Mappaggio ad alta densit\ue0 dell'attivit\ue0 focale delle vene polmonari: analisi dell'innesco della fibrillazione atriale parossisitica nell'uomo.

Scopo: Analizzare le caratteristiche dell\u2019attivit\ue0 focale originante dalle vene polmonari (VP) innescante la fibrillazione atriale (FA) nell\u2019uomo, mediante mappaggio tridimensionale (3D) ad alta densit\ue0. Metodi e risultati: L\u2019attivit\ue0 focale della VP \ue8 stata registrata mediante catetere basket (64 elettrodi) ed il segnale endocavitario analizzato con sistema di mappaggio computerizzato (QMS2). Sono stati analizzati 40 pazienti e registrata attivit\ue0 focale in 23 VP. L\u2019attivit\ue0 focale innescante la FA \ue8 stata registrata in 17 VP. La sequenza di acquisizioni nello stesso paziente e nella stessa VP mostra un pattern di attivazione riproducibile. Il pattern di attivazione pi\uf9 frequente risulta essere multifocale, prossimale alla giunzione atrio-venosa e breaktrough non correlata. La localizzazione dell\u2019attivit\ue0 focale \ue8 prevalente in sede anteriore e inferiore della vena. L\u2019attivit\ue0 focale innescante la FA \ue8 caratterizzata da attivit\ue0 fibrillato ria nelle zone di pi\uf9 precoce attivazione seguita da potenziali discreti nelle zone pi\uf9 tardive. L\u2019attivit\ue0 focale delle VP non innescante la FA presenta zone di minor precocit\ue0 di attivazione con minore sincronizzazione dei foci aritmici. Conclusioni: il mappaggio tridimensionale con catetere basket risulta essere un ottimo strumento di mappaggio endocavitario utile per la comprensione di aspetti anatomici e funzionali dell\u2019attivit\ue0 focale delle VP innescanti la fibrillazione atriale nell\u2019uomo

Mappaggio ad alta densità dell'attività focale delle vene polmonari: analisi dell'innesco della fibrillazione atriale parossisitica nell'uomo.

Scopo: Analizzare le caratteristiche dell’attività focale originante dalle vene polmonari (VP) innescante la fibrillazione atriale (FA) nell’uomo, mediante mappaggio tridimensionale (3D) ad alta densità. Metodi e risultati: L’attività focale della VP è stata registrata mediante catetere basket (64 elettrodi) ed il segnale endocavitario analizzato con sistema di mappaggio computerizzato (QMS2). Sono stati analizzati 40 pazienti e registrata attività focale in 23 VP. L’attività focale innescante la FA è stata registrata in 17 VP. La sequenza di acquisizioni nello stesso paziente e nella stessa VP mostra un pattern di attivazione riproducibile. Il pattern di attivazione più frequente risulta essere multifocale, prossimale alla giunzione atrio-venosa e breaktrough non correlata. La localizzazione dell’attività focale è prevalente in sede anteriore e inferiore della vena. L’attività focale innescante la FA è caratterizzata da attività fibrillato ria nelle zone di più precoce attivazione seguita da potenziali discreti nelle zone più tardive. L’attività focale delle VP non innescante la FA presenta zone di minor precocità di attivazione con minore sincronizzazione dei foci aritmici. Conclusioni: il mappaggio tridimensionale con catetere basket risulta essere un ottimo strumento di mappaggio endocavitario utile per la comprensione di aspetti anatomici e funzionali dell’attività focale delle VP innescanti la fibrillazione atriale nell’uomo

Livelli plasmatici di adrenomedullina come indicatori di prognosi dopo terapia di resincronizzazione cardiaca

The cardiac resynchronization therapy (CRT), based on correction of electro-mechanical dyssynchrony by biventricular pacing in patientswith severe chronicHF unresponsive to optimalmedical treatment and left ventricular conduction disturbances, has been developed. The determination of plasma adrenomedullin (ADM) levels before implantation could provide important additional information to reduce the high percentage (30%) of patients not responding to treatment despite the use of increasingly sophisticatedmethods for selecting candidates. The case described illustrates the importance of basal ADM plasma levels in predicting the clinical and functional improvement after treatment with CRT

Reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacing

<p>Abstract</p> <p>Background</p> <p>Chronic right ventricular (RV) apical pacing may lead to left ventricular (LV) dyssynchrony and LV dysfunction. In heart failure due to RV pacing, upgrading to biventricular stimulation (CRT) can improve NYHA Class and LV function. A proportion of patients do not respond to upgrading. Aim was to assess whether etiology of LV dysfunction accounts for responses to CRT in RV-paced patients.</p> <p>Methods</p> <p>Sixty-two patients treated by CRT, under RV pacing from 50.2 ± 5.4 months, were studied. Cause of LV dysfunction was non-ischemic (NIC) in 28 and ischemic cardiomyopathy (IC) in 34 patients. Clinical and conventional echocardiographic parameters were available within 1 month before RV pacing, within 1 month before CRT and at 12 ± 2 months of follow-up (FU).</p> <p>Results</p> <p>Decreased LVEF (from 37.0 ± 8.8 to 25.6 ± 6.1%, p <0.001), increased LV end-systolic dimensions (LVESD) (from 48.1 ± 8.6 to 55.2 ± 7.9 mm, p <0.001) and worsened NYHA Class (from 1.9 ± 1.1 to 3.2 ± .6, p < 0.005) were found before CRT, compared to pre RV-pacing. After CRT, 44/62 patients showed a ≥ 1 NYHA Class improvement; >10% decrease in LVESD was observed in 24 patients: 5 with IC, 19 with NIC (p < .0.001). The association between cause of LV dysfunction with >10% decrease in LVESD remained highly significant (p < 0.001) adjusting for pre-CRT QRS duration, NYHA Class, LVEF, LVESD, treatment or RV pacing duration.</p> <p>Conclusions</p> <p>CRT improves functional class even after long-lasting pacing. Reverse remodeling is evident in a small population, more likely with NIC.</p

Assessing the Relationship between Cognitive Workload, Workstation Design, User Acceptance and Trust in Collaborative Robots

Collaborative robots are revolutionising the manufacturing industry and the way workers perform their tasks. When designing shared workspaces between robots and humans, human factors and ergonomics are often overlooked. This study assessed the relationship between cognitive workload, workstation design, user acceptance and trust in collaborative robots. We combined subjective and objective data to evaluate the cognitive workload during an assembly task in three different scenarios in which we manipulated various features of the workstation and interaction modalities. Our results showed that participants experienced a reduction in cognitive workload in each of the three trials, indicating an improvement in cognitive performance. Additionally, we found that user acceptance predicted perceived stress across the trials but did not significantly impact the cognitive workload. Trust was not found to moderate the relationship between cognitive workload and perceived stress. This study has the potential to make a significant contribution to the field of collaborative assembly systems by providing valuable insights and helping to bridge the gap between researchers and practitioners. This study can potentially impact companies looking to improve safety, productivity and efficiency

Assessing the Relationship between Cognitive Workload, Workstation Design, User Acceptance and Trust in Collaborative Robots

Collaborative robots are revolutionising the manufacturing industry and the way workers perform their tasks. When designing shared workspaces between robots and humans, human factors and ergonomics are often overlooked. This study assessed the relationship between cognitive workload, workstation design, user acceptance and trust in collaborative robots. We combined subjective and objective data to evaluate the cognitive workload during an assembly task in three different scenarios in which we manipulated various features of the workstation and interaction modalities. Our results showed that participants experienced a reduction in cognitive workload in each of the three trials, indicating an improvement in cognitive performance. Additionally, we found that user acceptance predicted perceived stress across the trials but did not significantly impact the cognitive workload. Trust was not found to moderate the relationship between cognitive workload and perceived stress. This study has the potential to make a significant contribution to the field of collaborative assembly systems by providing valuable insights and helping to bridge the gap between researchers and practitioners. This study can potentially impact companies looking to improve safety, productivity and efficiency

The role of stress myocardial perfusion to predict left ventricular reverse remodeling in patients with ischemic cardiomyopathy treated by resynchronisation therapy

Purpose: Cardiac resynchronization therapy (CRT) improves quality of life and left ventricular (LV) function in patients (pts) with heart failure; however, improvement in LV function is known to be less evident in ischemic (IC) rather than in non ischemic cardiomyopathy. Assessment of baseline perfusion defects has been used for the prediction of response to CRT in IC; little is known on the effects of myocardial ischemia at the time of implantation on LV reverse remodeling at follow up (FU) in pts treated by CRT. Methods: Fortysix IC pts treated by CRT were studied. All were in NYHA Class III, LVEF ,35%, left bundle branch block with a QRS duration of 154+8 msec, under optimal medical therapy for ischemia and heart failure and no indications to percutaneous or surgical revascularization. Pts underwent conventional echocardiography and stress/ rest myocardial scintigraphy - effort in 28, i.v. dipyridamole in 18 - within 3 weeks before CRT. Among scintigraphic variables, summed rest (SRS), summed stress (SSS) and summed difference score (SDS) were quantitatively analyzed. Results: Pts were divided according to the extension of ischemic area detected by myocardial scintigraphy: Group I (n 32): pts in whom SDS was &#8804;4, Group II (n 14): pts with SDS .4. No differences were observed between Group I and II in NYHA Class, baseline LVEF, site of previous myocardial infarction, myocardial perfusion score (SRS: 12.4+1.2 vs 10.5+1.6) and pre-CRT echocardiographic end systolic dimensions (ESD): 56.2+1.2 vs 56.3+1.6 mm. At 12+1 month FU, clinical improvement (&#8805;1 NYHA Class reduction) was found in 29/46 pts, 23 in G I pts and 6 in G II pts (p=.05); however, a significant reduction in echocardiographic ESD was seen in G I pts, while no significant changes in ESD could be reported in G II (-9.1+1.2%, vs 20.9+1.1%, p ? 0.01). In the total population, no relation (r ? 0.12) existed between baseline perfusion and changes in ESD at FU. Conclusions: Extension of ischemia evaluated by stress myocardial scintigraphy provides more reliable information than baseline perfusion on LV reverse remodeling in IC pts with no revascularization options treated by CRT