Steam pops during irrigated radiofrequency ablation: feasibility of impedance monitoring for prevention

BACKGROUND: Steam pops are a risk of irrigated radiofrequency catheter ablation (RFA) and may cause cardiac perforation. Data to guide radiofrequency (RF) energy titration to avoid steam pops are limited. OBJECTIVE: This study sought to assess the frequency and consequence of audible pops and to determine the feasibility of using the magnitude of impedance change to predict pops. METHODS: We reviewed consecutive endocardial open-irrigated RFA for ventricular tachycardia (VT) with continuously recorded ablation data in 142 patients with structural heart disease. Steam pops were defined as an audible pop associated with a sudden spike in impedance. Ablation lesions before or after pops served as controls. RESULTS: From a total of 4,107 ablation lesions, 62 (1.5%) steam pops occurred in 42 procedures in 38 patients. Perforation with tamponade occurred with 1 of 62 (2%) pops. Applications with pops had a greater impedance decrease (22 +/- 7 Omega vs. 18 +/- 8 Omega, P = .001) and a higher maximum power (45 +/- 5 W vs. 43 +/- 6 W, P = .011), but did not differ in maximum catheter tip temperature (40 degrees C +/- 4 degrees C vs. 40 degrees C +/- 4 degrees C, P = .180) from applications without pops. Eighty percent of pops occurred after impedance decreased by at least 18 Omega. CONCLUSION: During VT ablation with open irrigation, audible pops are infrequent and do not usually cause perforation. Limiting RF power to achieve an impedance decrease of <18 Omega is a feasible method of reducing the likelihood of a pop when perforation risk is of concern.

Polychlorinated Biphenyls in Glaciers. 2. Model Results of Deposition and Incorporation Processes

In previous work, Alpine glaciers have been identified as a secondary source of persistent organic pollutants (POPs). However, detailed understanding of the processes organic chemicals undergo in a glacial system was missing. Here, we present results from a chemical fate model describing deposition and incorporation of polychlorinated biphenyls (PCBs) into an Alpine glacier (Fiescherhorn, Switzerland) and an Arctic glacier (Lomonosovfonna, Norway). To understand PCB fate and dynamics, we investigate the interaction of deposition, sorption to ice and particles in the atmosphere and within the glacier, revolatilization, diffusion and degradation, and discuss the effects of these processes on the fate of individual PCB congeners. The model is able to reproduce measured absolute concentrations in the two glaciers for most PCB congeners. While the model generally predicts concentration profiles peaking in the 1970s, in the measurements, this behavior can only be seen for higher-chlorinated PCB congeners on Fiescherhorn glacier. We suspect seasonal melt processes are disturbing the concentration profiles of the lower-chlorinated PCB congeners. While a lower-chlorinated PCB congener is mainly deposited by dry deposition and almost completely revolatilized after deposition, a higher-chlorinated PCB congener is predominantly transferred to the glacier surface by wet deposition and then is incorporated into the glacier ice. The incorporated amounts of PCBs are higher on the Alpine glacier than on the Arctic glacier due to the higher precipitation rate and aerosol particle concentration on the former. Future studies should include the effects of seasonal melt processes, calculate the quantities of PCBs incorporated into the entire glacier surface, and estimate the quantity of chemicals released from glaciers to determine the importance of glaciers as a secondary source of organic chemicals to remote aquatic ecosystems.

Direct Democracy and Institutional Trust: Relationships and Differences across Personality Traits

Direct democracy plays a prominent role in the explanation of institutional trust. To date, however, empirical findings on the effects of direct democracy remain inconclusive. In this article, we argue that this inconclusiveness can be partly ascribed to the diverse effects direct democracy has on individuals. In other words, direct democracy influences institutional trust, but how and to what degree depends on individuals’ personality traits. Running hierarchical analyses of unique survey data from a random sample of eligible Swiss voters, we document three findings: First, we show that the number of ballot measures is not directly associated with institutional trust. Second, we demonstrate that the Big Five personality traits affect the propensity to trust. Third, some of these traits also alter the relationship between direct democracy and institutional trust, suggesting that certain personality types are more likely to be sensitive to popular votes than others and that not everyone is equally likely to respond to political stimuli, even in highly democratic environments.