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Background Very high‐power short‐duration (vHPSD) catheters are associated with less irrigation fluid load than standard (STD RF) ablation catheters. However, the impact of this fluid reduction on biomarkers in pulmonary vein isolation (PVI) for atrial fibrillation (AF) remains unknown. Methods and Aim Biomarkers of heart failure, myocardial injury, and systemic inflammation status as Brain Natriuretic Peptide (BNP), high‐sensitivity Troponin I (hsTnI), and C‐reactive protein (CRP) were collected pre‐ and post‐procedure of PVI for symptomatic AF. The study aimed to assess the impact of vHPSD catheter compared to an STD catheter (respectively irrigation of 8 vs. 15 mL/min during ablation) on biomarker alterations. Results The study included 83 consecutive patients (59 males [71.1%], mean age 62.6 ± 11 years), with vHPSD catheters used in 53 cases (63.9%). No significant baseline differences were observed between groups.Fluid irrigation resulted in significantly lower with vHPSD catheter than STD RF (434.8 ± 105.6 vs. 806.6 ± 256.5 mL, p < .001). Correspondingly, BNP variation was significantly lower in the vHPSD group than in the STD RF group, both in absolute change (12 [IQR −9–47] pg/mL vs. 44.5 [IQR 21–88.7] pg/mL, p = .002) and percentage change (16.3 [IQR −13.2–108.6] % vs. 84.1 [IQR 32.5–172.1] %, p = .012). When considering absolute values, a statistically significant increase in BNP was found only in the STD catheter group (from 52 [IQR 35.2–113.5] to 113 [IQR 66.7–189.5] pg/mL, p < .001), whereas no significant increase was observed in the vHPSD group (p = .06). CRP levels increased post‐PVI in both groups, but the delta was significantly lower in the vHPSD group (p = .025). No significant differences in post‐procedural hsTnI were detected between groups. Conclusion The use of a vHPSD catheter is associated with reduced fluid irrigation and a correspondingly smaller increase in BNP, a biomarker indicative of fluid overload and heart failure. Differences in fluid irrigation (A), pre‐ and post‐procedure BNP absolute values change (B), and BNP percentage values change (C) in standard catheters (STD RF) versus very high‐power short‐duration catheters (vHPSD). vHPSD catheters use is associated with significantly less irrigation fluid than with standard STD RF catheters during pulmonary vein isolation for atrial fibrillation. This reduced fluid load is associated with a significantly smaller increase in BNP levels, suggesting a lower impact on fluid overload and reducing the risk of heart failure.

During the past decade, embodied knowledge has provided novel important insights to rethink mediation technology, thereby paving the way for a transdisciplinary approach to wearable technologies. Stemming from a phenomenological-based approach and considering current trends in sonic interaction design, this article proposes an extensive account on embodied approaches to mediation technology and underlines the increasing importance of somatic knowledge within the field. It also presents an autoethnographic analysis of my own performance, which provides an original contribution to the artistic application of wearable technologies. Stemming from an ongoing research-creation on musical improvisation with biophysical technologies, the case study emphasises how an embodied and visceral approach to interaction can transform wearable devices into an active sensory-perceptual mode of experiencing, which is capable of stimulating the performer’s sensorimotor metaplasticity. The reconfiguration of a body’s automations through the use of sound feedback is a process that unfolds with a high degree of sensitivity in which the body can be poetically understood as an emergent territoriality, inhabited and transfigured by the sound.

Key Clinical Message Effective and stable contact between the catheter tip and the tissue is crucial for both mapping and lesion formation during cardiac ablation procedures. Contact force catheter may be not only a therapeutic approach to arrhythmias, but also a tool for achieving accurate characterization of the arrhythmic substrate. Effective and stable contact between the catheter tip and the tissue is crucial for both mapping and lesion formation during cardiac ablation procedures. Contact force catheter may be not only a therapeutic approach to arrhythmias, but also a tool for achieving accurate characterization of the arrhythmic substrate

Key Clinical Message Sleep apnea syndrome (SAS) is a chronic condition associated with cardiovascular disease. In some pacemakers, an advanced algorithm using transthoracic impedance may be used to identify SAS. This algorithm may be also a useful tool for a long‐term monitoring helping physicians to optimize therapy, reducing risk factors, and improving therapeutic compliance. Sleep apnea syndrome (SAS) is a chronic condition associated with cardiovascular disease. In some pacemakers, an advanced algorithm using transthoracic impedance may be used to identify SAS. This algorithm may be also a useful tool for a long‐term monitoring helping physicians to optimize therapy, reducing risk factors, and improving therapeutic compliance.

Background Drugs used for sedation/analgesia may affect the basic cardiac electrophysiologic properties or even supraventricular tachycardia (SVT) inducibility. Dexmedetomidine (DEX) is a selective alpha-2 adrenergic agonist with sedative and analgesic properties. A comprehensive evaluation on use of DEX for reentrant SVT ablation in adults is lacking. The present study aims to systematically assess the impact of DEX on cardiac electrophysiology and SVT inducibility. Methods Hemodynamic, electrocardiographic, and electrophysiological parameters and SVT inducibility were assessed before and after DEX infusion in patients scheduled for ablation of reentrant SVT. Results The population of this prospective observational study included 55 patients (mean age of 58.7 ± 14 years, 29 males [52.7%]). A decrease in systolic and diastolic blood pressure and in heart rate was observed after DEX infusion ( p = 0.001 for all). DEX increased corrected sinus node refractory time, atrial effective refractory period, AH interval, AV Wenckebach cycle length, and AV node effective refractory period without affecting the His-Purkinje conduction or ventricular myocardium refractoriness. No AV blocks or sinus arrests occurred during DEX infusion. Globally, there was no difference in SVT inducibility in basal condition or after DEX infusion (46/55 [83.6%] vs. 43/55 [78.1%] patients; p = 0.55), without a difference in isoprenaline use ( p = 1.0). In 4 (7.3%) cases, the SVT was inducible only after DEX infusion. In 34.5% of cases, DEX infusion unmasked the presence of an obstructive sleeping respiratory pattern, represented mainly by snoring. Conclusions DEX depresses sinus node function and prolongs atrioventricular refractoriness without significantly affecting the rate of SVT inducibility in patients scheduled for reentrant SVT ablation

PurposeRadiation exposure related to conventional tachyarrhythmia radiofrequency catheter ablation (RFCA) carries small but definite risk for both patients and operators. Today, non-fluoroscopic mapping systems enable to perform catheter ablation with minimal or zero fluoroscopy. The purpose of this study was to evaluate the long-term outcome of patients who had undergone “Zero X-ray” ablation, since no information is available on the very long-term benefits.MethodsA total of 272 arrhythmias in 266 patients have been treated with catheter ablation by means of a zero-ray approach guided only by a nonconventional mapping system (EnSite NavX™, Ensite™ Velocity™ mapping system; subsequently Ensite™ Precision™ Abbott, St. Paul, MN). Fluoroscopy was never used.ResultsOver a period of 6 years, patients were followed up for an average of 2.9 ± 1.6 years. A 100% rate of acute success was observed in the study population, with a complication rate of 0.8%. Chronic success was achieved in 90.8% of the total number of procedures (272). Patients in whom the same arrhythmia recurred during follow-up underwent to a redo catheter ablation procedure in 60.0% of cases, while the remaining 40.0% underwent pharmacological treatment. A new post-ablation arrhythmia occurred in 7.7% of the sample.ConclusionsThe non-fluoroscopic approach is a feasible and safe alternative to fluoroscopy for arrhythmias ablation. This method ensures low complications rates, high acute procedural success rates, and comparable long-term outcomes with clinical benefits for both patients and physicians. The complete elimination of fluoroscopy during catheter ablation is advantageous and does not reduce patient safety.

La fibrillazione atriale (FA) è l’aritmia di più frequente riscontro in età avanzata. I pazienti anziani hanno numerose patologie associate, sono trattati con terapie complesse e vanno spesso incontro alle complicanze dell’aritmia. La FA può così essere considerata un marker di fragilità. Nelle linee guida si possono trovare solo poche raccomandazioni sulla gestione del paziente fragile. Il Frailty in Atrial Fibrillation Survey Study (FAST) è stato ideato per tentare di quantificare e superare il “gap” di conoscenze su FA e fragilità. Un team multidisciplinare di cardiologi, geriatri e internisti ha partecipato al progetto. In una prima fase, è stata condotta un’indagine per chiarire le differenze correlate alla specialità nella definizione di fragilità e nella gestione della terapia anticoagulante orale (TAO) dei pazienti fragili. Nella seconda fase, sono stati redatti capitoli specifici su: epidemiologia di FA e fragilità, rete per la gestione dell’aritmia, strategie diagnostiche (includendo alcuni strumenti essenziali della valutazione multidimensionale geriatrica), TAO e scelta tra una strategia di controllo del ritmo o della frequenza cardiaca. In ognuno dei capitoli, a partire dalle raccomandazioni delle linee guida, i 47 centri italiani partecipanti al progetto hanno presentato e discusso le evidenze attuali. Nella terza fase del FAST, i risultati della survey e la versione finale dei singoli capitoli sono stati uniti nella stesura di questo documento. Emerge una rilevante mancanza di omogeneità nel definire la fragilità. L’integrazione culturale e operativa di cardiologi, geriatri e internisti rappresenta lo strumento più efficace per superare le differenze, migliorando la gestione dei pazienti anziani fragili.

As a fly tracking the availability of fruits along climatic gradients, Drosophila suzukii is deemed to be rather flexible in relation to environmental factors, among which temperature is a major player. We sampled potential wild host fruits of D. suzukii along two elevational gradients in mountain areas of north-eastern Italy, in order to measure fly performance in relation to temperature. In addition, we used a strong natural temperature gradient in an open-top cave, covering the lower range of temperatures known for D. suzukii , to deploy laboratory stock colonies to mimic conditions existing along elevational gradients. At least nine wild host species yielded adults of D. suzukii in the mountain area ( Daphne mezereum, Lonicera alpigena, Lonicera caerulea, Lonicera nigra, Lonicera xylosteum, Rubus caesius, Rubus saxatilis, Sambucus nigra, and Sambucus racemosa ) when the daily average temperature in the three preceding weeks was at least 11.1 °C. Similar results were obtained with the laboratory colonies reared on an artificial medium in the cave, where oviposition and development from egg to adult occurred at above 11.6 °C. Both values are lower than previously recorded lower thresholds for development at both constant and fluctuating temperatures. These findings indicate that D. suzukii performs well at low temperatures, suggesting that population buildup may occur even under these conditions, with likely consequences on crops and wild host reproduction.

Background To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods This is a point prevalence study (called “Delirium Day”) including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01–1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12–1.27), dementia (OR 3.25, 95 % CI 2.41–4.38), malnutrition (OR 2.01, 95 % CI 1.29–3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45–2.82), feeding tubes (OR 2.51, 95 % CI 1.11–5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06–1.87), urinary catheters (OR 1.73, 95 % CI 1.30–2.29), and physical restraints (OR 1.84, 95 % CI 1.40–2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29–3.14), while admission to other settings was not. Conclusions Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The “Delirium Day” project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys.

Prolonged diapause occurs in a number of insects and is interpreted as a way to evade adverse conditions. The winter pine processionary moths ( Thaumetopoea pityocampa and Th. wilkinsoni ) are important pests of pines and cedars in the Mediterranean region. They are typically univoltine, with larvae feeding across the winter, pupating in spring in the soil and emerging as adults in summer. Pupae may, however, enter a prolonged diapause with adults emerging one or more years later. We tested the effect of variation in winter temperature on the incidence of prolonged diapause, using a total of 64 individual datasets related to insect cohorts over the period 1964–2015 for 36 sites in seven countries, covering most of the geographic range of both species. We found high variation in prolonged diapause incidence over their ranges. At both lower and upper ends of the thermal range in winter, prolonged diapause tended to be higher than at intermediate temperatures. Prolonged diapause may represent a risk-spreading strategy to mitigate climate uncertainty, although it may increase individual mortality because of a longer exposure to mortality factors such as predation, parasitism, diseases or energy depletion. Climate change, and in particular the increase of winter temperature, may reduce the incidence of prolonged diapause in colder regions whereas it may increase it in warmer ones, with consequences for population dynamics.