This study investigated the interaction effects of meteorological factors and air pollutants on the onset of acute coronary syndrome (ACS). Data of ACS patients were obtained from the Taiwan ACS Full Spectrum Registry and comprised 3164 patients with a definite onset date during the period October 2008 and January 2010 at 39 hospitals. Meteorological conditions and air pollutant concentrations at the 39 locations during the 488-day period were obtained. Time-lag Poisson and logistic regression were used to explore their association with ACS incidence. One-day lag atmospheric pressure (AP), humidity, particulate matter (PM2.5, and PM10), and carbon monoxide (CO) all had significant interaction effects with temperature on ACS occurrence. Days on which high temperatures (>26 °C) and low AP (<1009 hPa) occurred the previous day were associated with a greater likelihood of increased incidence of developing ACS. Typhoon Morakot was an example of high temperature with extremely low AP associated with higher ACS incidence than the daily average. Combinations of high concentrations of PM or CO with low temperatures (<21 °C) and high humidity levels with low temperatures were also associated with increased incidence of ACS. Atmospheric pollution and weather factors have synergistic effects on the incidence of ACS.

The novel algorithm incorporating a QRS duration of ≥133 ms with a conduction duration of the VA-RBB of >36 ms could be useful in differentiating PPM-VAs from LPF-VAs.

BackgroundThe aim of this study was to investigate the different substrate characteristics of repetitive premature ventricular complexed (PVC) trigger sites by the non-contact mapping (NCM).MethodsThirty-five consecutive patients, including 14 with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) and 21 with idiopathic right ventricular outflow tract tachycardia (RVOT VT), were enrolled for electrophysiological study and catheter ablation guided by the NCM. Substrate and electrogram (Eg) characteristics of the earliest activation (EA) and breakout (BO) sites of PVCs were investigated, and these were confirmed by successful PVC elimination.ResultsOverall 35 dominant focal PVCs were identified. PVCs arose from the focal origins with preferential conduction, breakout, and spread to the whole right ventricle. The conduction time and distance from EA to BO site were both longer in the ARVC than the RVOT group. The conduction velocity was similar between the 2 groups. The negative deflection of local unipolar Eg at the EA site (EA slope3,5,10ms values) was steeper in the RVOT, compared to ARVC patients. The PVCs of ARVC occurred in the diseased substrate in the ARVC patients. More radiofrequency applications were required to eliminate the triggers in ARVC patients.Conclusions/InterpretationThe substrate characteristics of PVC trigger may help to differentiate between idiopathic RVOT VT and ARVC. The slowing and slurred QS unipolar electrograms and longer distance from EA to BO in RVOT endocardium suggest that the triggers of ARVC may originate from mid- or sub-epicardial myocardium. More extensive ablation to the trigger site was required in order to create deeper lesions for a successful outcome.

No abstract

BACKGROUND: Patients with critical limb ischemia (CLI) often exhibit long, diffuse, totally occluded, and heavily calcified infrapopliteal (IP) lesions. Peripheral excimer laser atherectomy (PELA) has been proposed to increase the treatment success for complex IP lesions. This study evaluated the limb salvage after PELA plus low-pressure balloon inflation (LPBI) without stent deployment in CLI patients with severe IP disease. METHODS: We retrospectively evaluated for 82 consecutive patients with 125 IP vessels who underwent PELA plus LPBI in a 4-year period. Technical success was defined as IP straight-line flow being achieved below the malleolus. The binary logistic regression was performed to find factors associated with 6-month limb salvage RESULTS: A total of 113 vessels (90.4%) were totally occluded, and none of the patients received a stent. Twenty-one percentage of the patients were octogenarians, and 84% of the patients were Rutherford-Becker class 5 and 6. The technical success rate was 72% and 6-month limb salvage rate was 77%. Binary logistic regression showed age, smoking history and technical success were independent predictors for 6-month limb salvage. CONCLUSIONS: PELA plus LPBI without stent deployment is a reasonable option for treating complex IP lesions in patients with CLI. Technical success plays an important role in 6-month limb salvage