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Drops testing along with evaluation instruments employed in severe mind wellbeing settings: a review of procedures in Wales and england.
This study evaluated if modifying electrocardiographic (ECG) precordial leads to a higher intercostal position improved the accuracy of outflow tract ventricular arrhythmia (OTVA) localization.

Precordial ECG prediction algorithms that use a standard lead configuration localize OTVA with variable accuracy.

Patients who underwent OTVA ablation were prospectively enrolled to have a standard and modified (high) precordial ECG. R- and S-wave amplitudes and intervals were measured to develop an algorithm that differentiated the right ventricular outflow tract (RVOT) and the left ventricular outflow tract (LVOT) with high accuracy-the modified lead R-wave deflection interval (RWDI). This interval was defined from the earliest QRS onset (using all modified leads) to the lead with longest R-wave deflection. The RWDI was compared with all other ECG algorithms.

A total of 50 patients (38 women; mean age 51 ± 17 years) had successful catheter ablation for OTVA (RVOT 60%, LVOT 40%). The modified lead RWDI was significantly shorter in the RVOT group (18.5ms, interquartile range 25th to 75th percentile [IQR
] 0 to 29.5ms) compared with the LVOT group (67.5ms, IQR
56.5 to 77ms; p<0.05). Using a RWDI≤40ms to predict an RVOT focus, the sensitivity and specificity of the modified lead RWDI were 100% and 95%, respectively; the area under the receiver-operating characteristic curve was 0.96. This was superior to all previously developed algorithms. In a computed tomography analysis (n=50), the modified leads were significantly closer to the outflow tracts compared with the standard precordial leads.

The modified lead RWDI is a simple, easily interpretable algorithm that can potentially differentiate a right- or left-sided origin of OTVA with high accuracy.
The modified lead RWDI is a simple, easily interpretable algorithm that can potentially differentiate a right- or left-sided origin of OTVA with high accuracy.
The aim of this study was to investigate the mechanism underlying QRS-slurring in a patient with the early repolarization pattern in the electrocardiogram (ECG) and ventricular fibrillation (VF) storms.

The early repolarization pattern refers to abnormal ending of the QRS complex in subjects with structurally normal hearts and has been associated with VF.

We studied a patient with slurring of the QRS complex in leads II, III, and aVF of the ECG and recurrent episodes of VF. Echocardiographic and imaging studies did not reveal any abnormalities. Endocardial mapping was normal but subxyphoidal epicardial access was not possible. Open chest epicardial mapping was performed.

Mapping showed that the inferior right ventricular free wall activated the latest with local J-waves in unipolar electrograms. The last moment of epicardial activation concurred with QRS-slurring in the ECG whereas the J-waves in the local unipolar electrograms occurred in the ST-segment of the ECG. Myocardial biopsies obtained from the late activated tissue showed severe fibrofatty alterations in the inferior right ventricular wall where fractionation and local J-waves were present. After ablation, the early repolarization pattern in the ECG disappeared and arrhythmias have been absent since (follow-up 18months).

In this patient, the electrocardiographic early repolarization pattern was caused by late activation dueto structurally abnormal myocardium. The late activated areas were marked by J-waves in local electrograms. Ablation of these regions prevented arrhythmia recurrence and normalized the ECG.
In this patient, the electrocardiographic early repolarization pattern was caused by late activation due to structurally abnormal myocardium. The late activated areas were marked by J-waves in local electrograms. Ablation of these regions prevented arrhythmia recurrence and normalized the ECG.
This study sought to address whether technological innovations such as contact force sensing (CFS) can improve acute and long-term ablation outcomes of left ventricular papillary muscle (LV PAP) ventricular arrhythmias (VAs).

Catheter ablation of LV PAP VAs has been less efficacious than another focal VAs. It remains unclear whether technological innovations such as CFS can improve acute and long-term ablation outcomes of LV PAP VA.

From January 2015 to December 2019, a total of 137 patients underwent LV PAP VA ablation. VA site of origin (SOO) was identified using activation and pace-mapping guided by intracardiac echocardiography. Radiofrequency energy (20 to 50W for 60 to 90 s) was delivered by irrigated catheter with or without CFS. We defined acute success as complete suppression of targeted VA≥30min post ablation and clinical success as ≥80% VA burden reduction at outpatient follow-up.

VA manifested as premature ventricular complexes in 98 (71%), nonsustained ventricular tachycardia in 18 (13%), sustained ventricular tachycardia in 12 (9%) and premature ventricular complexes induced ventricular fibrillation in 9 (7%). VA SOO was anterolateral PAP in 51 (37%), posteromedial PAP in 73 (53%), and both PAPs in 13 (10%). VAs were targeted using CFS in 97 (71%) and non-CFS in 40 (29%). After a single procedure, acute success was achieved in 130 (95%) and clinical success was achieved in 112 (82%); neither was impacted by VA SOO and/or CFS. Complications occurred in 5 patients (3.6%).

Independent of CFS technology, intracardiac echocardiography-guided catheter ablation is highly efficacious and may be considered as first-line therapy in the management of LV PAP VA.
Independent of CFS technology, intracardiac echocardiography-guided catheter ablation is highly efficacious and may be considered as first-line therapy in the management of LV PAP VA.
This study sought to prospectively study the development and then regression of premature ventricular contraction (PVC)-induced cardiomyopathy, with the hypothesis that structural left ventricular (LV) changes that are of potential clinical significance may endure beyond the period of exposure to PVCs.

Recovery of LV function after eradication of PVCs in PVC-induced cardiomyopathy is incompletely defined.

Fifteen swine were exposed to 1) 50% paced PVCs from the LV lateral epicardium for 12weeks (LV PVC, n=5); 2) no pacing for 12weeks (Control, n=5); or 3) 50% paced LV PVCs for 12weeks followed by pacing cessation for 4weeks (Recovery, n=5). LV function was quantified biweekly in sinus rhythm with echocardiography. Dyssynchrony was measured from pressure-volume loops at baseline and terminal studies. LV fibrosis was quantified after sacrifice.

LV ejection fraction during sinus rhythm fell between baseline and terminal studies in the LV PVC group (65.8 ± 3.0 to 39.3 ± 3.2; p<0.05), whereas there was malization of LV systolic function but significant changes in myocardial fibrosis and LV dyssynchrony during sinus rhythm persist.
This study aimed to assess the presence of echocardiographic and electrocardiographic similarities in patients with Brugada syndrome (BrS) and arrhythmogenic cardiomyopathy (AC) and the prevalence and prognostic value of AC structural/electrical features in patients with BrS.

BrS and AC are genetic cardiac diseases with high risk for sudden cardiac death. Although BrS and AC display different features, previous reports suggest a phenotypic overlap.

We acquired clinical data, electrocardiogram, and transthoracic echocardiography in patients with BrS and AC. We assessed the presence of AC diagnostic criteria according to the 2010 AC task force criteria for right ventricular outflow tract (RVOT), fractional area change, depolarization, and repolarization in the patients with BrS. We compared arrhythmic outcome in BrS patients with and without AC structural/electrical criteria.

A total of 116 BrS and 141 AC patients were included. AC electrical features were present in 28 (24%) BrS patients and structuralmogenic cardiomyopathy diagnostic criteria in BrS patients was associated with a trend towards higher arrhythmic risk. The right ventricular outflow tract dilation criterion improved detection of arrhythmic BrS patients.
This study sought to establish a mapping and ablation strategy to target intramural ventricular arrhythmias (VAs) by identifying the precise arrhythmia site of origin (SOO).

Radiofrequency ablation of intramural VAs is challenging because the arrhythmia origin is difficult to localize.

In 83 consecutive patients with intramural VAs, a stepwise mapping approach was performed ablation targeted directly the SOO when possible followed by the closest adjacent anatomical structure when necessary. If the SOO could not be identified, the earliest endocardial breakout sites were ablated. Safety and procedural outcomes between patients in whom the SOO could and could not be identified were compared.

The SOO was identified in 19 of 83 (23%) patients, and radiofrequency ablation was effective in eliminating VAs in all 19 (100%) patients by ablation at the SOO alone (n=3), at the SOO and an anatomically adjacent area (n=7), or at an anatomically adjacent area alone (n=9). Breakout site mapping and ablation in the remaining 64 patients in whom the SOO was not identified was effective in 43 of 64 patients, which was significantly less than in patients in whom the SOO was identified (67% vs. 100%; p<0.05).

Identification of the SOO was associated with a successful ablation procedure by either targeting the SOO directly or targeting an adjacent anatomical structure. Ablation at the breakout sites of intramural VAs has a lower efficacy than when the SOO can be directly targeted.
Identification of the SOO was associated with a successful ablation procedure by either targeting the SOO directly or targeting an adjacent anatomical structure. Ablation at the breakout sites of intramural VAs has a lower efficacy than when the SOO can be directly targeted.
Based on current evidence, the benefit of intraoperative nerve monitoring (IONM) in thyroid surgery is equivocal.

All patients who underwent planned thyroid surgery in the 2016-2018 ACS NSQIP procedure-targeted thyroidectomy dataset were included. Multivariable regression analyses were performed to examine the association between nerve monitoring and recurrent laryngeal nerve (RLN) injury while adjusting for patient demographics, extent of surgery, and perioperative variables.

In total, 17,610 patients met inclusion criteria 77.8% were female, and the median age was 52 years. IONM was used in 63.9% of cases. Of the entire cohort, 6.1% experienced RLN injury. Cases with IONM use had a lower rate of RLN injury compared to those that did not use IONM (5.7% vs. 6.8%, p=0.0001). After adjustment, IONM was associated with reduced risk of RLN injury (OR 0.69, 95% CI 0.59-0.82, p<0.0001).

Nationally, IONM is used in nearly two thirds of thyroid surgeries. IONM is associated with a lower risk of recurrent laryngeal nerve injury.
Nationally, IONM is used in nearly two thirds of thyroid surgeries. IONM is associated with a lower risk of recurrent laryngeal nerve injury.
This study aims to understand the perspectives of operative autonomy of surgical residents at various postgraduate levels.

Categorical general surgery residents at a single academic residency were invited to participate in focus groups to discuss their opinions and definitions of operative autonomy. Employing constructivist thematic analysis, focus groups were audio recorded, transcribed, and inductively analyzed using a constant comparative technique.

Twenty clinical surgical residents participated in 6 focus groups. Overarching themes identified include autonomy as a dynamic, progressive path to operative independence and the complex interaction of resident-as-teacher development and operative autonomy. Four within operative case themes were intrinsic factors, extrinsic factors, autonomy promoting or inhibiting behaviors, and the relationship between residents and attendings.

Residents define operative autonomy as a progressive and dynamic pathway to operative independence. Teacher development is viewed as both an extension beyond operative independence and potentially in conflict with their colleagues' development.
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