Length of the Mitral Isthmus But Not Anatomical Location of Ablation Line Predicts Bidirectional Mitral Isthmus Block in Patients Undergoing Catheter Ablation of Persistent Atrial Fibrillation: A Randomized Controlled Trial

INTRODUCTION Mitral isthmus (MI) ablation is an effective option in patients undergoing ablation for persistent atrial fibrillation (AF). Achieving bidirectional conduction block across the MI is challenging, and predictors of MI ablation success remain incompletely understood. We sought to determine the impact of anatomical location of the ablation line on the efficacy of MI ablation. METHODS AND RESULTS A total of 40 consecutive patients (87% male; 54 ± 10 years) undergoing stepwise AF ablation were included. MI ablation was performed in sinus rhythm. MI ablation was performed from the left inferior PV to either the posterior (group 1) or the anterolateral (group 2) mitral annulus depending on randomization. The length of the MI line (measured with the 3D mapping system) and the amplitude of the EGMs at 3 positions on the MI were measured in each patient. MI block was achieved in 14/19 (74%) patients in group 1 and 15/21 (71%) patients in group 2 (P = NS). Total MI radiofrequency time (18 ± 7 min vs. 17 ± 8 min; P = NS) was similar between groups. Patients with incomplete MI block had a longer MI length (34 ± 6 mm vs. 24 ± 5 mm; P < 0.001), a higher bipolar voltage along the MI (1.75 ± 0.74 mV vs. 1.05 ± 0.69 mV; P < 0.01), and a longer history of continuous AF (19 ± 17 months vs. 10 ± 10 months; P < 0.05). In multivariate analysis, decreased length of the MI was an independent predictor of successful MI block (OR 1.5; 95% CI 1.1-2.1; P < 0.05). CONCLUSIONS Increased length but not anatomical location of the MI predicts failure to achieve bidirectional MI block during ablation of persistent AF.

Approaching atrial septal defects in pulmonary hypertension

Atrial septal defects (ASDs) are one of the most frequent congenital cardiac malformations, accounting for about 8-10% of all congenital heart defects. The prevalence of pulmonary arterial hypertension (PAH) in adults with an ASD is 8-10%. Different clinical PAH scenarios can be encountered. At one end of the spectrum are adults with no or only mild pulmonary vascular disease and a large shunt. These are patients who can safely undergo shunt closure. In the elderly, mild residual pulmonary hypertension after shunt closure is the rule. At the other end of the spectrum are adults with severe, irreversible pulmonary vascular disease, shunt reversal and chronic cyanosis, that is, Eisenmenger syndrome. These are patients who need to be managed medically. The challenge is to properly classify ASD patients with PAH falling in between the two ends of the spectrum as the ones with advanced, but reversible pulmonary vascular disease amenable to repair, versus the ones with progressive pulmonary vascular disease not responding to shunt closure. There are concerns that adults with progressive pulmonary vascular disease have worse outcomes after shunt closure than patients not undergoing shunt closure. Due to the correlation of pulmonary vascular changes and pulmonary hemodynamics, cardiac catheterization is used in the decision-making process. It is important to consider the hemodynamic data in the context of the clinical picture, the defect anatomy and further noninvasive tests when evaluating the option of shunt closure in these patients.

Associations of obesity and body fat distribution with incident atrial fibrillation in the biracial health aging and body composition cohort of older adults

UNLABELLED Obesity is a well-recognized risk factor for atrial fibrillation (AF), yet adiposity measures other than body mass index (BMI) have had limited assessment in relation to AF risk. We examined the associations of adiposity measures with AF in a biracial cohort of older adults. Given established racial differences in obesity and AF, we assessed for differences by black and white race in relating adiposity and AF. METHODS We analyzed data from 2,717 participants of the Health, Aging, and Body Composition Study. Adiposity measures were BMI, abdominal circumference, subcutaneous and visceral fat area, and total and percent fat mass. We determined the associations between the adiposity measures and 10-year incidence of AF using Cox proportional hazards models and assessed for their racial differences in these estimates. RESULTS In multivariable-adjusted models, 1-SD increases in BMI, abdominal circumference, and total fat mass were associated with a 13% to 16% increased AF risk (hazard ratio [HR] 1.14, 95% CI 1.02-1.28; HR 1.16, 95% CI 1.04-1.28; and HR 1.13, 95% CI 1.002-1.27). Subcutaneous and visceral fat areas were not significantly associated with incident AF. We did not identify racial differences in the associations between the adiposity measures and AF. CONCLUSION Body mass index, abdominal circumference, and total fat mass are associated with risk of AF for 10years among white and black older adults. Obesity is one of a limited number of modifiable risk factors for AF; future studies are essential to evaluate how obesity reduction can modify the incidence of AF.

Normal Thyroid Function and the Risk of Atrial Fibrillation: the Rotterdam Study

CONTEXT Hyperthyroidism is an established risk factor for atrial fibrillation (AF), but information concerning the association with variations within the normal range of thyroid function and subgroups at risk is lacking. OBJECTIVE This study aimed to investigate the association between normal thyroid function and AF prospectively and explore potential differential risk patterns. DESIGN, SETTING, AND PARTICIPANTS From the Rotterdam Study we included 9166 participants ≥ 45 y with TSH and/or free T4 (FT4) measurements and AF assessment (1997-2012 median followup, 6.8 y), with 399 prevalent and 403 incident AF cases. MAIN OUTCOME MEASURES Outcome measures were 3-fold: 1) hazard ratios (HRs) for the risk of incident AF by Cox proportional-hazards models, 2) 10-year absolute risks taking competing risk of death into account, and 3) discrimination ability of adding FT4 to the CHARGE-AF simple model, an established prediction model for AF. RESULTS Higher FT4 levels were associated with higher risks of AF (HR 1.63, 95% confidence interval, 1.19-2.22), when comparing those in the highest quartile to those in lowest quartile. Absolute 10-year risks increased with higher FT4 in participants ≤ 65 y from 1-9% and from 6-12% in subjects ≥ 65 y. Discrimination of the prediction model improved when adding FT4 to the simple model (c-statistic, 0.722 vs 0.729; P = .039). TSH levels were not associated with AF. CONCLUSIONS There is an increased risk of AF with higher FT4 levels within the normal range, especially in younger subjects. Adding FT4 to the simple model slightly improved discrimination of risk prediction.

Evaluation of coagulation and fibrinolysis in horses with atrial fibrillation

OBJECTIVE To evaluate horses with atrial fibrillation for hypercoagulability; plasma D-dimer concentrations, as a marker of a procoagulant state; and a relationship between coagulation profile results and duration of atrial fibrillation or presence of structural heart disease. DESIGN Case-control study. ANIMALS Plasma samples from 42 horses (25 with atrial fibrillation and 17 without cardiovascular or systemic disease [control group]). PROCEDURES Results of hematologic tests (ie, plasma fibrinogen and D-dimer concentrations, prothrombin and activated partial thromboplastin times, and antithrombin activity) in horses were recorded to assess coagulation and fibrinolysis. Historical and clinical variables, as associated with a hypercoagulable state in other species, were also recorded. RESULTS Horses with atrial fibrillation and control horses lacked clinical signs of hypercoagulation or thromboembolism. Compared with control horses, horses with atrial fibrillation had significantly lower antithrombin activity. No significant differences in plasma fibrinogen and D-dimer concentrations and prothrombin and activated partial thromboplastin times existed between horse groups. In horses with atrial fibrillation versus control horses, a significantly larger proportion had an abnormal plasma D-dimer concentration (10/25 vs 2/17), test results indicative of subclinical activated coagulation (18/25 vs 6/17), or abnormal coagulation test results (25/121 vs 7/85), respectively. CONCLUSIONS AND CLINICAL RELEVANCE Horses with atrial fibrillation did not have clinical evidence of a hypercoagulable state, but a higher proportion of horses with atrial fibrillation, compared with control horses, did have subclinical activated coagulation on the basis of standard coagulation test results.

Safety, feasibility, and long-term results of percutaneous closure of atrial septal defects using the Amplatzer septal occluder without periprocedural echocardiography.

OBJECTIVES We sought to assess the safety and efficacy of percutaneous closure of atrial septal defects (ASDs) under fluoroscopic guidance only, without periprocedural echocardiographic guidance. BACKGROUND Percutaneous closure of ASDs is usually performed using simultaneous fluoroscopic and transthoracic, transesophageal (TEE), or intracardiac echocardiographic (ICE) guidance. However, TEE requires deep sedation or general anesthesia, which considerably lengthens the procedure. TEE and ICE increase costs. METHODS Between 1997 and 2008, a total of 217 consecutive patients (age, 38 ± 22 years; 155 females and 62 males), of whom 44 were children ≤16 years, underwent percutaneous ASD closure with an Amplatzer ASD occluder (AASDO). TEE guidance and general anesthesia were restricted to the children, while devices were implanted under fluoroscopic guidance only in the adults. For comparison of technical safety and feasibility of the procedure without echocardiographic guidance, the children served as a control group. RESULTS The implantation procedure was successful in all but 3 patients (1 child and 2 adults; 1.4%). Mean device size was 23 ± 8 mm (range, 4-40 mm). There was 1 postprocedural complication (0.5%; transient perimyocarditis in an adult patient). At last echocardiographic follow-up, 13 ± 23 months after the procedure, 90% of patients had no residual shunt, whereas a minimal, moderate, or large shunt persisted in 7%, 1%, and 2%, respectively. Four adult patients (2%) underwent implantation of a second device for a residual shunt. During a mean follow-up period of 3 ± 2 years, 2 deaths and 1 ischemic stroke occurred. CONCLUSION According to these results, percutaneous ASD closure using the AASDO without periprocedural echocardiographic guidance seems safe and feasible.

Residuos motivados por obra de remodelación interior en distintas tipologías de vivienda.

El medio ambiente es cada vez, un tema de más actualidad. Un tema que ya está preocupando, incluso a los que antes no le daban importancia. En nuestro ámbito, el de la construcción, este tema también se plantea, ya que en nuestra actividad cotidiana nos encontramos con residuos de construcción, tanto durante el proceso edificatorio en sí mismo, como a posteriori, en demolición, bien sea total o parcial, rehabilitación o reforma. Nos topamos con residuos y no sabemos qué hacer con ellos, surgen varias preguntas: ¿Cómo los tratamos? ¿Los reciclamos? ¿Qué fin se le pueden dar? ¿O directamente van a vertedero o a incinerar? Quería estudiar este tema, pero a la vez quería que no fuese solo teórico sino que lo combinara con algo real, algo que en nuestra profesión sea habitual, entonces me planteo la siguiente pregunta: ¿Qué tipo, material y cantidad de residuos de construcción sacaríamos si aplicáramos unas reformas a distintas viviendas, según su programa de necesidades? Y básicamente, este estudio es la respuesta a dicha pregunta. Junto a los tutores, hemos elegido tres tipologías diferentes de vivienda, todas ellas ya construidas y existentes actualmente. Y después de un estudio de necesidades (bien sea sobre accesibilidad, conciliación de la vida familiar y profesional, movilidad, estética o nuevas tendencias...) según las características de dichas viviendas y de sus usuarios; se le han aplicado una supuesta reforma, obteniendo así unos datos, una información de residuos de construcción y demolición (RCDs) reales, que nos pueden tocar a cualquiera en nuestra labor profesional diaria. Y a partir de ellos, estudiamos la clasificación, el fin, el tratamiento etc. de estos.

Retrato de chabolista con piso : Análisis de redes sociales en la remodelación de barrios de Madrid

El libro analiza la operación conocidad como Barrios en Remodelación que transformó gran parte de la perifería madrileña en la década de los 80, construyendo cerca de 38.000 viviendas en las que fueron realojados los ciudadanos que antes vivían en los mismos espacios, reconociéndoles de hecho el "derecho a la ciudad" al reconocerles que el espacio reformado era consecuencia del habitar de los que allí vivieron previamente y por tanto de su ciudad. Se recogen aquí los aspectos principales de una operación que alcanzó las 38.000 viviendas en 28 barrios con una inversión, en precios de la época, de 220.000 millones de pesetas y en un plazo de 10 años.

Proyecto de remodelación del enlace de la carretera M-607 con la Avenida de Montecarmelo y la Calle de Afueras a Valverde

El objeto del presente Proyecto es la definición completa con el nivel de detalle suficiente de las obras conducentes a la remodelación del enlace de la carretera M-607 con la avenida de Montecarmelo y la calle de Afueras a Valverde, en el término municipal de Madrid.

Remodelación del puerto actual de Tarifa para su adaptación al nuevo uso de puerto deportivo

El presente proyecto tiene por objeto ampliar el puerto de Tarifa (Cádiz) y adaptarlo al uso deportivo, debido a la necesidad imperante que provoca tanto la demanda del servicio comercial como la de actividad deportiva. Por una parte, la creciente actividad comercial de tráfico de pasajeros y vehículos Tarifa-Tánger, requiere la ampliación de la actual Estación marítima. Además existe una demanda deportiva, no solo en cuanto al uso de embarcaciones de vela y a motor de propiedad privada, sino también como fenómeno turístico de interés por las actividades náuticas-deportivas y de avistamiento de cetáceos en el estrecho, para las cuales se destinará espacio en el puerto. La propuesta de construcción consiste en la realización de un nuevo dique, el cual albergue la actividad deportiva y náutico-deportiva y permita la función conjunta de la actividad comercial de tráfico de pasajeros y vehículos, y la construcción de una nueva estación marítima y dos muelles que permitan atender a la demanda generada. En el proyecto de construcción se van a calcular todos los elementos y estructuras al máximo detalle y exactitud para poder construir el nuevo puerto deportivo de Tarifa. Por lo que se calcula, la localización del puerto, el dique vertical de abrigo, el muelle sobre pilotes, los pantalanes flotantes, accesos, firmes e instalaciones.