Publications by authors named "David Gareth Jones"

18 Publications

  • Page 1 of 1

Anatomy in a Post-Covid-19 World: Tracing a New Trajectory.

Anat Sci Educ 2021 Mar;14(2):148-153

Department of Anatomy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.

In responding to Covid-19 anatomists have succeeded in adapting their teaching to online delivery. However, long-term reliance on this mode of teaching raises the prospect that transferring the whole of the learning environment to an impersonal digital world will lead to loss of anatomy's humanistic side. In looking to a future increasingly dependent upon digital input to teaching, a number of roadblocks are identified. These are: the peril of abandoning the ethos of anatomy; for the workload of staff and especially for female academic staff; by a lack of adequate resources; to the research nature of departments, including the quality of research; to the position of anatomy in the biomedical sciences; and from pressures to retreat from a dissection-based education. In tracing a future trajectory for anatomy, issues outlined are the inevitability of change, the need for anatomy to market itself to the world, and the opportunities presented for anatomy to view itself increasingly as a contributor to broad scholastic endeavors. Suggestions include exploring the possibilities presented by virtual anatomy museums, the use of online learning to reach those not normally in touch with anatomy teaching, and exploring the integrated courses with humanities disciplines. It is concluded that anatomy will flourish if there is a willingness to expand the traditional horizons and be prepared to integrate all that is best in the person-to-person and digital worlds.
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http://dx.doi.org/10.1002/ase.2054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014461PMC
March 2021

Catheter Ablation of Atrial Fibrillation in Patients With Functional Mitral Regurgitation and Left Ventricular Systolic Dysfunction.

Front Cardiovasc Med 2020 14;7:596491. Epub 2020 Dec 14.

Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom.

The efficacy of catheter ablation for atrial fibrillation (AF) in patients with functional mitral regurgitation (MR) and left ventricular (LV) systolic dysfunction (LVSD) is not known. The aim of the study is to determine the efficacy of catheter ablation for AF in patients with functional MR and LVSD, and to validate its effects on the severity of MR and cardiac reverse remodeling. We performed a retrospective study of 54 patients with functional MR who underwent AF ablation, including 21 (38.9%) with LVSD and 33 (61.1%) with normal LV systolic function (LVF). The primary outcomes evaluated were freedom from recurrent atrial tachyarrhythmia (ATa), severity of MR, and left atrial (LA) and LV remodeling. During a mean follow-up of 20.7 ± 16.8 months, freedom from recurrent ATa was not significantly different between patients with LVSD and those with normal LVF after the first ablation ( = 0.301) and after multiple ablations ( = 0.728). Multivariable predictors of recurrent ATa were AF duration [hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.01-1.25; = 0.039), previous stroke (HR 5.28, 95% CI 1.46-19.14; = 0.011), and estimated glomerular filtration rate (HR 0.97, 95% CI 0.95-0.99; = 0.012). Compared with baseline, there was a significant reduction in severity of MR ( = 0.007), LA size ( < 0.001) and LV end-systolic dimension ( = 0.008), and improvement in the LV ejection fraction ( = 0.001) after restoring sinus rhythm in patients with LVSD. Catheter ablation is a valid option for the treatment of AF in patients with functional MR and LVSD, even though multiple procedures may be required.
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http://dx.doi.org/10.3389/fcvm.2020.596491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767831PMC
December 2020

Spectral characterization and impact of stepwise ablation protocol including LAA electrical isolation on persistent AF.

Pacing Clin Electrophysiol 2021 Feb 12;44(2):318-326. Epub 2021 Jan 12.

Heart Rhythm Centre, The Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK.

Objectives: To study how left atrial appendage electrical isolation (LAAEI) impacts atrial dominant frequency (DF) in patients with long-standing persistent atrial fibrillation (LSPAF).

Background: LAAEI is associated with a high probability of freedom from atrial fibrillation (AF) and spectral analysis may identify high-frequency sources. How LAAEI impacts the AF dynamics and the subgroup of LSPAF patients in whom LAAEI would be most beneficial, is unclear.

Methods: Twenty patients with LSPAF were included in the study. Fast Fourier transforms (FFT) were performed on atrial electrograms recorded from 13 sites in the LA and RA. The highest peak frequency was defined as DF.

Results: There was no significant difference in DF between atrial sites except for at the superior vena cava which had the lowest DF at baseline. Stepwise ablation consisting of circumferential pulmonary vein isolation and a linear ablation set of mitral isthmus and roof significantly reduced the DF within the coronary sinus (CS) (5.93 ± 0.98 Hz vs. 5.09 ± 0.72 Hz, p < .05) and the LA posterior wall (LApos) (6.26 ± 0.92 Hz vs. 5.43 ± 0.98 Hz, p < .01). LAAEI preferentially further decreased the DF at the LApos (p < .01), but not at the CS. In cases where there was < 13.6% reduction in the DF of the LApos following the stepwise ablation, the addition of LAAEI was associated with an increased restoration of sinus rhythm (55%, p < .05).

Conclusion: LAAEI in addition to stepwise ablation results in further reduction of the DF in the LApos, which is associated with acute termination of AF and favorable ablation outcome.
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http://dx.doi.org/10.1111/pace.14151DOI Listing
February 2021

Catheter ablation vs. thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: CASA-AF randomized controlled trial.

Eur Heart J 2020 12;41(47):4471-4480

Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.

Aims: Long-standing persistent atrial fibrillation (LSPAF) is challenging to treat with suboptimal catheter ablation (CA) outcomes. Thoracoscopic surgical ablation (SA) has shown promising efficacy in atrial fibrillation (AF). This multicentre randomized controlled trial tested whether SA was superior to CA as the first interventional strategy in de novo LSPAF.

Methods And Results: We randomized 120 LSPAF patients to SA or CA. All patients underwent predetermined lesion sets and implantable loop recorder insertion. Primary outcome was single procedure freedom from AF/atrial tachycardia (AT) ≥30 s without anti-arrhythmic drugs at 12 months. Secondary outcomes included clinical success (≥75% reduction in AF/AT burden); procedure-related serious adverse events; changes in patients' symptoms and quality-of-life scores; and cost-effectiveness. At 12 months, freedom from AF/AT was recorded in 26% (14/54) of patients in SA vs. 28% (17/60) in the CA group [OR 1.128, 95% CI (0.46-2.83), P = 0.83]. Reduction in AF/AT burden ≥75% was recorded in 67% (36/54) vs. 77% (46/60) [OR 1.13, 95% CI (0.67-4.08), P = 0.3] in SA and CA groups, respectively. Procedure-related serious adverse events within 30 days of intervention were reported in 15% (8/55) of patients in SA vs. 10% (6/60) in CA, P = 0.46. One death was reported after SA. Improvements in AF symptoms were greater following CA. Over 12 months, SA was more expensive and provided fewer quality-adjusted life-years (QALYs) compared with CA (0.78 vs. 0.85, P = 0.02).

Conclusion: Single procedure thoracoscopic SA is not superior to CA in treating LSPAF. Catheter ablation provided greater improvements in symptoms and accrued significantly more QALYs during follow-up than SA.

Clinical Trial Registration: ISRCTN18250790 and ClinicalTrials.gov: NCT02755688.
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http://dx.doi.org/10.1093/eurheartj/ehaa658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767634PMC
December 2020

Ethical Responses to the Covid-19 Pandemic: Implications for the Ethos and Practice of Anatomy as a Health Science Discipline.

Anat Sci Educ 2020 Sep 10;13(5):549-555. Epub 2020 Aug 10.

Department of Anatomy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.

The move of much anatomy teaching online in response to the Covid-19 pandemic has been successfully implemented within very short time frames. This has necessitated a high degree of dependence upon the use of digitized cadaveric resources, has entailed immense workload demands on staff, and has disrupted students' studies. These educational exigencies have been accompanied by ethical uncertainties for a discipline centered on study of the dead human body. An ethical framework for anatomy is suggested based on the principles of equal concern and respect, minimization of harm, fairness, and reciprocity, in which all staff and students are to be treated with respect and as moral equals. A series of ethical obligations are proposed as a means of maintaining the ethos of anatomy, coping with the suspension of body donation, providing adequate resources, and responding to increased dependence upon external providers. Good academic practice raises more general obligations stemming from the welfare of students, the increased workload of staff, and checking on online assessment and invigilation. As anatomists respond to the educational and ethical lessons prompted by this pandemic, they should plan for future disruptions to normal work patterns by adopting a sustainable and equitable course of action.
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http://dx.doi.org/10.1002/ase.2003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404418PMC
September 2020

Cultural practices of the Zulu ethnic group on the body and their influence on body donation.

Anat Sci Educ 2020 Nov 3;13(6):721-731. Epub 2020 Mar 3.

Division of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.

Cultural practices in the African continent have been thought to impact negatively on body donation. Thus, most African countries continue to rely on unclaimed bodies for dissection programs, or bequests from the white population. The latter situation is dominant in South African medical schools. Since South Africa is multi-cultural with nine main ethnic groups of the Black African population, it is important to seek the reasons behind lack of participation in body donation. This report represents a move in this direction with its qualitative study of the cultural practices of the Zulu ethnic group in the province of KwaZulu-Natal from the perspective of a variety of participants, with emphasis on their treatment of the human body after death. Four themes emerged from interviews: (1) Death is not the end; (2) Effect of belief in ancestors; (3) Significance of rituals and customs carried out on human tissue; and (4) Burial as the only method of body disposal. Each of these themes is discussed in relation to the likelihood of body donation being seen by Zulus as an acceptable practice. It is concluded that this is unlikely, on account of the need to preserve the linkage between the physical human body and the spirit of the deceased person, and the perceived ongoing relationship between the spirit of the dead and the living. In view of these conclusions, a number of options are canvassed about the manner in which anatomists in KwaZulu-Natal might obtain bodies for dissection. These possibilities have implications for anatomists working in comparable cultural contexts.
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http://dx.doi.org/10.1002/ase.1950DOI Listing
November 2020

Ethical Perspectives on Body Donation Following Physician-Assisted Death.

Anat Sci Educ 2020 Jul 6;13(4):504-511. Epub 2019 Dec 6.

Department of Anatomy, University of Otago, Dunedin, New Zealand.

The increasing availability of physician-assisted death (PAD) has opened up a novel means of making donated bodies available for anatomical dissection. This practice has come to the fore in Canada, but is unlikely to be confined to that country as legislation changes in other countries. The ethical considerations raised by this development are placed within the framework of the ethical guidelines on body donation promulgated by the International Federation of Associations of Anatomists. The discussion centers on understanding the ethical dimensions of moral complicity, and whether it is accepted or rejected. If rejected it is possible to separate ethical concerns regarding PAD from subsequent use of donated bodies, as long as there is fully informed consent and complete ethical and procedural separation of the two. Openness about the origin of bodies for dissection is essential. Students should be instructed on the nuances of moral complicity, and consideration be given to those with moral doubts about PAD. Two issues are raised in considering whether these moves represent an ethical slippery slope: the attraction represented by obtaining relatively "high quality" bodies, and the manner in which organ donation following PAD has led to challenges to the dead donor rule. Although body donation raises fewer concerns, the ethical dimensions of the two are similar. The ethical constraints outlined here have the capacity to prevent an ethical slippery slope and constitute a sound basis for addressing an innovative opportunity for anatomists.
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http://dx.doi.org/10.1002/ase.1930DOI Listing
July 2020

Confucian Ethics on the Commercial Use of Human Bodies and Body Parts: Yi (Righteousness) or/and Li (Profit)?

Anat Sci Educ 2019 Jul 16;12(4):444-453. Epub 2019 Apr 16.

Department of Anatomy, Division of Health Sciences, University of Otago, Dunedin, New Zealand.

In China as elsewhere in the world, human bodies and body parts have long been used for a wide range of medical and non-medical purposes. In recent decades, China has played a considerable role in some of the public exhibitions of plastinated bodies and body parts, and the commercial trade in organ donations. These contemporary developments have raised numerous challenging ethical and governance questions. In spite of the growing role of China in these, there have been few studies devoted to Chinese ethical thinking that might govern its policies on the use of human bodies and body parts, and in particular on the issue of commercialization. The present study is an attempt to bridge this gap, and concludes that Confucian thinking stresses the primacy of righteousness over profits and utilities. This conclusion is reached directly by drawing on Confucian ethical responses to the peculiar practice of using human body parts, such as placenta and flesh, as drugs in traditional Chinese medicine in imperial China and what has been called "yili zhibian," the major Confucian discourse on yi (righteousness or justice) and li (profit or interest) in its long history. The principle of prioritizing righteousness over profit leads to a general moral opposition to the commodification of human bodies and body parts. While Confucianism may not place an absolute prohibition on any such use, it does require that any commercial uses are made subject to the fundamental moral principles, such as righteousness, as well as adequate ethical governance procedures.
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http://dx.doi.org/10.1002/ase.1876DOI Listing
July 2019

Characterization of the Mechanism and Substrate of Atrial Tachycardia Using Ultra-High-Density Mapping in Adults With Congenital Heart Disease: Impact on Clinical Outcomes.

J Am Heart Assoc 2019 02;8(4):e010535

1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom.

Background Atrial tachycardia ( AT ) is common in patients with adult congenital heart disease and is challenging to map and ablate. We used ultra-high-density mapping to characterize the AT mechanism and investigate whether substrate characteristics are related to ablation outcomes. Methods and Results A total of 50 AT s were mapped with ultra-high-density mapping in 23 procedures. Patients were followed up for up to 12 months. Procedures were classified to group A if there was 1 single AT induced (n=12) and group B if there were ≥2 AT s induced (n=11 procedures). AT mechanism per procedure was macro re-entry (n=10) and localized re-entry (n=2) in group A and multiple focal (n=6) or multiple macro re-entry (n=5) in group B. Procedure duration, low voltage area (0.05-0.5 mV), and low voltage area indexed for volume were higher in group B (159 [147-180] versus 412 [352-420] minutes, P<0.001, 22.6 [12.2-29.8] versus 54.2 [51.1-61.6] cm, P=0.014 and 0.17 [0.12-0.21] versus 0.26 [0.23-0.27] cm/mL, P=0.024 accordingly). Dense scar (<0.05 mV) and atrial volume were similar between groups. Acute success and freedom from arrhythmia recurrence were worse in group B (100% versus 77% P=0.009 and 11.3, CI 9.8-12.7 versus 4.9, CI 2.2-7.6 months, log rank P=0.004). Indexed low voltage area ≥0.24 cm/mL could predict recurrence with 100% sensitivity and 77% specificity (area under the curve 0.923, P=0.007). Conclusions Larger low voltage area but not dense scar is associated with the induction of multiple focal or re-entry AT s, which are subsequently associated with longer procedure duration and worse acute and midterm clinical outcomes.
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http://dx.doi.org/10.1161/JAHA.118.010535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405650PMC
February 2019

Three-dimensional Printing in Anatomy Education: Assessing Potential Ethical Dimensions.

Anat Sci Educ 2019 Jul 22;12(4):435-443. Epub 2019 Jan 22.

Department of Anatomy, University of Otago, Dunedin, New Zealand.

New technological developments have frequently had major consequences for anatomy education, and have raised ethical queries for anatomy educators. The advent of three-dimensional (3D) printing of human material is showing considerable promise as an educational tool that fits alongside cadaveric dissection, plastination, computer simulation, and anatomical models and images. At first glance its ethical implications appear minimal, and yet the more extensive ethical implications around clinical bioprinting suggest that a cautious approach to 3D printing in the dissecting room is in order. Following an overview of early groundbreaking studies into 3D printing of prosections, organs, and archived fetal material, it has become clear that their origin, using donated bodies or 3D files available on the Internet, has ethical overtones. The dynamic presented by digital technology raises questions about the nature of the consent provided by the body donor, reasons for 3D printing, the extent to which it will be commercialized, and its comparative advantages over other available teaching resources. In exploring questions like these, the place of 3D printing within a hierarchical sequence of value is outlined. Discussion centers on the significance of local usage of prints, the challenges created by regarding 3D prints as disposable property, the importance of retaining the human side to anatomy, and the unacceptability of obtaining 3D-printed material from unclaimed bodies. It is concluded that the scientific tenor of 3D processes represents a move away from the human person, so that efforts are required to prevent them accentuating depersonalization and commodification.
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http://dx.doi.org/10.1002/ase.1851DOI Listing
July 2019

Catheter Ablation versus Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation (CASA-AF): study protocol for a randomised controlled trial.

Trials 2018 Feb 20;19(1):117. Epub 2018 Feb 20.

Royal Brompton and Harefield NHS Trust, London, UK.

Background: Atrial fibrillation is the commonest arrhythmia which raises the risk of heart failure, thromboembolic stroke, morbidity and death. Pharmacological treatments of this condition are focused on heart rate control, rhythm control and reduction in risk of stroke. Selective ablation of cardiac tissues resulting in isolation of areas causing atrial fibrillation is another treatment strategy which can be delivered by two minimally invasive interventions: percutaneous catheter ablation and thoracoscopic surgical ablation. The main purpose of this trial is to compare the effectiveness and safety of these two interventions.

Methods/design: Catheter Ablation versus Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation (CASA-AF) is a prospective, multi-centre, randomised controlled trial within three NHS tertiary cardiovascular centres specialising in treatment of atrial fibrillation. Eligible adults (n = 120) with symptomatic, long-standing, persistent atrial fibrillation will be randomly allocated to either catheter ablation or thoracoscopic ablation in a 1:1 ratio. Pre-determined lesion sets will be delivered in each treatment arm with confirmation of appropriate conduction block. All patients will have an implantable loop recorder (ILR) inserted subcutaneously immediately following ablation to enable continuous heart rhythm monitoring for at least 12 months. The devices will be programmed to detect episodes of atrial fibrillation and atrial tachycardia ≥ 30 s in duration. The patients will be followed for 12 months, completing appropriate clinical assessments and questionnaires every 3 months. The ILR data will be wirelessly transmitted daily and evaluated every month for the duration of the follow-up. The primary endpoint in the study is freedom from atrial fibrillation and atrial tachycardia at the end of the follow-up period.

Discussion: The CASA-AF Trial is a National Institute for Health Research-funded study that will provide first-class evidence on the comparative efficacy, safety and cost-effectiveness of thoracoscopic surgical ablation and conventional percutaneous catheter ablation for long-standing persistent atrial fibrillation. In addition, the results of the trial will provide information on the effects on patients' quality of life.

Trial Registration: ISRCTN Registry, ISRCTN18250790 . Registered on 24 April 2015.
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http://dx.doi.org/10.1186/s13063-018-2487-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819216PMC
February 2018

The Artificial World of Plastination: A Challenge to Religious Perspectives on the Dead Human Body.

New Bioeth 2016 Nov 12;22(3):237-252. Epub 2016 Oct 12.

a Department of Anatomy , University of Otago , Dunedin , New Zealand.

The public exhibitions of plastinated (preserved) and dissected human cadavers have proved exceedingly popular and also very contentious. However, there has been little in the way of sustained analysis of these exhibitions from a Christian angle. The technique of plastination enables whole bodies to be displayed as though standing and playing a variety of sports, and with 'life-like' facial expressions. In analyzing this phenomenon, the plastination procedure is outlined, and the degree of naturalness of the whole body plastinates assessed. In searching for theological directives the debate over burial and cremation is used as a means of exploring the respect we give the dead body, and the significance of the resurrection of the body for our views of the dead body. In particular, attention is paid to devaluation of the dead body in situations ranging from dissection of the body through to commercial public exhibitions. The centrality of notions of altruism and 'gift' is discussed. It is concluded that there are many disquieting features to these exhibitions, necessitating caution in approaching them. Nevertheless, in reminding visitors of their mortality and the wonders of the human body, they are not to be dismissed entirely.
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http://dx.doi.org/10.1080/20502877.2016.1238580DOI Listing
November 2016

Searching for good practice recommendations on body donation across diverse cultures.

Clin Anat 2016 Jan 12;29(1):55-9. Epub 2015 Nov 12.

Department of Anatomy, University of Otago, Dunedin, New Zealand.

Good practice recommendations for the donation of human bodies and tissues for anatomical examination have been produced by the International Federation of Associations of Anatomists (IFAA). Against the background of these recommendations, the ethical values underlying them were outlined. These were the centrality of informed consent, their non-commercial nature, and the respect due to all associated with donations including family members. The latter was exemplified in part by the institution of thanksgiving services and commemorations. A number of issues in the recommendations were discussed, including the movement of bodies across national borders, donor anonymity, taking images of bodies and body parts, and the length of time for which bodies can be kept. Outstanding questions in connection with body donation included the availability of bodies for research as well as teaching, allowing TV cameras into the dissecting room, and the display of archival material in anatomy museums. Future prospects included whether IFAA could be formulating a position on the public exhibition of plastinated human material, and in what ways IFAA could assist countries currently dependent upon the use of unclaimed bodies.
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http://dx.doi.org/10.1002/ca.22648DOI Listing
January 2016

The public display of plastinates as a challenge to the integrity of anatomy.

Clin Anat 2016 Jan 18;29(1):46-54. Epub 2015 Nov 18.

Department of Anatomy, University of Otago, New Zealand.

Anatomy has been thrust into the public domain by the highly successful public displays of dissected and plastinated human bodies. This is anatomy in modern guise, anatomy as perceived by the general public. If this is the case, the message it is giving the public about the nature of anatomy is that it is an impersonal analysis of the human body of value within a medical and health care environment. While this is in part true, and while it reflects important aspects of anatomy's history, it fails to reflect the humanistic strands within an increasing swathe of contemporary anatomy. These are manifested in growing recognition of the centrality of informed consent in the practice of anatomy, awareness of the personal dimensions and relationships of those whose bodies are being dissected, and manifested in thanksgiving ceremonies involving staff and students. The notion that the bodies undergoing dissection can be students' first teachers and/or patients is gaining ground, another indication of the human dimensions of the anatomical enterprise. Exhibitions such as Body Worlds ignore these dimensions within anatomy by dislocating it from its clinical and relational base. The significance of this is that loss of these dimensions leads to a loss of the human face of anatomy by isolating it from the people whose body bequests made this knowledge possible. What is required is greater transparency and openness in the practices of all who deal with the dead human body, trends that owe much to the writings of scholars from within a range of humanities disciplines as they have responded to the public displays of dissected plastinated bodies. Anatomists have much to learn from these debates.
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http://dx.doi.org/10.1002/ca.22647DOI Listing
January 2016

Anatomy in ethical review.

Clin Anat 2016 Jan;29(1):2-3

Department of Anatomy, University of Otago, Dunedin, New Zealand.

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http://dx.doi.org/10.1002/ca.22646DOI Listing
January 2016

Atrial tachycardia after AF ablation: an alternate mechanism?

Pacing Clin Electrophysiol 2014 Mar 3;37(3):375-8. Epub 2013 Dec 3.

Heart Rhythm Centre, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, UK.

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http://dx.doi.org/10.1111/pace.12314DOI Listing
March 2014

Catheter ablation versus rate control for atrial fibrillation: what have we learnt from the ARC-HF trial?

Future Cardiol 2013 Sep;9(5):599-602

National Heart & Lung Institute, Imperial College London, London, UK.

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http://dx.doi.org/10.2217/fca.13.56DOI Listing
September 2013

A multi-purpose spiral high-density mapping catheter: initial clinical experience in complex atrial arrhythmias.

J Interv Card Electrophysiol 2011 Sep 20;31(3):225-35. Epub 2011 Apr 20.

Heart Rhythm Centre, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, Sydney Street, London, SW3 6NP, UK.

Purpose: There is an increasing need for catheter ablation procedures to treat complex atrial tachycardias (AT) and atrial fibrillation (AF), often requiring detailed endocardial mapping. The sequential point-to-point contact mapping of complex arrhythmias is time-consuming and may not always be feasible. We assessed the utility of a novel spiral duo-decapolar high-density (HD) mapping catheter to delineate complex arrhythmia substrates for ablation.

Methods: The patients underwent HD mapping using a spiral catheter (AFocusII) and the EnSite NavX system, during catheter ablation procedures, to treat atrial arrhythmias.

Results: In 26 patients, a total of 32 atrial arrhythmias were mapped and ablated, comprising of five focal AT, eight macroreentrant AT, 11 persistent AF and eight paroxysmal AF. The HD catheter was used to acquire endocardial surface geometries in all cases and to map the pulmonary veins in patients undergoing AF ablation. In persistent AF, HD catheter mapping permitted the creation of highly detailed complex fractionated electrogram maps (left atrium 449 ± 128 points in 7.2 ± 2.6 min; right atrium 411 ± 113 points in 6.7 ± 1.6 min). In AT, activation mapping was performed with the acquisition of 305 ± 158 timing points in 7.3 ± 2.6 min, guiding successful ablation in all cases. During the follow-up of 7.0 ± 2.6 months, all AT patients remained free of significant arrhythmia.

Conclusions: High-density contact mapping with a novel spiral multipolar catheter allows rapid assessment of focal and macroreentrant AT, and complex fractionated electrical activity in the atria. It has further multi-functional capabilities as a pulmonary vein mapping catheter and for accurate geometry creation when used with a 3D mapping system.
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http://dx.doi.org/10.1007/s10840-011-9574-0DOI Listing
September 2011