Boston Scientific (Germany)

BackgroundAtrial fibrillation (AF) affects 2% to 4.5% of the population. Catheter ablation, a key strategy for paroxysmal AF management, can be achieved through radiofrequency (RFA), cryoablation (CBA), or pulsed field ablation (PFA). While clinical outcomes are well studied, their environmental impact remains underexplored.ObjectivesThis study modeled the environmental impact of CBA and PFA ablation techniques in Europe, aiming to provide evidence to guide sustainable practices in AF treatment.MethodsAn early environmental analysis compared pentaspline PFA (Farapulse system, Boston Scientific) with CBA using a decision-analytic model. The model simulated the patient care pathway from a hospital perspective over a 1-year time horizon, considering index and redo procedures, and complications. The environmental impact, linked to resource use, was measured in kilograms of CO2 equivalents (kg CO2eq), incorporating length of stay, intervention time, anesthetic use, and complications. Probabilistic and scenario analyses, including a comparison with RFA, were performed to assess uncertainty and robustness of the results.ResultsThe environmental analysis showed that PFA resulted in total emissions of 13 899 kg CO2eq, compared with 16 383 kg CO2eq for CBA (−2483 kg CO2eq, −15.2%) per 100 patients. Monte Carlo simulation results confirmed these findings, showing median savings of 2409 kg CO2eq (95% credible interval: 581-4312 kg). Parameters, such as anesthesia time and anesthetic drug use, were key drivers of the results. In the RFA scenario analysis, PFA yielded a saving potential of −4640 kg (−25%). In Germany, for example, with approximately 24 000 CBA procedures annually, PFA adoption was projected to reduce emissions by 509 723 kg CO2eq.DiscussionPFA showed potential for reducing emissions by approximately 25 kg CO2eq per patient compared with CBA, driven by lower resource use. These findings aligned with studies identifying operating rooms and anesthetic drug use as major contributors to hospital emissions. A study limitation was the lack of data on catheter manufacturing and disposal.ConclusionsPFA was expected to reduce emissions compared with CBA in AF patients. Conscious medical device choices can foster more sustainable hospital practices. A full life-cycle analysis of catheters is needed to validate these findings.

Coming from the German automotive industry, RAWLAB has developed a software-based approach that enables non-experts to work with measurement datasets from various sources, make them comparable, and applying complex data-analysis algorithms. Recently, the approach has been extended to include the field of scintillometry. This presentation will introduce the underlying data process and its possibilities resulting from the benefits of combining scintillometry expert knowledge with industry methods. These comprise the use of ASAM's (Association for Standardisation of Automation and Measuring Systems) ODS (Open Data Services) format to store and access any kind of data, as well as the feature to quickly publish any combination of results in automated reports available in e.g. .pdf, .docx, and .pptx formats. Furthermore, novel results and insights concerning the processing of scintillometer data will be discussed, as well as how the software can be used in the operational monitoring of diurnal evapotranspiration. Here we will focus on the use of spectrograms to observe the variation of scintillometer spectra throughout the day, newly derived coefficients for AT and Aq valid for wavelengths between 0.3 - 3 mm, as well as on the preferred algorithms that allow users to get the best estimate for the total evapotranspiration over the course of a day. As an example, we will use two days of operational scintillometer data from the Lindenberg Observatory of the German Meteorological Service (DWD), Lindenberg, Germany, from June 2021 that were obtained during fair weather conditions with typical evapotranspiration summing up to about 3 mm per day.

In the environmental risk assessment for plant protection products in the European Union a default foliar dissipation half-life (DT50) of 10 d is used for the risk assessment of herbivorous birds and mammals feeding on sprayed foliage. This generic DT50 of 10 d is based on a compilation of residue trials conducted over 30 yr ago, in which many compounds and formulations were considered that are not used anymore. We therefore reassessed foliar dissipation based on a data set of 396 residue trials covering 30 compounds. Foliar DT50s were calculated, and potential factors determining dissipation were analyzed, such as crop group, residue zone, and rainfall. The strongest source of variability was found between individual trials. Other factors, including the residue zone and crop group, did not have a significant impact on dissipation. Only heavy rainfall (>6.5 mm/d, i.e., the 95th percentile of rainfall) had a statistically significant influence, although rainfall explained only approximately 5% of the overall variability. Moderate rainfall (≤6.5 mm/d) did not significantly correlate with dissipation and explained only 0.1% of the overall variability. Most importantly, the differences in DT50s between crops and residue zones were neither marked nor statistically significant; hence, trials from different residue zones and crops could be pooled to obtain more robust half-lives. Over all compounds, trials, zones, and crops the geometric mean DT50 was 3.2 d (90th percentile 7.9 d). Environ Toxicol Chem 2018;37:1926-1932. © 2018 SETAC.

Coupling between the ablation catheter and myocardium is critical to resistively heat tissue with radiofrequency ablation. The objective of this study was to evaluate whether a novel local impedance (LI) measurement on an ablation catheter identifies catheter-tissue coupling and is predictive of lesion formation. LI was studied in explanted hearts (n=10 swine) and in vivo (n=10; 50-70 kg swine) using an investigational electroanatomic mapping system that measures impedance from an ablation catheter with mini-electrodes incorporated in the distal electrode (Rhythmia and IntellaNav MiFi OI, Boston Scientific). Explanted tissue was placed in a warmed (37 °C) saline bath mounted on a scale, and LI was measured 15 mm away from tissue to 5 mm of catheter-tissue compression at multiple catheter angles. Lesions were created with 31 and 50 W for 5 to 45 seconds (n=90). During in vivo evaluation of LI, measurements of myocardium (n=90) and blood pool (n=30) were guided by intracardiac ultrasound while operators were blinded to LI data. Lesions were created with 31 and 50 W for 45 seconds in the ventricles (n=72). LI of myocardium (119.7 Ω) was significantly greater than that of blood pool (67.6 Ω; P<0.01). Models that incorporate LI drop (ΔLI) to predict lesion size had better performance than models that incorporate force-time integral (R2=0.75 versus R2=0.54) and generator impedance drop (R2=0.82 versus R2=0.58). Steam pops displayed a significantly higher starting LI and larger ΔLI compared with successful radiofrequency applications (P<0.01). LI recorded from miniature electrodes provides a valuable measure of catheter-tissue coupling, and ΔLI is predictive of lesion formation during radiofrequency ablation.

Abstract The relationships between concrete curing procedures, materials composition, and internal sulfate attack damage will be discussed in view of the experience obtained in Europe in the 1970s and 1980s. The heat-treatment procedures that were introduced and specified to eliminate or minimize the damage will be highlighted and suggestions will be made as to the needed adjustments in curing practices.