Benefit of pulmonary vein isolation guided by loss of pace capture on the ablation line: results from a prospective 2-center randomized trial.

OBJECTIVES This study was conducted to determine if an additional procedural endpoint of unexcitability (UE) to pacing along the ablation line reduces recurrence of atrial fibrillation (AF) or atrial tachycardia (AT) after radiofrequency catheter ablation. BACKGROUND AF/AT recurrence is common after pulmonary vein isolation (PVI). METHODS We included 102 patients from 2 centers (age 63 ± 10 years; 33 women; left atrium 38 ± 7 mm; left ventricular ejection fraction 61 ± 6%) with symptomatic paroxysmal AF. A 3-dimensional mapping system and circumferential mapping catheter were used in all patients for PVI. In group 1 (n = 50), the procedural endpoint was bidirectional block across the ablation line. In group 2 (n = 52), additional UE to bipolar pacing at an output of 10 mA and 2-ms pulse width was required. The primary endpoint was freedom from any AF/AT (>30 s) after discontinuation of antiarrhythmic drugs. RESULTS Procedural endpoints were successfully achieved in all patients. Procedure duration was significantly longer in group 2 (185 ± 58 min vs. 139 ± 57 min; p < 0.001); however, fluoroscopy times were not different (23 ± 9 min vs. 23 ± 9 min; p = 0.49). After a follow-up of 12 months in all patients, 26 patients (52%) in group 1 versus 43 (82.7%) in group 2 were free from any AF/AT (p = 0.001) after a single procedure. No major complications occurred. CONCLUSIONS The use of pacing to ensure UE along the PVI line markedly improved near-term single-procedure success, compared with demonstration of bidirectional block alone. This additional endpoint significantly improved patient outcomes after PVI. (Unexcitability Along the Ablation as an Endpoint for Atrial Fibrillation Ablation; NCT01724437).

Catheter ablation of persistent and long-standing persistent atrial fibrillation. Strategies and results

Catheter ablation for paroxysmal atrial fibrillation is a meanwhile established therapy option, which is most frequently performed using radiofrequency ablation. Mid-term success rate of 70 % are achievable with a single ablation procedure. However, the mechanistics of persistent atrial fibrillation are less well understood and catheter ablation is a far more challenging procedure. Different ablation approaches are being performed to treat persistent atrial fibrillation ranging from sole pulmonary vein isolation to additional ablation of fractionated electrograms aiming for termination of atrial fibrillation. Thus far, it has not been investigated which strategy is most successful in treating persistent atrial fibrillation. After extended ablation of atrial fibrillation, occurrence of organized atrial arrhythmias is not uncommon and can be successfully ablated. These consecutive arrhythmias can be considered as a next step towards stable sinus rhythm after repeat ablation. Improvement of mapping methods as well as a better understanding of mechanisms of atrial fibrillation may increase success rate of catheter ablation of persistent atrial fibrillation and may also help to improve success rate of these complex procedures.

Low single dose gabapentin does not affect prefrontal and occipital gamma-aminobutyric acid concentrations

The γ-aminobutyric acid (GABA) system has been proposed as a target for novel antidepressant and anxiolytic treatments. Emerging evidence suggests that gabapentin (GBP), an anticonvulsant drug that significantly increases brain GABA levels, is effective in the treatment of anxiety disorders. The current study was designed to measure prefrontal and occipital GABA levels in medication-free healthy subjects after taking 0 mg, 150 mg and 300 mg GBP. Subjects were scanned on a 3T scanner using a transmit-receive head coil that provided a relatively homogenous radiofrequency field to obtain spectroscopy measurement in the medial prefrontal (MPFC) and occipital cortex (OCC). There was no dose-dependent effect of GBP on GABA levels in the OCC or MPFC. There was also no effect on Glx, choline or N-acetyl-aspartate concentrations. The previously reported finding of increased GABA levels after GBP treatment is not evident for healthy subjects at the dose of 150 and 300 mg. As a result, if subjects are scanned on a 3T scanner, low dose GPB is not useful as an experimental challenge agent on the GABA system.

Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement

In children with structurally normal hearts, the mechanisms of arrhythmias are usually the same as in the adult patient. Some arrhythmias are particularly associated with young age and very rarely seen in adult patients. Arrhythmias in structural heart disease may be associated either with the underlying abnormality or result from surgical intervention. Chronic haemodynamic stress of congenital heart disease (CHD) might create an electrophysiological and anatomic substrate highly favourable for re-entrant arrhythmias. As a general rule, prescription of antiarrhythmic drugs requires a clear diagnosis with electrocardiographic documentation of a given arrhythmia. Risk-benefit analysis of drug therapy should be considered when facing an arrhythmia in a child. Prophylactic antiarrhythmic drug therapy is given only to protect the child from recurrent supraventricular tachycardia during this time span until the disease will eventually cease spontaneously. In the last decades, radiofrequency catheter ablation is progressively used as curative therapy for tachyarrhythmias in children and patients with or without CHD. Even in young children, procedures can be performed with high success rates and low complication rates as shown by several retrospective and prospective paediatric multi-centre studies. Three-dimensional mapping and non-fluoroscopic navigation techniques and enhanced catheter technology have further improved safety and efficacy even in CHD patients with complex arrhythmias. During last decades, cardiac devices (pacemakers and implantable cardiac defibrillator) have developed rapidly. The pacing generator size has diminished and the pacing leads have become progressively thinner. These developments have made application of cardiac pacing in children easier although no dedicated paediatric pacing systems exist.

Effect of high-intensity statin therapy on atherosclerosis in non-infarct-related coronary arteries (IBIS-4): a serial intravascular ultrasonography study

AIM The effect of long-term high-intensity statin therapy on coronary atherosclerosis among patients with acute ST-segment elevation myocardial infarction (STEMI) is unknown. The aim of this study was to quantify the impact of high-intensity statin therapy on plaque burden, composition, and phenotype in non-infarct-related arteries of STEMI patients undergoing primary percutaneous coronary intervention (PCI). METHODS AND RESULTS Between September 2009 and January 2011, 103 STEMI patients underwent intravascular ultrasonography (IVUS) and radiofrequency ultrasonography (RF-IVUS) of the two non-infarct-related epicardial coronary arteries (non-IRA) after successful primary PCI. Patients were treated with high-intensity rosuvastatin (40 mg/day) throughout 13 months and serial intracoronary imaging with the analysis of matched segments was available for 82 patients with 146 non-IRA. The primary IVUS end-point was the change in per cent atheroma volume (PAV). After 13 months, low-density lipoprotein cholesterol (LDL-C) had decreased from a median of 3.29 to 1.89 mmol/L (P < 0.001), and high-density lipoprotein cholesterol (HDL-C) levels had increased from 1.10 to 1.20 mmol/L (P < 0.001). PAV of the non-IRA decreased by -0.9% (95% CI: -1.56 to -0.25, P = 0.007). Patients with regression in at least one non-IRA were more common (74%) than those without (26%). Per cent necrotic core remained unchanged (-0.05%, 95% CI: -1.05 to 0.96%, P = 0.93) as did the number of RF-IVUS defined thin cap fibroatheromas (124 vs. 116, P = 0.15). CONCLUSION High-intensity rosuvastatin therapy over 13 months is associated with regression of coronary atherosclerosis in non-infarct-related arteries without changes in RF-IVUS defined necrotic core or plaque phenotype among STEMI patients.

Impact of biatrial defragmentation in patients with paroxysmal atrial fibrillation: Results from a randomized prospective study

Background Single procedure success rates of pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (PAF) are still unsatisfactory. In patients with persistent atrial fibrillation (AF), ablation of complex fractionated atrial electrograms (CFAEs) after PVI results in improved outcomes. Objective We aimed to investigate if PAF-patients with intraprocedurally sustained AF after PVI might benefit from additional CFAE ablation. Methods A total of 1134 consecutive patients underwent a first catheter ablation procedure of PAF between June 2008 and December 2012. In most patients, AF was either not inducible or terminated during PVI. In 68 patients (6%), AF sustained after successful PVI. These patients were randomized to either cardioversion (PVI-alone group; n = 33) or additional CFAE ablation (PVI+CFAE group; n = 35) and followed up every 1–3 months and serial Holter recordings were also obtained. The primary end point was the recurrence of AF/atrial tachycardia (AT) after a blanking period of 3 months. Results Procedure duration (127 ± 6 minutes vs 174 ± 10 minutes), radiofrequency application time (44 ± 3 minutes vs 74 ± 5 minutes), and fluoroscopy time (26 ± 2 minutes vs 41 ± 3 minutes) were longer in the PVI+CFAE group (all P < .001). In 30 of 35 patients (86%) in the PVI+CFAE group, ablation terminated AF. There was no significant group difference with respect to freedom from AF/AT (22 of 33 [67%] vs 22 of 35 [63%]; P = .66). Subsequently, 10 of 11 patients in the PVI-alone group (91%) and 11 of 13 patients in PVI+CFAE group (85%) underwent repeat ablation (P = 1.00). Overall, 29 of 33 [88%] vs 30 of 35 [86%] patients (P = 1.00) were free from AF/AT after 1.4 ± 0.1 vs 1.4 ± 0.2 (P = .87) procedures. Conclusion Patients with sustained AF after PVI in a PAF cohort are rare. Regarding AF/AT recurrence, these patients did not benefit from further CFAE ablation compared to PVI alone, but are exposed to longer procedure duration, fluoroscopy time, and radiofrequency application time.

Pulmonary Vein Isolation Versus Defragmentation: The CHASE-AF Clinical Trial

BACKGROUND Long-term success rates using ablation for persistent atrial fibrillation (AF) are disappointing and usually do not exceed 60%. OBJECTIVES This study sought to compare arrhythmia-free survival between pulmonary vein isolation (PVI) and a stepwise approach (full defrag) consisting of PVI, ablation of complex fractionated electrograms, and additional linear ablation lines in the setting of atrial tachycardias (AT) in patients with persistent AF after PVI. METHODS From November 2010 to February 2013, 205 patients (151 men; 61.7 ± 10.2 years of age) underwent de novo ablation for persistent AF. Subsequently, patients were prospectively randomized to either PVI alone (n = 78) or full defrag (n = 75), with 52 patients not randomized due to AF termination with the original PVI. The primary endpoint was recurrence of any AT after a blanking period of 3 months. RESULTS During the entire study, 241 ablations were performed (mean: 1.59 in the PVI-alone group, 1.55 in the full-defrag group). With the stepwise approach, termination of AF occurred in 45 (60%) patients. However, arrhythmia-free survival did not differ whether patients underwent single or multiple procedures (p = 0.468). Procedure duration, fluoroscopy time, and radiofrequency duration were significantly longer in the full-defrag group (all p < 0.001). CONCLUSIONS A stepwise approach aimed at AF termination does not seem to provide additional benefit over PVI alone in patients with persistent AF, but it is associated with significantly longer procedural and fluoroscopic duration as well as radiofrequency application time. (The Randomized Catheter Ablation of Persist End Atrial Fibrillation Study [CHASE-AF]; NCT01580124).

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.

Changes of coronary plaque composition correlate with C-reactive protein levels in patients with ST-elevation myocardial infarction following high-intensity statin therapy.

OBJECTIVES Levels of inflammatory biomarkers associate with changes of coronary atheroma burden in statin-treated patients with stable coronary artery disease. This study sought to determine changes of plaque composition in vivo in relation to high-sensitivity C-reactive protein (hs-CRP) levels in patients with ST-elevation myocardial infarction (STEMI) receiving high-intensity statin therapy. METHODS The IBIS-4 study performed serial (baseline and 13-month), 2-vessel intravascular ultrasound (IVUS) and radiofrequency-IVUS of the non-infarct-related arteries in patients with STEMI treated with high-intensity statin therapy. The present analysis included 44 patients (80 arteries) with serial measurements of hs-CRP. RESULTS At follow-up, median low-density lipoprotein cholesterol (LDL-C) levels decreased from 126 to 77 mg/dl, HDL-C increased from 44 to 47 mg/dl, and hs-CRP decreased from 1.6 to 0.7 mg/L. Regression of percent atheroma volume (-0.99%, 95% CI -1.84 to -0.14, p = 0.024) was accompanied by reduction of percent fibro-fatty (p = 0.04) and fibrous tissue (p < 0.001), and increase in percent necrotic core (p = 0.006) and dense calcium (p < 0.001). Follow-up levels of hs-CRP, but not LDL-C, correlated with changes in percent necrotic core (p = 0.001) and inversely with percent fibrous tissue volume (p = 0.008). Similarly, baseline-to-follow-up change of hs-CRP correlated with the change in percent necrotic core volume (p = 0.02). CONCLUSIONS In STEMI patients receiving high-intensity statin therapy, stabilization of VH-IVUS-defined necrotic core was confined to patients with lowest on-treatment levels and greatest reduction of hs-CRP. Elevated CRP levels at follow-up may identify progression of high-risk coronary plaque composition despite intensive statin therapy and overall regression of atheroma volume.

Motion-insensitive determination of B1+ amplitudes based on the bloch-siegert shift in single voxels of moving organs including the human heart.

PURPOSE To reliably determine the amplitude of the transmit radiofrequency ( B1+) field in moving organs like the liver and heart, where most current techniques are usually not feasible. METHODS B1+ field measurement based on the Bloch-Siegert shift induced by a pair of Fermi pulses in a double-triggered modified Point RESolved Spectroscopy (PRESS) sequence with motion-compensated crusher gradients has been developed. Performance of the sequence was tested in moving phantoms and in muscle, liver, and heart of six healthy volunteers each, using different arrangements of transmit/receive coils. RESULTS B1+ determination in a moving phantom was almost independent of type and amplitude of the motion and agreed well with theory. In vivo, repeated measurements led to very small coefficients of variance (CV) if the amplitude of the Fermi pulse was chosen above an appropriate level (CV in muscle 0.6%, liver 1.6%, heart 2.3% with moderate amplitude of the Fermi pulses and 1.2% with stronger Fermi pulses). CONCLUSION The proposed sequence shows a very robust determination of B1+ in a single voxel even under challenging conditions (transmission with a surface coil or measurements in the heart without breath-hold). Magn Reson Med, 2015. © 2015 Wiley Periodicals, Inc.

Focal Epilepsy: MR Imaging of Nonhemodynamic Field Effects by Using a Phase-cycled Stimulus-induced Rotary Saturation Approach with Spin-Lock Preparation.

Purpose To investigate whether nonhemodynamic resonant saturation effects can be detected in patients with focal epilepsy by using a phase-cycled stimulus-induced rotary saturation (PC-SIRS) approach with spin-lock (SL) preparation and whether they colocalize with the seizure onset zone and surface interictal epileptiform discharges (IED). Materials and Methods The study was approved by the local ethics committee, and all subjects gave written informed consent. Eight patients with focal epilepsy undergoing presurgical surface and intracranial electroencephalography (EEG) underwent magnetic resonance (MR) imaging at 3 T with a whole-brain PC-SIRS imaging sequence with alternating SL-on and SL-off and two-dimensional echo-planar readout. The power of the SL radiofrequency pulse was set to 120 Hz to sensitize the sequence to high gamma oscillations present in epileptogenic tissue. Phase cycling was applied to capture distributed current orientations. Voxel-wise subtraction of SL-off from SL-on images enabled the separation of T2* effects from rotary saturation effects. The topography of PC-SIRS effects was compared with the seizure onset zone at intracranial EEG and with surface IED-related potentials. Bayesian statistics were used to test whether prior PC-SIRS information could improve IED source reconstruction. Results Nonhemodynamic resonant saturation effects ipsilateral to the seizure onset zone were detected in six of eight patients (concordance rate, 0.75; 95% confidence interval: 0.40, 0.94) by means of the PC-SIRS technique. They were concordant with IED surface negativity in seven of eight patients (0.88; 95% confidence interval: 0.51, 1.00). Including PC-SIRS as prior information improved the evidence of the standard EEG source models compared with the use of uninformed reconstructions (exceedance probability, 0.77 vs 0.12; Wilcoxon test of model evidence, P < .05). Nonhemodynamic resonant saturation effects resolved in patients with favorable postsurgical outcomes, but persisted in patients with postsurgical seizure recurrence. Conclusion Nonhemodynamic resonant saturation effects are detectable during interictal periods with the PC-SIRS approach in patients with epilepsy. The method may be useful for MR imaging-based detection of neuronal currents in a clinical environment. (©) RSNA, 2016 Online supplemental material is available for this article.

A nested case-control study of radiation exposure and brain cancer incidence in the United States Air Force

A nested case-control study design was used to investigate the relationship between radiation exposure and brain cancer risk in the United States Air Force (USAF). The cohort consisted of approximately 880,000 men with at least 1 year of service between 1970 and 1989. Two hundred and thirty cases were identified from hospital discharge records with a diagnosis of primary malignant brain tumor (International Classification of Diseases, 9th revision, code 191). Four controls were exactly matched with each case on year of age and race using incidence density sampling. Potential career summary extremely low frequency (ELF) and microwave-radiofrequency (MWRF) radiation exposures were based upon the duration in each occupation and an intensity score assigned by an expert panel. Ionizing radiation (IR) exposures were obtained from personal dosimetry records.^ Relative to the unexposed, the overall age-race adjusted odds ratio (OR) for ELF exposure was 1.39, 95 percent confidence interval (CI) 1.03-1.88. A dose-response was not evident. The same was true for MWRF, although the OR = 1.59, with 95 percent CI 1.18-2.16. Excess risk was not found for IR exposure (OR = 0.66, 45 percent CI 0.26-1.72).^ Increasing socioeconomic status (SES), as identified by military pay grade, was associated with elevated brain tumor risk (officer vs. enlisted personnel age-race adjusted OR = 2.11, 95 percent CI 1.98-3.01, and senior officers vs. all others age-race adjusted OR = 3.30, 95 percent CI 2.0-5.46). SES proved to be an important confounder of the brain tumor risk associated with ELF and MWRF exposure. For ELF, the age-race-SES adjusted OR = 1.28, 95 percent CI 0.94-1.74, and for MWRF, the age-race-SES adjusted OR = 1.39, 95 percent CI 1.01-1.90.^ These results indicate that employment in Air Force occupations with potential electromagnetic field exposures is weakly, though not significantly, associated with increased risk for brain tumors. SES appeared to be the most consistent brain tumor risk factor in the USAF cohort. Other investigators have suggested that an association between brain tumor risk and SES may arise from differential access to medical care. However, in the USAF cohort health care is universally available. This study suggests that some factor other than access to medical care must underlie the association between SES and brain tumor risk. ^

Calculation Methodology and Fabrication Procedures for Particle Accelerator Strip-Line Kickers: Application to the CTF3 Combiner Ring Extraction Kicker and TL2 Tail Clippers

A particle accelerator is any device that, using electromagnetic fields, is able to communicate energy to charged particles (typically electrons or ionized atoms), accelerating and/or energizing them up to the required level for its purpose. The applications of particle accelerators are countless, beginning in a common TV CRT, passing through medical X-ray devices, and ending in large ion colliders utilized to find the smallest details of the matter. Among the other engineering applications, the ion implantation devices to obtain better semiconductors and materials of amazing properties are included. Materials supporting irradiation for future nuclear fusion plants are also benefited from particle accelerators. There are many devices in a particle accelerator required for its correct operation. The most important are the particle sources, the guiding, focalizing and correcting magnets, the radiofrequency accelerating cavities, the fast deflection devices, the beam diagnostic mechanisms and the particle detectors. Most of the fast particle deflection devices have been built historically by using copper coils and ferrite cores which could effectuate a relatively fast magnetic deflection, but needed large voltages and currents to counteract the high coil inductance in a response in the microseconds range. Various beam stability considerations and the new range of energies and sizes of present time accelerators and their rings require new devices featuring an improved wakefield behaviour and faster response (in the nanoseconds range). This can only be achieved by an electromagnetic deflection device based on a transmission line. The electromagnetic deflection device (strip-line kicker) produces a transverse displacement on the particle beam travelling close to the speed of light, in order to extract the particles to another experiment or to inject them into a different accelerator. The deflection is carried out by the means of two short, opposite phase pulses. The diversion of the particles is exerted by the integrated Lorentz force of the electromagnetic field travelling along the kicker. This Thesis deals with a detailed calculation, manufacturing and test methodology for strip-line kicker devices. The methodology is then applied to two real cases which are fully designed, built, tested and finally installed in the CTF3 accelerator facility at CERN (Geneva). Analytical and numerical calculations, both in 2D and 3D, are detailed starting from the basic specifications in order to obtain a conceptual design. Time domain and frequency domain calculations are developed in the process using different FDM and FEM codes. The following concepts among others are analyzed: scattering parameters, resonating high order modes, the wakefields, etc. Several contributions are presented in the calculation process dealing specifically with strip-line kicker devices fed by electromagnetic pulses. Materials and components typically used for the fabrication of these devices are analyzed in the manufacturing section. Mechanical supports and connexions of electrodes are also detailed, presenting some interesting contributions on these concepts. The electromagnetic and vacuum tests are then analyzed. These tests are required to ensure that the manufactured devices fulfil the specifications. Finally, and only from the analytical point of view, the strip-line kickers are studied together with a pulsed power supply based on solid state power switches (MOSFETs). The solid state technology applied to pulsed power supplies is introduced and several circuit topologies are modelled and simulated to obtain fast and good flat-top pulses.

Progresos en sub-sistemas RF y control de la Antena Adaptativa Multihaz GEODA

GEODA project started in 2006 as a complex and ambitious project in the smart antenna field. GEODA is a multiple planar array smart antenna working at 1.7 GHz designed to receive and automatically track several LEO satellite signals simultaneously [1-4]. GEODA evolved to GEODA-GRUA since transmission capabilities were given to the original idea [5-6], so that radiofrequency sub-systems had to be re-designed and digital management subsystem modified accordingly. In this paper, improvements in the reception/transmission (T/R) modules as well as in the Control Subsystem are presented, keeping the original radiating element.

High Efficiency Envelope Amplifier based on a Ripple Cancellation Buck Converter. Design, Optimization and Integration in an EER RFPA

Durante los últimos años la tendencia en el sector de las telecomunicaciones ha sido un aumento y diversificación en la transmisión de voz, video y fundamentalmente de datos. Para conseguir alcanzar las tasas de transmisión requeridas, los nuevos estándares de comunicaciones requieren un mayor ancho de banda y tienen un mayor factor de pico, lo cual influye en el bajo rendimiento del amplificador de radiofrecuencia (RFPA). Otro factor que ha influido en el bajo rendimiento es el diseño del amplificador de radiofrecuencia. Tradicionalmente se han utilizado amplificadores lineales por su buen funcionamiento. Sin embargo, debido al elevado factor de pico de las señales transmitidas, el rendimiento de este tipo de amplificadores es bajo. El bajo rendimiento del sistema conlleva desventajas adicionales como el aumento del coste y del tamaño del sistema de refrigeración, como en el caso de una estación base, o como la reducción del tiempo de uso y un mayor calentamiento del equipo para sistemas portátiles alimentados con baterías. Debido a estos factores, se han desarrollado durante las últimas décadas varias soluciones para aumentar el rendimiento del RFPA como la técnica de Outphasing, combinadores de potencia o la técnica de Doherty. Estas soluciones mejoran las prestaciones del RFPA y en algún caso han sido ampliamente utilizados comercialmente como la técnica de Doherty, que alcanza rendimientos hasta del 50% para el sistema completo para anchos de banda de hasta 20MHz. Pese a las mejoras obtenidas con estas soluciones, los mayores rendimientos del sistema se obtienen para soluciones basadas en la modulación de la tensión de alimentación del amplificador de potencia como “Envelope Tracking” o “EER”. La técnica de seguimiento de envolvente o “Envelope Tracking” está basada en la modulación de la tensión de alimentación de un amplificador lineal de potencia para obtener una mejora en el rendimiento en el sistema comparado a una solución con una tensión de alimentación constante. Para la implementación de esta técnica se necesita una etapa adicional, el amplificador de envolvente, que añade complejidad al amplificador de radiofrecuencia. En un amplificador diseñado con esta técnica, se aumentan las pérdidas debido a la etapa adicional que supone el amplificador de envolvente pero a su vez disminuyen las pérdidas en el amplificador de potencia. Si el diseño se optimiza adecuadamente, puede conseguirse un aumento global en el rendimiento del sistema superior al conseguido con las técnicas mencionadas anteriormente. Esta técnica presenta ventajas en el diseño del amplificador de envolvente, ya que el ancho de banda requerido puede ser menor que el ancho de banda de la señal de envolvente si se optimiza adecuadamente el diseño. Adicionalmente, debido a que la sincronización entre la señal de envolvente y de fase no tiene que ser perfecta, el proceso de integración conlleva ciertas ventajas respecto a otras técnicas como EER. La técnica de eliminación y restauración de envolvente, llamada EER o técnica de Kahn está basada en modulación simultánea de la envolvente y la fase de la señal usando un amplificador de potencia conmutado, no lineal y que permite obtener un elevado rendimiento. Esta solución fue propuesta en el año 1952, pero no ha sido implementada con éxito durante muchos años debido a los exigentes requerimientos en cuanto a la sincronización entre fase y envolvente, a las técnicas de control y de corrección de los errores y no linealidades de cada una de las etapas así como de los equipos para poder implementar estas técnicas, que tienen unos requerimientos exigentes en capacidad de cálculo y procesamiento. Dentro del diseño de un RFPA, el amplificador de envolvente tiene una gran importancia debido a su influencia en el rendimiento y ancho de banda del sistema completo. Adicionalmente, la linealidad y la calidad de la señal de transmitida deben ser elevados para poder cumplir con los diferentes estándares de telecomunicaciones. Esta tesis se centra en el amplificador de envolvente y el objetivo principal es el desarrollo de soluciones que permitan el aumento del rendimiento total del sistema a la vez que satisfagan los requerimientos de ancho de banda, calidad de la señal transmitida y de linealidad. Debido al elevado rendimiento que potencialmente puede alcanzarse con la técnica de EER, esta técnica ha sido objeto de análisis y en el estado del arte pueden encontrarse numerosas referencias que analizan el diseño y proponen diversas implementaciones. En una clasificación de alto nivel, podemos agrupar las soluciones propuestas del amplificador de envolvente según estén compuestas de una o múltiples etapas. Las soluciones para el amplificador de envolvente en una configuración multietapa se basan en la combinación de un convertidor conmutado, de elevado rendimiento con un regulador lineal, de alto ancho de banda, en una combinación serie o paralelo. Estas soluciones, debido a la combinación de las características de ambas etapas, proporcionan un buen compromiso entre rendimiento y buen funcionamiento del amplificador de RF. Por otro lado, la complejidad del sistema aumenta debido al mayor número de componentes y de señales de control necesarias y el aumento de rendimiento que se consigue con estas soluciones es limitado. Una configuración en una etapa tiene las ventajas de una mayor simplicidad, pero debido al elevado ancho de banda necesario, la frecuencia de conmutación debe aumentarse en gran medida. Esto implicará un bajo rendimiento y un peor funcionamiento del amplificador de envolvente. En el estado del arte pueden encontrarse diversas soluciones para un amplificador de envolvente en una etapa, como aumentar la frecuencia de conmutación y realizar la implementación en un circuito integrado, que tendrá mejor funcionamiento a altas frecuencias o utilizar técnicas topológicas y/o filtros de orden elevado, que permiten una reducción de la frecuencia de conmutación. En esta tesis se propone de manera original el uso de la técnica de cancelación de rizado, aplicado al convertidor reductor síncrono, para reducir la frecuencia de conmutación comparado con diseño equivalente del convertidor reductor convencional. Adicionalmente se han desarrollado dos variantes topológicas basadas en esta solución para aumentar la robustez y las prestaciones de la misma. Otro punto de interés en el diseño de un RFPA es la dificultad de poder estimar la influencia de los parámetros de diseño del amplificador de envolvente en el amplificador final integrado. En esta tesis se ha abordado este problema y se ha desarrollado una herramienta de diseño que permite obtener las principales figuras de mérito del amplificador integrado para la técnica de EER a partir del diseño del amplificador de envolvente. Mediante el uso de esta herramienta pueden validarse el efecto del ancho de banda, el rizado de tensión de salida o las no linealidades del diseño del amplificador de envolvente para varias modulaciones digitales. Las principales contribuciones originales de esta tesis son las siguientes: La aplicación de la técnica de cancelación de rizado a un convertidor reductor síncrono para un amplificador de envolvente de alto rendimiento para un RFPA linealizado mediante la técnica de EER. Una reducción del 66% en la frecuencia de conmutación, comparado con el reductor convencional equivalente. Esta reducción se ha validado experimentalmente obteniéndose una mejora en el rendimiento de entre el 12.4% y el 16% para las especificaciones de este trabajo. La topología y el diseño del convertidor reductor con dos redes de cancelación de rizado en cascada para mejorar el funcionamiento y robustez de la solución con una red de cancelación. La combinación de un convertidor redactor multifase con la técnica de cancelación de rizado para obtener una topología que proporciona una reducción del cociente entre frecuencia de conmutación y ancho de banda de la señal. El proceso de optimización del control del amplificador de envolvente en lazo cerrado para mejorar el funcionamiento respecto a la solución en lazo abierto del convertidor reductor con red de cancelación de rizado. Una herramienta de simulación para optimizar el proceso de diseño del amplificador de envolvente mediante la estimación de las figuras de mérito del RFPA, implementado mediante EER, basada en el diseño del amplificador de envolvente. La integración y caracterización del amplificador de envolvente basado en un convertidor reductor con red de cancelación de rizado en el transmisor de radiofrecuencia completo consiguiendo un elevado rendimiento, entre 57% y 70.6% para potencias de salida de 14.4W y 40.7W respectivamente. Esta tesis se divide en seis capítulos. El primer capítulo aborda la introducción enfocada en la aplicación, los amplificadores de potencia de radiofrecuencia, así como los principales problemas, retos y soluciones existentes. En el capítulo dos se desarrolla el estado del arte de amplificadores de potencia de RF, describiéndose las principales técnicas de diseño, las causas de no linealidad y las técnicas de optimización. El capítulo tres está centrado en las soluciones propuestas para el amplificador de envolvente. El modo de control se ha abordado en este capítulo y se ha presentado una optimización del diseño en lazo cerrado para el convertidor reductor convencional y para el convertidor reductor con red de cancelación de rizado. El capítulo cuatro se centra en el proceso de diseño del amplificador de envolvente. Se ha desarrollado una herramienta de diseño para evaluar la influencia del amplificador de envolvente en las figuras de mérito del RFPA. En el capítulo cinco se presenta el proceso de integración realizado y las pruebas realizadas para las diversas modulaciones, así como la completa caracterización y análisis del amplificador de RF. El capítulo seis describe las principales conclusiones de la tesis y las líneas futuras. ABSTRACT The trend in the telecommunications sector during the last years follow a high increase in the transmission rate of voice, video and mainly in data. To achieve the required levels of data rates, the new modulation standards demand higher bandwidths and have a higher peak to average power ratio (PAPR). These specifications have a direct impact in the low efficiency of the RFPA. An additional factor for the low efficiency of the RFPA is in the power amplifier design. Traditionally, linear classes have been used for the implementation of the power amplifier as they comply with the technical requirements. However, they have a low efficiency, especially in the operating range of signals with a high PAPR. The low efficiency of the transmitter has additional disadvantages as an increase in the cost and size as the cooling system needs to be increased for a base station and a temperature increase and a lower use time for portable devices. Several solutions have been proposed in the state of the art to improve the efficiency of the transmitter as Outphasing, power combiners or Doherty technique. However, the highest potential of efficiency improvement can be obtained using a modulated power supply for the power amplifier, as in the Envelope Tracking and EER techniques. The Envelope Tracking technique is based on the modulation of the power supply of a linear power amplifier to improve the overall efficiency compared to a fixed voltage supply. In the implementation of this technique an additional stage is needed, the envelope amplifier, that will increase the complexity of the RFPA. However, the efficiency of the linear power amplifier will increase and, if designed properly, the RFPA efficiency will be improved. The advantages of this technique are that the envelope amplifier design does not require such a high bandwidth as the envelope signal and that in the integration process a perfect synchronization between envelope and phase is not required. The Envelope Elimination and Restoration (EER) technique, known also as Kahn’s technique, is based on the simultaneous modulation of envelope and phase using a high efficiency switched power amplifier. This solution has the highest potential in terms of the efficiency improvement but also has the most challenging specifications. This solution, proposed in 1952, has not been successfully implemented until the last two decades due to the high demanding requirements for each of the stages as well as for the highly demanding processing and computation capabilities needed. At the system level, a very precise synchronization is required between the envelope and phase paths to avoid a linearity decrease of the system. Several techniques are used to compensate the non-linear effects in amplitude and phase and to improve the rejection of the out of band noise as predistortion, feedback and feed-forward. In order to obtain a high bandwidth and efficient RFPA using either ET or EER, the envelope amplifier stage will have a critical importance. The requirements for this stage are very demanding in terms of bandwidth, linearity and quality of the transmitted signal. Additionally the efficiency should be as high as possible, as the envelope amplifier has a direct impact in the efficiency of the overall system. This thesis is focused on the envelope amplifier stage and the main objective will be the development of high efficiency envelope amplifier solutions that comply with the requirements of the RFPA application. The design and optimization of an envelope amplifier for a RFPA application is a highly referenced research topic, and many solutions that address the envelope amplifier and the RFPA design and optimization can be found in the state of the art. From a high level classification, multiple and single stage envelope amplifiers can be identified. Envelope amplifiers for EER based on multiple stage architecture combine a linear assisted stage and a switched-mode stage, either in a series or parallel configuration, to achieve a very high performance RFPA. However, the complexity of the system increases and the efficiency improvement is limited. A single-stage envelope amplifier has the advantage of a lower complexity but in order to achieve the required bandwidth the switching frequency has to be highly increased, and therefore the performance and the efficiency are degraded. Several techniques are used to overcome this limitation, as the design of integrated circuits that are capable of switching at very high rates or the use of topological solutions, high order filters or a combination of both to reduce the switching frequency requirements. In this thesis it is originally proposed the use of the ripple cancellation technique, applied to a synchronous buck converter, to reduce the switching frequency requirements compared to a conventional buck converter for an envelope amplifier application. Three original proposals for the envelope amplifier stage, based on the ripple cancellation technique, are presented and one of the solutions has been experimentally validated and integrated in the complete amplifier, showing a high total efficiency increase compared to other solutions of the state of the art. Additionally, the proposed envelope amplifier has been integrated in the complete RFPA achieving a high total efficiency. The design process optimization has also been analyzed in this thesis. Due to the different figures of merit between the envelope amplifier and the complete RFPA it is very difficult to obtain an optimized design for the envelope amplifier. To reduce the design uncertainties, a design tool has been developed to provide an estimation of the RFPA figures of merit based on the design of the envelope amplifier. The main contributions of this thesis are: The application of the ripple cancellation technique to a synchronous buck converter for an envelope amplifier application to achieve a high efficiency and high bandwidth EER RFPA. A 66% reduction of the switching frequency, validated experimentally, compared to the equivalent conventional buck converter. This reduction has been reflected in an improvement in the efficiency between 12.4% and 16%, validated for the specifications of this work. The synchronous buck converter with two cascaded ripple cancellation networks (RCNs) topology and design to improve the robustness and the performance of the envelope amplifier. The combination of a phase-shifted multi-phase buck converter with the ripple cancellation technique to improve the envelope amplifier switching frequency to signal bandwidth ratio. The optimization of the control loop of an envelope amplifier to improve the performance of the open loop design for the conventional and ripple cancellation buck converter. A simulation tool to optimize the envelope amplifier design process. Using the envelope amplifier design as the input data, the main figures of merit of the complete RFPA for an EER application are obtained for several digital modulations. The successful integration of the envelope amplifier based on a RCN buck converter in the complete RFPA obtaining a high efficiency integrated amplifier. The efficiency obtained is between 57% and 70.6% for an output power of 14.4W and 40.7W respectively. The main figures of merit for the different modulations have been characterized and analyzed. This thesis is organized in six chapters. In Chapter 1 is provided an introduction of the RFPA application, where the main problems, challenges and solutions are described. In Chapter 2 the technical background for radiofrequency power amplifiers (RF) is presented. The main techniques to implement an RFPA are described and analyzed. The state of the art techniques to improve performance of the RFPA are identified as well as the main sources of no-linearities for the RFPA. Chapter 3 is focused on the envelope amplifier stage. The three different solutions proposed originally in this thesis for the envelope amplifier are presented and analyzed. The control stage design is analyzed and an optimization is proposed both for the conventional and the RCN buck converter. Chapter 4 is focused in the design and optimization process of the envelope amplifier and a design tool to evaluate the envelope amplifier design impact in the RFPA is presented. Chapter 5 shows the integration process of the complete amplifier. Chapter 6 addresses the main conclusions of the thesis and the future work.