Central Park Conservancy

Abstract WISEA J153429.75−104303.3 (a.k.a. “The Accident”) is a brown dwarf with unique observational properties unlike those of any other known (sub)stellar object. It is thought to be a very cold, metal-poor brown dwarf, and potentially the first identified Y-type subdwarf. Although WISEA J153429.75−104303.3 is extremely faint at λ ∼ 1.25 μm, low-temperature atmosphere models suggest that Y-band flux could increase dramatically relative to J-band as metallicity decreases from solar. We therefore obtained deep Y-band follow-up imaging of WISEA J153429.75−104303.3 with the Dark Energy Camera, and report a resulting Y-band limit of Y > 21.79 mag (Vega, 5σ).

Introduction: Increasing evidence has suggested improved outcomes in atrial fibrillation (AF) patients with heart failure (HF) undergoing catheter ablation (CA) as compared to medical therapy. We sought to investigate the benefit of CA on outcomes of patients with AF and HF as compared to medical therapy. Methods: A systematic review of PubMed, Embase, and Cochrane Central Register of Clinical Trials was performed for clinical studies evaluating the benefit of CA for patients with AF and HF. Primary endpoint was all-cause mortality. Secondary endpoints included atrial-arrhythmia recurrence and improvement in left ventricular ejection fraction (LVEF). Results: Eight randomized controlled trials were included with a total of 2121 patients (mean age: 65 ± 5 years; 72% male). Mean follow-up duration was 32.9 ± 14.5 months. All-cause mortality in patients who underwent CA was significantly lower than in the medical treatment group (8.8% vs. 13.5%, RR 0.65, 95% CI 0.51-0.83, P=0.0005). A 35% relative risk reduction and 4.7% absolute risk reduction in all-cause mortality was observed with CA. Rates of atrial-arrhythmia recurrence were significantly lower in the CA group (39.9% vs 69.6%, RR 0.55, 95% CI 0.40-0.76, P=0.0003). Improvement in LVEF was significantly higher in patients undergoing CA (+9.4 ±7.6%) as compared to conventional treatment (+3.3±8%) (Mean difference 6.2, 95% CI 3.6-8.8, P<0.00001). Conclusion: CA for AF in patients with HF decreases all-cause mortality, improves atrial-arrhythmia recurrence rate and LVEF when compared to medical management. CA should be considered the treatment of choice to improve survival in this select group of patients. Central Illustration summarizing study outcomes. A) All-cause mortality; B) Change in left ventricular ejection fraction; C) Atrial-arrhythmia recurrence 1

Introduction: Durable isolation of the pulmonary veins (PV) and the left atrial posterior wall (LAPW) are considered as key determinants of long-term success after catheter ablation in AF patients. Objective: We aimed to evaluate the PV and LAPW reconnection rate in real-world patients undergoing redo-ablation at our center. Methods: Consecutive AF patients that underwent their first AF ablation at our center from 2015-19 were included in this analysis. At the index procedure, all received electrical isolation of PVs and the LAPW area between the PVs, using radiofrequency (RF) ablation. Procedure was conducted with 3.5-mm irrigated-tip catheter guided by circular mapping catheter, intra-cardiac echocardiography and a 3-D mapping system. RF energy was delivered with a maximum temperature setting of 42 0 C, contact force of 10g and a power of up to 45W. Posterior wall isolation was performed using multiple ablation points covering the whole posterior wall. An esophageal probe was utilized in all patients to monitor esophageal temperature during ablation in the LAPW in close proximity to the esophagus. Complete abolition of all PV potentials rather than decrease in the amplitudes was the end point and confirmed by entrance and/or exit block. All patients were followed up prospectively for 2 years with quarterly evaluation during the first year and bi-annually afterwards and the data was collected in our IRB-approved AF registry. Recovery of conduction in the PVs and LAPW were assessed at the redo procedure using pacing or incremental isoproterenol infusion of 20- 30μg/min for 15-20min. Results: During the study period, 6,817 AF ablation procedures were performed at our institution of which 3,113 AF patients undergoing their first catheter ablation were included in the analysis and prospectively followed up for 2 years. Baseline characteristics of the study population is given in Table 1. At 23.1±12.8 months of follow-up, 614 (19.7%) patients had received redo-ablation, of which 139 (22.6%) had one or more PV or LAPW reconnected. Conclusion: In this series, with experienced operators performing the procedures, the rate of recovery of conduction in the PVs and LAPW was low compared to the reported high incidence rate in the literature.

Introduction: Studies have shown a correlation between leaks following left atrial appendage occlusion procedure and thromboembolic (TE) events. Hypothesis: We investigated the benefits of leak-closure in terms of safe discontinuation of oral anticoagulation (OAC) and minimization of the stroke-risk. Methods: Consecutive patients undergoing leak-closure procedure at our institution were included in the analysis. Procedures included closure with endovascular coils or Amplatzer plug or by using radiofrequency ablation (RFA). Persistence of the leak was verified by multiplane transesophageal echocardiogram (TEE) using color Doppler. Follow-up TEE were performed 60 ± 15 days post-procedure to evaluate LAA closure and patients were kept on OAC until then. After confirmation of closure, they were transitioned to ASA 81 mg/day. All patients were monitored quarterly for thromboembolic (TE) events. Results: A total of 139 post-Watchman patients undergoing leak-closure were included in the analysis (RFA: 10, Amplatzer plug: 5, coil-closure: 124). Pre-coil closure TE events were reported in 7 (5%) subjects. Moderate (3-4 mm) and severe (≥5 mm) leak were detected in 118 (85%) and 21 (15%) patients respectively. After the leak-closure procedure, complete sealing of the leak was confirmed at the follow-up TEE in 138 (99.2%) patients. Figure 1 shows significant reduction in TE events following the leak-closure procedure (p=0.031). During the 2-year follow-up period, six deaths were reported due to unrelated causes. Of the remaining 133 subjects, two patients were on DAPT because of history of coronary artery disease, two with prior stroke were on half-dose OAC and the remaining 129 (95.8%) were on ASA 81 mg/day. No TE events were reported in patients that transitioned to ASA. Conclusions: In this series, successful percutaneous leak-closure not only minimized the risk of stroke but also enabled the majority of patients to discontinue OAC without any TE events.

Background: Non-ischemic cardiomyopathies (NICM) occur in the absence of contributory coronary artery disease or significant valvular heart disease. This study examined if VT recurrence post-scar-homogenization in NICM patients was due to progression of the disease after successful ablation or incomplete ablation during the index procedure. Methods: Consecutive NICM patients receiving redo procedure after their 1st VT ablation were included. All patients underwent bipolar substrate mapping with standard scar settings of normal tissue >1.5 mV and severe scar <0.5 mV. Endocardial scar homogenization was followed by heparin reversal with protamine and subsequent epicardial ablation. Disease progression was defined as extension of index scar area or appearance of new scar and decline in the baseline left ventricular ejection fraction (LVEF). Incomplete ablation was described as ablation within the index scar area that was ablated in the earlier procedure. Recurrence within 12 months was considered as early recurrence . Results: A total of 310 NICM patients (age: 60±13.5 years; male: 231 (74%); LVEF: 37±11%) undergoing their first VT ablation procedure were followed up for 7 years, of which 38 (12.2%) experienced recurrence and underwent re-ablation. Of the 38, 13 received repeat ablation at 5.07±2.56 months ( early recurrence ) and the remaining 25 patients had the redo at 40±21.78 months ( late recurrence ). In these 38 patients, mean LVEF was significantly lower at redo (pre-index: 35.3±10.6; pre-redo: 30.2± 7.07%, p=0.015). In the early-recurrence group , 10 (77%) had ablation sites located within the index scar (incomplete ablation) and 3 (33%) had extension of the index scar area (disease progression) detected. Index scars were mostly mid-myocardial (11, 84.6%). In the late-recurrence cohort , extension of the index scar area was detected in 12 (48%) and new scar were mapped in 19 (76%); none of these patients had incomplete ablation noted. Conclusion: In NICM patients, VT recurrence within 1-year of index procedure was mostly associated with incomplete ablation of mid-myocardial scars, whereas disease progression evidenced by detection of new scar, extension of preexisting scar and decline in LVEF was prevalent in patients with very late recurrence.