Length of hospital stay for elective electrophysiological procedures: a survey from the European Heart Rhythm Association

AIMS: Electrophysiological (EP) operations that have traditionally involved long hospital lengths of stay (LOS) are now being undertaken as day case procedures. The coronavirus disease-19 pandemic served as an impetus for many centres to shorten LOS for EP procedures. This survey explores LOS for elective EP procedures in the modern era. METHODS AND RESULTS: An online survey consisting of 27 multiple-choice questions was completed by 245 respondents from 35 countries. With respect to de novo cardiac implantable electronic device (CIED) implantations, day case procedures were reported for 79.5% of implantable loop recorders, 13.3% of pacemakers (PMs), 10.4% of implantable cardioverter defibrillators (ICDs), and 10.2% of cardiac resynchronization therapy (CRT) devices. With respect to CIED generator replacements, day case procedures were reported for 61.7% of PMs, 49.2% of ICDs, and 48.2% of CRT devices. With regard to ablations, day case procedures were reported for 5.7% of atrial fibrillation (AF) ablations, 10.7% of left-sided ablations, and 17.5% of right-sided ablations. A LOS ≥ 2 days for CIED implantation was reported for 47.7% of PM, 54.5% of ICDs, and 56.9% of CRT devices and for 54.5% of AF ablations, 42.2% of right-sided ablations, and 46.1% of left-sided ablations. Reimbursement (43-56%) and bed availability (20-47%) were reported to have no consistent impact on the organization of elective procedures. CONCLUSION: There is a wide variation in the LOS for elective EP procedures. The LOS for some procedures appears disproportionate to their complexity. Neither reimbursement nor bed availability consistently influenced LOS

Type 2 diabetes – an autoinflammatory disease driven by metabolic stress

Type 2 diabetes has traditionally been viewed as a metabolic disorder characterised by chronic high glucose levels, insulin resistance, and declining insulin secretion from the pancreas. Modern lifestyle, with abundant nutrient supply and reduced physical activity, has resulted in dramatic increases in the rates of obesity-associated disease conditions, including diabetes. The associated excess of nutrients induces a state of systemic low-grade chronic inflammation that results from production and secretion of inflammatory mediators from the expanded pool of activated adipocytes. Here, we review the mechanisms by which obesity induces adipose tissue dysregulation, detailing the roles of adipose tissue secreted factors and their action upon other cells and tissues central to glucose homeostasis and type 2 diabetes. Furthermore, given the emerging importance of adipokines, cytokines and chemokines in disease progression, we suggest that type 2 diabetes should now be viewed as an autoinflammatory disease, albeit one that is driven by metabolic dysregulation

Modelling friction stir welding with thermally coupled fluid dynamics

The computational fluid dynamics approach for high velocity deformation processes as friction welding [1] or friction stir welding can successfully predict certain process aspects including microstructure development, if the thermal behaviour is included properly. We model the solid state material flow in the thermomechanically affected zone of the friction stir process using the Navier Stokes equations for an incompressible non Newtonian fluid field representing the ideally plastic material movement. Viscosity is related to the ideally plastic flow stress depending on temperature and strain rate. </jats:p

Modelling friction stir welding with thermally coupled fluid dynamics

The computational fluid dynamics approach for high velocity deformation processes as friction welding [1] or friction stir welding can successfully predict certain process aspects including microstructure development, if the thermal behaviour is included properly. We model the solid state material flow in the thermomechanically affected zone of the friction stir process using the Navier Stokes equations for an incompressible non Newtonian fluid field representing the ideally plastic material movement. Viscosity is related to the ideally plastic flow stress depending on temperature and strain rate

Cryoballoon-ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) Background Co-existence of atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) is common and severely affects morbidity and prognosis. Purpose This study evaluates outcome after cryoballoon-ablation for AF in HFpEF compared to patients without heart failure employing multiple diagnostic modalities. Methods A total of 102 patients scheduled for cryoablation of AF with LVEF≥50% were prospectively enrolled. Baseline evaluation included echocardiography, stress echocardiography, six-minute-walk-test, biomarker measurements and quality of life assessment (SF-36). HFpEF was diagnosed according to current guidelines and confirmed applying the HFA-PEFF-Score. Procedural parameters as well as clinical, functional and echocardiographic endpoints at follow-up ≥12 months after AF-ablation were compared between patients with and without HFpEF. Results Patients with HFpEF (n=24) were older (median: 73.5 years [Q25: 66.5 years; Q75: 75.8 years] vs. 64.5 years [Q25: 55.0 years; Q75: 71.3 years], P&amp;lt;0.001) and more often female (83.3% vs. 28.2%). They were characterized by more pronounced AF-related symptoms (median EHRA-score: 3.0 [Q25:3.0; Q75:3.0] vs. 2.0 [Q25: 2.0; Q75: 3.0], P&amp;lt;0.001), reduced distance in six-minute-walk-test (median 487.5m [Q25: 378.1m; Q75: 517.8m] vs. 539.0m [Q25: 489.3m; Q75:589.1 m], P&amp;lt;0.001), and higher mean left atrial (LA)-pressure measured at the needle tip at transseptal puncture (14.0mmHg [Q25: 10.3mmHg; Q75: 21.5mmHg] vs. 10.0 mmHg [Q25: 8.0mmHg; Q75: 13.3mmHg], P=0.008). Procedural parameters were comparable between the two subgroups. Rates of AF-recurrence, repeat AF-ablation and AF-related re-hospitalization were increased in HFpEF (Figure 1A-C), which was confirmed after adjusting for intergroup differences in sex and age distribution by multiple regression analysis. There was no improvement of heart failure-related symptoms and persistent elevation of cardiac biomarkers, even in HFpEF-patients with successful restoration of sinus rhythm at follow-up (Figure 2A-C). Echocardiographic follow-up showed progression of adverse LA-remodeling (LA-volume index at baseline: 35.8ml/m2 [Q25: 32.2ml/m2; Q75: 41.9ml/m2] vs. 12-month follow-up: 40.5ml/m2 [Q25: 36.0ml/m2; Q75: 51.4ml/m2], P=0.017) and no improvement in diastolic function in HFpEF (E/e’ at baseline: 9.7 [Q25: 7.8; Q75: 12.1] vs 12-month follow-up: 10.2 [Q25: 8.4; Q75: 11.8], P=0.874), in particular in patients with HFpEF and AF-recurrence. Quality of life improved in patients without HFpEF in both physical and mental summary scales, however, no beneficial effect was seen in HFpEF. Conclusion Patients with HFpEF constitute a distinct subgroup with an elevated risk for arrhythmia recurrence after cryoablation of AF. Functional hallmarks and heart-failure related symptoms of HFpEF persisted in our cohort, irrespective of rhythm-status at follow-up. Future research is needed to optimize tailored treatment strategies in HFpEF. </jats:sec

Analysis of Dual Class I Histone Deacetylase and Lysine Demethylase Inhibitor Domatinostat (4SC-202) on Growth and Cellular and Genomic Landscape of Atypical Teratoid/Rhabdoid

Central nervous system atypical teratoid/rhabdoid tumors (ATRTs) are rare and aggressive tumors with a very poor prognosis. Current treatments for ATRT include resection of the tumor, followed by systemic chemotherapy and radiation therapy, which have toxic side effects for young children. Gene expression analyses of human ATRTs and normal brain samples indicate that ATRTs have aberrant expression of epigenetic markers including class I histone deacetylases (HDAC’s) and lysine demethylase (LSD1). Here, we investigate the effect of a small molecule epigenetic modulator known as Domatinostat (4SC-202), which inhibits both class I HDAC’s and Lysine Demethylase (LSD1), on ATRT cell survival and single cell heterogeneity. Our findings suggest that 4SC-202 is both cytotoxic and cytostatic to ATRT in 2D and 3D scaffold cell culture models and may target cancer stem cells. Single-cell RNA sequencing data from ATRT-06 spheroids treated with 4SC-202 have a reduced population of cells overexpressing stem cell-related genes, including SOX2. Flow cytometry and immunofluorescence on 3D ATRT-06 scaffold models support these results suggesting that 4SC-202 reduces expression of cancer stem cell markers SOX2, CD133, and FOXM1. Drug-induced changes to the systems biology landscape are also explored by multi-omics enrichment analyses. In summary, our data indicate that 4SC-202 has both cytotoxic and cytostatic effects on ATRT, targets specific cell sub-populations, including those with cancer stem-like features, and is an important potential cancer therapeutic to be investigated in vivo.</jats:p