Electrocardiographic Identification of Abnormal Ventricular Depolarization and Repolarization in Patients With Idiopathic Ventricular Fibrillation 11This study was supported by Grant 93.080 from The Netherlands Heart Foundation.22All editorial decisions for this article, including selection of referees, were made by a Guest Editor. This policy applies to all articles with authors from the University of California San Francisco.

AbstractObjectives. We sought to gain more insight into the arrhythmogenic etiology of idiopathic ventricular fibrillation (VF) by assessing ventricular depolarization and repolarization properties by means of various electrocardiographic (ECG) techniques.Background. Idiopathic VF occurs in the absence of demonstrable structural heart disease. Abnormalities in ventricular depolarization or repolarization have been related to increased vulnerability to VF in various cardiac disorders and are possibly also present in patients with idiopathic VF.Methods. In 17 patients with a first episode of idiopathic VF, 62-lead body surface QRST integral maps, QT dispersion on the 12-lead ECG and XYZ-lead signal-averaged ECGs were computed.Results. All subjects of a healthy control group had a normal dipolar QRST integral map. In patients with idiopathic VF, either a normal dipolar map (29%), a dipolar map with an abnormally large negative area on the right side of the thorax (24%) or a nondipolar map (47%) were recorded. Only four patients (24%) had increased QT dispersion on the 12-lead ECG and late potentials could be recorded in 6 (38%) of 16 patients. During a median follow-up duration of 56 months (range 9 to 136), a recurrent arrhythmic event occurred in 7 patients (41%), all of whom had an abnormal QRST integral map. Five of these patients had late potentials, and three showed increased QT dispersion on the 12-lead ECG.Conclusions. In patients with idiopathic VF, ventricular areas of slow conduction, regionally delayed repolarization or dispersion in repolarization can be identified. Therefore, various electrophysiologic conditions, alone or in combination, may be responsible for the occurrence of idiopathic VF. Body surface QRST integral mapping may be a promising method to identify those patients who do not show a recurrent episode of VF

An Efficient and Robust Algorithm for Parallel Groupwise Registration of Bone Surfaces

Abstract. In this paper a novel groupwise registration algorithm is proposed for the unbiased registration of a large number of densely sampled point clouds. The method fits an evolving mean shape to each of the example point clouds thereby minimizing the total deformation. The registration algorithm alternates between a computationally expensive, but parallelizable, deformation step of the mean shape to each example shape and a very inexpensive step updating the mean shape. The algorithm is evaluated by comparing it to a state of the art registration algorith

Retracting and seeking movements during laparoscopic goal-oriented movements. Is the shortest path length optimal?

Aims- Minimally invasive surgery (MIS) requires a high degree of eye–hand coordination from the surgeon. To facilitate the learning process, objective assessment systems based on analysis of the instruments’ motion are being developed. To investigate the influence of performance on motion characteristics, we examined goaloriented movements in a box trainer. In general, goal-oriented movements consist of a retracting and a seeking phase, and are, however, not performed via the shortest path length. Therefore, we hypothesized that the shortest path is not an optimal concept in MIS. Methods-Participants were divided into three groups (experts, residents, and novices). Each participant performed a number of one-hand positioning tasks in a box trainer. Movements of the instrument were recorded with the TrEndo tracking system. The movement from point A to B was divided into two phases: A-M (retracting) and M-B (seeking). Normalized path lengths (given in %) of the two phases were compared. Results- Thirty eight participants contributed. For the retracting phase, we found no significant difference between experts [median (range) %: 152 (129–178)], residents [164 (126–250)], and novices [168 (136–268)]. In the seeking phase, we find a significant difference (<0.001) between experts [180 (172–247)], residents [201 (163–287)], and novices [290 (244–469)]. Moreover, within each group, a significant difference between retracting and seeking phases was observed. Conclusions- Goal-oriented movements in MIS can be split into two phases: retracting and seeking. Novices are less effective than experts and residents in the seeking phase. Therefore, the seeking phase is characteristic of performance differences. Furthermore, the retracting phase is essential, because it improves safety by avoiding intermediate tissue contact. Therefore, the shortest path length, as presently used during the assessment of basic MIS skills, may be not a proper concept for analyzing optimal movements and, therefore, needs to be revised.Biomechanical EngineeringMechanical, Maritime and Materials Engineerin

Software design for analysis of multichannel intracardial and body surface electrocardiograms

Analysis of multichannel ECG recordings (body surface maps (BSMs) and intracardial maps) requires special software. We created a software package and a user interface on top of a commercial data analysis package (MATLAB) by a combination of high-level and low-level programming. Our software was created to satisfy the needs of a diverse group of researchers. It can handle a large variety of recording configurations. It allows for interactive usage through a fast and robust user interface, and batch processing for the analysis of large amounts of data. The package is user-extensible, includes routines for both common and experimental data processing tasks, and works on several computer platforms. The source code is made intelligible using software for structured documentation and is available to the users. The package is currently used by more than ten research groups analysing ECG data worldwide. (C) 2002 Elsevier Science Ireland Ltd. All rights reserve

Investigation of training needs for Functional Endoscopic Sinus Surgery (FESS)

The use of simulators for training FESS may in the future offer substantial advantages like increased exposure to difficult scenarios, reduced learning curves, and reduced costs. Training simulators may range from very simple, involving only visual simulation, to more complex, involving haptic simulation or force feedback. To effectively employ these training means, insight is needed into the training needs for FESS procedure. A study was carried out to investigate which subtasks of FESS are hardest to perform and have the longest learning curve. A questionnaire was distributed among two groups of Ear, Nose and Throat (EAT) surgeons participating in a basic, as well as in an advanced sinus surgery course. Results showed that tasks related to spatial orientation are judged as hardest, whereas manual tasks are considered less difficult. These results suggest that simulators will not necessarily need haptic feedback to train the most important knowledge and skills needed for FES