Background-Endocardial mapping before sustained monomorphic ventricular tachycardia (SMVT) induction may reduce mapping time during tachycardia and facilitate the ablation of unmappable VT. Methods and Results-Left ventricular electroanatomic voltage maps obtained during right ventricular apex pacing in 26 patients with chronic myocardial infarction referred for VT ablation were analyzed to identify conducting channels (CCs) inside the scar tissue. A CC was defined by the presence of a corridor of consecutive electrograms differentiated by higher voltage amplitude than the surrounding area. The effect of different levels of voltage scar definition, from 0.5 to 0.1 mV, was analyzed. Twenty-three channels were identified in 20 patients. The majority of CCs were identified when the voltage scar definition was Յ0.2 mV. Electrograms with Ն2 components were recorded more frequently at the inner than at the entrance of CCs (100% versus 75%, PՅ0.01). The activation time of the latest component was longer at the inner than at the entrance of CCs (200Ϯ40 versus 164Ϯ53 ms, PՅ0.001). Pacing from these CCs gave rise to a long-stimulus QRS interval (110Ϯ49 ms). Radiofrequency lesion applied to CCs suppressed the inducibility in 88% of CC-related tachycardias. During a follow-up of 17Ϯ11 months, 23% of the patients experienced a VT recurrence. Conclusions-CCs represent areas of slow conduction that can be identified in 75% of patients with SMVT. A tiered decreasing-voltage definition of the scar is critical for CC identification.
We studied 21 patients with chronic obstructive pulmonary disease aged [mean (SD)] 63 (10) years, with a mean forced expiratory volume in 1 s of 40 (6)% and a peak oxygen uptake of 67 (11)% of predicted values. Patients trained for 6 weeks on a cycle ergometer at high work-rates (WR). Near-infrared spectroscopy was used to obtain the time-constant of the deoxygenation recovery signal (tauHbO(2)) during three constant WR exercise tests, one below and two above the lactic acidosis threshold (theta(L)). Glycolytic and oxidative enzymes and lactate concentrations were assessed in muscle biopsies. The tauHbO(2) decreased significantly in all three constant WR tests: -18 (24)s, -20 (23) s and -13 (22) s, respectively. Endurance time increased in the higher WR tests, by 5.7 (4.8) min and 3.6 (2.7) min, respectively. The activity of citrate-synthase (CS) and creatine-kinase changed significantly from 20 (10) to 30 (13) micro mol x min(-1) x g(-1)and from 3.825 (950) to 3.402 (526) micro mol x min(-1) x g(-1), respectively. Training also improved significantly the mean response time of the on-transient of oxygen uptake (tau'VO(2)) of the below-theta(L) test. We found significant correlations between changes in CS and changes in tauHbO(2), tau'VO(2) and endurance time. We conclude that leg training accelerates the speed of re-oxygenation of the vastus lateralis muscle after exercise. This improvement is correlated to changes in the oxidative enzymes.
Stakeholder participation is expected to improve the efficiency, equity, and sustainability of natural resource management research and development (R&D) projects by ensuring that research reflects users’ priorities, needs, capabilities, and constraints. Use of participatory methods and tools is growing rapidly; however, there is little systematic evidence about what participation actually means in practice, or about what difference it makes. Based on an inventory of 59 self‐described participatory R&D projects in the area of natural resource management, this article characterizes the typical project and analyzes how stakeholders are selected, how they participate in the research process, and what their involvement means for project costs and impacts. The results suggest that, while projects are generating a range of direct and indirect benefits for participants, more careful attention needs to be paid to achieving equitable impacts. Current practices may lag behind best practices in key areas, such as power sharing and participant selection, and may therefore be missing important contributions from women and other marginalized groups.
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