Significantly higher serum titanium concentrations were observed in subjects with titanium spinal instrumentation when compared with controls. Continued research is necessary to examine the relationship between Ti interbody devices and cross connectors with regards to serum ion levels.

Staged hybrid ablation of AF significantly increases the likelihood of discovering incomplete PVI at the time of endocardial mapping versus a same-day procedure. However, the staged approach did not improve time to first AT/AF recurrence.

BackgroundVentricular arrhythmias are common in patients with left ventricular assist devices (LVADs) but are often hemodynamically tolerated. Optimal implantable cardioverter defibrillator (ICD) tachy‐programming strategies in patients with LVAD have not been determined. We sought to determine if an ultra‐conservative ICD programming strategy in patients with LVAD affects ICD shocks.Methods and ResultsAdult patients with an existing ICD undergoing continuous flow LVAD implantation were randomized to standard ICD programming by their treating physician or an ultra‐conservative ICD programming strategy utilizing maximal allowable intervals to detection in the ventricular fibrillation and ventricular tachycardia zones with use of ATP. Patients with cardiac resynchronization therapy (CRT) devices were also randomized to CRT ON or OFF. Patients were followed a minimum of 6 months. The primary outcome was time to first ICD shock. Among the 83 patients studied, we found no statistically significant difference in time to first ICD shock or total ICD shocks between groups. In the ultra‐conservative group 16% of patients experienced at least one shock compared with 21% in the control group (P=0.66). There was no difference in mortality, arrhythmic hospitalization, or hospitalization for heart failure. In the 41 patients with CRT ICDs fewer shocks were observed with CRT‐ON but this was not statistically significant: 10% of patients with CRT‐ON (n=21) versus 38% with CRT‐OFF (n=20) received shocks (P=0.08).ConclusionsAn ultra‐conservative programming strategy did not reduce ICD shocks. Programming restrictions on ventricular tachycardia and ventricular fibrillation zone therapy should be reconsidered for the LVAD population. The role of CRT in patients with LVAD warrants further investigation.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01977703.

dylglycerol phosphate ( 3 ). For each of these lipids, there can exist several molecular species arising from the different lengths, unsaturation, and/or cyclopropane analogs of the acyl chains ( 4 ). The complexity of the E. coli lipidome, however, is even greater than can be explained by acyl chain heterogeneity. Numerous additional minor lipids are present in wild-type cells, as judged by isotopic labeling experiments and two-dimensional TLC ( 3 ). Many of these species cannot be identifi ed by their migration with standards of known lipids or biosynthetic precursors.Electrospray ionization-mass spectrometry (ESI-MS) is well suited to the analysis of intact lipids ( 5 ). Fragmentation during ionization is minimized and the sensitivity is high ( 6, 7 ). In addition, collision-induced dissociation mass spectrometry (MS/MS) allows for the structural analysis of the lipid ion of interest and, when combined with the high mass accuracy of time-of-fl ight mass spectrometers, can be used to propose a molecular formula for a particular ion.Current applications of mass spectrometry to lipid analysis have focused mainly on the quantifi cation of known lipid species, often coupling liquid chromatography directly to the mass spectrometer ( 8-10 ). These analyses compare levels of known lipid species present under various growth conditions or disease states. However, important changes in levels of unknown or minor lipids are diffi cult to analyze without knowledge of their structures and the availability of appropriate standards. Phosphatidylethanolamine (PE), phosphatidylglycerol (PG), and cardiolipin (CL) are the major membrane glycerophospholipids of Escherichia coli , constituting about 10% of the dry weight of the cell ( 1, 2 ). Important minor lipids include the precursors phosphatidic acid, CDP-diacylglycerol, phosphatidylserine, and phosphati-

Because of anatomical and physiological constraints, many VAs remain refractory to catheter ablation and remain a significant challenge for the electrophysiologist. While CSD has been described as a therapy for long QT syndrome and catecholaminergic polymorphic ventricular tachycardia, data regarding its use in other cardiac conditions are sparse. This series illustrates that CSD may be a viable treatment option for patients with a variety of etiologies of VAs.

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Electrospray ionization mass spectrometry is a powerful technique to analyze lipid extracts especially for the identification of new lipid metabolites. A hurdle to lipid identification is the presence of solvent contaminants that hinder the identification of low abundance species or covalently modify abundant lipid species. We have identified several non-enzymatically derived minor lipid species in lipid extracts of Escherichia coli, phosphatidylmethanol, ethyl and methyl carbamates of PE and N-succinyl PE were identified in lipid extracts of Escherichia coli. Phosphatidylmethanol (PM) was identified by exact mass measurement and collision induced dissociation tandem mass spectrometry (MS/MS). Extraction in the presence of deuterated methanol leads to a 3 atomic mass unit shift in the [M-H]- ions of PM indicating its formation during extraction. Ethyl and methyl carbamates of PE, also identified by exact mass measurement and MS/MS, are likely to be formed by phosgene, a breakdown product of chloroform. Addition of phosgene to extractions containing synthetic PE significantly increases the levels of PE-MC detected in the lipid extracts by ESI-MS. Extraction in the presence of methylene chloride significantly reduced the levels of these lipid species. N-succinyl PE is formed from reaction of succinyl-CoA with PE during extraction. Interestingly N-succinyl PE can be formed in an aqueous reaction mixture in the absence of added E. coli proteins. This work highlights the reactivity of the amine of PE and emphasizes that careful extraction controls are required to ensure that new minor lipid species identified using mass spectrometry are indeed endogenous lipid metabolites.