Background Catheter ablation for persistent atrial fibrillation (AF) is associated with less favorable outcomes than for paroxysmal AF. Substrate modification is often added to pulmonary vein isolation (PVI) to try to improve success rates. Recent studies have shown improved clinical outcomes with use of regional ablation index (AI) targets for PVI. We hypothesized that prospective use of AI-guided PVI in persistent AF patients would result in a low rate of PV reconnection at repeat electrophysiology study and that a high success rate can be achieved with durable PVI alone. Methods Forty consecutive patients with persistent AF underwent AI-guided PVI with target values of 550 for anterior and 400 for posterior left atrial regions, followed by a protocol-mandated repeat procedure after 2 months. Patients were monitored for atrial tachyarrhythmia recurrence via daily plus symptom-initiated ECG recordings for 12 months. Recurrence was defined as ≥30 seconds of any atrial tachyarrhythmia after a 3-month blanking period. Results PV reconnection was seen at repeat electrophysiology study in 22% of patients, affecting 7% of PVs. Ablation on the intervenous carina was required in 44% patients to achieve durable PVI. Atrial tachyarrhythmia recurrence was documented in 8 (20%) patients, only one of whom had PV reconnection at repeat study. At 12 months, 38/40 (95%) patients were in sinus rhythm, with 4 (10%) patients having started antiarrhythmic drugs. Higher body mass index and excess alcohol consumption were the only significant factors associated with atrial tachyarrhythmia recurrence. Conclusions Use of AI targets results in a high level of durable PVI. A good clinical outcome can be achieved in the great majority of persistent AF patients with AI-guided PVI alone. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02628730.

AI-guided ablation is associated with significant improvements in the incidence of acute PV reconnection and atrial tachyarrhythmia recurrence rate compared to CF-guided ablation, potentially due to creation of better quality lesions as suggested by greater impedance drop.

EuroSCORE II improves on the original logistic EuroSCORE, though mainly for combined AVR and CABG cases. Concerns still exist, however, over its use for isolated AVR procedures, aortic surgery and miscellaneous procedures. There is still room for improvement in risk modelling.

RDW is a significant factor after risk adjustment, determining in-hospital morbidity, mortality and long-term survival in patients post-potentially curative resections for non-small-cell lung cancer. Further work is needed to elucidate the exact mechanism of RDW impact on in-hospital morbidity, mortality and long-term survival. We speculate that subtle bone marrow dysfunction may be an issue.

Patients with ATAD who are operated on by lower-volume surgeons experience higher levels of in-hospital mortality. Directing these patients to higher-volume surgeons may be a strategy to reduce in-hospital mortality.

1. Eight women were studied under metabolic-ward conditions while consuming a constant diet throughout a single menstrual cycle. Basal body temperature, salivary and urinary hormone concentrations were used in monitoring the cycle and designing the study so that whole-body calorimetry for 36 h was conducted at four phases of the cycle in relation to the time of ovulation.2. The metabolic rate during sleep showed cyclical changes, being lowest in the late follicular phase and highest in the late luteal phase. The increase amounted to 6 1 (SD 27) YO. Energy expenditure (24 h) also increased but the change was not statistically significant (P > 0.05). Exercise efficiency did not change during the cycle.3. There were no significant changes in plasma thyroxine, 3,5,3'-triiodothyronine or free 3,5,3'-triiodothyronine concentrations to explain the metabolic rate changes; nor did they relate to urinary luteinizing hormone, pregnanediol-3a-glucuronide or oestrone-3-glucuronide excretion rates. No link with salivary cortisol or progesterone concentrations was observed, but there was a small inverse relation between the individual increase in sleeping metabolic rate and the subjects' falling ratio of urinary oestrone-3-glucuronide : pregnanediol-3a-glucuronide.The variability in energy balance of women during the menstrual cycle has been of interest since research workers in the 1920s examined the problem. At first there was little appreciation that changes might occur at times other than menstruation itself and whether systematic changes did occur was disputed (Snell et al. Hitchcock & Wardwell, 1929). Some authors failed to find any effect, whereas others showed an increase in basal metabolic rate (BMR) during the premenstrual phase of the menstrual cycle. In all these early studies the dietary intake was uncontrolled so that any changes in food intake could have affected BMR. More recently, Solomon et al. (1982) overcame this problem by measuring BMR in the course of studies which involved changing the protein intake in sequential menstrual cycles. Thus, the diet was maintained constant during a single cycle but the protein intake varied from cycle to cycle. The BMR was found to increase significantly during the luteal phase of the cycle. M E T H O D SThe purpose of the present study was to maintain food intake constant throughout the cycles of eight women who remained under metabolic-ward conditions. Total faecal and urine collections were made to quantify energy and protein losses, and thyroidal, cortisol and sex hormones were also monitored throughout the cycles to assess whether they might influence energy expenditure. Energy expenditure itself was measured under a variety of * For reprintshttps://www.cambridge.org/core/terms. https://doi

About 85.2% of patients with an indication for a primary or secondary prevention ICD have a surface ECG that is suitable for S-ICD implantation when assessed with an S-ICD screening template. There is minor inter-observer variation in assessment of eligibility using the S-ICD screening template.

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