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Catheter ablation of cardiac arrhythmias is usually performed through the femoral venous approach. Systemic venous return anomalies such as interruption of the inferior vena cava may represent a challenge during electrophysiological procedures. A 55-year-old patient with previous surgical correction of abnormal pulmonary venous return was admitted for poorly tolerated atrial flutter recurrences. He also had an interrupted inferior vena cava continuing as azygos vein and left superior vena cava draining via coronary sinus into the right atrium. Cavotricuspid isthmus radiofrequency ablation was successfully performed through the persistent left superior vena cava using a three-dimensional (3D) electroanatomical mapping system. Despite systemic venous abnormalities may potentially have important implications during electrophysiological procedures, arrhythmias can be successfully ablated with the aid of 3D electroanatomical mapping systems. < Learning objective: Congenital venous return anomalies can represent significant difficulties in accessing catheters to the cardiac chambers during electrophysiological procedures, which may be facilitated by three-dimensional mapping systems. Radiofrequency ablation of the cavotricuspid isthmus can be successfully performed using the femoral approach and introducing catheters into the right atrium sequentially through the femoral-iliac venous axis, the azygos vein, the persistent left superior vena cava, and the coronary sinus.> [ABSTRACT FROM AUTHOR]

• After the first procedure, 92.4% of the WPW patients were cured by ablation. • In half of recurred patients, accessory pathway (AP) recurrences were recorded within 36 h after ablation. • Parahisian and multiple APs were significant independent predictors of AP recurrences after the 1st procedure. Catheter ablation is the established treatment for patients with symptomatic Wolff–Parkinson–White syndrome (WPW). However, some patients undergo a challenging ablation or have recurrences during the early post-ablation phase. The aim of this study was to evaluate the clinical factors associated with an unsuccessful ablation outcome or repeated sessions. Four hundred seventy-five symptomatic consecutive WPW patients (38.2 ± 16.2 years old, 61% men, 69% with pre-excitation) who underwent an accessory pathway (AP) ablation from August 2005 to December 2015 were enrolled. When APs recurred, a redo ablation procedure was performed according to the patients' desire. Four hundred thirty-nine patients (92.4%) were cured by ablation, but it failed in 36 (7.6%) after the first procedure. Seventeen patients had AP recurrences during the acute phase within 36 h post-ablation. On the other hand, 4 were identified after more than one year. In a multivariate logistic regression analysis, multiple, parahisian, and broad APs were significant independent predictors of recurrences after the 1st procedure, with odds ratios of 14.88 (p < 0.001), 10.14 (p < 0.001), and 6.88 (p < 0.001), respectively. Finally, 468 patients (98.5%) received a successful ablation during a mean follow-up of 8.3 ± 3.0 years. However, after the final procedure no significant predictors were recognized. Out of 508 total procedures, three major (0.6%) complications occurred. Symptomatic WPW patients with multiple, parahisian, and broad APs had a significantly higher risk of recurrence. In half of the recurrence patients, AP recurrences were confirmed during the acute phase, but were rarely recorded in the very late phase. [ABSTRACT FROM AUTHOR]

Background: Left bundle branch block (LBBB) and left axis deviation (LAD) patients may have poor response to resynchronization therapy (CRT). We sought to assess if LBBB and LAD patients show a specific pattern of mechanical asynchrony.Methods: CRT candidates with non-ischemic cardiomyopathy and LBBB were categorized as having normal QRS axis (within -30° and +90°) or LAD (within -30° and -90°). Patients underwent tissue Doppler imaging (TDI) to measure time interval between onset of QRS complex and peak systolic velocity in ejection period (Q-peak) at basal segments of septal, inferior, lateral and anterior walls, as expression of local timing of mechanical activation.Results: Thirty patients (mean age 70.6years; 19 males) were included. Mean left ventricular ejection fraction was 0.28±0.06. Mean QRS duration was 172.5±13.9ms. Fifteen patients showed LBBB with LAD (QRS duration 173±14; EF 0.27±0.06). The other 15 patients had LBBB with a normal QRS axis (QRS duration 172±14; EF 0.29±0.05). Among patients with LAD, Q-peak interval was significantly longer at the anterior wall in comparison to each other walls (septal 201±46ms, inferior 242±58ms, lateral 267±45ms, anterior 302±50ms; p<0.0001). Conversely, in patients without LAD Q-peak interval was longer at lateral wall, when compared to each other (septal 228±65ms, inferior 250±64ms, lateral 328±98ms, anterior 291±86ms; p<0.0001).Conclusions: Patients with heart failure, presenting LBBB and LAD, show a specific pattern of ventricular asynchrony, with latest activation at anterior wall. This finding could affect target vessel selection during CRT procedures in these patients. [ABSTRACT FROM AUTHOR]

[Display omitted] • Ice-creams have been developed replacing milk cream with extra virgin olive oil (EVOO) • EVOO-ice-creams showed an increased intensity of sensory descriptor "grassy" • EVOO-ice-creams had less saturated and more mono- and poly-unsaturated fatty acids. • EVOO-ice-creams provided bioaccessible polyphenols and increased antioxidant activity. In this study, we explored the sensory and nutritional properties of innovative ice-creams designed totally replacing cow's milk cream with extra virgin olive oil (EVOO). Milk and chocolate flavored ice-creams containing 14.1% and 10.2% milk cream or 5.1% and 3.6% of EVOO were produced. In a triangle test, only the milk-flavored ice-cream with EVOO was distinguished from its traditional counterpart whereas in a quantitative descriptive sensory analysis EVOO ice-creams showed an increased intensity of the descriptor "grassy" that was supported by the greater concentrations of specific volatile organic compounds coming from EVOO, compared to traditional ice-creams. Moreover, EVOO ice-creams contained less saturated fatty acids and more mono- and poly- unsaturated fatty acids along an increased concentration of bioaccessible polyphenols and antioxidant activity measured after an in vitro digestion, which was more pronounced in milk-flavored sample. Data showed that EVOO can be a functional fat replacer in ice-cream recipes to produce healthier products. [ABSTRACT FROM AUTHOR]

Background: Cardiac resynchronization therapy (CRT) is ineffective in approximately 30% of recipients, in part due to sub-optimal left ventricular (LV) pacing location. The Quartet LV lead, with 2 additional electrodes proximal to conventional bipolar lead electrodes, enables 10 different pacing configurations at four independent LV locations. In a CRT patient cohort, we sought to evaluate the spectrum of echocardiographic and electrocardiographic response over these 10 configurations, to select the optimal one in each patient. Moreover, we sought to evaluate the 6-months clinical and echocardiographic response to a “tailored approach” in which the optimal LV pacing configuration for CRT was determined by echocardiographic measures, QRSd and pacing capture thresholds. Methods: Twenty-two consecutive CRT indicated patients were implanted with a quadripolar CRT system (St. Jude Medical). Optimal LV pacing configuration was determined by echocardiographic measures, including velocity time integral (VTI), myocardial performance index (MPI) and mitral regurgitation (MR), and an electrocardiographic measure (QRS duration) during pacing from each of the configurations at pre-discharge. The optimal LV pacing vector was chosen for every patient. Clinical and echocardiographic assessment was repeated after 6 months. Results: Various configurations provided different VTI, MPI, MR and QRSd values. Conventional bipolar vectors (ie, D1-M2, D1-RVc, M2-RVc) were rarely associated with the best echocardiographic improvements and provided significantly worse VTI, MR, MPI, and QRSd values than the best configuration for every patient (P = .005, P = .05 and P = .03 for VTI; P = .01, P = .005 and P = .001 for MPI; P = .003, P = .01 and P = .005 for MR, P > .5, P = .01 and P = .05 for QRSd) Conversely, “unconventional” proximal configurations (ie, making use of P4 and M3 electrodes) were generally characterized by higher acute VTI, MR and MPI improvements. CRT devices were reprogrammed with an “unconventional” LV pacing configuration in 50% of patients. A significant improvement in New York Heart Association class (81%), LV ejection fraction (76%), end-diastolic and end-systolic volumes was observed after 6 months (P = .02, P < .001, P = .02 and P = .003, respectively). Conclusions: In this study, conventional bipolar vectors of quadripolar-CRT were rarely associated with the best echocardiographic improvements. Quadripolar CRT utilizing optimal LV pacing configuration was associated with a significant improvement in New York Heart Association class and LV ejection fraction after 6 months. [Copyright &y& Elsevier]

Background: Inappropriate sinus tachycardia (IST) is characterized by an elevated heart rate (HR) at rest and an exaggerated HR response to physical activity or emotional stress. Beta-blockers and calcium channel blockers are the first-line therapy but sometimes are poorly tolerated due to side effects. Objective: The purpose of this study was to evaluate the efficacy and safety of ivabradine, a selective inhibitor of the If current of the sinoatrial node, in patients affected by IST. Methods: Eighteen consecutive symptomatic patients (2 men and 16 women; mean age 45 ± 15 years) affected by IST were enrolled in the study. Every patient underwent resting ECG, 24-hour Holter ECG, and exercise ECG at baseline and at 3-month and 6-month follow-up. Results: Sixteen patients (14 women; mean age 41 ± 14 years) completed the study. Holter ECG assessment showed a significant reduction of medium HR (P <.001) and maximal HR (P <.001, basal vs 3–6 months; P = .02, 3 vs 6 months). Minimal HR slightly decreased at 3 months and then stabilized (P = .49, 3 vs 6 months) despite an increased drug dose. Stress test showed a significant decrease at rest (P <.001) and maximal HR (P <.05), suggesting an increased tolerance to physical stress, which was confirmed by a progressive increase of maximal load reached (>100 W) during stress test at 3 months (75%) and 6 months (85%). One patient was excluded because of phosphenes despite dose lowering, and another patient did not complete the protocol. Conclusion: Ivabradine could represent an effective and safe alternative to calcium channel blockers and beta-blockers for treatment of IST. [ABSTRACT FROM AUTHOR]

• N -acylphosphatidylethanolamines and N -acylethanolamines are abundant in plant-foods. • Endocannabinoids are almost exclusively present in animal products. • Acylethanolamine intake is higher in Mediterranean and vegetarian than Western diet. • Endocannabinoid intake is higher in Western and Mediterranean than vegetarian diet. The contents of N -acylphosphatidylethanolamines (NAPEs), N -acylethanolamines (NAEs) and endocannabinoids (ECs) in 43 food products were assessed and daily intakes, based on consumption of Mediterranean, vegetarian and Western diets, were simulated. NAPEs and NAEs were more abundant in plant-based foods than in animal food products; NAPEs were in the ranges 0–4032 vs 4–398 µg/g dw and NAEs were in the ranges 0–35 vs 0.1–0.7 µg/g dw, respectively while ECs were in the range 0–0.1 vs 0–34 µg/g dw. Daily intakes of NAPEs and NAEs were higher from Mediterranean (263 and 0.25 mg/day) and vegetarian (242 and 0.28 mg/day) diets than the Western diet (163 and 0.08 mg/day). Conversely, ECs intakes were higher from Western and Mediterranean diets (0.17 mg/day) than the vegetarian diet (0.01 mg/day). Future studies will evaluate the physiological role of dietary NAPEs, NAEs and ECs in humans. [ABSTRACT FROM AUTHOR]

The butyric acid content produced by three Lactobacillus plantarum (Lactiplantibacillus plantarum) strains (FP37, FP38 and FP48) deposited as probiotic strains was determined. The experimentation was carried out to evaluate whether the production of butyric acid was due to lipolytic activity for the presence of specific lipases or was related to the fermentation of saccharides. Therefore, the three strains were inoculated in different substrates with and without the addition of fat (tributyrin). The free butyric acid contents were determined by gas chromatography after distilling each culture medium. The results showed that butyric acid production occurred mainly in the substrates supplemented with fat and therefore it was linked to the activity of specific L. plantarum lipase. The L. plantarum FP48 strain produced the highest amount of butyric acid in fat substrates and could be a useful strain in the development of dairy products with functional properties. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to evaluate the impact of the amount and type of food dietary fiber on salivary concentrations of N -acylethanolamines (NAEs) and glucose upon food mastication and in the post-prandial phase. Three types of biscuits enriched with 3% barley β-glucan (βGB) or whole-wheat bran (WWBB) or without dietary fiber (control, CB) were developed. A crossover randomized human study was carried out by collecting saliva samples from eighteen healthy and fasting participants in a resting condition, upon mastication of parafilm and one of the three biscuits. Subsequently, the amount of biscuits consumed in an ad-libitum breakfast was measured and post-prandial saliva samples, blood glucose, appetite, and food liking were collected over the following 2 h. Salivary concentration of oleoylethanolamide (OEA) and linoleoylethanolamide (LEA) significantly increased during all biscuits mastication compared to food-free conditions, with OEA increasing more (~ 138 folds) than LEA (~ 7 folds). Subjects consumed always 75 g of biscuits at breakfast. Salivary OEA peaked at 15 min and returned to baseline concentration at 60 min after consumption of all types of biscuits whereas LEA peaked only after WWBB. Fifteen minutes after βGB consumption all NAE levels were significantly lower than those after WWBB. No difference of biscuit type on post prandial blood glucose was recorded. Results demonstrated that NAEs were released in saliva during biscuit mastication, independently from dietary fiber composition. The type of dietary fiber could influence the persistence of NAEs in saliva over 30 min after consumption. Future studies will clarify the mechanisms behind these findings and the role of salivary NAEs in food liking and appetite cues after food consumption. [ABSTRACT FROM AUTHOR]

Pyroglutamic acid (pGlu) influences the aromatic and sensory properties of foods and has several benefits for human health. The presence and kinetics of pGlu formation in fermented milk samples were investigated from a chemical point of view. Plain yoghurt, kefir and other probiotic fermented milk products available on the market were analysed to quantify lactic acid and pGlu. The pGlu concentrations in fermented milks ranged from 51.65 to 277.37 mg 100 g−1 dry matter. Laboratory-scale fermented milk was produced, and samples were taken at different times of fermentation and storage to construct the kinetics curve. At the beginning of the fermentation process, pGlu was already present in UHT milk (188.69 mg 100 g−1 dry matter) used to elaborate fermented milk, and its content increased not only during fermentation but during storage as well, reaching up to 403.56 mg 100 g−1 dry matter after 30 days. [ABSTRACT FROM AUTHOR]

Abstract: Background: The prevalence of the Brugada-type ECG and its natural history are still unclear. The recently proposed diagnostic criteria have not been systematically applied in a European general population. Methods: We retrospectively analyzed ECGs and clinical data of 12,012 apparently healthy individuals who had undergone medical examination for occupational reasons. We sought follow-up information on the subjects with at least one ECG fulfilling the criteria for the Brugada pattern. Results: A Brugada-type ECG was found in 23 subjects (0.19%; 95% confidence interval 0.12–0.27%) on the first ECG recorded in that subject. In a further 8 cases, the Brugada pattern was present in a subsequent ECG, so that it was present at some time in 31 subjects (0.26%, 95% confidence interval 0.18–0.37%), all male. Only 2 patients displayed the classical type 1 Brugada ECG pattern. In 29 patients (94%), clinical information was available subsequent to the first Brugada pattern ECG recorded. The mean follow-up was 10.1±5.5 years. A sudden death occurred in a 27-year-old man with Brugada type 2 ECG pattern. No sudden death or symptomatic ventricular arrhythmia occurred among the other 28 patients. The annual rate of sudden death associated with Brugada ECG pattern was 0.3% per patient-year of follow-up. Conclusion: The Brugada-type ECG pattern, as currently defined, is uncommon in a young healthy male European population and confers a moderately elevated risk of sudden death. Our findings underscore the need to study risk predictors in asymptomatic patients with a Brugada-type ECG. [Copyright &y& Elsevier]