P1448Ablation of cti-dependent flutter using a novel advanced mini-electrodes technology: preliminary results from Leonardo registry

Funding Acknowledgements

NO FUNDING

OnBehalf

LEONARDO study group

Background

Ablation of cavotricuspid isthmus (CTI) represents the standard therapeutic approach for the creation of bidirectional conduction block (BDB) across the isthmus and the prevention of recurrences, yet recurrence of arrhythmia is common.

Objective

To evaluate the acute and long-term outcome of CTI ablation through a novel ablation catheter equipped with three radially distributed mini-electrodes (ME) compared with standard ablation catheter technology (ST).

Methods

Atrial Flutter Ablation in a Real World Population (LEONARDO) is a prospective, multicenter cohort study aimed at providing an estimate of acute to long-term outcome in a large population of pts indicated for AFL ablation from 2015 to 2017. The procedural endpoint was the creation of a BDB. Presence of widely split double potentials (DP) along the ablation line and assessment of the atrial activation sequence (AAS) were used as criteria for complete BDB. Recurrence of AFL and complications were assessed at 12-month follow-up.

Results

  205 consecutive pts undergoing typical AFL ablation were included (74% male, 50.6% with history of AF, median of 7[4–11] ablation lesions, median ablation time of 20[10-30] min). Complete BDB was achieved in 175 (85.4%) pts (10 pts had DP only criterion, 19 pts had AAS only criterion whereas in 1 pt we failed to reach a BDB). 15 (7.3%) pts experienced AFL recurrence during follow-up. 102 pts (49.8%) underwent ablation procedure with ME catheters whereas 103 (50.2%) pts were treated by ST catheters. The median number of lesions/pt was significantly lower in the ME group compared to the ST one (4[3-6] vs 8.5[6-12], p < 0.0001), whereas no differences were found in terms of fluoroscopy time (10.5[7-15] min vs 10[5.8 ± 15] min, p = NS) or ablation time (22.5[10-30.5] min vs 18[10-26] min, p = NS). No complications were reported. The acute procedural success was comparable between groups (81.4% vs 89.2%, p = NS) whereas the time to AFL recurrence was significantly longer among pts targeted with ME catheters (HR = 0.343; 0.12 to 0.97; log-rank p = 0.044).

Conclusions

In our preliminary experience, the use of the ME technology seemed safe and effective. It resulted in fewer lesions/pt and a lower AFL recurrence rate at 1-year follow-up compared with ST ablation catheters.

Sequential use of vinorelbine followed by gefitinib enhances the antitumor effect in NSCLC cell lines poorly responsive to reversible EGFR tyrosine kinase inhibitors

Preclinical studies have suggested that combining cytotoxic agents with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) to treat EGFR-mutated tumors may increase their inhibitory effect depending on the order of drug administration. The antitumor efficacy of different treatment sequences using vinorelbine (VNB) and gefitinib (GEF) was investigated both in vitro and in vivo in non-small cell lung cancer (NSCLC) cell lines with the rationale of potentially translating these findings into the clinical setting. The EGFR-wild-type A549 and the EGFR-mutated (exon 21 L858R/exon 20 T790M) H1975 cell lines were treated as follows: GEF followed by VNB, VNB followed by GEF and the two drugs applied individually or concurrently. Results in vitro demonstrated that the sequence of VNB followed by GEF was significantly more active than single-agent treatments. The expression of activated EGFR and its downstream pathway genes indicated that the increased cytotoxic effect of the VNB and GEF treatment sequence was accompanied by inhibition of EGFR, AKT and ERK1/2. Moreover, the increased inhibition of tumor growth after treatment with VNB followed by GEF was also confirmed in CD1-nude mice that were xenotransplanted with H1975 cells (p < 0.0001). This effect was paralleled by a corresponding decrease in cancer glucose consumption, as assessed by micro-positron emission tomography scans (p < 0.05). These preclinical findings in NSCLC cell lines, which are poorly responsive to EGFR-TKIs, demonstrated that the sequential treatment of VNB followed by GEF induced a significant antitumor effect, which supports the translation of this treatment schedule into a clinical setting.

Cardiometabolic and immune factors associated with increased common carotid artery intima-media thickness and cardiovascular disease in patients with systemic lupus erythematosus

BACKGROUND AND AIM

Patients with systemic lupus erythematosus (SLE) have a higher prevalence of subclinical atherosclerosis and higher risk of cardiovascular (CV) events compared to the general population. The relative contribution of CV-, immune- and disease-related risk factors to accelerated atherogenesis in SLE is unclear.

METHODS AND RESULTS

Fifty SLE patients with long-lasting disease (mean age 44 ± 10 years, 86% female) and 50 sex- and age-matched control subjects were studied. Common carotid artery intima-media thickness (CCA-IMT) was used as a surrogate marker of atherosclerosis. We evaluated traditional and immune- and disease-related factors, assessed multiple T-cell subsets by 10-parameter-eight-colour polychromatic flow cytometry and addressed the effect of pharmacological therapies on CCA-IMT. In SLE patients, among several cardiometabolic risk factors, only high-density lipoprotein levels (HDL) and their adenosine triphosphate-binding cassette transporter 1 (ABCA-1)-dependent cholesterol efflux capacity were markedly reduced (p < 0.01), whereas the CCA-IMT was significantly increased (p = 0.03) compared to controls. CCA-IMT correlated with systolic blood pressure, low-density lipoprotein (LDL) cholesterol and body mass index (BMI), but not with disease activity and duration. The activated CD4(+)HLA-DR(+) and CCR5(+) T-cell subsets were expanded in SLE patients. Patients under hydroxychloroquine (HCQ) therapy showed lower CCA-IMT (0.62 ± 0.08 vs. 0.68 ± 0.10 mm; p = 0.03) and better risk-factor profile and presented reduced circulating pro-atherogenic effector memory T-cell subsets and a parallel increased percentage of naïve T-cell subsets.

CONCLUSION

HDL represents the main metabolic parameter altered in SLE patients. The increased CCA-IMT in SLE patients may represent the net result of a process in which 'classic' CV risk factors give a continuous contribution, together with immunological factors (CD4(+)HLA-DR(+) T cells) which, on the contrary, could contribute through flares of activity of various degrees over time. Patients under HCQ therapy present a modified metabolic profile, a reduced T-cell activation associated with decreased subclinical atherosclerosis.

[Bioadhesives: rationale, state of the art and therapeutic potential]

Pharmaceutical research is going on the way to formulate drugs in dosage forms and delivery systems able to improve their biopharmaceutical properties. For some routes of administration, among them the transmucosal ones, such improvements may be reached by increasing the time and the nature of the contact between mucosal tissues and drug dosage forms via chemical or physical bioadhesive links. Biopharmaceutical AFI Study Group efforts were oriented in analyzing the actual state of the art in the field of bioadhesive drug delivery. Rationals of use of drug dosage forms with bioadhesive properties, analytical method of control of bioadhesion (both in vitro and in vivo) and therapeutical potentialities are the matter of this review.

Nasal formulations of ketorolac tromethamine: technological evaluation--bioavailability and tolerability in rabbits

This paper describes the development of a novel formulation of the powerful non narcotic analgesic ketorolac tromethamine. This drug is given orally three to four times/day to deliver a total of 30 to 60 mg of drug. Higher doses cannot be given orally because of gastrointestinal side effects and intramuscular injections, three times/day must then be used. The need for injections limits the drug to a clinical setting. Nasal delivery offers a method of achieving the high blood levels of repeated intramuscular injections in a formulation that can be easily applied by the patients. Four formulations were evaluated in "in vitro" and "in vivo" rabbit tests. The best formulation consisted of a 5% solution of ketorolac tromethamine containing 0.3% sodium glycocolate as a known mucosal drug absorption enhancer. Ketorolac applied in this way had a bioavailability greater than 80%. The controlled release nature of nasal delivery also doubled the drug's apparent half life. The drug formulation was stable in three-months stability tests and produced minimal nasal irritation.