Device orientation of a leadless pacemaker and subcutaneous implantable cardioverter-defibrillator in canine and human subjects and the effect on intrabody communication

Aims: The development of communicating modular cardiac rhythm management systems relies on effective intrabody communication between a subcutaneous implantable cardioverter-defibrillator (S-ICD) and a leadless pacemaker (LP), using conducted communication. Communication success is affected by the LP and S-ICD orientation. This study is designed to evaluate the orientation of the LP and S-ICD in canine subjects and measure success and threshold of intrabody communication. To gain more human insights, we will explore device orientation in LP and S-ICD patients. Methods and results: Canine subjects implanted with a prototype S-ICD and LP (both Boston Scientific, MA, USA) with anterior-posterior fluoroscopy images were included in this analysis. For comparison, a retrospective analysis of human S-ICD and LP patients was performed. The angle of the long axis of the LP towards the vertical axis of 0°, and distance between the coil and LP were measured. Twenty-three canine subjects were analysed. Median angle of the LP was 29° and median distance of the S-ICD coil to LP was 0.8 cm. All canine subjects had successful communication. The median communicating threshold was 2.5 V. In the human retrospective analysis, 72 LP patients and 100 S-ICD patients were included. The mean angle of the LP was 56° and the median distance between the S-ICD coil and LP was 4.6 cm. Conclusion: Despite the less favourable LP orientation in canine subjects, all communication attempts were successful. In the human subjects, we observed a greater and in theory more favourable LP angle towards the communication vector. These data suggests suitability of human anatomy for conductive intrabody communication

Stadslogistiek in beeld: de bevoorrading van goederen in de Oude Pijp in Amsterdam: kenmerken en kansen

In opdracht van Connekt, hebben de Hogeschool van Amsterdam, EVO en LeanCargo Consultancy tussen april en augustus 2016 onderzoek gedaan naar de bevoorrading in de Oude Pijp. Dit gebeurde in samenwerking met de gemeente Amsterdam en Stadsdeel Zuid

Acute and 3-Month Performance of a Communicating Leadless Antitachycardia Pacemaker and Subcutaneous Implantable Defibrillator

Objectives The primary objective was to assess the acute and 3-month performance of the modular antitachycardia pacing (ATP)-enabled leadless pacemaker (LP) and subcutaneous implantable cardioverter-defibrillator (S-ICD) system, particularly device–device communication and ATP delivery. Background Transvenous pacemakers and implantable cardioverter-defibrillators (ICDs) have considerable rates of lead complications. We examined the next step in multicomponent leadless cardiac rhythm management: feasibility of pacing (including ATP) by a LP, commanded by an implanted S-ICD through wireless, intrabody, device–device communication. Methods The combined modular cardiac rhythm management therapy system of the LP and S-ICD prototypes was evaluated in 3 animal models (ovine, porcine, and canine) both in acute and chronic (90 days) experiments. LP performance, S-ICD to LP communication, S-ICD and LP rhythm discrimination, and ATP delivery triggered by the S-ICD were tested. Results The LP and S-ICD were successfully implanted in 98% of the animals (39 of 40). Of the 39 animals, 23 were followed up for 90 days post-implant. LP performance was adequate and exhibited appropriate VVI behavior during the 90 days of follow-up in all tested animals. Unidirectional communication between the S-ICD and LP was successful in 99% (398 of 401) of attempts, resulting in 100% ATP delivery by the LP (10 beats at 81% of the coupling interval). Adequate S-ICD sensing was observed during normal sinus rhythm, LP pacing, and ventricular tachycardia/ventricular fibrillation. Conclusions This study presents the preclinical acute and chronic performance of the combined function of an ATP-enabled LP and S-ICD. Appropriate VVI functionality, successful wireless device–device communication, and ATP delivery were demonstrated by the LP. Clinical studies on safety and performance are needed

Long-term performance of a novel communicating antitachycardia pacing–enabled leadless pacemaker and subcutaneous implantable cardioverter-defibrillator system: A comprehensive preclinical study

Background: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) and leadless pacemakers (LPs) are intended to diminish transvenous lead–related complications. However, S-ICDs do not deliver antibradycardia pacing or antitachycardia pacing, and currently, there is no commercially available coordinated leadless option for patients with defibrillator and (expected) pacing needs. Objective: We evaluated the performance, safety, and potential replacement strategies of a novel modular cardiac rhythm management (mCRM) system, a wirelessly communicating antitachycardia pacing–enabled LP and S-ICD in a preclinical model. Methods: LP implantation was attempted in 68 canine subjects, and in 38 an S-ICD was implanted as well. Animals were evaluated serially up to 18 months. At all evaluations, communication thresholds (CTs) between the devices, LP electrical parameters, and system-related complications were assessed. Different replacement strategies were tested. Results: The LP was successfully implanted in 67 of 68 (98.5%) and the concomitant S-ICD in 38 of 38 (100%). mCRM communication was successful in 1022 of 1024 evaluations (99.8%). The mean CT was 2.2 ± 0.7 V at implantation and stable afterward (18 months: 1.8 ± 0.7 V). In multivariable analysis, larger LP-to-S-ICD angle and dorsal posture were associated with higher CTs. At implantation, the mean pacing capture threshold, impedance, and R-wave amplitude were 0.3 ± 0.1 V, 898.4 ± 198.9 Ω, and 26.4 ± 8.2 mV. The mean pacing capture threshold remained stable and impedance and R-wave amplitudes were within acceptable ranges throughout (0.7 ± 0.4 V, 619.1 ± 90.6 Ω, and 20.1 ± 8.4 mV at 18 months). Different replacement strategies seem feasible. Conclusion: This first mCRM system demonstrated excellent performance up to 18 months in a preclinical model

Typo EINA 15 years

Aquest llibre commemora els 15 anys dels cursos de tipografia a Eina. Han estat 15 edicions de durades i continguts diferents però que sempre han considerat la lletra com la manera per entendre i construir la pàgina. Les primeres tres edicions no van tenir cap mena de tiulació per després passar a un postgrau i finalment a un màster de títol propi de la Universitat Autònoma de Barcelona. A les pàgines següents, trobareu les dates, la llista de professors i la llista d’alumnes de cada curs i, a continuació, una tria de treballs destacats d’alguns alumnes que han cursat els estudis. En fer aquesta publicació, un cop acabada la tria, és quan ens hem adonat de la importància d’allò que ha deixat el curs i de com de diferents són els ambits relacionats amb la lletra.Este libro conmemora los 15 años de los cursos de tipografía en Eina. Han sido 15 ediciones de duraciones y contenidos diferentes pero que siempre han considerado la letra como la forma de entender y construir la página. Las primeras tres ediciones no tuvieron forma de titulación alguna, para después pasar a un posgrado y finalmente a un máster de título propio en la Universitat Autònoma de Barcelona. Encontraréis en la siguientes páginas las fechas, la lista de profesores y la lista de alumnos de cada curso, y a continuación una selección de trabajos destacados de quienes pasaron por los cursos. Al hacer esta publicación, una vez terminada la selección, es cuando nos hemos dado cuenta de cómo de importante es lo que ha dejado el curso y de cómo de diferentes son los ámbitos relacionados con la letra.This book commemorates 15 years of typography courses at Eina. These courses have had different lengths and contents, but all have considered the letter as the key to understanding and building the page. For the first three years, there was no formal degree attached to the program, but Typography later became a postgraduate degree and finally an accredited Master´s degree from Autonomous University of Barcelona. In the following pages you’ll find the dates, professors and students of each year of the program, followed by a selection of outstanding projects. Putting this publication together was a reminder of just how important this course is, and of the many different ways there are of thinking about letters