The usability assessment of a pacemaker is a complex task where the dedicated programmer for testing programmed algorithms is necessary.This paper provides the outcomes of development and complex testing of the artifi...The usability assessment of a pacemaker is a complex task where the dedicated programmer for testing programmed algorithms is necessary.This paper provides the outcomes of development and complex testing of the artificial cardiac system to evaluate the pacemaker’s functionality.In this work,we used the modular laboratory platform ELVIS II and created graphical user interface in LabVIEW programming environment.The electrical model of the heart allows signals generation(right atrium,right ventricle)and the monitoring of the stimulation pulses.The LabVIEW user interface allows to set the parameters of the generated signals and the simulation of the cardiac rhythm disorders as well as the monitoring and visualization of the pacemaker behavior in real-time.The results demonstrate the capability of proposed system to evaluate the paced and sensed pulses.The proposed solution allows the scientists to test the behavior of any cardiac pacemaker for its pre-programmed settings and pacing mode.In addition,the proposed system can simulate various disorders and test cardiac pacemakers in different working modes.展开更多
Objective: To analyze the effect of continuous nursing on self-care ability and quality of life of patients with permanent artificial pacemaker implantation. Methods: A total of 90 patients receiving permanent artific...Objective: To analyze the effect of continuous nursing on self-care ability and quality of life of patients with permanent artificial pacemaker implantation. Methods: A total of 90 patients receiving permanent artificial pacemaker treatment in our hospital during the first 8 months of November 2021 were selected as samples to compare the data differences between the two groups (control group and intervention group were 45 patients /n = 45 patients/group, respectively). Results: The compliance of the intervention group was higher than that of the control group (P;There was no significant difference in EDCA score between groups before intervention (P>0.05). After intervention, EDCA score in the intervention group was higher than that in the control group (P<0.05). The nursing quality score of intervention group was higher than that of control group (P;The compliance score of intervention group was higher than that of control group (P<0.05). After intervention, SRSS and MNA scores in the intervention group were higher than those in the control group (P<0.05). The scores of the four items in the intervention group were higher than those in the control group (P < 0.05). Discussion: Continuous nursing intervention can effectively improve the quality and effect of nursing, and has significant application value.展开更多
BACKGROUND A key cardiac magnetic resonance(CMR)challenge is breath-holding duration,difficult for cardiac patients.AIM To evaluate whether artificial intelligence-assisted compressed sensing CINE(AICS-CINE)reduces im...BACKGROUND A key cardiac magnetic resonance(CMR)challenge is breath-holding duration,difficult for cardiac patients.AIM To evaluate whether artificial intelligence-assisted compressed sensing CINE(AICS-CINE)reduces image acquisition time of CMR compared to conventional CINE(C-CINE).METHODS Cardio-oncology patients(n=60)and healthy volunteers(n=29)underwent sequential C-CINE and AI-CS-CINE with a 1.5-T scanner.Acquisition time,visual image quality assessment,and biventricular metrics(end-diastolic volume,endsystolic volume,stroke volume,ejection fraction,left ventricular mass,and wall thickness)were analyzed and compared between C-CINE and AI-CS-CINE with Bland–Altman analysis,and calculation of intraclass coefficient(ICC).RESULTS In 89 participants(58.5±16.8 years,42 males,47 females),total AI-CS-CINE acquisition and reconstruction time(37 seconds)was 84%faster than C-CINE(238 seconds).C-CINE required repeats in 23%(20/89)of cases(approximately 8 minutes lost),while AI-CS-CINE only needed one repeat(1%;2 seconds lost).AICS-CINE had slightly lower contrast but preserved structural clarity.Bland-Altman plots and ICC(0.73≤r≤0.98)showed strong agreement for left ventricle(LV)and right ventricle(RV)metrics,including those in the cardiac amyloidosis subgroup(n=31).AI-CS-CINE enabled faster,easier imaging in patients with claustrophobia,dyspnea,arrhythmias,or restlessness.Motion-artifacted C-CINE images were reliably interpreted from AI-CS-CINE.CONCLUSION AI-CS-CINE accelerated CMR image acquisition and reconstruction,preserved anatomical detail,and diminished impact of patient-related motion.Quantitative AI-CS-CINE metrics agreed closely with C-CINE in cardio-oncology patients,including the cardiac amyloidosis cohort,as well as healthy volunteers regardless of left and right ventricular size and function.AI-CS-CINE significantly enhanced CMR workflow,particularly in challenging cases.The strong analytical concordance underscores reliability and robustness of AI-CS-CINE as a valuable tool.展开更多
Modern cardiopulmonary resuscitation(CPR)has been established for more than 60 years;however,its success rate remains low.Currently,the global incidence of out-of-hospital cardiac arrest(OHCA)is rising,ranging from 52...Modern cardiopulmonary resuscitation(CPR)has been established for more than 60 years;however,its success rate remains low.Currently,the global incidence of out-of-hospital cardiac arrest(OHCA)is rising,ranging from 52.5 to 97.1 per 100,000 population.[1,2]Survival-to-discharge rates for OHCA and in-hospital cardiac arrest(IHCA)are not satisfactory,with ranges of 1.2%-9.9%and 9.1%-19.1%,respectively.展开更多
Background:Cardiac implantable electronic devices(CIEDs)are essential for preventing sudden cardiac death in patients with cardiovascular diseases,but implantation procedures carry risks of complications such as infec...Background:Cardiac implantable electronic devices(CIEDs)are essential for preventing sudden cardiac death in patients with cardiovascular diseases,but implantation procedures carry risks of complications such as infection,hematoma,and bleeding,with incidence rates of 3–4%.Previous studies have examined individual risk factors separately,but integrated predictive models are lacking.We compared the predictive performance and interpretability of artificial neural network(ANN)and logistic regression models to evaluate their respective strengths in clinical risk assessment.Methods:This retrospective study analyzed data from 180 patients who underwent cardiac implantable electronic device(CIED)implantation in Taiwan between 2017 and 2018.To address class imbalance and enhance model training,the dataset was augmented to 540 records using the Synthetic Minority Oversampling Technique(SMOTE).A total of 13 clinical risk factors were evaluated(e.g.,age,body mass index(BMI),platelet count,left ventricular ejection fraction(LVEF),prothrombin time/international normalized ratio(PT/INR),hemoglobin(Hb),comorbidities,and antithrombotic use).Results:The most influential risk factors identified by the ANN model were platelet count,PT/INR,LVEF,Hb,and age.In the logistic regression analysis,reduced LVEF,lower hemoglobin levels,prolonged PT/INR,and lower BMI were significantly associated with an increased risk of complications.ANN model achieved a higher area under the curve(AUC=0.952)compared to the logistic regression model(AUC=0.802),indicating superior predictive performance.Additionally,the overall model quality was also higher for the ANN model(0.93)than for logistic regression(0.76).Conclusions:This study demonstrates that ANN models can effectively predict complications associated CIED procedures and identify critical preoperative risk factors.These findings support the use of ANN-based models for individualized risk stratification,enhancing procedural safety,improving patient outcomes,and potentially reducing healthcare costs associated with postoperative complications.展开更多
Despite advances in intelligent medical care,difficulties remain.Due to its complicated governance,designing,planning,improving,and managing the cardiac system remains difficult.Oversight,including intelligent monitor...Despite advances in intelligent medical care,difficulties remain.Due to its complicated governance,designing,planning,improving,and managing the cardiac system remains difficult.Oversight,including intelligent monitoring,feedback systems,and management practises,is unsuccessful.Current platforms cannot deliver lifelong personal health management services.Insufficient accuracy in patient crisis warning programmes.No frequent,direct interaction between healthcare workers and patients is visible.Physical medical systems and intelligent information systems are not integrated.This study introduces the Advanced Cardiac Twin(ACT)model integrated with Artificial Neural Network(ANN)to handle real-time monitoring,decision-making,and crisis prediction.THINGSPEAK is used to create an IoT platform that accepts patient sensor data.Importing these data sets into MATLAB allows display and analysis.A myocardial ischemia research examined Health Condition Tracking’s(HCT’s)potential.In the case study,75%of the training sets(Xt),15%of the verified data,and 10%of the test data were used.Training set feature values(Xt)were given with the data.Training,Validation,and Testing accuracy rates were 99.9%,99.9%,and 99.9%,respectively.General research accuracy was 99.9%.The proposed HCT system and Artificial Neural Network(ANN)model gather historical and real-time data to manage and anticipate cardiac issues.展开更多
To solve the low power transfer efficiency and magnetic field leakage problems of cardiac pacemaker wireless powering, we proposed a wireless power supply system suitable for implanted cardiac pacemaker based on mu-ne...To solve the low power transfer efficiency and magnetic field leakage problems of cardiac pacemaker wireless powering, we proposed a wireless power supply system suitable for implanted cardiac pacemaker based on mu-negative(MNG) and mu-nearzero(MNZ) metamaterials. First, a hybrid metamaterial consisted of central MNG unit for magnetic field concentration and surrounding MNZ units for magnetic leakage shielding was established by theoretical calculation. Afterwards, the magnetic field distribution of wireless power supply system with MNG-MNZ metamaterial slab was acquired via finite element simulation and verified to be better than the distribution with conventional MNG slab deployed. Finally, an experimental platform of wireless power supply system was established with which power transfer experiment and system temperature rise experiment were conducted.Simulation and experimental results showed that the power transfer efficiency was improved from 44.44%,19.42%, 8.63% and 6.19% to 55.77%, 62.39%, 20.81%and 14.52% at 9.6 mm, 20 mm, 30 mm and 50 mm,respectively. The maximum SAR acquired by SAR simulation under human body environment was-7.14 dbm and maximum reduction of the magnetic field strength around the receiving coil was 2.82 A/m. The maximum temperature rise during 30min charging test was 3.85℃,and the safety requirements of human bodies were met.展开更多
BACKGROUND Mesenchymal stem cells(MSC)modified by gene transfer to express cardiac pacemaker channels such as HCN2 or HCN4 were shown to elicit pacemaker function after intracardiac transplantation in experimental ani...BACKGROUND Mesenchymal stem cells(MSC)modified by gene transfer to express cardiac pacemaker channels such as HCN2 or HCN4 were shown to elicit pacemaker function after intracardiac transplantation in experimental animal models.Human MSC derived from adipose tissue(haMSC)differentiate into cells with pacemaker properties in vitro,but little is known about their behavior after intracardiac transplantation.AIM To investigate whether haMSC elicit biological pacemaker function in vivo after transplantation into pig hearts.METHODS haMSC under native conditions(nhaMSC)or after pre-conditioning by medium differentiation(dhaMSC)(n=6 pigs each,5×106 cells/animal)were injected into the porcine left ventricular free wall.Animals receiving PBS injection served as controls(n=6).Four weeks later,total atrioventricular(AV)-block was induced by radiofrequency catheter ablation,and electronic pacemaker devices were implanted for backup stimulation and heart rate monitoring.Ventricular rate and rhythm of pigs were evaluated during a follow-up of 15 d post ablation by 12-lead-ECG with heart rate assessment,24-h continuous rate monitoring recorded by electronic pacemaker,assessment of escape recovery time,and pharmacological challenge to address catecholaminergic rate response.Finally,hearts were analyzed by histological and immunohistochemical investigations.RESULTS In vivo transplantation of dhaMSC into the left ventricular free wall of pigs elicited spontaneous and regular rhythms that were pace-mapped to ventricular injection sites(mean heart rate 72.2±3.6 bpm;n=6)after experimental total AV block.Ventricular rhythms were stably detected over a 15-d period and were sensitive to catecholaminergic stimulation(mean maximum heart rate 131.0±6.2 bpm;n=6;P<0.001).Pigs,which received nhaMSC or PBS presented significantly lower ventricular rates(mean heart rates 47.2±2.5 bpm and 37.4±3.2 bpm,respectively;n=6 each;P<0.001)and exhibited little sensitivity towards catecholaminergic stimulation(mean maximum heart rates 76.4±3.1 bpm and 60.5±3.1 bpm,respectively;n=6 each;P<0.05).Histological and immunohistochemical evaluation of hearts treated with dhaMSC revealed local clusters of transplanted cells at the injection sites that lacked macrophage or lymphocyte infiltrations or tumor formation.Intense fluorescence signals at these sites indicated membrane expression of HCN4 and other pacemaker-specific proteins involved in cardiac automaticity and impulse propagation.CONCLUSION dhaMSC transplanted into pig left ventricles sustainably induced rate-responsive ventricular pacemaker activity after in vivo engraftment for four weeks.The data suggest that pre-conditioned MSC may further differentiate along a pacemakerrelated lineage after myocardial integration and may establish superior pacemaker properties in vivo.展开更多
AIM:To determine if there were any interactions between cardiac devices and small bowel capsules secondary to electromagnetic interference (EMI) in patients who have undergone small bowel capsule endoscopy (SBCE).METH...AIM:To determine if there were any interactions between cardiac devices and small bowel capsules secondary to electromagnetic interference (EMI) in patients who have undergone small bowel capsule endoscopy (SBCE).METHODS:Authors conducted a chart review of 20 patients with a cardiac pacemaker (CP) or implantable cardioverter defibrillator (ICD) who underwent continuous electrocardiographic monitoring during their SBCE from 2003-2008.authors searched for unexplained electrocardiogram (ECG) findings,changes in CP andICD set parameters,any abnormality in transmitted capsule data,and adverse clinical events.RESULTS:There were no adverse events or hemodynamically significant arrhythmias reported.CP and ICD set parameters were preserved.The majority of ECG abnormalities were also found in pre-or post-SBCE ECG tracings and the CP behavior during arrhythmias appeared appropriate.Two patients seemed to have episodes of undersensing by the CP.However,similar findings were documented in ECGs taken outside the time frame of the SBCE.One patient was observed to have a low signal encountered from the capsule resulting in lack of localization,but no images were lost.CONCLUSION:Capsule-induced EMI remains a possibility but is unlikely to be clinically important.CPinduced interference of SBCE is also possible,but is infrequent and does not result in loss of images transmitted by the capsule.展开更多
Wireless capsule endoscopy is a new endoscopic tool for the diagnosis and management of small bowel diseases. The main indication at present is the evaluation of GI bleeding of obscure origin, Crohn’s disease, coelia...Wireless capsule endoscopy is a new endoscopic tool for the diagnosis and management of small bowel diseases. The main indication at present is the evaluation of GI bleeding of obscure origin, Crohn’s disease, coeliac disease and small bowel tumors. Studies suggest that capsule endoscopy is associated with few adverse events. Whether cardiac pacemaker may interfere with capsule endoscopy is still a controversial issue. We here report a case showing that there is a possibility of interference between the two procedures, cardiac pacemaker affecting the proper functioning of capsule endoscopy and that this is related to the distance between the pacemaker and the recorder.展开更多
Objectives: The purpose of this study is to identify how to manage oversensing of pacemakers in chest CT. Methods: Four different models of pacemakers were examined to select the pacemaker generating oversensing. To t...Objectives: The purpose of this study is to identify how to manage oversensing of pacemakers in chest CT. Methods: Four different models of pacemakers were examined to select the pacemaker generating oversensing. To the pacemaker with oversensing, intermittent switching X-ray was exposed using ECG-gated CT helical scan system at prospective CTA mode. IVY Model was used to synchronize the ECG. Only during in the alert period that is non-refractory and sensing is available, intermittent switching X-ray (300 msec/sec) was exposed in chest CT. For comparison, the same intermittent switching X-ray (300 msec/sec) was exposed in the refractory period when sensing was not available. Results: Oversensing was detected only in one of the four pacemakers tested. In this pacemaker, oversensing was generated by exposure of the intermittent switching X-ray in the alert (non-refractory) period, but oversensing was not observed in the refractory period. Conclusion: A pacemaker has alert and refractory periods. Oversensing of a pacemaker was found to be inhibited by selective ECG-synchronized exposure in the refractory period. Since all pacemakers have the refractory period, the results of this study can be widely applied to the patients with pacemakers in chest CT, and their chest CT can be operated safely.展开更多
Objective: To inquire into the effect of systematic family nursing guidance on improving the Quality of Life for elderly patients with implanted cardiac pacemaker. Methods: 41 elderly patients in accordance with the c...Objective: To inquire into the effect of systematic family nursing guidance on improving the Quality of Life for elderly patients with implanted cardiac pacemaker. Methods: 41 elderly patients in accordance with the corresponding requirements were studied after offering systematic family nursing guidance and surveyed through the questionnaires about the QOL (quality of life) respectively 1 month, 3 months and 6 months after leaving hospital. Results: Compared with that of 1 month and 3 months after the operation, the questionnaire scores for 6 months after the operation were found to have significant improvement, and the differences were statistically significant. Conclusion: Systematic family nursing guidance can effectively improve the QOL for elderly patients with implanted cardiac pacemaker, which makes them spend their old age in comfort and happiness.展开更多
Artificial intelligence(AI)is the process of having a computational program that can perform tasks of human intelligence by mimicking human thought processes.AI is a rapidly evolving transdisciplinary field which inte...Artificial intelligence(AI)is the process of having a computational program that can perform tasks of human intelligence by mimicking human thought processes.AI is a rapidly evolving transdisciplinary field which integrates many elements to develop algorithms that aim to simulate human intuition,decision-making,and object recognition.The overarching aims of AI in cardiovascular medicine are threefold:To optimize patient care,improve efficiency,and improve clinical outcomes.In cardiology,there has been a growth in the potential sources of new patient data,as well as advances in investigations and therapies,which position the field well to uniquely benefit from AI.In this editorial,we highlight some of the main research priorities currently and where the next steps are heading us.展开更多
Objective:To investigate the effect of 12-lead electrocardiogram and 24-hour dynamic electrocardiogram in detecting pacemaker dysfunction and changes in cardiac function indexes in patients with pacemaker implantation...Objective:To investigate the effect of 12-lead electrocardiogram and 24-hour dynamic electrocardiogram in detecting pacemaker dysfunction and changes in cardiac function indexes in patients with pacemaker implantation.Methods:A total of 136 patients with pacemaker implantation in the First Clinical Medical College of Three Gorges University,Institute of Cardiovascular Disease of Three Gorges University and Yicang Central People’s Hospital from January 2023 to December 2024 were selected as the research objects.All patients received 12-lead electrocardiogram and 24-hour holter 3–14 days after implantation.Results:The overall detection rate of various types of pacemaker dysfunction by Holter was significantly higher than that by conventional ECG(27.21%vs.5.15%,χ^(2)=24.402,P<0.001).The overall arrhythmia detection rate of Holter was significantly higher than that of conventional electrocardiogram(57.35%vs.10.29%,χ^(2)=67.277,P<0.001).The time domain indexes of heart rate variability obtained by 24-hour continuous monitoring of Holter were significantly improved compared with those of conventional electrocardiogram(P<0.05).Conclusions:Compared with 12-lead electrocardiogram,24-hour holter monitoring can more accurately detect pacemaker dysfunction and arrhythmia in patients with pacemaker implantation,and provide more comprehensive data of heart rate variability,which is helpful for clinicians to better evaluate the cardiac function of patients and adjust treatment plans.展开更多
Background：High cost of imported pacemakers is a main obstacle for Chinese patients suffering from bradyarrhythmia,and a domestically developed pacemaker will help lower the burden.This study aimed to evaluate the sa...Background：High cost of imported pacemakers is a main obstacle for Chinese patients suffering from bradyarrhythmia,and a domestically developed pacemaker will help lower the burden.This study aimed to evaluate the safety and efficacy ofQinming8631 DR （Qinming Medical,Baoji,China）,the first domestically developed dual-chamber pacemaker of China,compared with a commercially available pacemaker Talos DR （Biotronik,Berlin,Germany） in Chinese patients.Methods：A prospective randomized trial was conducted at 14 centers in China.Participants were randomized into trial （Qinming8631 DR） and control （Talos DR） groups.Parameters of the pacing systems were collected immediately after device implantation and during follow-ups.The effective pacing rate at 6-month follow-up was recorded as the primary end point.Electrical properties,magnet response,single-and double-pole polarity conversion,rate response function,and adverse events of the pacing system were analyzed.The Cochran-Mantel-Haenszel Chi-square test,paired t-test,and Wilcoxon signed-rank test were used for measuring primary qualitative outcomes and comparing normally and abnormally distributed measurement data.Results：A total of 225 patients with a diagnosis ofbradyarrhythmia and eligible for this study were randomly enrolled into the trial （n =113） and control （n =112） groups.They underwent successful pacemaker implantation with acceptable postoperative pacing threshold and sensitivity.Effective pacing rates of trial and control groups were comparable both in the full analysis set and the per protocol set （81.4% vs.79.5%,P =0.712 and 95.4% vs.89.5%,P =0.143,respectively）.In both data sets,noninferiority of the trial group was above the predefined noninferiority limit（-9.5%）.Conclusions：This study established the noninferiority ofQinming8631 DR to Talos DR.The safety and efficacy ofQinming8631 DR pacemaker were comparable to those of Talos DR in treating patients with cardiac bradyarrhythmia.展开更多
Cardiac rehabilitation is a crucial multidisciplinary approach to improve patient outcomes.There is a growing body of evidence that suggests that these programs contribute towards reducing cardiovascular mortality and...Cardiac rehabilitation is a crucial multidisciplinary approach to improve patient outcomes.There is a growing body of evidence that suggests that these programs contribute towards reducing cardiovascular mortality and recurrence.Despite this,cardiac rehabilitation is underutilized and adherence to these programs has been a demonstrated barrier in achieving these outcomes.As a result,there is a growing focus on innovating these programs,especially from the standpoint of digital health and personalized medicine.This editorial discusses the possible roles of large language models,such as their role in ChatGPT,in further personalizing cardiac rehabilitation programs through simplifying medical jargon and employing motivational interviewing techniques,thus boosting patient engagement and adherence.However,these possibilities must be further investigated in the clinical literature.Likewise,the integration of large language models in cardiac rehabilitation will be challenging in its nascent stages to ensure accurate and ethical information delivery.展开更多
Hyperpolarization-activated cyclic-nucleotide-gated (HCN) channels in the heart modulate cardiac automaticity via the hyperpolarization-activated cation current ( named Ⅰf, Ⅰh, or Ⅰq). Recent studies have unveiled ...Hyperpolarization-activated cyclic-nucleotide-gated (HCN) channels in the heart modulate cardiac automaticity via the hyperpolarization-activated cation current ( named Ⅰf, Ⅰh, or Ⅰq). Recent studies have unveiled the molecular identity of HCN (HCN1-4) channels. HCN isoforms are unevenly expressed in the heart, even in the sinoatrial node. Features of HCN currents have been characterized in cardiac and other types of cells or in cell lines transfected with the HCN isoforms. The factors modulating Ih and the physiological significance of HCN channels in the heart have been extensively investigated in recent years. The hypothesis for transplanting and/or creating biological pacemakers to replace diseased sinoatrial and/or atrioventricular nodes has been postulated and tested in animal models. Local overexpression of HCN2 channels in the left atrium or in the left conductive bundle branch of the left ventricle via gene delivery induced significant Ⅰh and escape rhythms during vagal stimulation in canines. In addition, implantation of human mesenchymal stem cells with overexpression of HCN2 channels to the canine left ventricular wall was associated with formation of spontaneous escape rhythms of left-sided origin during vagal-stimulation-induced sinus arrest. This preliminary data suggest that the use of HCN channels may hold great promise in,the development of biological pacemakers.展开更多
The effect of ischemia like solution and high concentration of isoprenaline and Phenylephrine in that solution on normal pacemaker current If of sheep cardiac Puekinje fibres were observed After perfusing the preparat...The effect of ischemia like solution and high concentration of isoprenaline and Phenylephrine in that solution on normal pacemaker current If of sheep cardiac Puekinje fibres were observed After perfusing the preparations with “ischemia” solution 15, 30, and 60 min, the amplitude of If current at all measured membrane potentials (from -60 to -120 mV) decreased (n=7,p<0.05)and the activation curve of If current shiftea to left side,E0.5 changed from control value -85.0±3.7 mV to -91.7±4.1 mV at 30 min. Isoprenaline 1×10-6mol/L could increase the amplitude of If current in “ischemia” solution (n= 10, P<0.05) and shift the activation curve of If current back to right side, but it could not completely reverse the inhibitory effect of“ ischemia“. In the presence of propranolol 5 ×10-7 mol/L, 5×10-5 mol/L phenylephrine decreased the amplitude of If current further in “ischemia” solution (n= 7, P<0.05-0.01), the activatior curve of If current shifted to left side further. The above results indicate that the normal pacemaker current was inhibited in “ischemia” condition even in the presence of high concentration of beta and alpha adrenoceptor agonists so the genesis of ischemic ventricular arrhythmia is hardly due to the abnormal enhancement of normal ventricular pacemaker activity.展开更多
In patients with heart failure and disordered intracardiac conduction of activation, doctors implant a biven- tricular pacemaker (“cardiac resynchronization therapy”, CRT) to allow adjustment of the relative timings...In patients with heart failure and disordered intracardiac conduction of activation, doctors implant a biven- tricular pacemaker (“cardiac resynchronization therapy”, CRT) to allow adjustment of the relative timings of activation of parts of the heart. The process of selecting the pacemaker timings that maximize cardiac function is called “optimization”. Although optimization—more than any other clinical assessment—needs to be precise, it is not yet conventional to report the standard error of the optimum alongside its value in clinical practice, nor even in research, because no method is available to calculate precision from one optimization dataset. Moreover, as long as the determinants of precision remain unknown, they will remain unconsidered, preventing candidate haemodynamic variables from being screened for suitability for use in optimization. This manuscript derives algebraically a clinically-applicable method to calculate the precision of the optimum value of x arising from fitting noisy biological measurements of y (such as blood flow or pressure) obtained at a series of known values of x (such as atrioventricular or interventricular delay) to a quadratic curve. A formula for uncertainty in the optimum value of x is obtained, in terms of the amount of scatter (irreproducibility) of y, the intensity of its curvature with respect to x, the width of the range and number of values of x tested, the number of replicate measurements made at each value of x, and the position of the optimum within the tested range. The ratio of scatter to curvature is found to be the overwhelming practical determinant of precision of the optimum. The new formulae have three uses. First, they are a basic science for anyone desiring time-efficient, reliable optimization protocols. Second, asking for the precision of every reported optimum may expose optimization methods whose precision is unacceptable. Third, evaluating precision quantitatively will help clinicians decide whether an apparent change in optimum between successive visits is real and not just noise.展开更多
The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertio...The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertion is associated with well-defined risks, and less invasive techniques exist to treat transient, hemodynamically significant intraoperative brady-arrhythmias. The present case report details the performance of general anesthesia for arthroscopic knee surgery in an adult patient with this condition without a pacemaker. Documentation of preoperative chronotropic competence with isoproterenol may be of value in deciding whether to proceed without temporary pacing capability in this setting.展开更多
基金Thework and the contributions were supported by the project SV4502261/SP2022/98‘Biomedical Engineering systems XVIII’.
文摘The usability assessment of a pacemaker is a complex task where the dedicated programmer for testing programmed algorithms is necessary.This paper provides the outcomes of development and complex testing of the artificial cardiac system to evaluate the pacemaker’s functionality.In this work,we used the modular laboratory platform ELVIS II and created graphical user interface in LabVIEW programming environment.The electrical model of the heart allows signals generation(right atrium,right ventricle)and the monitoring of the stimulation pulses.The LabVIEW user interface allows to set the parameters of the generated signals and the simulation of the cardiac rhythm disorders as well as the monitoring and visualization of the pacemaker behavior in real-time.The results demonstrate the capability of proposed system to evaluate the paced and sensed pulses.The proposed solution allows the scientists to test the behavior of any cardiac pacemaker for its pre-programmed settings and pacing mode.In addition,the proposed system can simulate various disorders and test cardiac pacemakers in different working modes.
文摘Objective: To analyze the effect of continuous nursing on self-care ability and quality of life of patients with permanent artificial pacemaker implantation. Methods: A total of 90 patients receiving permanent artificial pacemaker treatment in our hospital during the first 8 months of November 2021 were selected as samples to compare the data differences between the two groups (control group and intervention group were 45 patients /n = 45 patients/group, respectively). Results: The compliance of the intervention group was higher than that of the control group (P;There was no significant difference in EDCA score between groups before intervention (P>0.05). After intervention, EDCA score in the intervention group was higher than that in the control group (P<0.05). The nursing quality score of intervention group was higher than that of control group (P;The compliance score of intervention group was higher than that of control group (P<0.05). After intervention, SRSS and MNA scores in the intervention group were higher than those in the control group (P<0.05). The scores of the four items in the intervention group were higher than those in the control group (P < 0.05). Discussion: Continuous nursing intervention can effectively improve the quality and effect of nursing, and has significant application value.
基金Supported by James Russell Hornsby and Jun Xiong Fund and United Imaging Healthcare.
文摘BACKGROUND A key cardiac magnetic resonance(CMR)challenge is breath-holding duration,difficult for cardiac patients.AIM To evaluate whether artificial intelligence-assisted compressed sensing CINE(AICS-CINE)reduces image acquisition time of CMR compared to conventional CINE(C-CINE).METHODS Cardio-oncology patients(n=60)and healthy volunteers(n=29)underwent sequential C-CINE and AI-CS-CINE with a 1.5-T scanner.Acquisition time,visual image quality assessment,and biventricular metrics(end-diastolic volume,endsystolic volume,stroke volume,ejection fraction,left ventricular mass,and wall thickness)were analyzed and compared between C-CINE and AI-CS-CINE with Bland–Altman analysis,and calculation of intraclass coefficient(ICC).RESULTS In 89 participants(58.5±16.8 years,42 males,47 females),total AI-CS-CINE acquisition and reconstruction time(37 seconds)was 84%faster than C-CINE(238 seconds).C-CINE required repeats in 23%(20/89)of cases(approximately 8 minutes lost),while AI-CS-CINE only needed one repeat(1%;2 seconds lost).AICS-CINE had slightly lower contrast but preserved structural clarity.Bland-Altman plots and ICC(0.73≤r≤0.98)showed strong agreement for left ventricle(LV)and right ventricle(RV)metrics,including those in the cardiac amyloidosis subgroup(n=31).AI-CS-CINE enabled faster,easier imaging in patients with claustrophobia,dyspnea,arrhythmias,or restlessness.Motion-artifacted C-CINE images were reliably interpreted from AI-CS-CINE.CONCLUSION AI-CS-CINE accelerated CMR image acquisition and reconstruction,preserved anatomical detail,and diminished impact of patient-related motion.Quantitative AI-CS-CINE metrics agreed closely with C-CINE in cardio-oncology patients,including the cardiac amyloidosis cohort,as well as healthy volunteers regardless of left and right ventricular size and function.AI-CS-CINE significantly enhanced CMR workflow,particularly in challenging cases.The strong analytical concordance underscores reliability and robustness of AI-CS-CINE as a valuable tool.
文摘Modern cardiopulmonary resuscitation(CPR)has been established for more than 60 years;however,its success rate remains low.Currently,the global incidence of out-of-hospital cardiac arrest(OHCA)is rising,ranging from 52.5 to 97.1 per 100,000 population.[1,2]Survival-to-discharge rates for OHCA and in-hospital cardiac arrest(IHCA)are not satisfactory,with ranges of 1.2%-9.9%and 9.1%-19.1%,respectively.
文摘Background:Cardiac implantable electronic devices(CIEDs)are essential for preventing sudden cardiac death in patients with cardiovascular diseases,but implantation procedures carry risks of complications such as infection,hematoma,and bleeding,with incidence rates of 3–4%.Previous studies have examined individual risk factors separately,but integrated predictive models are lacking.We compared the predictive performance and interpretability of artificial neural network(ANN)and logistic regression models to evaluate their respective strengths in clinical risk assessment.Methods:This retrospective study analyzed data from 180 patients who underwent cardiac implantable electronic device(CIED)implantation in Taiwan between 2017 and 2018.To address class imbalance and enhance model training,the dataset was augmented to 540 records using the Synthetic Minority Oversampling Technique(SMOTE).A total of 13 clinical risk factors were evaluated(e.g.,age,body mass index(BMI),platelet count,left ventricular ejection fraction(LVEF),prothrombin time/international normalized ratio(PT/INR),hemoglobin(Hb),comorbidities,and antithrombotic use).Results:The most influential risk factors identified by the ANN model were platelet count,PT/INR,LVEF,Hb,and age.In the logistic regression analysis,reduced LVEF,lower hemoglobin levels,prolonged PT/INR,and lower BMI were significantly associated with an increased risk of complications.ANN model achieved a higher area under the curve(AUC=0.952)compared to the logistic regression model(AUC=0.802),indicating superior predictive performance.Additionally,the overall model quality was also higher for the ANN model(0.93)than for logistic regression(0.76).Conclusions:This study demonstrates that ANN models can effectively predict complications associated CIED procedures and identify critical preoperative risk factors.These findings support the use of ANN-based models for individualized risk stratification,enhancing procedural safety,improving patient outcomes,and potentially reducing healthcare costs associated with postoperative complications.
文摘Despite advances in intelligent medical care,difficulties remain.Due to its complicated governance,designing,planning,improving,and managing the cardiac system remains difficult.Oversight,including intelligent monitoring,feedback systems,and management practises,is unsuccessful.Current platforms cannot deliver lifelong personal health management services.Insufficient accuracy in patient crisis warning programmes.No frequent,direct interaction between healthcare workers and patients is visible.Physical medical systems and intelligent information systems are not integrated.This study introduces the Advanced Cardiac Twin(ACT)model integrated with Artificial Neural Network(ANN)to handle real-time monitoring,decision-making,and crisis prediction.THINGSPEAK is used to create an IoT platform that accepts patient sensor data.Importing these data sets into MATLAB allows display and analysis.A myocardial ischemia research examined Health Condition Tracking’s(HCT’s)potential.In the case study,75%of the training sets(Xt),15%of the verified data,and 10%of the test data were used.Training set feature values(Xt)were given with the data.Training,Validation,and Testing accuracy rates were 99.9%,99.9%,and 99.9%,respectively.General research accuracy was 99.9%.The proposed HCT system and Artificial Neural Network(ANN)model gather historical and real-time data to manage and anticipate cardiac issues.
基金supported by 2023 Liaoning Provincial Department of Education Basic Research Project (General Project)(JYTMS20230815)。
文摘To solve the low power transfer efficiency and magnetic field leakage problems of cardiac pacemaker wireless powering, we proposed a wireless power supply system suitable for implanted cardiac pacemaker based on mu-negative(MNG) and mu-nearzero(MNZ) metamaterials. First, a hybrid metamaterial consisted of central MNG unit for magnetic field concentration and surrounding MNZ units for magnetic leakage shielding was established by theoretical calculation. Afterwards, the magnetic field distribution of wireless power supply system with MNG-MNZ metamaterial slab was acquired via finite element simulation and verified to be better than the distribution with conventional MNG slab deployed. Finally, an experimental platform of wireless power supply system was established with which power transfer experiment and system temperature rise experiment were conducted.Simulation and experimental results showed that the power transfer efficiency was improved from 44.44%,19.42%, 8.63% and 6.19% to 55.77%, 62.39%, 20.81%and 14.52% at 9.6 mm, 20 mm, 30 mm and 50 mm,respectively. The maximum SAR acquired by SAR simulation under human body environment was-7.14 dbm and maximum reduction of the magnetic field strength around the receiving coil was 2.82 A/m. The maximum temperature rise during 30min charging test was 3.85℃,and the safety requirements of human bodies were met.
基金Max-Planck-Society(TANDEM project to Koenen M and Schweizer PA)Ministry of Science,Research and the Arts Baden-Wuerttemberg(Sonderlinie Medizin to Thomas D)+5 种基金German Heart Foundation(Kaltenbach scholarship to Darche FF)German Cardiac Society(Otto-Hess scholarship to Rahm AK)Heidelberg Medical Faculty(Physician Scientist-Programm to Darche FF,Rivinius R and Rahm AK)German Cardiac Society(Research scholarship to Rivinius R)the German Society of Internal Medicine(Clinician-Scientist-Program to Rahm AK)and the German Centre for Cardiovascular Research(DZHK).
文摘BACKGROUND Mesenchymal stem cells(MSC)modified by gene transfer to express cardiac pacemaker channels such as HCN2 or HCN4 were shown to elicit pacemaker function after intracardiac transplantation in experimental animal models.Human MSC derived from adipose tissue(haMSC)differentiate into cells with pacemaker properties in vitro,but little is known about their behavior after intracardiac transplantation.AIM To investigate whether haMSC elicit biological pacemaker function in vivo after transplantation into pig hearts.METHODS haMSC under native conditions(nhaMSC)or after pre-conditioning by medium differentiation(dhaMSC)(n=6 pigs each,5×106 cells/animal)were injected into the porcine left ventricular free wall.Animals receiving PBS injection served as controls(n=6).Four weeks later,total atrioventricular(AV)-block was induced by radiofrequency catheter ablation,and electronic pacemaker devices were implanted for backup stimulation and heart rate monitoring.Ventricular rate and rhythm of pigs were evaluated during a follow-up of 15 d post ablation by 12-lead-ECG with heart rate assessment,24-h continuous rate monitoring recorded by electronic pacemaker,assessment of escape recovery time,and pharmacological challenge to address catecholaminergic rate response.Finally,hearts were analyzed by histological and immunohistochemical investigations.RESULTS In vivo transplantation of dhaMSC into the left ventricular free wall of pigs elicited spontaneous and regular rhythms that were pace-mapped to ventricular injection sites(mean heart rate 72.2±3.6 bpm;n=6)after experimental total AV block.Ventricular rhythms were stably detected over a 15-d period and were sensitive to catecholaminergic stimulation(mean maximum heart rate 131.0±6.2 bpm;n=6;P<0.001).Pigs,which received nhaMSC or PBS presented significantly lower ventricular rates(mean heart rates 47.2±2.5 bpm and 37.4±3.2 bpm,respectively;n=6 each;P<0.001)and exhibited little sensitivity towards catecholaminergic stimulation(mean maximum heart rates 76.4±3.1 bpm and 60.5±3.1 bpm,respectively;n=6 each;P<0.05).Histological and immunohistochemical evaluation of hearts treated with dhaMSC revealed local clusters of transplanted cells at the injection sites that lacked macrophage or lymphocyte infiltrations or tumor formation.Intense fluorescence signals at these sites indicated membrane expression of HCN4 and other pacemaker-specific proteins involved in cardiac automaticity and impulse propagation.CONCLUSION dhaMSC transplanted into pig left ventricles sustainably induced rate-responsive ventricular pacemaker activity after in vivo engraftment for four weeks.The data suggest that pre-conditioned MSC may further differentiate along a pacemakerrelated lineage after myocardial integration and may establish superior pacemaker properties in vivo.
文摘AIM:To determine if there were any interactions between cardiac devices and small bowel capsules secondary to electromagnetic interference (EMI) in patients who have undergone small bowel capsule endoscopy (SBCE).METHODS:Authors conducted a chart review of 20 patients with a cardiac pacemaker (CP) or implantable cardioverter defibrillator (ICD) who underwent continuous electrocardiographic monitoring during their SBCE from 2003-2008.authors searched for unexplained electrocardiogram (ECG) findings,changes in CP andICD set parameters,any abnormality in transmitted capsule data,and adverse clinical events.RESULTS:There were no adverse events or hemodynamically significant arrhythmias reported.CP and ICD set parameters were preserved.The majority of ECG abnormalities were also found in pre-or post-SBCE ECG tracings and the CP behavior during arrhythmias appeared appropriate.Two patients seemed to have episodes of undersensing by the CP.However,similar findings were documented in ECGs taken outside the time frame of the SBCE.One patient was observed to have a low signal encountered from the capsule resulting in lack of localization,but no images were lost.CONCLUSION:Capsule-induced EMI remains a possibility but is unlikely to be clinically important.CPinduced interference of SBCE is also possible,but is infrequent and does not result in loss of images transmitted by the capsule.
文摘Wireless capsule endoscopy is a new endoscopic tool for the diagnosis and management of small bowel diseases. The main indication at present is the evaluation of GI bleeding of obscure origin, Crohn’s disease, coeliac disease and small bowel tumors. Studies suggest that capsule endoscopy is associated with few adverse events. Whether cardiac pacemaker may interfere with capsule endoscopy is still a controversial issue. We here report a case showing that there is a possibility of interference between the two procedures, cardiac pacemaker affecting the proper functioning of capsule endoscopy and that this is related to the distance between the pacemaker and the recorder.
文摘Objectives: The purpose of this study is to identify how to manage oversensing of pacemakers in chest CT. Methods: Four different models of pacemakers were examined to select the pacemaker generating oversensing. To the pacemaker with oversensing, intermittent switching X-ray was exposed using ECG-gated CT helical scan system at prospective CTA mode. IVY Model was used to synchronize the ECG. Only during in the alert period that is non-refractory and sensing is available, intermittent switching X-ray (300 msec/sec) was exposed in chest CT. For comparison, the same intermittent switching X-ray (300 msec/sec) was exposed in the refractory period when sensing was not available. Results: Oversensing was detected only in one of the four pacemakers tested. In this pacemaker, oversensing was generated by exposure of the intermittent switching X-ray in the alert (non-refractory) period, but oversensing was not observed in the refractory period. Conclusion: A pacemaker has alert and refractory periods. Oversensing of a pacemaker was found to be inhibited by selective ECG-synchronized exposure in the refractory period. Since all pacemakers have the refractory period, the results of this study can be widely applied to the patients with pacemakers in chest CT, and their chest CT can be operated safely.
文摘Objective: To inquire into the effect of systematic family nursing guidance on improving the Quality of Life for elderly patients with implanted cardiac pacemaker. Methods: 41 elderly patients in accordance with the corresponding requirements were studied after offering systematic family nursing guidance and surveyed through the questionnaires about the QOL (quality of life) respectively 1 month, 3 months and 6 months after leaving hospital. Results: Compared with that of 1 month and 3 months after the operation, the questionnaire scores for 6 months after the operation were found to have significant improvement, and the differences were statistically significant. Conclusion: Systematic family nursing guidance can effectively improve the QOL for elderly patients with implanted cardiac pacemaker, which makes them spend their old age in comfort and happiness.
文摘Artificial intelligence(AI)is the process of having a computational program that can perform tasks of human intelligence by mimicking human thought processes.AI is a rapidly evolving transdisciplinary field which integrates many elements to develop algorithms that aim to simulate human intuition,decision-making,and object recognition.The overarching aims of AI in cardiovascular medicine are threefold:To optimize patient care,improve efficiency,and improve clinical outcomes.In cardiology,there has been a growth in the potential sources of new patient data,as well as advances in investigations and therapies,which position the field well to uniquely benefit from AI.In this editorial,we highlight some of the main research priorities currently and where the next steps are heading us.
文摘Objective:To investigate the effect of 12-lead electrocardiogram and 24-hour dynamic electrocardiogram in detecting pacemaker dysfunction and changes in cardiac function indexes in patients with pacemaker implantation.Methods:A total of 136 patients with pacemaker implantation in the First Clinical Medical College of Three Gorges University,Institute of Cardiovascular Disease of Three Gorges University and Yicang Central People’s Hospital from January 2023 to December 2024 were selected as the research objects.All patients received 12-lead electrocardiogram and 24-hour holter 3–14 days after implantation.Results:The overall detection rate of various types of pacemaker dysfunction by Holter was significantly higher than that by conventional ECG(27.21%vs.5.15%,χ^(2)=24.402,P<0.001).The overall arrhythmia detection rate of Holter was significantly higher than that of conventional electrocardiogram(57.35%vs.10.29%,χ^(2)=67.277,P<0.001).The time domain indexes of heart rate variability obtained by 24-hour continuous monitoring of Holter were significantly improved compared with those of conventional electrocardiogram(P<0.05).Conclusions:Compared with 12-lead electrocardiogram,24-hour holter monitoring can more accurately detect pacemaker dysfunction and arrhythmia in patients with pacemaker implantation,and provide more comprehensive data of heart rate variability,which is helpful for clinicians to better evaluate the cardiac function of patients and adjust treatment plans.
文摘Background：High cost of imported pacemakers is a main obstacle for Chinese patients suffering from bradyarrhythmia,and a domestically developed pacemaker will help lower the burden.This study aimed to evaluate the safety and efficacy ofQinming8631 DR （Qinming Medical,Baoji,China）,the first domestically developed dual-chamber pacemaker of China,compared with a commercially available pacemaker Talos DR （Biotronik,Berlin,Germany） in Chinese patients.Methods：A prospective randomized trial was conducted at 14 centers in China.Participants were randomized into trial （Qinming8631 DR） and control （Talos DR） groups.Parameters of the pacing systems were collected immediately after device implantation and during follow-ups.The effective pacing rate at 6-month follow-up was recorded as the primary end point.Electrical properties,magnet response,single-and double-pole polarity conversion,rate response function,and adverse events of the pacing system were analyzed.The Cochran-Mantel-Haenszel Chi-square test,paired t-test,and Wilcoxon signed-rank test were used for measuring primary qualitative outcomes and comparing normally and abnormally distributed measurement data.Results：A total of 225 patients with a diagnosis ofbradyarrhythmia and eligible for this study were randomly enrolled into the trial （n =113） and control （n =112） groups.They underwent successful pacemaker implantation with acceptable postoperative pacing threshold and sensitivity.Effective pacing rates of trial and control groups were comparable both in the full analysis set and the per protocol set （81.4% vs.79.5%,P =0.712 and 95.4% vs.89.5%,P =0.143,respectively）.In both data sets,noninferiority of the trial group was above the predefined noninferiority limit（-9.5%）.Conclusions：This study established the noninferiority ofQinming8631 DR to Talos DR.The safety and efficacy ofQinming8631 DR pacemaker were comparable to those of Talos DR in treating patients with cardiac bradyarrhythmia.
文摘Cardiac rehabilitation is a crucial multidisciplinary approach to improve patient outcomes.There is a growing body of evidence that suggests that these programs contribute towards reducing cardiovascular mortality and recurrence.Despite this,cardiac rehabilitation is underutilized and adherence to these programs has been a demonstrated barrier in achieving these outcomes.As a result,there is a growing focus on innovating these programs,especially from the standpoint of digital health and personalized medicine.This editorial discusses the possible roles of large language models,such as their role in ChatGPT,in further personalizing cardiac rehabilitation programs through simplifying medical jargon and employing motivational interviewing techniques,thus boosting patient engagement and adherence.However,these possibilities must be further investigated in the clinical literature.Likewise,the integration of large language models in cardiac rehabilitation will be challenging in its nascent stages to ensure accurate and ethical information delivery.
文摘Hyperpolarization-activated cyclic-nucleotide-gated (HCN) channels in the heart modulate cardiac automaticity via the hyperpolarization-activated cation current ( named Ⅰf, Ⅰh, or Ⅰq). Recent studies have unveiled the molecular identity of HCN (HCN1-4) channels. HCN isoforms are unevenly expressed in the heart, even in the sinoatrial node. Features of HCN currents have been characterized in cardiac and other types of cells or in cell lines transfected with the HCN isoforms. The factors modulating Ih and the physiological significance of HCN channels in the heart have been extensively investigated in recent years. The hypothesis for transplanting and/or creating biological pacemakers to replace diseased sinoatrial and/or atrioventricular nodes has been postulated and tested in animal models. Local overexpression of HCN2 channels in the left atrium or in the left conductive bundle branch of the left ventricle via gene delivery induced significant Ⅰh and escape rhythms during vagal stimulation in canines. In addition, implantation of human mesenchymal stem cells with overexpression of HCN2 channels to the canine left ventricular wall was associated with formation of spontaneous escape rhythms of left-sided origin during vagal-stimulation-induced sinus arrest. This preliminary data suggest that the use of HCN channels may hold great promise in,the development of biological pacemakers.
文摘The effect of ischemia like solution and high concentration of isoprenaline and Phenylephrine in that solution on normal pacemaker current If of sheep cardiac Puekinje fibres were observed After perfusing the preparations with “ischemia” solution 15, 30, and 60 min, the amplitude of If current at all measured membrane potentials (from -60 to -120 mV) decreased (n=7,p<0.05)and the activation curve of If current shiftea to left side,E0.5 changed from control value -85.0±3.7 mV to -91.7±4.1 mV at 30 min. Isoprenaline 1×10-6mol/L could increase the amplitude of If current in “ischemia” solution (n= 10, P<0.05) and shift the activation curve of If current back to right side, but it could not completely reverse the inhibitory effect of“ ischemia“. In the presence of propranolol 5 ×10-7 mol/L, 5×10-5 mol/L phenylephrine decreased the amplitude of If current further in “ischemia” solution (n= 7, P<0.05-0.01), the activatior curve of If current shifted to left side further. The above results indicate that the normal pacemaker current was inhibited in “ischemia” condition even in the presence of high concentration of beta and alpha adrenoceptor agonists so the genesis of ischemic ventricular arrhythmia is hardly due to the abnormal enhancement of normal ventricular pacemaker activity.
文摘In patients with heart failure and disordered intracardiac conduction of activation, doctors implant a biven- tricular pacemaker (“cardiac resynchronization therapy”, CRT) to allow adjustment of the relative timings of activation of parts of the heart. The process of selecting the pacemaker timings that maximize cardiac function is called “optimization”. Although optimization—more than any other clinical assessment—needs to be precise, it is not yet conventional to report the standard error of the optimum alongside its value in clinical practice, nor even in research, because no method is available to calculate precision from one optimization dataset. Moreover, as long as the determinants of precision remain unknown, they will remain unconsidered, preventing candidate haemodynamic variables from being screened for suitability for use in optimization. This manuscript derives algebraically a clinically-applicable method to calculate the precision of the optimum value of x arising from fitting noisy biological measurements of y (such as blood flow or pressure) obtained at a series of known values of x (such as atrioventricular or interventricular delay) to a quadratic curve. A formula for uncertainty in the optimum value of x is obtained, in terms of the amount of scatter (irreproducibility) of y, the intensity of its curvature with respect to x, the width of the range and number of values of x tested, the number of replicate measurements made at each value of x, and the position of the optimum within the tested range. The ratio of scatter to curvature is found to be the overwhelming practical determinant of precision of the optimum. The new formulae have three uses. First, they are a basic science for anyone desiring time-efficient, reliable optimization protocols. Second, asking for the precision of every reported optimum may expose optimization methods whose precision is unacceptable. Third, evaluating precision quantitatively will help clinicians decide whether an apparent change in optimum between successive visits is real and not just noise.
文摘The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertion is associated with well-defined risks, and less invasive techniques exist to treat transient, hemodynamically significant intraoperative brady-arrhythmias. The present case report details the performance of general anesthesia for arthroscopic knee surgery in an adult patient with this condition without a pacemaker. Documentation of preoperative chronotropic competence with isoproterenol may be of value in deciding whether to proceed without temporary pacing capability in this setting.
