Relation Between Body Surface Mapping and Endocardial Spread of Ventricular Activation in Postinfarction Heart

INTRODUCTION: Body surface mapping (BSM) can be used to identify the site of earliest endocardial activation of ventricular tachycardias (VTs). The multielectrode QRS morphology during VT is determined by both the site of earliest activation and the subsequent spread of electrical activation through the ventricles. This study investigated the relationship between the site of earliest endocardial activation, endocardial spread of activation, and the morphology of the multielectrode surface map in patients with remote myocardial infarction. METHODS AND RESULTS: In 14 patients with VT late (8.2+/-5.2 years) after myocardial infarction, BSM and simultaneous left ventricular 64-site basket endocardial mapping was performed during a total of 17 monomorphic VTs. In addition, multisite pacing by sequential use of the 64 basket electrodes was performed in 9 patients. BSM and basket mapping revealed the same endocardial breakthrough sites in 8 (47%) of 17 VTs and 189 (59%) of 322 pacing sites; adjacent sites were found in 2 (12%) of 17 VTs and 36 (11%) of 322 pacing sites. Large zones of conduction block explained the mismatch in localization in 2 (12%) of 17 VTs and 52 (16%) of 322 pacing sites. Regional differences in endocardial electrogram amplitudes were found as a cause for dissimilarity in 3 (18%) of 17 VTs and 73 (23%) of 322 pacing sites. Multiple endocardial breakthrough sites were found in 1 (6%) of 17 VTs and 8 (2%) of 322 pacing sites Finally, an epicardial exit site was suggested in 3 (18%) of 17 VTs as an explanation for mismatch, as no early endocardial activity could be recorded. CONCLUSION: Zones of conduction block, regional differences in signal amplitude, and multiple endocardial breakthrough sites are frequent causes for mismatch between BSM and basket catheter activation mapping.     

In-vitro exoerythrocytic development of Plasmodium cynomolgi bastianellii inhibitory activity of monoclonal antibodies against sporozoites of different P. cynomolgi strains and of P. knowlesi

The inhibitory effect of anti-sporozoite monoclonal antibodies (MoAb) on the in-vitro development of liver stages of Plasmodium cynomolgi bastianellii (NIH strain) was evaluated using primary cultures of rhesus monkey hepatocytes. MoAbs against the circumsporozoite proteins of five strains of P. cynomolgi (NIH, London, Gombak, Ceylon, Berok), and of P. knowlesi (H strain) were used. Incubation of sporozoites of P. cynomolgi bastianellii with the anti-NIH strain MoAbs entirely prevented liver-stage development; MoAbs produced against the other four strains had no apparent activity. The anti-P. knowlesi MoAbs had a partially inhibitory effect on parasite development. These functional studies complement previous immunological studies on P. cynomolgi strain specificity, and confirm the cross-reactivity observed previously between sporozoites of P. cynomolgi bastianellii and P. knowlesi (H strain).     

The Impact of Modern Noninvasive Cardiac Imaging on Coronary Intervention Rates

Objectives

It remains still unclear whether the use of modern noninvasive diagnostic modalities for evaluation of coronary artery disease (computed tomography coronary angiography (CTCA), nuclear myocardial perfusion imaging (MPI)) were able to change the “diagnostic yield” of invasive coronary angiography (ICA).

Methods

The total number of ICA in the years 2000–2009 was related to the number of percutaneous interventions (PCIs) and we assessed whether there was a significant trend over time using time series analyses. We compared these data with the number of patients undergoing CTCA and nuclear MPI in the same time period.

Results

During the 10‐year observational period, 23,397 ICA were performed. The proportion of purely diagnostic ICA (without PCI) remained stable over the whole study period (tau = ?0.111, P = 0.721). A CTCA program was initiated in 2005 and 1,407 examinations were performed until 2009. Similarly, the number of nuclear MPI increased from 2,284 in the years 2000–2004 to 5,260 in the years 2005–2009 (P = 0.009).

Conclusion

Despite increasing availability, noninvasive testing modalities did not significantly alter the rate of purely diagnostic ICA, and still are underused as gatekeeper to ICA. Further effort is needed to optimize the use of noninvasive imaging modalities in the work‐up process for coronary artery disease. (J Interven Cardiol 2014;27:50–57)

     

Improvement of Quality of Life by Means of Antitachy Pacing: From PainFREE to the ADVANCE-D Trial

Background: Implantable cardioverter-defibrillators (ICD) can terminate ventricular tachyarrhythmias with shocks (painful) or antitachycardia pacing (painless). According to the results of the Pacing Fast VT Reduces Shock ThErapies Trials, antitachycardia pacing (ATP) can avoid painful shocks and also increase device longevity. The purpose of the ADVANCE-D (Atp DeliVery for PAiNless ICD ThErapy) study is to determine the most appropriate ventricular tachycardia (VT) therapy, so as to optimize painless therapy for life-threatening arrhythmias.
Methods and Results: The ADVANCE-D is a prospective, multicenter, parallel, two-arm randomized study designed to evaluate the efficacy of two different sequences of ATP therapies (burst 15 pulses, 88%, vs burst 8 pulses, 88%), during an episode of spontaneous arrhythmia classified as fast VT (FVT) in patients with a Class I or IIA indication for ICD implantation (single and dual chamber devices). The primary endpoint is to compare the efficacy of two ATP therapies for FVT episodes. The study will enroll a minimum of 900 patients within 2 years, followed-up for 12 months. The investigation is expected to be completed in 2007.
Conclusions: The ADVANCE-D trial is the first large randomized clinical investigation aimed to evaluate optimal programming and efficacy of ATP.     

Streptococcus pyogenes and β‐lactam antibiotics

Letters to the Editor are welcomed for publication (subject to editing). Letters must be signed by all authors, typewritten double spaced, and must not exceed two pages of text including references. Two copies of all letters should be submitted along with one copy on disk. Letters should not duplicate material submitted or published in other journals. Prepublication proofs will not be provided.     

Rationalization of Esthetic Restorative Dentistry Based on Biomimetics

Abstract: The exponential progressivism that characterizes the current decade often comes with substantial financial implications. Dental care is not spared by this phenomenon. However, new generations of concepts emerging from biomimetics provide the operator with the ability to restore the biomechanical, structural, and esthetic integrity of teeth. The development of adhesion and the evolution of porcelain veneers constitute striking examples of this nascent process. Indications for bonding porcelain are extending to more perilous situations (crown-fractured incisors, nonvital teeth), resulting in considerable improvements, comprising both the medical-biologic aspect (economy of sound tissues and maintenance of tooth vitality) and the socioeconomical context (decrease of costs compared to traditional and more invasive prosthetic treatments).
CLINICAL SIGNIFICANCE: In the bonded porcelain veneer and its extensions, restorative dentistry has found new solutions for the anterior segment that balance the need for functional and esthetic reconstruction. The optimal stiffness of porcelain in thin section, the ideal surface characteristics, and the biomechanical continuum achieved through high performance bonding mean the crown of the tooth as a whole can support incisal or masticatory function. By the same token, the conduction of optical effects from within the tooth combined with the ideal surface features of the porcelain veneer make this restorative approach the ultimate in esthetic satisfaction, for both the practitioner and the patient.     

Estimating alcohol‐attributable mortality among Indigenous Australians: Towards Indigenous‐specific alcohol aetiologic fractions

Introduction and Aims. Past estimates of Indigenous alcohol‐attributable health in Australia have been based on drinking prevalence estimates from the general population, rather than prevalence figures from the Indigenous population. The purpose of this paper is to demonstrate the efficacy of using Indigenous‐specific drinking prevalence to estimate alcohol‐attributable deaths among Indigenous Australians. Design and Methods. Estimates of Indigenous alcohol‐attributable deaths between 2000 and 2004 were obtained using both (i) national general‐population drinking prevalence estimates and (ii) national Indigenous‐specific drinking prevalence. Estimates were calculated using the ‘aetiologic fraction’ method. Results. By using national general‐population drinking prevalence figures, past reports on Indigenous health have underestimated alcohol‐attributable deaths for the national Indigenous population. Female deaths due to alcohol‐attributable haemorrhagic stroke were estimated to be approximately four times higher and alcohol‐attributable suicides among men were estimated to be 30% higher than was previously held, when Indigenous‐specific drinking prevalence figures were used. Discussion and Conclusions. By substituting Indigenous‐specific alcohol consumption prevalence estimates for general‐population drinking prevalence, the accuracy of estimates of alcohol‐related harm among Indigenous Australians can be significantly improved.[Pascal R, Chikritzhs T, Gray D. Estimating alcohol‐attributable mortality among Indigenous Australians: Towards Indigenous‐specific alcohol aetiologic fractions. Drug Alcohol Rev 2009;28:196–200]