A trial fibrillation (AF) is the most common human arrhythmia and is associated with increased risk for ischemic stroke and cardiovascular mortality. The pulmonary veins (PV) are important trigger sites of paroxysmal AF, 1 and their electric isolation from the left atrium (LA) is associated with a high rate of freedom from AF in patients without comorbidities.2 In persistent AF, however, additional arrhythmogenic atrial sites are responsible for AF maintenance and pulmonary vein isolation (PVI) is much less successful with reported 5-year AF freedom rate of 20% after a single and 45% after multiple procedures.3,4 Additional ablation strategies have been developed to improve outcomes including linear lesions and ablation of complex-fractionated atrial electrograms (CFAE) in the left and right atrium (RA), both as a stand-alone approach 5 or in addition to PV isolation. 6 Albeit improving the rate of AF-free survival in some studies, these ablation strategies are inconsistent because of the variable definition and significance of CFAE and require prolonged radiofrequency delivery times. Moreover, the recent multicenter trial, Substrate and Trigger Ablation for Reduction of Atrial Fibrillation 2 (STAR AF 2), did not reveal significant differences in rate of arrhythmia freedom between PVI only versus PVI+CFAE ablation versus PVI+linear ablation: all the 3 strategies resulted in a 1-year arrhythmia freedom of about 50%. 8,9 Recent clinical and experimental studies have identified more specific electrograms in a discrete point or within a region suggestive of a localized reentry during ongoing AF and have been associated with higher ablation impact on AF. Original ArticleBackground-Complex-fractionated atrial electrograms and atrial fibrosis are associated with maintenance of persistent atrial fibrillation (AF). We hypothesized that pulmonary vein isolation (PVI) plus ablation of selective atrial low-voltage sites may be more successful than PVI only. Methods and Results-A total of 85 consecutive patients with persistent AF underwent high-density atrial voltage mapping, PVI, and ablation at low-voltage areas (LVA<0.5 mV in AF) associated with electric activity lasting >70% of AF cycle length on a single electrode (fractionated activity) or multiple electrodes around the circumferential mapping catheter (rotational activity) or discrete rapid local activity (group I). The procedural end point was AF termination. Arrhythmia freedom was compared with a control group (66 patients) undergoing PVI only (group II). PVI alone was performed in 23 of 85 (27%) patients of group I with low amount (<10% of left atrial surface area) of atrial low voltage. Selective atrial ablation in addition to PVI was performed in 62 patients with termination of AF in 45 (73%) after 11±9 minutes radiofrequency delivery. AF-termination sites colocalized within LVA in 80% and at border zones in 20%. Singleprocedural arrhythmia freedom at 13 months median follow-up was achieved in 59 of 85 (69%) patients in group I, which was significantly higher th...

Delay in follow-up after an abnormal mammogram is associated with advanced disease stage, poorer survival, and increased anxiety. Despite the implementation of many patient navigator programs across the country, there are few published, peer-reviewed studies documenting its effectiveness. We tested the effectiveness of a patient navigator in improving timeliness to diagnosis, decreasing anxiety, and increasing satisfaction in urban minority women after an abnormal mammogram. Women with suspicious mammograms were randomly assigned to usual care (N=50) or usual care plus intervention with a patient navigator (N=55). There were no demographic differences between the two groups. Women in the intervention group had shorter times to diagnostic resolution (mean 25.0 vs. 42.7 days; p=.001), with 22% of women in the control group without a final diagnosis at 60 days vs. 6% in the intervention group. The intervention group also had lower mean anxiety scores (decrease of 8.0 in intervention vs. increase of 5.8 in control; p<.001), and higher mean satisfaction scores (4.3 vs. 2.9; p<.001). Patient navigation is an effective strategy to improve timely diagnostic resolution, significantly decrease anxiety, and increase patient satisfaction among urban minority women with abnormal mammograms.

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