Internship in arrhythmology

The arrhythmology focuses on the diagnosis and treatment of heart rhythm disorders and their complications, and has undergone a dramatic evolution over the past two decades. The widespread use of catheter ablation, the introduction of implantable cardioverter defibrillators for the prevention of sudden cardiac death and, finally, the development of cardiac resynchronization therapy led to a gradual loss of the impact of antiarrhythmic drugs as a therapeutic approach. This report was performed as a result of an internship performed in Cardiac Physiology with the duration of 400 hours. The main goal of the internship was to strengthen theoretical knowledge and acquire practical experience in the varied fields of arrhythmology, especially in the areas of Cardiac Pacing and Electrophysiology. During the internship were performed 41 electrophysiologic studies, where Atrioventricular Node Reentrant Tachycardia and Atrial Fibrillation were the most observed arrhythmias. New technologies such as three-dimensional mapping for electrophysiology studies are developing quickly and being use on a daily basis, as they prove to have safe and higher success rates. The proof is that in approximately half of the studies, one of the two mapping systems available, Carto or NavX, was used. In addition, were interrogated 283 pacemakers during the pacing clinics, being the dual chamber with DDD pacing mode the most encountered device. A large number of devices with Cardiac Resynchronization Therapy and/or Implantable Cardioverter Defibrillators were also observed. This report is divided into three chapters. Chapter I is constituted by a revision of the literature and includes concepts such as definition and mechanisms of cardiac arrhythmias; a brief description of the varied diagnostic tools and its recommendations; and a presentation of the different therapeutic approaches available and its indications. The second chapter is a descriptive drawing of the activity performed in the modules of Electrophysiology and Pacing. Lastly, the chapter III presents two clinical cases in Electrophysiology considered interesting from a clinical point of view

Statistical and Graph-Based Signal Processing: Fundamental Results and Application to Cardiac Electrophysiology

The goal of cardiac electrophysiology is to obtain information about the mechanism, function, and performance of the electrical activities of the heart, the identification of deviation from normal pattern and the design of treatments. Offering a better insight into cardiac arrhythmias comprehension and management, signal processing can help the physician to enhance the treatment strategies, in particular in case of atrial fibrillation (AF), a very common atrial arrhythmia which is associated to significant morbidities, such as increased risk of mortality, heart failure, and thromboembolic events. Catheter ablation of AF is a therapeutic technique which uses radiofrequency energy to destroy atrial tissue involved in the arrhythmia sustenance, typically aiming at the electrical disconnection of the of the pulmonary veins triggers. However, recurrence rate is still very high, showing that the very complex and heterogeneous nature of AF still represents a challenging problem. Leveraging the tools of non-stationary and statistical signal processing, the first part of our work has a twofold focus: firstly, we compare the performance of two different ablation technologies, based on contact force sensing or remote magnetic controlled, using signal-based criteria as surrogates for lesion assessment. Furthermore, we investigate the role of ablation parameters in lesion formation using the late-gadolinium enhanced magnetic resonance imaging. Secondly, we hypothesized that in human atria the frequency content of the bipolar signal is directly related to the local conduction velocity (CV), a key parameter characterizing the substrate abnormality and influencing atrial arrhythmias. Comparing the degree of spectral compression among signals recorded at different points of the endocardial surface in response to decreasing pacing rate, our experimental data demonstrate a significant correlation between CV and the corresponding spectral centroids. However, complex spatio-temporal propagation pattern characterizing AF spurred the need for new signals acquisition and processing methods. Multi-electrode catheters allow whole-chamber panoramic mapping of electrical activity but produce an amount of data which need to be preprocessed and analyzed to provide clinically relevant support to the physician. Graph signal processing has shown its potential on a variety of applications involving high-dimensional data on irregular domains and complex network. Nevertheless, though state-of-the-art graph-based methods have been successful for many tasks, so far they predominantly ignore the time-dimension of data. To address this shortcoming, in the second part of this dissertation, we put forth a Time-Vertex Signal Processing Framework, as a particular case of the multi-dimensional graph signal processing. Linking together the time-domain signal processing techniques with the tools of GSP, the Time-Vertex Signal Processing facilitates the analysis of graph structured data which also evolve in time. We motivate our framework leveraging the notion of partial differential equations on graphs. We introduce joint operators, such as time-vertex localization and we present a novel approach to significantly improve the accuracy of fast joint filtering. We also illustrate how to build time-vertex dictionaries, providing conditions for efficient invertibility and examples of constructions. The experimental results on a variety of datasets suggest that the proposed tools can bring significant benefits in various signal processing and learning tasks involving time-series on graphs. We close the gap between the two parts illustrating the application of graph and time-vertex signal processing to the challenging case of multi-channels intracardiac signals

Cardiac Arrhythmias

The most intimate mechanisms of cardiac arrhythmias are still quite unknown to scientists. Genetic studies on ionic alterations, the electrocardiographic features of cardiac rhythm and an arsenal of diagnostic tests have done more in the last five years than in all the history of cardiology. Similarly, therapy to prevent or cure such diseases is growing rapidly day by day. In this book the reader will be able to see with brighter light some of these intimate mechanisms of production, as well as cutting-edge therapies to date. Genetic studies, electrophysiological and electrocardiographyc features, ion channel alterations, heart diseases still unknown , and even the relationship between the psychic sphere and the heart have been exposed in this book. It deserves to be read

EXPLORING THE HEART AND AETHER IN ENERGY MEDICINE

The heart is presented as the energetic center of the human subtle energy system that plays a coordinating role in human physiology beyond its accepted role as a cardiovascular pump. As the body’s most dynamic field integrator of life energy, the heart plays a formative role in the creation of the new paradigm of energy medicine. This paper explores the role of the heart in cardiovascular functioning, healing, cognition and subtle energy modulation. Water and blood are shown to play a central role in mediating consciousness and intention. A hypothesis is presented that the heart utilizes diverse subtle energy and electromagnetic regulatory processes to coordinate complex information flows within the body and the environment. A new model of a non-material higher-dimensional Planck aether developed by Klaus Volkamer is presented based on research of anomalous mass determinations with subtle energy detectors. The heart becomes a metaphor for the new synthesis between science and spirit that was the theme of the 2009 ISSSEEM conference

EXPLORING THE HEART AND AETHER IN ENERGY MEDICINE

The heart is presented as the energetic center of the human subtle energy system that plays a coordinating role in human physiology beyond its accepted role as a cardiovascular pump. As the body’s most dynamic field integrator of life energy, the heart plays a formative role in the creation of the new paradigm of energy medicine. This paper explores the role of the heart in cardiovascular functioning, healing, cognition and subtle energy modulation. Water and blood are shown to play a central role in mediating consciousness and intention. A hypothesis is presented that the heart utilizes diverse subtle energy and electromagnetic regulatory processes to coordinate complex information flows within the body and the environment. A new model of a non-material higher-dimensional Planck aether developed by Klaus Volkamer is presented based on research of anomalous mass determinations with subtle energy detectors. The heart becomes a metaphor for the new synthesis between science and spirit that was the theme of the 2009 ISSSEEM conference

Load-Independent And Regional Measures Of Cardiac Function Via Real-Time Mri

LOAD-INDEPENDENT AND REGIONAL MEASURES OF CARDIAC FUNCTION VIA REAL-TIME MRI Francisco Jose Contijoch Robert C Gorman, MD Expansion of infarcted tissue during left ventricular (LV) remodeling after a myocardial infarction is associated with poor long-term prognosis. Several interventions have been developed to limit infarct expansion by modifying the material properties of the infarcted or surrounding borderzone tissue. Measures of myocardial function and material properties can be obtained non-invasively via imaging. However, these measures are sensitive to variations in loading conditions and acquisition of load-independent measures have been limited by surgically invasive procedures and limited spatial resolution. In this dissertation, a real-time magnetic resonance imaging (MRI) technique was validated in clinical patients and instrumented animals, several technical improvements in MRI acquisition and reconstruction were presented for improved imaging resolution, load-independent measures were obtained in animal studies via non-invasive imaging, and regional variations in function were measured in both na�ve and post-infarction animals. Specifically, a golden-angle radial MRI acquisition with non-Cartesian SENSE-based reconstruction with an exposure time less than 95 ms and a frame rate above 89 fps allows for accurate estimation of LV slice volume in clinical patients and instrumented animals. Two technical developments were pursued to improve image quality and spatial resolution. First, the slice volume obtained can be used as a self-navigator signal to generate retrospectively-gated, high-resolution datasets of multiple beat morphologies. Second, cross-correlation of the ECG with previously observed values resulted in accurate interpretation of cardiac phase in patients with arrhythmias and allowed for multi-shot imaging of dynamic scenarios. Synchronizing the measured LV slice volume with an LV pressure signal allowed for pressure-volume loops and corresponding load-independent measures of function to be obtained in instrumented animals. Acquiring LV slice volume at multiple slice locations revealed regional differences in contractile function. Motion-tracking of the myocardium during real-time imaging allowed for differences in contractile function between normal, borderzone, and infarcted myocardium to be measured. Lastly, application of real-time imaging to patients with arrhythmias revealed the variable impact of ectopic beats on global hemodynamic function, depending on frequency and ectopic pattern. This work established the feasibility of obtaining load-independent measures of function via real-time MRI and illustrated regional variations in cardiac function

Performance Analysis and Optimization of 2-D Cardiac Strain Imaging for Clinical Applications

Heart disease has remained the deadliest disease in the United States for the past 100 years. Imaging methods are frequently employed in cardiology in order to help clinicians diagnose the specific type of heart disease and to guide treatment decisions. Ultrasound is the most frequently used imaging modality in cardiology because it is inexpensive, portable, easy to use, and extremely safe for patients. Using a variety of imaging processing techniques, deformations exhibited by the cardiac tissue during contraction can be imaged with ultrasound and used as an indicator of myocardial health. This dissertation will demonstrate the clinical implementation of two ultrasound-based strain estimation techniques developed in the Ultrasound and Elasticity Imaging Laboratory at Columbia University. Each of the two imaging methods will be tailored for clinical applications using techniques for optimal strain estimation derived from ultrasound and imaging processing theory. The motion estimation rate (MER) used for strain estimation is examined in the context of the theoretical Strain Filter and used to increase the precision of axial strain estimation. Diverging beam sequences are used to achieve full-view high MER imaging within a single heartbeat. At approximately 500 Hz, the expected elastographic signal-to-noise ratio (E(SNRe|ε)) of the axial strain becomes single-peaked, indicating an absence of “peak-hopping” errors which can severely corrupt strain estimation. In order to mediate the tradeoff in spatial resolution resulting from the use of diverging beams, coherent spatial compounding is used to increase the accuracy of the lateral strain estimation, resulting in a more physiologic strain profile. A sequence with 5 coherently compounded diverging waves is used at 500 Hz to improve the radial SNRe of the strain estimation compared to a single-source diverging sequence at 500 Hz. The first technique, Myocardial Elastography (ME), is used in conjunction with an intracardiac echocardiography (ICE) system to image the formation of thermal ablation lesions in vivo using a canine model (n=6). By comparing the systolic strain before and after the formation of a lesion, lesion maps are generated which allow for the visualization of the lesion in real-time during the procedure. A good correlation is found between the lesion maps and the actual lesion volume as measured using gross pathology (r2=0.86). The transmurality of the lesions are also shown to be in good agreement with gross pathology. Finally, the feasibility of imaging gaps between neighboring lesions is established. Lesion size and the presence of gaps have been associated with the success rate of cardiac ablation procedures, demonstrating the value of ME as a potentially useful technique for clinicians to help improve patient outcomes following ablation procedures. The second technique, Electromechanical Wave Imaging (EWI), is implemented using a transthoracic echocardiography system in a study of heart failure patients (n=16) and healthy subjects (n=4). EWI uses the transient inter-frame strains to generate maps of electromechanical activation, which are then used to distinguish heart failure patients from healthy controls (p<.05). EWI was also shown to be capable of distinguishing responders from non-responders to cardiac resynchronization therapy (CRT) on the basis of the activation time of the lateral wall. These results indicate that EWI could be used as an adjunct tool to monitor patient response to CRT, in addition to helping guide lead placement prior to device implantation

Electromagnetic compatibility issues of electrical and electronic devices

The PhD dissertation addresses EMC issues of electrical and electronic devices. In the first part of this work (Part_01), EMC fundamentals are briefly resumed and discussed, particularly focusing on EMC susceptibility and conducted/radiated emissions. Subsequently, attention is moved to both intentional and nonintentional EMI sources, particularly on RFID devices and power electronic converters respectively. These last are very widespread in several application fields, such as battery chargers, personal computers, electrical drives and grid interfaces. They consists of passive elements (inductors, capacitors, etc.), which are appropriately coupled by means of switching devices in order to guarantee appropriate voltage and/or current supply. The inherent switching nature of power electronic converters make them non-intentional EMI sources, may leading to high levels of conducted and/or radiated emissions. Particularly, conducted emissions are mainly due to unsuitable coupling among heat sinks, wires and printed circuits. Whereas radiated emissions are due to the switching devices, which behave as antenna when operate at high frequency value. Thus, the second part of this PhD dissertation (Part_02) deals with modelling and simulation of power electronic converters, whose switching frequencies generally lie within several hundred kilohertz. Then, several experimental results are presented regarding EMC tests performed in an RF anechoic chamber, highlighting the most critical EMC issues in terms of both conducted and radiated emission levels. The last part of this work (Part_03) is devoted to EMC susceptibility/immunity of implantable medical devices. At the present time these kinds of electrical and electronic devices are implanted even from a very young age, allowing more people to live a normal life. Consequently, EMC issues related to them are becoming increasingly relevant for both researcher and manufacturer, international standards being slightly outdated. In this context, an Implantable Cardioverter Defibrillator (ICD) have been considered with the aim of determining an EMC characterization in terms of sensing performances. This goal is achieved by developing a suitable sensing test procedure, which allows the evaluation of the ICD susceptibility level at different patient state of health. The proposed testing procedure has been validated through several experimental tests, which have been performed in the RF anechoic chamber above-mentioned. It assures pre-compliance of the tests in accordance with international standards, shielding against uncontrolled EMI sources. Experimental results are finally reported and discussed, highlighting the effectiveness of the proposed procedure

DEVELOPMENT OF PIEZOELECTRIC SENSORS AND METHODOLOGY FOR NONINVASIVE SIMULTANEOUS DETECTION OF MULTIPLE VITAL SIGNS

The activity of piezoelectric material linked the applied electric field with the strain generated that can be translated into geometrical variations. Flexible steel substrate exhibits fascinating mechanical properties which enable their integration into the emerging field of flexible microelectronics. This work presents an extended technique based on capacitance-voltage dependency to extract the geometrical variations in thin-film piezoelectric materials deposited on a flexible steel. A 50 μm flexible steel sheet has been sandwiched by two PZT film layers, each of 2.4 μm in thickness deposited by sputtering. An aluminum layer of 370 nm has been deposited above each PZT layer to form the electrical contact. The steel sheet represents the common electrode for both PZT structures. Gamry references 3000 analyzers were used to collect the capacitance-voltage measurements then estimating the piezoelectric charge constant. Experimental work has been validated by implementing the same method on a bulk piezoelectric film. Results have shown that the measured capacitance varies by 1% due to dielectric constant voltage dependency. On the other hand, 99% of capacitance variations depend on the change in physical dimensions of the sample via the piezoelectric effect. Further to that, this thesis explores the utilization of piezoelectric-based sensors to collect a corresponding representative signal from the chest surface. The subject typically needs to hold his or her breath to eliminate the respiration effect. This work further contributes to the extraction of the corresponding representative vital signs directly from the measured respiration signal. The contraction and expansion of the heart muscles, as well as the respiration activities, will induce a mechanical vibration across the chest wall. This vibration can be converted into an electrical output voltage via piezoelectric sensors. During breathing, the measured voltage signal is composed of the cardiac cycle activities modulated along with the respiratory cycle activity. The proposed technique employs the principles of piezoelectric and signal-processing methods to extract the corresponding signal of cardiac cycle activities from a breathing signal measured in real-time. All the results were validated step by step by a conventional apparatus, with good agreement observed

Privacy-Protecting Techniques for Behavioral Data: A Survey

Our behavior (the way we talk, walk, or think) is unique and can be used as a biometric trait. It also correlates with sensitive attributes like emotions. Hence, techniques to protect individuals privacy against unwanted inferences are required. To consolidate knowledge in this area, we systematically reviewed applicable anonymization techniques. We taxonomize and compare existing solutions regarding privacy goals, conceptual operation, advantages, and limitations. Our analysis shows that some behavioral traits (e.g., voice) have received much attention, while others (e.g., eye-gaze, brainwaves) are mostly neglected. We also find that the evaluation methodology of behavioral anonymization techniques can be further improved