Evidence that conflict regarding size of haemodynamic response to interventricular delay optimization of cardiac resynchronization therapy may arise from differences in how atrioventricular delay is kept constant.

Aims: Whether adjusting interventricular (VV) delay changes haemodynamic efficacy of cardiac resynchronization therapy (CRT) is controversial, with conflicting results. This study addresses whether the convention for keeping atrioventricular (AV) delay constant during VV optimization might explain these conflicts. / Method and results: Twenty-two patients in sinus rhythm with existing CRT underwent VV optimization using non-invasive systolic blood pressure. Interventricular optimization was performed with four methods for keeping the AV delay constant: (i) atrium and left ventricle delay kept constant, (ii) atrium and right ventricle delay kept constant, (iii) time to the first-activated ventricle kept constant, and (iv) time to the second-activated ventricle kept constant. In 11 patients this was performed with AV delay of 120 ms, and in 11 at AV optimum. At AV 120 ms, time to the first ventricular lead (left or right) was the overwhelming determinant of haemodynamics (13.75 mmHg at ±80 ms, P < 0.001) with no significant effect of time to second lead (0.47 mmHg, P = 0.50), P < 0.001 for difference. At AV optimum, time to first ventricular lead again had a larger effect (5.03 mmHg, P < 0.001) than time to second (2.92 mmHg, P = 0.001), P = 0.02 for difference. / Conclusion: Time to first ventricular activation is the overwhelming determinant of circulatory function, regardless of whether this is the left or right ventricular lead. If this is kept constant, the effect of changing time to the second ventricle is small or nil, and is not beneficial. In practice, it may be advisable to leave VV delay at zero. Specifying how AV delay is kept fixed might make future VV delay research more enlightening

L-infinity Norm Design of Linear-phase Robust Broadband Beamformers using Constrained Optimization

A new method for the design of linear-phase robust far-field broadband beamformers using constrained optimization is proposed. In the method, the maximum passband ripple and minimum stopband attenuation are ensured to be within prescribed levels, while at the same time maintaining a good linear-phase characteristic at a prescribed group delay in the passband. Since the beamformer is intended primarily for small-sized microphone arrays where the microphone spacing is small relative to the wavelength at low frequencies, the beamformer can become highly sensitive to spatial white noise and array imperfections if a direct minimization of the error is performed. Therefore, to limit the sensitivity of the beamformer the optimization is carried out by constraining a sensitivity parameter, namely, the white noise gain (WNG) to be above prescribed levels across the frequency band. Two novel design variants have been developed. The first variant is formulated as a convex optimization problem where the maximum error in the passband is minimized, while the second variant is formulated as an iterative optimization problem and has the advantage of significantly improving the linear-phase characteristics of the beamformer under any prescribed group delay or linear-array configuration. In the second variant, the passband group-delay deviation is minimized while ensuring that the maximum passband ripple and stopband attenuation are within prescribed levels. To reduce the computational effort in carrying out the optimization, a nonuniform variable sampling approach over the frequency and angular dimensions is used to compute the required parameters. Experiment results show that beamformers designed using the proposed methods have much smaller passband group-delay deviation for similar passband ripple and stopband attenuation than a modified version of an existing method