Background: Mural type vein of Galen malformation (mVOGM) is a congenital high flow arteriovenous shunt between choroidal arteries and the prosencephalic vein of Markowski leading to heart failure and hydrovenous disorder in children. Embolizing fistulous connections can be challenging and typically requires adjunctive techniques such as induced hypotension, balloon-assisted flow control, and creation of a coil basket. These maneuvers add time, complexity, and unpredictability. Rapid ventricular pacing (RVP) has been proposed as an alternative strategy with fewer drawbacks, but has not been well studied. The approach involves catheterizing the right ventricle with a pacing catheter connected to a temporary external pacemaker. Prior to embolization, RVP is initiated to lower cardiac output. Following embolization, pacing is discontinued, and the heart returns to sinus rhythm. Methods: We performed RVP in five mVOGM patients from 4/2020 through 7/2021. Accounting for multiple procedures, RVP was utilized in ten cases and twenty-six pedicles. Results: Ventricular capture was achieved in all instances and was well tolerated, without arrhythmia. Casting the arterial pedicle with liquid embolic immediately adjacent to, or traversing, the fistulous point was achieved in 9/10 cases. There were no procedural complications. In 1 case, creation of a coil basket in the venous pouch was required to achieve a stable arterial cast Conclusions: This report describes the largest case series utilizing RVP in mVOGM. The technique appears safe and well tolerated.

The consequences of climate change will affect aquatic ecosystems, including aquatic invasive species (AIS) that are already affecting these ecosystems. Effects on AIS include range shifts and more frequent overwintering of species. These effects may create new challenges for AIS management. We examined available U.S. state AIS management plans to assess each program's capacity to adapt to climate-change effects. We scored the adaptive capacity of AIS management plans on the basis of whether they addressed potential impacts resulting from climate change; demonstrated a capacity to adapt to changing conditions; provided for monitoring strategies; provided for plan revisions; and described funding for implementation. Most plans did not mention climate change specifically, but some did acknowledge climatic boundaries of species and ecosystem sensitivities to changing conditions. Just under half the plans mentioned changing environmental conditions as a factor, most frequently as part of research activities. Activities associated with monitoring showed the highest capacity to include information on changing conditions, and future revisions to management plans are likely to be the easiest avenue through which to address climate-change effects on AIS management activities. Our results show that programs have the capacity to incorporate information about climate-change effects and that the adaptive-management framework may be an appropriate approach.

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