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The mitochondrial matrix peptidase CLPP is crucial during cell stress. Its loss causes Perrault syndrome type 3 (PRLTS3) with infertility, neurodegeneration, and a growth deficit. Its target proteins are disaggregated by CLPX, which also regulates heme biosynthesis via unfolding ALAS enzymes, providing access for pyridoxal-5′-phosphate (PLP). Despite efforts in diverse organisms with multiple techniques, CLPXP substrates remain controversial. Here, avoiding recombinant overexpression, we employed complexomics in mitochondria from three mouse tissues to identify endogenous targets. A CLPP absence caused the accumulation and dispersion of CLPX-VWA8 as AAA+ unfoldases, and of PLPBP. Similar changes and CLPX-VWA8 co-migration were evident for mitoribosomal central protuberance clusters, translation factors like GFM1-HARS2, the RNA granule components LRPPRC-SLIRP, and enzymes OAT-ALDH18A1. Mitochondrially translated proteins in testes showed reductions to <30% for MTCO1-3, the mis-assembly of the complex IV supercomplex, and accumulated metal-binding assembly factors COX15-SFXN4. Indeed, heavy metal levels were increased for iron, molybdenum, cobalt, and manganese. RT-qPCR showed compensatory downregulation only for Clpx mRNA; most accumulated proteins appeared transcriptionally upregulated. Immunoblots validated VWA8, MRPL38, MRPL18, GFM1, and OAT accumulation. Co-immunoprecipitation confirmed CLPX binding to MRPL38, GFM1, and OAT, so excess CLPX and PLP may affect their activity. Our data mechanistically elucidate the mitochondrial translation fidelity deficits which underlie progressive hearing impairment in PRLTS3.
Mitochondrial matrix peptidase CLPP is crucial during cell stress. Its loss causes Perrault syndrome type 3 (PRLTS3) with infertility, neurodegeneration and growth deficit. Its target proteins are disaggregated by CLPX, which also regulates heme biosynthesis via unfolding ALAS enzyme, providing access of pyridoxal-5’-phosphate (PLP). Despite efforts in diverse organisms with multiple techniques, CLPXP substrates remain controversial. Here, avoiding recombinant overexpression, we employed complexomics in mitochondria from three mouse tissues to identify endogenous targets. CLPP absence caused accumulation and dispersion of CLPX-VWA8 as AAA+ unfoldases, and of PLPBP. Similar changes and CLPX-VWA8 comigration were evident for mitoribosomal central protuberance clusters, translation factors like GFM1-HARS2, RNA granule components LRPPRC-SLIRP, and enzymes OAT-ALDH18A1. Mitochondrially translated proteins in testis showed reductions to <30% for MTCO1-3, misassembly of complex-IV supercomplex, and accumulated metal-binding assembly factors COX15-SFXN4. Indeed, heavy metal levels were increased for iron, molybdenum, cobalt and manganese. RT-qPCR showed compensatory downregulation only for Clpx mRNA, most accumulated proteins appeared transcriptionally upregulated. Immunoblots validated VWA8, MRPL38, MRPL18, GFM1 and OAT accumulation. Coimmunoprecipitation confirmed CLPX binding to MRPL38, GFM1 and OAT, so excess CLPX and PLP may affect their activity. Our data elucidate mechanistically the mitochondrial translation fidelity deficits, which underlie progressive hearing impairment in PRLTS3.
Morbus Parkinson (abgekürzt als PD vom Englischen Parkinson’s disease) ist nach Alzheimer die zweithäufigste neurodegenerative Erkrankung. Die Hauptmerkmale sind Rigidität und Bradykinesie, sowie Tremor und posturale Instabilität. Im Gehirn lässt sich bei Parkinsonpatienten post mortem ein Verlust an Neuronen in der Substantia nigra feststellen, was zu den ersten beiden Anzeichen führt. Zudem gibt es intrazelluläre Einschlüsse in den betroffenen Nervenzellen – Lewy-Körperchen genannt – die aus Alpha-Synuklein und anderen Proteinen wie Ubiquitin zusammengesetzt sind. Außerdem ist der Eisenmetabolismus in Gehirnen von Parkinsonpatienten gestört und man findet Eisen-Ablagerungen, vor allem im Mittelhirn. Die Ursachen für PD sind bislang nicht abschließend geklärt. Der Großteil der Fälle ist sporadischer Natur mit unbekannter Ursache und nur bei einem geringen Anteil liegt eine Mutation in einem einzelnen Gen zugrunde. Die häufigsten Mutationen tritt in den Genen für Alpha-Synuklein (SNCA), PINK1 und PARKIN auf.
Die Serin-Threonin-Kinase PINK1 und die E3-Ubiquitin-Protein-Ligase PARKIN sind zwei Proteine, die in Stresssituationen an der Mitochondrien-Außenmembran am Abbau von alten oder nicht richtig funktionierenden Mitochondrien beteiligt sind. Dieser Vorgang nennt sich Mitophagie.
Die dieser Arbeit zugrunde liegenden Publikationen gehen den Zusammenhängen zwischen mitochondrialen Fehlfunktionen und der Pathogenese von PD nach. Da die Krankheit meist erst im hohen Alter auftritt, davon größtenteils ohne direkte Ursache, liegt der Schluss nahe, dass neben genetischen Ursachen auch Umweltfaktoren eine größere Rolle spielen könnten. Um dies näher zu analysieren, wurden experimentell verschiedene Stressoren eingesetzt.
Insgesamt wurden folgende Aspekte untersucht:
I. Welche Auswirkungen hat das Fehlen von PINK1 auf die Zelle? Gibt es einen Biomarker, der mit höherem Alter immer stärker verändert ist?
II. Welchen Einfluss haben Umweltfaktoren wie veränderte Eisen-Exposition auf die Zelle und was verändert sich beim Fehlen von PINK1?
III. Wie können mitochondriale Fehlfunktionen präferentiell das Nervensystem betreffen, wenn es nicht um respiratorische Insuffizienz geht?
Die einzelnen Studien zeigten folgende Ergebnisse:
Torres-Odio/Key et al. 2017 widmete sich der Suche nach molekularen Biomarkern, wodurch PD präsymptomatisch erkannt und die Progression der Erkrankung eingeschätzt werden kann. Die Transkriptom-Analyse der Kleinhirne von Mäusen mit Pink1-/--Mutation in drei verschiedenen Altersstufen zeigte eindrücklich, dass nicht ein einzelner Faktor immer stärker verändert war, sondern, dass immer mehr Faktoren und daher auch eine steigende Zahl an
Signalwegen mit höherem Alter beteiligt waren. Diese Veränderungen betrafen inflammatorische Signalwege, insbesondere Faktoren, die mit der Erkennung und Verarbeitung von zellfremden Nukleinsäuren assoziiert sind. Aufgrund der evolutionären Herkunft von Mitochondrien als frühere Protobakterien haben mitochondriale Nukleinsäuren und Proteine zum Teil bakterielle Ähnlichkeiten, und könnten bei Fehlfunktionen ins Zytosol gelangen. Vor diesem Hintergrund lassen die Ergebnisse der Studie den Schluss zu, dass das angeborene Immunsystem in Neuronen durch eine PINK1-assoziierte mitochondriale Störung aktiviert wird.
In der Publikation Key et al. 2020 wurde Eisen als ein im täglichen Leben vorkommender Stressor eingesetzt und es wurden systematisch Faktoren des Eisenstoffwechsels bei hohen und niedrigen Eisenspiegeln im Zusammenhang mit Parkinson-Mutationen untersucht. Da Eisen für die Gesundheit von Mitochondrien eine große Rolle spielt und Eisen-Chelatoren als Therapie bei PD Patienten bereits diskutiert werden, haben die molekularen Befunde große Relevanz. Die Ergebnisse zeigen, dass unter niedrigen Eisenspiegeln Proteine reduziert waren, die am Nukleotid-Stoffwechsel beteiligt sind, sowie Faktoren, die Eisen-Schwefel-Cluster als Cofaktoren haben und wichtig für die Nukleotid-Qualitätskontrolle sind. Das Fehlen von Eisen führte zu einer Induktion von Pink1 und Prkn, was auf verstärkte Mitophagie hindeutet. Insgesamt konnte gezeigt werden, dass die mitochondriale Eisen-Schwefel-Cluster Biogenese und die post-transkriptionelle Eisenregulation entscheidend für die Pathogenese von PD, bzw. das gesunde Fortbestehen einer Zelle und letztlich auch eines Organismus sind.
In Key et al. 2019 wurde erstmalig das Gesamt-Ubiquitylom aus Gehirnen von gealterten Parkin-knockout (KO) Mäusen erhoben und analysiert, um Ubiquitylierungs-Substrate von PARKIN zu identifizieren. Hierbei zeigte sich eine veränderte Ubiquitylierung von mehreren Faktoren, die an der zellulären Calcium-Homöostase beteiligt sind. Weitere elektrophysiologische Experimente in Gehirnen von gealterten Parkin-/--KO Mäusen ergaben, dass in Nervenzellen im Locus coeruleus die Geschwindigkeit der spontanen Taktgeber erhöht, dass die langsame Nachhyperpolarisation reduziert und, dass die Dauer der Aktionspotentiale erniedrigt war, ohne Veränderung der Kaliumkanal-Ströme.
Insgesamt geht aus den drei Studien hervor, dass mitochondriale Fehlfunktionen bei dauerhaftem Bestehen weitreichende Folgen für die Gesundheit des Nervensystems haben können, denn auch kleine Veränderungen, seien es durch Mutationen oder Umweltfaktoren wie Eisen, können in einer so großen Lebensspanne wie der des Menschen über Krankheit oder Gesundheit entscheiden!
This article demonstrates the use of guided elastic waves (GEW) for multiple-in and multiple-out (MIMO) data communication in the framework of a structural health monitoring (SHM) system. Therefore, miniaturized low-voltage communication nodes have been developed. They are arranged in a spatially distributed and permanently installed network. Wireless exchange of encoded information across a metallic plate and a stiffened carbon-fiber reinforced plastics (CFRP) structure is investigated. A combination of square-wave excitation sequences and frequency-division multiplexing (FDM) is explored for parallel communication with multiple nodes. Moreover, the impact of the excitation-sequence length on the reliability of information transmission is studied in view of future energy-aware application scenarios. The presented system achieves in both studied structures error-free transmission at a data rate of 0.17 kbps (per carrier frequency) with a power consumption of 224 mW.
Capturing intermolecular interactions accurately is essential for describing, e.g., morphology of molecular matter on the nanoscale. When it reveals characteristics which are not directly accessible through experiments or ab initio theories, a model here becomes eminently beneficial. In laboratory astrochemistry, the intense study of ices has led i.a. to the exploration of the spontelectric state of nanofilms. Despite its success in biophysics or biochemistry and despite its predictive power, molecular modeling has however not yet been widely deployed for solid-state astrochemistry. In this article, therefore a pertinent hitherto unaddressed problem is tackled by means of the classical molecular-dynamics method, namely the unknown distribution of relative dipole orientations in spontelectric cis-methyl formate (MF). In doing so, from ab initio data, a molecular model is derived which confirms for the first time the anomalous temperature-dependent polarization of MF. These insights thus represent a further step toward understanding spontelectric behavior. Moreover, unprecedented first-principles predictions are reported regarding the ground-state geometry of the MF trimer and tetramer. In conjunction with the study of the binding to carbonaceous substrates, these additional findings can help to exemplarily elucidate molecular ice formation in astrochemical settings.
Sparse sensor networks for Lamb wave-based structural health monitoring (SHM) can detect defects in plate-like structures. However, the limited number of sensor positions provides little information to characterize the unknown scatterer. This can be achieved by full wavefield analysis e.g. using Laser Doppler vibrometry measurements.
This paper proposes deconvolution processing that enhances the acoustic wavefield interpretation by increasing the temporal resolution of the underlying ultrasound signals. Applying this preprocessor to the whole wavefield allows improved non-destructive assessment of the defect. This approach is verified experimentally through a case study on an isotropic aluminum plate with four cracks.
Internet Gaming Disorder (IGD) has been included in the DSM-5 as a diagnosis for further study, and Gaming Disorder as a new diagnosis in the ICD-11. Nonetheless, little is known about the clinical prevalence of IGD in children and adolescents. Additionally, it is unclear if patients with IGD are already identified in routine psychotherapy, using the ICD-10 diagnosis F 63.8 (recommended classification of IGD in ICD-10). This study investigated N = 358 children and adolescents (self and parental rating) of an outpatient psychotherapy centre in Germany using the Video Game Dependency Scale. According to self-report 4.0% of the 11- to 17-year-old patients met criteria for a tentative IGD diagnosis and 14.0% according to the parental report. Of the 5- to 10-year-old patients, 4.1% were diagnosed with tentative IGD according to parental report. Patients meeting IGD criteria were most frequently diagnosed with hyperkinetic disorders, followed by anxiety disorders, F 63.8, conduct disorders, mood disorders and obsessive-compulsive disorders (descending order) as primary clinical diagnoses. Consequently, this study indicates that a significant amount of the clinical population presents IGD. Meaning, appropriate diagnostics should be included in routine psychological diagnostics in order to avoid “hidden” cases of IGD in the future.
During the last decade, three new acidophilous forests associations were detected in the Mecsek Mts (SW Hungary), and described as acidophilous beech wood (Sorbo torminalis-Fagetum (A. O. Horvat 1963a) Borhidi et Kevey in Kevey 2001), acido-mesophilous oak wood (Luzulo forsteri-Quercetum petraeae (A. O. Horvat 1963a) Borhidi et Kevey 1996) and acido-xerophilous oak shrubland (Genisto pilosae-Quercetum polycarpae (A. O. Horvat 1967) Borhidi et Kevey 1996). In this article two further new associations are described: the acidophilous oakwood of the Mecsek (Viscario-Quercetum polycarpae Kevey, ass. nova) and the acido-mesophilous oakwood of western Hungary (Campanulo rotundifoliae-Quercetum petraeae (Csapody 1964) Kevey, ass. nova). These associations are related to the acidophilous forests of the Balkan Peninsula based on the infrequent presence of sub-Mediterranean species. A detailed comparative study of these new associations with the earlier known ones permitted to develop a reshaped classification of the syntaxonomy of these units, creating four new suballiances: within the frame of Quercion farnetto I. Horvat 1938 the suballiances Luzulo forsteri-Quercenion polycarpae Kevey, suball. nova and the typical Quercenion farnetto Kevey, suball. nova, in the frame of Quercion petraeae Zolyomi et Jakucs 1957 the suballiances Luzulo multiflorae-Quercenion petraeae Kevey, suball. nova and the Quercenion petraeae Kevey, suball. nova.
Background: Mastectomy in male transgender patients is an important (and often the first) step toward physical manhood. At our department, mastectomies in transgender patients have been performed for several decades.
Methods: Recorded data were collected and analyzed for all male transgender patients undergoing mastectomy over a period of 24 years at our department.
Results: In total, 268 gender-reassigning mastectomies were performed. Several different mastectomy techniques (areolar incision, n=172; sub-mammary incision, n=96) were used according to patients' habitus and breast features. Corresponding to algorithms presented in the current literature, certain breast qualities were matched with a particular mastectomy technique. Overall, small breasts with marginal ptosis and good skin elasticity allowed small areolar incisions as a method of access for glandular removal. In contrast, large breasts and those with heavy ptosis or poor skin elasticity often required larger incisions for breast amputation. The secondary correction rate (38%) was high for gender reassignment mastectomy, as is also reflected by data in the current literature. Secondary correction frequently involved revision of chest wall recontouring, suggesting inadequate removal of the mammary tissue, as well as scar revision, which may reflect intense traction during wound healing (36%). Secondary corrections were performed more often after using small areolar incision techniques (48%) than after using large sub-mammary incisions (21%).
Conclusions: Choosing the suitable mastectomy technique for each patient requires careful individual evaluation of breast features such as size, degree of ptosis, and skin elasticity in order to maximize patient satisfaction and minimize secondary revisions.
A feature of the Northern Iroquoian languages is their especially rich inventory of particles. This paper is concerned with one particle in the Cayuga language which has a widespread distribution and performs a broad range of apparently unrelated functions. The particle ne:' is commonly .translated as 'it is/that is', 'this' or ' that'. In other instances it is translated as predominant stress, or is simply omitted in the translation. The particle can occur in almost any syntactic or semantic environment, but it is not obligatory in any context. The various functions that have been suggested in the literature include indication of declarative mood and assertion, marking of emphasis, focus or contrast, and expression of predicative and deictic force. I argue that the particle ne:' can be described successfully if its distribution is considered from a wider perspective, taking into account discourse structure and variation in scope. Its analysis as a focus marker can account for the variety of apparently unrelated functions. The analysis is based on a detailed study of the particle' s distribution in spoken language using a database of five Cayuga texts by four different speakers, including three narratives, one procedural text and a children 's version of a ceremonial text.
Am Peischlachtörl (2484 m Meereshöhe, nördliche Schobergruppe, Nationalpark Hohe Tauern) wurden Bültenböden vegetations- und bodenkundlich untersucht und mit einem typischen alpinen Rasen (Caricetum curvulae) verglichen. Insgesamt wurden 380 Vegetationsaufnahmen à 10 x 10 cm entlang von 14 Kleintransekten durchgeführt, um das Vegetationsmosaik von Bülten und Senken darzustellen. Die Untersuchungen umfassten auch die Bestimmung der Bodentypen, pH-Messungen und Korngrößenanalysen. Bodentemperaturmessungen erfolgten in 10 und 50 cm Bodentiefe von 2003 bis 2005. Es zeigte sich eine deutliche Vegetationszonierung von den Bülten zu den Senken. Die Bultkuppen werden von einer Gesellschaft bestimmt, die dem Caricetum curvulae zugeordnet werden kann, mit einer Loiseleuria procumbens-Ausbildung an einer kleineren Anzahl von Kuppen, einer Oreochloa disticha-Ausbildung für den überwiegenden Anteil der Kuppen sowie einer Ligusticum mutellina-Ausbildung im Übergang zu den Senken. Der alpine Rasen (Caricetum curvulae) lässt sich gut mit der Vegetation der Bultkuppen vergleichen, wobei der überwiegende Teil der Rasen-Aufnahmen zur Oreochloa disticha-Ausbildung gezählt werden kann. Die Senken der Bültenböden werden von einer Luzula alpinopilosa-Ausbildung charakterisiert. Eine pflanzensoziologische Zuordnung dieser Gesellschaft ist sehr schwierig, da Schneebodenarten, Gräser der subalpinen Stufe und Caricetum curvulae-Arten vermischt vorkommen. Im Bereich der Bülten wurde eine pseudovergleyte Braunerde bzw. ein Semipodsol festgestellt, in der Senke ein Pseudogley und im alpinen Rasen ein Eisen-Humus-Podsol. Bültenböden und alpiner Rasen unterscheiden sich signifikant hinsichtlich der Korngrößen: der Boden des alpinen Rasens ist wesentlich skelett- und sandreicher. Kuppen und Senken unterscheiden sich nur unwesentlich in ihrer Körnung. - Der erste Winter zeichnete sich durch fehlenden Bodenfrost aus, während im zweiten Winter sowohl der Boden des alpinen Rasens als auch die Bülten tief durchfroren. Die Temperatur in den Senken sank dagegen nur leicht unter 0 °C ab.
Using hand-collected data on CEO appointments during shareholder activism campaigns, this study examines whether shareholder involvement in CEO recruiting affects frictions in CEO hiring decisions. The results indicate that appointments of CEOs who are recruited with shareholder activist influence are followed by more favorable stock market reactions and stronger profitability improvements than CEO appointments that also occur during activism campaigns but without the influence of activists. I find little evidence that shareholder activists increase hiring frictions by facilitating the recruiting of CEOs who will implement myopic corporate policies. Analyses of recruiting process characteristics reveal that activist influence is associated with more resources being dedicated to the CEO search process and with a higher propensity to recruit CEOs from outside the firm. These findings contribute to the CEO labor market literature, which tends to focus on the decision to remove incumbent CEOs but provides limited insights into CEO recruiting.
In this contribution, I would like to examine the way in which Bakhtin, in the two essays dedicated to the chronotope, lays the foundations for a theory of literary imagination. […] His concept of the chronotope may be interpreted as a contribution to a tradition in which Henri Bergson, William James, Charles Sander Peirce and Gilles Deleuze have been key figures. Like these four authors, Bakhtin is a philosopher in the school of pragmatism. His predilection for what Gary Saul Morson and Caryl Emerson have called “prosaics” puts him right at the heart of a philosophical family that calls forth multiplicity against metaphysical essentialism, and prefers the mundane to the universal. It seems wise to proceed carefully in the attempt to reconstruct Bakhtin’s theory of imagination. In this contribution to the debate, I choose to develop a philosophical dialogue between Bakhtin and the above-mentioned philosophical family. More specifically, it seems to me that the ideal point of departure for examining the way in which Bakhtin attempts to get to the bottom of the mysteries of literary imagination is Gilles Deleuze’s synthesis of Bergson’s epistemological view on knowledge as “the perception of images”, as well as Peirce’s theory of experience based on a typology of images. In the following, I show that Bakhtin’s view of the temporal-spatial constellations in literature demonstrates a strong affinity to the Bergsonian view that perception of the spatial world is colored by the lived time experienced by the observer. Based on this observation, I then develop a typology of images which places the concept of the chronotope in a more systematic framework.
1 Kt. auf 2 Bl., zsgeklebt : mehrfarb. Kupferst. ; Gesamtgr. 86 x 50 cm. Mit 1 Nebenkt.: Afteekening van't inkomen van de rivier van Suriname Gesüdet. - Mit Erl. Aus: [Auswahlatlas Hübner / 1] ; 100
Mongolian spots (MS) are congenital dermal conditions resulting from neural crest-derived melanocytes migration to the skin during embryogenesis. MS incidences are highly variable in different populations. Morphologically, MS present as hyperpigmented maculae of varying size and form, ranging from round spots of 1 cm in diameter to extensive discolorations covering predominantly the lower back and buttocks. Due to their coloring, which is also dependent on the skin type, MS may mimic hematoma thus posing a challenge on the physician conducting examinations of children in cases of suspected child abuse. In the present study, MS incidences and distribution, as well as skin types, were documented in a collective of 253 children examined on the basis of suspected child abuse. From these data, a classification scheme was derived to document MS and to help identify cases with a need for recurrent examination for unambiguous interpretation of initial findings alongside the main decisive factors for re-examination such as general circumstances of the initial examination (e. g., experience of the examiner, lighting conditions) and given dermatological conditions of the patient (e. g., diaper rash).
Der Beitrag versucht die Lektüre einer wenig bekannten Erzählung Oskar Panizzas unter machttheoretischen Aspekten. Mit ihrer Fokussierung auf Panizzas Kritik an der Hegemonie des wilhelminischen Kaiserreiches reproduziert die Panizza-Forschung ein Machtverständnis, das Macht als Besitz der Herrschenden konzipiert. Ein solches Verständnis verstellt den Blick auf die produktive Qualität und die performative Wirkung von Panizzas Texten. In Anlehnung an Michel Foucaults Konzept von Macht als produktivem Netz von Kräfteverhältnissen zeigt mein Beitrag, wie sich das Verhältnis zwischen Norm und Abweichung nicht in der zentralen Ausübung einer einzelnen Machtinstanz, sondern in dem dezentralen und produktiven Spiel der Kräfteverhältnisse beschreiben lässt. Vermittels literarischer Techniken inszeniert Panizzas Erzählung Ein scandalöser Fall ein solch dynamisches Machtverständnis und macht dabei die prekäre Beschaffenheit hegemonialer Konstellationen sichtbar.
Aim: To evaluate the long-term outcome of catheter ablation of atrial fibrillation (AF) facilitated by preprocedural three-dimensional (3-D) transesophageal echocardiography.
Methods: In 50 patients, 3D transesophageal echocardiography (3D TEE) was performed immediately prior to an ablation procedure (paroxysmal AF: 30 patients, persistent AF: 20 patients). The images were available throughout the ablation procedure. Two different ablation strategies were used. In most of the patients with paroxysmal AF, the cryoablation technique was used (Arctic Front Balloon, CryoCath Technologies/Medtronic; group A2). In the other patients, a circumferential pulmonary vein ablation was performed using the CARTO system [Biosense Webster; group A1 (paroxysmal AF), group B (persistent AF)]. Success rates and complication rates were analysed at 4-year follow-up.
Results: A 3D TEE could be performed successfully in all patients prior to the ablation procedure and all four pulmonary vein ostia could be evaluated in 84% of patients. The image quality was excellent in the majority of patients and several variations of the pulmonary vein anatomy could be visualized precisely (e.g., common pulmonary vein ostia, accessory pulmonary veins, varying diameter of the left atrial appendage and its distance to the left superior pulmonary vein). All ablation procedures could be performed as planned and almost all pulmonary veins could be isolated successfully. At 48-mo follow-up, 68.0% of all patients were free from an arrhythmia recurrence (group A1: 72.7%, group A2: 73.7%, group B: 60.0%). There were no major complications.
Conclusion: 3D TEE provides an excellent overview over the left atrial anatomy prior to AF ablation procedures and these procedures are associated with a favourable long-term outcome.
Aim: To evaluate the effectiveness of two different strategies using radiofrequency catheter ablation for redo procedures after cryoablation of atrial fibrillation.
Methods: Thirty patients (paroxysmal atrial fibrillation: 22 patients, persistent atrial fibrillation: 8 patients) had to undergo a redo procedure after initially successful circumferential pulmonary vein (PV) isolation with the cryoballoon technique (Arctic Front Balloon, CryoCath Technologies/Medtronic). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (CARTO; Biosense Webster) depending on the intra-procedural findings. After discharge, patients were scheduled for repeated visits at the arrhythmia clinic. A 7-day Holter monitoring was performed at 3, 12 and 24 mo after the ablation procedure.
Results: During the redo procedure, a mean number of 2.9 re-conducting pulmonary veins (SD ± 1.0 PVs) were detected (using a circular mapping catheter). In 20 patients, a segmental approach was sufficient to eliminate the residual pulmonary vein conduction because there were only a few recovered pulmonary vein fibres. In the remaining 10 patients, a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction. All recovered pulmonary veins could be isolated successfully again. At 2-year follow-up, 73.3% of all patients were free from an arrhythmia recurrence (22/30). There were no major complications.
Conclusion: In patients with an initial circumferential pulmonary vein isolation using the cryoballoon technique, a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation.