A pairwise maximum entropy model describes energy landscape for spiral wave dynamics of cardiac fibrillation

Heart is an electrically-connected network. Spiral wave dynamics of cardiac fibrillation shows chaotic and disintegrated patterns while sinus rhythm shows synchronized excitation patterns. To determine functional interactions between cardiomyocytes during complex fibrillation states, we applied a pairwise maximum entropy model (MEM) to the sequential electrical activity maps acquired from the 2D computational simulation of human atrial fibrillation. Then, we constructed energy landscape and estimated hierarchical structure among the different local minima (attractors) to explain the dynamic properties of cardiac fibrillation. Four types of the wave dynamics were considered: sinus rhythm; single stable rotor; single rotor with wavebreak; and multiple wavelet. The MEM could describe all types of wave dynamics (both accuracy and reliability>0.9) except the multiple random wavelet. Both of the sinus rhythm and the single stable rotor showed relatively high pairwise interaction coefficients among the cardiomyocytes. Also, the local energy minima had relatively large basins and high energy barrier, showing stable attractor properties. However, in the single rotor with wavebreak, there were relatively low pairwise interaction coefficients and a similar number of the local minima separated by a relatively low energy barrier compared with the single stable rotor case. The energy landscape of the multiple wavelet consisted of a large number of the local minima separated by a relatively low energy barrier, showing unstable dynamics. These results indicate that the MEM provides information about local and global coherence among the cardiomyocytes beyond the simple structural connectivity. Energy landscape analysis can explain stability and transitional properties of complex dynamics of cardiac fibrillation, which might be determined by the presence of 'driver' such as sinus node or rotor.Comment: Presented at the 62nd Biophysical Society Annual Meeting, San Francisco, California, 201

Mid-Septal Hypertrophy and Apical Ballooning; Potential Mechanism of Ventricular Tachycardia Storm in Patients with Hypertrophic Cardiomyopathy

Medically refractory ventricular tachycardia (VT) storm can be controlled with radiofrequency catheter ablation (RFCA), however, it may be difficult to control in some patients with hemodynamic overload. We experienced a patient with intractable VT storm controlled by hemodynamic unloading. The patient had mid-septal hypertrophic cardiomyopathy with an implantable cardioverter defibrillator (ICD) back-up. Because of the severe mid-septal hypertrophy, his left ventricle (LV) had an hourglass-like morphology and showed apical ballooning; the focus of VT was at the border of apical ballooning. Although we performed VT ablation because of electrical storm with multiple ICD shocks, VT recurred 1 hour after procedure. As the post-RFCA monomorphic VT was refractory to anti-tachycardia pacing or ICD shock, we reduced the hemodynamic overload of LV with β-blockade, hydration, and sedation. VT spontaneously stopped 1.5 hours later and the patient has remained free of VT for 24 months with β-blockade alone. In patients with VT storm refractory to antiarrhythmic drugs or RFCA, the mechanism of mechano-electrical feedback should be considered and hemodynamic unloading may be an essential component of treatment

Large Circular Ring Catheter Ablation Versus Anatomically Guided Ablation of Atrial Fibrillation: Back to the Future for Successful Catheter Ablation of Atrial Fibrillation?

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Stochastic Particle Flow for Nonlinear High-Dimensional Filtering Problems

A series of novel filters for probabilistic inference that propose an alternative way of performing Bayesian updates, called particle flow filters, have been attracting recent interest. These filters provide approximate solutions to nonlinear filtering problems. They do so by defining a continuum of densities between the prior probability density and the posterior, i.e. the filtering density. Building on these methods' successes, we propose a novel filter. The new filter aims to address the shortcomings of sequential Monte Carlo methods when applied to important nonlinear high-dimensional filtering problems. The novel filter uses equally weighted samples, each of which is associated with a local solution of the Fokker-Planck equation. This hybrid of Monte Carlo and local parametric approximation gives rise to a global approximation of the filtering density of interest. We show that, when compared with state-of-the-art methods, the Gaussian-mixture implementation of the new filtering technique, which we call Stochastic Particle Flow, has utility in the context of benchmark nonlinear high-dimensional filtering problems. In addition, we extend the original particle flow filters for tackling multi-target multi-sensor tracking problems to enable a comparison with the new filter

Male Pseudohermaphroditism Presented with Sudden Cardiac Arrest

Torsades de Pointes is a life-threatening arrhythmia associated with a number of causes, but is very rare among endocrinologic disorders. We report a case of male pseudohermaphroditism with hyperaldosteronism due to a 17α-hydroxylase deficiency presented with sudden cardiac arrest

Electroanatomical Characteristics of Idiopathic Left Ventricular Tachycardia and Optimal Ablation Target during Sinus Rhythm: Significance of Preferential Conduction through Purkinje Fibers

∙ The authors have no financial conflicts of interest. © Copyright: Yonsei University College of Medicine 2012 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial Licens

Fever-Induced QTc Prolongation and Ventricular Fibrillation in a Healthy Young Man

Long QT syndrome is associated with lethal tachyarrhythmia that can lead to syncope, seizure, and sudden death. Congenital long QT syndrome is a genetic disorder, characterized by delayed cardiac repolarization and prolongation of the QT interval on the electrocardiogram (ECG). Type 2 congenital long QT is linked to mutations in the human ether a go-go-related gene (HERG). There are environmental triggers of adverse cardiac events such as emotional and acoustic stimuli, but fever can also be a potential trigger of life-threatening arrhythmias in long QT syndrome type 2 patients. Herein, we report a healthy young man who experienced fever-induced polymorphic ventricular tachycardia and QT interval prolongation