Ablation Targets Research Articles

PET-MRI Imaging to assess severity and distribution of atrial fibrosis in atrial fibrillation

Abstract Background Atrial fibrosis is a major determinant of atrial fibrillation (AF) susceptibility and ablation targeting fibrotic areas to suppress AF revealed by magnetic resonance imaging (MRI) was considered a promising approach to treat persistent AF; however, its outcome has been disappointing. We sought to develop a new imaging modality to detect the severity and distribution of atrial fibrosis. Methods This study enrolled 19 healthy volunteers and 85 patients with various cardiovascular (CV) diseases of whom 22 had persistent AF. Each patient underwent 18F-labeled aluminum fluoride targeting fibroblast activation protein inhibitor (18F-AlF-FAPI)-positron emission tomography - magnetic resonance imaging (PET-MRI). Left atrial appendage tissue biopsied at 18F-FAPI-uptake positive and negative sites was stained with Masson trichome to detect fibrosis (N=10). We compared cardiac atrial 18F-AlF-FAPI-PET-MRI imaging among healthy individuals, patients without AF and patients with persistent AF as well as patients developing and not developing postoperative AF (POAF). Results Degree of fibrosis based on Masson staining was consistent with 18F-FAPI-uptake (P<0.05). Whereas 18F-FAPI uptake was essentially undetectable in healthy volunteers, in patients with CV diseases, 18F-FAPI uptake was present in all atrial chambers. Patients with persistent AF had the greatest and most widespread uptake (P<0.001), including left atrium (P=0.001), right atrium (P<0.001), left atrial appendage (P=0.007), right atrial appendage (P<0.001), and left atrial posterior wall (P=0.004). 18F-FAPI-uptake did not differ between those with versus without POAF. Conclusions 18F-AlF-FAPI-PET-MRI imaging detected atrial fibrosis in patients with various CV diseases; patients with persistent AF exhibit severe and widespread fibrosis, while POAF is not associated with increased 18F-FAPI uptake.

Spatiotemporal stability of digital twin-guided atrial fibrillation dominant frequency sites and the clinical outcome of catheter ablation

Abstract Background Although the dominant frequency (DF) may localize the reentrant drivers of atrial fibrillation (AF), its meandering nature makes it difficult to localize as an extra-pulmonary vein (extra-PV) target. Purpose We explored and quantified the spatiotemporal stability of DF by sophisticated digital-twin maps and the association with the rhythm outcome of clinical AF catheter ablation (AFCA). Methods We retrospectively examined the DF sites in the digital twin integrated by high-density electroanatomical maps (EAM) of 170 patients previously included in the CUVIA-AF2 trial (male 70.6%, 59.2±11.3 years old, 100% persistent AF). We monitored 34 seconds of virtual AF and analyzed DF sites in 10 different left atrial (LA) regions at 3 consecutive periods (6 seconds each after 16sec induction and blanking periods). The spatiotemporal stability index (STSI) was calculated to quantify mean DF's spatial and temporal variability. During protocol-based rhythm follow-up, we assessed the atrial arrhythmia recurrence rate by dividing patients into two groups based on STSI 0.75. Results During the simulation, 108 out of 170 (63.5%) patients obtained mean DF values in all three consecutive periods. There were 26 (24.1%) patients in the stable DF group (STSI ≥0.75, Stable group) and 82 (75.9%) patients in the unstable DF group (STSI <0.75, Unstable group). Although the proportion of patients with hypertension (73.1 vs. 47.6%, p=0.041) was higher and left ventricular end-diastole diameter (51.3±3.9 vs. 49.0±4.4 mm, p=0.020) was larger in the stable DF group than in the unstable DF group, other parameters, including LA size, LA voltage, or AF ablation targets, did not differ between two groups. During the median 19 [15-22] months follow-up, the atrial arrhythmia recurrence rate of the Stable group is higher than that of the Unstable group (log-rank p=0.031, HR = 2.06, CI [1.06-4.01]) Conclusions We found that the temporally stable DF in EAM-integrated virtual AF, the potential extra-PV AF drivers, is a surrogate marker of the adverse rhythm outcome of AFCA. A prospective clinical trial targeting the spatiotemporally stable DF will be warranted.

Improving functional substrate delineation for ablation of ventricular tachycardia using high-density electroanatomic mapping and double ventricular extra stimuli protocol

Abstract Background A partial delineation of targets for ventricular tachycardia (VT) ablation may contribute to a suboptimal success rate. Abnormal electrograms (EGMs) with low-voltage near-field components might be concealed within high-amplitude far-field signals. Our hypothesis posited that acquiring functional mapping after double ventricular extrastimuli (S3 protocol) could reveal relevant areas of functional substrate overlooked during sinus or S1 mapping. Purpose To assess the benefit and feasibility of functional substrate mapping using a full ventricle S3 protocol and to evaluate its colocalization with conducting channels (CCs) identified in late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Methods (Figure 1) - An S3 mapping protocol with a drive train of S1 followed by S2 (effective refractory period (ERP) +30ms) and S3 (ERP+50ms) from the RV apex was conducted in 40 consecutive patients undergoing scar-related VT ablation. Deceleration zones (DZs) and areas of late potentials (LPs) were identified for all maps (S1, S2, and S3). Pre-procedural non-invasive substrate assessment was performed with LGE-CMR and post-processing using a commercially available system with automated CC identification. Results The S3 protocol was completed in 34 of the 40 procedures (85.0%). Repeated induction of ventricular arrhythmias prevented the full S3 protocol in 5 patients (15.0%). Functional substrate identified during S3 activation mapping was significantly more extensive than that identified using S2 and S1, including a higher number of DZs (2.94, 2.47, and 1.82, respectively; p<0.01) and a wider area of LPs (44.1cm2, 38.2cm2, and 29.4cm2, respectively; p<0.001). The percentage of CCs unmasked by DZs and LPs using S3 maps was significantly higher than the ones using S2 and S1 maps(78%, 65%, and 48%; p<0.001, and 88%, 81%, and 68%; p<0.01, repectively). After VT ablation based on an S3 protocol, 77.9% of patients have been VT free during a median follow-up of 13.6 months. Conclusions (Graphical abstract -Figure 2) - This novel substrate-based protocol for assessing functional substrate is feasible in most patients, enables better identification of ablation targets, and has the potential to improve patient prognosis post-ablation.Methods - The S3 protocolConclusion - Graphical abstract

SIMULATION AND EX VIVO EXPERIMENTAL STUDY OF MICROWAVE ABLATION OF ADRENAL ADENOMA BY COAXIAL SLOT ANTENNA

Object: Microwave ablation has been widely used in tumor treatment, and the antenna is a critical component of microwave ablation. We aimed to evaluate a single-slot antenna to generate a small volume ablation zone ([Formula: see text] in adrenal tissue. Methods: A three-dimensional numerical model of the adrenal tissue was built and solved by the Finite Element Method. In the simulation model, the slot antenna was placed between the adrenal gland and fat, and the microwave ablation power and time were adjusted to obtain the target ablation zone. In ex vivo experiments, the length and width of the ablation zone were measured, and the significance of ablation parameters on it was determined using a multi-factorial analysis of variance method. The temperature versus time curves at 3[Formula: see text]mm and 7[Formula: see text]mm from the antenna were plotted to validate the simulation. Results: The simulation results showed that the combination of microwave ablation parameter settings 30[Formula: see text]W/300[Formula: see text]s, 40[Formula: see text]W/180[Formula: see text]s, and 40[Formula: see text]W/300[Formula: see text]s could create ablation zones in the adrenal tissue volumes of [Formula: see text] and [Formula: see text], respectively, with minimal damage (less than [Formula: see text] to the surrounding fat tissue. Both power and heating time significantly affected the length and width of the ablation zone. The temperature rise curves obtained in the simulation and ex vivo experiments were in good agreement. Conclusion: This work shows that utilizing a slot antenna can produce a small volume ablation zone in adrenal tissue for microwave ablation of benign adrenal adenomas.

Cardiac magnetic resonance - aided ventricular tachycardia substrate ablation

Abstract Objectives To assess feasibility and reliability of Cardiac magnetic resonance (CMR)-derived pixel signal intensity (PSI) maps obtained by Three Dimensional (3D)- Late Gadolinium Enhancement (LGE) images for detecting potential targets for VT substrate ablation procedures. Background Parametric imaging with color-coded PSI maps obtained from pre-ablation 3D LGE -CMR imaging can be used for identification and characterization of arrhythmic abnormal substrate. Recent publications have shown that PSI maps permit visualization of border zone areas inside the scar. Specifically, corridors of viable tissue within the scar connecting healthy myocardium define VT corridors that may be the electrical equivalent of the abnormal conducting channels on the electroanatomical mapping (EAM). Methods 8 patients with scar-dependent monomorphic VTs who underwent 3D-LGE CMR imaging prior to substrate ablation were included in the study. The studies were performed at 1.5T scanner. We obtained two data sets of 3D whole heart LGE imaging with high resolution. Patients underwent two acquisitions: the conventional respiratory navigated, electrocardiographically-gated 3D fast gradient echo (1.3slice thickness, 256x256 matrix acquisition) and the image-navigated isotropic high resolution 3D GE with Dixon water-fat separation. 3D LGE-CMR images were processed with ADAS-VT software to produce a 3-dimensional model of the heart with 10 layers from the endocardium to epicardium and PSI maps color-coded from the LGE data projected to each of the shells (Figure 1). In the LGE-CMR PSI maps, VT corridors were obtained automatically by the ADAS VT software. Subsequently, data were given to the electrophysiologists and merged with the CARTO3 system EAM data obtained for the ablation (Figure2). CMR information was used to facilitate the identification of target ablation sites in the areas identified by CMR as abnormal substrate and radiofrequency was applied in the presence of both a pathological electrogram (EGM) and a VT corridor as identified by CMR. Results There was a 95% agreement between the abnormal conducting channels as detected by abnormal electrograms in the EAM and the VT corridors identified by 3D LGE CMR imaging. In two occasions, there was one VT corridor that did not correlate with abnormal electrograms and was not ablated. The two 3D LGE sequences used for ADAS-VT corridors analysis showed complete agreement in the number and location of VT corridors. Mean acquisition time for 3D LGE imaging was 11±4minutes for the conventional fast gradient echo sequence, and 5±2minutes for the novel 3D self-image navigated LGE sequence. The image quality of 3D LGE was superior with the Dixon fat-water separation. Overall CMR-aided VT ablation reduced the procedural and fluoroscopy time by 40%. Conclusions CMR-aided VT ablation is feasible, reliable and significantly reduces the procedural time.

Optimizing ablation sites in recurrent atrial fibrillation cases: a novel approach using emphasize settings

Abstract Backgrounds Although catheter ablation techniques for atrial fibrillation (AF) have advanced, a certain number of cases of re-conduction after pulmonary vein isolation (PVI) still exist and are the most common cause of recurrence of atrial tachyarrhythmias. In some cases, the diversity of anatomical wall thickness and fiber orientation around the PVs might contribute to re-conduction. Identification of optimal target ablation site of re-conduction could reduce unnecessary ablation and decrease the risk of complications. However, in cases where local electrograms consisted with far filed and near filed potentials were coexist, conventional activation mapping with bipolar electrograms sometimes fails to identify the re-conduction sites. Purpose We investigated the utility of using the Emphasize settings in the emphasis map obtained by combining activation mapping and peak frequency mapping in the EnSite X system to determine the optimal ablation sites compared to the conventional map based on the activation mapping. Methods Patients undergoing AF ablation of PVI with the EnSite X system who had recurrent cases or had PVI re-conduction at the initial ablation were included. We retrospectively analyzed the cases from January 2022 to November 2023. In all cases, bipolar voltage and activation maps for left atrium and PVs were obtained by a 16-pole grid catheter (Advisor HD Grid) during atrial pacing or sinus rhythm. Local activation timing and peak frequency maps of the left atrium were performed to obtain the Emphasize settings indicating the optimal ablation sites (E-group). The Emphasize settings obtained from the maps were adjusted to make the site of re-conduction most apparent (Figures). Another group determined the ablation sites based on the activation mapping (A-group). The clinical backgrounds, laboratory data, and echocardiography data were also evaluated. Intravenous administration of ATP was performed in all targeted PVs after successful re-isolation of PVs. Results Total 44 patients (69±10 years, 32 males) and 90 PVs were found to be re-conducted and analyzed. The gaps of 34 and 40 points of PVI were observed in the E-group and C-group, respectively. The number of needs for the ablation points to successful elimination of gap was markedly smaller in the E-group (1.3±0.7 vs. 6.2±3.2, p<0.001). The optimal Emphasize settings was 340 ±75 Hz in the E-group. None of the cases showed dormant conductions by ATP administration in both groups. There were no differences in age, gender, left atrial volume index, left ventricular ejection fraction, serum creatinine levels, and N-terminal pro-brain natriuretic peptide levels between the two groups. Conclusion The optimal ablation site was visualized by adjusting the Emphasize settings, and the number of ablation points to re-isolation of PV might be markedly reduced.

Preclinical Study of Pulsed Field Ablation of Difficult Ventricular Targets: Intracavitary Mobile Structures, Interventricular Septum, and Left Ventricular Free Wall.

Endocardial catheter-based pulsed field ablation (PFA) of the ventricular myocardium is promising. However, little is known about PFA's ability to target intracavitary structures, epicardium, and ways to achieve transmural lesions across thick ventricular tissue. A lattice-tip catheter was used to deliver biphasic monopolar PFA to swine ventricles under general anesthesia, with electroanatomical mapping, fluoroscopy and intracardiac echocardiography guidance. We conducted experiments to assess the feasibility and safety of repetitive monopolar PFA applications to ablate (1) intracavitary papillary muscles and moderator bands, (2) epicardial targets, and (3) bipolar PFA for midmyocardial targets in the interventricular septum and left ventricular free wall. (1) Papillary muscles (n=13) were successfully ablated and then evaluated at 2, 7, and 21 days. Nine lesions with stable contact measured 18.3±2.4 mm long, 15.3±1.5 mm wide, and 5.8±1.0 mm deep at 2 days. Chronic lesions demonstrated preserved chordae without mitral regurgitation. Two targeted moderator bands were transmurally ablated without structural disruption. (2) Transatrial saline/carbon dioxide assisted epicardial access was obtained successfully and epicardial monopolar lesions had a mean length, width, and depth of 30.4±4.2, 23.5±4.1, and 9.1±1.9 mm, respectively. (3) Bipolar PFA lesions were delivered across the septum (n=11) and the left ventricular free wall (n=7). Twelve completed bipolar lesions had a mean length, width, and depth of 29.6±5.5, 21.0±7.3, and 14.3±4.7 mm, respectively. Chronically, these lesions demonstrated uniform fibrotic changes without tissue disruption. Bipolar lesions were significantly deeper than the monopolar epicardial lesions. This in vivo evaluation demonstrates that PFA can successfully ablate intracavitary structures and create deep epicardial lesions and transmural left ventricular lesions.

Substrate Mapping for Ventricular Tachycardia Ablation Through High-Density Whole-Chamber Double Extra Stimuli: The S3 Protocol

BackgroundA partial delineation of targets for ablation of ventricular tachycardia (VT) during a stable rhythm is likely responsible for a suboptimal success rate. The abnormal low-voltage near-field functional components may be hidden within the high-amplitude far-field signal. ObjectivesThe aim of this study was to evaluate the benefit and feasibility of functional substrate mapping using a full-ventricle S3 protocol and to assess its colocalization with arrhythmogenic conducting channels (CCs) on late gadolinium enhancement cardiac magnetic resonance. MethodsAn S3 mapping protocol with a drive train of S1 followed by S2 (effective refractory period + 30 ms) and S3 (effective refractory period + 50 ms) from the right ventricular apex was performed in 40 consecutive patients undergoing scar-related VT ablation. Deceleration zones (DZs) and areas of late potentials (LPs) were identified for all maps. A preprocedural noninvasive substrate assessment was done using late gadolinium enhancement cardiac magnetic resonance and postprocessing with automated CC identification. ResultsThe S3 protocol was completed in 34 of the 40 procedures (85.0%). The S3 protocol enhanced the identification of VT isthmus on the basis of DZ (89% vs 62%; P < 0.01) and LP (93% vs 78%; P = 0.04) assessment. The percentage of CCs unmasked by DZs and LPs using S3 maps was significantly higher than the ones using S2 and S1 maps (78%, 65%, and 48% [P < 0.001] and 88%, 81%, and 68% [P < 0.01], respectively). The functional substrate identified during S3 activation mapping was significantly more extensive than the one identified using S2 and S1, including a greater number of DZs (2.94, 2.47, and 1.82, respectively; P < 0.001) and a wider area of LPs (44.1, 38.2, and 29.4 cm2, respectively; P < 0.001). After VT ablation, 77.9% of patients have been VT free during a median follow-up period of 13.6 months. ConclusionsThe S3 protocol was feasible in 85% of patients, allows a better identification of targets for ablation, and might improve VT ablation results.

Automated prediction of isthmus areas in scar-related atrial tachycardias using artificial intelligence.

Ablation of scar-related reentrant atrial tachycardia (SRRAT) involves identification and ablation of a critical isthmus. A graph convolutional network (GCN) is a machine learning structure that is well-suited to analyze the irregularly-structured data obtained in mapping procedures and may be used to identify potential isthmuses. Electroanatomic maps from 29 SRRATs were collected, and custom electrogram features assessing key tissue and wavefront properties were calculated for each point. Isthmuses were labeled off-line. Training data was used to determine the optimal GCN parameters and train the final model. Putative isthmus points were predicted in the training and test populations and grouped into proposed isthmus areas based on density and distance thresholds. The primary outcome was the distance between the centroids of the true and closest proposed isthmus areas. A total of 193 821 points were collected. Thirty isthmuses were detected in 29 tachycardias among 25 patients (median age 65.0, 5 women). The median (IQR) distance between true and the closest proposed isthmus area centroids was 8.2 (3.5, 14.4) mm in the training and 7.3 (2.8, 16.1) mm in the test group. The mean overlap in areas, measured by the Dice coefficient, was 11.5 ± 3.2% in the training group and 13.9 ± 4.6% in the test group. A GCN can be trained to identify isthmus areas in SRRATs and may help identify critical ablation targets.

Plasma-deposited reactive species assisted synthesis of colloidal zinc-oxide nanostructures

A surface-wave microwave discharge is applied to deposit reactive oxygen and nitrogen species (RONS) into the liquid subsequently used as a medium for laser ablation of a Zn metallic target. It is shown that during laser ablation in plasma-treated liquids the H2O2 concentration decreases, while in deionized water (DIW) significant H2O2 is produced. Meanwhile, the pH—initially adjusted by applying reductive metals—increases in the acidic liquids and decreases in the alkaline ones. During months of storage the pH of colloids stabilize around pH 6, which insures the long-term stability of RONS. It is demonstrated that in DIW metallic Zn NPs are created, which gradually oxidize during storage, while in the plasma-treated liquids ZnO NPs are produced with the mean size of 18 nm. In the alkaline plasma-treated liquid the NPs form large aggregates, which slows the dissolution of NPs. In the acidic and neutral solutions besides NPs nanosheets are also formed, which during storage evolve into nanosheet networks as a result of the dissolution of NPs. The band gap of the colloidal ZnO is found to decrease with the formation of aggregates and nanosheet networks. The ZnO NPs ablated in plasma-treated liquids exhibit a high-intensity visible emission covering the green-to-red spectral region. The photoluminescence spectra is dominated by the orange-red emission—previously not detected in the case of laser-ablated ZnO NPs and attributed to the interstitial Zn and oxygen sites—and the yellow emission, which can be attributed to the OH groups on the surface. It is shown that during months of storage, due to the dissolution of NPs and formation of nanosheets, the intensity of the visible emission decreases and shifts to the blue-green spectral region.

Peak frequency annotation algorithm–guided slow pathway ablation in typical atrioventricular nodal reentrant tachycardia

BackgroundThe slow pathway potential is difficult to annotate because it is buried within the atrial potential. Omnipolar technology near field can automatically annotate the peak frequency potential associated with acquired intracardiac electrograms. ObjectivesThis study aimed to visualize the junction between the transitional cells and the slow pathway using a peak frequency map with omnipolar technology near field and evaluate whether the high-frequency site around the tricuspid annulus (TA) is an effective target for slow pathway ablation. MethodsThis prospective observational study enrolled 37 patients with typical atrioventricular nodal reentrant tachycardia. Patients underwent slow pathway ablation using a peak frequency map (n = 17) and the conventional approach based on anatomical and electrophysiological findings (n = 20). ResultsHigh-frequency sites were distributed at the TA side of the 4–5 o’clock position in all patients mapped using the peak frequency map of OTNF. The distance to the His bundle from the successful ablation site was farther (24.0 ± 4.8 mm vs 12.7 ± 4.0 mm; P < .0001), junctional rhythm was slower (88 ± 17 beats/min vs 115 ± 12 beats/min; P < .0001), the time to junctional rhythm after radiofrequency application was shorter (3.4 ± 1.4 seconds vs 8.2 ± 4.6 seconds; P < .0001), and the elimination rate of jump ups (71% vs 30%; P = .02) was higher in the peak frequency map–guided group. ConclusionThe high-frequency site of the TA at 4–5 o’clock in the peak frequency map could be a novel target of slow pathway ablation with high safety, efficiency, and efficacy.

Gas-phase Condensation of Carbonated Silicate Grains

Reports on the detection of carbonates in planetary nebulae (PNe) and protostars have suggested the existence of a mechanism that produces these compounds in stellar winds and outflows. A subsequent laboratory study has reported a possible mechanism by presenting the non-thermodynamic-equilibrium (TE), gas-phase condensation of amorphous silicate grains with amorphous calcium carbonate inclusions. The authors concluded that water vapor was necessary for the formation of the carbonates. We present a laboratory study with pulsed laser ablation of a MgSi target in O2 and CO2 gases and report, in the absence of water vapor, the non-TE, gas-phase condensation of amorphous carbonated magnesium silicate dust. It consists of amorphous silicate grains with the formula MgSiO3, which comprise carbonate groups homogeneously dispersed in their structure. The IR spectra of the grains show the characteristic bands of amorphous silicates and two bands at ∼6.3 and ∼7.0 μm, which we assign to the carbonate groups. The silicate bands are not significantly affected at an estimated Si:C ratio of 9:1–9:2. Such grains could form in winds and outflows of evolved stars and PNe if C atoms are present during silicate condensation. Additionally, we find that Lyα radiation dissociates the carbonate groups at the surface of the carbonated silicate grains and we estimate the corresponding photodissociation cross section of (0.04 ± 0.02) ×10−16 cm2. Therefore, photodissociation would limit the formation of carbonate groups on grains in winds and outflows of stars emitting vacuum ultraviolet photons, and the carbonates observed in protostars have not formed by gas-phase condensation.

Study on nanosecond laser-induced iron plasma reactive etching of single-crystal CVD diamond

Single-crystal diamond has great potential applications in national defense, military, and aerospace fields. However, the high hardness, chemical inertness, and anisotropy bring great challenges to machine microstructures on the diamond. Here, iron plasma, generated by infrared nanosecond laser ablation of a Fe target, was utilized to etch single-crystal diamond. The EDS, Raman, and XPS analysis revealed the formation of iron carbide within the sputtered layer surrounding the diamond microgrooves, thereby confirming that the iron plasma reacts chemically with the diamond. It was observed that employing a reactive metal, such as iron, for etching diamond microgrooves yields improved morphological characteristics and enhanced etching efficiency compared to the use of a non-reactive metal, such as copper. Moreover, the process of material removal through laser-induced iron plasma etching of diamond was elucidated. Subsequently, a systematic investigation was conducted on the impact of processing parameters on the laser-induced iron plasma etching of diamonds. Various periodic microstructures with regular edges and no chipping and cracks were successfully processed on the diamond using suitable laser parameters. This study furnishes a novel approach for the efficient fabrication of high-quality microstructures on single-crystal diamonds.

Optical energy band gap investigation of the zinc carbide nanoparticles prepared by nanosecond pulsed laser ablation of zinc metals in hexane liquid medium

Many different applications make use of carbide nanoparticles, which could be prepared via conventional techniques, but all of these techniques tend to be intricate, and several steps must be completed before fabrication can begin. However, in this study, we present, for the first time, a straightforward technique for the production of zinc carbide nanoparticles (ZnC) through the use of nanosecond laser ablation of a zinc target immersed in hexane with the assistance of a purged nitrogen gas. We conducted optical absorption spectroscopy on the produced nanostructured materials. We studied the optical properties using the conventional method of the Tauc relation. We compared these values with various innovative approaches, including the absorption spectrum fitting method (ASF) and its derivative method (DASF). We conducted an investigation into each approach's correction to achieve a satisfactory level of agreement between the values, and documented a comparable pattern. These results help us understand the physicochemical properties of zinc carbide and other nanoparticles or nanocomposites that do not have any chemical residues. They make them a possible candidate to improve luminescence catalytic activity, photonics, and optoelectronic applications.

Fabrication of Nanostructures Consisting of Composite Nanoparticles by Open-Air PLD

We present a two-step physical method for the fabrication of composite nanoparticle-based nanostructures. The proposed method is based on the pulsed laser deposition (PLD) technique performed sequentially in vacuum and in air. As a first step, thin-alloyed films of iron with noble metal were deposited by PLD in vacuum. The films were prepared by ablation of a mosaic target formed by equal iron and gold sectors. As a second step, the as-prepared alloyed films were ablated in air at atmospheric pressure as the laser beam scanned their surface. Two sets of experiments were performed in the second step, namely, by applying nanosecond (ns) and picosecond (ps) laser pulses for ablation. The structure, microstructure, morphology, and optical properties of the samples obtained were studied with respect to the laser ablation regime applied. The implementation of the ablation process in open air resulted in the formation of nanoparticle and/or nanoparticle aggregates in the plasma plume regardless of the ablation regime applied. These nanoparticles and/or nanoaggregates deposited on the substrate formed a complex porous structure. It was found that ablating FeAu films in air by ns pulses resulted in the fabrication of alloyed nanoparticles, while ablation by ps laser pulses results in separation of the metals in the alloy and further oxidation of Fe. In the latter case, the as-deposited structures also contain core–shell type nanoparticles, with the shell consisting of Fe-oxide phase. The obtained structures, regardless of the ablation regime applied, demonstrate a red-shifted plasmon resonance with respect to the plasmon resonance of pure Au nanoparticles.

Prominent crista terminalis mimicking a right atrial mass: a systematic literature review and meta-analysis.

The crista terminalis is an anatomical structure localized on the posterolateral wall of the right atrium (RA). We performed a systematic review of the literature and meta-analysis concerning cases of unusual prominent crista terminalis mimicking RA mass. Moreover, we described the differential diagnosis of cardiac masses with the use of echocardiography, computed tomography, and cardiac magnetic resonance (CMR). We also emphasize the potential importance of this structure in electrophysiological procedures, including its role in exaggerated arrhythmias. Prominent crista terminalis may be a potential obstacle during invasive cardiac procedures or catheter ablation target. In analyzed cases, the crista terminalis was often erroneously interpreted as pathologic and at first confused with a thrombus or tumor during transthoracic echocardiography examination. The correct final diagnoses were mostly made with used transesophageal echocardiography or CMR. The most important imaging findings suggestive of prominent crista terminalis rather than tumor were a similar echogenicity/intensity with adjacent myocardium, the location on posterolateral wall of the RA, the phasic change in size, and no enhancement after contrast injection. We describe up to date and detailed imaging features for the differential diagnostics of selected intracardiac masses using various imaging techniques, including multimodality cardiac imaging. Familiarity with the anatomy and the imaging findings of the prominent crista terminalis will reduce misdiagnosis and avoid additional tests and unwarranted clinical interventions, while in patients considered for invasive cardiac procedures it might increase their efficacy and safety.

Structural, spectroscopi c and laser properties of transparent Tm:YScO3 ceramic based on gas-phase synthesized nanoparticles

Owing to the combination of good thermo-optical properties and inhomogeneously broadened fluorescence spectra suitable for ultrashort laser pulse generation, rare-earth doped solid solutions of sesquioxides (Y,Lu,Sc)2O3 have attracted considerable interest in recent years. In this study, compositionally disordered Tm3+-doped YScO3 transparent ceramic was fabricated using solid-state vacuum sintering of nanopowder produced using laser ablation of solid target in air flow. The as-synthesized powder consisted of weakly aggregated spherical particles having 20 nm diameter and a mostly monoclinic (space group C2/m) crystal structure, whose symmetry was transformed into cubic (space group Ia-3) by calcination at 1050 °C. From high resolution transmission electron microscopy (HRTEM) and energy dispersive X-ray analysis (EDX), we observed a homogeneous distribution of components both throughout individual nanoparticles and 100-nm-thick ceramic foil resulting in high structural and optical quality of the obtained samples. The sintered ceramic featured an optical transmission of 77% at 600 nm and above 81% near 2 μm, an average grain size of 24.2 μm and a content of scattering centers of 26.1 ppm. The absorption spectra at several temperatures, from 93 K to 293 K, were measured and the corresponding absorption coefficients were obtained by Lambert-Beer formula in the range from 600 nm to 900 nm and from 1400 nm to 2100 nm. In particular, the room temperature absorption cross section at 794 nm and 1634 nm were determined to be σabs = 4.25 × 10−21 cm2 and σabs = 5.01 × 10−21 cm2 respectively. Concerning the emission cross section it was calculated by Fuchtbauer-Ladenburg equation starting from the fluorescence spectrum acquired at the laser work temperature: at 1951 nm and 2106 nm corresponding to the main two emission peaks belonging the curve, it was found σem = 9.2 × 10−21 cm2 and σem = 4.9 × 10−21 cm2, respectively. Finally, it was tested the laser behavior of the ceramic: pumped at 793 nm in quasi-CW mode it delivered 1.27 W of output power with a slope efficiency of 10.33% at 2081 nm. The tunability curve spans from 1942 nm to 2110 nm (i.e. 168 nm).

Functional substrate mapping of atrium in patients with atrial scar: A novel method to predict critical isthmus of atrial tachycardia.

Atrial tachycardia (AT) is a common rhythm disorder, especially in patients with atrial structural abnormalities. Although voltage mapping can provide a general picture of structural alterations which are mainly secondary to prior ablations, surgery or pressure/volume overload, data is scarce regarding the functional characteristics of low voltage regions in the atrium to predict critical isthmus of ATs. Recently, functional substrate mapping (FSM) emerged as a potential tool to evaluate the functionality of structurally altered regions in the atrium to predict critical sites of reentry. Current evidence suggested a clear association between deceleration zones of isochronal late activation mapping (ILAM) during sinus/paced rhythm and critical isthmus of reentry in patients with left AT. Therefore, these areas seem to be potential ablation targets even not detected during AT. Furthermore, abnormal conduction detected by ILAM may also have a role to identify the potential substrate and predict atrial fibrillation outcome after pulmonary vein isolation. Despite these promising findings, the utility of such an approach needs to be evaluated in large-scale comparative studies. In this review, we aimed to share our experience and review the current literature regarding the use of FSM during sinus/paced rhythm in the prediction of re-entrant ATs and discuss future implications and potential use in patients with atrial low-voltage areas.

Focal atrial tachycardias originating from the aorta-mitral continuity: Anatomical and electrophysiological characteristics

BackgroundThe aorta-mitral annulus conjunction (AMC) is an uncommon site of origin of focal atrial tachycardias (ATs). Hence, the electrophysiological and ablation target characteristics are poorly described. ObjectiveThe purpose of this study was to describe the characteristics of AMC ATs in detail. MethodsThe study enrolled 650 patients with ATs, 21 (3.2%) of whom had ATs originating from the AMC. A comprehensive evaluation, including electrocardiography, electrophysiology study, computed tomography scan, and intracardiac echocardiography, was performed. ResultsThe majority (19, 90.5%) of ATs occurred spontaneously. The mean age of this group was 48.9 ± 21.6 years, with 12 being female (57.1%). Seventeen patients had a typical biphasic P wave with a prominent positive component. The earliest activation site in the right atrium was near the His bundle, with average activation −10.3 ± 6.0 ms preceding the P wave. The successful ablation targets were distributed as follows: 1 case at 9 o’clock, 6 cases at 10 o’clock, 7 cases at 11 o’clock, 6 cases at 12 o’clock, and 1 case in the left coronary cusp. The local AMC potential differed from the commonly perceived annular potential and was characterized by a prominent A wave and a smaller V wave (atrial-to-ventricular ratio > 1). The angle of encroachment on the left atrial anterior wall, compressed by the left coronary cusp, was significantly smaller in the AMC ATs group than in the control group consisted of 40 patients who underwent coronary artery CT scans because of the chest pain but without atrial arrhythmias were randomly selected, which may have contributed to the arrhythmia substrate (141.7° ± 11.5° vs 155.2° ± 13.9°; P = .026). ConclusionA new strategy for mapping AMC ATs has been introduced. The ablation target should have an atrial-to-ventricular ratio of >1.

Characteristics of radiofrequency lesions in patients with symptomatic periesophageal vagal nerve injury after pulmonary vein isolation

AbstractBackgroundPeriesophageal vagal nerve injury (PNI) is an unpredictable and serious complication of atrial fibrillation (AF) ablation. We aimed to identify the factors associated with symptomatic PNI.MethodsThis study included 1391 patients who underwent ablation index‐guided pulmonary vein isolation (PVI) using the CARTO system. The target ablation index was set at 550, except for the left atrial (LA) posterior wall near the esophagus, where radiofrequency (RF) power and duration were limited. Ten patients (0.72%) were diagnosed with symptomatic PNI. We randomly selected 40 patients without PNI (1:4 ratio) matched based on age, sex, body mass index, LA diameter, type of AF, and esophageal location. We measured the shortest distance from the RF lesions to the esophagus (LED) and classified the RF lesions according to the LED into four groups: 0–5, 5–10, 10–15, and 15–20 mm. We conducted a comparative analysis of classified RF lesions between patients with PNI (n = 10) and those without (n = 40).ResultsThe contact force at LED 0–5 mm was significantly higher in patients with PNI than in those without (14.6 ± 1.7 vs. 12.0 ± 2.9 g; p = .01). Multivariate logistic analysis revealed that the independent factor for PNI was contact force at an LED of 0–5 mm (odds ratio: 1.506; 95% confidence interval: 1.053–2.153; p = .025).ConclusionsThe symptomatic PNI was significantly associated with a higher contact force near the esophagus. Strategies for regulating contact force near the esophagus may aid in the prevention of PNI.