Objectives The goal of this study was to determine the relationship of the ventricular tachycardia (VT) isthmus to channels of preserved voltage on an electroanatomic voltage map in postinfarction cardiomyopathy.Background Substrate mapping in patients with postinfarction cardiomyopathy and VT may involve lowering the voltage cutoff that defines the scar (<1.5 mV) to identify "channels" of relative higher voltage within the scar. However, the prevalence of channels within the scar identified by using electroanatomic mapping and the relationship to the protected VT isthmus identified by entrainment mapping is unknown.Methods Detailed bipolar endocardial voltage maps (398 +/- 152 points) from 24 patients (mean age 69 +/- 9 years) with postinfarction cardiomyopathy (ejection fraction 33 +/- 9%) and tolerated VT were reviewed. Endocardial scar was defined according to voltage <1.5 mV. Isolated late potentials (ILPs) were identified and tagged on the electroanatomic voltage map. The baseline voltage cutoffs were then adjusted until all channels were identified. The VT isthmus was identified using entrainment mapping.Results Inferior and anterior/lateral infarction was present by voltage mapping in 18 and 6 patients, respectively (scar area 44 +/- 24 cm(2)). By adjusting voltage cutoffs, 37 channels were identified in 21 (88%) of 24 patients. The presence of ILPs within a channel was seen in 11 (46%) of 24 patients and 17 (46%) of 37 channels. A VT isthmus site was contained within a channel in only 11 of 24 patients or 11 of 37 channels. No difference in voltage characteristics was identified between clinical and nonclinical channels. Voltage channels with ILPs harbored the clinical isthmus with a sensitivity and specificity of 78% and 85%, respectively.Conclusions Channels were identified in 88% of patients with VT by adjusting the voltage limits of bipolar maps; however, the specificity of those channels in predicting the location of VT isthmus sites was only 30%. The presence of ILPs inside the voltage channel significantly increases the specificity for identifying the clinical VT isthmus. (C) 2013 by the American College of Cardiology Foundation

Bipolar endocardial signal amplitude (BESA) <1.5 mV defines scar in the left ventricle (LV). It is not known if LV hypertrophy (LVH) increases overall bipolar signal amplitude and if scar identification with LVH requires a higher voltage cutoff.

BACKGROUND:Left ventricular outflow tract tachycardia/premature depolarizations (VT/VPDs) arising near the anterior epicardial veins may be difficult to eliminate through the coronary venous system. OBJECTIVE:To describe the characteristics of an alternative successful ablation strategy targeting the left sinus of Valsalva (LSV) and/or the adjacent left ventricular (LV) endocardium. METHODS:Of 276 patients undergoing mapping/ablation for outflow tract VT/VPDs, 16 consecutive patients (8 men; mean age 52 ± 17 years) had an ablation attempt from the LSV and/or the adjacent LV endocardium for VT/VPDs mapped marginally closer to the distal great cardiac vein (GCV) or anterior interventricular vein (AIV). RESULTS:Successful ablation was achieved in 9 of the 16 patients (56%) targeting the LSV (5 patients), adjacent LV endocardium (2 patients), or both (2 patients). The R-wave amplitude ratio in lead III/II and the Q-wave amplitude ratio in aVL/aVR were smaller in the successful group (1.05 ± 0.13 vs 1.34 ± 0.37 and 1.24 ± 0.42 vs 2.15 ± 1.05, respectively; P = .043 for both). The anatomical distance from the earliest GCV/AIV site to the closest point in the LSV region was shorter for the successful group (11.0 ± 6.5 mm vs 20.4 ± 12.1 mm; P = .048). A Q-wave ratio of <1.45 in aVL/aVR and an anatomical distance of <13.5 mm had sensitivity and specificity of 89%, 75% and 78%, 64%, respectively, for the identification of successful ablation. CONCLUSIONS:VT/VPDs originating near the GCV/AIV can be ablated from the LSV/adjacent LV endocardium. A Q-wave ratio of <1.45 in aVL/aVR and a close anatomical distance of <13.5 mm help identify appropriate candidates.

Objectives We sought to develop electrocardiography (ECG) criteria for distinguishing left ventricular outflow tract (LVOT) from right ventricular outflow tract (RVOT) origin in patients with idiopathic outflow tract ventricular tachycardia (OTVT) and lead V-3 R/S transition.Background Several ECG criteria have been proposed for differentiating left from right OTVT origin; ventricular tachycardias (VTs) with left bundle branch block and V-3 transition remain a challenge.Methods We analyzed the surface ECG pattern of patients with OTVT with a precordial transition in lead V-3 who underwent successful catheter ablation. Sinus and VT QRS morphologies were measured in limb and precordial leads with electronic calipers. The V-2 and V3 transition ratios were calculated by computing the percentage R-wave during VT (R/R + S)(VT) divided by the percentage R-wave in sinus rhythm (R/R+S)(SR).Results We retrospectively analyzed ECGs from 40 patients (mean age 44 +/- 14 years, 21 female) with outflow tract premature ventricular contractions (PVCs)/VT. Patients with structural heart disease, paced rhythms, and bundle branch block during sinus rhythm were excluded. The V2 transition ratio was significantly greater for LVOT PVCs compared with RVOT PVCs (1.27 +/- 0.60 vs. 0.23 +/- 0.16; p < 0.001) and was the only independent predictor of LVOT origin. In 21 prospective cases, a V2 transition ratio >= 0.60 predicted an LVOT origin with 91% accuracy. A PVC precordial transition occurring later than the sinus rhythm transition excluded an LVOT origin with 100% accuracy.Conclusions The V-2 transition ratio is a novel electrocardiographic measure that reliably distinguishes LVOT from RVOT origin in patients with lead V-3 precordial transition. This measure might be useful for counseling patients and planning an ablation strategy. (J Am Coll Cardiol 2011;57:2255-62) (C) 2011 by the American College of Cardiology Foundation

Congenital coronary artery fistula is frequently associated with pulmonary atresia and intact ventricular septum (PA/IVS). Aneurysmal dilatation is rare, and can be complicated by rupture, distal thrombi and myocardial ischaemia.

The concept of position in sociology.—The sociologist’s interest in human ecology is in man’s relation to other men as found in the definite and typical patterns which the population assumes in natural areas. In so far as social structure can be defined in terms of position, and social changes in terms of movement of the population, social phenomena are subject to mathematical measurement. The growth of a city is not a matter of mere aggregation of people, but involves changes in the central business district which are reflected in all parts of the city, the multiplication of professions and occupations, and incidental increase in land values, all of which are measurable in terms of mobility of the population. Social disorders, such as mob violence, may be measured in terms of movements of people and of social metabolism, or the assimilation of newcomers into the existing social order. Changes in social and economic status and degrees of personal success or failure are registered in changes of location of residence. Local geography and transportation divide the city into areas which come to have definite occupational and population groups, each of which has a certain rate of mobility. However, not all social phenomena can be measured in terms of location, position, and mobility, for the true unit of social interaction is not an unchanging individual but a changing attitude. Physical barriers are of importance only as they affect communication and contacts. Other factors which affect communication and complicate the problem of measurement Are the individuality of social experiences and the inhibiting effect of selfconsciousness. Nevertheless social relations are frequently correlated with spatial relations, and hence are in a degree measurable. Some thirty years ago Professor Eugenius Warming, of Copenhagen, published a little volume entitled Plant Communities (Plantesam fund). Warming’s observations called attention to the fact that different species of plants tend to form permanent groups, which he called communities. Plant communities, it turned out, exhibit a good many of the traits of living organisms. They come into existence gradually, pass through certain characteristic changes, and eventually are broken up and succeeded by other communities of a very different sort. These observations later become the point of departure for a series of investigations which have since become familiar under the

В статье американского классика социологии описан «идеальный тип» человека мобильного - бродяги. Автор рассматривает его в контексте особого типа свободы бродяги - индивидуалистической свободы. Суть этой проблемы автор помещает в ряд вопросов: «что происходит с сознанием бродяги. Почему при всем разнообразии своего опыта он так тупо проводит свои дни? Почему, имея столько свободного времени, он не склонен к философствованию? Почему при таком обширном знакомстве с различными местами, людьми, городами, с жизнью в трущобах и на дорогах, он почти не способен расширить наше знание жизни?» Ответ, предлагаемый автором - отсутствие (напрочь) у бродяги группового сознания и какой-бы то ни было привязки к месту.

This is one of the most famous works of Robert Park - Chicago School theorist and one of the founders of the urban sociology which is for the first time published in Russian. The city is convenient for the Park locus of research, since it is here that any feature of human behavior concentrated on a relatively small (foreseeable) space, the natural growth of the institutions is the fastest. In the published article, despite the fact that it may seem a review, recorded a number of basic methodological positions - both in terms of the city, the dynamics of its social development and differentiation, and relative to the social sciences have reached a point where it became possible to organize and carry out laboratory experiment.

La comunidad urbana se presenta desde este punto de vista como algo m?s que un simple conjunto de poblaciones y de instituciones Los elementos que la componen, las instituciones y las personas est?n por el contrario, tan estrechamente ligadas en tre si que la totalidad tiende a adoptar las caracter?sticas de un or ganismo o, utilizando un t?rmino de Herbert Spencer, de un su perorganismo. En este sentido los limites de la comunidad urbana no deben ser identificados con los de la ciudad en tanto que uni dad administrativa, sino m?s bien con los de la regi?n metropoli tana que no est?n arbitrariamente fijados; esta regi?n ser? coex tensiva a la zona en la cual la ciudad, en tanto que fen?meno na tural funciona realmente o quiz?s a aquella en la que ejerce una dominaci?n econ?mica y en menor grado una influencia cultural.