Bonus Application Research Articles

Optimizing cryoballoon pulmonary vein isolation: lessons from >1000 procedures- the Frankfurt approach.

Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted ablation strategy for rhythm control in atrial fibrillation (AF). We describe efficacy and safety in a high volume centre with a long experience in the use of the second-generation CB (CB2). Consecutive paroxysmal AF (PAF) or persistent AF (persAF) patients undergoing CB2-PVI were enrolled. Procedural data, efficacy, and safety issues were systematically collected. The 28 mm CB2 was used in combination with an inner lumen spiral catheter, a luminal oesophageal temperature (LET) probe was used with a cut-off of 15°C, the phrenic nerve (PN) monitored during septal PVs ablation. Freeze duration was mainly set at 240 s with a bonus application in case of delayed time-to-isolation (TTI > 75 s). A total of 1017 CB2 procedures were analysed (58% male, 66 ± 12 years old, 70% with PAF). 3964 PVs were identified, 99.8% PVs isolated using solely the 28 mm CB. Mean procedure time was 69 ± 25 min, TTI during the first application was recorded in 77% of PVs after a mean of 48 ± 31 s. We recorded 0.2% cardiac tamponade, 4.8% PN injury (1.6% of PN palsy), and 19% of LET < 15°C. Among 725 patients with follow-up data, 84% with PAF and 75% with persAF were in stable SR at 1 year. Shorter freezing duration and longer TTI were procedural predictors for recurrence. Cryoballoon procedures are fast and associated with a benign safety profile. Shorter TTI and longer freeze durations are associated with sinus rhythm during follow-up.

Long-term outcomes after second-generation cryoballoon ablation of paroxysmal atrial fibrillation – Feasibility of a single short freeze strategy without bonus applications

BackgroundA paucity of data exists about long-term outcomes after second-generation cryoballoon ablation (2nd-CBA), and the feasibility of short freeze strategies remains under debate. We assessed the long-term follow-up outcomes. MethodsThis study included 186 paroxysmal atrial fibrillation (PAF) patients (62 ± 11 years, 136 men) who underwent 2nd-CBAs with a 28-mm balloon and single 3-min freeze strategy without bonus applications. Fourteen-day consecutive monitoring was performed to detect early AF recurrences (ERAFs). ResultsOverall, 713/736(96.9%) PVs were isolated with CBs. The total number of applications/patient was 5.3 ± 1.5. The total procedure and fluoroscopic times were 79.9 ± 28.1 and 24.4 ± 14.2 min. Asymptomatic right phrenic nerve injury occurred in 11 patients, however, all recovered during the follow-up. A total of 76(41.7%) patients experienced ERAFs. During a median 45.0 [30.0–51.0] month follow-up, the single procedure AF freedom was 76.1, 73.5, 70.5, and 63.7% at 1, 2, 3, and 4 years, respectively. At a median of 7.0 [4.0–12.0] months after the initial procedure, 35 (18.8%) patients underwent second procedures, and 106/137 (77.4%) PVs were still isolated. The multiple procedure AF freedom was 91.7, 89.3, 86.8, and 81.3% at 1, 2, 3, and 4 years, respectively. A Cox's proportional hazards model determined that the presence of ERAF was associated with a greater risk of recurrence after the last procedure (Hazard ratio = 2.830; 95% confidence interval = 1.173–6.833; p = 0.021). The percentage of continuation of anticoagulation therapy after the initial procedure was 33.1, 23.5, 21.7, and 21.7% at 1, 2, 3, and 4 years, respectively. ConclusionsOur long-term follow-up data demonstrated the feasibility of a single short freeze strategy in PAF patients.

Investment tax deduction as an alternative to amortization

The object of this research is the investment tax deduction, which gives organizations the ability to reduce the calculated income tax contributing to reduction of income tax burden, freeing up finances, and allowing for faster replenishment of the capital asset fund of the organization. The subject of this research is the ability to use this deduction as an alternative to amortization. The author examines the economic impact of an organization in application of investment tax deduction and amortization withholdings based on various forms of property and international accounting standards. This article presents the results of comparative analysis of amortization withholdings and investment tax deduction. The author calculates the economic impact of application of investment deduction, methods of amortization, as well as application of amortization bonus, and studies international experience. Despite the difficulty of the question in hand from the practical perspective, in light of absence of statistical data and clarification from the Ministry of Finance of the Russian Federation, as well as case law on the application of this legislative norm, the author determines the key advantages and disadvantages of using investment deduction. The description is given to the risks of applying investment tax deduction; recommendations are formulated for using the investment tax deduction.

A novel simple, fast, and safe approach for effective superior vena cava isolation using the third-generation cryoballoon.

Superior vena cava (SVC) isolation with radiofrequency energy remains a challenge due to potential side effects, especially phrenic nerve (PN) or sinus node injury. The purpose of this study was to evaluate the feasibility of a novel SVC isolation technique using the third-generation cryoballoon (CB3). Patients undergoing atrial fibrillation (AF) ablation were prospectively included. The procedure was performed with the CB3, beginning with the pulmonary veins and ending with SVC isolation. During applications in the SVC, continuous PN capture and sinus rate were monitored. Once reached SVC isolation during the application, 60 s more was applied, with no bonus application. If after 90 s the SVC was not isolated, application was stopped. A maximum number of four applications were permitted. Thirty patients (62 ± 9 years; 74% male, 78% paroxysmal AF) were included. No SVC activity was observed in two patients. Success rate for SVC isolation was 89%. Mean number of applications per patient was 2.3±1. Mean time to SVC isolation was 37±20 s. Mean duration of application was 92 ± 15 s. Mean total time of procedure for SVC isolation was 218 ± 43s. We recorded only two complications: one transient PN palsy and one short and transient sinus arrest. After a mean follow-up of 5 ± 2 months, 89% are free from arrhythmia recurrence. We present a promising simple SVC-isolation technique using CB3, featuring a high success rate and very low incidence of complications.

Medium- and long-term outcome after a single second-generation cryoballoon ablation in patients with paroxysmal and persistent atrial fibrillation

Introduction and objectivesTo report medium- and long-term results following a single second-generation cryoballoon (CB2)-based ablation procedure in patients with paroxysmal (PAF) and persistent (PeAF) atrial fibrillation. MethodsA retrospective study was performed of consecutive patients undergoing a first CB2-based ablation procedure in a tertiary center. Cryoenergy was applied for 3 min if a time to effect <60 s was documented or 4 min otherwise, with a bonus application in cases of late isolation or suboptimal temperature. Follow-up was obtained from the regional health electronic records system and by telephone or personal interviews. Recurrence was defined as any atrial arrhythmia >30 s beyond a three-month blanking period. The clinical impact of recurrences was classified using a severity score. ResultsA total of 172 patients (134 PAF and 38 PeAF) were included, of whom 25 (14.5%) had structural heart disease and 120 (69.7%) had a normal or mildly dilated left atrium. Acute success was achieved in 167 (97.1%). After a median follow-up of 27 (14-41) months, 100 patients (58.1%) remained free of atrial arrhythmias (64.2% for PAF and 36.8% for PeAF, p=0.006). Left atrial size (p=0.05) and clinical presentation as PeAF (p=0.006) were predictors of recurrence. Of patients with recurrences, 11.1% did not require further therapies and an additional 16.7% had good control with antiarrhythmic drugs. ConclusionsA single CB2 procedure resulted in 58.1% of patients remaining free of atrial arrhythmias at 27-month follow-up. Conservative management was useful in 27.8% of patients with recurrences.

Cryoablation of the para-Hisian region

Basis: the ablation of the para-Hisian region is a challenge due to the risk of inadvertent lesion of a bundle of His. Cryoablation, due to its slower progression, allows interruption of the application in case of signs of undesired lesions and catheter adhesion during the applications, which has made cryoablation the ideal method for these patients. Objectives: to demonstrate the results of an initial series of patients referred for cryoablation of para-Hisian pathways. Patients and methods: From April 2015 to August 2017, 13 patients were referred for cryoablation due to the necessity for a para-Hisian approach detected in previous ablation procedures. Of the 13 patients, seven were submitted a radiofrequency ablation attempt (RF) and presented failure or recurrence, five performed only electrophysiological studies, and no ablation was attempted, and one was indicated primarily. The mean age was 32 ± 16 years. Eleven patients had manifest anomalous pathways (APs), one hidden and one nodal reentrant tachycardia (NRT) with a transient atrioventricular block (AB) during RF. A cycle of 4 minutes followed by one more cycle in case of a positive result. Results: Of the 13 patients, 11 had an acute success in eliminating the accessory pathway. One patient had multiple accessory pathways, one right side, and one left side. In this patient, it was possible only the ablation of the left pathway. In all others, it was observed exuberant Hisian potential at the point of application with success. The patient with NRT was ablated in the M region without intercurrences. Four applications were required on average to eliminate the accessory pathway successfully. The mean local temperature was -74 ºC. In five patients, the occurrence of third-degree right branch block (RBB) was observed. In one patient, early application of RBB was interrupted and the bonus application was not applied. This wasthe only acutely successful patient who presented clinical recurrence. Transient AB was not observed in any patient. No complications were observed. Conclusion: Cryoablation of para-Hisian pathways and NRTs in regions surrounding the His was an effective method for treatment in this population of patients refractory or refused for RF treatment. The occurrence of acute RBB does not seem to be a criterion for the interruption of applications.

Impact of electrical connections between ipsilateral pulmonary veins on the second-generation cryoballoon ablation procedure.

Electrical connections between ipsilateral pulmonary veins (PVs) have been reported histologically and electrophysiologically. This study investigated the impact of electrical connections between ipsilateral PVs on PV isolation using second-generation cryoballoons (CB2-PVI). Five hundred eleven atrial fibrillation patients, without any PV anomalies, underwent CB2-PVI using one 28-mm balloon and a single 3-minute freeze strategy without any bonus applications. Overall, 1966 of 2044 (96.2%) PVs were isolated exclusively by using 28-mm cryoballoons. Among them, 13 left superior PV (LSPVs) and two right superior PV were not persistently isolated by the first application despite a complete vein occlusion, but were isolated by subsequent applications targeting other ipsilateral PVs. Among the 13 LSPVs, six were transiently isolated by 87 (62-146) second time-to-isolation LSPV applications, but were immediately reconnected after the application. The nadir balloon temperature during the LSPV application was similar between the 13 LSPVs not isolated by the LSPV application but were not so by subsequent left inferior PV (LIPV) applications and the 488 LSPVs persistently isolated by LSPV applications (-49.4℃ ± 4.3℃ vs -50.8℃ ± 5.1℃; P = 0.328). In 59 patients in whom the initial LSPV application failed despite a complete occlusion, LIPVs were targeted for the second applications in 31 patients, and both the LSPV and LIPV were simultaneously isolated in 13 of 31 (41.9%). Electrical connections between ipsilateral PVs could have an impact on the CB2-PVI procedure. When the vein isolation failed despite a complete occlusion, especially for left ipsilateral PVs, it was reasonable to target the other ipsilateral PV instead of repeatedly targeting the same vein.

ASSESSMENT OF POTENTIAL LOCATIONS FOR BONUS ZONING IN BANDUNG

Despite being a common practice in other countries, bonus zoning is still relatively new in Indonesia. Bonus zoning is a zoning regulation tool that allows developers to increase density in exchange for the improvement or provision of public facilities. Bandung, in particular, has already designated areas for bonus zoning within its Local By-law No.10/2015 concerning Detailed Spatial Plan and Zoning Regulation. Its detailed mechanism however is not yet implemented. This research seeks to investigate a) the rationale behind the application of bonus zoning in Bandung; b) the carrying capacity of the areas where bonus zoning could be applied; c) the type of public space to be provided as development compensation; and d) the calculation for compensation. Content analysis was used to review literature and legal documents regarding planning and development in Bandung. This research expects to find which areas are suitable for implementing bonus zoning and come up with its compensation as the basis for sustainable planning in Bandung that not only benefits the developers but also the public as a whole.

ASSESSMENT OF POTENTIAL LOCATIONS FOR BONUS ZONING IN BANDUNG

Despite being a common practice in other countries, bonus zoning is still relatively new in Indonesia. Bonus zoning is a zoning regulation tool that allows developers to increase density in exchange for the improvement or provision of public facilities. Bandung, in particular, has already designated areas for bonus zoning within its Local By-law No.10/2015 concerning Detailed Spatial Plan and Zoning Regulation. Its detailed mechanism however is not yet implemented. This research seeks to investigate a) the rationale behind the application of bonus zoning in Bandung; b) the carrying capacity of the areas where bonus zoning could be applied; c) the type of public space to be provided as development compensation; and d) the calculation for compensation. Content analysis was used to review literature and legal documents regarding planning and development in Bandung. This research expects to find which areas are suitable for implementing bonus zoning and come up with its compensation as the basis for sustainable planning in Bandung that not only benefits the developers but also the public as a whole.

Is “bonus” application required after pulmonary vein isolation using second-generation cryoballoon catheter? A 1-year follow-up study

Delivery of a “bonus” application after the pulmonary vein isolation (PVI) using cryoballoon (CB) catheter is still routine practice despite clear evidence regarding its efficacy. To assess the one year results of paroxysmal (PAF) and short persistent atrial fibrillation (SpAF) ablation using the last generation Arctic Front Advance ® CB catheter without bonus application. All consecutive patients who underwent CB ablation for PAF and SpAF in Rouen university hospital between June 2012 and March 2015 were enrolled. Duration of CB application was set to 240 sec, and no bonus applications were performed after PVI. Patients were seen in outpatient clinic, and underwent ECG and a 24-hour recording at 4 and 12 months. Population consisted of 170 patients (male = 74.1%; mean age = 57.8 ± 10.2 years). The mean duration of AF was 4.3 ± 4.0 years. The mean CHA 2 DS 2 VASC score was 1.2 ± 1.2. A 28 mm balloon was used in 146 (85.9%) and 655 (99.2%) PVs were isolated with the CB only. Mean number applications were 1.4 ± 0.7, 1.6 ± 1.1, 1.3 ± 0.7, 1.5 ± 0.6, 1.1 ± 0.3, 3.65 ± 3.0, for right superior PV, right inferior PV, left superior PV, left inferior PV supernumerary veins and common ostia respectively. Mean procedure and fluoroscopy times were 88.5 ± 28.2 and 14.1 ± 8.6 min respectively. Phrenic nerve palsy occurred during the procedure in 7 patients (4.1%). Tamponade occurred in 3 patients (1.8%) and pericardial effusion was observed in 7 patients (4.1%). Sixteen patients (9.4%) underwent a redo procedure for symptomatic atrial arrhythmia. The 1-year follow-up was completed in 163 (95.9%) patients. The majority (128/163, 78.5%) were asymptomatic. AF was documented in 15 patients (9%). Anti-arrhythmic drugs were stopped in 140 (85.8%) patients and anticoagulant therapy in 86 (52.7%). Our results suggest that CB bonus application is not required. This strategy could shorten procedure, fluoroscopy time and improve safety.

The short‐term impact of the catheter ablation on noninvasive autonomic nervous system parameters in patients with paroxysmal atrial fibrillation

The autonomic nervous system (ANS) is a potentially potent modulator of the initiation and perpetuation ofatrialfibrillation (AF), whereas the presence of AF can activate and alter the ANS. The catheter ablation of AF (AFCA) may cause the cardiac ANS dysfunction, whereasrestoration of sinus rhythm or sympathovagal imbalance by AFCA canreverse this process. Our principal goal was to investigate the short-term effect of AFCA on ANS functions evaluated by noninvasive chronotropic (CI), resting heart rate (RHR), and heart rate recovery (HRR) indices. A total of 45 patients were enrolled with symptomatic, drug refractoryparoxysmal AF undergoing first cryoballoon (CB) pulmonary vein antrum isolation (PVAI) with one 28-mm CB using single 3-minute freeze techniques without bonus applications. All patients underwent symptom-limited exercise treadmill testing to evaluate noninvasive parameters of ANS before PVAI. For those patients who remained in sinus rhythm, an additional exercise test was repeated after 1 and 3 months after discharge. The autonomic CI and RHR/HRR indices were impaired after PVAI and persisted post-PVAI 3 months. However, these parameters were not different in patients with and without recurrence. This study demonstrated that the successful AFCA might concurrently impair the ANS parameters. The autonomic imbalance between the sympathetic and parasympathetic activity after AFCA could either become antiarrhythmic and/or proarrhythmic based on which of the two components was going to prevail after successful AFCA. The impaired ANS balance after PVAI might also be another hypothetical mechanism for AF recurrence particularly in the absence of PV reconnection.

Pulmonary Vein Isolation Using a Second-Generation Cryoballoon in Patients With Paroxysmal Atrial Fibrillation: One-Year Outcome Using a Single Big-Balloon 3-Minute Freeze Technique.

The second-generation cryoballoon (CB) has been recently introduced into clinical use for pulmonary vein isolation (PVI). Data on the feasibility, long-term outcome, and optimal freeze cycle are still limited. We assessed the 1-year clinical outcome after second-generation CB ablation with single 3-minute freeze techniques, and clinical variables associated with AF recurrence. A total of 108 paroxysmal atrial fibrillation (PAF) patients undergoing cryothermal PVI were enrolled. PVI was performed with one 28-mm CB using single 3-minute freeze techniques without bonus applications. Fourteen-day consecutive monitoring was done after discharge to detect early AF recurrences (ERAFs). Out of 425 PVs, 409 (96.2%) were isolated using exclusively CBs, and 16 required touch-up ablation. Transient phrenic nerve injury, pericardial tamponade, and 50% PV stenosis occurred in 9, 1, and 1 patients, respectively. No PV stenosis >50% was observed in any patients. The total procedure and fluoroscopic times were 82.9±26.4 and 26.2±14.8 minutes, respectively. ERAFs were detected in 51 (47.2%) patients. At 1-year after single and repeat procedures, 71.6% and 84.3% of the patients were free from recurrent AF off antiarrhythmic drugs (AADs), respectively. Eighteen patients underwent repeat procedures (median 6.0 [4.0-9.3] months post procedure), and 68.6% of PVs were still isolated. Cox's proportional models determined that ERAFs were significantly associated with AF recurrence (HR = 7.236; 95%CI = 2.753-19.016; P < 0.0001). AF-freedom off AADs at 1-year after single procedures was 90.8% and 50.3% in patients without and with ERAFs. Second-generation CB ablation using single 3-minute freeze techniques appears feasible in PAF patients. ERAFs were significant factors for predicting clinical outcomes.

Application of Tax Bonus Under the Slovak and Czech Republic

Abstract This paper deals with the issue of practical application of tax bonus. It answers basic questions related to tax bonus and to a taxable party entitled to it under the valid legislation of the Slovak and Czech Republic.

0536: Use of 2nd generation cryoballoon with reduced dosing strategy is superior to 1st generation cryoballoon for paroxysmal atrial fibrillation ablation

With the technical properties of the 2 nd generation (Arctic Front Advance, AFA) cryoballoon (CB), we postulated we could reduce complication rate without impairing efficacy in the treatment of paroxysmal atrial fibrillation if we stop the bonus application. Since January 2011, all patients referred to our institution for ablation of symptomatic drug refractory paroxysmal atrial fibrillation were included (n=129). Until June 2012, the ablation was performed with the Arctic Front cryoballoon (AF-CB) with application of 4mm bonus freeze after PVI (n=47). From July 2012 to December 2013, the ablation procedure was performed with the AFA-CB, without bonus freeze after PVI in 82 patients. All patients were seen at 4 to 6 month follow-up. They underwent at least 1 Holter monitoring in the post-operative period (2-4 month after ablation). Mid-term clinical success was defined by the association of sinus rhythm on ECG and Holter monitoring and lack of symptoms. Compared to the AFCB group, there was a significant reduction of the procedure time (131 min vs 95 min; p < 0.01), the X-ray exposure (27Gy/cm 2 vs 20 Gy/cm 2 ; p = 0.04) in the AFACB group. Isolation of the 4 PVs was obtained in 89 and 96% (p = 0.24) before performing a touch up with a Freezor Max catheter in the AFCB and AFACB group respectively. Using our definition for success, the mid-term success rate was higher in the AFA-CB group as compared with that of in the AF-CB group (78% vs 53% p = 0.01; CI [1,3 - 6,5]). Significant complications occurred in 9% in the AFA-CB group versus 13% in the AF-CB group (p = 0.44). There was no difference regarding the rate of phrenic nerve palsy (7% AF-CB group vs 5% AFA-CB group;p=0.24). The lack of a bonus freeze application after PVI allows to significantly reducing the procedure time and the X-ray exposure. Even when using a reduced dosing strategy, our study shows the AFA-CB leads to a better outcome as compared to the AF-CB.

Single 3-minute freeze for second-generation cryoballoon ablation: one-year follow-up after pulmonary vein isolation.

The second-generation cryoballoon (CB-Adv) is effective in achieving pulmonary vein isolation (PVI) with encouraging results. The mid-term clinical efficacy of a single 3-minute freeze, without a routine bonus application, has been recently demonstrated. The purpose of this study was to assess long-term clinical outcome after PVI with the CB-Adv using a single 3-minute application. A total of 143 consecutive patients (93 male [65%], mean age 59.6 ± 12.0 years) with paroxysmal atrial fibrillation (PAF; 113/143 [79%]) or early persistent atrial fibrillation (AF; 30/143 [21%]) underwent PVI using CB-Adv with a single 3-minute freeze. Atrial tachyarrhythmia recurrences were defined as symptomatic or documented episodes >30 seconds. After a single freeze, isolation could be reached in 94.1% of all identified pulmonary veins. Complete PVI was successfully achieved with 1.1 ± 0.4 mean freezes. Persistent phrenic nerve palsy occurred in 5 of 143 patients (3.5%). At a mean 12.1 ± 4.4 months of follow-up, after a 3-month blanking period (BP), 80.4% (115/143) were in stable sinus rhythm (93/113 [82.3%] for PAF; 22/30 [73.3%] for early persistent AF). Fifteen patients underwent a second procedure with radiofrequency ablation showing reconnection in 7 of 15 right-sided (46.7%) and 6 of 15 left-sided (40%) pulmonary veins. Relapses during BP (P <.01), time to PVI (P = .02), and longer AF duration (P = .04) were independent predictors of recurrences. A single 3-minute freeze is highly effective, determining an atrial tachyarrhythmia freedom of 80.4% at 1-year follow-up. The incidence of persistent phrenic nerve palsy is 3.5%. Relapses during BP, time to PVI, and longer AF duration are predictors of recurrences. Routine use of an "insurance freeze" may not be needed.

Extreme X-ray beam compression for a high-resolution table-top grazing-incidence small-angle X-ray scattering setup

The application of V-shaped channel-cut GeSi(220) and Ge(220) monochromators for one-dimensional extreme X-ray beam compression was tested on a table-top setup for grazing-incidence small-angle X-ray scattering (GISAXS) with a microfocus source. A lattice constant gradient and different asymmetry angles of the diffractors were employed to enhance the compression factor to 21 and 15, respectively. It was demonstrated that the output beam parameters in terms of the size, divergence, photon flux and spectral bandwidth surpass those of the slit collimators used traditionally in GISAXS. A beam size far below 100 µm allows a high-resolution spatial GISAXS mapping, while the reciprocal space resolution of ∼500 nm approaches the level of synchrotron measurements and allows a fast one-shot detection of high-resolution GISAXS patterns. An oversampling shifts the detection limit up to ∼1 µm. The very short design of the compact high-resolution table-top GISAXS setup is another advantage of the extreme beam compression. Benefits of V-shaped monochromators for medium-resolution X-ray diffraction experiments as a bonus application are demonstrated by a comparison with parallel channel-cut monochromators combined with a slit.

Incidence and characteristics of phrenic nerve palsy following pulmonary vein isolation with the novel second-generation cryoballoon as compared to the first-generation balloon

Purpose: To describe incidence and characteristics of Phrenic Nerve Palsy (PNP) following Pulmonary Vein Isolation (PVI) using the novel second-generation cryoballoon with enhanced surface cooling (CB2) as compared to the first-generation balloon (CB1). Methods: 191 consecutive patients with paroxysmal or persistent (< 6 months) atrial fibrillation underwent single-transseptal PVI with the CB2 (last 86 patients) or the CB1 (105 patients, control group) in conjunction with an endoluminal spiral mapping catheter. After successful PVI, one bonus CB application was applied for each PV. The right PN was continuously stimulated by a catheter from the superior caval vein during ablation of the septal PVs. In case of loss or weakening of diaphragm contraction, freezing was immediately stopped and no bonus application was applied. Transient PN palsy was defined as weakening/loss of diaphragm contraction with full recovery until discharge as demonstrated by chest fluoroscopy. Persistent PN palsy was defined as weakening/loss of diaphragm contraction present at discharge. Results: In total, PNP occurred in 9/86 (10,5%) patients in the CB2 group and 6/105 (5,7%) patients in the CB1 group (p = 0,23; chi-square test). Persistent PNP occurred in 3 (3,5%) and 2 (1,9%) patients in the CB2 and CB1 group, respectively (p = 0,66; Fisher's exact test). Transient PNP occurred in 6 (7%) and 4 (3,8%) patients in the CB2 and CB1 group, respectively (p = 0,25; Fisher's exact test). PNP occurred exclusively during freezing at the right superior PV in the CB1 group, while in 5 patients (5,8%) of the CB2 group, PNP occurred during freezing at the right inferior PV (RIPV). PNP was generally right-sided with the exception of 1 patient in the CB2 group (1,1%), in whom delayed left-sided PNP was demonstrated 1 day after the procedure with unimpaired intraprocedural diaphragm movement. In the CB2 group, 2/3 patients with persistent PNP demonstrated partial recovery of PN function during 3±2 months of follow-up, 2 patients felt mild exertional dyspnea. In the CB1 group, 1/2 patients with persistent PNP demonstrated complete recovery of PN function after 1 month. The other patient was asymptomatic and declined further chest fluoroscopy. Conclusions: We observed a numerical higher incidence of transient and persistent PNP following PVI with the novel CB2 vs. CB1, that did not, however, reach statistical significance. Particular awareness has to be given during ablation at the RIPV using CB2, since the majority of PNP cases occurred at this PV, which is in contrast to prior observations with the CB1.

Two Versus One Repeat Freeze–Thaw Cycle(s) After Cryoballoon Pulmonary Vein Isolation: The ALSTER EXTRA Pilot Study

Repeated freezing (bonus applications) during cryoballoon pulmonary vein isolation (PVI) has been suggested to improve lesion durability. However, the long-term clinical effects of repeated freezing have not been investigated. A total of 51 patients (pts) with paroxysmal atrial fibrillation (AF) underwent PVI using the single big (28 mm) cryoballoon technique. One (27 pts, group I) or 2 bonus applications (24 pts, group II) were performed at all PVs subsequent to PVI. Clinical follow-up consisted of continuous rhythm monitoring by an implantable cardiac monitor (ICM, 24 pts) and serial 7-day Holter-ECG recording (7DH, 27 pts). The primary endpoint was defined as recurrent AF or atrial tachycardia. Acute PVI of all PVs was obtained in 50/51 pts (98%). The median (Q1;Q3) follow-up duration in this study was 384 (213;638) days. The primary endpoint occurred in 48% (group I, 15 pts ICM, 12 pts 7DH) and 46% (group II, 9 pts ICM, 15 pts 7DH), P = 0.84. Procedure- and fluoroscopy-time for group I versus group II was 193 ± 56 minutes versus 207 ± 27 and 33 ± 13 minutes versus 34 ± 11 minutes, respectively. Right phrenic nerve palsy (PNP) occurred in 3 pts (all group II, time to resolution: 128 ± 112 days). In 2 of these pts, PNP occurred during the second bonus application. Application of 2 when compared to 1 freeze-thaw cycle(s) following cryoballoon PVI did not result in improved clinical success but was associated with a higher complication rate.

Skin diagnosis algorithm for analysis of skin images captured from a fingerprint sensor

This paper presents a skin diagnosis algorithm installable in cell phones that have fingerprint identification function. The algorithm can analyse low contrast skin images captured from a fingerprint sensor based on two dimensional linear prediction analysis. The authors' devices can be smaller than conventional skin diagnosis devices having a camera, without an optical lens or a focus adjustment apparatus. Especially, it can be installed in fingerprint identification devices as a bonus application. The authors' algorithm presented in this paper has been embedded in Pantech PG-6200 mobile phone.

On the Application of Bonuses to Limit either the term of an Assurance or the number of payments to be made under it being Excerpts from a paper read before the Actuarial Society of Edinburgh, on 5th December, 1867

The application of bonus to the hastening of the time fixed by the original contract for the payment of a life assurance policy, and the using of it to extinguish the premiums payable during the latter years of life, are systems, which, partly from their growing favor with the public, and consequent adoption by many offices, and still more from the fact, that the subject is by no means exhausted, notwithstanding various able articles that have appeared in this Journal, seem to me to render apology unnecessary for again treating of it.