1,630 research outputs found
High density endocardial mapping of shifts in the site of earliest depolarization during sinus rhythm and sinus tachycardia
No full textPrevious mapping studies of sinus rhythm suggest faster rates arise from more cranial sites within the lateral right atrium. In the intact, beating heart, mapping has been limited to epicardial plaques or single endocardial catheters. The present study was designed to examine shifts in the site of the earliest endocardial depolarization during sinus rhythm and sinus tachycardia using high density activation mapping. Noncontact mapping of the right atrium during sinus rhythm was performed on ten anesthetized swine. Recordings were made during sinus rhythm, phenylephrine infusion, and isoproterenol infusion. The hearts were then excised and the histological sinus node identified. The mean minimum and maximum cycle lengths recorded were355 ± 43and717 ± 108 ms. A median of three (range two to five) sites of earliest endocardial depolarization were documented in each animal. With increasing heart rate the site of earliest endocardial depolarization remained stationary until a sudden shift in a cranial or caudal direction, often to sites beyond the histological sinoatrial node. The endocardial shift was unpredictable with considerable variation between animals; however, faster rates arose from more cranial sites(r = 0.46, P = 0.023). There was no difference in the mean cycle length of sinus rhythm originating from specific positions on the terminal crest(r = 0.44, P = 0.17). Cranial sites displayed a more diffuse pattern of early depolarization than caudal sites. In the porcine heart the relationship between heart rate and site of earliest endocardial depolarization shows considerable variation between individual animals. These findings may have implications for clinical mapping and ablation procedures
Global dynamic coupling of activation and repolarization in the human ventricle
No full textBackground: The ability to determine spatial and dynamic changes in ventricular repolarization may help to understand arrhythmogenic mechanisms in humans. We hypothesized that noncontact mapping could be used to investigate global activation-repolarization coupling in the human ventricle during steady state and premature extrastimulation.Methods and Results: Activation-recovery intervals (ARIs) determined from reconstructed unipolar electrograms by the Ensite system were analyzed during sinus rhythm, constant pacing, spontaneous ventricular ectopic beats, and premature stimulation at intermediate and short coupling intervals in the left or right ventricle of 13 patients (6 female; mean age, 48 years) without structural myocardial disease. ARIs were measured from 32 sites in each ventricle with the use of a method validated with monophasic action potential recordings and unipolar contact electrograms. Global T-wave distribution was displayed on a 3-dimensional geometry of the ventricle, with polarities opposite to the direction of activation during steady state and premature stimulation. There was a significant inverse correlation between activation times and ARIs during sinus rhythm, ventricular ectopy, and premature stimulation (r=0.72, slope=–0.76, P<0.001). Premature stimuli at short coupling intervals flattened the regression slope compared with sinus rhythm (–0.61 versus –0.81; P=0.05), but the global pattern of repolarization was preserved. In comparison to our method, the Wyatt method of ARI measurement failed to demonstrate significant coupling between activation and repolarization (r=0.34, slope=0.19).Conclusions: Global, dynamic repolarization mapping of the human ventricle is feasible. An inverse coupling of activation and repolarization during steady state and premature stimulation may preserve electric stability in the normal ventricle
Determination of human ventricular repolarization by noncontact mapping: validation with monophasic action potential recordings
No full textBackground: Noncontact mapping (NCM) has not been validated as a clinical technique to measure ventricular repolarization. We used NCM to determine repolarization characteristics by analysis of reconstructed unipolar electrograms (UEs) at the same sites as monophasic action potential (MAP) recordings in the human ventricle.Methods and Results: MAPs were recorded from a total of 355 beats at 46 sites in the left or right ventricle of 9 patients undergoing ablation of ventricular tachycardia guided by NCM (EnSite system). Measurements were made during sinus rhythm, constant right ventricular pacing, and ventricular extrastimuli during restitution-curve construction. The EnGuide locator signal was used to document MAP catheter locations on the endocardial geometry. UE-determined activation-recovery interval (ARI) measured at the maximum derivative of the T wave (Wyatt method) and the minimum derivative of the positive T wave (alternative method) was correlated with MAP measured at 90% repolarization (MAP90%) at the same sites. ARI correlated with MAP90% during steady state by the Wyatt method (r=0.83, P<0.001) and the alternative method (r=0.94, P<0.001). Restitution curves constructed from MAP and UE data exhibited the same characteristics, with a mean correlation coefficient of 0.95 (range, 0.90 to 0.99, P<0.001). The error between ARI and MAP90% was greater over a shorter diastolic coupling interval but was not influenced by distance of the sampling site from the multielectrode array.Conclusions: NCM accurately determines steady-state and dynamic endocardial repolarization in humans. Global, high-density, NCM data could be used to characterize abnormalities of human ventricular repolarization
Inappropriate shock therapy in a heart failure defibrillator
No full textA 63-year-old male with dilated cardiomyopathy underwent implantation of a "heart failure" defibrillator capable of biventricular pacing. He received an inappropriate shock 5 hours after the procedure. Stored electrograms revealed that during each sinus beat the ventricular channel recorded up to three separate events. These resulted from far-field atrial sensing by the coronary venous lead, appropriate right ventricular sensing, then delayed left ventricular sensing (the result of left bundle branch block). As a consequence of far-field left atrial sensing the two subsequent ventricular electrograms fell within the VF zone. Following an atrial premature beat, VF detection criteria were satisfied and shock therapy delivered. Although coronary venous lead repositioning eliminated far-field atrial sensing, double counting of the widely split right and left ventricular electrograms still occurred during sinus rhythm. Shortening the programmed AV delay resulted in constant biventricular pacing with a single electrogram
Three-dimensional mapping of right atrial activation during sinus rhythm and its relationship to endocardial architecture
No full textIntroduction: Previous mapping studies of right atrial (RA) activation during sinus rhythm have been limited by the use of epicardial electrode plaques in open chest subjects or microelectrodes in the excised heart. This study describes global RA endocardial activation patterns using high-density mapping and compares the results with underlying endocardial architecture.Methods and Results: Noncontact mapping of the RA was performed in 21 anesthetized swine. Isopotential and isochronal maps were superimposed upon three-dimensional reconstructions of RA geometry. Hearts were excised and endocardial dissection performed. Two patterns of RA activation were recorded. The site of earliest endocardial activation occurred either laterally at a position consistent with the terminal crest or superiorly at the junction between the superior caval vein and RA appendage. The subsequent spread of depolarization followed the longitudinal orientation of muscle fibers. Areas of conduction delay and block were seen at the junction between the terminal crest and posterior wall, the cavotricuspid isthmus, and around the margins of the triangle of Koch. Endocardial dissection at these sites demonstrated complex fiber orientation. A lateral site of earliest activation demonstrated a more prominent display of conduction delay or block.Conclusion: The spread of the sinus impulse follows endocardial myofiber orientation and is dictated by the site of earliest activation. Even during sinus rhythm, anisotropic conduction results in areas of conduction block or delay. These findings have implications in the development of reentrant arrhythmias and may influence surgical or electrophysiologic procedures
Characteristics of right atrial activation during coronary sinus pacing
No full textIntroduction: Anatomic and electrical connections between the left atrium and right atrium (RA) have been described. The relationship between coronary sinus (CS) pacing site and RA activation has not been examined.Methods and Results: Fifteen anesthetized swine underwent high-density noncontact mapping of the RA during pacing from up to five different sites within the CS. Isopotential mapping identified the site of earliest RA depolarization and the pattern of subsequent activation. Hearts were excised and endocardial dissection performed. Earliest RA activation occurred at the CS os with proximal CS pacing sites and at Bachmann's bundle at distal pacing sites. The mean depth at which a shift in earliest RA activation site occurred was 46 ± 13 mm (range 21 to 63 mm). RA activation times following earliest activation at the CS and Bachmann's bundle were 40 ± 4 msec and 51 ± 6 msec (P < 0.002). Conduction delay or block was recorded at the lateral cavotricuspid isthmus, terminal crest, and tendon of Todaro. Latest RA activation always occurred in the high anterolateral atrium after ascending the anterolateral wall. The lateral RA was activated by the wavefront that traversed the posterior wall rather than by the wavefront crossing the cavotricuspid isthmus, even with earliest RA activation at the CS os.Conclusion: The site of earliest RA activation during CS pacing is dependent upon the pacing depth within the CS. In the porcine heart, areas of conduction delay influence RA activation patterns and timings. These findings may have implications for patients undergoing assessment of radiofrequency ablation of atrial flutter
An Investigation of the Digital Sublime in Video Game Production
No full textThis research project examines how video games can be programmed to generate the sense of the digital sublime. The digital sublime is a term proposed by this research to describe experiences where the combination of code and art produces games that appear boundless and autonomous. The definition of this term is arrived at by building on various texts and literature such as the work of Kant, Deleuze and Wark and on video games such as Proteus, Minecraft and Love. The research is based on the investigative practice of my work as an artist-programmer and demonstrates how games can be produced to encourage digitally sublime scenarios. In the three games developed for this thesis I employ computer code as an artistic medium, to generate games that explore permutational complexity and present experiences that walk the margins between confusion and control. The structure of this thesis begins with a reading of the Kantian sublime, which I introduce as the foundation for my definition of the digital sublime. I then combine this reading with elements of contemporary philosophy and computational theory to establish a definition applicable to the medium of digital games. This definition is used to guide my art practice in the development of three games that examine different aspects of the digital sublime such as autonomy, abstraction, complexity and permutation. The production of these games is at the core of my research methodology and their development and analysis is used to produce contributions in the following areas.
1. New models for artist-led game design. This includes methods that re-contextualise existing aesthetic forms such as futurism, synaesthesia and romantic landscape through game design and coding. It also presents techniques that merge visuals and mechanics into a format developed for artistic and philosophical enquiry.
2. The development of new procedural and generative techniques in the programming of video games. This includes the implementation of a realtime marching cubes algorithm that generates fractal noise filtered terrain. It also includes a versatile three-dimensional space packing architectural construction algorithm.
3. A new reading of the digital sublime. This reading draws from the Kantian sublime and the writings of Deleuze, Wark and De Landa in order to present an understanding of the digital sublime specific to the domain of art practice within video games. These contributions are evidenced in the writing of this thesis and in the construction of the associated portfolio of games
Further evidence of the association between LQT syndrome and epilepsy in a family with KCNQ1 pathogenic variant
No full textIon channels are expressed both in the heart and in the brain, being advocated as responsible for sudden unexpected death in epilepsy but few pathogenic mutations have been identified. We aim to identify a novel gen associated with channelopathies and epilepsy in a family
Evaluating Citebase, an open access Web-based citation-ranked search and impact discovery service
No full textCitebase is a new citation-ranked search and impact discovery service that measures citations of scholarly research papers which are openly accessible on the Web, i.e. papers that are assessable continuously online. Other services, such as ResearchIndex, have emerged in recent years to offer citation indexing of Web research papers. In the first detailed user evaluation of an open access Web citation indexing service, Citebase has been evaluated by nearly 200 users from different backgrounds. The paper details the procedures used in the evaluation, and analyses the results of this study, which took place between June and October 2002. It was found that within the scope of its primary components, the search interface and services available from its rich bibliographic records, Citebase can be used simply and reliably for the purpose intended, and that it compares favourably with other bibliographic services. It is shown tasks can be accomplished efficiently with Citebase regardless of the background of the user. More data need to be collected and the process refined before it is as reliable for measuring citation impact of indexed papers. Better explanations and guidance are required for first-time users. Coverage is seen as a limiting factor, even though Citebase indexes over 200,000 papers from arXiv. Non-physicists were frustrated at the lack of papers from other sciences. The principle of citation searching of open access archives has thus been demonstrated and need not be restricted to current users. Since the evaluation, Citebase has become a featured service of the ArXiv physics eprint archives
Accepting Optimally in Automated Negotiation with Incomplete Information (abstract)
No full textIntelligent SystemsElectrical Engineering, Mathematics and Computer Scienc
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