Reliable prediction of very late recurrence of atrial fibrillation (VLRAF) occuring >12 months after catheter ablation (CA) in apparently "cured" patients could optimize long-term follow-up and modify decision-making regarding the discontinuation of oral anticoagulant therapy. In a single-centre cohort of consecutive patients post radiofrequency AFCA, we retrospectively derived a novel score for VLRAF prediction. Of 133 consecutive post AFCA patients (mean age 56.9 ± 11.8 years, 63.9% male, 69.2% with paroxysmal AF) who were arrhythmia-free at 12 months (excluding 3-month "blanking period"), Catheter-ablation (CA) is superior to antiarrhythmic drugs (AADs) in patients with symptomatic atrial fibrillation (AF), but AF may re-occur despite multiple re-do procedures and recent technical improvements 1,2 . Most arrhythmia recurrences are identified within the first year after the procedure, while further long-term follow-up strategy for initially "successfully" treated patients is less well defined and inconsistently reported 1-9 .Several studies described a progressive increase in the arrhythmia recurrence rates over time in patients with initial post-ablation suppression of AF 4-6 . It is reported that 10-40% of patients who were arrhythmia free within the first post-procedural year experienced very late recurrence of AF (VLRAF) over long-term follow-up 2-9 . Several scoring systems (i.e., the APPLE, ALARMc and BASE-AF2 score) were recently proposed to predict the short-term risk of AF recurrence after the procedure 10-12 . However, none of these scores have addressed VLRAF occurring in patients who were free of AF at 1 year post procedure. Importantly, reliable identification of increased risk of VLRAF could strongly influence decision-making regarding the long-term use of oral anticoagulation and/or AAD therapy as well as the long-term monitoring strategy after the procedure 1,2 . Due to altered risk/benefit ratio, multiple AF ablation procedures may not be justified in patients at high risk of recurrent AF, and reliable prediction of VLRAF could optimize the patient selection for re-do CA 1,2,9,11 .

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IntroductionCardiac tamponade (CT) is a life-threatening complication of radiofrequency ablation (RFA). The course and outcome of CT in low-to-medium volume electrophysiology centers are underreported.MethodsWe analyzed the incidence, management and outcomes of CT in 1500 consecutive RFAs performed in our center during 2011–2016.ResultsOf 1500 RFAs performed in 1352 patients (age 55 years, interquartile range: 41–63), 569 were left-sided procedures (n = 406 with transseptal access). Conventional RFA or irrigated RFA was performed in 40.9% and 59.1% of procedures, respectively. Ablation was performed mostly for atrioventricular nodal reentrant tachycardia (25.4%), atrial fibrillation (AF; 18.5%), atrial flutter (18.4%), accessory pathway (16.5%) or idiopathic ventricular arrhythmia (VA; 12.3%), and rarely for structural VA (2.1%). CT occurred in 12 procedures (0.8%): 10 AF ablations, 1 idiopathic VA and 1 typical atrial flutter ablation. Factors significantly associated with CT were older age, pre-procedural oral anticoagulation, left-sided procedures, transseptal access, AF ablation, irrigated RFA and longer fluoroscopy time (on univariate analysis), and AF ablation (on multivariable analysis). The perforation site was located in the left atrium (n = 7), right atrium (n = 3), or in the left ventricle or coronary sinus (n = 1 each). Upon pericardiocentesis, two patients underwent urgent cardiac surgery because of continued bleeding. There was no fatal outcome. During the follow-up of 19 ± 14 months, eight patients were arrhythmia free.ConclusionIncidence of RFA-related CT in our medium-volume center was low and significantly associated with AF ablation. The outcome of CT was mostly favorable after pericardiocentesis, but readily accessible cardiothoracic surgery back-up should be mandatory in RFA centers.

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Increased pollution by plastics has become a serious global environmental problem, but the concerns for human health have been raised after reported presence of microplastics (MPs) and nanoplastics (NPs) in food and beverages. Unfortunately, few studies have investigate the potentially harmful effects of MPs/NPs on early human development and human health. Therefore, we used a new platform to study possible effects of polystyrene NPs (PSNPs) on the transcription profile of preimplantation human embryos and human induced pluripotent stem cells (hiPSCs). Two pluripotency genes, LEFTY1 and LEFTY2, which encode secreted ligands of the transforming growth factor‐beta, were downregulated, while CA4 and OCLM, which are related to eye development, were upregulated in both samples. The gene set enrichment analysis showed that the development of atrioventricular heart valves and the dysfunction of cellular components, including extracellular matrix, were significantly affected after exposure of hiPSCs to PSNPs. Finally, using the HiPathia method, which uncovers disease mechanisms and predicts clinical outcomes, we determined the APOC3 circuit, which is responsible for increased risk for ischemic cardiovascular disease. These results clearly demonstrate that better understanding of NPs bioactivities and its implications for human health is of extreme importance. Thus, the presented platform opens further aspects to study interactions between different environmental and intracellular pollutions with the aim to decipher the mechanism and origin of human diseases.

To our knowledge, this is the first study systematically investigating the reconnection of standardized left atrium linear lesions such as RL and MIL after RF-CA for AF in consecutive patients. The RL and MIL 3-month reconnection rates were relatively low (28% and 24%), with poor anatomical concordance between the sites with acute and 3-month reconnections.

Grape pomace (grape skin, seeds, and stems) represents a valuable source of bioactive compounds, thus the interest in making use of these wine waste products is increasing. Prokupac is an autochthonous Serbian variety of black grape with a long tradition in production of red wine. Identification of the superficial polyphenolic compounds by LC/MS revealed presence of 19 compounds including hydroxybenzoic acid derivatives, ellagic acid derivatives, flavan‐3‐ol monomers, proanthocyanidins, and flavonols. Catechin and epicatechin together with proanthocyanidins were the most abundant compounds and the highest content of phenolic compounds was determined in Prokupac clones 43/1, 40/1, and 40/2. Grape seed oil consisted of dominantly UFA (87–95 %) where methyl linoleate was the most abundant in all samples (69–81 %). Palmitic (3–8 %) and stearic acid (2–4 %) methyl esters were dominant SFA. Prokupac clone 43/3 was the most abundant in UFA (95 %) with the lowest percentage of SFA (5 %), while clones 41/1 and 43/5 had the lowest percentage of UFA (87 %) and the highest content of SFA (13 %). Favorable chemical profile of Prokupac clone seeds implicates its potential to be used as a raw material in further processing and possibility to be included as one of the quality parameters in further selection of the most interesting Prokupac clone.