Acute Hemodynamic Effect of a Novel Dual-Vein, Multisite Biventricular Pacing Configuration.

BACKGROUND: Biventricular pacing (BVP) from multiple left ventricular (LV) sites could enhance the efficacy of cardiac resynchronization therapy (CRT) by engaging a greater myocardial mass. OBJECTIVES: The goal of this study was to evaluate the acute hemodynamic effect of various multisite pacing (MSP) configurations against conventional BVP. METHODS: Twenty patients with nonischemic dilated cardiomyopathy and left bundle branch block (mean age: 59 ± 14 years; LV ejection fraction: 27% ± 6%; native QRS: 171 ± 16 milliseconds) were investigated during a routine CRT implant procedure. In addition to conventional right atrial and right ventricular leads, 2 quadripolar leads were placed in the distant coronary venous branches. LV hemodynamics was evaluated by using a micromanometer-tipped catheter during atrioventricular BVP with 4 LV lead configurations: single-lead conventional BVP; single-lead multipoint pacing; triventricular pacing from distal dipoles of 2 LV leads; and maximum MSP (MSP-Max) from 4 dipoles of 2 LV leads. RESULTS: Compared with right atrial pacing, any BVP configuration produced a significant increase in the maximal LV diastolic pressure rise (LVdP/dTMax) (a median relative increase of 28% [IQR: 8%-45%], 25% [IQR: 18%-46%], 36% [IQR: 18%-54%], and 38% [IQR: 28%-58%], respectively; all, P < 0.001). MSP-Max but no other multisite BVP generated a significant increase of the maximal LVdP/dTMax than conventional BVP (P = 0.041). Increased LVdP/dTMax during MSP-Max was associated with greater LV diameter and lower LV ejection fraction, independently of the QRS width. CONCLUSIONS: The study shows the hemodynamic advantage of a novel dual-vein MSP-Max configuration that could be useful for CRT in patients with advanced LV remodeling.

Localization of the ventricular pacing site from BSPM and standard 12-lead ECG: a comparison study.

Inverse ECG imaging methods typically require 32-250 leads to create body surface potential maps (BSPM), limiting their routine clinical use. This study evaluated the accuracy of PaceView inverse ECG method to localize the left or right ventricular (LV and RV, respectively) pacing leads using either a 99-lead BSPM or the 12-lead ECG. A 99-lead BSPM was recorded in patients with cardiac resynchronization therapy (CRT) during sinus rhythm and sequential LV/RV pacing. The non-contrast CT was performed to localize precisely both ECG electrodes and CRT leads. From a BSPM, nine signals were selected to obtain the 12-lead ECG. Both BSPM and 12-lead ECG were used to localize the RV and LV lead, and the localization error was calculated. Consecutive patients with dilated cardiomyopathy, previously implanted with a CRT device, were enrolled (n = 19). The localization error for the RV/LV lead was 9.0 [IQR 4.8-13.6] / 7.7 [IQR 0.0-10.3] mm using the 12-lead ECG and 9.1 [IQR 5.4-15.7] / 9.8 [IQR 8.6-13.1] mm for the BSPM. Thus, the noninvasive lead localization using the 12-lead ECG was accurate enough and comparable to 99-lead BSPM, potentially increasing the capability of 12-lead ECG for the optimization of the LV/RV pacing sites during CRT implant or for the most favorable programming.

Assessment of electrical dyssynchrony in cardiac resynchronization therapy: 12-lead electrocardiogram vs. 96-lead body surface map.

AIMS: The standard deviation of activation time (SDAT) derived from body surface maps (BSMs) has been proposed as an optimal measure of electrical dyssynchrony in patients with cardiac resynchronization therapy (CRT). The goal of this study was two-fold: (i) to compare the values of SDAT in individual CRT patients with reconstructed myocardial metrics of depolarization heterogeneity using an inverse solution algorithm and (ii) to compare SDAT calculated from 96-lead BSM with a clinically easily applicable 12-lead electrocardiogram (ECG). METHODS AND RESULTS: Cardiac resynchronization therapy patients with sinus rhythm and left bundle branch block at baseline (n = 19, 58% males, age 60 ± 11 years, New York Heart Association Classes II and III, QRS 167 ± 16) were studied using a 96-lead BSM. The activation time (AT) was automatically detected for each ECG lead, and SDAT was calculated using either 96 leads or standard 12 leads. Standard deviation of activation time was assessed in sinus rhythm and during six different pacing modes, including atrial pacing, sequential left or right ventricular, and biventricular pacing. Changes in SDAT calculated both from BSM and from 12-lead ECG corresponded to changes in reconstructed myocardial ATs. A high degree of reliability was found between SDAT values obtained from 12-lead ECG and BSM for different pacing modes, and the intraclass correlation coefficient varied between 0.78 and 0.96 (P < 0.001). CONCLUSION: Standard deviation of activation time measurement from BSM correlated with reconstructed myocardial ATs, supporting its utility in the assessment of electrical dyssynchrony in CRT. Importantly, 12-lead ECG provided similar information as BSM. Further prospective studies are necessary to verify the clinical utility of SDAT from 12-lead ECG in larger patient cohorts, including those with ischaemic cardiomyopathy.

Plastic Cutlery Alternative: Case Study with Biodegradable Spoons.

Plastics are mixtures of organic polymers that play a major role in environmental contamination worldwide. One way to reduce the waste arising from the use of plastics, especially disposable ones, can be to produce environmentally friendly cutlery. The aim of the work was the production of biodegradable spoons and evaluation of their texture, antioxidant activities and total polyphenols content. The spoons were made from a combination of the following ingredients: water, grape, proso millet, wheat, xanthan and palm oil in different concentrations. The samples were baked at 180 or 240 °C, some spoons were dried in a fruit dehydrator. According to the results of the analysis, a spoon prepared from a mixture of all three flours and with the addition of xanthan appears to be the most suitable replacement for plastic cutlery. This spoon showed high strength and antioxidant activity. It was confirmed that the use of grape flour has a beneficial effect on the nutritional profile of the experimentally produced biodegradable spoons.

Advances in the separation of gangliosides by counter-current chromatography (CCC).

Gangliosides play critical roles in the development of many progressive diseases. Due to their structural diversity, efficient methods are needed to separate individual gangliosides for studies of their functions, and for use as standards in the analysis of ganglioside mixtures. This proof-of-concept study reports a useful analytical-semi-preparative scale counter-current chromatography (CCC) enrichment of multiple ganglioside homologues of various species and classes at the milligram level. Since few individual ganglioside standards were available, this research aimed to achieve analytical-semi-preparative scale separation of gangliosides by differences in saccharide monomer compositions (classes), their arrangements (species), or ceramide compositions (homologues), using CCC. The solvent system composition, addition of solvent modifiers, and elution modes were all adjusted to separate porcine gangliosides, mainly GM1 (d36:1), GD1a (d36:1), GD1b (d36:1) and their (d38:1) homologues as a demonstration. The eluted compounds were analyzed by flow-injection analysis (FIA)-MS and LC-MS/MS. A two-phase solvent system, consisting of butanol/methyl t-butyl ether/acetonitrile/water at a ratio of 2:4:3:8 (v/v/v/v) with 0.5% (v/v) acetic acid added to the lower phase, was used to separate mg-levels of porcine gangliosides under dual-mode elution. The relative abundances of the above 6 gangliosides increased from 10 to 21% in the ganglioside extract to 55-73% in the collected fractions through the purification.