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Pulsed field ablation (PFA) is a non-thermal ablative modality using a strong electrical field created around a dedicated catheter to produce pores in the cellular membrane. As the amount of energy required to produce electroporation is highly tissue dependent, the atrial myocardium can be specifically targeted while sparing adjacent tissues. This new ablation modality could increase the safety of pulmonary vein isolation (PVI) procedures compared to PVI using thermal energies. Real-life clinical data are still limited. To assess safety and one-year efficacy of PVI performed using PFA. We included all patients who underwent PVI for symptomatic atrial fibrillation (AF) using PFA in our hospital between June 2021 and June 2022. A 12 Fr multi-electrode pentaspline PFA catheter was advanced into the left atrium. Two applications (2.5 sec and 2 kV per application) were performed in "basket" configuration, then the catheter was slightly rotated (30–40°) before delivery of 2 additional applications. This sequence of ablation was repeated in "flower" configuration. PVI was assessed with the PFA catheter. A 24-hour holter monitoring was performed at 4-month and one-year follow-up. The primary efficacy endpoint was freedom from atrial arrhythmia recurrence ≥ 30 seconds after a 3-month blanking period. The population consisted of 102 patients (72 paroxysmal AF, 30 persistent AF) with a mean age of 59 ± 13 yo (Table 1). The mean procedure duration was 39 ± 13 min, and mean fluoroscopy duration was 8 ± 3 min (4 ± 3 Gy.cm2). PVI was confirmed for all veins in all patients at the end of the procedures. Pericardial effusion occurred in 1 patient during the early phase of our experience (patient no 8). There was no other complication. After a mean follow-up of 13 ± 3 months, the one-year Kaplan-Meier estimate for freedom from atrial arrhythmia was 90% (95%CI 86–97%) (Figure 1). AF recurrence occured in 6/102 patients (6%) during the 3-month blanking period only. At last follow-up, 25/102 patients (25%) remained under anti-arrhythmic drugs and 64/102 (63%) remained under anticoagulant therapy. 6 patients underwent a redo procedure: pulmonary vein reconnection was observed in 5/6. PVI performed with PFA appeared safe and efficient with short procedure and acceptable fluoroscopy durations. Further data regarding long-term efficacy are now required. [ABSTRACT FROM AUTHOR]

Right ventricular pacing (RVP) induces ventricular asynchrony in patients with normal QRS and increases the risk of heart failure and atrial fibrillation in long-term. His bundle pacing (HBP) is a physiological alternative to RVP, and could overcome its drawbacks. Recent studies assessed the feasibility and safety of HBP in expert centers with a vast experience of this technique. These results may not apply to less experienced centers. We aim to evaluate the feasibility and safety of permanent HBP performed by physicians who are new to this technique. We included all patients who underwent pacemaker implantation with attempt of HBP in three hospitals between September 2017 and January 2020. Indication for HBP was left to operators' discretion. All the operators were new for HBP. His bundle (HB) electrical parameters were recorded at implant, 3- and 12-month follow-up. HBP was successful in 141 of 170 patients (82.9%); selective HBP was obtained in 96 patients and nonselective HBP in 45. The mean procedure and fluoroscopy durations were 67.0 ± 28.8 min, and 7.3 ± 8.1 min (3.1 ± 4.1 Gy·cm2), respectively. The mean HB paced QRS duration was 106 ± 18 ms. The mean HB capture threshold was 1.29 ± 0.77 V and did not increase at 3- and 12-month follow-up. The ventricular lead revision was required in five patients. Our results showed a rapid technical learning allowing a high procedure success rate (89.8%) after 15 procedures (Fig. 1). HBP performed by operators new to this technique appeared feasible and safe. This should encourage HBP to be performed in patients expected to experience high RVP burden. [ABSTRACT FROM AUTHOR]

While women account for 40-50 % of patients hospitalized for coronavirus disease 2019 (Covid-19), no specific data have been reported in this population. Assess the burden of cardiovascular comorbidities on outcomes in women hospitalized for Covid-19. We conducted a retrospective observational multicenter study from February 26 to April 20, 2020 in 24 French hospitals including all adults admitted for Covid-19. Primary composite outcome included transfer to intensive care unit (ICU) or in-hospital death. Among 2878 patients hospitalized for Covid-19, 1212 (42.1 %) were women. Women were significantly older (68.3 ± 18.0 vs. 65.4 ± 16.0 years, P < 0.001) but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8 %) experienced the primary outcome, including 161 (13.3 %) transfer to ICU and 115 (9.5 %) deaths without transfer to ICU. The survival free from death or transfer to ICU was higher in women (HR 0.63, 95 %CI 0.53-0.73, P < 0.001), whereas the observed difference in in-hospital deaths did not reach statistical significance (P = 0.18). The proportion of women that experienced the primary outcome were 37.8 % in women with heart failure (n = 112), 30.9 % in women with coronary artery disease (n = 81), 29.1 % in women with diabetes (n = 254), 26.1 % in women with dyslipidemia (n = 315), and 26.0 % in women with hypertension (n = 632). Age (HR 1.05, 5 years increments, 95 %CI 1.01-1.10), body mass index (HR 1.06, 2 units increments, 95 %CI 1.02-1.10), chronic kidney disease (HR 1.57, 95 %CI 1.11-2.22), and heart failure (HR 1.52, 95 %CI 1.04-2.22) were independently associated with the primary outcome (Fig. 1). Women hospitalized for Covid-19 were older and had less prevalent cardiovascular comorbidities than men. While female sex was associated with a lower risk of transfer to ICU or in-hospital death, Covid-19 remains associated with considerable morbi-mortality in women, especially in those with cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Abstract: The work presented here concerns the evaluation of the reactivity of the [Ti8O8(OOCCH2Bu t )16] cluster towards phenol, resorcinol and catechol using NMR techniques. Whereas the reactions conducted in the presence of phenol and resorcinol showed to be particularly slow, it appeared that catechol allowed the quantitative displacement of the carboxylato ligands. Upon addition of a large excess of catechol, a complete transformation of the [Ti8O8] core was noticed leading to final products formulated as Ti2(cat)4(L)2 (L=DMA, DMF). [Copyright &y& Elsevier]

Although cryoenergy safety profile is appropriate for the ablation of arrhythmogenic foci near the conduction system, mapping using the cryoablation catheter is of limited precision. Combining the safety of cryoenergy and the high precision of a 3D mapping system therefore appears the most appropriate set-up for ablation in the vicinity of the His bundle. A 29-year-old woman with a 3-year history of increasing shorteness of breath and palpitations refractory to medical treatment was sent to the EP laboratory for catheter ablation. Surface ECG showed sinus rhythm and frequent ectopic beats with narrow QRS complexes similar to those of the sinus beats. The left ventricular ejection fraction was impaired (38%) with no other etiology found, apart from frequent ectopies. Detailed intracardiac mapping, using a 3D electroanatomical system, revealed that the ectopy originated from the distal His bundle, which was indicated by both antegrade and reversed His bundle activation sequence during ectopy compared to that during sinus rhythm. Due to the proximity of the conduction system, cryoenergy rather than radiofrequency was chosen to target this Hisian ectopy. A special set-up was made in order to allow the cryoablation catheter to be visualized into the 3D mapping system. Cryoenergy delivered to the site of earliest Hisian ectopy activation completely abolished it (Fig. 1). Such a combined approach may help to improve therapeutic strategy for ablation procedures with a high-risk of injury to the conduction system. It could notably be extended to the ablation of para-Hisian ectopy or accessory pathways. [ABSTRACT FROM AUTHOR]

Either cryoenergy or radiofrequency can be used during atrioventricular nodal reentrant tachycardia (AVNRT) ablation. There is still limited data comparing their respective long-term efficacy (> 1 year). This study sought to compare the very long-term outcomes of AVNRT ablation using radiofrequency or cryotherapy. We retrospectively included all patients who had undergone a first AVNRT ablation in our institution between January 2010 and December 2017. The primary endpoint was recurrence of documented AVNRT. The study population consisted of 409 patients (274 females, mean age 49.9 year-old). Ablation was performed using cryoenergy in 260 patients and radiofrequency in 149. High acute procedural success rate (> 98%) was obtained and no permanent AV block was observed using both techniques. During a mean follow-up of 3.3 ± 2.3 years, documented AVNRT recurrence occurred in 24 (9.2%) and 4 patients (2.7%) in the cryoablation and radiofrequency group respectively. The risk of AVNRT recurrence was significantly higher in the CA group as compared to the RF group (hazard ratio = 3.7, 95% CI: 1.3 to 5.9). Most of the recurrences after cryoablation occurred between 1- and 6-year follow-up (14/24; 58.3%), with 1/3rd of late recurrences after 3-year follow-up. In multivariable analysis, only Koch's triangle anatomical variant was associated with AVNRT recurrence after cryoablation (hazard ratio = 6.7, 95% CI: 2.7–16.3) (Fig. 1). While AVNRT recurrence rates were similar at one year of follow-up regardless of the energy used, long-term efficacy appeared higher after radiofrequency ablation. Strikingly, recurrences occurred much later after cryotherapy compared to radiofrequency ablation. [ABSTRACT FROM AUTHOR]

Right ventricular pacing (RVP) induces ventricular asynchrony in patients with normal QRS and increases the risk of heart failure and atrial fibrillation on long-term. His bundle pacing (HBP) is a physiological alternative to RVP, and could overcome its drawbacks. Recent studies assessed feasibility and safety of HBP in expert centers with a vast experience of this technique. These results may not apply to less experienced centers. We aim to evaluate feasibility and safety of permanent HBP performed by physicians who are new to this technique. We included all patients who underwent pacemaker implantation with attempt of HBP in 3 hospitals between September 2017 and January 2020. Indication for HBP was left to operators' discretion. All the operators were new for HBP. His Bundle (HB) electrical parameters were recorded at implant, 3- and 12-month follow-up. HBP was successful in 141 of 170 patients (82.9%); selective HBP was obtained in 96 patients and nonselective HBP in 45. The mean procedure and fluoroscopy durations were 67.0 ± 28.8 min, and 7.3 ± 8.1 min (3.1 ± 4.1 Gy.cm2), respectively. The mean HB paced QRS duration was 106 ± 18 ms. The mean HB capture threshold was 1.29 ± 0.77 V and did not increase at 3- and 12-month follow-up. Ventricular lead revision was required in 5 patients. Our results showed a rapid technical learning allowing a high procedure success rate (89.8%) after 15 procedures (Fig. 1). HBP performed by operators new to this technique appeared feasible and safe. This should encourage HBP to be performed in patients expected to experience high RVP burden. [ABSTRACT FROM AUTHOR]

Ventricular rate control is essential in the management of atrial fibrillation. Atrioventricular node ablation (AVNA) and ventricular pacing can be an effective option when pharmacological rate control is insufficient. However, right ventricular pacing (RVP) induces ventricular desynchronization and increases the risk of heart failure on long term. His bundle pacing (HBP) is a physiological alternative to RVP. Observational studies have demonstrated the feasibility of HBP but there is still very limited data about the feasibility of AVNA after HBP. To evaluate feasibility and safety of HBP followed by AVNA in patients with non-controlled atrial arrhythmia. We included all patients who underwent AVNA for non-controlled atrial arrhythmia after HBP implantation in three hospitals. No back-up right ventricular lead was implanted. AVNA procedures were performed with 8 mm-tip ablation catheter. Acute HBP threshold increase was defined as a threshold elevation > 1 V. HBP thresholds were recorded at 3 months follow-up. AVNA after HBP lead implantation was performed in 36 patients. AVNA was successful in 27 of 36 patients (75%). Modulation of the AV node conduction was obtained in 5. The mean procedure duration was 50 ± 11 min, and fluoroscopy duration was 8 ± 3 min. A mean number of 7.8 ± 3.2 RF applications (430 ± 185 sec) were necessary to obtain an AV block. Acute HBP threshold increase occurred in 7 patients (19.4%) with return to baseline value at day 1 in 5. Mean HBP threshold at implant was 1.39 ± 0.25 V and did not increase at 3 months follow-up (1.29 ± 0.25 V). AV node re-conduction was observed in 5 patients (18.5%) with a second successful ablation procedure in 4. The baseline native QRS duration was 105 ± 8ms and the paced QRS duration was 109 ± 6ms (Fig. 1). AVNA combined with HBP for non-controlled atrial arrhythmia is feasible and does not compromise HBP but seems technically difficult with significant AV nodal re-conduction rate. [ABSTRACT FROM AUTHOR]

Right ventricular pacing (RVP) induces ventricular asynchrony in patients with normal QRS and increases the risk of heart failure and atrial fibrillation on long-term. His bundle pacing (HBP) is a physiological alternative to RVP. Interest in HBP has been hampered in part by technical challenges and limited implantation tool set. Recent studies showed that it was feasible and safe in expert centers with a vast experience of HBP. These results may not apply to less experienced centers. To evaluate feasibility and safety of permanent His bundle pacing in hospitals with limited technical training to this technique and to evaluate stability of His bundle capture (HBC) thresholds. We included all patients who underwent pacemaker implantation with attempt of HBP in 3 hospitals between September 2017 and January 2019. All the 5 operators were novice for HBP. HBC thresholds were recorded at 3 months and 9 months follow-up. HPB was successful in 62 of 69 patients (89.9%); selective HBC was obtained in 48 patients while nonselective HBC occurred in 14 patients. Indication for pacemaker implantation was atrioventricular conduction disease in 39 patients, sinus node dysfunction in 6 patients and AV nodal ablation for non-controlled atrial arrhythmias in 24 patients. The mean procedure duration was 75 ± 8 min, and mean fluoroscopy duration was 10 ± 2 min The mean HBC threshold was 1.39 ± 0.26 V and did not increase at 3 months follow-up (1.08 ± 0.25 V, n = 48 patients) and 9 months follow-up (1.37 ± 0.31 V, n = 14 patients). Only 7 patients had HBC threshold > 2.5 V/0.5ms. There was no pericardial effusion, no pneumothorax and no device infection. Ventricular lead revision was required at 3 months in one patient for sudden threshold increase, without obvious dislodgement (Fig. 1). His bundle pacing performed by novice operators to this technique appeared feasible and safe. The mean HBC threshold did not increase at 3 months and 9 months follow-up. [ABSTRACT FROM AUTHOR]

Introduction Right ventricular pacing (RVP) induces ventricular desynchronization in patients with normal QRS and increases the risk of heart failure and atrial fibrillation on long term. His bundle pacing (HBP) is a physiological alternative to RVP. Objective To evaluate feasibility and safety of permanent HBP and to evaluate stability of His capture thresholds at 3 months follow-up. Method We included all patients who underwent pacemaker implantation with attempt of His bundle pacing in Rouen University Hospital and GH Le Havre between September 2017 and September 2018. Selective His capture was defined as concordance of QRS and T waves complexes with the native ECG (patients with underlying bundle branch block may normalize), presence of a delay between spike and QRS complex, absence of widening of the QRS at a low pacing output, and recordable His bundle electrogram. At 3 months follow-up, His bundle capture thresholds, R-wave amplitudes and pacing impedances were recorded. Results His bundle capture (HBC) was successful in 35 of 40 patients (87.5%); selective HBC was obtained in 28 patients while nonselective HBC occurred in 7 patients. Indication for pacemaker implantation was atrioventricular conduction disease in 18 patients (45%), sinus node dysfunction in 4 patients (10%) and AV nodal ablation for non-controlled atrial arrhythmias in 18 patients (45%). AV nodal ablation was performed during the same procedure in 12 patients. Mean procedure duration was 74 ± 10 min, and mean fluoroscopy duration was 10.3 ± 7 min. Mean His bundle capture threshold was 1.37 ± 0.3 V and did not increase after a 3 months follow-up (1.02 ± 0.3 V). Only 2 patients had His capture threshold > 2 V/0.5ms. There was no pericardial effusion, no pneumothorax, no device infection and no ventricular lead revision required at 3 months (Fig. 1). Conclusion His bundle pacing was feasible and safe after a one-year experience. His bundle capture thresholds slightly decreased at 3 months follow-up. [ABSTRACT FROM AUTHOR]

The coronary sinus (CS) is surrounded by a myocardial coat with extensive connections to the left and right atria that contributes to the interatrial electrical connection. Whereas epicardial connections between CS musculature and the left atrium have largely been demonstrated, clinically relevant epicardial connections from the CS musculature toward the low right atrium (LRA) and epicardial connections between two regions of the right atrium remain questionable (Fig. 1). Five patients underwent electrophysiology (EP) study for typical atrial flutter (AFl) using either conventional multipolar catheters (four patients) or three-dimensional high-density mapping system (one patient). All five patients had a similar sequence of events during the EP studies. After several cavotricuspid isthmus (CTI) radiofrequency (RF) applications, double potentials were recorded along the ablation line while tachycardia persisted. The right atrial activation pattern strongly suggested the presence of a complete endocardial CTI line of the block. Based on the detailed conventional atrial mapping, RF applications at the middle cardiac vein/CS ostium allowed sinus rhythm restoration in four patients. High-density mapping showed an early breakthrough site at the septal side of the ablation line, close to the CS ostium during counterclockwise AFl, in the fifth patient. RF applications at this site resulted in tachycardia termination. Our observations suggested the existence of epicardial fibers connecting the LRA with either the CS musculature or a remote right atrial region. When AFl ablation fails whereas evidence for the local endocardial block is observed, the operators should integrate this finding in the diagnosis and ablation strategy. [ABSTRACT FROM AUTHOR]

Right ventricular pacing (RVP) induces ventricular asynchrony in patients with normal QRS and increases the risk of heart failure and atrial fibrillation on long term. His bundle pacing (HBP) is a physiological alternative to RVP. Observational studies have demonstrated the feasibility of this technique. However, it is associated with longer procedure time and higher fluoroscopy exposure compared to standard pacemaker implantation. We evaluated the possibility to guide the His Bundle (HB) lead placement using HB unipolar mapping only, in an attempt to reduce radiation exposure. From October 2019 to January 2020, all consecutive patients candidates for HBP in our institution underwent pacemaker implantation using mainly unipolar mapping of the His bundle for lead placement. The pacing lead was delivered through a fixed curve sheath. His bundle electrogram was mapped with the pacing lead and directly recorded on both EP recording system and Medtronic pacing analyser. Thirty-nine patients were implanted according to this new approach. Sixteen patients (41%) had a dual chamber pacemaker implantation. HBP was successful in all patients. Selective HBP was obtained in 25 patients (64%) while non-selective HBP occurred in 14 patients (36%). His Bundle signal was successfully detected with the pacing lead during all procedures. The overall procedure fluoroscopy duration, including the atrial lead implantation, was 48 ± 54 sec and the mean radiation exposure was 0.34 ± 0.57 Gy.cm2. The mean procedure duration was 48.4 ± 15.6 min. The mean His Bundle capture threshold at implant was 1.36 ± 0.71V@0.5ms. There was no pericardial effusion, no pneumothorax and no early lead dislodgment (Fig. 1). His Bundle lead placement mainly using HB unipolar mapping was feasible and effective and was associated with very limited radiation exposure without compromising procedure duration. [ABSTRACT FROM AUTHOR]

Right ventricular pacing (RVP) induces ventricular asynchrony in patients with normal QRS and increases the long term risk of heart failure and atrial fibrillation. His bundle pacing (HBP) is a physiological alternative to RVP. Interest in HBP has been hampered by technical challenges and limited implantation tool set. Recent studies assessed feasibility and safety of HBP in expert centres. These results may not apply to less experienced centres. To evaluate feasibility and safety of permanent His bundle pacing in hospitals with limited technical training to this technique and to evaluate stability of His Bundle capture (HBC) thresholds. We included all patients who underwent pacemaker implantation with attempt of HBP in 3 hospitals between September 2017 and December 2019. All the 6 operators were novice for HBP. HPB was successful in 134 of 154 patients (87.0%); selective HBP was obtained in 93 patients while non-selective HBP occurred in 41 patients. Indication for pacemaker implantation was AV conduction disease in 74 patients (48%), sinus node dysfunction in 30 patients (19.5%) and AV nodal ablation for non-controlled atrial arrhythmias in 50 (32.5%). The mean procedure duration was 68.2 ± 30.2 min, and the mean fluoroscopy duration was 7.5 ± 8.5 min (3.06 ± 1.01 Gy.cm2). The mean HBC threshold was 1.28 ± 0.84V@0.5ms and did not increase at 3 months (1.26 ± 0.88V@0.5ms) and 12 months (1.25 ± 0.79V@0.5ms) follow-up. Ventricular lead revision was required at 3 months in two patients for sudden threshold increase without obvious lead dislodgement and at one month in one patient for lead dislodgement. There was no pericardial effusion, no pneumothorax and no device infection (Fig. 1). His Bundle pacing performed by novice operators to this technique appeared feasible and safe. The mean HBC threshold did not increase at 3 months and one-year follow-up. [ABSTRACT FROM AUTHOR]

Ventricular rate control is essential in the management of atrial fibrillation. Atrioventricular node ablation (AVNA) and ventricular pacing can be an effective option when pharmacological rate control is insufficient. However, right ventricular pacing induces ventricular desynchronisation in patients with normal QRS and increases the risk of heart failure on long-term. His bundle pacing (HBP) is a physiological alternative. There is still very limited data about the feasibility of AVNA after HBP. To evaluate feasibility and safety of HBP followed by AVNA in patients with non-controlled atrial arrhythmia. We included all patients who underwent AVNA for non-controlled atrial arrhythmia after HBP implantation in 3 hospitals. No back-up ventricular lead was implanted. AVNA procedures were performed with 8 mm-tip ablation catheters. AVNA after HBP lead implantation was performed in 50 patients. AVNA was successful in 36 of 50 patients (72%). Modulation of the AV node conduction was obtained in 8 patients (16%). The mean procedure duration was 44 ± 25 min, and mean fluoroscopy duration was 5.9 ± 7.7 min. A mean number of 6.6 ± 9.0 RF applications (315 ± 450 s) were delivered to obtain complete/incomplete AV block. Acute HB capture (HBC) threshold increase > 1 V occurred in 9 patients (18%) with return to baseline value at day 1 in 6. There was no lead dislodgment. Mean HBC threshold after AVNA was 1.25 ± 0.78V@0.5 ms. AV node re-conduction was observed in 6 patients (16.7%). No ventricular lead revision was required during the follow-up period. The baseline native QRS duration was 102 ± 21 ms and the paced QRS duration was 107 ± 18 ms (Fig. 1). AVNA combined with HBP for non-controlled atrial arrhythmia is feasible and does not compromise HBC but seems technically difficult with significant AV nodal re-conduction rate. The presence of a back-up ventricular lead could have changed our results and would require further evaluation. [ABSTRACT FROM AUTHOR]

Main features of COVID-19 patients have been reported in the literature. While young patients under 45 years old (y/o) account for a non-negligible part of hospitalized patients, data on this population remain sparse. To describe the characteristics and outcomes of hospitalized COVID-19 young patients (< 45 y/o). The Critical COVID France (CCF) study was an observational multicenter study including patients hospitalized for COVID-19. Primary composite outcome included transfer to ICU or in-hospital death. Secondary outcomes were cardiovascular complications diagnosed by the referring medical team according to available clinical, biological and radiological findings. Among 2,878 patients hospitalized for COVID-19 in 24 centers, 321 (11.2%) patients were under the age of 45 y/o. They had a higher body mass index (BMI) (28.9 ± 6.6 vs 27.7 ± 6.0, P = 0.004) but less other cardiovascular risk factors including hypertension (29 (9.2%) vs. 1422 (56.1%), P < 0.001), diabetes (20 (6.3%) vs. 656 (25.9%), P < 0.001) and dyslipidemia (15 (4.7%) vs. 783 (30.7%), P < 0.001). The primary outcome occurred in 54 (16.8%) patients under 45 y/o vs. 783 (30.7%) in patients aged > 45 y/o (P < 0.001), with a strong impact on the death rate (3 (0.9%) vs. 358 (14.0%), P < 0.001). The group under 45 y/o experienced more frequently related COVID-19 cardiovascular complications such as pericarditis (12 (0.5%) vs. 7 (2.2%), P = 0.003) and myocarditis (14 (0.6%) vs 8 (2.5%), P = 0.002). Conversely, acute heart failure occurred more frequently in patients aged > 45 y/o (183 (7.2%) vs. 3 (0.9%), P < 0.001). Acute coronary syndrome and stroke were similar between the two groups (Fig. 1). In this nationwide multicenter observational study of hospitalized COVID-19 patients, patients under the age of 45 y/o had less cardiovascular risk factors but more specific related COVID-19 cardiovascular complications such as pericarditis and myocarditis. [ABSTRACT FROM AUTHOR]

His bundle pacing (HBP) is a physiological alternative to right ventricular pacing. Observational studies have demonstrated the feasibility of this technique. However, it is associated with longer procedure time and higher fluoroscopy exposure compared to standard pacemaker implantation. We evaluated the possibility to guide the His Bundle (HB) lead placement using HB unipolar mapping only, in an attempt to reduce radiation exposure. From October to November 2019, all consecutive patients candidates for HBP in our institution underwent pacemaker implantation using mainly unipolar mapping of the His bundle for lead placement. All procedures were performed by a single trained operator. His bundle electrogram was mapped with the pacing lead and directly recorded on both EP recording system and Medtronic pacing analyzer. Fourteen patients were implanted according to this new approach. Seven patients had a dual chamber pacemaker implantation. Indication for pacemaker implantation was sinus node dysfunction in 2 patients, AV nodal ablation for non-controlled atrial arrhythmias in 5 patients and atrioventricular conduction disease in 7 patients. HBP was successful in all patients. His Bundle signal was detected with the SelectSecure pacing lead during all procedures. Selective HBP was obtained in 9 patients (64%) while non selective HBP occurred in 5 patients. The mean procedure duration was 44 ± 8 min. The overall procedure fluoroscopy duration, including the atrial lead implantation, was 30 ± 13 sec. The mean radiation exposure was 0.22 ± 0.12 Gy.cm2. The baseline QRS duration was 102 ± 16ms and the paced QRS duration was 103 ± 14ms. The mean HBP threshold at implant was 1.31 ± 0.4 V. There was no pericardial effusion and no pneumothorax. His Bundle lead placement mainly using HB unipolar mapping was feasible and effective and was associated with very limited radiation exposure without compromising procedure duration. [ABSTRACT FROM AUTHOR]

Abstract: In agricultural landscapes, pesticides can be transported by surface or tile-drained waters to aquatic ecosystems. In such situations, artificial wetlands can be placed to receive tile drainage discharge, and be effective pesticide pollution remediation tools. Artificial wetland implementation and design largely depend on land availability and suitability, which is particularly critical in Europe where land is scarce. Wetlands can be configured to either divert and treat a portion of stream discharge (i.e., parallel configuration), or placed to capture all stream discharge (i.e., series configuration) generated by a catchment. A field experiment was conducted at the outlets of two subsurface drained catchments in France to compare the pesticide retention efficiency of these two types of artificial wetlands. The two agricultural catchments were cultivated for similar crops (winter wheat, barley, rapeseed, and sugar beet) on poorly drained tile-drained soils. The Aulnoy artificial wetland was situated in-stream, at the outlet of a 36-ha watershed. It included a deep wetland with a 9000-m3 water storage capacity. Its volume and surface area to watershed area ratios were 300m3 per upstream drained hectare (equivalent to 30mm runoff storage capacity) and 1.2%, respectively. The Bray wetland was constructed off-stream, in parallel to the main agricultural ditch and associated with an open/close strategy managed by the farmer according to his pesticide applications. This artificial wetland consisted of three vegetated cells in a series with shallow water for a total volume of 330m3 corresponding to 7m3 ha−1 (0.7mm runoff storage capacity) and 0.5% of a 46-ha catchment. Inlet and outlet discharges and pesticide concentrations were continuously monitored to characterize the seasonality of pesticide export and the removal efficiency of the artificial wetlands. Both artificial wetlands showed positive impacts on water quality (54 and 45% reduction for in- and off-stream configurations, respectively), attributable to distinct retention processes. Significant dilution occurred at Aulnoy where pesticide concentrations were frequently below detection levels, making it difficult to discern whether significant degradation or retention took place in the wetland. Conversely, the Bray shallow artificial wetland showed significant pesticide adsorption, desorption and degradation. However, these processes were limited in the Bray wetland due to insufficient retention time. The off-stream constructed wetland appears to be a promising technical solution for reducing land use impact. [Copyright &y& Elsevier]