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Although athletic participation lowers cardiovascular risk and improves quality of life, it may represent a hazard in high-risk group athletes such as those with cardiac abnormalities receiving an implantable cardioverter defibrillator (ICD). ICD sports participants are exposed to the potential risk of inappropriate shocks due to sinus tachycardia and other supraventricular arrhythmias during exertion as well as device injury. The safety of athletic participation of ICD-patients is not completely defined and ICD efficacy in interrupting malignant arrhythmias during intense exercise is partly unknown. This explains difficulties in current recommendations made by physicians, given the associated potentially ischemic, autonomic and metabolic conditions. The scope of this review is to underline specific considerations including potential risks and recommendations for athletic participation in this patient-group. [ABSTRACT FROM AUTHOR]

Although athletic participation lowers cardiovascular risk and improves quality of life, it may represent a hazard in high-risk group athletes such as those with cardiac abnormalities receiving an implantable cardioverter defibrillator (ICD). ICD sports participants are exposed to the potential risk of inappropriate shocks due to sinus tachycardia and other supraventricular arrhythmias during exertion as well as device injury. The safety of athletic participation of ICD-patients is not completely defined and ICD efficacy in interrupting malignant arrhythmias during intense exercise is partly unknown. This explains difficulties in current recommendations made by physicians, given the associated potentially ischemic, autonomic and metabolic conditions. The scope of this review is to underline specific considerations including potential risks and recommendations for athletic participation in this patient-group. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Popping, char and perforation are complications that can occur following catheter ablation. We measured the amount of grams (g) applied to the endocardium during ablation using a sensor incorporated in the long sheath of a robotic system. We evaluated the relationship between lesion formation, pressure, and the development of complications. METHODS: Using a robotic navigation system, lesions were placed in the left atrium (LA) at six settings, using a constant duration (40 seconds) and flow rate of either 17 cc/min or 30 cc/min with an open irrigated catheter (OIC). Evidence of complications was noted and lesion location recorded for later analysis at necropsy. RESULTS: Lesions using 30 Watts (W) were more likely to be transmural at higher (>40 g) than lower (<30 g) pressures (75% vs 25%, P < 0.001). Significantly higher number of lesions using >40 g of pressure demonstrated 'popping' and crater formation as compared with lesions with 20-30 g of pressure (41% vs 15%, P = 0.008). A majority of lesions placed using higher power (45 W) with higher pressures (>40 g) were associated with char and crater formation (66.7%). No lesions using 10 g of pressure were transmural, regardless of the power. Lesions placed with a power setting less than 35 W were more likely to result in 'relative' sparing of the endocardial surface than lesions at a power setting higher than 35 W (62% vs 33.3%, P = 0.02) regardless of the pressure. CONCLUSIONS: When using an OIC, lower power settings (

A new high order FV method is presented for the solution of convection–diffusion equations, based on a 4-point approximation of the diffusive term and on the definition of a quadratic profile for the approximation of the convective term, in which coefficients are obtained by imposing conditions on the truncation error. The method works on unequal volumes (ratios of consecutive volume sizes in the interval [1/3,3]). The properties of this method are analysed formally. Numerical examples are given. © 1997 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A self-adaptive method for the solution of elliptic and parabolic problems defined over 3D general multiconnected regions by generalized finite-difference formulae, with boundary approximation by means of polyhedra, is proposed. Different approaches to space refinements are studied and implemented. Numerical examples are given. [ABSTRACT FROM AUTHOR]

Corticobasal degeneration (CBD) is an uncommon, sporadic, neurodegenerative disorder of mid- to late-adult life. We describe a further example of the pathologic heterogeneity of this condition. A 71-year-old woman initially presented dysarthria, clumsiness, progressive asymmetric bradykinesia, and rigidity in left arm. Rigidity gradually involved ipsilateral leg; postural instability with falls, blepharospasm, and dysphagia subsequently developed. She has been previously diagnosed as unresponsive Parkinson's Disease. At our clinical examination, she presented left upper-arm-fixed-dystonia, spasticity in left lower limb and pyramidal signs (Babinski and Hoffmann). Brain MRI showed asymmetric cortical atrophy in the right frontotemporal cortex. Neuropsychological examination showed an impairment in visuospatial functioning, frontal-executive dysfunction, and hemineglect. This case demonstrates that association of asymmetrical focal cortical and subcortical features remains the clinical hallmark of this condition. There are no absolute markers for the clinical diagnosis that is complicated by the variability of presentation involving also cognitive symptoms that are reviewed in the paper. Despite the difficulty of diagnosing CBD, somatosensory evoked potentials, motor evoked potentials, long latency reflexes, and correlations between results on electroencephalography (EEG) and electromyography (EMG) provide further support for a CBD diagnosis. These techniques are also used to identify neurophysiological correlates of the neurological signs of the disease. [ABSTRACT FROM AUTHOR]

In this study the effects on the thermal field of a medium scale GSHP system located in Alessandria (Italy) and installed in highly heterogeneous alluvials are considered. The system was monitored over a year and data showed a progressive loss of efficiency. Simulation results obtained from a 3D numerical model show that the analyzed GSHP system has an inadequate design even for a short/medium period operation. A strong probe interference phenomenon was observed, due to the particular layout of the probe field and to the high energy request for building conditioning. The efficiency loss is also amplified by the presence of alluvial deposits with poor thermal properties. Adopting a homogeneous distribution of the thermal properties of the subsurface results in an underestimation of the thermal alteration of 25% while the increase of probe distance by 55% produces a reduction of thermal alteration of 45%. In this case study the homogeneous subsurface assumption leads to excessive simplification of the observed strong heterogeneity and it underrates thermal impact on the soil, especially in layers with poor thermal properties. [ABSTRACT FROM AUTHOR]

We examined 52 patients with idiopathic cardiomyopathy (IDCM) for coeliac disease. Three of them had coeliac disease, suggesting that prevalence of coeliac disease in IDCM patients is increased. [ABSTRACT FROM AUTHOR]

The inability to achieve durable pulmonary vein isolation (PVI) remains a major limitation to catheter ablation for the treatment of atrial fibrillation (AF), potentially resulting in AF recurrence. In this review, we discuss the research performed investigating methods to improve lesion permanence for the goal of durable PVI. Investigations evaluating procedural techniques, various catheters utilized, adjunctive pharmacologic therapy, and novel energy sources designed to improve ablation lesion permanence are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Context: Transcatheter ablation of atrial fibrillation (AF) has undergone important development, with acceptable midterm results in terms of the safety and recurrence. A meta-analysis was performed to identify the periprocedural complications, midterm success rates and predictors of recurrence after AF ablation. Methods and results: 4357 patients with paroxysmal AF, 1083 with persistent AF and 1777 with long standing AF were included. The pooled analysis showed that there was an in-hospital complication rate of tamponade requiring drainage of 0.99% (0.44–1.54; CI 99%), stroke with neurological persistent impairment of 0.22% (0.04–0.47; CI 99%), and stroke without of 0.36% (0.03–0.70; CI 99%) After a follow up of 22 (13–28) months and 1.23 (1.19–1.5; CI 99%) procedures per patient, the AF recurrence rate was 31.20% (24.87–34.81; CI 99%). The persistent AF patients exhibited a greater risk of recurrence after the first ablation (OR 1.78 [1.14, 2.77] CI 99%), but a trend towards non significance was present in the patients with more than one procedure (OR 1.69 [0.95, 3.00] CI 99%). The most powerful predictors of an AF ablation failure in the overall population were a recurrence within 30-days (OR 4.30; 2.00–10.80), valvular AF (OR 5.20; 2.22–9.50) and a left atrium diameter of more than 50mm (OR 5.10 2.00–12.90; all CI 95%). Conclusions: Persistent AF remains burdened from higher recurrence rates, however not so following redo-procedures. Three predictors, valvular AF, a left atrium diameter longer than 50mm and recurrence within 30days, could be appraised to drive selection of patients and therapeutic strategy. [Copyright &y& Elsevier]

More than 450 000 Americans die suddenly each year from sustained ventricular tachycardia or fibrillation. A correct identification of these patients is crucial for a rational clinical management, because the demonstrated effectiveness of implantable cardioverter-defibrillators (ICD) on the reduction of sudden cardiac death. Basing on the results of multiple clinical trials, left ventricular systolic function, measured as ejection fraction, is currently the only recommended tool to identify patients at higher risk of sudden death that would benefit from a prophylactic ICD. However, the systematic implementation of prophylactic ICD recommendations results in a substantial number of inappropriate ICD implantations, while failing to prevent the majority of sudden deaths occurring in the general population. That has been the case implementing arrhythmic risk stratification with a rough arrhythmic risk marker, such as ejection fraction, that lacks sensitivity and specificity in the prediction of sudden cardiac death. The aim of this viewpoint is to critically revise the value of ejection fraction in the identification of patients at risk of sudden cardiac death. [ABSTRACT FROM AUTHOR]

An abstract of the article "Influence of Body Mass Index and Metabolic-Inflammatory Variables on Prognosis of Outpatients With Chronic Heart Failure: Data From the Italian Network on Congestive Heart Failure (IN-CHF registry)," by R. Urso and colleagues, is presented.