Coronary artery injury due to catheter ablation in adults: presentations and outcomes

BACKGROUND: Currently, only anecdotal information exists on the presentation and outcome of coronary arterial injury after ablation procedures. METHODS AND RESULTS: Four patients who sustained coronary artery injury of a cohort of patients undergoing 4655 consecutive ablation procedures (0.09%) are described. The patients' mean age was 45+/-11 years, and 1.8+/-0.5 prior ablation attempts had been unsuccessful. Coronary injury occurred from epicardial ventricular tachycardia ablation in 2 patients (irrigated radiofrequency ablation in one and cryoablation in the other) and ablation within the middle cardiac vein with irrigated radiofrequency in 2 patients. All involved branches of the right coronary artery. Acute occlusion presenting with ST-segment elevation immediately after ablation was recognized during the procedure in 2 cases. Occlusion failed to respond to nitroglycerin or balloon dilation, and stenting was required in both cases. Acute myocardial infarction occurred 2 weeks after epicardial ablation as a result of occlusion of a right ventricular branch of the right coronary artery giving rise to the posterior descending coronary artery in 1 patient. A moderate asymptomatic stenosis was seen on angiography after epicardial cryoablation in 1 patient. All patients recovered and remained asymptomatic from the coronary injury and arrhythmias during 37+/-53 months of follow-up. CONCLUSIONS: Coronary arterial injury after ablation procedures is rare. It may present acutely or several weeks after an ablation procedure. Acute occlusion appears to require coronary stenting. Unanticipated anatomic variations can predispose to coronary injury.

Search for non-pointing photons in the diphoton and ETmiss final state in sqrt(s) = 7 TeV proton-proton collisions using the ATLAS detector

A search has been performed for photons originating in the decay of a neutral long-lived particle, exploiting the capabilities of the ATLAS electromagnetic calorimeter to make precise measurements of the flight direction of photons, as well as the calorimeter's excellent time resolution. The search has been made in the diphoton plus missing transverse energy final state, using the full data sample of 4.8 fb(-1) of 7 TeV proton-proton collisions collected in 2011 with the ATLAS detector at the LHC. No excess is observed above the background expected from Standard Model processes. The results are used to set exclusion limits in the context of gauge mediated supersymmetry breaking models, with the lightest neutralino being the next-to-lightest supersymmetric particle and decaying with a lifetime in excess of 0.25 ns into a photon and a gravitino.

The domestic physician or Guardian of health : Pointing out, in the most familiar manner, the symptoms of every disorder incident to mankind; together with their gradual progress and method of cure ... : To which is added, an appendix, forming a complete dispensatory /

Mode of access: Internet.

A Sheltered crisis : the state of fair housing in the eighties : presentations at a consultation sponsored by the United States Commission of Civil Rights, Washington, D.C., September 26-27, 1983.

Mode of access: Internet.

The wrongs of children, or, A practical vindication of children from the injustice done them in early nurture and education : addressed to parents, tutors, guardians, and masters, and to legislators and governors, setting forth the source of much human misery, and pointing out the remedy in a series of essays on education to be published periodically /

Goldsmiths'-Kress no. 22547.

The medical companion, or family physician; treating of the diseases of the United States, with their symptoms, causes, cure and means of prevention: common cases in surgery, as fractures, dislocations, &c. the management and diseases of women and children. A dispensatory, for preparing family medicine, and a glossary explaining technical terms. To which are added, a brief anatomy and physiology of the human body, shewing, on rational principles, the cause and cure of diseases: an essay on hygiene, or the art of preserving health, without the aid of medicine: an American materia medica, pointing out the virtues and doses of our medicinal plants. Also, the nurse's guide,

Mode of access: Internet.

The domestic guide in cases of insanity, pointing out the causes, means of preventing, and proper treatment of that disorder.

Mode of access: Internet.

Letters from Italy, between the years 1792 and 1798, containing a view of the revolutions in that country, from the capture of Nice by the French republic to the expulsion of Pius VI. from the ecclesiastical state; likewise pointing out the matchless works of art which still embellish Pisa, Florence, Siena, Rome, Naples, Bologna, Venice, &c. With instructions for the use of invalids and families ...

Mode of access: Internet.

James Oliver Curwood (pointing) with another individual on horseback overlooking Grizzly Valley in British Columbia

On verso: State Journal Sunday no. 25; 3 col. Sun Outdoors