Minimizing right ventricular pacing in patients with sinus node disease and prolonged PQ interval: The impact on exercise capacity

Background: Several clinical and experimental studies have shown that unnecessary right ventricular pacing in sinus node disease can be detrimental. Inter- and intra-ventricular asyn­chrony imposed by right ventricular pacing may cause reduction in contractility and relaxation of left ventricle, worsening mitral regurgitation, regional redistribution of myocardial perfusion and oxygen consumption, and asymmetrical hypertrophy of left ventricular wall. In some patients, sinus node disease coexists with impaired atrioventricular conduction. The optimal pacing mode in this population is not determined. Minimizing right ventricular pacing can preserve inter- and intra-ventricular synchrony. On the other hand, longer atrioventricular delay may cause atrioventricular asynchrony. The aim of this study was to prospectively assess the impact of minimizing right ventricular pacing in patients with DDD pacemaker implanted for sinus node disease and prolonged PQ interval on exercise capacity, cardiac function and quality of life. Methods: The study enrolled 50 consecutive patients with prolonged PQ interval who were implanted with DDD pacemaker because of sinus node disease. Each patient was treated alternately with 2 pacing modes in random order for 4-month periods: conventional dualchamber pacing and dual-chamber minimal ventricular pacing (prolonged atrioventricular delay). At the end of each phase the following tests were performed: cardiopulmonary exercise testing, echocardiographic evaluation and quality of life assessment (SF36). Results: There was no significant relationship between pacing mode and cardiopulmonary parameters, echocardiographic parameters and quality of life. Conclusions: Sequential atrioventricular pacing may be a reasonable choice for treating patients with sinus node disease and prolonged PQ interval.

Neuromarkers of anxiety and depression in a patient after neuro-ophthalmic surgery of the meningioma : effect of individually-tailored tDCS and neurofeedback

The aim of the study was to evaluate the effectiveness of individually tailored anodal tDCs/ neurofeedback protocol for the reduction of post-operative depression after a neuroophtalmological operation of the meningioma. The neuromarkers in Quantitative EEG (QEEG) and Event-related potentials (ERPs) were utilized in the construction of protocol and evaluation. [b]Case description[/b]. A 45-year-old female after successful neuro-ophthalmic surgery of the meningioma, complained of severe pain and anxiety, difficulties with sleeping, attention and memory problems, as well as inability to continue working in her given profession. Neuropsychological testing showed lack of cognitive disturbances and post-operative depression. Two working hypotheses were tested to find neuromarkers of depression and anxiety. In line with the ‘depression hypothesis’ a frontal alpha asymmetry pattern was found in the patient, and in line with the ‘anxiety’ hypothesis an increased left temporal P1 wave in response to visual stimuli was found in ERPs. A specific alpha asymmetry neurofeedback protocol combined with an anodal tDCS was suggested. Twenty sessions of individually-tailored anodal tDCs/ neurofeedback protocol were performed. The QEEG frontal asymmetry pattern and the excessive temporal P1 wave were normalized after the intervention. [b]Conclusions. [/b]The patient recovered from post-operative depression and returned to work after 20 sessions of the combined neurofeedback/tDCS protocol. Specific patterns of QEEG and ERPs serve as neuromarkers for constructing the protocol and for monitoring the results of intervention

Neuromarkers of anxiety and depression in a patient after neuro-ophthalmic surgery of the meningioma – effect of individually-tailored tDCS and neurofeedback

The aim of the study was to evaluate the effectiveness of individually tailored anodal tDCs/ neurofeedback protocol for the reduction of post-operative depression after a neuroophtalmological operation of the meningioma. The neuromarkers in Quantitative EEG (QEEG) and Event-related potentials (ERPs) were utilized in the construction of protocol and evaluation. [b]Case description[/b]. A 45-year-old female after successful neuro-ophthalmic surgery of the meningioma, complained of severe pain and anxiety, difficulties with sleeping, attention and memory problems, as well as inability to continue working in her given profession. Neuropsychological testing showed lack of cognitive disturbances and post-operative depression. Two working hypotheses were tested to find neuromarkers of depression and anxiety. In line with the ‘depression hypothesis’ a frontal alpha asymmetry pattern was found in the patient, and in line with the ‘anxiety’ hypothesis an increased left temporal P1 wave in response to visual stimuli was found in ERPs. A specific alpha asymmetry neurofeedback protocol combined with an anodal tDCS was suggested. Twenty sessions of individually-tailored anodal tDCs/ neurofeedback protocol were performed. The QEEG frontal asymmetry pattern and the excessive temporal P1 wave were normalized after the intervention. [b]Conclusions. [/b]The patient recovered from post-operative depression and returned to work after 20 sessions of the combined neurofeedback/tDCS protocol. Specific patterns of QEEG and ERPs serve as neuromarkers for constructing the protocol and for monitoring the results of intervention

Resolution of exercise oscillatory ventilation with adaptive servoventilation in patients with chronic heart failure and Cheyne−Stokes respiration: preliminary study

Background: Exercise oscillatory ventilation (EOV) is a common pattern of breathing in heart failure (HF) patients, and indicates a poor prognosis. Aim: To investigate the effects of adaptive servoventilation (ASV) on ventilatory response during exercise. Methods: We studied 39 HF patients with left ventricular ejection fraction (LVEF) &#163; 45. Cardiorespiratory polygraphy, cardiopulmonary exercise testing (CPET), echocardiography, and measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration were performed. Twenty patients with Cheyne-Stokes respiration and apnoea&#8211;hypopnoea index (AHI) &#8805; 15/h were identified. Of these, 11 patients were successfully titrated on ASV and continued therapy. In the third month of ASV treatment, polygraphy, CPET, echocardiography, and measurement of NT-proBNP concentration were performed again. Results: The EOV was detected at baseline in 12 (31%) HF patients, including eight (67%) who underwent ASV. The EOV was associated with significantly lower LVEF, peak oxygen uptake (VO2), and ventilatory anaerobic threshold (VAT), and a significantly higher left ventricular diastolic diameter (LVDD), slope of ventilatory equivalent for carbon dioxide (VE/VCO2), AHI, central AHI and NT-proBNP concentration. In seven patients with EOV, reversal of EOV in the third month of ASV therapy was observed; only in one patient did EOV persist (p = 0.0156). Conclusions: The EOV can be reversed with ASV therapy. The EOV in association with central sleep apnoea and Cheyne- -Stokes respiration (CSA/CSR) is prevalent in HF patients and correlates with severity of the disease. Kardiol Pol 2011; 69, 12: 1266&#8211;1271Wstęp: Periodyczne oddychanie jest częstym zjawiskiem u pacjentów z przewlekłą niewydolnością serca (HF). Występuje ono nie tylko w czasie snu, ale i podczas wysiłku. Periodyczne oddychanie w czasie wysiłku (EOV) jest silnym predykatorem śmiertelności z przyczyn sercowych u pacjentów z HF. Adaptoserwowentylacja (ASV) jest nową metodą leczenia osób z oddychaniem typu Cheyne-Stokesa. Wykazano, że znacznie redukuje ona centralne bezdechy senne i normalizuje patologiczny tor oddychania w czasie snu. Cel: Celem badania była ocena wpływu ASV na tor oddychania w czasie wysiłku. Metody: Do badania włączono 39 pacjentów z przewlekłą HF, z frakcją wyrzutową lewej komory (LVEF) &#163; 45%. U wszystkich chorych wykonano badanie poligraficzne, ergospirometryczną próbę wysiłkową, badanie echokardiograficzne i oznaczono stężenie N-końcowego propeptydu natriuretycznego typu B (NT-proBNP). Oddychanie typu Cheyne-Stokesa i wskaźnik AHI (apnea&#8211;hypopnea) > 15/h stwierdzono u 20 (51%) pacjentów. U 11 spośród nich skutecznie wdrożono leczenie ASV. W 3. miesiącu terapii ponownie wykonano badanie poligraficzne, ergospirometryczną próbę wysiłkową, badanie echokardiograficzne i oznaczono stężenie NT-proBNP. Wyniki: U 12 (31%) pacjentów z HF stwierdzono EOV, w tym u 8 (67%) leczonych ASV. Chorzy z EOV w porównaniu z osobami z prawidłowym torem oddychania w czasie wysiłku charakteryzowali się istotnie niższą LVEF, szczytowym pochłanianiem tlenu (VO2), progiem beztlenowym oraz istotnie większym rozkurczowym wymiarem lewej komory, nachyleniem VE/VCO2, AHI, centralnym AHI i stężeniem NT-proBNP. W 3. miesiącu terapii ASV stwierdzono ustąpienie EOV u 7 pacjentów, tylko u 1 osoby nie zaobserwowano poprawy w zakresie toru oddychania (p = 0,0156). Wśród pozostałych parametrów ergospirometrycznych tylko puls tlenowy istotnie wzrósł. Szczytowe pochłanianie tlenu i próg beztlenowy nieznacznie się poprawiły, ale różnice te nie osiągnęły istotności statystycznej. U wszystkich pacjentów leczonych ASV stwierdzono normalizację toru oddychania w czasie snu i zmniejszenie AHI do < 5/h. Ponadto w trakcie leczenia ASV zaobserwowano znamienne zwiększenie LVEF i istotną redukcję stężenia NT-proBNP. Wnioski: Badanie pokazuje oryginalne zjawisko normalizacji toru oddychania w czasie wysiłku u pacjentów z centralnym bezdechem sennym leczonych ASV. Na podstawie powyższych danych nie można jednak wnioskować bezpośrednio o znaczeniu klinicznym tej obserwacji. Wpływ ustąpienia EOV w czasie leczenia ASV na rokowanie odległe wymaga przeprowadzenia dalszych badań. Również ze względu na ograniczenia tego badania (krótki okres obserwacji, mała grupa badana) jego wyniki wymagają potwierdzenia w kolejnych pracach. Kardiol Pol 2011; 69, 12: 1266&#8211;127

Rapid and Complete Surface Modification with Strain‐Promoted Oxidation‐Controlled Cyclooctyne‐1,2‐Quinone Cycloaddition (SPOCQ)

Strain‐promoted oxidation‐controlled cyclooctyne‐1,2‐quinone cycloaddition (SPOCQ) between functionalized bicyclo[6.1.0]non‐4‐yne (BCN) and surface‐bound quinones revealed an unprecedented 100 % conjugation efficiency. In addition, monitoring by direct analysis in real time mass spectrometry (DART‐MS) revealed the underlying kinetics and activation parameters of this immobilization process in dependence on its microenvironment

Making sky maps from Planck data

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