Taiwan's resource recycling program was formally established in 1989, starting with the mandatory recycling of polyethylene terephthalate bottles. The number of mandatory regulated materials was extended to 8 categories with 27 items by 2002. Because of false data reporting, financial scandal, lack of transparency of the system, and the demand from parliament, the recycling policy has gradually changed from entirely privatized to being nationalized. Currently, the structure is built on six main bodies: fund management committee, consumers, industries responsible, recyclers, fee reviewing committee, and auditing agents. The industries that are responsible submit a fee, which is set by the fee reviewing committee, to the waste recycling fund (WRF), which is operated by the fund management committee. The auditing agents routinely check the responsible industries by documentation review as well as on-site counting to ensure that the fee is correctly submitted. The WRF provides initiatives to collect and dispose of the end-of-life products. The fund is split into a trust fund and a nonbusiness fund to deal with the collection, disposal, and treatment of the listed materials. The latter deals with the supporting works and ensures that the system runs effectively. The ratio of trust fund to nonbusiness fund is 80 -20%. It is no doubt that the current practice achieves some improvements. Household waste has been reduced by 22%. And, most importantly, the benefit-to-cost ratio was as high as 1.24. However, similar to other state-owned systems, the resource recycling program has been criticized for false reporting from the responsible industries, a rigid system, and complicated procedures. To build a sustainable enterprise, the recycling program should be privatized as the recycling market and operating procedures are well established and fully mature.
Introduction: Accurate identification of slow conducting regions in patients with scar-related atrial tachycardia (AT) is difficult using conventional electrogram annotation for cardiac electroanatomic mapping (EAM). Estimating delays between neighboring mapping sites is a potential option for activation map computation. We describe our initial experience with CARTO 3 Coherent Mapping (Biosense Webster Inc,) in the ablation of complex ATs.Methods: Twenty patients (58 ± 10 y/o, 15 males) with complex ATs were included.We created three-dimensional EAMs using CARTO 3 system with CONFIDENSE and a high-resolution mapping catheter (Biosense Webster Inc). Local activation time and coherent maps were used to aid in the identification of conduction isthmus (CI) and focal origin sites. System-defined slow or nonconducting zones and CI, defined by concealed entrainment (postpacing interval < 20 ms), CV < 0.3 m/s and local fractionated electrograms were evaluated.Results: Twenty-six complex ATs were mapped (mean: 1.3 ± 0.7 maps/pt; 4 focal, 22 isthmus-dependent). Coherent mapping was better in identifying CI/breakout sites where ablation terminated the tachycardia (96.2% vs 69.2%; P = .010) and identified significantly more CI (mean/chamber 2.0 ± 1.1 vs 1.0 ± 0.7; P < .001) with narrower width (19.8 ± 10.5 vs 43.0 ± 23.9 mm; P < .001) than conventional mapping. Ablation at origin and CI sites was successful in 25 (96.2%) with long-term recurrence in 25%.
---This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Conclusions: Coherent mapping with conduction velocity vectors derived from adjacent mapping sites significantly improved the identification of CI sites in scar-related ATs with isthmus-dependent re-entry better than conventional mapping. It may be used in conjunction with conventional mapping strategies to facilitate recognition of slow conduction areas and critical sites that are important targets of ablation. K E Y W O R D S activation mapping, atrial tachycardia, coherent mapping, focal atrial tachycardia, scar-related macro re-entrant 1438 | VICERA ET AL.
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