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Masouleh is one of the ancient cities located in a high mountainous area in Gilan province of northern Iran. The region is threatened by a hazardous landslide, which was last activated in 1998, causing 32 dead and 45 injured. Significant temporal decorrelation caused by dense vegetation coverage within the landslide area makes the use of Synthetic Aperture Radar Interferometry (InSAR) for monitoring landslide movement very challenging. In this paper, we investigate the capability of three InSAR time-series techniques for evaluating creep motion on Masouleh landslide. The techniques are Persistent Scatterer Interferometry (PSI), Small BAseline Subset (SBAS) and SqueeSAR. The analysis is done using a dataset of 33 TerraSAR-X images in SpotLight (SL) mode covering a period of 15 months between June 2015 and September 2016. Results show the distinguished capability of SqueeSAR method in comparison to 2 other techniques for assessing landslide movement. The final number of scatterers in the landslide body detected by PSI and SBAS are about 70 and 120 respectively while this increases to about 345 in SqueeSAR. The coherence of interferograms improved by about 37% for SqueeSAR as compared to SBAS. The same rate of displacement was observed in those regions where all the methods were able to detect scatterers. Maximum rates of displacement detected by SqueeSAR technique in the northern edge, older and younger part of the landslide body are about -39, -65 and -22 mm/y, respectively.

Glacier melt is an essential source of freshwater for the arid regions surrounding the Tian Shan. However, the knowledge about glacier volume and mass changes over the last decades is limited. In the present study, glacier area, glacier dynamics and mass changes are investigated for the period ~1975–2007 for Southern Inylchek Glacier (SIG) and Northern Inylchek Glacier (NIG), the largest glacier system in Central Tian Shan separated by the regularly draining Lake Merzbacher. The area of NIG increased by 2.0 ± 0.1 km2 (~1.3%) in the period ~1975–2007. In contrast, SIG has shrunk continuously in all investigated periods since ~1975. Velocities of SIG in the central part of the ablation region reached ~100–120 m a−1 in 2002/2003, which was slightly higher than the average velocity in 2010/2011. The central part of SIG flows mainly towards Lake Merzbacher rather than towards its terminus. The measured velocities at the distal part of the terminus downstream of Lake Merzbacher were below the uncertainty, indicating very low flow with even stagnant parts. Geodetic glacier mass balances have been calculated using multi-temporal digital elevation models from KH-9 Hexagon (representing the year 1975), SRTM3 (1999), ALOS PRISM (2006) and SPOT-5 high-resolution geometrical (HRG) data (2007). In general, a continuous mass loss for both SIG and NIG could be observed between ~1975 and 2007. SIG lost mass at a rate of 0.43 ± 0.10 m w.e. a−1 and NIG at a rate of 0.25 ± 0.10 m w.e. a−1 within the period ~1975–1999. For the period 1999–2007, the highest mass loss of 0.57 ± 0.46 m w.e. a−1 was found for NIG, whilst SIG showed a potential moderate mass loss of 0.28 ± 0.46 m w.e. a−1. Both glaciers showed a small retreat during this period. Between ~1975 and 1999, we identified a thickening at the front of NIG with a maximum surface elevation increase of about 150 m as a consequence of a surge event. In contrast significant thinning (>0.5 m a−1) and comparatively high velocities close to the dam of Lake Merzbacher were observed for SIG, indicating that Lake Merzbacher enhances glacier mass loss.

Objective: Atrial fibrillation or atrial flutter (AF) and heart failure (HF) often go hand in hand and, in combination, lead to an increased risk of death compared with patients with just one of both entities. Sex-specific differences in patients with AF and HF are under-reported. Therefore, the aim of this study was to investigate sex-specific catheter ablation (CA) use and acute in-hospital outcomes in patients with AF and concomitant HF in a retrospective cohort study., Methods: Using International Statistical Classification of Diseases and Related Health Problems and Operations and Procedures codes, administrative data of 75 hospitals from 2010 to 2018 were analysed to identify cases with AF and HF. Sex differences were compared for baseline characteristics, right and left atrial CA use, procedure-related adverse outcomes and in-hospital mortality., Results: Of 54 645 analysed cases with AF and HF, 46.2% were women. Women were significantly older (75.4±9.5 vs 68.7±11.1 years, p<0.001), had different comorbidities (more frequently: cerebrovascular disease (2.4% vs 1.8%, p<0.001), dementia (5.3% vs 2.2%, p<0.001), rheumatic disease (2.1% vs 0.8%, p<0.001), diabetes with chronic complications (9.7% vs 9.1%, p=0.033), hemiplegia or paraplegia (1.7% vs 1.2%, p<0.001) and chronic kidney disease (43.7% vs 33.5%, p<0.001); less frequently: myocardial infarction (5.4% vs 10.5%, p<0.001), peripheral vascular disease (6.9% vs 11.3%, p<0.001), mild liver disease (2.0% vs 2.3%, p=0.003) or any malignancy (1.0% vs 1.3%, p<0.001), underwent less often CA (12.0% vs 20.7%, p<0.001), had longer hospitalisations (6.6±5.8 vs 5.2±5.2 days, p<0.001) and higher in-hospital mortality (1.6% vs 0.9%, p<0.001). However, in the multivariable generalised linear mixed model for in-hospital mortality, sex did not remain an independent predictor (OR 0.96, 95% CI 0.82 to 1.12, p=0.579) when adjusted for age and comorbidities. Vascular access complications requiring interventions (4.8% vs 4.2%, p=0.001) and cardiac tamponade (0.3% vs 0.1%, p<0.001) occurred more frequently in women, whereas stroke (0.6% vs 0.5%, p=0.179) and death (0.3% vs 0.1%, p=0.101) showed no sex difference in patients undergoing CA., Conclusions: There are sex differences in patients with AF and HF with respect to demographics, resource utilisation and in-hospital outcomes. This needs to be considered when treating women with AF and HF, especially for a sufficient patient informed decision making in clinical practice., Competing Interests: Competing interests: GH is receiving grants through the Leipzig Heart Institute from Boston Scientific (Boston Scientific Corporation, Marlborough, Massachusetts, USA) and Abbott/St. Jude Medical (Abbott Laboratories, Chicago, Illinois, USA), no personal payments are to declare. JT is receiving personal fees from Medtronic (Medtronic plc, Minneapolis, Minnesota, USA). The other authors state that there is no conflict of interest., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The role of atrial arrhythmia inducibility as an endpoint of catheter ablation of atrial fibrillation (AF) has been a controversial subject in many studies. Our goal is to evaluate the significance of inducibility, the impact of multiple sites or protocols of stimulation or the change in inducibility status in a prospective study including patients with AF undergoing first catheter ablation., Methods: We studied 170 consecutive patients with AF (62.9% paroxysmal) undergoing catheter ablation. All patients underwent two separate stimulation protocols before and after the ablation from the coronary sinus ostium and the left atrial appendage: burst pacing at 300, 250, 200 milliseconds (or until refractoriness) for 10 seconds and ramp decrementing from 300 to 200 milliseconds in increments of 10 milliseconds every three beats for 10 seconds. Inducibility was defined as any sustained AF or organized atrial tachycardia (AT) lasting >30 seconds., Results: We had AF/AT inducibility in 55 patients at baseline compared to 36 following ablation. After a mean of 41, 3 months follow-up, 115 patients were free of AF. Inducibility before or after the ablation or change in inducibility status did not influence AF recurrence. There were no significant differences regarding paroxysmal or persistent patients with AF., Conclusions: Non-inducibility of atrial arrhythmia or change in inducibility status following pulmonary vein (PV) isolation and substrate modification are not associated with long-term freedom from recurrent arrhythmia. Therefore, the use of induction of an endpoint in AF ablation is limited., (© 2020 Wiley Periodicals, Inc.)

Aims: Catheter ablation is an established therapy in patients with symptomatic atrial fibrillation (AF) with increasing popularity. Pericardial effusion requiring intervention (PE) is one of the most threatening adverse outcomes. The aim of this study was to examine rates of PE after catheter ablation in a large 'real-world' data set in a German-wide hospital network., Methods and Results: Using ICD and OPS codes, administrative data of 85 Helios hospitals from 2010 to 2017 was used to identify AF catheter ablation cases [Helios atrial fibrillation ablation registry (SAFER)]. PE occurred in 0.9% of 21 141 catheter ablation procedures. Patients with PE were significantly older, to a higher percentage female, had more frequently hypertension, mild liver disease, diabetes with chronic complications, and renal disease. Low hospital volume (<50 procedures per year) and radiofrequency ablation (vs. cryoablation) were significantly associated with PE. Using two logistic regression models, age, female gender, hypertension, mild liver disease, diabetes with chronic complications, renal disease, low hospital volume, and radiofrequency ablation remained independent predictors for PE., Conclusion: Overall PE rate was 0.9%. Predictors for PE occurrence involved factors ascribed to the patient (age, gender, comorbidities), the type of catheter ablation (radiofrequency), and the institution (low-volume centres).

Aims: Atrial fibrillation (AFib) and atrial flutter (AFlut) are common arrhythmias with increased use of invasive procedures. A steady re-evaluation of relevant safety endpoints is recommended and both quality management and pay-for-performance programs are evolving. Therefore, the aims of this study were (i) to investigate and report overall in-hospital mortality and mortality of invasive arrhythmia-related procedures and (ii) to identify mortality predictors in a German-wide hospital network., Methods and Results: Administrative data provided by 78 Helios hospitals between 2010 and 2017 were examined using International Statistical Classification of Diseases and Related Health Problems- and Operations and Procedures-codes to identify patients with AFib or AFlut as main discharge diagnosis or secondary diagnosis combined with invasive arrhythmia-related interventions. In 161 502 patients, in-hospital mortality was 0.6% with a significant decrease from 0.75% to 0.5% (P < 0.01) during the observational period. In multivariable analysis, age [odds ratio (OR) 2.69, 95% confidence interval (CI) 2.36-3.05; P < 0.01], high centre volume (OR 0.57, 95% CI 0.50-0.65; P < 0.01), emergency hospital admission (OR 1.57, 95% CI 1.38-1.79; P < 0.01), and Charlson Comorbidity Index (CCI, OR 4.95, 95% CI 4.50-5.44; P < 0.01) were found as independent predictors of in-hospital mortality. Mortality rates were 0.05% for left atrial catheter ablation (CA, n = 21 744), 0.3% for right atrial CA (n = 9972), and 0.56% for implantation of a left atrial appendage occluder (n = 2309), respectively., Conclusion: We analysed for the first time in-hospital mortality rates of patients with atrial arrhythmias in a German-wide, multi-centre administrative dataset. This allows feasible, comparable, and up-to-date performance measurement of clinically important endpoints in a real-world setting which may contribute to quality management programs and towards value-based healthcare.

Aims: A discordant left ventricular (LV) lead position can be responsible for cardiac resynchronization therapy (CRT) non-response. In this study, tailored optimization of the individual LV wall motion was evaluated for the outcome in these patients., Methods and Results: Two hundred and forty-six CRT outpatients were screened for non-response due to a discordant LV lead. In 17 patients, three-dimensional data of fluoroscopic rotation scan and echocardiography were integrated to analyse the individual LV wall motion with respect to the LV lead position. Optimization was guided by the systolic dyssynchrony index (SDI) and LV ejection fraction (LVEF) during different interventricular (VV)-delay programming. If re-programming failed, implantation of a second LV lead was performed. A discordant or partly concordant LV lead position was found in nearly all patients (16/17, 94%), which contributed to an unchanged baseline amount of LV dyssynchrony with either CRT on or off (SDI 11.3 vs. 11.0%; P = 0.744). In the majority of patients, VV-delay re-programming achieved better resynchronization, 4/17 patients needed implantation of a second LV lead. After 3 months, significant improvement of NYHA functional class (1 class; P = 0.004), peak oxygen consumption (10 vs. 13 mL/min/kg; P = 0.008), LVEF (27 vs. 39%; P = 0.003), and SDI (11.0 vs. 5.8; P = 0.02) was observed. Clinical and echocardiographic responses were found in 77 and 59%, respectively, with even good results on long-term follow-up., Conclusion: Tailored optimization of the individual LV wall motion can lead to significant clinical and echocardiographic improvements in previous CRT non-responders with a discordant LV lead position., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)