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Atrial fibrillation cryoablation is an effective day case treatment: the UK PolarX vs. Arctic Front Advance experience. Europace 2023; 25:euad286. [PMID: 37738643 PMCID: PMC10629714 DOI: 10.1093/europace/euad286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/28/2023] [Indexed: 09/24/2023] Open
Abstract
AIMS Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation (AF). There are limited data on the PolarX Cryoballoon. The study aimed to establish the safety, efficacy, and feasibility of same day discharge for Cryoballoon PVI. METHODS AND RESULTS Multi-centre study across 12 centres. Procedural metrics, safety profile, and procedural efficacy of the PolarX Cryoballoon with the Arctic Front Advance (AFA) Cryoballoon were compared in a cohort large enough to provide definitive comparative data. A total of 1688 patients underwent PVI with cryoablation (50% PolarX and 50% AFA). Successful PVI was achieved with 1677 (99.3%) patients with 97.2% (n = 1641) performed as day case procedures with a complication rate of <1%. Safety, procedural metrics, and efficacy of the PolarX Cryoballoon were comparable with the AFA cohort. The PolarX Cryoballoon demonstrated a nadir temperature of -54.6 ± 7.6°C, temperature at 30 s of -38.6 ± 7.2°C, time to -40°C of 34.1 ± 13.7 s, and time to isolation of 49.8 ± 33.2 s. Independent predictors for achieving PVI included time to reach -40°C [odds ratio (OR) 1.34; P < 0.001] and nadir temperature (OR 1.24; P < 0.001) with an optimal cut-off of ≤34 s [area under the curve (AUC) 0.73; P < 0.001] and nadir temperature of ≤-54.0°C (AUC 0.71; P < 0.001), respectively. CONCLUSIONS This large-scale UK multi-centre study has shown that Cryoballoon PVI is a safe, effective day case procedure. PVI using the PolarX Cryoballoon was similarly safe and effective as the AFA Cryoballoon. The cryoablation metrics achieved with the PolarX Cryoballoon were different to that reported with the AFA Cryoballoon. Modified cryoablation targets are required when utilizing the PolarX Cryoballoon.
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Efficacy and safety of hybrid epicardial and endocardial ablation versus endocardial ablation in patients with persistent and longstanding persistent atrial fibrillation: a randomised, controlled trial. EClinicalMedicine 2023; 61:102052. [PMID: 37425372 PMCID: PMC10329123 DOI: 10.1016/j.eclinm.2023.102052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 07/11/2023] Open
Abstract
Background Endocardial catheter ablation (CA) has limited long-term benefit for persistent and longstanding persistent atrial fibrillation (PersAF/LSPAF). We hypothesized hybrid epicardial-endocardial ablation (HA) would have superior effectiveness compared to CA, including repeat (rCA), in PersAF/LSPAF. Methods CEASE-AF (NCT02695277) is a prospective, multi-center, randomized controlled trial. Nine hospitals in Poland, Czech Republic, Germany, United Kingdom, and the Netherlands enrolled eligible participants with symptomatic, drug refractory PersAF and left atrial diameter (LAD) > 4.0 cm or LSPAF. Randomization was 2:1 to HA or CA by an independent statistician and stratified by site. Treatment assignments were masked to the core rhythm monitoring laboratory. For HA, pulmonary veins (PV) and left posterior atrial wall were isolated with thoracoscopic epicardial ablation including left atrial appendage exclusion. Endocardial touch-up ablation was performed 91-180 days post-index procedure. For CA, endocardial PV isolation and optional substrate ablation were performed. rCA was permitted between days 91-180. Primary effectiveness was freedom from AF/atrial flutter/atrial tachycardia >30-s through 12-months absent class I/III anti-arrhythmic drugs except those not exceeding previously failed doses. It was assessed in the modified intention-to-treat (mITT) population who had the index procedure and follow-up data. Major complications were assessed in the ITT population who had the index procedure. Thirty-six month follow-up continues. Findings Enrollment began November 20, 2015 and ended May 22, 2020. In 154 ITT patients (102 HA; 52 CA), 75% were male, mean age was 60.7 ± 7.9 years, mean LAD was 4.7 ± 0.4 cm, and 81% had PersAF. Primary effectiveness was 71.6% (68/95) in HA versus 39.2% (20/51) in CA (absolute benefit increase: 32.4% [95% CI 14.3%-48.0%], p < 0.001). Major complications through 30-days after index procedures plus 30-days after second stage/rCA were similar (HA: 7.8% [8/102] versus CA: 5.8% [3/52], p = 0.75). Interpretation HA had superior effectiveness compared to CA/rCA in PersAF/LSPAF without significant procedural risk increase. Funding AtriCure, Inc.
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Loperamide-induced ventricular tachycardia storm. THE BRITISH JOURNAL OF CARDIOLOGY 2021; 28:46. [PMID: 35747063 PMCID: PMC9063705 DOI: 10.5837/bjc.2021.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Loperamide is an over-the-counter, peripherally-acting, μ-opioid receptor agonist commonly used in the treatment of diarrhoea. It has increasingly been recognised as a potential drug of misuse, having previously been thought to have low potential for abuse owing to its low bioavailability and poor penetration of the central nervous system. High doses can result in life-threatening cardiac-toxicity. We present a case of a young woman who had been self-treating her depression with high doses of loperamide for one year, who then presented to hospital with syncope secondary to ventricular tachycardia (VT). While in the emergency department (ED) the patient had monomorphic pulseless VT requiring electrical cardioversion multiple times. Transfer to a tertiary cardiac centre was immediately arranged after she was stabilised and intubated. This complicated the diagnostic process as a thorough history could not be obtained on arrival to the tertiary centre, which meant the loperamide misuse only came to light multiple days into admission, after the patient was extubated. The final diagnosis of loperamide-induced secondary long-QT syndrome was made and the patient made a full recovery.
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Radiofrequency ablation of ventricular tachycardia in Anderson–Fabry disease: a case series. Eur Heart J Case Rep 2021; 5:ytaa529. [PMID: 33569526 PMCID: PMC7859597 DOI: 10.1093/ehjcr/ytaa529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/05/2020] [Accepted: 12/01/2020] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Cardiac involvement in Anderson–Fabry disease (AFD) can lead to arrhythmia, including ventricular tachycardia (VT). The literature on radiofrequency ablation (RFA) for the treatment of VT in AFD disease is limited.
Case summary
We discuss RFA of drug-refractory VT electrical storm in three males with AFD. The first patient (53 years old) had extensive involvement of the inferolateral left ventricle (LV) demonstrated with cardiac magnetic resonance imaging (CMRI), with a left ventricular ejection fraction (LVEF) of 35%. Two VT ablation procedures were performed. At the first procedure, the inferobasal endocardial LV was ablated. Furthermore, VT prompted a second ablation, where epicardial and endocardial sites were ablated. The acute arrhythmia burden was controlled but he died 4 months later despite appropriate implantable cardioverter-defibrillator therapies for VT. The second patient (67 years old) had full-thickness inferolateral involvement demonstrated with CMRI and LVEF of 45%. RFA of several endocardial left ventricular sites was performed. Over a 3-year follow-up, only brief non-sustained VT was identified, but he subsequently died of cardiac failure. Our third patient (69 years old), had an LVEF of 35%. He had RFA of endocardial left ventricular apical disease, but died 3 weeks later of cardiac failure.
Discussion
RFA of drug-refractory VT in AFD is feasible using standard electrophysiological mapping and ablation techniques, although the added clinical benefit is of questionable value. VT storm in the context of AFD may be a marker of end-stage disease.
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Faecal score and dry matter content after feeding synbiotics to neonatal Jersey crossbred calves. INDIAN JOURNAL OF DAIRY SCIENCE 2020. [DOI: 10.33785/ijds.2020.v73i03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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An exercise-based cardiac rehabilitation programme for AF patients in the NHS: a feasibility study. THE BRITISH JOURNAL OF CARDIOLOGY 2020; 27:20. [PMID: 35747085 PMCID: PMC8793934 DOI: 10.5837/bjc.2020.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
There is increasing evidence for the role of exercise-based cardiac rehabilitation in the management of patients with atrial fibrillation (AF). However, this intervention has not yet been widely adopted within the National Health Service (NHS). We performed a feasibility study on the utilisation of an established NHS cardiac rehabilitation programme in the management of AF, and examined the effects of this intervention on exercise capacity, weight, and psychological health. We then identified factors that might prevent patients from enrolling on our programme. Patients with symptomatic AF were invited to participate in an established six-week exercise-based cardiac rehabilitation programme, composed of physical activity and education sessions. At the start of the programme, patients were weighed and measured, performed the six-minute walk test (6MWT), completed the Generalised Anxiety Disorder Questionnaire (GAD-7), and the Patient Health Questionnaire (PHQ-9). Measurements were repeated on completion of the programme. Over two years, 77 patients were invited to join the programme. Twenty-two patients (28.5%) declined participation prior to initial assessment and 22 (28.5%) accepted and attended the initial assessment, but subsequently withdrew from the programme. In total, 33 patients completed the entire programme (63.9 ± 1.7 years, 58% female). On completion, patients covered longer distances during the 6MWT, had lower GAD-7 scores, and lower PHQ-9 scores, compared with their baseline results. Compared with patients that completed the entire programme, those who withdrew from the study had, at baseline, a significantly higher body mass index (BMI), covered a shorter distance during the 6MWT, and had higher PHQ-9 and GAD-7 scores. In conclusion, enrolling patients with AF into an NHS cardiac rehabilitation programme is feasible, with nearly half of those invited completing the programme. In this feasibility study, cardiac rehabilitation resulted in an improved 6MWT, and reduced anxiety and depression levels, in the short term. Severe obesity, higher anxiety and depression levels, and lower initial exercise capacity appear to be barriers to completing exercise-based cardiac rehabilitation. These results warrant further investigation in larger cohorts.
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Prescribing dronedarone for paroxysmal atrial fibrillation: how is it done across the UK and is it safe? Eur J Hosp Pharm 2019; 26:220-222. [PMID: 31338172 DOI: 10.1136/ejhpharm-2017-001207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/21/2017] [Accepted: 04/03/2017] [Indexed: 11/04/2022] Open
Abstract
Dronedarone, a useful treatment for paroxysmal atrial fibrillation, is often only prescribed in secondary care. To support a protocol shared between primary and secondary care, dronedarone use was audited in our centre and prescribing practices across UK secondary care centres were reviewed. From 2010 to 2015, a total of 181 patients were started on dronedarone. There were no deaths or serious adverse events. Median cessation time due to adverse effects was 52 days and 88% stopped dronedarone within 6 months. Of 17 local prescribing protocols across the UK, 12 involved shared care and 5 purely secondary care follow-up. In our review, dronedarone was safe and well tolerated. The use of shared care protocols is well established in other UK centres. The development of a local shared care protocol between primary and secondary care is feasible with existing systems in place to support its introduction.
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Condensed Low Dose Total Skin Electron Beam Therapy for Mycosis Fungoides: A Single Institution Experience. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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74Predicting success of atrial fibrillation ablation by point by point and single shot ablation techniques. Europace 2017. [DOI: 10.1093/europace/eux283.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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76MADIT RIT in the real world – an observational tertiary centre study. Europace 2017. [DOI: 10.1093/europace/eux283.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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147 Primary aleukemic myeloid leukemia cutis remission following radiotherapy. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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POSTERS (1)59MULTIPOLAR CONTACT MAPPING GUIDED ABLATION OF TEMPORALLY STABLE HIGH FREQUENCY AND COMPLEX FRACTIONATED ATRIAL ELECTROGRAM SITES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION60INTRA-CARDIAC AND PERIPHERAL LEVELS OF BIOCHEMICAL MARKERS OF FIBROSES IN PATIENTS UNDERGOING CATHETER ABLATION FOR ATRIAL FIBRILATION61THE DON'T WAIT TO ANTICOAGULATE PROJECT (DWAC) BY THE WEST OF ENGLAND ACADEMIC HEALTH SCIENCE NETWORK (AHSN) OPTIMISES STROKE PREVENTION FOR PATIENTS WITH ATRIAL FIBRILLATION (AF) WITHIN PRIMARY CARE IN LINE WITH NICE CG180 IN THE WEST OF ENGLAND62ILLNESS AND TREATMENT REPRESENTATIONS, COPING AND DISTRESS: VICIOUS CYCLES OF EVERYDAY EXPERIENCES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION63THE NEEDS OF THE ADOLESCENT LIVING WITH AN INHERITED CARDIAC CONDITION: THE PATIENTS' PERSPECTIVE64SAFETY AND EFFICACY OF PARAMEDIC TREATMENT OF REGULAR SUPRAVENTRICULAR TACHYCARDIA (PARA-SVT)65NATURAL PROGRESSION OF QRS DURATION FOLLOWING IMPLATABLE CARDIOVERTER DEFIBRILLATORS (ICD) - IMPLANTATION66COMPARISON OF EFFICACY OF VOLTAGE DIRECTED CAVOTRICUSPID ISTHMUS ABLATION USING MINI VS CONVENTIONAL ELETRODES67CRYOBALLOON ABLATION (CRYO) FOR ATRIAL FIBRILLATION (AF) CANNOT BE GUIDED BY TEMPERATURE END-POINTS ALONE68MODERATOR BAND ECTOPY UNMASKED BY ADENOSINE AS A CAUSE OF ECTOPIC TRIGGERED IDIOPATHIC VF69EARLY CLINICAL EXPERIENCE WITH TARGETED SITE SELECTION FOR THE WiCS-LV ELECTRODE FOR CRT70DOES VECTOR MAPPING PRIOR TO IMPLANTABLE LOOP RECORDER INSERTION IMPROVE THE DETECTION OF ARRHYTHMIA?71THE ROLE OF SPECKLE TRACKING STRAIN IMAGING IN ASSESSING LEFT VENTRICULAR RESPONSE TO CARDIAC RESYNCHRONISATION THERAPY IN RESPONDERS AND NON-RESPONDERS72EVALUATING PATIENTS' EXPERIENCE AND SATISFACTION OF THE ATRIAL FIBRILLATION ABLATION PROCEDURE: A RETROSPECTIVE ANALYSIS73TROUBLESHOOTING LV LEAD IMPLANTATION - NOVEL “UNIRAIL TECHNIQUE”74SUBCLINICAL ATHEROSCELEROSIS AND COGNITIVE IMPAIRMENT75EFFECT OF LOZARTANE ON DEVELOPMENT OF THE ELECTRICAL INSTABILITY OF THE MYOCARDIUM76THE INTERPLAY BETWEEN BODY COMPOSITION AND LEFT VENTRICULAR REMODELLING IN CARDIAC RESYNCHRONISATION THERAPY77FAMILY SCREENING IN IDIOPATHIC VENTRICULAR FIBRILLATION78MANAGEMENT OF ATRIAL FIBRILLATION IN A LARGE TEACHING HOSPITAL79THE EFFECT OF LEFT VENTRICULAR LEAD POSITION ON SURVIVAL IN PATIENTS WITH BINVENTRICULAR PACEMAKRS/DEFIBRILLATORS80ACUTE DEVICE IMPLANT-RELATED COMPLICATIONS DO NOT INCREASE LATE MORTALITY81ABORTED CARIDAC ARREST AS THE SENTINEL PRESENTATION IN A COHORT OF PATIENTS WITH THE CONCEALED BRUGADA PHENOTYPE82POST-CARDIAC DEVICE IMPLANTATION MOBILISATION ADVICE: A NATIONAL SURVEY83DO RISK SCORES DEVELOPED TO PROTECT ONE-YEAR MORTALITY ACTUALLY HELP IN ACCURATELY SELECTING PATIENTS RECEIVING PRIMARY PREVENTION ICD?84ATRIAL TACHYCARDIA ARISING FROM THE NON-CORONARY AORTIC CUSP85THE EFFECT OF DIFFERENT ATRIAL FIBRILLATION ABLATION STRATEGIES ON SURFACE ECG P WAVE DURATION86PRESCRIBING DRONEDARONE: HOW IS IT DONE ACROSS THE UK AND IS IT SAFE?87A CASE OF WIDE COMPLEX TACHYCARDIA88TRANSITION TO DEDICATED DAY CASE DEVICES - SAFETY AND EFFICACY IN A LARGE VOLUME CENTRE89SEQUENTIAL REGIONAL DOMINANT FREQUENCY MAPPING DURING ATRIAL FIBRILLATION: A NOVEL TEQUNIQUE90ELECTIVE CARDIOVERSION ENERGY PROTOCOLS: A RETROSPECTIVE COMPARISON OF ESCALATION STRATEGIES91THE INCIDENCE OF CLINCALLY RELEVANT HAEMATOMAS WITH PERIOPERATIVE USE OF NEWER P2Y12 INHIBITORS AND INTERRUPTED NOAC THERAPY IN CARDIAC IMPLANTABLE ELECTRONIC DEVICE INSERTION92AN AUDIT OF THE OUTCOMES FOR CHEMICAL AND DIRECT CURRENT CARDIOVERSION FOR ATRIAL FIBRILLATION AT OUR DGH OVER A 3 YEAR DURATION93REAL LIFE ACUTE MANAGEMET OF HAEMODYNAMICALLY TOLERATED MONOMORPHIC VENTRICULAR TACHYCARDIA. ARE WE MAKING EVIDENCE BASED ON DECISIONS?94A SERVICE EVALUATION TO ASSESS THE EFFICACY AND SAFETY OF NOVEL ORAL ANTICOAGULANTS VERSUS WARFARIN FOR ELECTIVE CARDIVERSION IN PATIENTS WITH NON VALVULAR AF IN A NURSE LED CARDIOVERSION SERVICE95PICK UP RATE OF IMPLANTED LOOP RECORDER AT A DISTRICT HOSPITAL. Europace 2016. [DOI: 10.1093/europace/euw273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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POSTERS (2)96CONTINUOUS VERSUS INTERMITTENT MONITORING FOR DETECTION OF SUBCLINICAL ATRIAL FIBRILLATION IN HIGH-RISK PATIENTS97HIGH DAY-TO-DAY INTRA-INDIVIDUAL REPRODUCIBILITY OF THE HEART RATE RESPONSE TO EXERCISE IN THE UK BIOBANK DATA98USE OF NOVEL GLOBAL ULTRASOUND IMAGING AND CONTINUEOUS DIPOLE DENSITY MAPPING TO GUIDE ABLATION IN MACRO-REENTRANT TACHYCARDIAS99ANTICOAGULATION AND THE RISK OF COMPLICATIONS IN PATIENTS UNDERGOING VT AND PVC ABLATION100NON-SUSTAINED VENTRICULAR TACHYCARDIA FREQUENTLY PRECEDES CARDIAC ARREST IN PATIENTS WITH BRUGADA SYNDROME101USING HIGH PRECISION HAEMODYNAMIC MEASUREMENTS TO ASSESS DIFFERENCES IN AV OPTIMUM BETWEEN DIFFERENT LEFT VENTRICULAR LEAD POSITIONS IN BIVENTRICULAR PACING102CAN WE PREDICT MEDIUM TERM MORTALITY FROM TRANSVENOUS LEAD EXTRACTION PRE-OPERATIVELY?103PREVENTION OF UNECESSARY ADMISSIONS IN ATRIAL FIBRILLATION104EPICARDIAL CATHETER ABLATION FOR VENTRICULAR TACHYCARDIA ON UNINTERRUPTED WARFARIN: A SAFE APPROACH?105HOW WELL DOES THE NATIONAL INSTITUTE OF CLINICAL EXCELLENCE (NICE) GUIDENCE ON TRANSIENT LOSS OF CONSCIOUSNESS (T-LoC) WORK IN A REAL WORLD? AN AUDIT OF THE SECOND STAGE SPECIALIST CARDIOVASCULAT ASSESSMENT AND DIAGNOSIS106DETECTION OF ATRIAL FIBRILLATION IN COMMUNITY LOCATIONS USING NOVEL TECHNOLOGY'S AS A METHOD OF STROKE PREVENTION IN THE OVER 65'S ASYMPTOMATIC POPULATION - SHOULD IT BECOME STANDARD PRACTISE?107HIGH-DOSE ISOPRENALINE INFUSION AS A METHOD OF INDUCTION OF ATRIAL FIBRILLATION: A MULTI-CENTRE, PLACEBO CONTROLLED CLINICAL TRIAL IN PATIENTS WITH VARYING ARRHYTHMIC RISK108PACEMAKER COMPLICATIONS IN A DISTRICT GENERAL HOSPITAL109CARDIAC RESYNCHRONISATION THERAPY: A TRADE-OFF BETWEEN LEFT VENTRICULAR VOLTAGE OUTPUT AND EJECTION FRACTION?110RAPID DETERIORATION IN LEFT VENTRICULAR FUNCTION AND ACUTE HEART FAILURE AFTER DUAL CHAMBER PACEMAKER INSERTION WITH RESOLUTION FOLLOWING BIVENTRICULAR PACING111LOCALLY PERSONALISED ATRIAL ELECTROPHYSIOLOGY MODELS FROM PENTARAY CATHETER MEASUREMENTS112EVALUATION OF SUBCUTANEOUS ICD VERSUS TRANSVENOUS ICD- A PROPENSITY MATCHED COST-EFFICACY ANALYSIS OF COMPLICATIONS & OUTCOMES113LOCALISING DRIVERS USING ORGANISATIONAL INDEX IN CONTACT MAPPING OF HUMAN PERSISTENT ATRIAL FIBRILLATION114RISK FACTORS FOR SUDDEN CARDIAC DEATH IN PAEDIATRIC HYPERTROPHIC CARDIOMYOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS115EFFECT OF CATHETER STABILITY AND CONTACT FORCE ON VISITAG DENSITY DURING PULMONARY VEIN ISOLATION116HEPATIC CAPSULE ENHANCEMENT IS COMMONLY SEEN DURING MR-GUIDED ABLATION OF ATRIAL FLUTTER: A MECHANISTIC INSIGHT INTO PROCEDURAL PAIN117DOES HIGHER CONTACT FORCE IMPAIR LESION FORMATION AT THE CAVOTRICUSPID ISTHMUS? INSIGHTS FROM MR-GUIDED ABLATION OF ATRIAL FLUTTER118CLINICAL CHARACTERISATION OF A MALIGNANT SCN5A MUTATION IN CHILDHOOD119RADIOFREQUENCY ASSOCIATED VENTRICULAR FIBRILLATION120CONTRACTILE RESERVE EXPRESSED AS SYSTOLIC VELOCITY DOES NOT PREDICT RESPONSE TO CRT121DAY-CASE DEVICES - A RETROSPECTIVE STUDY USING PATIENT CODING DATA122PATIENTS UNDERGOING SVT ABLATION HAVE A HIGH INCIDENCE OF SECONDARY ARRHYTHMIA ON FOLLOW UP: IMPLICATIONS FOR PRE-PROCEDURE COUNSELLING123PROGNOSTIC ROLE OF HAEMOGLOBINN AND RED BLOOD CELL DITRIBUTION WIDTH IN PATIENTS WITH HEART FAILURE UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY124REMOTE MONITORING AND FOLLOW UP DEVICES125A 20-YEAR, SINGLE-CENTRE EXPERIENCE OF IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD) IN CHILDREN: TIME TO CONSIDER THE SUBCUTANEOUS ICD?126EXPERIENCE OF MAGNETIC REASONANCE IMAGING (MEI) IN PATIENTS WITH MRI CONDITIONAL DEVICES127THE SINUS BRADYCARDIA SEEN IN ATHLETES IS NOT CAUSED BY ENHANCED VAGAL TONE BUT INSTEAD REFLECTS INTRINSIC CHANGES IN THE SINUS NODE REVEALED BY
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(F) BLOCKADE128SUCCESSFUL DAY-CASE PACEMAKER IMPLANTATION - AN EIGHT YEAR SINGLE-CENTRE EXPERIENCE129LEFT VENTRICULAR INDEX MASS ASSOCIATED WITH ESC HYPERTROPHIC CARDIOMYOPATHY RISK SCORE IN PATIENTS WITH ICDs: A TERTIARY CENTRE HCM REGISTRY130A DGH EXPERIENCE OF DAY-CASE CARDIAC PACEMAKER IMPLANTATION131IS PRE-PROCEDURAL FASTING A NECESSITY FOR SAFE PACEMAKER IMPLANTATION? Europace 2016. [DOI: 10.1093/europace/euw274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Initial Clinical Experience of Short-Course Low-Dose Total Skin Electron Beam Irradiation (TSEBT) for Patients With Mycosis Fungoides. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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078 Dsg2 enhances spontaneous BCC formation in Ptc1 +/− mice. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Is this ST-elevation because of myocardial ischaemia or a Brugada pattern? An interesting case review. Intern Emerg Med 2015; 10:249-50. [PMID: 25190625 DOI: 10.1007/s11739-014-1127-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 08/27/2014] [Indexed: 11/25/2022]
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Brugada syndrome unmasked by ischemia needs full risk evaluation: author's reply. Intern Emerg Med 2015; 10:113. [PMID: 25411138 DOI: 10.1007/s11739-014-1150-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/05/2014] [Indexed: 11/28/2022]
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100 kW peak power picosecond thulium-doped fiber amplifier system seeded by a gain-switched diode laser at 2 μm. OPTICS LETTERS 2013; 38:1615-1617. [PMID: 23938887 DOI: 10.1364/ol.38.001615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report on the generation of picosecond pulses at 2 μm directly from a gain-switched discrete-mode diode laser and their amplification in a multistage thulium-doped fiber amplifier chain. The system is capable of operating at repetition rates in the range of 2 MHz-1.5 GHz without change of configuration, delivering high-quality 33 ps pulses with up to 3.5 μJ energy and 100 kW peak power, as well as up to 18 W of average power. These results represent a major technological advance and a 1 order of magnitude increase in peak power and pulse energy compared to existing picosecond sources at 2 μm.
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Three mode Er3+ ring-doped fiber amplifier for mode-division multiplexed transmission. OPTICS EXPRESS 2013; 21:10383-10392. [PMID: 23609749 DOI: 10.1364/oe.21.010383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We successfully fabricate three-mode erbium doped fiber with a confined Er(3+) doped ring structure and experimentally characterize the amplifier performance with a view to mode-division multiplexed (MDM) transmission. The differential modal gain was effectively mitigated by controlling the relative thickness of the ring-doped layer in the active fiber and pump launch conditions. A detailed study of the modal gain properties, amplifier performance in a MDM transmission system and inter-modal cross-gain modulation and associated transient effects is presented.
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Atrial fibrillation with ventricular pre-excitation. Emerg Med J 2012; 29:998-9. [PMID: 22505300 DOI: 10.1136/emermed-2012-201251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fragmentation and embolization of pacemaker leads as a complication of lead extraction. Europace 2010; 12:754-5. [DOI: 10.1093/europace/euq001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Vesicles prepared from self-assembly of hydrated non-ionic surfactants molecules are called niosomes. These types of vesicles were first reported in the cosmetic industries. Niosomes exhibit more chemical stability than liposomes (a phospholipids vesicle) as non-ionic surfactants are more stable than phospholipids. Non-ionic surfactants used in formation of niosomes are polyglyceryl alkyl ether, glucosyldialkyl ether, crown ether, polyoxyethylenealkyl ether, ester-linked surfactants, and steroid-linked surfactants and a spans, and tweens series. Niosomes preparation is affected by processes variables, nature of surfactants, and presence of membrane additives and nature of drug to be encapsulated. This review article presents an overview of theoretical concept of factors affecting niosome formation, techniques of noisome preparation, characterization of niosome, applications, limitations and market status of such delivery system.
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Ytterbium-doped large-core fiber laser with 1.36 kW continuous-wave output power. OPTICS EXPRESS 2004; 12:6088-6092. [PMID: 19488250 DOI: 10.1364/opex.12.006088] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We have demonstrated a highly-efficient cladding-pumped ytterbium-doped fiber laser generating 1.36 kW of continuous-wave output power at 1.1 mum with 83% slope efficiency and near diffraction-limited beam quality. The laser was end-pumped through both fiber ends and showed no evidence of roll-over even at the highest output power, which was limited only by available pump power.
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Cladding pumped Ytterbium-doped fiber laser with holey inner and outer cladding. OPTICS EXPRESS 2001; 9:714-720. [PMID: 19424311 DOI: 10.1364/oe.9.000714] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We have fabricated an ytterbium doped all-glass double-clad large mode area holey fiber. A highly efficient cladding pumped single transverse mode holey fiber laser has been demonstrated, allowing continuous-wave output powers in excess of 1W with efficiencies of more than 80%. Furthermore both Q-switched and mode-locked operation of the laser have been demonstrated.
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The teaching of leprosy in the medical colleges of Orissa, India. LEPROSY REV 1992; 63:292-3. [PMID: 1406027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Heterotrophic growth and nitrogen fixation in the filamentous blue-green alga Anabaena sp. ZEITSCHRIFT FUR ALLGEMEINE MIKROBIOLOGIE 1981; 21:669-76. [PMID: 6801875 DOI: 10.1002/jobm.3630210906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Experiments were conducted to study the effect of five different organic substrates viz. lactose, fructose, mannose, xylose and sodium acetate on the heterotrophic growth characteristics with emphasis on growth, pigment composition, heterocyst frequency and nitrogen fixation of Anabaena sp. under light and dark conditions. Lactose was found to be the best carbon source to support the heterotrophic growth of the alga. Phycoerythrin pigments were synthesized in photoheterotrophic cultures but pigment production was not observed in dark-grown cultures. The alga fixed nitrogen to a limited extent in the dark in pure inorganic medium. But when suitable organic substrates were supplemented, appreciable nitrogen fixation was observed in dark heterotrophic as well as in photoheterotrophic cultures.
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