Long-Term Outcome of Cardiac Denervation Procedures: The Anatomically Guided Septal Approach.

BACKGROUND: Functional bradycardia is a challenging condition that affects a healthy population. Ganglionated plexus ablation has emerged as a therapeutic alternative to avoid a pacemaker. OBJECTIVES: The purpose of this study is to evaluate long-term effects of anatomically guided cardiac denervation. METHODS: This is a prospective longitudinal study that included 36 patients with symptomatic functional bradycardia. Electroanatomic reconstruction of both atria was carried out, and the main septal ganglionated plexi were anatomically located and targeted. RESULTS: Ablation endpoints were: 1) heart rate increment; 2) Wenckebach cycle length shortening; and 3) atrio-Hisian (AH) interval shortening. A sinus node denervation was obtained in all patients with an increment of 21.6% in the mean heart rate. All patients presented a negative atropine test after ablation. Twenty-eight (77.7%) patients presented immediate sings of atrioventricular node denervation, with a shortening of 15.6% of mean Wenckebach cycle length and 15.9% of the mean AH interval. All heart rate variability parameters showed a significant reduction after 12 months, enduring after 18 months. Thirty (83.3%) patients remained free of events after a mean follow-up of 52.1 ± 35.2 months. One patient (2.77%) presented acute sinus node artery occlusion during ablation with persistent sinus dysfunction and had a pacemaker implantation; 3 (8.3%) other patients evolved with sinus tachycardia, and 4 (11.1%) patients presented syncope recurrence during follow-up, 3 (8.3%) of them requiring a pacemaker implantation. No other tachyarrhythmia was observed. CONCLUSIONS: The anatomically guided septal approach is an effective technique for syncope prevention, promoting long-lasting autonomic changes. No significant proarrhythmia effect has been observed during the long-term follow-up.

Sinus Node Artery Occlusion During Cardiac Denervation Procedures.

Cardioneural ablation is a novel treatment for functional bradycardia. However, the risk of acute complications is still unknown. The aim of this case report is to describe acute occlusion of the sinus node artery after cardiac denervation procedures in 2 patients and to encourage measures to prevent it, such as evaluating the aortic angulation in older patients before the procedure and by monitoring signs of sinus failure during ablation in patients with electroanatomical maps showing a constricted aspect of the right atrium. (Level of Difficulty: Advanced.).

Sustainable Solutions for Sea Monitoring With Robotic Sailboats: N-Boat and F-Boat Twins.

Strategic management and production of internal energy in autonomous robots is becoming a research topic with growing importance, especially for platforms that target long-endurance missions, with long-range and duration. It is fundamental for autonomous vehicles to have energy self-generation capability to improve energy autonomy, especially in situations where refueling is not viable, such as an autonomous sailboat in ocean traversing. Hence, the development of energy estimation and management solutions is an important research topic to better optimize the use of available energy supply and generation potential. In this work, we revisit the challenges behind the project design and construction for two fully autonomous sailboats and propose a methodology based on the Restricted Boltzmann Machine (RBM) in order to find the best way to manage the supplementary energy generated by solar panels. To verify the approach, we introduce a case study with our two developed sailboats that have planned payload with electric and electronics, and one of them is equipped with an electrical engine that may eventually help with the sailboat propulsion. Our current results show that it is possible to augment the system confidence level for the potential energy that can be harvested from the environment and the remaining energy stored, optimizing the energy usage of autonomous vehicles and improving their energy robustness.

A novel treatment for esophageal lesions following atrial fibrillation ablation.

This study presents a novel technique for the treatment of a deep esophageal ulcer after ablation of paroxysmal atrial fibrillation (AF). Pulmonary vein isolation was performed using a radiofrequency irrigated tip catheter. On Day 5 of follow-up, a deep esophageal ulcer was observed. No significant visual improvement was observed after conventional treatment. Endoscopic negative pressure therapy in the esophagus was then applied for 5 days. A significant decrease in diameter and depth of the lesion was observed, possibly preventing perforation. Endoscopic negative pressure therapy can be used to heal thermal lesions after AF ablation procedures.

Accelerating simulations of cardiac electrical dynamics through a multi-GPU platform and an optimized data structure.

Simulations of cardiac electrophysiological models in tissue, particularly in 3D require the solutions of billions of differential equations even for just a couple of milliseconds, thus highly demanding in computational resources. In fact, even studies in small domains with very complex models may take several hours to reproduce seconds of electrical cardiac behavior. Today's Graphics Processor Units (GPUs) are becoming a way to accelerate such simulations, and give the added possibilities to run them locally without the need for supercomputers. Nevertheless, when using GPUs, bottlenecks related to global memory access caused by the spatial discretization of the large tissue domains being simulated, become a big challenge. For simulations in a single GPU, we propose a strategy to accelerate the computation of the diffusion term through a data-structure and memory access pattern designed to maximize coalescent memory transactions and minimize branch divergence, achieving results approximately 1.4 times faster than a standard GPU method. We also combine this data structure with a designed communication strategy to take advantage in the case of simulations in multi-GPU platforms. We demonstrate that, in the multi-GPU approach performs, simulations in 3D tissue can be just 4× slower than real time.

A Versatile Method for Depth Data Error Estimation in RGB-D Sensors.

We propose a versatile method for estimating the RMS error of depth data provided by generic 3D sensors with the capability of generating RGB and depth (D) data of the scene, i.e., the ones based on techniques such as structured light, time of flight and stereo. A common checkerboard is used, the corners are detected and two point clouds are created, one with the real coordinates of the pattern corners and one with the corner coordinates given by the device. After a registration of these two clouds, the RMS error is computed. Then, using curve fittings methods, an equation is obtained that generalizes the RMS error as a function of the distance between the sensor and the checkerboard pattern. The depth errors estimated by our method are compared to those estimated by state-of-the-art approaches, validating its accuracy and utility. This method can be used to rapidly estimate the quality of RGB-D sensors, facilitating robotics applications as SLAM and object recognition.

Targets and End Points in Cardiac Autonomic Denervation Procedures.

BACKGROUND: Autonomic denervation is an alternative approach for patients with symptomatic bradycardia. No consensus exists on the critical targets and end points of the procedure. The aim of this study was to identify immediate end points and critical atrial regions responsible for vagal denervation. METHODS AND RESULTS: We enrolled 14 patients (50% men; age: 34.0±13.8 years) with cardioinhibitory syncope, advanced atrioventricular block or sinus arrest, and no structural heart disease. Anatomic mapping of ganglionated plexuses was performed, followed by radiofrequency ablation. Heart rate, sinus node recovery time, Wenckebach cycle length, and atrial-His (AH) interval were measured before and after every radiofrequency pulse. Wilcoxon signed-rank test was used for comparison. Significant shortening of the R-R interval (P=0.0009), Wenckebach cycle length (P=0.0009), and AH intervals (P=0.0014) was observed after ablation. The heart rate elevation was 23.8±12.5%, and the Wenckebach cycle length and AH interval shortening was 18.1±11% and 24.6±19%, respectively. Atropine bolus injection (0.04 mg/kg) did not increase heart rate further. Targeting a single spot of the left side (64% of the patients) or right side (36%) of the interatrial septum was observed to be responsible for ≥80% of the final R-R and AH interval shortening during ablation. CONCLUSIONS: Targeting specific sites of the interatrial septum is followed by an increase in heart rate and atrioventricular nodal conduction properties and might be critical for vagal attenuation. The R-R interval, Wenckebach cycle length, and AH interval shortening, associated with a negative response to atropine, could be considered immediate end points of the procedure.

Protección miocárdica durante la cirugía cardíaca / Myocardial protection during cardiac surgery

Durante el último siglo,los avances científicos permitieron estudiar los mecanismos responsables del daño celular producidos por isquemia.Gracias a ello,numerosas técnicas fueron propuestas,modificadas,aceptadas o rechazadas hasta nuestros días.Actualmente los cadiocirujanos disponen de un arsenal terapéutico muy variado que permite disminuir en un grado importante esta injuria.Sin embargo, todavía ésta no puede ser evitada totalmente.Las contínuas investigaciones en proceso y a realizar permitirán, tal vez, conocer mecanismos y las técnicas necesarias de protección miocárdica para impedirlo

Protección miocárdica durante la cirugía cardíaca / Myocardial protection during cardiac surgery

Durante el último siglo,los avances científicos permitieron estudiar los mecanismos responsables del daño celular producidos por isquemia.Gracias a ello,numerosas técnicas fueron propuestas,modificadas,aceptadas o rechazadas hasta nuestros días.Actualmente los cadiocirujanos disponen de un arsenal terapéutico muy variado que permite disminuir en un grado importante esta injuria.Sin embargo, todavía ésta no puede ser evitada totalmente.Las contínuas investigaciones en proceso y a realizar permitirán, tal vez, conocer mecanismos y las técnicas necesarias de protección miocárdica para impedirlo