Ventricular rate during acute atrial fibrillation and outcome of electrical cardioversion: The FinCV Study

The impact of ventricular rate (VR) on the outcome of electrical cardioversion (ECV) of acute atrial fibrillation (AF) is currently unknown. We aimed to determine the effect of VR during acute AF on the success of ECV, recurrence of AF and occurrence of post-cardioversion complications in 30 days follow-up. All ECVs performed in patients with acute atrial fibrillation lasting <48 hours in 2 Finnish university hospitals during 2003-2010 and 1 central hospital during 2010 were retrospectively identified. A total of 6,624 ECVs were performed in 2,821 consecutive patients. VR≤60 BPM was defined low and VR≥160 BPM high. The median VR before ECV was 109 BPM. The success rate of ECV was 94.2%. Bradycardia occurred in 62 (0.9%) and thromboembolic complications in 39 (0.6%) ECVs. Low VR was observed before 75 (1.1%) ECVs and male sex was its only independent predictor. High VR was observed in 165 (2.5%) ECVs. The independent predictors of high VR were younger age, <12 h episode duration, no previous history of AF and alcohol abuse. Low or high VR were not related to the success of ECV, incidence of thromboembolic or bradycardic complications, or recurrence of AF, although VR was significantly (p<0.001) lower in the patients in whom AF recurred. In conclusion, ECV of acute AF is an effective procedure and VR during AF does not affect its efficacy, the maintenance of sinus rhythm or the incidence of bradycardic, thromboembolic or other complications during 30 days follow-up after ECV. Low VR is predominately observed in male patients, while high VR was a feature related to a shorter history of AF and high alcohol-intake.

Droplet Deposition in the Last Stage of Steam Turbine

During the expansion of steam in turbine, the steam crosses the saturation line and hence subsequent turbine stages run under wet condition. The stages under wet condition run with low efficiency as compared to stages running with supersaturated steam and the life of the last stage cascade is reduced due to erosion. After the steam crosses the saturation line it does not condense immediately but instead it becomes supersaturated which is a meta-stable state and reversion of equilibrium results in the formation of large number of small droplets in the range of 0.05 - 1 μm. Although these droplets are small enough to follow the stream lines of vapor however some of the fog droplets are deposited on the blade surface. After deposition they coagulate into films and rivulets which are then drawn towards the trailing edge of the blade due to viscous drag of the steam. These large droplets in the range of radius 100 μm are accelerated by steam until they impact on the next blade row causing erosion. The two phenomenon responsible for deposition are inertial impaction and turbulent-diffusion. This work shall discuss the deposition mechanism in steam turbine in detail and numerically model and validate with practical data.