scholarly journals 1286: IMPACT OF PEDIATRIC ECPR SIMULATION ON COMPLIANCE WITH CPR MEASURES AND ECMO ACTIVATION TIMES

2021 ◽  
Vol 50 (1) ◽  
pp. 644-644
Author(s):  
Ripal Patel ◽  
Cortney Foster ◽  
Nan Garber ◽  
Jenni Day ◽  
Dayanand Bagdure
Keyword(s):  
Activation Times

scholarly journals 3-Dimensional ventricular electrical activation pattern assessed from a novel high-frequency electrocardiographic imaging technique: principles and clinical importance

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pavel Jurak ◽  
Laura R. Bear ◽  
Uyên Châu Nguyên ◽  
Ivo Viscor ◽  
Petr Andrla ◽  
...  
Keyword(s):  
High Frequency ◽  
Ex Vivo ◽  
Clinical Importance ◽  
Electrical Activation ◽  
Bundle Branch Block ◽  
Electrocardiographic Imaging ◽  
3 Dimensional ◽  
Intraventricular Conduction ◽  
Clinical Measurements ◽  
Activation Times

AbstractThe study introduces and validates a novel high-frequency (100–400 Hz bandwidth, 2 kHz sampling frequency) electrocardiographic imaging (HFECGI) technique that measures intramural ventricular electrical activation. Ex-vivo experiments and clinical measurements were employed. Ex-vivo, two pig hearts were suspended in a human-torso shaped tank using surface tank electrodes, epicardial electrode sock, and plunge electrodes. We compared conventional epicardial electrocardiographic imaging (ECGI) with intramural activation by HFECGI and verified with sock and plunge electrodes. Clinical importance of HFECGI measurements was performed on 14 patients with variable conduction abnormalities. From 3 × 4 needle and 108 sock electrodes, 256 torso or 184 body surface electrodes records, transmural activation times, sock epicardial activation times, ECGI-derived activation times, and high-frequency activation times were computed. The ex-vivo transmural measurements showed that HFECGI measures intramural electrical activation, and ECGI-HFECGI activation times differences indicate endo-to-epi or epi-to-endo conduction direction. HFECGI-derived volumetric dyssynchrony was significantly lower than epicardial ECGI dyssynchrony. HFECGI dyssynchrony was able to distinguish between intraventricular conduction disturbance and bundle branch block patients.

scholarly journals Determination of dominant loop in dual loop atrial tachycardia with direct graph mapping: an alternative for entrainment mapping?

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
L Lowie ◽  
E Van Nieuwenhuyse ◽  
J Sanchez ◽  
A Panfilov ◽  
S Knecht ◽  
...  
Keyword(s):  
Simulated Data ◽  
Anterior Wall ◽  
Specific Model ◽  
Patient Specific ◽  
Double Loop ◽  
Direct Graph ◽  
Funding Sources ◽  
Graph Mapping ◽  
Activation Times ◽  
Clinical Cases

Abstract Funding Acknowledgements Type of funding sources: None. Background Entrainment mapping (EM) is an important tool to determine the mechanism of complex reentrant atrial tachycardias (ATs), mostly to distinguish dominant from bystander reentrant loops. However, entrainment maneuvers are challenging, time consuming and risk to end the tachycardia.  Purpose Recently, we developed a novel method Directed Graph Mapping (DGM), using concepts of network theory, allowing to automatically determine AT reentry loops from the local activation times (LAT) of any clinical mapping system. DGM showed good performance: it correctly finds ablation target (100 % success rate) on simple AT cases and could automatically determine reentry loops confirmed by the expert electrophysiologist with EM in complex AT cases. Out of 32 single loop cases, 62.5 % was identified correctly with automated DGM and out of 6 true double loop cases, 83.3 %. Lower performance for single reentry complex cases compared to EM was mainly because DGM could not distinguish the dominant loop from additional bystander loops found by DGM. Hence, the purpose of this work was to develop additional algorithms which in case of multiple found DGM loops could automatically find the dominant loop and compare it with the results of EM. Methods We performed multiple  simulations of various types of double loop reentry on a patient specific model of the left atrium. Based on a clinical case, double loops were simulated around a scar at the anterior wall (localized reentry) and the mitral valve (MV). LAT maps were determined similar as in the clinic. By varying the size of the scar in multiple steps, we obtained a transition from a regime of a dominant loop around the scar (small scar), to a true double loop and further to a regime of a dominant loop around the MV (large scar). We developed a novel DGM algorithm to determine the dominant loop from the region of collision (ROC) found from the vector field of the wavefront graph.   The developed method was also tested on 8 clinical cases of double loop ATs with EM measurements. Results Our algorithm found the location of the ROC and determined the correct dominant loop in 100% of the simulated data.  We tested this on 8 clinical cases of AT, and accuracy of the method was 75 %. Conclusions Determining the ROC in case of multiple loops in AT could correctly determine the dominant versus bystander loop, leading to the correct ablation target, without the need for further EM.

scholarly journals Bachmann bundle impairment following linear ablation of left anterior wall: impact on left atrial function

2020 ◽  
Author(s):  
Yanjuan Zhang ◽  
Fengming Wu ◽  
Yu Gao ◽  
Nan Wu ◽  
Gang Yang ◽  
...  
Keyword(s):  
Contractile Function ◽  
Anterior Wall ◽  
Activation Time ◽  
Linear Ablation ◽  
Measured Activation ◽  
Mechanical Remodeling ◽  
Activation Times ◽  
And Function ◽  
Bachmann Bundle

Background: We aimed to evaluate the effect of Bachmann bundle (BB) impairment on electrical and mechanical function of the left atrium (LA), as well as the long-term clinical impact of such impairment. Design: We measured activation time in the five LA walls in 56 patients with atrial fibrillation. LA reservoir, conduit, and contractile function were also evaluated. Patients were divided into two groups based on ablation strategy: the circumferential pulmonary vein isolation (CPVI) group and CPVI with anterior wall linear ablation (LAWA) group. Patients in the CPVI+LAWA group were divided into two sub-groups based on ECG differences following ablation: the BB impairment group and intact BB group. LA activation time and function were then compared between the ablation strategy groups and the CPVI+LAWA subgroups. Results: Patients in the CPVI+LAWA group exhibited longer activation times in the anterior and lateral walls of the LA, poorer LA synchrony, and reduced LA contractile and reservoir function when compared with those in the CPVI group. In the BB impairment subgroup, we observed a discrepancy between electrical/mechanical remodeling. Among five walls, activation time was longest in this region. BB impairment was also associated with reduced LA function. Conclusion: Significant changes in LA function and conductibility were observed in patients with anterior wall ablation, especially those with iatrogenic BB impairment.

scholarly journals Prolonged Sinus Pauses upon Termination of Paroxysmal Atrial Fibrillation: Abnormal Right Atrial Electrophysiologic and Electroanatomic Findings

2017 ◽  
Vol 44 (2) ◽  
pp. 107-114 ◽  
Author(s):  
Zhengyu Bao ◽  
Hongwu Chen ◽  
Bing Yang ◽  
Michael Shehata ◽  
Weizhu Ju ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Node ◽  
P Wave ◽  
Right Atrial ◽  
Control Group ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Group A ◽  
Group B ◽  
Activation Times ◽  
The Right

The efficacy of pulmonary vein antral isolation for patients with prolonged sinus pauses (PSP) on termination of atrial fibrillation has been reported. We studied the right atrial (RA) electrophysiologic and electroanatomic characteristics in such patients. Forty patients underwent electroanatomic mapping of the RA: 13 had PSP (group A), 13 had no PSP (group B), and 14 had paroxysmal supraventricular tachycardia (control group C). Group A had longer P-wave durations in lead II than did groups B and C (115.5 ± 15.4 vs 99.5 ± 10.9 vs 96.5 ± 10.4 ms; P=0.001), and RA activation times (106.8 ± 13.8 vs 99 ± 8.7 vs 94.5 ± 9.1 s; P=0.02). Group A's PP intervals were longer during adenosine triphosphate testing before ablation (4.6 ± 2.3 vs 1.7 ± 0.6 vs 1.5 ± 1 s; P <0.001) and after ablation (4.7 ± 2.5 vs 2.2 ± 1.4 vs 1.6 ± 0.8 s; P <0.001), and group A had more complex electrograms (11.4% ± 5.4% vs 9.3% ± 1.6% vs 5.8% ± 1.6%; P <0.001). Compared with group C, group A had significantly longer corrected sinus node recovery times at a 400-ms pacing cycle length after ablation, larger RA volumes (100.1 ± 23.1 vs 83 ± 22.1 mL; P=0.04), and lower conduction velocities in the high posterior (0.87 ± 0.13 vs 1.02 ± 0.21 mm/ms; P=0.02) and high lateral RA (0.89 ± 0.2 vs 1.1 ± 0.35 mm/ms; P=0.04). We found that patients with PSP upon termination of atrial fibrillation have RA electrophysiologic and electroanatomic abnormalities that warrant post-ablation monitoring.

scholarly journals The Use of Electrocardiographic Imaging in Localising the Origin of Arrhythmias During Catheter Ablation of Ventricular Tachycardia

2021 ◽  
Vol 10 (3) ◽  
pp. 211-217
Author(s):  
Adam J Graham ◽  
Richard J Schilling
Keyword(s):  
Inverse Problem ◽  
Ventricular Arrhythmia ◽  
Clinical Tool ◽  
Electrocardiographic Imaging ◽  
Surface Electrodes ◽  
Non Invasive ◽  
Large Target ◽  
The Us ◽  
Activation Times ◽  
Unipolar Electrograms

Non-invasive electrocardiographic imaging (ECGI) is a novel clinical tool for mapping ventricular arrhythmia. Using multiple body surface electrodes to collect unipolar electrograms and conventional medical imaging of the heart, an epicardial shell can be created to display calculated electrograms. This calculation is achieved by solving the inverse problem and allows activation times to be calculated from a single beat. The technology was initially pioneered in the US using an experimental torso-shaped tank. Accuracy from studies in humans has varied. Early data was promising, with more recent work suggesting only moderate accuracy when reproducing cardiac activation. Despite these limitations, the system has been successfully used in pioneering work with non-invasive cardiac radioablation to treat ventricular arrhythmia. This suggests that the resolution may be sufficient for treatment of large target areas. Although untested in a well conducted clinical study it is likely that it would not be accurate enough to guide more discreet radiofrequency ablation.

scholarly journals Effect of Ceramic Interposition and Post-activation Times on Knoop Hardness of Different Shades of Resin Cement

2018 ◽  
Vol 29 (1) ◽  
pp. 76-81 ◽  
Author(s):  
Marina Barrêto Pereira Moreno ◽  
Ana Rosa Costa ◽  
Frederick Allen Rueggeberg ◽  
Américo Bortolazzo Correr ◽  
Mário Alexandre Coelho Sinhoreti ◽  
...  
Keyword(s):  
Light Exposure ◽  
Knoop Hardness ◽  
Resin Cement ◽  
Cross Sectional ◽  
Commercial Resin ◽  
Cure Time ◽  
Different Depths ◽  
Activation Times ◽  
Post Hoc ◽  
Made In

Abstract The aim of this study was to evaluate Knoop hardness of different shades of a resin cement light-cured directly or through ceramic discs, measured 15 min or 24 h after light exposure, and at different depths. Specimens of a commercial resin cement (Variolink Veneer) in seven shades, were fabricated in an elastomeric mold, covered with a mylar strip, a 0.7 mm thick ceramic disc (IPS e.max Press) was placed and the cement was light-activated for 20 s using a blue LED (Radii-Cal). The cured resin cement specimens were transversely wet-flattened to their middle portion and microhardness (Knoop) values were recorded at 15 min after light exposure and after deionized water storage at 37 ºC for 24 h. Five indentations were made in the cross-sectional area at 100 and 700 μm depths from the top surface. Ten specimens were made for each test conditions. Data were submitted to ANOVA split-plot design (shade, post-cure time, mode of activation and depth), followed by Tukey post hoc test (α=0.05). Significant differences for shade (p<0.0001), mode of activation (p<0.001), post-cure time (p<0.0001) and depth (p<0.0001) were detected. No significant interactions (p>0.05) were found, except for shade x post-cure time (p<0.0045) and mode of activation x post-cure time (p<0.0003). Resin cement shade has a significant effect on Knoop hardness. Indirect activation through a ceramic material reduced significantly Knoop hardness. Hardness Knoop significantly increased after 24 h in all cements shades compared to values obtained after 15 min. Resin cement depth significantly reduced Knoop hardness.

Abstract 3491: Endo-Epicardial Dissociation of Electrical Activity Increases During the Development of the Substrate for Atrial Fibrillation in the Goat

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jens Eckstein ◽  
Bart Maesen ◽  
Sander Verheule ◽  
Maurits Allessie ◽  
Ulrich Schotten
Keyword(s):  
Atrial Fibrillation ◽  
Mapping Tool ◽  
Time Criterion ◽  
High Incidence ◽  
Subepicardial Layer ◽  
Local Direction ◽  
Endocardial Layer ◽  
Activation Times ◽  
Over Time

Background: The high incidence of transmural conduction of fibrillation waves (breakthroughs) in a complex substrate for atrial fibrillation (AF) implies the presence of electrical dissociation between the subepicardial layer (Epi) and the endocardial bundle network (Endo). The presence of this Endo/Epi dissociation (EED) in remodeled atria and its role in the progressive stabilization of AF over time has not been studied yet. Methods: We developed a mapping tool for synchronous Endo/Epi mapping (spatial resolution 1.6mm) with 90 exactly opposing electrode pairs (open chest experiment). We included 3 groups of goats: C = Control (acute AF induced by 50Hz burst pacing, n=7), 3wk = 3weeks AF (n=7) and 6mo = 6months AF (n=7). Dissociated activity was postulated when either activation times differed by more than 12ms vertically or 8ms horizontally (indicating a local conduction velocity < 20cm/s) or local direction of propagation between Endo and Epi differed by more than 90 degrees. To monitor AF stability, repetitive in-vivo cardioversion experiments with class 1C drugs were performed in 6 of the 6mo goats at 2,6,10 and 14wk AF. Results: Applying the time criterion, EED increased from 15±4% (C) to 22±11% (3wk) and 35±13% (6mo, p=0.002 vs. C). Also the differences in the direction of propagation significantly contributed to EED. Using the combined criterion, EED increased from 38±5% (C) to 46±10% (3wk) and 53±11% (6mo, p=0.007 vs. C). Dissociation within the epicardial and the endocardial layer (time criterion) increased to a comparable extent (19±8% vs. 27±14% vs. 37± 7%, p<0.001 C vs. 6mo). Mean Endo/Epi activation time differences were close to 0ms in all three groups (−1.0±15ms vs. −0.8±16ms vs. −0.3±20ms), ruling out preferential conduction from Endo to Epi or vice versa. Success rate of cardioversion experiments decreased from 83% (2w) to 33% (6wk) to 16% (10wk) to 0% (14wk) indicating increasing stability of AF over time. Conclusion: During AF, pronounced EED occurs. EED (like dissociation within Endo and Epi) increases over time, contributing to the progressive stabilization of AF. Enhanced EED might explain the high incidence of transmural conduction (breakthroughs) in a complex substrate for AF.

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