Left sided ablation for Atrioventricular Nodal Re-entrant Tachycardia: Frequency,Characteristics and Outcomes

BackgroundLeft-sided ablation, targeting left inferior AV nodal extensions, is thought to be necessary for success in a small proportion of atrioventricular nodal re-entrant tachycardia (AVNRT) ablations; however Indian data are scarce in this regard.MethodsConsecutive cases of AVNRT undergoing slow pathway ablation in a single centre over an 18-month period were retrospectively analyzed. Left-sided ablation at the posteroseptal mitral annulus was performed if right-sided ablation failed to abolish AVNRT.ResultsFrom January 2017 to June 2018, out of 215 consecutive supraventricular tachycardia (SVT) cases, 154 (71.6%) were AVNRT (47.1 ± 13.1 years, 46.1% male). Trans-septal ablation was required in 5 (3.2%) cases (mean age 48.8 ± 9.4 years; 4 female, 1 male); all with typical (slow-fast) form of AVNRT. Compared with cases needing only right-sided ablation, radiofrequency time (50.8 ± 16.9 vs. 9.9 ± 8.5 min; p = 0.005) and procedure time (166.0 ± 35.0 vs 79.6 ± 35.9 min; p = 0.004) were significantly longer for trans-septal cases, while baseline intervals and tachycardia cycle length were not significantly different. Junctional ectopy was seen in only 2 of the 5 cases during left-sided ablation, but acute success (non-inducibility) was obtained in 3 cases. There were no instances of AV block. Over mean follow-up of 12.2 ± 4.0 months, clinical recurrence of AVNRT occurred in one case, while others remained arrhythmia-free without medication.ConclusionLeft-sided ablation was required in a small proportion of AVNRT ablations. Trans-septal approach targeting the posteroseptal mitral annulus was safe and yielded good mid-term clinical success.     

Dyssynchronous Ventricular Activation in Asymptomatic Wolff-Parkinson-White Syndrome: A Risk Factor for Development of Dilated Cardiomyopathy

A subset of children and adults with Wolff-Parkinson-White (WPW) syndrome develop dilated cardiomyopathy (DCM). Although DCM may occur in symptomatic WPW patients with sustained tachyarrhythmias, emerging evidence suggests that significant left ventricular dysfunction may arise in WPW in the absence of incessant tachyarrhythmias. An invariable electrophysiological feature in this non-tachyarrhythmia type of DCM is the presence of a right-sided septal or paraseptal accessory pathway. It is thought that premature ventricular activation over these accessory pathways induces septal wall motion abnormalities and ventricular dyssynchrony. LV dyssynchrony induces cellular and structural ventricular remodelling, which may have detrimental effects on cardiac performance. This review summarizes recent evidence for development of DCM in asymptomatic patients with WPW, discusses its pathogenesis, clinical presentation, management and treatment. The prognosis of accessory pathway-induced DCM is excellent. LV dysfunction reverses following catheter ablation of the accessory pathway, suggesting an association between DCM and ventricular preexcitation. Accessory pathway-induced DCM should be suspected in all patients presenting with heart failure and overt ventricular preexcitation, in whom no cause for their DCM can be found.     

Patterns of mortality in endangered Cook Inlet beluga whales: Insights from pairing a long-term photo-identification study with stranding records

Mortality is a demographic metric crucial for understanding the dynamics of endangered populations such as Cook Inlet beluga whales (CIBWs, Delphinapterus leucas), but patterns of mortality are currently not well understood for CIBWs, making decisions about recovery actions challenging. We combined long-term photo-ID data from approximately 420 individual belugas identified during the period 2005–2017 with stranding data from 95 dead belugas to identify patterns of mortality with respect to age, sex, geographic range, cause of death, and to estimate minimum mortality rates. Reported mortality was greatest for adults of reproductive age, followed by calves, with fewer subadults and no adults older than 49 years in the stranding data set despite lifespans of 70+ years reported in other beluga populations. Dead females and males were evenly represented. Live stranding was the predominant assigned cause of death but represented only ~33% of deaths of known cause. Causal factors for the majority of deaths and live strandings are unknown. Annual mortality estimated from reported carcasses relative to total population size averaged 2.2%. Our analysis advances our current understanding of mortality patterns in CIBWs but linking a greater proportion of carcasses to photo-ID individuals would further improve our understanding; we conclude with recommendations for achieving this.     

Preliminary observations on the collection of baboon oviducal fluid

Five sexually mature and regularly ovulating baboons (Papio cyanocephalus) were subjected to bilateral oviducal cannulation. Prior to failure of the primary cannulation, peri-ovulatory fluids were collected during three menstrual cycles from one animal, during two cycles from a second animal, and during a single cycle from each of two additional animals. These four animals were subsequently recannulated and oviducal fluids obtained during six additional cycles, but tubal fluid collection after the second procedure was generally less satisfactory than following the initial manipulation. Two attempted cannulations in the fifth animal did not result in oviducal fluid collection. Of the 13 menstrual cycles during which tubal fluid was collected, four were apparently anovulatory. Collections from two of these as well as from three ovulatory cycles were characterized by erratic flow and mucous-blood contamination. Tubal fluids were collected without apparent technical interference or serum contamination from six ovulatory and two anovulatory cycles. Maximum volumes (1.77±.34 ml/oviduct/24 hours) of tubal fluids were collected during the 48 hours following the midcycle LH peak. Thereafter, the rate of oviducal fluid collection declined rapidly.