The Clinical Usefulness of Narcotic Antagonists: Preliminary Findings on the Use of Naltrexone

This report presents the preliminary results of a national survey of Alcoholism Treatment Centers (ATCs). The data were collected through mail-return questionnaires. The sample was selected from a very comprehensive current listing of facilities known to treat alcoholic patients, which was provided by the National Institute on Alcohol Abuse and Alcoholism. The completion rate was high, with about 75% of all eligible ATCs responding. This report presents data on 396 ATCs which returned the questionnaire. These data indicated that ATCs were fairly active, with each treating and/or referring about 818 patients on the average per year. The facilities employed a broad range of treatment regimens, but the services of AA were quite widespread. As expected, the most common full-time treatment personnel were alcohol counselors. There was only 1 full-time psychiatrist for every three ATCs. The demographic profile of patients at these ATCs matched the known profile of ATC patients, which reinforces the validity of the obtained sample. Additional data were presented on the source of patient referrals to ATCs. These data revealed that the most common source of patient referrals were criminal justice agencies (22.5%), closely followed by self-referrals (21.9%). In addition, specific types of referrals were associated with patients from different demographic backgrounds.     

Geoelectric potential changes: possible precursors to earthquakes in Japan

Whether electromagnetic precursors to earthquakes (EQs) exist is an important question not only for EQ prediction but also for understanding the physical processes of EQ generation. Slow transient geoelectric potential changes have been observed before several recent EQs in Japan. In most cases, they appeared 1-19 days before the EQs, and their duration and intensity were several minutes to 1 h and 1-2 mV/100 m. The changes appeared before five of all six EQs with magnitude >/= 5 that occurred within 20 km of our stations during the observation period. Changes were also detected at greater epicentral distances (up to 75 km) before two other EQs, including one EQ of magnitude 4.7, which was preceded by a signal simultaneously recorded at three widely separated stations. These geoelectric potential changes have been distinguished through the following criteria from a multitude of other changes, which were noise of various origins. (i) The selected changes were proportional in amplitude to the length of the recording station's short ( approximately 100 m) dipoles and were simultaneously detected also on long (1-10 km) dipoles when the latter were in operation. (ii) No such changes occurred during the observation period that were not followed by EQs. Although the EQ precursory nature of these geoelectric potential changes is admittedly unproven, it seems that the present results warrant continued serious research into the occurrence, generation, and transmission of these signals and their possible causal relationship to EQs.     

Array-CGH identifies cyclin D1 and UBCH10 amplicons in anaplastic thyroid carcinoma

Anaplastic thyroid cancer (ATC) is a rare but highly aggressive disease with largely unexplained etiology and molecular pathogenesis. In this study, we analyzed genome-wide copy number changes, BRAF (V-raf sarcoma viral oncogene homolog B1) mutations, and p16 and cyclin D1 expressions in a panel of ATC primary tumors. Three ATCs harbored the common BRAF mutation V600E. Using array-comparative genomic hybridisation (array-CGH), several distinct recurrent copy number alterations were revealed including gains in 16p11.2, 20q11.2, and 20q13.12. Subsequent fluorescence in situ hybridization revealed recurrent locus gain of UBCH10 in 20q13.12 and Cyclin D1 (CCND1) in 11q13. The detection of a homozygous loss encompassing the CDKN2A locus in 9p21.3 motivated the examination of p16 protein expression, which was undetectable in 24/27 ATCs (89%). Based on the frequent gain in 11q13 (41%; n=11), the role of CCND1 was further investigated. Expression of cyclin D1 protein was observed at varying levels in 18/27 ATCs (67%). The effect of CCND1 on thyroid cell proliferation was assessed in vitro in ATC cells by means of siRNA and in thyroid cells after CCND1 transfection. In summary, the recurrent chromosomal copy number changes and molecular alterations identified in this study may provide an insight into the pathogenesis and development of ATC.     

Irregular topography at the Earth's inner core boundary

Compressional seismic wave reflected off the Earth’s inner core boundary (ICB) from earthquakes occurring in the Banda Sea and recorded at the Hi-net stations in Japan exhibits significant variations in travel time (from -2 to 2.5 s) and amplitude (with a factor of more than 4) across the seismic array. Such variations indicate that Earth’s ICB is irregular, with a combination of at least two scales of topography: a height variation of 14 km changing within a lateral distance of no more than 6 km, and a height variation of 4–8 km with a lateral length scale of 2–4 km. The characteristics of the ICB topography indicate that small-scale variations of temperature and/or core composition exist near the ICB, and/or the ICB topographic surface is being deformed by small-scale forces out of its thermocompositional equilibrium position and is metastable.     

Scale dependence in earthquake phenomena and its relevance to earthquake prediction

The recent discovery of a low-velocity, low-Q zone with a width of 50-200 m reaching to the top of the ductile part of the crust, by observations on seismic guided waves trapped in the fault zone of the Landers earthquake of 1992, and its identification with the shear zone inferred from the distribution of tension cracks observed on the surface support the existence of a characteristic scale length of the order of 100 m affecting various earthquake phenomena in southern California, as evidenced earlier by the kink in the magnitude-frequency relation at about M3, the constant corner frequency for earthquakes with M below about 3, and the sourcecontrolled fmax of 5-10 Hz for major earthquakes. The temporal correlation between coda Q-1 and the fractional rate of occurrence of earthquakes in the magnitude range 3-3.5, the geographical similarity of coda Q-1 and seismic velocity at a depth of 20 km, and the simultaneous change of coda Q-1 and conductivity at the lower crust support the hypotheses that coda Q-1 may represent the activity of creep fracture in the ductile part of the lithosphere occurring over cracks with a characteristic size of the order of 100 m. The existence of such a characteristic scale length cannot be consistent with the overall self-similarity of earthquakes unless we postulate a discrete hierarchy of such characteristic scale lengths. The discrete hierarchy of characteristic scale lengths is consistent with recently observed logarithmic periodicity in precursory seismicity.     

Phosphatidylinositol 3-kinase/akt and ras/raf-mitogen-activated protein kinase pathway mutations in anaplastic thyroid cancer

CONTEXT: Anaplastic thyroid carcinoma (ATC) can occur in the setting of differentiated thyroid carcinoma (DTC), which suggests a continuum in malignant progression from DTC to ATC. The Ras/Raf-MAPK and the phosphatidylinositol 3-kinase/Akt signaling pathways play critical roles in DTC tumorigenesis, but their roles in the pathogenesis of ATC are poorly defined. OBJECTIVE: Our objective was to explore the potential contributions of these two pathways in ATC pathogenesis. DESIGN, SETTING, AND SUBJECTS: The mutational status of BRAF, PIK3CA, PTEN, and RAS genes was analyzed in genomic DNA from microdissected tumor specimens of 36 cases of ATC, and in 16 samples of paired-matched lymph node metastases. PIK3CA copy number gain was assessed by real-time quantitative PCR. We performed immunohistochemistry for phospho-ERK and phospho-AKT in 26 cases of ATC. RESULTS: DTC was present in half of the cases. BRAF V600E mutation was identified in nine of 36 (25%) ATCs; seven cases had identical mutations in both the ATC and DTC components. PIK3CA kinase domain mutations were found in five (14%) ATCs, one of which had mutations in both differentiated and anaplastic areas. RAS and PTEN mutations were each found in two (6%) ATCs. PIK3CA gain copy number was found notably increased in 14 (39%) ATCs. CONCLUSIONS: BRAF mutations appear to play a role in the tumorigenesis of a subset of ATCs, and the majority of lymph node metastases. PIK3CA alterations occur preferentially in the later stages of ATC and were the most relevant events during thyroid cancer progression. The activation of both pathways suggests an important role in ATC dedifferentiation.     

Direct evidence for a receptor-ligand interaction between the T-cell surface antigen CD2 and lymphocyte-function-associated antigen 3

The recognition of foreign antigen by T lymphocytes requires direct contact with cells expressing the antigen. It has recently become clear that T lymphocytes can form conjugates with other cells in the absence of foreign antigen expression. Studies using monoclonal antibodies (mAbs) to inhibit conjugate formation have suggested that a portion of the antigen-dependent adhesion is mediated by T lymphocytes interacting with cells expressing lymphocyte-function-associated antigen 3 (LFA-3), a widely distributed cell surface protein. We have investigated antigen-independent adhesion by incorporating affinity-purified LFA-3 into the lipid membrane of an artificial target cell (ATC; a nylon-matrix vesicle with a lipid membrane). These vesicles are similar in size and density to intact cells, so that conjugates between cells and ATCs may be seen by light microscopy. ATCs expressing a density of LFA-3 similar to that on intact cells were found to form conjugates with T cells, but only if the T cells expressed the sheep erythrocyte receptor, CD2 (T11; LFA-2). Previous studies using mAbs have implicated the CD2 molecule in both adhesion and T-cell activation. ATCs prepared without surface protein or with purified HLA class I protein failed to interact with the CD2-positive T cells, indicating that the adhesion found was mediated by the LFA-3 molecule. Furthermore, mAb against LFA-3 or CD2 was able to block the LFA-3-mediated vesicle-cell interaction, whereas mAb against LFA-1 or HLA failed to inhibit the interaction. These results provide direct evidence that LFA-3 functions as an adhesion molecule by serving as a ligand for the CD2 molecule on T cells.     

Environmental facilitators for outdoor walking and development of walking difficulty in community-dwelling older adults

Older adults who report environmental barriers in their neighborhood have a higher risk for walking difficulty. However, environmental facilitators that protect against walking difficulty are not well known. The objective of this study was to identify the effect of environmental facilitators for outdoor walking on development of walking difficulty in community-dwelling older people. This was a prospective study with a 3.5-year follow-up time on 261 community-dwelling people aged 75–81 years, who at baseline were able to walk 0.5 km without difficulty. Environmental facilitators for outdoor walking were self-reported with standardized questionnaires, including having features in one’s home which make it easy to access the outdoors, having a park or other green area within a walking distance from home, having outdoor recreational facilities within a walking distance from home, having features in the nearby environment, which are attractive for outdoor activities, and perceiving the surrounding environment or facilities nearby as motivating factors for physical activity. Self-reported difficulty in walking 0.5 km was assessed every 6 months. Of the participants, 46 % developed walking difficulty during the follow-up. Having a park or other green area within a walking distance from home was the most frequently reported facilitator. Environmental facilitators decreased the risk for development of walking difficulty, hazard ratio per item 0.86, (95 % confidence interval 0.73–1.02). The results indicate that the mobility of older community-dwelling people may be promoted with outdoor recreational facilities that are easy to access and located within a walking distance from home.     

Lyme disease in New York State: spatial pattern at a regional scale.

Lyme disease occurs commonly in New York State, but its geographic distribution is heterogeneous. Over each of nine consecutive years, incidence rates from 57 New York State counties were subjected to spatial autocorrelation analysis. Although the epidemic advanced during the study period, the analyses reveal a consistent pattern of spatial dependence. The correlation distance, the distance over which incidence rates covary positively, remained near 120 km over the nine years. A local spatial analysis around Westchester County, a major disease focus, indicated that the global correlation distance matched the extent of the most intense local clustering; statistically weaker clustering extended to 200 km from Westchester. Analyzing the spatial character of the epidemic may reveal the epizootic processes underlying patterns in human infection, and may help identify a spatial scale for regional control of disease.     

大骨节病膝关节镜下清理术后远期疗效评价

目的 评价膝关节镜下关节清理修复手术治疗大骨节病膝关节骨性关节炎的远期疗效.方法 对31例行膝关节镜下关节清理术的大骨节病患者进行术后6年随访,记录疼痛指数、症状改善自我评价、关节活动度、行走距离和30°、60°单腿站立试验等指标值,与术前资料进行对比分析.结果 6年后共随访24例.术后6年患者疼痛指数(3.38±2.87)与术前(6.88±1.45)比较显著减小(t=5.30,P＜0.05).患者对症状改善的主观自我评价显效率为70.83%(17/24),有效率为100%(24/24).术后6年30°、60°单腿站立试验,可站立例数(21、18例)明显多于术前(14、11例),二者比较差异有统计学意义(x2值分别为5.17、4.27,P均＜0.05).术后6年患者行走距离(＜1、1～5、＞5 km分别为3、11、10例)与术前(＜1、1～5、＞5 km分别为12、9、3例)比较明显改善(U=2.88,P＜0.05).术后6年膝关节活动度[(132.25±14.52)°]与术前[(131.58±14.68)°]比较,差异无统计学意义(t=0.16,P＞0.05).结论 膝关节镜下关节清理修复手术治疗大骨节病膝关节骨性关节炎能够显著减少疼痛,改善功能及行走距离,具有较稳定的远期满意疗效.     

Changes of walking distance in patients with intermittent claudication during six months intensive physical training

Patients with intermittent claudication were treated with six months intensive physical training. They were instructed to walk with a speed of 6 km/h until they got complaints and then to rest for some time. This sequence was repeated until men below 65 years had walked 2 km. Men above the age of 65 years and women had to walk 1.5 km. This training session was performed 3 times a day. Every two months the claudication distances in a corridor and on a treadmill were measured. Out of 95 patients 65 completed the training. In 38 patients (59%) there was no substantial change in walking distance. Fourteen patients (22%) doubled their walking distance, seven (11%) could walk more than 1000 m, but their complaints remained. Six (9%) could walk more than 1000 m without claudication pain. Most patients gained their result during the last 2 months of the program. After the training 48% of the patients were satisfied with their walking distance.     

Travel for HIV care in England: a choice or a necessity?

Objectives

The aims of the study were (1) to measure the distance required to travel, and the distance actually travelled, to HIV services by HIV‐infected adults, and (2) to calculate the proportion of patients who travelled beyond local services and identify socio‐demographic and clinical predictors of use of non‐local services.

Methods

The straight‐line distance between a patient's residence and HIV services was determined for HIV‐infected patients in England in 2007. ‘Local services’ were defined as the closest HIV service to a patient's residence and other services within an additional 5 km radius. Multivariable logistic regression was used to identify socio‐demographic and clinical predictors of accessing non‐local services.

Results

In 2007, nearly 57 000 adults with diagnosed HIV infection accessed HIV services in England; 42% lived in the most deprived areas. Overall, 81% of patients lived within 5 km of a service, and 8.7% used their closest HIV service. The median distance to the closest HIV service was 2.5 km [interquartile range (IQR) 1.5–4.2 km] and the median actual distance travelled was 4.8 km (IQR 2.5–9.7 km). A quarter of patients used a ‘non‐local’ service. Patients living in the least deprived areas were twice as likely to use non‐local services as those living in the most deprived areas [adjusted odds ratio (AOR) 2.16; 95% confidence interval (CI) 1.98–2.37]. Other predictors for accessing non‐local services included living in an urban area (AOR 0.77; 95% CI 0.69–0.85) and being diagnosed more than 12 months (AOR 1.48; 95% CI 1.38–1.59).

Conclusion

In England, 81% of HIV‐infected patients live within 5 km of HIV services and a quarter of HIV‐infected adults travel to non‐local HIV services. Those living in deprived areas are less likely to travel to non‐local services.     

Anaplastic thyroid cancer: cytogenetic patterns by comparative genomic hybridization.

We studied chromosomal abnormalities by comparative genomic hybridization (CGH) and flow cytometry in anaplastic thyroid cancer (ATC), and when present in coexisting or previous differentiated thyroid cancer (DTC). Overall 10 frozen tissues from patients with ATC and 5 cell lines (1 ATC and 4 DTCs) were analyzed. We found chromosomal abnormalities in 5 of 10 ATC tissues, with 24 abnormalities (22 gains and 2 losses). Among 8 ATCs that were associated with prior or concurrent DTC, more chromosomal abnormalities were found in ATC associated with follicular thyroid cancer (FTC) than those associated with PTC (median numbers 9.5 and 0.5, respectively, p = 0.046) or no associated differentiated thyroid cancer. Gain of 1q was relatively common in ATCs (30%). By flow cytometry, we found aneuploidy in 6 of 10 ATC tissues and diploidy in 4. There was concordance between DNA aneuploidy and the presence of chromosomal abnormalities by CGH in 4 of the 5 ATCs (p = 0.048). We also found 26 chromosomal abnormalities in an ATC cell line, 14.3 in 3 FTC cell line, and 3 in a PTC cell line. In conclusion, chromosomal abnormalities are frequent in ATCs associated with FTC, but uncommon in those associated with PTC and in ATCs with no associated differentiated thyroid cancer. These findings support the concept that PTC and FTC have different genetic backgrounds and, even after the transformation to ATC, they may retain some of their cytogenetic characteristics.     

Antitumor activity and long-term fate of chimeric antigen receptor-positive T cells in patients with neuroblastoma

We generated MHC-independent chimeric antigen receptors (CARs) directed to the GD2 antigen expressed by neuroblastoma tumor cells and treated patients with this disease. Two distinguishable forms of this CAR were expressed in EBV-specific cytotoxic T lymphocytes (EBV-CTLs) and activated T cells (ATCs). We have previously shown that EBV-CTLs expressing GD2-CARs (CAR-CTLs) circulated at higher levels than GD2-CAR ATCs (CAR-ATCs) early after infusion, but by 6 weeks, both subsets became low or undetectable. We now report the long-term clinical and immunologic consequences of infusions in 19 patients with high-risk neuroblastoma: 8 in remission at infusion and 11 with active disease. Three of 11 patients with active disease achieved complete remission, and persistence of either CAR-ATCs or CAR-CTLs beyond 6 weeks was associated with superior clinical outcome. We observed persistence for up to 192 weeks for CAR-ATCs and 96 weeks for CAR-CTLs, and duration of persistence was highly concordant with the percentage of CD4(+) cells and central memory cells (CD45RO(+)CD62L(+)) in the infused product. In conclusion, GD2-CAR T cells can induce complete tumor responses in patients with active neuroblastoma; these CAR T cells may have extended, low-level persistence in patients, and such persistence was associated with longer survival. This study is registered at www.clinialtrials.gov as #NCT00085930.     

Source pool geometry and the assembly of continental avifaunas

Classical niche-assembly models propose that the composition of biotic communities in continental landscapes is determined chiefly by the autecology of species, interspecific competition, and the diversity of resources and habitats within a region. In contrast, stochastic models propose that simulation algorithms can replicate the macroecological patterns, if not the mechanisms, of community assembly. Despite fundamental differences in assumptions, both categories of models assume that species are drawn from regional source pools. We explored the implications of source pool geometry on the assembly of avian communities with an analysis of assemblage dispersion fields, which can be visualized by overlaying the geographic ranges of all species that occur in an assemblage. Contours of species richness surrounding focal quadrats illustrate the decay rate of assemblage similarity with distance and the probable geometry of assemblage source pools. We used a geographic database for 2,891 species of South American birds to characterize dispersion fields for assemblages sampled by 1 degrees latitude-longitude quadrats (n = 1,676). We show that the median range size of dispersion fields varies by an order of magnitude across the continent. Because abundance generally correlates with geographic range size within taxonomic groups, the number of individuals per species in avifaunal source pools must also vary by an order of magnitude. Most significantly, dispersion field geometry was surprisingly asymmetrical and exhibited complex geographical patterns that were associated with the distribution of biomes. These results are broadly consistent with the predictions of niche-assembly models but offer little support for stochastic assembly models.     

The repetition of large-earthquake ruptures

This survey of well-documented repeated fault rupture confirms that some faults have exhibited a "characteristic" behavior during repeated large earthquakes--that is, the magnitude, distribution, and style of slip on the fault has repeated during two or more consecutive events. In two cases faults exhibit slip functions that vary little from earthquake to earthquake. In one other well-documented case, however, fault lengths contrast markedly for two consecutive ruptures, but the amount of offset at individual sites was similar. Adjacent individual patches, 10 km or more in length, failed singly during one event and in tandem during the other. More complex cases of repetition may also represent the failure of several distinct patches. The faults of the 1992 Landers earthquake provide an instructive example of such complexity. Together, these examples suggest that large earthquakes commonly result from the failure of one or more patches, each characterized by a slip function that is roughly invariant through consecutive earthquake cycles. The persistence of these slip-patches through two or more large earthquakes indicates that some quasi-invariant physical property controls the pattern and magnitude of slip. These data seem incompatible with theoretical models that produce slip distributions that are highly variable in consecutive large events.     

Reentrant ventricular arrhythmias in the late myocardial infarction period: 17. Correlation of activation patterns of sinus and reentrant ventricular tachycardia

The relationship between myocardial sites with late activation during sinus rhythm and sites critical for the initiation and sustentation of reentrant ventricular tachycardia was systematically examined in the 4-day-old postinfarction canine heart. The critical sites for prevention of the initiation of reentry and for termination of sustained figure-of-8 reentrant tachycardia by cryothermal techniques were correlated with the last 20 msec isochrone during sinus rhythm. In 12 experiments, 20 critical sites were examined. The mean distance between sites critical for reentry and the latest isochrone during sinus rhythm was 26.7 +/- 13.3 mm. Only five sites (25%) were within a 12 mm distance, which corresponded to the diameter of the cryoprobe. Nine sites (45%) were within a 24 mm distance (twice the diameter of the cryoprobe), while 11 sites (55%) were separated by more than 24 mm. In three experiments the sites of latest activation during sinus rhythm represented areas showing Wenckebach period or 2:1 conduction block. These sites became dissociated and did not participate in the reentrant excitation induced by premature stimulation. Poor correlation was explained by the fact that sites critical for reentry were intimately related to the location and extent of the arcs of functional conduction block while sites of delayed activation during sinus rhythm were not.     

Assessment of fibrosis in infarcted human hearts by analysis of ultrasonic backscatter

In animal hearts, the magnitude of integrated ultrasonic backscatter is increased in fibrotic myocardium. Our purpose in this study was to quantitate the relationship between ultrasonic backscatter and collagen deposition in 10 excised human hearts with old infarcts. A 2.25 MHz, 50% fractional bandwidth transducer was positioned at the transducer focal distance from the epicardium of each specimen. The radio frequency backscatter signal was digitized, squared, and integrated to yield the integrated ultrasonic backscatter, which was referenced to the backscatter from a water/steel interface. The interrogated myocardium was then excised and divided into two portions. One portion was assayed for hydroxyproline, a marker for collagen. A second portion was sectioned, stained with Masson's trichrome, and studied with the use of a computer-assisted image analysis system. There was a linear correlation between the magnitude of integrated backscatter and myocardial collagen content estimated by hydroxyproline assay (r = .78). Quantitative histologic analysis revealed a variable relationship between the transmural distribution of collagen and the corresponding transmural pattern of the backscatter signal. In two specimens exhibiting a discrete layer of subendocardial fibrosis, the backscatter amplitude was also increased in the subendocardial region. In specimens with other patterns of fibrosis, the local backscatter amplitude did not correspond to the transmural pattern of collagen distribution. We conclude that the quantitative analysis of ultrasonic backscatter shows promise for the noninvasive evaluation of myocardial fibrosis after infarction.     

Shearing instabilities accompanying high-pressure phase transformations and the mechanics of deep earthquakes

Deep earthquakes have been a paradox since their discovery in the 1920s. The combined increase of pressure and temperature with depth precludes brittle failure or frictional sliding beyond a few tens of kilometers, yet earthquakes occur continually in subduction zones to approximately 700 km. The expected healing effects of pressure and temperature and growing amounts of seismic and experimental data suggest that earthquakes at depth probably represent self-organized failure analogous to, but different from, brittle failure. The only high-pressure shearing instabilities identified by experiment require generation in situ of a small fraction of very weak material differing significantly in density from the parent material. This "fluid" spontaneously forms mode I microcracks or microanticracks that self-organize via the elastic strain fields at their tips, leading to shear failure. Growing evidence suggests that the great majority of subduction zone earthquakes shallower than 400 km are initiated by breakdown of hydrous phases and that deeper ones probably initiate as a shearing instability associated with breakdown of metastable olivine to its higher-pressure polymorphs. In either case, fault propagation could be enhanced by shear heating, just as is sometimes the case with frictional sliding in the crust. Extensive seismological interrogation of the region of the Tonga subduction zone in the southwest Pacific Ocean provides evidence suggesting significant metastable olivine, with implication for its presence in other regions of deep seismicity. If metastable olivine is confirmed, either current thermal models of subducting slabs are too warm or published kinetics of olivine breakdown reactions are too fast.     

Atrial noninvasive activation mapping of paced rhythm data

INTRODUCTION: Atrial arrhythmias have emerged as a topic of great interest for clinical electrophysiologists. Noninvasive imaging of electrical function in humans may be useful for computer-aided diagnosis and treatment of cardiac arrhythmias, which can be accomplished by the fusion of data from ECG mapping and magnetic resonance imaging (MRI). METHODS AND RESULTS: In this study, a bidomain-theory-based surface heart model activation time (AT) imaging approach was applied to paced rhythm data from four patients. Pacing sites were the right superior pulmonary vein, left inferior pulmonary vein, left superior pulmonary vein, coronary sinus, posterior wall of right atrium, and high right atrium. For coronary sinus pacing, the AT pattern of the right atrium was compared with a CARTO map. The root mean square error between CARTO geometry (85 nodal points) and the surface model of the right atrium was 8.6 mm. The correlation coefficient of the noninvasively obtained AT map of the right atrium and the CARTO map was 0.76. All pulmonary vein pacing sites were identified. The reconstructed pacing site of right posterior atrial pacing correlates with the invasively determined pacing catheter position with a localization distance of 4 mm. CONCLUSION: The individual anatomic model of the atria of each patient enables accurate noninvasive AT imaging within the atria, resulting in a localization error for the pacing sites within 10 mm. Our findings may have implications for imaging of atrial activity in patients with focal arrhythmias or focal triggers.