Role of pharmacotherapy in Brugada syndrome

In patients who undergo aborted sudden cardiac death or syncope of unknown origin (symptomatic Brugada syndrome), no one argues that the implantation of an ICD is the first-line therapy regardless of the findings of the EP study. For those patients, drug therapy plays not a contradictory but a complimentary role to the ICD by reducing the number of ICD shock deliveries. Prevention of VF contributes to the improvement in the quality of life of the patients by avoiding uncomfortable ICD shock deliveries. As mentioned above, Belhassen et al. 11, performed EP-guided medical therapy in 34 patients with idiopathic VF, in 5 of whom the criterion of Brugada syndrome were fulfilled, and reported excellent long-term results. Although medical therapy requires markers that can accurately predict the preventive effect of VF over a long-term period, there, however, seems to be no reliable marker. An EP study is usually used to examine the preventive effects of antiarrhythmic agents on sustained ventricular tachycardia in patients with structural heart disease, whereas the prognostic value of the EP study in predicting life-threatening events in Brugada syndrome is still controversial. Brugada et al., 3 suggested that among the asymptomatic patients, the inducibility of VT during the EP study might be a prognostic marker of risk. Studies by Priori et al., 22 and Kanda et al., 23 failed to find an association between the inducibility and recurrence of VT/VF in patients with Brugada syndrome regardless of whether it was symptomatic or asymptomatic. As Belhassen suggested 13, the difference might be due to the VF induction protocol in the EP study, in which Belhassen et al., used a stimulus current intensity of five times the diastolic threshold along with the use of repetition of double and triple extrastimulation at the shortest coupling intervals that resulted in ventricular capture. Further appropriate clinical trials are needed to clarify this issue. In patients with asymptomatic Brugada syndrome who are family members of symptomatic Brugada syndrome patients, the same strategy as that for the symptomatic Brugada syndrome patients should be considered 2,3,4. In another asymptomatic-patient group in whom an ECG that discloses the Brugada sign is performed for routine reasons such as a workup prior to surgery or sport license or screening for insurance, risk stratification to find the patients at high risk is needed because in most cases these patients have a benign prognosis3,22,23. Antzelevitch et al. 4, recommended that all asymptomatic patients with the Brugada sign should undergo an EP study for risk stratification, and, if inducible, an ICD should be implanted since Brugada et al.3, reported that an overall 8% life-threatening event rate was found in initially asymptomatic patients. Belhassen et al.,13 suggested that EP study-guided quinidine therapy might become an alternative to ICD therapy for prophylaxis of arrhythmic events in these patients. Further appropriate clinical trials are needed

Generalized Two Color Map Theorem -- Complete Theorem of Robust Gait Plan for a Tilt-rotor

Gait plan is a procedure that is typically applied on the ground robots, e.g., quadrupedal robots; the tilt-rotor, a novel type of quadrotor with eight inputs, is not one of them. While controlling the tilt-rotor relying on feedback linearization, the tilting angles (inputs) are expected to change over-intensively, which may not be expected in the application. To help suppress the intensive change in the tilting angles, a gait plan procedure is introduced to the tilt-rotor before feedback linearization. The tilting angles are specified with time in advance by users rather than given by the control rule. However, based on this scenario, the decoupling matrix in feedback linearization can be singular for some attitudes, combinations of roll angle and pitch angle. It hinders the further application of the feedback linearization. With this concern, Two Color Map Theorem is established to maximize the acceptable attitude region, where the combinations of roll and pitch will give an invertible decoupling matrix. That theorem, however, over-restricts the choice of the tilting angles, which can rule out some feasible robust gaits. This paper gives the generalized Two Color Map Theorem; all the robust gaits can be found based on this generalized theorem. The robustness of three gaits that satisfy this generalized Two Color Map Theorem (while violating Two Color Map Theorem) are analyzed. The results show that Generalized Two Color Map Theorem completes the search for the robust gaits for a tilt-rotor

Four-dimensional Gait Surfaces for A Tilt-rotor -- Two Color Map Theorem

This article presents the four-dimensional surfaces which instruct the gait plan for a tilt-rotor. The previous gaits analyzed in the tilt-rotor research are inspired by animals; no theoretical base backs the robustness of these gaits. This research deduces the gaits by diminishing the effect of the attitude of the tilt-rotor for the first time. Four-dimensional gait surfaces are subsequently found, on which the gaits are expected to be robust to the attitude. These surfaces provide the region where the gait is suggested to be planned. However, a discontinuous region may hinder the gait plan process while utilizing the proposal gait surfaces. A Two Color Map Theorem is then established to guarantee the continuity of each gait designed. The robustness of the typical gaits obeying the Two Color Map Theorem and on the gait surface is demonstrated by comparing the singular curve in attitude with the gaits not on the gait surface. The result shows that the acceptable attitudes enlarge for the gaits on the gait surface

Visualization of Flow in Scroll Compressor by Radiography

Saving energy and resources in the air conditioning industry is required in order to protect the global environment. To save resources, miniaturization of the compressor in air conditioners is necessary. This miniaturization will increase the oil circulation rate (OCR) of the compressor because the oil separation space will be reduced. To improve the oil separation efficiency, it is necessary to understand the appearance of the flow of oil and refrigerant in the compressor chamber. This paper reports a technique to visualize the flow by using neutron radiography and X-ray radiography. Furthermore, a method to measure the oil concentration by carrying out image processing is described

Effects of verapamil and lidocaine on two components of the re-entry circuit of verapamil-sensitive idiopathic left ventricular tachycardia

AbstractOBJECTIVESWe characterized pharmacologically the slow conduction zone of verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) with regard to the late diastolic potential (LDP).BACKGROUNDWe showed that the slow conduction zone of ILVT could be divided into two components by LDP; that is, the distal component with a tachycardia-dependent conduction delay property and the proximal one without it.METHODSElectrophysiologic studies were performed in eight consecutive patients. The LDP was recorded during left ventricular (LV) mapping during ILVT. Entrainment was performed from the right ventricular outflow tract while recording LDP. The effects of lidocaine (1 mg/kg body weight) and verapamil (0.5 or 1.0 mg) were examined during entrainment.RESULTSThe LDPs preceding the Purkinje potential (PP) were serially recorded from the upper third to the middle of the LV septum along the narrow longitudinal line. The ventricular tachycardia (VT) cycle length increased after lidocaine (p < 0.05), and further after verapamil (p < 0.05). The increments in the VT cycle length after administration of the drugs strongly correlated with those in LDP-PP (r > 0.9 for both drugs). The interval from the ventricular potential to LDP was unchanged after administration of the drugs. In one patient, verapamil terminated VT by local conduction block between LDP and PP. The LDP-PP measured during entrainment increased after lidocaine, and further after verapamil, whereas the interval from the stimulus to LDP remained unchanged.CONCLUSIONSThe component distal to LDP is mainly calcium channel-dependent and partly depressed sodium channel-dependent. The proximal component is considered to be sodium channel-dependent (normal)