. The protocol of the examination involved Holter monitoring, loading tests, electrophysiological study, two-dimensional echocardiography, cardiac angiography of the right and left ventricles, coronary angiography. The most severe arrhythmias were observed in athletes whose mean age was 23.4 years, 20 patients had sustained ventricular tachycardia (it occurred only in 19 who were indulging in sports), 6 presented with transient ventricular tachycardia, and 1 had ventricular fibrillation. They all had been considered fit for sports. The disease proceeded severely in 16 of 32 athletes (in 13 of 16 while indulging in sports), the conditions close to syncope were seen in 9 patients (8 had sustained ventricular tachycardias and 1 had transient ventricular tachycardias), syncopes were observed in 5 patients (sustained ventricular tachycardias).

Arrhythmia patterns in athletes with arrhythmogenic right ventricular dysplasia

Arrhythmogenic right ventricular dysplasia (ARVD) is a typical 'silent' arrhythmogenic cardiomyopathy in athletes, with the possibility of normal ventricular performance and life-threatening arrhythmias. We studied 32 athletes (28 M, 4 F), mean age 23 years, follow-up 6.7 years, all previously declared fit for sports activity. They were studied for significant ventricular arrhythmias with LBBB with a final diagnosis of ARVD based on accepted clinical, echocardiographic and angiographic criteria. The study protocol included Holter monitoring (HM), stress test (ST), electrophysiological endocavitary study (EES), 2D echocardiography, RV and LV cardioangiography and coronarography. The most serious arrhythmia appeared at a mean age of 23.4 years, 20 had clinical sustained ventricular tachycardia (VT) (19/20, 95% during sports activity), six non-sustained VT and one ventricular fibrillation (VF). Severe symptoms occurred in 16/32 athletes (50%) during sports activity in 13/16 (81%): presyncope in nine (non-sustained VT in one, sustained VT in eight); syncope in five (sustained VT); aborted sudden death (SD) in one, SD (follow-up) in one. The reproducibility (HM, ST, EES) of clinically severe arrhythmic manifestations which occurred during sports activity was not high. In fact, during sport many factors are at work which may activate several arrhythmogenic mechanisms not easily reproducible in the laboratory. We conclude that a cardioarrhythmological study is mandatory in suspected right ventricular arrhythmias, including morphological study of the RV, to avoid arrhythmic risk during athletic activity.

[Arrhythmologic study of 50 patients with arrhythmogenic disease of the right ventricle: prognostic implications]

Arrhythmogenic right ventricular disease is a syndrome which involves a wide spectrum of anatomo-clinical features. It is characterised by different levels of right ventricle anomaly, and by life-threatening "right" hyperkinetic ventricular arrhythmias. Fifty consecutive pts were retrospectively examined at the Arrhythmological Centre in Trento between 1977 and 1988. The results of rigorous arrhythmological, echocardiographic and angiographic criteria showed that all pts were affected by arrhythmogenic right ventricular disease.

CASE STUDY

39/50 (78%) males, 11/50 (22%) females; age 30.6 years (11-78) at the time of the first study.

METHODS

clinical history in 50/50 pts, electrocardiogram in 50/50 pts, Holter monitoring in 50/50 pts, ergometric test in 49/50 pts, non-invasive analysis using signal-averaging QRS in 17/50 pts, 2D echocardiogram in 50/50 pts, angiography in 38/50 pts, electrophysiological endocavitary study in 35/50 pts.

RESULTS

familial 2/50 (4%); 1/50 (2%) was in class II NYHA; first arrhythmia at 24.6 years (8-60); most severe arrhythmia at 27.7 years (9-74). Forty-three out of fifty patients (86%) were symptomatic for arrhythmias: 28/50 (56%) as a result of stress; 20/50 (40%) had life-threatening symptoms; 6/50 (12%) had aborted sudden death. Arrhythmogenic right ventricular disease was "localized" in 42/50 (84%) and "diffused" in 8/50 (16%) and was associated with anomalies of the left ventricle in 30/50 (60%). Electrocardiogram showed: right bundle branch block in 10/50 (20%), negative T wave on the right precordial leads in 19/50 (38%), delayed ventricular potentials in 4/17 (23.5%). Using the electrocardiogram, Holter monitoring and electrophysiological endocavitary study the following were documented: a) clinical ventricular tachycardia in 40/50 (80%): non-sustained ventricular tachycardia in 10/50 (20%), sustained ventricular tachycardia in 30/50 (60%); b) electrically induced ventricular tachycardia in 26/35 (74.2%): non-sustained ventricular tachycardia in 8/35 (22.8%), sustained ventricular tachycardia in 18/35 (51.4%) (clinical sustained ventricular tachycardia in 18/18); c) multiform ventricular tachycardia in 12/50 (24%) (diffused arrhythmogenic right ventricular disease in 3/12 and associated anomalies of the left ventricle in 11/12); d) pleomorphic sustained ventricular tachycardia in 9/30 (30%) (diffused arrhythmogenic right ventricular disease in 2/9, and associated anomalies of the left ventricle in 8/9). Forty-two out of fifty patients (84%) underwent antiarrhythmic treatment. When the study was carried out 6.6 years (1 month-22 years) had passed since the first symptom; follow-up was 2.1 years (1 month-11 years) while the interval between the first symptom and the last check-up was 8.4 years (1-30 years); 2/50 dropped out and 2/50 died suddenly.(ABSTRACT TRUNCATED AT 400 WORDS)

[Effects on renal function of a drug antagonistic to morphine-like peptide systems after water load]

Following i.v. administration of 0,4 mg Naloxone, a pure antagonist of opioid peptides, a study of renal function was performed in 5 patients who underwent oral water load equal to 20 cc/Kg water for 15-20 min. Within 15 min after administration of the drug all cases showed a further increase in urinary flow resulting from an increase in glomerular filtration rate and CH2O. The absence of systemic haemodynamic changes (BP, HR) suggested an intrarenal origin of the phenomena observed, as a sign of expansion of the system responsible for free water elimination. We put forward the hypothesis that Naloxone inhibits the antidiuretic activity of opioid peptides - in any case quiescent under water load conditions - which is masked by osmotic and volume mechanism.