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IntroductionThe assessment of the ventricular myocardial substrate critically depends on the size of mapping electrodes, their orientation with respect to wavefront propagation, and interelectrode distance. We conducted a dual-center study to evaluate the impact of microelectrode mapping in patients undergoing catheter ablation (CA) of ventricular tachycardia (VT). MethodsWe included 21 consecutive patients (median age, 68 [12], 95% male) with structural heart disease undergoing CA for electrical storm (n = 14) or recurrent VT (n = 7) using the QDOT Micro catheter and a multipolar catheter (PentaRay, n = 9). The associations of peak-to-peak maximum standard bipolar (BVc) and minibipolar (PentaRay, BVp) with microbipolar (BV mu Max) voltages were respectively tested in sinus rhythm with mixed effect models. Furthermore, we compared the features of standard bipolar (BE) and microbipolar (mu BE) electrograms in sinus rhythm at sites of termination with radiofrequency energy. ResultsBV(mu Max) was moderately associated with both BVc (beta = .85, p < .01) and BVp (beta = .56, p < .01). BV mu Max was 0.98 (95% CI: 0.93-1.04, p < .01) mV larger than corresponding BVc, and 0.27 (95% CI: 0.16-0.37, p < .01) mV larger than matching BVp in sinus rhythm, with higher percentage differences in low voltage regions, leading to smaller endocardial dense scar (2.3 [2.7] vs. 12.1 [17] cm(2), p < .01) and border zone (3.2 [7.4] vs. 4.8 [20.1] cm(2), p = .03) regions in microbipolar maps compared to standard bipolar maps. Late potentials areas were nonsignificantly greater in microelectrode maps, compared to standard electrode maps. At sites of VT termination (n = 14), mu BE were of higher amplitude (0.9 [0.8] vs. 0.4 [0.2] mV, p < .01), longer duration (117 [66] vs. 74 [38] ms, p < .01), and with greater number of peaks (4 [2] vs. 2 [1], p < .01) in sinus rhythm compared to BE. Conclusionmicroelectrode mapping is more sensitive than standard bipolar mapping in the identification of viable myocytes in SR, and may facilitate recognition of targets for CA.

Background Provide a brief overview of recent technological advances that can potentially give information for treatment of different kind of arrhythmias. Methods In this report, we describe the features of Omnipolar technology (OT) using high density mapping catheter and we report five different scenario in which this new tool can give some important information to understand arrhythmia’s substrate and guide the treatment. OT combine three unipolar and two bipolar signals and provides maximum voltage regardless of electrode-wavefront orientation, local wavefront activation direction and local measurements of wave speed: it allow to create a velocity map. Results OT has been used to study different types of supraventricular tachycardias. Regarding reentry tachycardias, velocity map has allowed the characterization and definition of the impulse velocity along the dual nodal pathway and the accessory pathways (AP). As regards atrial flutter, it has successfully allowed the definition of the slowest zone of the critical isthmus and radiofrequency (RF) delivery at that point resulted in termination of the arrhythmia. During mapping of the left atrium in sinus rhythm, the velocity map allowed the identification of the course of the Bachmann’s bundle, which could potentially play a role during the ablation of persistent atrial fibrillation (AF). Conclusion OT and velocity map offer significant advantages in the management of challenging arrhythmias, and can potentially improve the efficacy of the treatment of some arrhythmias such as atrial flutter and AF.

The use of Central Venous Catheters (CVCs) represents an important step in the management of the surgical, onco-hematology and critically ill patients. CVCs in neonates, like in adult patients, are mainly used to infuse hyperosmolar solutions, to take blood samples and for hemodynamic monitoring. The need for CVCs is higher in neonates than in adults. Poor peripheral access and the high demand for IV access and blood samples are already valuable indications for a CVC.

Progress in medical and scientific research has increased the chances of survival for young patients with congenital diseases, children who, in the past, would not have had any chance of survival. Nowadays, congenital diseases can be treated with appropriate replacement therapies. These treatments can be difficult to administer in young patients because of the high frequency of administration (sometimes more than a dose per week), the use of intravenous infusion and the long-term or life-term requirement.