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Sample records for gating-engineered pacemaker hcn

  1. Characterization of a right atrial subsidiary pacemaker and acceleration of the pacing rate by HCN over-expression.

    Science.gov (United States)

    Morris, Gwilym M; D'Souza, Alicia; Dobrzynski, Halina; Lei, Ming; Choudhury, Moinuddin; Billeter, Rudi; Kryukova, Yelena; Robinson, Richard B; Kingston, Paul A; Boyett, Mark R

    2013-10-01

    Although the right atrium (RA contains subsidiary atrial pacemaker (SAP) tissue that can take over from the sinoatrial node (SAN) in sick sinus syndrome (SSS), SAP tissue is bradycardic. Little is known about SAP tissue and one aim of the study was to characterize ion channel expression to obtain insight into SAP pacemaker mechanisms. A second aim was to determine whether HCN over-expression (a 'biopacemaker'-like strategy) can accelerate the pacemaker rate producing a pacemaker that is similar in nature to the SAN. SAP tissue was isolated from the rat and the leading pacemaker site was characterized. Cell size at the leading pacemaker site in the SAP was smaller than in the RA and comparable to that in the SAN. mRNA levels showed the SAP to be similar to, but distinct from, the SAN. For example, in the SAN and SAP, expression of Tbx3 and HCN1 was higher and Nav1.5 and Cx43 lower than in the RA. Organ-cultured SAP tissue beat spontaneously, but at a slower rate than the SAN. Adenovirus-mediated gene transfer of HCN2 and the chimeric protein HCN212 significantly increased the pacemaker rate of the SAP close to that of the native SAN, but HCN4 was ineffective. SAP tissue near the inferior vena cava is bradycardic, but shares characteristics with the SAN. Pacing can be accelerated by the over-expression of HCN2 or HCN212. This provides proof of concept for the use of SAP tissue as a substrate for biopacemaking in the treatment of SSS.

  2. Genetically engineered cardiac pacemaker: Stem cells transfected with HCN2 gene and myocytes-A model

    Energy Technology Data Exchange (ETDEWEB)

    Kanani, S. [Institut Genomique Fonctionelle, 141 Rue de la Cardonille, 34396 Montpellier (France); Institut Non Lineaire de Nice, CNRS and Universite de Nice, 1361 route des Lucioles, 06560 Valbonne (France); Pumir, A. [Institut Non Lineaire de Nice, CNRS and Universite de Nice, 1361 route des Lucioles, 06560 Valbonne (France); Laboratoire J.A. Dieudonne, CNRS and Universite de Nice, Parc Valrose, 06108 Nice (France)], E-mail: alain.pumir@unice.fr; Krinsky, V. [Institut Non Lineaire de Nice, CNRS and Universite de Nice, 1361 route des Lucioles, 06560 Valbonne (France)

    2008-01-07

    One of the successfully tested methods to design genetically engineered cardiac pacemaker cells consists in transfecting a human mesenchymal stem cell (hMSC) with a HCN2 gene and connecting it to a myocyte. We develop and study a mathematical model, describing a myocyte connected to a hMSC transfected with a HCN2 gene. The cardiac action potential is described both with the simple Beeler-Reuter model, as well as with the elaborate dynamic Luo-Rudy model. The HCN2 channel is described by fitting electrophysiological records, in the spirit of Hodgkin-Huxley. The model shows that oscillations can occur in a pair myocyte-stem cell, that was not observed in the experiments yet. The model predicted that: (1) HCN pacemaker channels can induce oscillations only if the number of expressed I{sub K1} channels is low enough. At too high an expression level of I{sub K1} channels, oscillations cannot be induced, no matter how many pacemaker channels are expressed. (2) At low expression levels of I{sub K1} channels, a large domain of values in the parameter space (n, N) exists, where oscillations should be observed. We denote N the number of expressed pacemaker channels in the stem cell, and n the number of gap junction channels coupling the stem cell and the myocyte. (3) The expression levels of I{sub K1} channels observed in ventricular myocytes, both in the Beeler-Reuter and in the dynamic Luo-Rudy models are too high to allow to observe oscillations. With expression levels below {approx}1/4 of the original value, oscillations can be observed. The main consequence of this work is that in order to obtain oscillations in an experiment with a myocyte-stem cell pair, increasing the values of n, N is unlikely to be helpful, unless the expression level of I{sub K1} has been reduced enough. The model also allows us to explore levels of gene expression not yet achieved in experiments, and could be useful to plan new experiments, aimed at improving the robustness of the oscillations.

  3. Pacemaker

    Science.gov (United States)

    ... heart disease or for people who have had heart transplants . Children, teens, and adults can use pacemakers. Before ... also may give you antibiotics to prevent infection. First, your doctor will insert a needle into a ...

  4. Novel insights into the distribution of cardiac HCN channels: an expression study in the mouse heart.

    Science.gov (United States)

    Herrmann, Stefan; Layh, Beate; Ludwig, Andreas

    2011-12-01

    HCN pacemaker channels (I(f) channels) are believed to contribute to important functions in the heart; thus these channels became an attractive target for generating transgenic mouse mutants to elucidate their role in physiological and pathophysiological cardiac conditions. A full understanding of cardiac I(f) and the interpretation of studies using HCN mouse mutants require detailed information about the expression profile of the individual HCN subunits. Here we investigate the cardiac expression pattern of the HCN isoforms at the mRNA as well as at the protein level. The specificity of antibodies used was strictly confirmed by the use of HCN1, HCN2 and HCN4 knockout animals. We find a low, but highly differential HCN expression profile outside the cardiac conduction pathway including left and right atria and ventricles. Additionally HCN distribution was investigated in tissue slices of the sinoatrial node, the atrioventricular node, the bundle of His and the bundle branches. The conduction system was marked by acetylcholine esterase staining. HCN4 was confirmed as the predominant isoform of the primary pacemaker followed by a distinct expression of HCN1. In contrast HCN2 shows only a confined expression to individual pacemaker cells. Immunolabeling of the AV-node reveals also a pronounced specificity for HCN1 and HCN4. Compared to the SN and AVN we found a low but selective expression of HCN4 as the only isoform in the atrioventricular bundle. However in the bundle branches HCN1, HCN4 and also HCN2 show a prominent and selective expression pattern. Our results display a characteristic distribution of individual HCN isoforms in several cardiac compartments and reveal that beside HCN4, HCN1 represents the isoform which is selectively expressed in most parts of the conduction system suggesting a substantial contribution of HCN1 to pacemaking. 2011 Elsevier Ltd. All rights reserved.

  5. Heart pacemaker - discharge

    Science.gov (United States)

    Cardiac pacemaker implantation - discharge; Artificial pacemaker - discharge; Permanent pacemaker - discharge; Internal pacemaker - discharge; Cardiac resynchronization therapy - discharge; CRT - discharge; ...

  6. Pacemaker (image)

    Science.gov (United States)

    A pacemaker is a small, battery-operated electronic device which is inserted under the skin to help the heart beat regularly and at an appropriate rate. The pacemaker has leads that travel through a large vein ...

  7. Cardiac Pacemakers

    International Nuclear Information System (INIS)

    Fiandra, O.; Espasandin, W.; Fiandra, H.

    1984-01-01

    A complete survey of physiological biophysical,clinical and engineering aspects of cardiac facing,including the history and an assessment of possible future developments.Among the topics studied are: pacemakers, energy search, heart stimulating with pacemakers ,mathematical aspects of the electric cardio stimulation chronic, pacemaker implants,proceeding,treatment and control

  8. HCN Channels—Modulators of Cardiac and Neuronal Excitability

    Directory of Open Access Journals (Sweden)

    Stefan Herrmann

    2015-01-01

    Full Text Available Hyperpolarization-activated cyclic nucleotide-gated (HCN channels comprise a family of cation channels activated by hyperpolarized membrane potentials and stimulated by intracellular cyclic nucleotides. The four members of this family, HCN1–4, show distinct biophysical properties which are most evident in the kinetics of activation and deactivation, the sensitivity towards cyclic nucleotides and the modulation by tyrosine phosphorylation. The four isoforms are differentially expressed in various excitable tissues. This review will mainly focus on recent insights into the functional role of the channels apart from their classic role as pacemakers. The importance of HCN channels in the cardiac ventricle and ventricular hypertrophy will be discussed. In addition, their functional significance in the peripheral nervous system and nociception will be examined. The data, which are mainly derived from studies using transgenic mice, suggest that HCN channels contribute significantly to cellular excitability in these tissues. Remarkably, the impact of the channels is clearly more pronounced in pathophysiological states including ventricular hypertrophy as well as neural inflammation and neuropathy suggesting that HCN channels may constitute promising drug targets in the treatment of these conditions. This perspective as well as the current therapeutic use of HCN blockers will also be addressed.

  9. Biological pacemakers in canines exhibit positive chronotropic response to emotional arousal

    NARCIS (Netherlands)

    Shlapakova, Iryna N.; Nearing, Bruce D.; Lau, David H.; Boink, Gerard J. J.; Danilo, Peter; Kryukova, Yelena; Robinson, Richard B.; Cohen, Ira S.; Rosen, Michael R.; Verrier, Richard L.

    2010-01-01

    Biological pacemakers based on the HCN2 channel isoform respond to beta-adrenergic and muscarinic stimulation, suggesting a capacity to respond to autonomic input. The purpose of this study was to investigate autonomic response to emotional arousal in canines implanted with murine HCN2-based

  10. Advanced Pacemaker

    Science.gov (United States)

    1990-01-01

    Synchrony, developed by St. Jude Medical's Cardiac Rhythm Management Division (formerly known as Pacesetter Systems, Inc.) is an advanced state-of-the-art implantable pacemaker that closely matches the natural rhythm of the heart. The companion element of the Synchrony Pacemaker System is the Programmer Analyzer APS-II which allows a doctor to reprogram and fine tune the pacemaker to each user's special requirements without surgery. The two-way communications capability that allows the physician to instruct and query the pacemaker is accomplished by bidirectional telemetry. APS-II features 28 pacing functions and thousands of programming combinations to accommodate diverse lifestyles. Microprocessor unit also records and stores pertinent patient data up to a year.

  11. Molecular Mapping of Sinoatrial Node HCN Channel Expression in the Human Heart.

    Science.gov (United States)

    Li, Ning; Csepe, Thomas A; Hansen, Brian J; Dobrzynski, Halina; Higgins, Robert S D; Kilic, Ahmet; Mohler, Peter J; Janssen, Paul M L; Rosen, Michael R; Biesiadecki, Brandon J; Fedorov, Vadim V

    2015-10-01

    The hyperpolarization-activated current, If, plays an important role in sinoatrial node (SAN) pacemaking. Surprisingly, the distribution of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels in human SAN has only been investigated at the mRNA level. Our aim was to define the expression pattern of HCN proteins in human SAN and different atrial regions. Entire SAN complexes were isolated from failing (n=5) and nonfailing (n=9) human hearts cardioplegically arrested in the operating room. Three-dimensional intramural SAN structure was identified as the fibrotic compact region around the SAN artery with Connexin 43-negative pacemaker cardiomyocytes visualized in Masson's trichrome and immunostained cryosections. SAN protein was precisely isolated from the adjacent frozen SAN tissue blocks using a 16G biopsy needle. The purity of the SAN protein was confirmed by Connexin 43 immunoblot. All 3 HCN isoform proteins were detected in SAN. HCN1 was predominantly distributed in the human SAN with a 125.1±40.2 (n=12) expression ratio of SAN to right atrium. HCN2 and HCN4 expression levels were higher in SAN than in atria, with SAN to right atrium ratios of 6.1±0.9 and 4.6±0.6 (n=12), respectively. This is the first study to conduct precise 3D molecular mapping of the human SAN by isolating pure pacemaker SAN tissue. All 3 cardiac HCN isoforms had higher expression in the SAN than in the atria. HCN1 was almost exclusively expressed in SAN, emphasizing its utility as a new specific molecular marker of the human SAN and as a potential target of specific treatments intended to modify sinus rhythm. © 2015 American Heart Association, Inc.

  12. Heart pacemaker

    Science.gov (United States)

    ... labels Implantable cardioverter defibrillator - discharge Low-salt diet Mediterranean diet Surgical wound care - open Images Pacemaker References Epstein AE, DiMarco JP, Ellenbogen KA, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based ...

  13. Targeted deletion of Kcne2 impairs HCN channel function in mouse thalamocortical circuits.

    Directory of Open Access Journals (Sweden)

    Shui-Wang Ying

    Full Text Available Hyperpolarization-activated, cyclic nucleotide-gated (HCN channels generate the pacemaking current, I(h, which regulates neuronal excitability, burst firing activity, rhythmogenesis, and synaptic integration. The physiological consequence of HCN activation depends on regulation of channel gating by endogenous modulators and stabilization of the channel complex formed by principal and ancillary subunits. KCNE2 is a voltage-gated potassium channel ancillary subunit that also regulates heterologously expressed HCN channels; whether KCNE2 regulates neuronal HCN channel function is unknown.We investigated the effects of Kcne2 gene deletion on I(h properties and excitability in ventrobasal (VB and cortical layer 6 pyramidal neurons using brain slices prepared from Kcne2(+/+ and Kcne2(-/- mice. Kcne2 deletion shifted the voltage-dependence of I(h activation to more hyperpolarized potentials, slowed gating kinetics, and decreased I(h density. Kcne2 deletion was associated with a reduction in whole-brain expression of both HCN1 and HCN2 (but not HCN4, although co-immunoprecipitation from whole-brain lysates failed to detect interaction of KCNE2 with HCN1 or 2. Kcne2 deletion also increased input resistance and temporal summation of subthreshold voltage responses; this increased intrinsic excitability enhanced burst firing in response to 4-aminopyridine. Burst duration increased in corticothalamic, but not thalamocortical, neurons, suggesting enhanced cortical excitatory input to the thalamus; such augmented excitability did not result from changes in glutamate release machinery since miniature EPSC frequency was unaltered in Kcne2(-/- neurons.Loss of KCNE2 leads to downregulation of HCN channel function associated with increased excitability in neurons in the cortico-thalamo-cortical loop. Such findings further our understanding of the normal physiology of brain circuitry critically involved in cognition and have implications for our understanding of

  14. Gain-of-function HCN2 variants in genetic epilepsy.

    Science.gov (United States)

    Li, Melody; Maljevic, Snezana; Phillips, A Marie; Petrovski, Slave; Hildebrand, Michael S; Burgess, Rosemary; Mount, Therese; Zara, Federico; Striano, Pasquale; Schubert, Julian; Thiele, Holger; Nürnberg, Peter; Wong, Michael; Weisenberg, Judith L; Thio, Liu Lin; Lerche, Holger; Scheffer, Ingrid E; Berkovic, Samuel F; Petrou, Steven; Reid, Christopher A

    2018-02-01

    Genetic generalized epilepsy (GGE) is a common epilepsy syndrome that encompasses seizure disorders characterized by spike-and-wave discharges (SWDs). Pacemaker hyperpolarization-activated cyclic nucleotide-gated channels (HCN) are considered integral to SWD genesis, making them an ideal gene candidate for GGE. We identified HCN2 missense variants from a large cohort of 585 GGE patients, recruited by the Epilepsy Phenome-Genome Project (EPGP), and performed functional analysis using two-electrode voltage clamp recordings from Xenopus oocytes. The p.S632W variant was identified in a patient with idiopathic photosensitive occipital epilepsy and segregated in the family. This variant was also independently identified in an unrelated patient with childhood absence seizures from a European cohort of 238 familial GGE cases. The p.V246M variant was identified in a patient with photo-sensitive GGE and his father diagnosed with juvenile myoclonic epilepsy. Functional studies revealed that both p.S632W and p.V246M had an identical functional impact including a depolarizing shift in the voltage dependence of activation that is consistent with a gain-of-function. In contrast, no biophysical changes resulted from the introduction of common population variants, p.E280K and p.A705T, and the p.R756C variant from EPGP that did not segregate with disease. Our data suggest that HCN2 variants can confer susceptibility to GGE via a gain-of-function mechanism. © 2017 Wiley Periodicals, Inc.

  15. Cardiac pacemaker

    International Nuclear Information System (INIS)

    Kolenik, S.A.

    1976-01-01

    The construction of a cardiac pacemaker is described which is characterized by particularly small dimensions, small weight and long life duration. The weight is under 100g, the specific weight under 1.7. Mass inertia forces which occur through acceleration and retardation processes, thus remain below the threshold values, above which one would have to reckon with considerable damaging of the surrounding body tissue. The maintaining of small size and slight weight is achieved by using an oscillator on COSMOS basis, where by considerably lower energy consumption, amongst others the lifetimes of the batteries used - a lithium anode with thionyl chloride electrolyte - is extended to over 5 years. The reliability can be increased by the use of 2 or more batteries. The designed dimension are 20x60x60 mm 3 . (ORU/LH) [de

  16. What Is a Pacemaker?

    Science.gov (United States)

    ... your pacemaker. • If you work around industrial microwaves, electricity, cars or other large motors, ask your doctor about possible effects. Can I use a cell phone or microwave oven if I have a pacemaker? Microwave ovens, electric blankets, remote controls for TV and other common ...

  17. [Analysis of pacemaker ECGs].

    Science.gov (United States)

    Israel, Carsten W; Ekosso-Ejangue, Lucy; Sheta, Mohamed-Karim

    2015-09-01

    The key to a successful analysis of a pacemaker electrocardiogram (ECG) is the application of the systematic approach used for any other ECG without a pacemaker: analysis of (1) basic rhythm and rate, (2) QRS axis, (3) PQ, QRS and QT intervals, (4) morphology of P waves, QRS, ST segments and T(U) waves and (5) the presence of arrhythmias. If only the most obvious abnormality of a pacemaker ECG is considered, wrong conclusions can easily be drawn. If a systematic approach is skipped it may be overlooked that e.g. atrial pacing is ineffective, the left ventricle is paced instead of the right ventricle, pacing competes with intrinsic conduction or that the atrioventricular (AV) conduction time is programmed too long. Apart from this analysis, a pacemaker ECG which is not clear should be checked for the presence of arrhythmias (e.g. atrial fibrillation, atrial flutter, junctional escape rhythm and endless loop tachycardia), pacemaker malfunction (e.g. atrial or ventricular undersensing or oversensing, atrial or ventricular loss of capture) and activity of specific pacing algorithms, such as automatic mode switching, rate adaptation, AV delay modifying algorithms, reaction to premature ventricular contractions (PVC), safety window pacing, hysteresis and noise mode. A systematic analysis of the pacemaker ECG almost always allows a probable diagnosis of arrhythmias and malfunctions to be made, which can be confirmed by pacemaker control and can often be corrected at the touch of the right button to the patient's benefit.

  18. Health Code Number (HCN) Development Procedure

    Energy Technology Data Exchange (ETDEWEB)

    Petrocchi, Rocky; Craig, Douglas K.; Bond, Jayne-Anne; Trott, Donna M.; Yu, Xiao-Ying

    2013-09-01

    This report provides the detailed description of health code numbers (HCNs) and the procedure of how each HCN is assigned. It contains many guidelines and rationales of HCNs. HCNs are used in the chemical mixture methodology (CMM), a method recommended by the department of energy (DOE) for assessing health effects as a result of exposures to airborne aerosols in an emergency. The procedure is a useful tool for proficient HCN code developers. Intense training and quality assurance with qualified HCN developers are required before an individual comprehends the procedure to develop HCNs for DOE.

  19. CO and HCN observations of carbon stars

    NARCIS (Netherlands)

    Baas, F; deJong, T; Loup, C

    We present CO and HCN observations of carbon stars. They consist of partly new detections in the (CO)-C-12 J = (1-0), (2-1) and HCN(1-0) lines obtained with the SEST and the IRAM telescope, and of (CO)-C-12 and (CO)-C-13 J = (1-0), (2-1) and (3-2) observations with IRAM and the JCMT of some of the

  20. Waiting for a pacemaker

    DEFF Research Database (Denmark)

    Risgaard, B.; Elming, H.; Jensen, G.V.

    2012-01-01

    AimsTo determine waiting period-related morbidity, mortality, and adverse events in acute patients waiting for a permanent pacemaker (PPM).Methods and resultsA retrospective chart review of all PPM implantations in Region Zealand, Denmark, in 2009 was conducted. Patients were excluded if they were...... event during the waiting period. The present study indicates that a waiting period is dangerous as it is associated with an increased risk of adverse events. Acute PPMs should be implanted with a 24-h pacemaker implantation service capacity. Published on behalf of the European Society of Cardiology. All...

  1. Same-Single-Cell Analysis of Pacemaker-Specific Markers in Human Induced Pluripotent Stem Cell-Derived Cardiomyocyte Subtypes Classified by Electrophysiology

    Science.gov (United States)

    Yechikov, Sergey; Copaciu, Raul; Gluck, Jessica M.; Deng, Wenbin; Chiamvimonvat, Nipavan; Chan, James W.; Lieu, Deborah K.

    2018-01-01

    Insights into the expression of pacemaker-specific markers in human induced pluripotent stem cell (hiPSC)-derived cardiomyocyte subtypes can facilitate the enrichment and track differentiation and maturation of hiPSC-derived pacemaker-like cardiomyocytes. To date, no study has directly assessed gene expression in each pacemaker-, atria-, and ventricular-like cardiomyocyte subtype derived from hiPSCs since currently the subtypes of these immature cardiomyocytes can only be identified by action potential profiles. Traditional acquisition of action potentials using patch-clamp recordings renders the cells unviable for subsequent analysis. We circumvented these issues by acquiring the action potential profile of a single cell optically followed by assessment of protein expression through immunostaining in that same cell. Our same-single-cell analysis for the first time revealed expression of proposed pacemaker-specific markers—hyperpolarization-activated cyclic nucleotide-modulated (HCN)4 channel and Islet (Isl)1—at the protein level in all three hiPSC-derived cardiomyocyte subtypes. HCN4 expression was found to be higher in pacemaker-like hiPSC-derived cardiomyocytes than atrial- and ventricular-like subtypes but its downregulation over time in all subtypes diminished the differences. Isl1 expression in pacemaker-like hiPSC-derived cardiomyocytes was initially not statistically different than the contractile subtypes but did become statistically higher than ventricular-like cells with time. Our observations suggest that although HCN4 and Isl1 are differentially expressed in hiPSC-derived pacemaker-like relative to ventricular-like cardiomyocytes, these markers alone are insufficient in identifying hiPSC-derived pacemaker-like cardiomyocytes. PMID:27434649

  2. Ketamine, propofol and the EEG: a neural field analysis of HCN1-mediated interactions

    Directory of Open Access Journals (Sweden)

    Ingo eBojak

    2013-04-01

    Full Text Available Ketamine and propofol are two well-known, powerful anesthetic agents, yet at first sight this appears to be their only commonality. Ketamine is a dissociative anesthetic agent, whose main mechanism of action is considered to be N-methyl-D-aspartate (NMDA antagonism; whereas propofol is a general anesthetic agent, which is assumed to primarily potentiate currents gated by γ-aminobutyric acid type A (GABA A receptors. However, several experimental observations suggest a closer relationship. First, the effect of ketamine on the electroencephalogram (EEG is markedly changed in the presence of propofol: on its own ketamine increases theta (4–8 Hz and decreases alpha (8–13 Hz oscillations, whereas ketamine induces a significant shift to beta band frequencies (13–30 Hz in the presence of propofol. Second, both ketamine and propofol cause inhibition of the inward pacemaker current Ih, by binding to the corresponding hyperpolarization-activated cyclic nucleotide-gated potassium channel 1 (HCN1 subunit. The resulting effect is a hyperpolarization of the neuron’s resting membrane potential. Third, the ability of both ketamine and propofol to induce hypnosis is reduced in HCN1-knockout mice. Here we show that one can theoretically understand the observed spectral changes of the EEG based on HCN1-mediated hyperpolarizations alone, without involving the supposed main mechanisms of action of these drugs through NMDA and GABA A, respectively. On the basis of our successful EEG model we conclude that ketamine and propofol should be antagonistic to each other in their interaction at HCN1 subunits. Such a prediction is in accord with the results of clinical experiment in which it is found that ketamine and propofol interact in an infra-additive manner with respect to the endpoints of hypnosis and immobility.

  3. Gabapentin Modulates HCN4 Channel Voltage-Dependence

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    Han-Shen Tae

    2017-08-01

    Full Text Available Gabapentin (GBP is widely used to treat epilepsy and neuropathic pain. There is evidence that GBP can act on hyperpolarization-activated cation (HCN channel-mediated Ih in brain slice experiments. However, evidence showing that GBP directly modulates HCN channels is lacking. The effect of GBP was tested using two-electrode voltage clamp recordings from human HCN1, HCN2, and HCN4 channels expressed in Xenopus oocytes. Whole-cell recordings were also made from mouse spinal cord slices targeting either parvalbumin positive (PV+ or calretinin positive (CR+ inhibitory neurons. The effect of GBP on Ih was measured in each inhibitory neuron population. HCN4 expression was assessed in the spinal cord using immunohistochemistry. When applied to HCN4 channels, GBP (100 μM caused a hyperpolarizing shift in the voltage of half activation (V1/2 thereby reducing the currents. Gabapentin had no impact on the V1/2 of HCN1 or HCN2 channels. There was a robust increase in the time to half activation for HCN4 channels with only a small increase noted for HCN1 channels. Gabapentin also caused a hyperpolarizing shift in the V1/2 of Ih measured from HCN4-expressing PV+ inhibitory neurons in the spinal dorsal horn. Gabapentin had minimal effect on Ih recorded from CR+ neurons. Consistent with this, immunohistochemical analysis revealed that the majority of CR+ inhibitory neurons do not express somatic HCN4 channels. In conclusion, GBP reduces HCN4 channel-mediated currents through a hyperpolarized shift in the V1/2. The HCN channel subtype selectivity of GBP provides a unique tool for investigating HCN4 channel function in the central nervous system. The HCN4 channel is a candidate molecular target for the acute analgesic and anticonvulsant actions of GBP.

  4. Detection of interstellar vibrationally excited HCN

    International Nuclear Information System (INIS)

    Ziurys, L.M.; Turner, B.E.

    1986-01-01

    Vibrationally excited HCN has been observed for the first time in the interstellar medium. The J = 3-2 rotational transitions of the l-doubled (0,1/sup 1d/,1c, 0) bending mode of HCN have been detected toward Orion-KL and IRC +10216. In Orion, the overall column density in the (0,1,0) mode, which exclusively samples the ''hot core,'' is 1.7-10 16 cm -2 and can be understood in terms of the ''doughnut'' model for Orion. The ground-state HCN column density implied by the excited-state observations is 2.3 x 10 18 cm -2 in the hot core, at least one order of magnitude greater than the column densities derived for HCN in its spike and plateau/doughnut components. Radiative excitation by 14 μm flux from IRc2 accounts for the (0,1,0) population provided the hot core is approx.6-7 x 10 16 cm distant from IRc2, in agreement with the ''cavity'' model for KL. Toward IRC +10216 we have detected J = 3-2 transitions of both (0,1/sup 1c/,/sup 1d/,0) and (0,2 0 ,0) excited states. The spectral profiles have been modeled to yield abundances and excitation conditions throughout the expanding envelope

  5. Pacemaker Use Following Heart Transplantation

    Science.gov (United States)

    Mallidi, Hari R.; Bates, Michael

    2017-01-01

    Background: The incidence of permanent pacemaker implantation after orthotopic heart transplantation has been reported to be 2%-24%. Transplanted hearts usually exhibit sinus rhythm in the operating room following reperfusion, and most patients do not exhibit significant arrhythmias during the postoperative period. However, among the patients who do exhibit abnormalities, pacemakers may be implanted for early sinus node dysfunction but are rarely used after 6 months. Permanent pacing is often required for atrioventricular block. A different cohort of transplant patients presents later with bradycardia requiring pacemaker implantation, reported to occur in approximately 1.5% of patients. The objectives of this study were to investigate the indications for pacemaker implantation, compare the need for pacemakers following bicaval vs biatrial anastomosis, and examine the long-term outcomes of heart transplant patients who received pacemakers. Methods: For this retrospective, case-cohort, single-institution study, patients were identified from clinical research and administrative transplant databases. Information was supplemented with review of the medical records. Standard statistical techniques were used, with chi-square testing for categorical variables and the 2-tailed t test for continuous variables. Survival was compared with the use of log-rank methods. Results: Between January 1968 and February 2008, 1,450 heart transplants were performed at Stanford University. Eighty-four patients (5.8%) were identified as having had a pacemaker implanted. Of these patients, 65.5% (55) had the device implanted within 30 days of transplantation, and 34.5% (29) had late implantation. The mean survival of patients who had an early pacemaker implant was 6.4 years compared to 7.7 years for those with a late pacemaker implant (Ppacemaker implantation. Starting in 1997, a bicaval technique was used for implantation. The incidence of pacemaker implantation by technique was 2.0% for

  6. Reassignment of Millimeterwave Spectrum of the HCN Internal Rotation Bands of H_2-HCN

    Science.gov (United States)

    Harada, Kensuke; Yamanaka, Risa; Tanaka, Keiichi

    2011-06-01

    The H_2-HCN complex is a weakly bound molecular complex and we have reported the pure rotational transitions of H_2-HCN in the MMW region. footnote{M. Ishiguro, T. Tanaka, K. Harada, C. J. Whitham and K. Tanaka, J. Chem. Phys. 115, 5155 (2001).} According to the results, ortho- and para-H_2 complexes have different structures in the ground state, H_2 is attached to the nitrogen and hydrogen end of HCN, respectively, for ortho- and para-H_2 complexes and the Σ symmetry has been confirmed for both species. We also reported the MMW spectroscopy of j=1-0 internal rotation band of H_2-HCN in 2006 footnote{M. Hagi, K. Harada, and K. Tanaka, The 61st International Symposium on Molecular Spectroscopy, TE01, (2006).}, where j is the quantum number for the HCN internal rotation. Although we assigned most of intense lines to the Σ_1-Σ_0 and Π_1-Σ_0 bands of (ortho)H_2-HCN, some intense lines are unidentified. To confirm their assignments, we performed the MMW-MMW double resonance spectroscopy in the present study and came to the conclusion that our previous assignments of Σ_1-Σ_0 and Π_1-Σ_0 bands should be changed, and then all of the intense lines are finally assigned to the Π_1-Σ_0 (R_0, R_1,R_2, Q_1, Q_2, and P_2) and Σ_1-Σ_0 (R_0, and P_2) bands. The band origins of the Σ_1-Σ_0 and Π_1-Σ_0 bands of (ortho)H_2-HCN newly determined are 187 and 165 GHz, respectively. They are larger than those of Ne-HCN (133 and 107 GHz) but comparable with those of Ar-HCN (165 and 182 GHz, their order is reversed) indicating that the potential anisotropy of (ortho)H_2-HCN is larger than that of Ne-HCN but comparable with that of Ar-HCN. The mean square amplitudes of HCN for excited states ( 57^circ and 51^circ for Σ_1 and Π_1), given by the analysis of hyperfine structure of the nitrogen nucleus, are much larger than that (33^circ) of the ground Σ_0 state. A plenty of weak lines in the 100-300 GHz region are still unassigned, possibly due to the higher internal rotation

  7. New Concepts in Pacemaker Syndrome

    Directory of Open Access Journals (Sweden)

    D. Michael Farmer

    2004-10-01

    Full Text Available After implantation of a permanent pacemaker, patients may experience severe symptoms of dyspnea, palpitations, malaise, and syncope resulting from pacemaker syndrome. Although pacemaker syndrome is most often ascribed to the loss of atrioventricular (A-V synchrony, more recent data may also implicate left ventricular dysynchrony caused by right ventricular pacing. Previous studies have not shown reductions in mortality or stroke with rate-modulated dual-chamber (DDDR pacing as compared to ventricular-based (VVI pacing. The benefits in A-V sequential pacing with the DDDR mode are likely mitigated by the interventricular (V-V dysynchrony imposed by the high percentage of ventricular pacing commonly seen in the DDDR mode. Programming DDDR pacemakers to encourage intrinsic A-V conduction and reduce right ventricular pacing will likely decrease heart failure and pacemaker syndrome. Studies are currently ongoing to address these questions.

  8. The Nitrogen Isotopic Composition of Meteoritic HCN

    Science.gov (United States)

    Pizzarello, Sandra

    2014-12-01

    HCN is ubiquitous in extraterrestrial environments and is central to current theories on the origin of early solar system organic compounds such as amino acids. These compounds, observed in carbonaceous meteorites, were likely important in the origin and/or evolution of early life. As part of our attempts to understand the origin(s) of meteoritic CN-, we have analyzed the 15N/14N isotopic composition of HCN gas released from water extracts of the Murchison meteorite and found its value to be near those of the terrestrial atmosphere. The findings, when evaluated viz-a-viz molecular abundances and isotopic data of meteoritic organic compounds, suggest that HCN formation could have occurred during the protracted water alteration processes known to have affected the mineralogy of many asteroidal bodies during their solar residence. This was an active synthetic stage, which likely involved simple gasses, organic molecules, their presolar precursors, as well as mineral catalysts and would have lead to the formation of molecules of differing isotopic composition, including some with solar values.

  9. Defibrillator/monitor/pacemakers.

    Science.gov (United States)

    1998-02-01

    This study updates our May-June 1993 Evaluation of defibrillator/monitor/pacemakers, published in Health Devices 22(5-6), in which we tested eight units from six suppliers. For this Update Evaluation, we tested three additional units, each from a different supplier. We also present update information, including some new ratings, for most of the previously evaluated units. We judged the new units against the same basic criteria and rated and ranked them using the same scheme--with some minor revisions--as in our original Evaluation. We judged the suitability of these units for three primary clinical applications: (1) general crash-cart use, (2) prehospital (emergency medical service [EMS]) use, and (3) in-hospital transport use. Because our criteria have changed slightly since the original study, we have repeated them in this issue. The test methods have not changed significantly and can be found in the original 1993 Evaluation. For more detailed information about this technology, the environments in which these units are used, and the factors to consider when selecting this type of device, we encourage readers to refer to the following sections in the original Evaluation: the Clinical Perspective "The Importance of Early Defibrillation"; the Clinical and Technical Overview; and the Selection and Use Guide for Defibrillator/Monitor/Pacemakers.

  10. Structural studies on HCN oligomers. [catalysts for prebiotic processes

    Science.gov (United States)

    Ferris, J. P.; Edelson, E. H.; Auyeung, J. M.; Joshi, P. C.

    1981-01-01

    NMR spectral studies on the HCN oligomers suggest the presence of carboxamide and urea groupings. The release of CO2, H2O, HCN, CH3CN, HCONH2 and pyridine on pyrolysis is consistent with the presence of these groupings as well as carboxylic acid groups. No basic primary amine groupings could be detected with fluorescamine. Hydrazinolysis of the HCN oligomers releases 10% of the amino acids normally released by acid hydrolysis. The oligomers give a positive biuret test but this is not due to the presence of peptide bonds. There is no conclusive evidence for the presence of peptide bonds in the HCN oligomers. No diglycine was detected on partial hydrolysis of the HCN oligomers at pH 8.5 suggesting that HCN oligomers were not a source of prebiotic peptides.

  11. Development of the cardiac pacemaker

    Science.gov (United States)

    Liang, Xingqun; Evans, Sylvia M.

    2017-01-01

    The sinoatrial node (SAN) is the dominant pacemaker of the heart. Abnormalities in SAN formation and function can cause sinus arrhythmia, including sick sinus syndrome and sudden death. A better understanding of genes and signaling pathways that regulate SAN development and function is essential to develop more effective treatment to sinus arrhythmia, including biological pacemakers. In this review, we briefly summarize the key processes of SAN morphogenesis during development, and focus on the transcriptional network that drives SAN development. PMID:27770149

  12. Electric discharge synthesis of HCN in simulated Jovian atmospheres.

    Science.gov (United States)

    Stribling, R; Miller, S L

    1987-01-01

    HCN has been detected in the Jovian atmosphere at a column density of about 2.2 x 10(-7) moles cm-2. While photochemical synthesis from methylamine and aziridine, upwelling, and lightning have been proposed as possible sources of this HCN, corona discharge has not been previously considered. HCN energy yields (moles J-1) were measured using corona discharge for gas mixtures containing H2, CH4, NH3, with H2/CH4 ratios from 4.4 to 1585. The yields are approximately proportional to the mole fraction of methane in the gas mixture. Assuming that the 3/1 ratio of corona discharge to lightning energy on the Earth applies to Jupiter, HCN column densities from corona discharge could account for approximately 10% of the observed HCN. These estimates are very dependent on the values used for the energy available as lightning on Jupiter and the eddy diffusion coefficients in the region of synthesis.

  13. Pacemakers and Implantable Defibrillators - Multiple Languages

    Science.gov (United States)

    ... 简体中文) Expand Section Pacemaker - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Chinese, Traditional (Cantonese dialect) (繁體中文) Expand Section Pacemaker - ...

  14. Wireless power transfer for a pacemaker application.

    Science.gov (United States)

    Vulfin, Vladimir; Sayfan-Altman, Shai; Ianconescu, Reuven

    2017-05-01

    An artificial pacemaker is a small medical device that uses electrical impulses, delivered by electrodes contracting the heart muscles, to regulate the beating of the heart. The pacemaker is implanted under the skin, and uses for many years regular non-rechargeable batteries. However, the demand for rechargeable batteries in pacemakers increased, and the aim of this work is to design an efficient charging system for pacemakers.

  15. Simple Organics and Biomonomers Identified in HCN Polymers: An Overview

    Directory of Open Access Journals (Sweden)

    Susana Osuna-Esteban

    2013-07-01

    Full Text Available Hydrogen cyanide (HCN is a ubiquitous molecule in the Universe. It is a compound that is easily produced in significant yields in prebiotic simulation experiments using a reducing atmosphere. HCN can spontaneously polymerise under a wide set of experimental conditions. It has even been proposed that HCN polymers could be present in objects such as asteroids, moons, planets and, in particular, comets. Moreover, it has been suggested that these polymers could play an important role in the origin of life. In this review, the simple organics and biomonomers that have been detected in HCN polymers, the analytical techniques and procedures that have been used to detect and characterise these molecules and an exhaustive classification of the experimental/environmental conditions that favour the formation of HCN polymers are summarised. Nucleobases, amino acids, carboxylic acids, cofactor derivatives and other compounds have been identified in HCN polymers. The great molecular diversity found in HCN polymers encourages their placement at the central core of a plausible protobiological system.

  16. 21 CFR 870.3670 - Pacemaker charger.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker charger. 870.3670 Section 870.3670 Food... DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3670 Pacemaker charger. (a) Identification. A pacemaker charger is a device used transcutaneously to recharge the batteries of a rechargeable...

  17. 21 CFR 870.3700 - Pacemaker programmers.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker programmers. 870.3700 Section 870.3700...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3700 Pacemaker programmers. (a) Identification. A pacemaker programmer is a device used to change noninvasively one or more of...

  18. Syncope in Patients with Pacemakers

    OpenAIRE

    Sutton, Richard

    2015-01-01

    Syncope in a pacemaker patient is a serious symptom but it is rarely due a pacemaker system malfunction. Syncope occurs in about 5 % of patients paced for atrioventricular (AV) block in 5 years, 18% in those paced for sinus node disease in 10 years, 20 % of those paced for carotid sinus syndrome in 5 years and 5–55 % of those older patients paced for vasovagal syncope in 2 years. The vastly different results in vasovagal syncope depend on the results of tilt testing, where those with negative...

  19. [Wide QRS tachycardia preceded by pacemaker spikes].

    Science.gov (United States)

    Romero, M; Aranda, A; Gómez, F J; Jurado, A

    2014-04-01

    The differential diagnosis and therapeutic management of wide QRS tachycardia preceded by pacemaker spike is presented. The pacemaker-mediated tachycardia, tachycardia fibrillo-flutter in patients with pacemakers, and runaway pacemakers, have a similar surface electrocardiogram, but respond to different therapeutic measures. The tachycardia response to the application of a magnet over the pacemaker could help in the differential diagnosis, and in some cases will be therapeutic, as in the case of a tachycardia-mediated pacemaker. Although these conditions are diagnosed and treated in hospitals with catheterization laboratories using the application programmer over the pacemaker, patients presenting in primary care clinic and emergency forced us to make a diagnosis and treat the haemodynamically unstable patient prior to referral. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  20. First Degree Pacemaker Exit Block

    Directory of Open Access Journals (Sweden)

    Johnson Francis

    2016-10-01

    Full Text Available Usually atrial and ventricular depolarizations follow soon after the pacemaker stimulus (spike on the ECG. But there can be an exit block due to fibrosis at the electrode - tissue interface at the lead tip. This can increase the delay between the spike and atrial or ventricular depolarization.

  1. Catalytic and Gas-Solid Reactions Involving HCN over Limestone

    DEFF Research Database (Denmark)

    Jensen, Anker; Johnsson, Jan Erik; Dam-Johansen, Kim

    1997-01-01

    In coal-fired combustion systems solid calcium species may be present as ash components or limestone added to the combustion chamber. In this study heterogeneous reactions involving HCN over seven different limestones were investigated in a laboratory fixed-bed quartz reactor at 873-1,173 K....... The results indicate that heterogeneous oxidation of HCN is important in calciners and fluidized-bed combustors with limestone addition or when burning coals with an ash with a high catalytic activity....

  2. Complete atrial-specific knockout of sodium-calcium exchange eliminates sinoatrial node pacemaker activity.

    Directory of Open Access Journals (Sweden)

    Sabine Groenke

    Full Text Available The origin of sinoatrial node (SAN pacemaker activity in the heart is controversial. The leading candidates are diastolic depolarization by "funny" current (If through HCN4 channels (the "Membrane Clock" hypothesis, depolarization by cardiac Na-Ca exchange (NCX1 in response to intracellular Ca cycling (the "Calcium Clock" hypothesis, and a combination of the two ("Coupled Clock". To address this controversy, we used Cre/loxP technology to generate atrial-specific NCX1 KO mice. NCX1 protein was undetectable in KO atrial tissue, including the SAN. Surface ECG and intracardiac electrograms showed no atrial depolarization and a slow junctional escape rhythm in KO that responded appropriately to β-adrenergic and muscarinic stimulation. Although KO atria were quiescent they could be stimulated by external pacing suggesting that electrical coupling between cells remained intact. Despite normal electrophysiological properties of If in isolated patch clamped KO SAN cells, pacemaker activity was absent. Recurring Ca sparks were present in all KO SAN cells, suggesting that Ca cycling persists but is uncoupled from the sarcolemma. We conclude that NCX1 is required for normal pacemaker activity in murine SAN.

  3. Pacemakers and Implantable Defibrillators: MedlinePlus Health Topic

    Science.gov (United States)

    ... ClinicalTrials.gov: Pacemaker, Artificial (National Institutes of Health) Journal Articles References and abstracts from MEDLINE/PubMed (National ... Leadless Cardiac Pacemakers: The Next Evolution in Pacemaker Technology. ... on Pacemakers and Implantable Defibrillators is the National Heart, Lung, and Blood Institute Other Languages Find health information in languages other than English on Pacemakers and ...

  4. The Photodissociation of HCN and HNC: Effects on the HNC/HCN Abundance Ratio in the Interstellar Medium

    Energy Technology Data Exchange (ETDEWEB)

    Aguado, Alfredo [Departamento de Química Física Aplicada (UAM), Unidad Asociada a IFF-CSIC, Facultad de Ciencias Módulo 14, Universidad Autónoma de Madrid, E-28049, Madrid (Spain); Roncero, Octavio; Zanchet, Alexandre [Instituto de Física Fundamental (IFF-CSIC), C.S.I.C., Serrano 123, E-28006 Madrid (Spain); Agúndez, Marcelino; Cernicharo, José, E-mail: octavio.roncero@csic.es [Instituto de Ciencia de Materiales de Madrid, CSIC, C/ Sor Juana Inés de la Cruz 3, Cantoblanco E-28049 (Spain)

    2017-03-20

    The impact of the photodissociation of HCN and HNC isomers is analyzed in different astrophysical environments. For this purpose, the individual photodissociation cross sections of HCN and HNC isomers have been calculated in the 7–13.6 eV photon energy range for a temperature of 10 K. These calculations are based on the ab initio calculation of three-dimensional adiabatic potential energy surfaces of the 21 lower electronic states. The cross sections are then obtained using a quantum wave packet calculation of the rotational transitions needed to simulate a rotational temperature of 10 K. The cross section calculated for HCN shows significant differences with respect to the experimental one, and this is attributed to the need to consider non-adiabatic transitions. Ratios between the photodissociation rates of HCN and HNC under different ultraviolet radiation fields have been computed by renormalizing the rates to the experimental value. It is found that HNC is photodissociated faster than HCN by a factor of 2.2 for the local interstellar radiation field and 9.2 for the solar radiation field, at 1 au. We conclude that to properly describe the HNC/HCN abundance ratio in astronomical environments illuminated by an intense ultraviolet radiation field, it is necessary to use different photodissociation rates for each of the two isomers, which are obtained by integrating the product of the photodissociation cross sections and ultraviolet radiation field over the relevant wavelength range.

  5. The vertical Distribution and Origin of HCN in Neptune's Atmosphere

    Science.gov (United States)

    Lellouch, Emmanuel; Romani, Paul N.; Rosenqvist, Jan

    1994-03-01

    Measurements and modeling of the (3-2) rotational line of hydrogen cyanide at 265.9 GHz in Neptune's atmosphere are presented. High signal-to-noise observations, performed at IRAM in October 1991 and April 1992, provide information on the HCN vertical distribution in Neptune's stratosphere. The HCN mixing ratio is found to be nearly uniform with height above the condensation level (3 mbar). Best fits occur for HCN distributions that have a slight increase with altitude (HCN scale height approximately 5 × the atmospheric scale height). A least-squares analysis yields a mixing ratio of (3.2 ± 0.8) 10 -10 at 2 mbar and a mean mixing ratio scale height of 250 +750+110 km in the 0.1-3 mbar region. To interpret these results, we developed a photochemical model of HCN, based in part upon the hydrocarbon model of Romani et al. (Icarus, 106, 442-463 (1993)). HCN formation is initiated by the reaction between CH 3 radicals, produced from methane photochemistry, and N atoms. The primary sink for HCN is condensation, with minor contributions from photolysis and chemical losses. Two possible sources of N atoms are investigated: (1) infall of N escaped from Triton's upper atmosphere, and (2) galactic cosmic ray (GCR) impact on internal N 2. For the Triton source, a total N flux of 5 × 10 24 atoms sec -1 is necessary to match the HCN abundance, and the observed HCN profile suggests an eddy diffusion profile with a rapid transition from slow mixing at p ≥ 2 mbar to rapid mixing at lower pressures. The required N flux is approximately 50% of the estimated N escape from Triton's upper atmosphere. For the GCR source, a simple model of ionization and dissociation of N 2 by cosmic rays was developed. In this case, both smooth and discontinuous eddy K profiles satisfy the observations. The tropospheric N 2 mixing ratio required to fit the HCN observations is in the range 0.3-1.7% if our GCR interaction model is correct. The range results from uncertainties in the chemistry of the

  6. HCN1 and HCN2 in Rat DRG neurons: levels in nociceptors and non-nociceptors, NT3-dependence and influence of CFA-induced skin inflammation on HCN2 and NT3 expression.

    Science.gov (United States)

    Acosta, Cristian; McMullan, Simon; Djouhri, Laiche; Gao, Linlin; Watkins, Roger; Berry, Carol; Dempsey, Katherine; Lawson, Sally N

    2012-01-01

    I(h), which influences neuronal excitability, has recently been measured in vivo in sensory neuron subtypes in dorsal root ganglia (DRGs). However, expression levels of HCN (hyperpolarization-activated cyclic nucleotide-gated) channel proteins that underlie I(h) were unknown. We therefore examined immunostaining of the most abundant isoforms in DRGs, HCN1 and HCN2 in these neuron subtypes. This immunostaining was cytoplasmic and membrane-associated (ring). Ring-staining for both isoforms was in neurofilament-rich A-fiber neurons, but not in small neurofilament-poor C-fiber neurons, although some C-neurons showed cytoplasmic HCN2 staining. We recorded intracellularly from DRG neurons in vivo, determined their sensory properties (nociceptive or low-threshold-mechanoreceptive, LTM) and conduction velocities (CVs). We then injected fluorescent dye enabling subsequent immunostaining. For each dye-injected neuron, ring- and cytoplasmic-immunointensities were determined relative to maximum ring-immunointensity. Both HCN1- and HCN2-ring-immunointensities were positively correlated with CV in both nociceptors and LTMs; they were high in Aβ-nociceptors and Aα/β-LTMs. High HCN1 and HCN2 levels in Aα/β-neurons may, via I(h), influence normal non-painful (e.g. touch and proprioceptive) sensations as well as nociception and pain. HCN2-, not HCN1-, ring-intensities were higher in muscle spindle afferents (MSAs) than in all other neurons. The previously reported very high I(h) in MSAs may relate to their very high HCN2. In normal C-nociceptors, low HCN1 and HCN2 were consistent with their low/undetectable I(h.) In some C-LTMs HCN2-intensities were higher than in C-nociceptors. Together, HCN1 and HCN2 expressions reflect previously reported I(h) magnitudes and properties in neuronal subgroups, suggesting these isoforms underlie I(h) in DRG neurons. Expression of both isoforms was NT3-dependent in cultured DRG neurons. HCN2-immunostaining in small neurons increased 1 day after

  7. HCN channels are not required for mechanotransduction in sensory hair cells of the mouse inner ear.

    Directory of Open Access Journals (Sweden)

    Geoffrey C Horwitz

    Full Text Available The molecular composition of the hair cell transduction channel has not been identified. Here we explore the novel hypothesis that hair cell transduction channels include HCN subunits. The HCN family of ion channels includes four members, HCN1-4. They were originally identified as the molecular correlates of the hyperpolarization-activated, cyclic nucleotide gated ion channels that carry currents known as If, IQ or Ih. However, based on recent evidence it has been suggested that HCN subunits may also be components of the elusive hair cell transduction channel. To investigate this hypothesis we examined expression of mRNA that encodes HCN1-4 in sensory epithelia of the mouse inner ear, immunolocalization of HCN subunits 1, 2 and 4, uptake of the transduction channel permeable dye, FM1-43 and electrophysiological measurement of mechanotransduction current. Dye uptake and transduction current were assayed in cochlear and vestibular hair cells of wildtype mice exposed to HCN channel blockers or a dominant-negative form of HCN2 that contained a pore mutation and in mutant mice that lacked HCN1, HCN2 or both. We found robust expression of HCNs 1, 2 and 4 but little evidence that localized HCN subunits in hair bundles, the site of mechanotransduction. Although high concentrations of the HCN antagonist, ZD7288, blocked 50-70% of the transduction current, we found no reduction of transduction current in either cochlear or vestibular hair cells of HCN1- or HCN2- deficient mice relative to wild-type mice. Furthermore, mice that lacked both HCN1 and HCN2 also had normal transduction currents. Lastly, we found that mice exposed to the dominant-negative mutant form of HCN2 had normal transduction currents as well. Taken together, the evidence suggests that HCN subunits are not required for mechanotransduction in hair cells of the mouse inner ear.

  8. Syncope in Patients with Pacemakers.

    Science.gov (United States)

    Sutton, Richard

    2015-12-01

    Syncope in a pacemaker patient is a serious symptom but it is rarely due a pacemaker system malfunction. Syncope occurs in about 5 % of patients paced for atrioventricular (AV) block in 5 years, 18% in those paced for sinus node disease in 10 years, 20 % of those paced for carotid sinus syndrome in 5 years and 5-55 % of those older patients paced for vasovagal syncope in 2 years. The vastly different results in vasovagal syncope depend on the results of tilt testing, where those with negative tests approach results in pacing for AV block and those with a positive tilt test show no better results than with no pacemaker. The implication of tilt results is that a hypotensive tendency is clearly demonstrated by tilt positivity pointing to syncope recurrence with hypotension. This problem may be addressed by treatment with vasoconstrictor drugs in those who are suited or, more commonly, a reduction or cessation of hypotensive therapy in hypertensive patients. Other causes of syncope such as tachyarrhythmias are rare. The clinical approach to patients who report syncope is detailed.

  9. The nuclear pacemaker: Is renewed interest warranted

    International Nuclear Information System (INIS)

    Parsonnet, V.; Berstein, A.D.; Perry, G.Y.

    1990-01-01

    From 1973 through 1987, 155 radioisotope-powered nuclear pacemakers were implanted in 132 patients at the Newark Beth Israel Medical Center. The longevity of the first 15 devices, all of which were fixed-rate (VOO) pacemakers, was significantly better than that of 15 lithium-chemistry demand (VVI) pacemakers used as control devices (p = 0.0002). Of the entire cohort of 155 nuclear pacemakers, 136 were VVI devices and 19 were VOO units. The patients with VOO pacemakers needed reoperations more often than did those with VVI pacemakers, chiefly for mode change (p less than 0.001). Power-source failure was observed in only 1 case, but 47 nuclear pacemakers were removed for other reasons, including component malfunction (15 units), mode change (12 units), high pacing thresholds (8 units) and lead or connector problems (5 units). The actuarial survival at 15 years was 99% for power sources and 82% for the entire pacing systems (pulse generators plus leads). The frequency of malignancy was similar to that of the population at large and primary tumor sites were randomly distributed. Deaths most commonly were due to cardiac causes (68%). Thus, nuclear pacemakers are safe and reliable and their greater initial cost appears to be offset by their longevity and the resulting decrease in the frequency of reoperations. It is reasonable to suggest that further use be made of long-lasting nuclear power sources for modern pacemakers and other implantable rhythm-management devices

  10. On the Evolution of the Cardiac Pacemaker

    Science.gov (United States)

    Burkhard, Silja; van Eif, Vincent; Garric, Laurence; Christoffels, Vincent M.; Bakkers, Jeroen

    2017-01-01

    The rhythmic contraction of the heart is initiated and controlled by an intrinsic pacemaker system. Cardiac contractions commence at very early embryonic stages and coordination remains crucial for survival. The underlying molecular mechanisms of pacemaker cell development and function are still not fully understood. Heart form and function show high evolutionary conservation. Even in simple contractile cardiac tubes in primitive invertebrates, cardiac function is controlled by intrinsic, autonomous pacemaker cells. Understanding the evolutionary origin and development of cardiac pacemaker cells will help us outline the important pathways and factors involved. Key patterning factors, such as the homeodomain transcription factors Nkx2.5 and Shox2, and the LIM-homeodomain transcription factor Islet-1, components of the T-box (Tbx), and bone morphogenic protein (Bmp) families are well conserved. Here we compare the dominant pacemaking systems in various organisms with respect to the underlying molecular regulation. Comparative analysis of the pathways involved in patterning the pacemaker domain in an evolutionary context might help us outline a common fundamental pacemaker cell gene programme. Special focus is given to pacemaker development in zebrafish, an extensively used model for vertebrate development. Finally, we conclude with a summary of highly conserved key factors in pacemaker cell development and function. PMID:29367536

  11. cAMP control of HCN2 channel Mg2+ block reveals loose coupling between the cyclic nucleotide-gating ring and the pore.

    Directory of Open Access Journals (Sweden)

    Alex K Lyashchenko

    Full Text Available Hyperpolarization-activated cyclic nucleotide-regulated HCN channels underlie the Na+-K+ permeable IH pacemaker current. As with other voltage-gated members of the 6-transmembrane KV channel superfamily, opening of HCN channels involves dilation of a helical bundle formed by the intracellular ends of S6 albeit this is promoted by inward, not outward, displacement of S4. Direct agonist binding to a ring of cyclic nucleotide-binding sites, one of which lies immediately distal to each S6 helix, imparts cAMP sensitivity to HCN channel opening. At depolarized potentials, HCN channels are further modulated by intracellular Mg2+ which blocks the open channel pore and blunts the inhibitory effect of outward K+ flux. Here, we show that cAMP binding to the gating ring enhances not only channel opening but also the kinetics of Mg2+ block. A combination of experimental and simulation studies demonstrates that agonist acceleration of block is mediated via acceleration of the blocking reaction itself rather than as a secondary consequence of the cAMP enhancement of channel opening. These results suggest that the activation status of the gating ring and the open state of the pore are not coupled in an obligate manner (as required by the often invoked Monod-Wyman-Changeux allosteric model but couple more loosely (as envisioned in a modular model of protein activation. Importantly, the emergence of second messenger sensitivity of open channel rectification suggests that loose coupling may have an unexpected consequence: it may endow these erstwhile "slow" channels with an ability to exert voltage and ligand-modulated control over cellular excitability on the fastest of physiologically relevant time scales.

  12. Feasibility of pacemaker therapy after dynamic cardiomyoplasty

    NARCIS (Netherlands)

    Van den Berg, MP; Nagelkerke, D; Brouwer, RMHJ; Mulder, H; De Boer, H; Crijns, HJGM

    1999-01-01

    A 54-year-old man presented with total atrioventricular (AV) block 3 months after dynamic cardiomyoplasty was performed because of heart failure due to idiopathic dilated cardiomyopathy. Though the cardiomyostimulator acted as a back-up pacemaker, a DDDR pacemaker was implanted to optimize

  13. On the Evolution of the Cardiac Pacemaker

    NARCIS (Netherlands)

    Burkhard, Silja; van Eif, Vincent; Garric, Laurence; Christoffels, Vincent M; Bakkers, Jeroen

    2017-01-01

    The rhythmic contraction of the heart is initiated and controlled by an intrinsic pacemaker system. Cardiac contractions commence at very early embryonic stages and coordination remains crucial for survival. The underlying molecular mechanisms of pacemaker cell development and function are still not

  14. Biofilm on artificial pacemaker: fiction or reality?

    Science.gov (United States)

    Santos, Ana Paula Azevedo; Watanabe, Evandro; Andrade, Denise de

    2011-11-01

    Cardiac pacing through cardiac pacemaker is one of the most promising alternatives in the treatment of arrhythmias, but it can cause reactions natural or complex reactions, either early or late. This study aimed to describe the scientific evidence on the risk of infection and biofilm formation associated with cardiac pacemaker. This is a study of integrative literature review. It included 14 publications classified into three thematic categories: diagnosis (microbiological and/or clinical), complications and therapy of infections. Staphylococcus epidermidis and Staphylococcus aureus were the microorganisms most frequently isolated. It was not possible to determine the incidence of infection associated with pacemakers, since the studies were generally of prevalence. In terms of therapy, the complete removal of pacemakers stood out, especially in cases of suspected biofilm. Still controversial is the use of systemic antibiotic prophylaxis in reducing the incidence of infection associated with implantation of a pacemaker.

  15. Surgical removal of infected transvenous pacemaker leads.

    Science.gov (United States)

    Frame, R; Brodman, R F; Furman, S; Andrews, C A; Gross, J N

    1993-12-01

    Infection, though uncommon, can be the most lethal of all potential complications following transvenous pacemaker implantation. Eradication of infection associated with pacemakers requires complete removal of all hardware, including inactive leads. Since 1972, 5,089 patients have had 8,508 pacemaker generators implanted at Montefiore Medical Center. There were 91 infections (1.06%); four of our patients required surgical removal. Nine additional patients were referred for surgical removal of infected transvenous pacemaker leads from other institutions. Surgical methods for removal included use of cardiopulmonary bypass or inflow occlusion. Surgery may be safely used in unstable or elderly patients and should not be reserved as a last resort. This article reviews our surgical experience removing infected pacemaker leads at Montefiore Medical Center.

  16. De novo mutations in HCN1 cause early infantile epileptic encephalopathy

    DEFF Research Database (Denmark)

    Nava, Caroline; Dalle, Carine; Rastetter, Agnès

    2014-01-01

    Hyperpolarization-activated, cyclic nucleotide-gated (HCN) channels contribute to cationic Ih current in neurons and regulate the excitability of neuronal networks. Studies in rat models have shown that the Hcn1 gene has a key role in epilepsy, but clinical evidence implicating HCN1 mutations in ...

  17. Investigating cyclic nucleotide and cyclic dinucleotide binding to HCN channels by surface plasmon resonance.

    Directory of Open Access Journals (Sweden)

    Sebastien Hayoz

    Full Text Available Hyperpolarization-activated cyclic nucleotide-modulated (HCN channels control cardiac and neuronal rhythmicity. HCN channels contain cyclic nucleotide-binding domain (CNBD in their C-terminal region linked to the pore-forming transmembrane segment with a C-linker. The C-linker couples the conformational changes caused by the direct binding of cyclic nucleotides to the HCN pore opening. Recently, cyclic dinucleotides were shown to antagonize the effect of cyclic nucleotides in HCN4 but not in HCN2 channels. Based on the structural analysis and mutational studies it has been proposed that cyclic dinucleotides affect HCN4 channels by binding to the C-linker pocket (CLP. Here, we first show that surface plasmon resonance (SPR can be used to accurately measure cyclic nucleotide binding affinity to the C-linker/CNBD of HCN2 and HCN4 channels. We then used SPR to investigate cyclic dinucleotide binding in HCN channels. To our surprise, we detected no binding of cyclic dinucleotides to the isolated monomeric C-linker/CNBDs of HCN4 channels with SPR. The binding of cyclic dinucleotides was further examined with isothermal calorimetry (ITC, which indicated no binding of cyclic dinucleotides to both monomeric and tetrameric C-linker/CNBDs of HCN4 channels. Taken together, our results suggest that interaction of the C-linker/CNBD with other parts of the channel is necessary for cyclic-dinucleotide binding in HCN4 channels.

  18. Radiotherapy for breast cancer and pacemaker

    International Nuclear Information System (INIS)

    Menard, J.; Campana, F.; Bollet, M.A.; Dendale, R.; Fournier-Bidoz, N.; Marchand, V.; Mazal, A.; Fourquet, A.; Kirova, Y.M.; Kirov, K.M.; Esteve, M.

    2011-01-01

    Purpose. - Patients with permanent cardiac pacemakers occasionally require radiotherapy. Therapeutic Irradiation may cause pacemakers to malfunction due to the effects of ionizing radiation or electromagnetic interference. We studied the breast cancer patients who needed breast and/or chest wall and lymph node irradiation to assess the feasibility and tolerance in this population of patients. Patients and methods. - From November 2008 to December 2009, more than 900 patients received radiotherapy for their breast cancer in our department using megavoltage linear accelerator (X 4-6 MV and electrons). Among them, seven patients were with permanent pacemaker. All patients have been treated to the breast and chest wall and/or lymph nodes. Total dose to breast and/or chest wall was 50 Gy/25 fractions and 46 Gy/23 fractions to lymph nodes. Patients who underwent conserving surgery followed by breast irradiation were boosted when indicated to tumour bed with 16 Gy/8 fractions. All patients were monitored everyday in presence of radiation oncologist to follow the function of their pacemaker. All pacemakers were controlled before and after radiotherapy by the patients' cardiologist. Results. - Seven patients were referred in our department for postoperative breast cancer radiotherapy. Among them, only one patient was declined for radiotherapy and underwent mastectomy without radiotherapy. In four cases the pacemaker was repositioned before the beginning of radiotherapy. Six patients, aged between 48 and 84 years underwent irradiation for their breast cancer. Four patients were treated with conserving surgery followed by breast radiotherapy and two with mastectomy followed by chest wall and internal mammary chain, supra- and infra-clavicular lymph node irradiation. The dose to the pacemaker generator was kept below 2 Gy. There was no pacemaker dysfunction observed during the radiotherapy. Conclusion. - The multidisciplinary work with position change of the pacemaker before

  19. Photochemistry on Pluto: part II HCN and nitrogen isotope fractionation

    Science.gov (United States)

    Mandt, Kathleen; Luspay-Kuti, Adrienn; Hamel, Mark; Jessup, Kandis-Lea; Hue, Vincent; Kammer, Josh; Filwett, Rachael

    2017-11-01

    We have converted our Titan one-dimensional photochemical model to simulate the photochemistry of Pluto's atmosphere and include condensation and aerosol trapping in the model. We find that condensation and aerosol trapping are important processes in producing the HCN altitude profile observed by the Atacama Large Millimeter Array (ALMA). The nitrogen isotope chemistry in Pluto's atmosphere does not appear to significantly fractionate the isotope ratio between N2 and HCN as occurs at Titan. However, our simulations only cover a brief period of time in a Pluto year, and thus only a brief portion of the solar forcing conditions that Pluto's atmosphere experiences. More work is needed to evaluate photochemical fractionation over a Pluto year. Condensation and aerosol trapping appear to have a major impact on the altitude profile of the isotope ratio in HCN. Since ALMA did not detect HC15N in Pluto's atmosphere, we conclude that condensation and aerosol trapping must be much more efficient for HC15N compared to HC14N. The large uncertainty in photochemical fractionation makes it difficult to use any potential current measurement of 14N/15N in N2 to determine the origin of Pluto's nitrogen. More work is needed to understand photochemical fractionation and to evaluate how condensation, sublimation and aerosol trapping will fractionate N2 and HCN.

  20. HCN and HCO+ images of the Orion Bar photodissociation region

    NARCIS (Netherlands)

    Owl, RCY; Meixner, MM; Wolfire, M; Tielens, AGGM; Tauber, J

    2000-01-01

    The Orion Bar is an ideal astrophysical laboratory for studying photodissociation regions because of its nearly edge-on orientation in the observer's line of sight. High angular resolution (similar to 9") maps of the Orion Bar in the J = 1-0 emission lines of HCO+ and HCN have been made by combining

  1. 21 CFR 870.3620 - Pacemaker lead adaptor.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker lead adaptor. 870.3620 Section 870.3620...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3620 Pacemaker lead adaptor. (a) Identification. A pacemaker lead adaptor is a device used to adapt a pacemaker lead so that it...

  2. 21 CFR 870.3640 - Indirect pacemaker generator function analyzer.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Indirect pacemaker generator function analyzer... Indirect pacemaker generator function analyzer. (a) Identification. An indirect pacemaker generator function analyzer is an electrically powered device that is used to determine pacemaker function or...

  3. HCN Polymers: Toward Structure Comprehension Using High Resolution Mass Spectrometry

    Science.gov (United States)

    Bonnet, Jean-Yves; Thissen, Roland; Frisari, Ma; Vuitton, Veronique; Quirico, Eric; Le Roy, Léna; Fray, Nicolas; Cottin, Hervé; Horst, Sarah; Yelle, Roger

    A lot of solar system materials, including cometary ices and Titan aerosols, contain dark matter that can be interpreted as complex nitrogen bearing organic matter [1]. In laboratory experi-ments, HCN polymers are thus analogs of great interest. In fact they may be present in Titan atmosphere and in comet nuclei and then reprocessed as a CN distributed source [2], when ices began to sublimate and ejects from the nucleus organic matter grains [3]. The presence of HCN polymers is suggested because HCN molecule has been directly observed in 1P/Halley comet [4] and others. HCN polymers are also of prebiotic interest [5] as it can form amino acid under hydrolysis conditions. Even if they have been studied during the last decades, their chemical composition and structure are still poorly understood, and a great analytical effort has to be continued. In this way we present a high resolution mass spectrometry (HRMS) and a high resolution tandem mass spectrometry (MS/HRMS) analysis of HCN polymers. It was shown [6] that this is a suitable technique to elucidate composition and structure of the soluble part of tholins analogs of Titan's atmosphere aerosols. HCN polymers have never been studied by HRMS, thus we used a LTQ-Orbitrap XL high resolution mass spectrometer to analyse the HCN polymers. These are produced at LISA by direct polymerisation of pure liquid HCN, catalyzed by ammonia. HCN polymers have been completely dissolved in methanol and then injected in the mass spectrometer by ElectroSpray Ionization (ESI). This atmospheric pressure ionization process produces protonated or deprotonated ions, but it does not fragment molecules. Thus HRMS, allows a direct access to the stoechiometry of all the ionizable molecules present in the samples. Fragmentation analyses (MS/MS) of selected ions have also been performed. Thess analysis provide information about the different chemical fonctionnalities present in HCN poly-mers and also about their structure. Thus we are able to

  4. Pacemakers charging using body energy

    Science.gov (United States)

    Bhatia, Dinesh; Bairagi, Sweeti; Goel, Sanat; Jangra, Manoj

    2010-01-01

    Life-saving medical implants like pacemakers and defibrillators face a big drawback that their batteries eventually run out and patients require frequent surgery to have these batteries replaced. With the advent of technology, alternatives can be provided for such surgeries. To power these devices, body energy harvesting techniques may be employed. Some of the power sources are patient's heartbeat, blood flow inside the vessels, movement of the body parts, and the body temperature (heat). Different types of sensors are employed, such as for sensing the energy from the heartbeat the piezoelectric and semiconducting coupled nanowires are used that convert the mechanical energy into electricity. Similarly, for sensing the blood flow energy, nanogenerators driven by ultrasonic waves are used that have the ability to directly convert the hydraulic energy in human body to electrical energy. Another consideration is to use body heat employing biothermal battery to generate electricity using multiple arrays of thermoelectric generators built into an implantable chip. These generators exploit the well-known thermocouple effect. For the biothermal device to work, it needs a 2°C temperature difference across it. But there are many parts of the body where a temperature difference of 5°C exists – typically in the few millimeters just below the skin, where it is planned to place this device. This study focuses on using body heat as an alternative energy source to recharge pacemaker batteries and other medical devices and prevent the possibility of life-risk during repeated surgery. PMID:21814432

  5. Pacemakers charging using body energy.

    Science.gov (United States)

    Bhatia, Dinesh; Bairagi, Sweeti; Goel, Sanat; Jangra, Manoj

    2010-01-01

    Life-saving medical implants like pacemakers and defibrillators face a big drawback that their batteries eventually run out and patients require frequent surgery to have these batteries replaced. With the advent of technology, alternatives can be provided for such surgeries. To power these devices, body energy harvesting techniques may be employed. Some of the power sources are patient's heartbeat, blood flow inside the vessels, movement of the body parts, and the body temperature (heat). Different types of sensors are employed, such as for sensing the energy from the heartbeat the piezoelectric and semiconducting coupled nanowires are used that convert the mechanical energy into electricity. Similarly, for sensing the blood flow energy, nanogenerators driven by ultrasonic waves are used that have the ability to directly convert the hydraulic energy in human body to electrical energy. Another consideration is to use body heat employing biothermal battery to generate electricity using multiple arrays of thermoelectric generators built into an implantable chip. These generators exploit the well-known thermocouple effect. For the biothermal device to work, it needs a 2°C temperature difference across it. But there are many parts of the body where a temperature difference of 5°C exists - typically in the few millimeters just below the skin, where it is planned to place this device. This study focuses on using body heat as an alternative energy source to recharge pacemaker batteries and other medical devices and prevent the possibility of life-risk during repeated surgery.

  6. Pacemakers charging using body energy

    Directory of Open Access Journals (Sweden)

    Dinesh Bhatia

    2010-01-01

    Full Text Available Life-saving medical implants like pacemakers and defibrillators face a big drawback that their batteries eventually run out and patients require frequent surgery to have these batteries replaced. With the advent of technology, alternatives can be provided for such surgeries. To power these devices, body energy harvesting techniques may be employed. Some of the power sources are patient′s heartbeat, blood flow inside the vessels, movement of the body parts, and the body temperature (heat. Different types of sensors are employed, such as for sensing the energy from the heartbeat the piezoelectric and semiconducting coupled nanowires are used that convert the mechanical energy into electricity. Similarly, for sensing the blood flow energy, nanogenerators driven by ultrasonic waves are used that have the ability to directly convert the hydraulic energy in human body to electrical energy. Another consideration is to use body heat employing biothermal battery to generate electricity using multiple arrays of thermoelectric generators built into an implantable chip. These generators exploit the well-known thermocouple effect. For the biothermal device to work, it needs a 2°C temperature difference across it. But there are many parts of the body where a temperature difference of 5°C exists - typically in the few millimeters just below the skin, where it is planned to place this device. This study focuses on using body heat as an alternative energy source to recharge pacemaker batteries and other medical devices and prevent the possibility of life-risk during repeated surgery.

  7. ALMA OBSERVATIONS OF HCN AND ITS ISOTOPOLOGUES ON TITAN

    Energy Technology Data Exchange (ETDEWEB)

    Molter, Edward M.; Nixon, C. A.; Cordiner, M. A.; Charnley, S. B.; Lindberg, J. E. [NASA Goddard Space Flight Center, 8800 Greenbelt Road, Greenbelt, MD 20771 (United States); Serigano, J. [Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, MD 21218 (United States); Irwin, P. G. J. [Atmospheric, Oceanic, and Planetary Physics, Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU (United Kingdom); Teanby, N. A., E-mail: edward.m.molter@nasa.gov [School of Earth Sciences, University of Bristol, Wills Memorial Building, Queens Road, Bristol, BS8 1RJ (United Kingdom)

    2016-08-01

    We present sub-millimeter spectra of HCN isotopologues on Titan, derived from publicly available ALMA flux calibration observations of Titan taken in early 2014. We report the detection of a new HCN isotopologue on Titan, H{sup 13}C{sup 15}N, and confirm an earlier report of detection of DCN. We model high signal-to-noise observations of HCN, H{sup 13}CN, HC{sup 15}N, DCN, and H{sup 13}C{sup 15}N to derive abundances and infer the following isotopic ratios: {sup 12}C/{sup 13}C = 89.8 ± 2.8, {sup 14}N/{sup 15}N = 72.3 ± 2.2, D/H = (2.5 ± 0.2) × 10{sup −4}, and HCN/H{sup 13}C{sup 15}N = 5800 ± 270 (1 σ errors). The carbon and nitrogen ratios are consistent with and improve on the precision of previous results, confirming a factor of ∼2.3 elevation in {sup 14}N/{sup 15}N in HCN compared to N{sub 2} and a lack of fractionation in {sup 12}C/{sup 13}C from the protosolar value. This is the first published measurement of D/H in a nitrile species on Titan, and we find evidence for a factor of ∼2 deuterium enrichment in hydrogen cyanide compared to methane. The isotopic ratios we derive may be used as constraints for future models to better understand the fractionation processes occurring in Titan’s atmosphere.

  8. Functional Characterization of Cnidarian HCN Channels Points to an Early Evolution of Ih.

    Directory of Open Access Journals (Sweden)

    Emma C Baker

    Full Text Available HCN channels play a unique role in bilaterian physiology as the only hyperpolarization-gated cation channels. Their voltage-gating is regulated by cyclic nucleotides and phosphatidylinositol 4,5-bisphosphate (PIP2. Activation of HCN channels provides the depolarizing current in response to hyperpolarization that is critical for intrinsic rhythmicity in neurons and the sinoatrial node. Additionally, HCN channels regulate dendritic excitability in a wide variety of neurons. Little is known about the early functional evolution of HCN channels, but the presence of HCN sequences in basal metazoan phyla and choanoflagellates, a protozoan sister group to the metazoans, indicate that the gene family predates metazoan emergence. We functionally characterized two HCN channel orthologs from Nematostella vectensis (Cnidaria, Anthozoa to determine which properties of HCN channels were established prior to the emergence of bilaterians. We find Nematostella HCN channels share all the major functional features of bilaterian HCNs, including reversed voltage-dependence, activation by cAMP and PIP2, and block by extracellular Cs+. Thus bilaterian-like HCN channels were already present in the common parahoxozoan ancestor of bilaterians and cnidarians, at a time when the functional diversity of voltage-gated K+ channels was rapidly expanding. NvHCN1 and NvHCN2 are expressed broadly in planulae and in both the endoderm and ectoderm of juvenile polyps.

  9. Pacemaker

    Science.gov (United States)

    ... Heart and Vascular Diseases Precision Medicine Activities Obesity, Nutrition, and Physical Activity Population and Epidemiology Studies Women’s Health All Science A-Z Grants and Training Grants and Training ...

  10. Quality assessment of pacemaker implantations in Denmark

    DEFF Research Database (Denmark)

    Møller, M; Arnsbo, P; Asklund, Mogens

    2002-01-01

    AIMS: Quality assessment of therapeutic procedures is essential to insure a cost-effective health care system. Pacemaker implantation is a common procedure with more than 500,000 implantations world-wide per year, but the general complication rate is not well described. We studied procedure related...... complications for all implantations performed in an entire nation over a 3-year period. METHODS AND RESULTS: A prospective study of complications related to 99% of the 5648 primary pacemaker implantations performed in the 12 Danish pacemaker centres in 1997-1999 was carried out. Overall 76% of the patients...... received a physiological pacemaker system and 91% received the optimal pacing mode according to international guidelines. Perioperative complications requiring reoperation were: haematoma 0.3%, atrial lead related 1.9%, ventricular lead related 1.7%. Late complications requiring reoperation were: infection...

  11. Mathematical Models of Cardiac Pacemaking Function

    Directory of Open Access Journals (Sweden)

    Pan eLi

    2013-10-01

    Full Text Available Over the past half century, there has been intense and fruitful interaction between experimental and computational investigations of cardiac function. This interaction has, for example, led to deep understanding of cardiac excitation-contraction coupling; how it works, as well as how it fails. However, many lines of inquiry remain unresolved, among them the initiation of each heartbeat. The sinoatrial node, a cluster of specialized pacemaking cells in the right atrium of the heart, spontaneously generates an electro-chemical wave that spreads through the atria and through the cardiac conduction system to the ventricles, initiating the contraction of cardiac muscle essential for pumping blood to the body. Despite the fundamental importance of this primary pacemaker, this process is still not fully understood, and ionic mechanisms underlying cardiac pacemaking function are currently under heated debate. Several mathematical models of sinoatrial node cell membrane electrophysiology have been constructed as based on different experimental data sets and hypotheses. As could be expected, these differing models offer diverse predictions about cardiac pacemaking activities. This paper aims to present the current state of debate over the origins of the pacemaking function of the sinoatrial node. Here, we will specifically review the state-of-the-art of cardiac pacemaker modeling, with a special emphasis on current discrepancies, limitations, and future challenges.

  12. Response of Si- and Al-doped graphenes toward HCN: A computational study

    International Nuclear Information System (INIS)

    Rastegar, Somayeh F.; Peyghan, Ali Ahmadi; Hadipour, Nasser L.

    2013-01-01

    Highlights: ► Sensitivity of Si- and Al-doped graphene (SiG and AlG) toward HCN is investigated. ► The electronic properties of AlG are significantly changed in the presence of HCN. ► It is established that AlG can be a good sensor for HCN molecule. - Abstract: Sensitivity of Si- and Al-doped graphenes (SiG and AlG) toward toxic HCN has been investigated using density functional theory (DFT) in terms of energetic, geometric and electronic properties. Optimized configurations corresponding to physisorption and, subsequently, chemisorption of HCN on each surface have been identified. It is found that HCN molecule can be adsorbed on impurity atoms with adsorption energies about −27.20 and −38.75 kcal/mol on the SiG and the AlG, respectively. By comparing to HCN adsorption on SiG, it can be inferred that molecular HCN adsorbed on AlG can induce significant change in AlG conductivity. On the basis of calculated changes in the HOMO/LUMO energy gap it is found that electronic properties of AlG are sensitive toward adsorption of HCN and the reverse is correct for SiG, suggesting that the AlG may be a promising sensor for HCN.

  13. Pacemaker diagnostics in atrial fibrillation: limited usefulness for therapy initiation in a pacemaker practice.

    Science.gov (United States)

    Yedlapati, Neeraja; Fisher, John D

    2014-09-01

    We aimed to determine the practical value of pacemaker diagnostics for atrial fibrillation (AF) in an unselected general pacemaker practice, specifically workflow and initiation of anticoagulation or antiarrhythmic drug (AAD) therapy. We prospectively followed consecutive pacemaker interrogations over a period of 1 year to identify patients with AF (burden from 1% to 99%). We contacted referring physicians with AF details, and then determined whether the information resulted in therapeutic changes. Of the 1,100 pacemakers interrogated, 728 were dual chamber (DDDs) with AF diagnostic capability. AF was recorded in 73 (10%) but seven had limited information, leaving 66 patients; of these, 42 (63%) patients were already anticoagulated and in five (7%) patients, anticoagulation had been stopped because of complications. Initial diagnosis of AF was made by the pacemaker in 17 patients (26% of 66; 2% of 728); four (6% of 66) patients were newly initiated on anticoagulation. Of the 66 patients, 17 patients were already on AADs; 49 (74%) had satisfactory rate control or had other issues; only two (3% of 66; 0.3% of 728) received new AADs. Of 728 patients with DDD pacemakers, only 17 were newly discovered to have AF, and six (0.8%) had changes in medications based on the pacemaker data. Adding pacemaker-derived data to existing clinical information had little therapeutic impact, due to a combination of cumbersome workflow, and because AF was usually known to practitioners. Developments in automated monitoring systems may provide more accessible and therapeutically useful information. ©2014 Wiley Periodicals, Inc.

  14. Aggregatibacter aphrophilus pacemaker endocarditis: a case report.

    Science.gov (United States)

    Patel, Sahil R; Patel, Nishi H; Borah, Amit; Saltzman, Heath

    2014-12-08

    Aggregatibacter bacteria are a rare cause of endocarditis in adults. They are part of a group of organisms known as HACEK--Haemophilus, Aggregatibacter, Cardiobacter, Eikenella, and Kingella. Among these organisms, several Haemophilus species have been reclassified under the genus Aggregatibacter. Very few cases of Aggregatibacter endocarditis in patients with pacemaker devices have been reported. We present here what we believe to be the first case of Aggregatibacter aphrophilus pacemaker endocarditis. A 62-year-old African American male with a medical history significant for dual-chamber pacemaker placement in 1996 for complete heart block with subsequent lead manipulation in 2007, presented to his primary care doctor with fever, chills, night sweats, fatigue, and ten-pound weight loss over a four-month period. Physical examination revealed a new murmur and jugular venous distension which prompted initiation of antibiotics for suspicion of endocarditis. Both sets of initial blood cultures were positive for A. aphrophilus. Transesophageal echocardiogram revealed vegetations on the tricuspid valve and the right ventricular pacemaker lead (Figure 1). This case highlights the importance of identifying rare causes of endocarditis and recognizing that treatment may not differ from the standard treatment for typical presentations. The patient received intravenous ceftriaxone for his endocarditis for a total of six weeks. Upon device removal, temporary jugular venous pacing wires were placed. After two weeks of antibiotic treatment and no clinical deterioration, a new permanent pacemaker was placed and the patient was discharged home. This is the first case of A. aphrophilus endocarditis in a patient with a permanent pacemaker. Our patient had no obvious risk factors other than poor dentition and a history of repeated pacemaker lead manipulation. This suggests that valvulopathies secondary to repeated lead manipulation can be clinically significant factors in morbidity

  15. Alterations in hyperpolarization-activated cyclic nucleotidegated cation channel (HCN expression in the hippocampus following pilocarpine-induced status epilepticus

    Directory of Open Access Journals (Sweden)

    Yun-Jung Oh, Jongju Na, Ji-Heon Jeong, Dae-Kyoon Park, Kyung-Ho Park, Jeong-Sik Ko & Duk-Soo Kim*

    2012-11-01

    Full Text Available To understand the effects of HCN as potential mediators in thepathogenesis of epilepsy that evoke long-term impairedexcitability; the present study was designed to elucidate whetherthe alterations of HCN expression induced by status epilepticus(SE is responsible for epileptogenesis. Although HCN1 immunoreactivitywas observed in the hippocampus, its immunoreactivitieswere enhanced at 12 hrs following SE. Although, HCN1immunoreactivities were reduced in all the hippocampi at 2weeks, a re-increase in the expression at 2-3 months followingSE was observed. In contrast to HCN1, HCN 4 expressions wereun-changed, although HCN2 immunoreactive neurons exhibitedsome changes following SE. Taken together, our findings suggestthat altered expressions of HCN1 following SE may be mainlyinvolved in the imbalances of neurotransmissions to hippocampalcircuits; thus, it is proposed that HCN1 may play animportant role in the epileptogenic period as a compensatoryresponse.

  16. HCN Producing Bacteria Enable Sensing Of Non-Bioavailable Hg Species by the Whole Cell Biosensor

    Science.gov (United States)

    Horvat, M.; Rijavec, T.; Koron, N.; Lapanje, A.

    2015-12-01

    Bacteria play an important role in Hg transformation reactions. The production of cyanide (HCN) and other secondary metabolites seems to be key elements involved in these transformations. Current hypotheses link the role of HCN production to growth inhibition of nonHCN producing competitor organisms (role of an antimicrobial agent). Our past investigations showed that HCN production did not correlate with antimicrobial activity and since pK value of HCN is very high (pK = 9,21), it can be expected that most of the produced HCN is removed from the microenvironment. This way, the expected inhibitory concentrations can hardly be reached. Accordingly, we proposed a new concept, where the ability of complexation of transient metals by HCN served as a regulation process for the accessibility of micro-elements. In our study, we focused on the presence of HCN producing bacteria and carried it out in the Hg contaminated environment connected to the Idrija Mercury Mine, Slovenia. We characterised the isolates according to the presence of Hg resistance (HgR), level of HCN production and genetic similarities. In laboratory setups, using our merR whole cell based biosensor, we determined the transformation of low bioavailable Hg0 and HgS forms into bioavailable Hg by these HCN producing bacteria. We observed that HgR strains producing HCN had the highest impact on increased Hg bioavailability. In the proposed ecological strategy HgR HCN producing bacteria increase their competitive edge over non-HgR competitors through the increase of Hg toxicity. Due to their activity, Hg is made available to other organisms as well and thus enters into the ecosystem. Finally, using some of the characteristics of bacteria (e.g. Hg resistance genetic elements), we developed a fully automated sensing approach, combining biosensorics and mechatronics, to measure the bioavailability of Hg in situ.

  17. Runaway pacemaker: a still existing complication and therapeutic guidelines

    DEFF Research Database (Denmark)

    Mickley, H; Andersen, C; Nielsen, L H

    1989-01-01

    Runaway pacemaker is a rare, but still existing potential lethal complication in permanent pacemakers. Within 4 1/2 years, we saw two cases of runaway pacemaker in patients with multiprogrammable, VVI pacemakers (Siemens-Elema, Model 668). In both cases a pacemaker-induced ventricular tachycardia...... (rate 240-260 beats/min) was documented. One patient died. Runaway pacemakers must be exchanged as soon as possible. Until this can be accomplished, different emergency maneuvers should be tried. As documented in the cases presented, placing a magnet over the pacemaker may result in a lower, more...... pacemaker may be connected to the permanent pacing lead. Thereafter, the lead can be safely cut. As an alternative, a temporary transvenous pacing lead may be established prior to disconnecting the permanent pacing lead....

  18. Drugs and pacemakers for vasovagal, carotid sinus and situational syncope

    NARCIS (Netherlands)

    Romme, Jacobus J. C. M.; Reitsma, Johannes B.; Black, Catherine N.; Colman, Nancy; Scholten, Rob J. P. M.; Wieling, Wouter; van Dijk, Nynke

    2011-01-01

    Background Neurally mediated reflex syncope is the most common cause of transient loss of consciousness. In patients not responding to nonpharmacological treatment, pharmacological or pacemaker treatment might be considered. Objectives To examine the effects of pharmacological therapy and pacemaker

  19. Pacemaker patients’ perspective and experiences in a pacemaker outpatient clinic in relation to test intervals of the pacemaker

    DEFF Research Database (Denmark)

    Lauberg, Astrid; Hansen, Tina; Pedersen, Trine Pernille Dahl

    an evident decline in quality of life regarding psychological and social aspects 6 month after the implantation in terms of cognitive function, work ability, and sexual activity. Mlynarski et al (2009) have found correlations between pacemaker implantation and anxiety and depression. Aim The aim...... the pacemaker and psychological reactions. Patients with pacemakers older than 3 months lacked communication with fellowmen. Conclusion The patients express receiving competent and professional treatment when visiting the outpatient clinic, there seems to be a discrepancy between the long test intervals...... and the critical period in which anxiety and depression may occur. Minor problems and questions may grow into fatal conditions if the patients are not offered an opportunity to discuss this with experts. Patients are not informed that it is possible to discuss problems that imply psychological topics and they do...

  20. The change of HCN1/HCN2 mRNA expression in peripheral nerve after chronic constriction injury induced neuropathy followed by pulsed electromagnetic field therapy

    Science.gov (United States)

    Liu, Hui; Zhou, Jun; Gu, Lianbing; Zuo, Yunxia

    2017-01-01

    Neuropathic pain is usually defined as a chronic pain state caused by peripheral or central nerve injury as a result of acute damage or systemic diseases. It remains a difficult disease to treat. Recent studies showed that the frequency of action potentials in nociceptive afferents is affected by the activity of hyperpolarization-activated cyclic nucleotide-gated cation channels (HCN) family. In the current study, we used a neuropathy rat model induced by chronic constriction injury (CCI) of sciatic nerve to evaluate the change of expression of HCN1/HCN2 mRNA in peripheral nerve and spinal cord. Rats were subjected to CCI with or without pulsed electromagnetic field (PEMF) therapy. It was found that CCI induced neural cell degeneration while PEMF promoted nerve regeneration as documented by Nissl staining. CCI shortened the hind paw withdrawal latency (PWL) and hind paw withdrawal threshold (PWT) and PEMF prolonged the PWL and PWT. In addition, CCI lowers the expression of HCN1 and HCN2 mRNA and PEMF cannot restore the expression of HCN1 and HCN2 mRNA. Our results indicated that PEMF can promote nerve regeneration and could be used for the treatment of neuropathic pain. PMID:27901476

  1. The change of HCN1/HCN2 mRNA expression in peripheral nerve after chronic constriction injury induced neuropathy followed by pulsed electromagnetic field therapy.

    Science.gov (United States)

    Liu, Hui; Zhou, Jun; Gu, Lianbing; Zuo, Yunxia

    2017-01-03

    Neuropathic pain is usually defined as a chronic pain state caused by peripheral or central nerve injury as a result of acute damage or systemic diseases. It remains a difficult disease to treat. Recent studies showed that the frequency of action potentials in nociceptive afferents is affected by the activity of hyperpolarization-activated cyclic nucleotide-gated cation channels (HCN) family. In the current study, we used a neuropathy rat model induced by chronic constriction injury (CCI) of sciatic nerve to evaluate the change of expression of HCN1/HCN2 mRNA in peripheral nerve and spinal cord. Rats were subjected to CCI with or without pulsed electromagnetic field (PEMF) therapy. It was found that CCI induced neural cell degeneration while PEMF promoted nerve regeneration as documented by Nissl staining. CCI shortened the hind paw withdrawal latency (PWL) and hind paw withdrawal threshold (PWT) and PEMF prolonged the PWL and PWT. In addition, CCI lowers the expression of HCN1 and HCN2 mRNA and PEMF cannot restore the expression of HCN1 and HCN2 mRNA. Our results indicated that PEMF can promote nerve regeneration and could be used for the treatment of neuropathic pain.

  2. The pacemaker-twiddler's syndrome: an infrequent cause of pacemaker failure.

    Science.gov (United States)

    Salahuddin, Mohammad; Cader, Fathima Aaysha; Nasrin, Sahela; Chowdhury, Mashhud Zia

    2016-01-20

    The pacemaker-twiddler's syndrome is an uncommon cause of pacemaker malfunction. It occurs due to unintentional or deliberate manipulation of the pacemaker pulse generator within its skin pocket by the patient. This causes coiling of the lead and its dislodgement, resulting in failure of ventricular pacing. More commonly reported among elderly females with impaired cognition, the phenomenon usually occurs in the first year following pacemaker implantation. Treatment involves repositioning of the dislodged leads and suture fixation of the lead and pulse generator within its pocket. An 87 year old Bangladeshi lady who underwent a single chamber ventricular pacemaker (VVI mode: i.e. ventricle paced, ventricle sensed, inhibitory mode) implantation with the indication of complete heart block, and presented to us again 7 weeks later, with syncopal attacks. She admitted to repeatedly manipulating the pacemaker generator in her left pectoral region. Physical examination revealed a heart rate of 42 beats/minute, blood pressure 140/80 mmHg and bilateral crackles on lung auscultation. She had no cognitive deficit. An immediate electrocardiogram showed complete heart block with pacemaker spikes and failure to capture. Chest X-ray showed coiled and retracted right ventricular lead and rotated pulse generator. An emergent temporary pace maker was set at a rate of 60 beats per minute. Subsequently, she underwent successful lead repositioning with strong counselling to avoid further twiddling. Twiddler's syndrome should be considered as a cause of pacemaker failure in elderly patients presenting with bradyarrythmias following pacemaker implantation. Chest X-ray and electrocardiograms are simple and easily-available first line investigations for its diagnosis. Lead repositioning is required, however proper patient education and counselling against further manipulation is paramount to long-term management.

  3. 21 CFR 870.3710 - Pacemaker repair or replacement material.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker repair or replacement material. 870.3710... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3710 Pacemaker repair or replacement material. (a) Identification. A pacemaker repair or replacement material is an...

  4. 21 CFR 870.3730 - Pacemaker service tools.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker service tools. 870.3730 Section 870.3730...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3730 Pacemaker service tools. (a) Identification. Pacemaker service tools are devices such as screwdrivers and Allen wrenches...

  5. 21 CFR 870.5550 - External transcutaneous cardiac pacemaker (noninvasive).

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External transcutaneous cardiac pacemaker... § 870.5550 External transcutaneous cardiac pacemaker (noninvasive). (a) Identification. An external transcutaneous cardiac pacemaker (noninvasive) is a device used to supply a periodic electrical pulse intended to...

  6. 21 CFR 870.3720 - Pacemaker electrode function tester.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker electrode function tester. 870.3720... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3720 Pacemaker electrode function tester. (a) Identification. A pacemaker electrode function tester is a device which is...

  7. 21 CFR 870.3650 - Pacemaker polymeric mesh bag.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker polymeric mesh bag. 870.3650 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3650 Pacemaker polymeric mesh bag. (a) Identification. A pacemaker polymeric mesh bag is an implanted device used to hold a...

  8. 21 CFR 870.3630 - Pacemaker generator function analyzer.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker generator function analyzer. 870.3630... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3630 Pacemaker generator function analyzer. (a) Identification. A pacemaker generator function analyzer is a device that is...

  9. 21 CFR 870.3610 - Implantable pacemaker pulse generator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Implantable pacemaker pulse generator. 870.3610 Section 870.3610 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... pacemaker pulse generator. (a) Identification. An implantable pacemaker pulse generator is a device that has...

  10. 21 CFR 870.1750 - External programmable pacemaker pulse generator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External programmable pacemaker pulse generator... External programmable pacemaker pulse generator. (a) Identification. An external programmable pacemaker pulse generators is a device that can be programmed to produce one or more pulses at preselected...

  11. 21 CFR 870.3600 - External pacemaker pulse generator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External pacemaker pulse generator. 870.3600 Section 870.3600 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... pacemaker pulse generator. (a) Identification. An external pacemaker pulse generator is a device that has a...

  12. 21 CFR 870.3690 - Pacemaker test magnet.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker test magnet. 870.3690 Section 870.3690...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3690 Pacemaker test magnet. (a) Identification. A pacemaker test magnet is a device used to test an inhibited or triggered type...

  13. Analysis of a five year experience of permanent pacemaker ...

    African Journals Online (AJOL)

    Introduction: Permanent pacemaker implantation is available in Nigeria. There is however no national registry or framework for pacemaker data collection. A pacemaker database has been developed in our institution and the results are analyzed in this study. Methods: The study period was between January 2008 and ...

  14. Lidocaine Inhibits HCN Currents in Rat Spinal Substantia Gelatinosa Neurons

    Science.gov (United States)

    Hu, Tao; Liu, Nana; Lv, Minhua; Ma, Longxian; Peng, Huizhen; Peng, Sicong

    2016-01-01

    BACKGROUND: Lidocaine, which blocks voltage-gated sodium channels, is widely used in surgical anesthesia and pain management. Recently, it has been proposed that the hyperpolarization-activated cyclic nucleotide (HCN) channel is one of the other novel targets of lidocaine. Substantia gelatinosa in the spinal dorsal horn, which plays key roles in modulating nociceptive information from primary afferents, comprises heterogeneous interneurons that can be electrophysiologically categorized by firing pattern. Our previous study demonstrated that a substantial proportion of substantia gelatinosa neurons reveal the presence of HCN current (Ih); however, the roles of lidocaine and HCN channel expression in different types of substantia gelatinosa neurons remain unclear. METHODS: By using the whole-cell patch-clamp technique, we investigated the effect of lidocaine on Ih in rat substantia gelatinosa neurons of acute dissociated spinal cord slices. RESULTS: We found that lidocaine rapidly decreased the peak Ih amplitude with an IC50 of 80 μM. The inhibition rate on Ih was not significantly different with a second application of lidocaine in the same neuron. Tetrodotoxin, a sodium channel blocker, did not affect lidocaine’s effect on Ih. In addition, lidocaine shifted the half-activation potential of Ih from −109.7 to −114.9 mV and slowed activation. Moreover, the reversal potential of Ih was shifted by −7.5 mV by lidocaine. In the current clamp, lidocaine decreased the resting membrane potential, increased membrane resistance, delayed rebound depolarization latency, and reduced the rebound spike frequency. We further found that approximately 58% of substantia gelatinosa neurons examined expressed Ih, in which most of them were tonically firing. CONCLUSIONS: Our studies demonstrate that lidocaine strongly inhibits Ih in a reversible and concentration-dependent manner in substantia gelatinosa neurons, independent of tetrodotoxin-sensitive sodium channels. Thus, our

  15. Does bipolar pacemaker current activate blood platelets?

    DEFF Research Database (Denmark)

    Gjesdal, Grunde; Hansen, Annebirthe Bo; Brandes, Axel

    2009-01-01

    to the pacemaker can. METHODS: Platelet-rich plasma was prepared from two healthy subjects. Platelet reactivity to the agonist ADP was tested in paired samples in an aggregometer in a case/control setup. RESULTS: Eighteen of 46 tested pairs of platelet-rich plasma showed increased reactivity in the paced sample......OBJECTIVE: The aim of this study was to investigate whether bipolar pacemaker current lead can activate blood platelets. The null hypothesis was that 1 minute of electrical stimulation of platelets would not influence their subsequent reactivity to adenosine diphosphate (ADP). BACKGROUND: Both...... platelets and muscle cells contain actin and myosin filaments, and both cells are activated following calcium influx. Muscle cells open their calcium channels and contract when exposed to an electric current. Current through a bipolar pacemaker lead will expose a small volume of blood, including platelets...

  16. Plasma density calculation based on the HCN waveform data

    International Nuclear Information System (INIS)

    Chen Liaoyuan; Pan Li; Luo Cuiwen; Zhou Yan; Deng Zhongchao

    2004-01-01

    A method to improve the plasma density calculation is introduced using the base voltage and the phase zero points obtained from the HCN interference waveform data. The method includes making the signal quality higher by putting the signal control device and the analog-to-digit converters in the same location and charging them by the same power, and excluding the noise's effect according to the possible changing rate of the signal's phase, and to make the base voltage more accurate by dynamical data processing. (authors)

  17. A calcium-dependent plasticity rule for HCN channels maintains activity homeostasis and stable synaptic learning.

    Science.gov (United States)

    Honnuraiah, Suraj; Narayanan, Rishikesh

    2013-01-01

    Theoretical and computational frameworks for synaptic plasticity and learning have a long and cherished history, with few parallels within the well-established literature for plasticity of voltage-gated ion channels. In this study, we derive rules for plasticity in the hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, and assess the synergy between synaptic and HCN channel plasticity in establishing stability during synaptic learning. To do this, we employ a conductance-based model for the hippocampal pyramidal neuron, and incorporate synaptic plasticity through the well-established Bienenstock-Cooper-Munro (BCM)-like rule for synaptic plasticity, wherein the direction and strength of the plasticity is dependent on the concentration of calcium influx. Under this framework, we derive a rule for HCN channel plasticity to establish homeostasis in synaptically-driven firing rate, and incorporate such plasticity into our model. In demonstrating that this rule for HCN channel plasticity helps maintain firing rate homeostasis after bidirectional synaptic plasticity, we observe a linear relationship between synaptic plasticity and HCN channel plasticity for maintaining firing rate homeostasis. Motivated by this linear relationship, we derive a calcium-dependent rule for HCN-channel plasticity, and demonstrate that firing rate homeostasis is maintained in the face of synaptic plasticity when moderate and high levels of cytosolic calcium influx induced depression and potentiation of the HCN-channel conductance, respectively. Additionally, we show that such synergy between synaptic and HCN-channel plasticity enhances the stability of synaptic learning through metaplasticity in the BCM-like synaptic plasticity profile. Finally, we demonstrate that the synergistic interaction between synaptic and HCN-channel plasticity preserves robustness of information transfer across the neuron under a rate-coding schema. Our results establish specific physiological roles

  18. A calcium-dependent plasticity rule for HCN channels maintains activity homeostasis and stable synaptic learning.

    Directory of Open Access Journals (Sweden)

    Suraj Honnuraiah

    Full Text Available Theoretical and computational frameworks for synaptic plasticity and learning have a long and cherished history, with few parallels within the well-established literature for plasticity of voltage-gated ion channels. In this study, we derive rules for plasticity in the hyperpolarization-activated cyclic nucleotide-gated (HCN channels, and assess the synergy between synaptic and HCN channel plasticity in establishing stability during synaptic learning. To do this, we employ a conductance-based model for the hippocampal pyramidal neuron, and incorporate synaptic plasticity through the well-established Bienenstock-Cooper-Munro (BCM-like rule for synaptic plasticity, wherein the direction and strength of the plasticity is dependent on the concentration of calcium influx. Under this framework, we derive a rule for HCN channel plasticity to establish homeostasis in synaptically-driven firing rate, and incorporate such plasticity into our model. In demonstrating that this rule for HCN channel plasticity helps maintain firing rate homeostasis after bidirectional synaptic plasticity, we observe a linear relationship between synaptic plasticity and HCN channel plasticity for maintaining firing rate homeostasis. Motivated by this linear relationship, we derive a calcium-dependent rule for HCN-channel plasticity, and demonstrate that firing rate homeostasis is maintained in the face of synaptic plasticity when moderate and high levels of cytosolic calcium influx induced depression and potentiation of the HCN-channel conductance, respectively. Additionally, we show that such synergy between synaptic and HCN-channel plasticity enhances the stability of synaptic learning through metaplasticity in the BCM-like synaptic plasticity profile. Finally, we demonstrate that the synergistic interaction between synaptic and HCN-channel plasticity preserves robustness of information transfer across the neuron under a rate-coding schema. Our results establish specific

  19. A Calcium-Dependent Plasticity Rule for HCN Channels Maintains Activity Homeostasis and Stable Synaptic Learning

    Science.gov (United States)

    Honnuraiah, Suraj; Narayanan, Rishikesh

    2013-01-01

    Theoretical and computational frameworks for synaptic plasticity and learning have a long and cherished history, with few parallels within the well-established literature for plasticity of voltage-gated ion channels. In this study, we derive rules for plasticity in the hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, and assess the synergy between synaptic and HCN channel plasticity in establishing stability during synaptic learning. To do this, we employ a conductance-based model for the hippocampal pyramidal neuron, and incorporate synaptic plasticity through the well-established Bienenstock-Cooper-Munro (BCM)-like rule for synaptic plasticity, wherein the direction and strength of the plasticity is dependent on the concentration of calcium influx. Under this framework, we derive a rule for HCN channel plasticity to establish homeostasis in synaptically-driven firing rate, and incorporate such plasticity into our model. In demonstrating that this rule for HCN channel plasticity helps maintain firing rate homeostasis after bidirectional synaptic plasticity, we observe a linear relationship between synaptic plasticity and HCN channel plasticity for maintaining firing rate homeostasis. Motivated by this linear relationship, we derive a calcium-dependent rule for HCN-channel plasticity, and demonstrate that firing rate homeostasis is maintained in the face of synaptic plasticity when moderate and high levels of cytosolic calcium influx induced depression and potentiation of the HCN-channel conductance, respectively. Additionally, we show that such synergy between synaptic and HCN-channel plasticity enhances the stability of synaptic learning through metaplasticity in the BCM-like synaptic plasticity profile. Finally, we demonstrate that the synergistic interaction between synaptic and HCN-channel plasticity preserves robustness of information transfer across the neuron under a rate-coding schema. Our results establish specific physiological roles

  20. A novel 'splice site' HCN4 Gene mutation, c.1737+1 G>T, causes familial bradycardia, reduced heart rate response, impaired chronotropic competence and increased short-term heart rate variability.

    Science.gov (United States)

    Hategan, Lidia; Csányi, Beáta; Ördög, Balázs; Kákonyi, Kornél; Tringer, Annamária; Kiss, Orsolya; Orosz, Andrea; Sághy, László; Nagy, István; Hegedűs, Zoltán; Rudas, László; Széll, Márta; Varró, András; Forster, Tamás; Sepp, Róbert

    2017-08-15

    The most important molecular determinant of heart rate regulation in sino-atrial pacemaker cells includes hyperpolarization-activated, cyclic nucleotide-gated ion channels, the major isoform of which is encoded by the HCN4 gene. Mutations affecting the HCN4 gene are associated primarily with sick sinus syndrome. A novel c.1737+1 G>T 'splice-site' HCN4 mutation was identified in a large family with familial bradycardia which co-segregated with the disease providing a two-point LOD score of 4.87. Twelve out of the 22 investigated family members [4 males, 8 females average age 36 (SD 6) years] were considered as clinically affected (heart rateheart rates [62 (SD 8) vs. 73 (SD 8) bpm, p=0.0168) were significantly lower in carriers on 24-hour Holter recordings. Under maximum exercise test carriers achieved significantly lower heart rates than non-carrier family members, and percent heart rate reserve and percent corrected heart rate reserve were significantly lower in carriers. Applying rigorous criteria for chronotropic incompetence a higher number of carriers exhibited chronotropic incompetence. Parameters, characterizing short-term variability of heart rate (i.e. rMSSD and pNN50%) were increased in carrier family members, even after normalization for heart rate, in the 24-hour ECG recordings with the same relative increase in 5-minute recordings. The identified novel 'splice site' HCN4 gene mutation, c.1737+1 G>T, causes familial bradycardia and leads to reduced heart rate response, impaired chronotropic competence and increased short-term heart rate variability in the mutation carriers. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Reflex sympathetic dystrophy following pacemaker insertion.

    Science.gov (United States)

    Londhey, Vikram A; Singh, Nishant; Kini, Seema

    2011-09-01

    A 55 year old male presented with pain and swelling over dorsum of right hand and small joints, and loss of sweating over right hand since two months. He was a known case of mitral valve prolapse (MVP) with mitral regurgitation and complete heart block for which pacemaker was implanted 1 year back. Bilateral wrist X-ray was suggestive of pronounced demineralization (osteopenia) in the right hand. He was thus diagnosed to have reflex sympathetic dystrophy syndrome (RSDS) considered to be induced by pacemaker insertion. After treatment with amitryptiline and indomethacin his symptoms dramatically improved.

  2. Nuclear-powered pacemaker fuel cladding study

    International Nuclear Information System (INIS)

    Shoup, R.L.

    1976-07-01

    The fabrication of fuel capsules with refractory metal and alloy clads used in nuclear-powered cardiac pacemakers precludes the expedient dissolution of the clad in inorganic acid solutions. An experiment to measure penetration rates of acids on commonly used fuel pellet clads indicated that it is not impossible, but that it would be very difficult to dissolve the multiple cladding. This work was performed because of a suggestion that a 238 PuO 2 -powered pacemaker could be transformed into a terrorism weapon

  3. Leadless Pacemakers: State of the Art and Future Perspectives.

    Science.gov (United States)

    Della Rocca, Domenico G; Gianni, Carola; Di Biase, Luigi; Natale, Andrea; Al-Ahmad, Amin

    2018-03-01

    Leadless pacemaker therapy is a new technology that aims at avoiding lead- and pocket-related complications of conventional transvenous and epicardial pacing. To date, 2 self-contained leadless pacemakers for right ventricular pacing have been clinically available: the Nanostim Leadless Pacemaker System and the Micra Transcatheter Pacing System. Additionally, a new multicomponent leadless pacemaker for endocardial left ventricular pacing has been proposed as an alternative choice for cardiac resynchronization therapy. In this review, we describe the state of the art of leadless pacing and compare the currently available devices with traditional transvenous leadless pacemakers. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. The influence of radiation therapy on cardiac pacemakers

    International Nuclear Information System (INIS)

    Coles, J.R.; Ciddor, G.S.

    1980-01-01

    The results of an investigation to determine the influence on pacemaking of ionizing radiation and electromagnetic radiation from a number of radiotherapy machines are reported. In vitro tests were carried out on unipolar cardiac pacemakers of the ventricular inhibited type. The pacemakers were largely unaffected by the environment of clinical radiotherapy machines. Ionizing radiation had no detrimental effect on the pacemakers and electromagnetic interference caused only temporary single-beat inhibition at most. With the betatron used, malfunction of the pacemakers regularly occurred whilst in their inhibited made of operation. The demand function became disabled allowing competitive asynchronous pulses to be produced

  5. Disturbed Processing of Contextual Information in HCN3 Channel Deficient Mice

    Directory of Open Access Journals (Sweden)

    Marc S. Stieglitz

    2018-01-01

    Full Text Available Hyperpolarization-activated cyclic nucleotide-gated channels (HCNs in the nervous system are implicated in a variety of neuronal functions including learning and memory, regulation of vigilance states and pain. Dysfunctions or genetic loss of these channels have been shown to cause human diseases such as epilepsy, depression, schizophrenia, and Parkinson's disease. The physiological functions of HCN1 and HCN2 channels in the nervous system have been analyzed using genetic knockout mouse models. By contrast, there are no such genetic studies for HCN3 channels so far. Here, we use a HCN3-deficient (HCN3−/− mouse line, which has been previously generated in our group to examine the expression and function of this channel in the CNS. Specifically, we investigate the role of HCN3 channels for the regulation of circadian rhythm and for the determination of behavior. Contrary to previous suggestions we find that HCN3−/− mice show normal visual, photic, and non-photic circadian function. In addition, HCN3−/− mice are impaired in processing contextual information, which is characterized by attenuated long-term extinction of contextual fear and increased fear to a neutral context upon repeated exposure.

  6. Permanent Leadless Cardiac Pacemaker Therapy: A Comprehensive Review.

    Science.gov (United States)

    Tjong, Fleur V Y; Reddy, Vivek Y

    2017-04-11

    A new technology, leadless pacemaker therapy, was recently introduced clinically to address lead- and pocket-related complications in conventional transvenous pacemaker therapy. These leadless devices are self-contained right ventricular single-chamber pacemakers implanted by using a femoral percutaneous approach. In this review of available clinical data on leadless pacemakers, early results with leadless devices are compared with historical results with conventional single-chamber pacing. Both presently manufactured leadless pacemakers show similar complications, which are mostly related to the implant procedure: cardiac perforation, device dislocation, and femoral vascular access site complications. In comparison with conventional transvenous single-chamber pacemakers, slightly higher short-term complication rates have been observed: 4.8% for leadless pacemakers versus 4.1% for conventional pacemakers. The complication rate of the leadless pacemakers is influenced by the implanter learning curve for this new procedure. No long-term outcome data are yet available for the leadless pacemakers. Larger leadless pacing trials, with long-term follow-up and direct randomized comparison with conventional pacing systems, will be required to define the proper clinical role of these leadless systems. Although current leadless pacemakers are limited to right ventricular pacing, future advanced, communicating, multicomponent systems are expected to expand the potential benefits of leadless therapy to a larger patient population. © 2017 American Heart Association, Inc.

  7. Pacemaker stimulus amplitude alteration without loss of capture: an unusual ECG finding in cardiac tamponade from pacemaker lead perforation.

    Science.gov (United States)

    Suksaranjit, P; Prasidthrathsint, K

    2014-01-01

    A variation in pacemaker stimulus amplitude can represent pacemaker system dysfunction from generator malfunction, lead insulation defect, lead fracture, or artefact of digital signal processing of the electrocardiography recorder. Pacemaker lead perforation into the pericardial space typically results in loss of capture which was not demonstrated in our patient. In summary, we report an unusual ECG finding of pacemaker stimulus amplitude alteration without loss of capture in the setting of cardiac tamponade from pacemaker lead perforation. Copyright © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  8. Pseudo SVT in the pacemaker patient.

    Science.gov (United States)

    Modi, Simon; Barker, Diane; Cooper, Robert; Patwala, Ash; Hall, Mark

    2012-07-01

    This is an interesting report of a supraventricular tachycardia in a paced patient with intermittent atrioventricular nodal block. Only electrophysiology testing revealed the correct diagnosis. Images explain how pacemaker timing cycles and refractory periods can confuse an otherwise straightforward diagnosis. ©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.

  9. Quality assessment of pacemaker implantations in Denmark

    DEFF Research Database (Denmark)

    Møller, M; Arnsbo, P; Asklund, Mogens

    2002-01-01

    AIMS: Quality assessment of therapeutic procedures is essential to insure a cost-effective health care system. Pacemaker implantation is a common procedure with more than 500,000 implantations world-wide per year, but the general complication rate is not well described. We studied procedure relat...

  10. The Drosophila melanogaster circadian pacemaker circuit

    Indian Academy of Sciences (India)

    2008-12-07

    Dec 7, 2008 ... large variety of tissues in the fly such as the eye, brain, pro- boscis, antennae, wings, abdomen, Malpighian tubules and testes (Plautz et al. 1997; Giebultowicz 2001). Although cell-autonomous circadian function is attributed to several tissues in Drosophila, circadian pacemaker neurons located in the brain ...

  11. Keeping the Rhythm : Cardiac Pacemaker Cell Development

    NARCIS (Netherlands)

    Burkhard, Silja

    2017-01-01

    The heart is the first organ to form and function in the developing vertebrate embryo. Its proper morphogenesis and function is crucial for survival. Here we focus on the development and characterization of a highly specialized subset of cardiac cells, the pacemaker cells. In the mammalian heart,

  12. HCN1 Channels Enhance Rod System Responsivity in the Retina under Conditions of Light Exposure.

    Directory of Open Access Journals (Sweden)

    Vithiyanjali Sothilingam

    Full Text Available Vision originates in rods and cones at the outer retina. Already at these early stages, diverse processing schemes shape and enhance image information to permit perception over a wide range of lighting conditions. In this work, we address the role of hyperpolarization-activated and cyclic nucleotide-gated channels 1 (HCN1 in rod photoreceptors for the enhancement of rod system responsivity under conditions of light exposure.To isolate HCN1 channel actions in rod system responses, we generated double mutant mice by crossbreeding Hcn1-/- mice with Cnga3-/- mice in which cones are non-functional. Retinal function in the resulting Hcn1-/- Cnga3-/- animals was followed by means of electroretinography (ERG up to the age of four month. Retinal imaging via scanning laser ophthalmoscopy (SLO and optical coherence tomography (OCT was also performed to exclude potential morphological alterations.This study on Hcn1-/- Cnga3-/- mutant mice complements our previous work on HCN1 channel function in the retina. We show here in a functional rod-only setting that rod responses following bright light exposure terminate without the counteraction of HCN channels much later than normal. The resulting sustained signal elevation does saturate the retinal network due to an intensity-dependent reduction in the dynamic range. In addition, the lack of rapid adaptational feedback modulation of rod photoreceptor output via HCN1 in this double mutant limits the ability to follow repetitive (flicker stimuli, particularly under mesopic conditions.This work corroborates the hypothesis that, in the absence of HCN1-mediated feedback, the amplitude of rod signals remains at high levels for a prolonged period of time, leading to saturation of the retinal pathways. Our results demonstrate the importance of HCN1 channels for regular vision.

  13. Measuring pacemaker dose: A clinical perspective

    Energy Technology Data Exchange (ETDEWEB)

    Studenski, Matthew T., E-mail: matthew.studenski@jeffersonhospital.org [Department of Radiation Oncology at the Jefferson Medical College and Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States); Xiao Ying; Harrison, Amy S. [Department of Radiation Oncology at the Jefferson Medical College and Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States)

    2012-07-01

    Recently in our clinic, we have seen an increased number of patients presenting with pacemakers and defibrillators. Precautions are taken to develop a treatment plan that minimizes the dose to the pacemaker because of the adverse effects of radiation on the electronics. Here we analyze different dosimeters to determine which is the most accurate in measuring pacemaker or defibrillator dose while at the same time not requiring a significant investment in time to maintain an efficient workflow in the clinic. The dosimeters analyzed here were ion chambers, diodes, metal-oxide-semiconductor field effect transistor (MOSFETs), and optically stimulated luminescence (OSL) dosimeters. A simple phantom was used to quantify the angular and energy dependence of each dosimeter. Next, 8 patients plans were delivered to a Rando phantom with all the dosimeters located where the pacemaker would be, and the measurements were compared with the predicted dose. A cone beam computed tomography (CBCT) image was obtained to determine the dosimeter response in the kilovoltage energy range. In terms of the angular and energy dependence of the dosimeters, the ion chamber and diode were the most stable. For the clinical cases, all the dosimeters match relatively well with the predicted dose, although the ideal dosimeter to use is case dependent. The dosimeters, especially the MOSFETS, tend to be less accurate for the plans, with many lateral beams. Because of their efficiency, we recommend using a MOSFET or a diode to measure the dose. If a discrepancy is observed between the measured and expected dose (especially when the pacemaker to field edge is <10 cm), we recommend analyzing the treatment plan to see whether there are many lateral beams. Follow-up with another dosimeter rather than repeating multiple times with the same type of dosimeter. All dosimeters should be placed after the CBCT has been acquired.

  14. Pacemakers and implantable cardioverter defibrillators - general and anesthetic considerations

    Directory of Open Access Journals (Sweden)

    Amy G. Rapsang

    2014-06-01

    Full Text Available A pacemaking system consists of an impulse generator and lead or leads to carry the electrical impulse to the patient's heart. Pacemaker and implantable cardioverter defibrillator codes were made to describe the type of pacemaker or implantable cardioverter defibrillator implanted. Indications for pacing and implantable cardioverter defibrillator implantation were given by the American College of Cardiologists. Certain pacemakers have magnet-operated reed switches incorporated; however, magnet application can have serious adverse effects; hence, devices should be considered programmable unless known otherwise. When a device patient undergoes any procedure (with or without anesthesia, special precautions have to be observed including a focused history/physical examination, interrogation of pacemaker before and after the procedure, emergency drugs/temporary pacing and defibrillation, reprogramming of pacemaker and disabling certain pacemaker functions if required, monitoring of electrolyte and metabolic disturbance and avoiding certain drugs and equipments that can interfere with pacemaker function. If unanticipated device interactions are found, consider discontinuation of the procedure until the source of interference can be eliminated or managed and all corrective measures should be taken to ensure proper pacemaker function should be done. Post procedure, the cardiac rate and rhythm should be monitored continuously and emergency drugs and equipments should be kept ready and consultation with a cardiologist or a pacemaker-implantable cardioverter defibrillator service may be necessary.

  15. Pacemaker recycling: A notion whose time has come.

    Science.gov (United States)

    Runge, Mason W; Baman, Timir S; Davis, Sheldon; Weatherwax, Kevin; Goldman, Ed; Eagle, Kim A; Crawford, Thomas C

    2017-04-26

    The purpose of this paper is to summarize the need, feasibility, safety, legality, and ethical perspectives of pacemaker reutilization in low- and middle-income countries (LMICs). It will also describe, in-depth, Project My Heart Your Heart (PMHYH) as a model for pacemaker reuse in LMICs. The primary source of the discussion points in this paper is a collection of 14 publications produced by the research team at the University of Michigan and its collaborative partners. The need for pacemaker reutilization in LMICs is evident. Numerous studies show that the concept of pacemaker reutilization in LMICs is feasible. Infection and device malfunction are the main concerns in regard to pacemaker reutilization, yet many studies have shown that pacemaker reuse is not associated with increased infection risk or higher mortality compared with new device implantation. Under the right circumstances, the ethical and legal bases for pacemaker reutilization are supported. PMHYH is a proof of concept pacemaker donation initiative that has allowed funeral home and crematory directors to send explanted devices to an academic center for evaluation and re-sterilization before donation to underserved patients in LMICs. The time is now to pursue large-scale studies and trials of pacemaker reuse for the betterment of society. PMHYH is leading the way in the effort and is poised to conduct a prospective randomized, non-inferiority, multicenter study to confirm the clinical efficacy and safety of pacemaker reuse, for clinical and legal support.

  16. Pacemaker deactivation: withdrawal of support or active ending of life?

    Science.gov (United States)

    Huddle, Thomas S; Amos Bailey, F

    2012-12-01

    In spite of ethical analyses assimilating the palliative deactivation of pacemakers to commonly accepted withdrawings of life-sustaining therapy, many clinicians remain ethically uncomfortable with pacemaker deactivation at the end of life. Various reasons have been posited for this discomfort. Some cardiologists have suggested that reluctance to deactivate pacemakers may stem from a sense that the pacemaker has become part of the patient's "self." The authors suggest that Daniel Sulmasy is correct to contend that any such identification of the pacemaker is misguided. The authors argue that clinicians uncomfortable with pacemaker deactivation are nevertheless correct to see it as incompatible with the traditional medical ethics of withdrawal of support. Traditional medical ethics is presently taken by many to sanction pacemaker deactivation when such deactivation honors the patient's right to refuse treatment. The authors suggest that the right to refuse treatment applies to treatments involving ongoing physician agency. This right cannot underwrite patient demands that physicians reverse the effects of treatments previously administered, in which ongoing physician agency is no longer implicated. The permanently indwelling pacemaker is best seen as such a treatment. As such, its deactivation in the pacemaker-dependent patient is best seen not as withdrawal of support but as active ending of life. That being the case, clinicians adhering to the usual ethical analysis of withdrawal of support are correct to be uncomfortable with pacemaker deactivation at the end of life.

  17. Magnetic Resonance Imaging in Nondependent Pacemaker Patients with Pacemakers and Defibrillators with a Nearly Depleted Battery.

    Science.gov (United States)

    Okamura, Hideo; Padmanabhan, Deepak; Watson, Robert E; Dalzell, Connie; Acker, Nancy; Jondal, Mary; Romme, Abby L; Cha, Yong-Mei; Asirvatham, Samuel J; Felmlee, Joel P; Friedman, Paul A

    2017-05-01

    Magnetic resonance imaging (MRI) in patients with non-MRI-conditional cardiac implantable electronic devices (CIEDs) has been shown to be safe when performed under closely monitored protocols. However, the safety of MRI in patients with devices with a nearly depleted battery has not been reported. Prospective data were collected between January 2008 and May 2015 in patients with non-MRI-conditional CIEDs undergoing clinically indicated MRI under institutional protocol. Patients who were pacemaker dependent were excluded. Patients whose devices were at elective replacement indicator (ERI) at the time of MRI or close to ERI (ERI or replacement for battery depletion within 3 months of scan) were identified through database review and analyzed for clinical events. MRI scans (n = 569) were performed in 442 patients. Of these, we identified 13 scans performed with a nearly depleted battery in nine patients. All scans with implantable cardioverter defibrillators (ICDs, n = 9) were uneventful. However, two scans with pacemakers close to ERI resulted in a power-on-reset (PoR) event. One scan with a pacemaker close to ERI that was programmed to DOO mode reached ERI during MRI and automatically changed to VVI mode. Additionally, one scan with a pacemaker at ERI did not allow programming. All pacemakers with events were implanted before 2005. Patients with pacemakers and ICDs with a nearly depleted battery can safely undergo MRI when patients are not pacemaker dependent. Attention should be paid because old devices can result in PoR or ERI during MRI, which may lead to oversensing and inhibition of pacing. © 2017 Wiley Periodicals, Inc.

  18. An Ab Initio MP2 Study of HCN-HX Hydrogen Bonded Complexes

    Directory of Open Access Journals (Sweden)

    Araújo Regiane C.M.U.

    1998-01-01

    Full Text Available An ab initio MP2/6-311++G** study has been performed to obtain geometries, binding energies and vibrational properties of HCN-HX H-bonded complexes with X = F, Cl, NC, CN and CCH. These MP2/6-311++G** results have revealed that: (i the calculated H-bond lengths are in very good agreement with the experimental ones; (ii the H-bond strength is associated with the intermolecular charge transfer and follows the order: HCN-HNC ~ HCN-HF > HCN-HCl ~ HCN-HCN > HCN-HCCH; (iii BSSE correction introduces an average reduction of 2.4 kJ/mol on the MP2/6-311++G** binding energies, i.e. 11% of the uncorrected binding energy; (iv the calculated zero-point energies reduce the stability of these complexes and show a good agreement with the available experimental values; (v the H-X stretching frequency is shifted downward upon H-bond formation. This displacement is associated with the H-bond length; (vi The more pronounced effect on the infrared intensities occurs with the H-X stretching intensity. It is much enhanced after complexation due to the charge-flux term; (vii the calculated intermolecular stretching frequencies are in very good agreement with the experimental ones; and, finally, (viii the results obtained for the HCN-HX complexes follow the same profile as those found for the acetylene-HX series but, in the latter case, the effects on the properties of the free molecules due to complexation are less pronounced than those in HCN-HX.

  19. The Puzzle of HCN in Comets: Is it both a Product and a Primary Species?

    Science.gov (United States)

    Mumma, Michael J.; Bonev, Boncho P.; Charnley, Steven B.; Cordiner, Martin A.; DiSanti, Michael A.; Gibb, Erika L.; Magee-Sauer, Karen; Paganini, Lucas; Villanueva, Geronimo L.

    2014-11-01

    Hydrogen cyanide has long been regarded as a primary volatile in comets, stemming from its presence in dense molecular cloud cores and its supposed storage in the cometary nucleus. Here, we examine the observational evidence for and against that hypothesis, and argue that HCN may also result from near-nucleus chemical reactions in the coma. The distinction (product vs. primary species) is important for multiple reasons: 1. HCN is often used as a proxy for water when the dominant species (H2O) is not available for simultaneous measurement, as at radio wavelengths. 2. HCN is one of the few volatile carriers of nitrogen accessible to remote sensing. If HCN is mainly a product species, its precursor becomes the more important metric for compiling a taxonomic classification based on nitrogen chemistry. 3. The stereoisomer HNC is now confirmed as a product species. Could reaction of a primary precursor (X-CN) with a hydrocarbon co-produce both HNC and HCN? 4. The production rate for CN greatly exceeds that of HCN in some comets, demonstrating the presence of another (more important) precursor of CN. Several puzzling lines of evidence raise issues about the origin of HCN: a. The production rates of HCN measured through rotational (radio) and vibrational (infrared) spectroscopy agree in some comets - in others the infrared rate exceeds the radio rate substantially. b. With its strong dipole moment and H-bonding character, HCN should be linked more strongly in the nuclear ice to other molecules with similar properties (H2O, CH3OH), but instead its spatial release in some comets seems strongly coupled to volatiles that lack a dipole moment and thus do not form H-bonds (methane, ethane). c. The nucleus-centered rotational temperatures measured for H2O and other species (C2H6, CH3OH) usually agree within error, but those for HCN are often slightly smaller. d. In comet ISON, ALMA maps of HCN and the dust continuum show a slight displacement 80 km) in the centroids. We will

  20. Pacemaker lead related tricuspid stenosis: a report of two cases

    OpenAIRE

    Heaven, D; Henein, M; Sutton, R

    2000-01-01

    Only four cases of tricuspid stenosis related to endocardial pacemaker leads have been reported. Two further cases associated with perforation of a tricuspid valve leaflet by a pacemaker lead are presented: a 46 year old woman and a 60 year old man. It is possible that tricuspid valve disease related to endocardial pacemaker and non-thoracotomy defibrillator leads is underrecognised. Diagnosis requires clinical suspicion and the use of Doppler echocardiography. Recent evidence of fibrosis aff...

  1. Protection of pacemaker wearers: effects on magnetic fields on the operation of implanted cardiac pacemakers

    International Nuclear Information System (INIS)

    Souques, M.; Lambrozo, J.; Frank, R.; Himbert, C.

    2002-01-01

    The aim of this study was to assess the changes in the behavior of cardiac pacemakers exposed to 50 and 60 Hz magnetic fields generated by industrial current and 20 to 50 khz magnetic fields generated by a household in a booming period - the induction cook top - and to study the incidence of these changes in a population of subjects with implanted pacemakers. This will enabled to give patients advices about dealing with electric transport lines and facilities and with induction cook tops and to advise manufacturers about the risks involved

  2. 76 FR 53851 - Effective Date of Requirement for Premarket Approval for Cardiovascular Permanent Pacemaker...

    Science.gov (United States)

    2011-08-30

    ... Approval for Cardiovascular Permanent Pacemaker Electrode; Correction AGENCY: Food and Drug Administration... development protocol for the class III preamendments device: Cardiovascular permanent pacemaker electrode. The...

  3. A 1D coordination polymer of UF{sub 5} with HCN as a ligand

    Energy Technology Data Exchange (ETDEWEB)

    Scheibe, Benjamin; Rudel, Stefan S.; Buchner, Magnus R.; Kraus, Florian [Fachbereich Chemie, Philipps-Universitaet Marburg (Germany); Karttunen, Antti J. [Department of Chemistry, Aalto University (Finland)

    2017-01-05

    β-Uranium(V) fluoride was reacted with liquid anhydrous hydrogen cyanide to obtain a 1D coordination polymer with the composition {sup 1}{sub ∞}[UF{sub 5}(HCN){sub 2}], {sup 1}{sub ∞}[UF{sub 4/1}F{sub 2/2}-(HCN){sub 2/1}], revealed by single-crystal X-ray structure determination. The reaction system was furthermore studied by means of vibrational and NMR spectroscopy, as well as by quantum chemical calculations. The compound presents the first described polymeric HCN Lewis adduct and the first HCN adduct of a uranium fluoride. (copyright 2017 Wiley-VCH Verlag GmbH and Co. KGaA, Weinheim)

  4. MLS/Aura Level 2 Hydrogen Cyanide (HCN) Mixing Ratio V004

    Data.gov (United States)

    National Aeronautics and Space Administration — ML2HCN is the EOS Aura Microwave Limb Sounder (MLS) standard product for hydrogen cyanide derived from radiances measured primarily by the 190 GHz radiometer. The...

  5. MLS/Aura L2 Hydrogen Cyanide (HCN) Mixing Ratio V003

    Data.gov (United States)

    National Aeronautics and Space Administration — ML2HCN is the EOS Aura Microwave Limb Sounder (MLS) standard product for hydrogen cyanide derived from radiances measured primarily by the 190 GHz radiometer. The...

  6. MLS/Aura L2 Hydrogen Cyanide (HCN) Mixing Ratio V002

    Data.gov (United States)

    National Aeronautics and Space Administration — ML2HCN is the EOS Aura Microwave Limb Sounder (MLS) standard product for hydrogen cyanide derived from radiances measured primarily by the 190 GHz radiometer. The...

  7. Distribution and function of HCN channels in the apical dendritic tuft of neocortical pyramidal neurons.

    Science.gov (United States)

    Harnett, Mark T; Magee, Jeffrey C; Williams, Stephen R

    2015-01-21

    The apical tuft is the most remote area of the dendritic tree of neocortical pyramidal neurons. Despite its distal location, the apical dendritic tuft of layer 5 pyramidal neurons receives substantial excitatory synaptic drive and actively processes corticocortical input during behavior. The properties of the voltage-activated ion channels that regulate synaptic integration in tuft dendrites have, however, not been thoroughly investigated. Here, we use electrophysiological and optical approaches to examine the subcellular distribution and function of hyperpolarization-activated cyclic nucleotide-gated nonselective cation (HCN) channels in rat layer 5B pyramidal neurons. Outside-out patch recordings demonstrated that the amplitude and properties of ensemble HCN channel activity were uniform in patches excised from distal apical dendritic trunk and tuft sites. Simultaneous apical dendritic tuft and trunk whole-cell current-clamp recordings revealed that the pharmacological blockade of HCN channels decreased voltage compartmentalization and enhanced the generation and spread of apical dendritic tuft and trunk regenerative activity. Furthermore, multisite two-photon glutamate uncaging demonstrated that HCN channels control the amplitude and duration of synaptically evoked regenerative activity in the distal apical dendritic tuft. In contrast, at proximal apical dendritic trunk and somatic recording sites, the blockade of HCN channels decreased excitability. Dynamic-clamp experiments revealed that these compartment-specific actions of HCN channels were heavily influenced by the local and distributed impact of the high density of HCN channels in the distal apical dendritic arbor. The properties and subcellular distribution pattern of HCN channels are therefore tuned to regulate the interaction between integration compartments in layer 5B pyramidal neurons. Copyright © 2015 the authors 0270-6474/15/351024-14$15.00/0.

  8. Bima Array Detections of HCN in Comets Linear (C/2002 T7) and Neat (C/2001 Q4)

    Science.gov (United States)

    Friedel, D. N.; Remijan, A.; Snyder, L. E.; AHearn, M. F.; Blake, Geoffrey A.; dePater, Imke; Dickel, H. R.; Forster, J. R.; Hogerheijde, M. R.

    2004-01-01

    We present interferometric detections of HCN in comets LINEAR (C/2002 T7) and NEAT (C/2001 Q4) with the Berkeley-Illinois-Maryland Association (BIMA) Array in its D-configuration cross-correlation mode. We detected the HCN J = 1 - 0 emission line in both comets. With a 25".4 x 20".3 synthesized beam around Comet LINEAR, we found a total beam averaged HCN column density (assuming a rotation temperature of 146 K) of = 2.1(11)x 10(sup 13) cm(exp -2), and a HCN production rate of Q(HCN)=2.8(15)x 10(sup 27) s(exp -1). With a 21".3 x 17".5 synthesized beam around Comet NEAT, we found a total beam averaged HCN column density (assuming a rotation temperature of 107 K) of = 5.7(30) x 10(sup l2) cm(exp -2), and a HCN production rate of Q(HCN)=8.3(44) x 10(sup 26) s(exp -l) giving a production rate of HCN relative to H2O of approximately 0.09(5)%. The production rates relative to H2O and spatial extent of HCN are similar to previous comet observations.

  9. De novo mutations in HCN1 cause early infantile epileptic encephalopathy.

    Science.gov (United States)

    Nava, Caroline; Dalle, Carine; Rastetter, Agnès; Striano, Pasquale; de Kovel, Carolien G F; Nabbout, Rima; Cancès, Claude; Ville, Dorothée; Brilstra, Eva H; Gobbi, Giuseppe; Raffo, Emmanuel; Bouteiller, Delphine; Marie, Yannick; Trouillard, Oriane; Robbiano, Angela; Keren, Boris; Agher, Dahbia; Roze, Emmanuel; Lesage, Suzanne; Nicolas, Aude; Brice, Alexis; Baulac, Michel; Vogt, Cornelia; El Hajj, Nady; Schneider, Eberhard; Suls, Arvid; Weckhuysen, Sarah; Gormley, Padhraig; Lehesjoki, Anna-Elina; De Jonghe, Peter; Helbig, Ingo; Baulac, Stéphanie; Zara, Federico; Koeleman, Bobby P C; Haaf, Thomas; LeGuern, Eric; Depienne, Christel

    2014-06-01

    Hyperpolarization-activated, cyclic nucleotide-gated (HCN) channels contribute to cationic Ih current in neurons and regulate the excitability of neuronal networks. Studies in rat models have shown that the Hcn1 gene has a key role in epilepsy, but clinical evidence implicating HCN1 mutations in human epilepsy is lacking. We carried out exome sequencing for parent-offspring trios with fever-sensitive, intractable epileptic encephalopathy, leading to the discovery of two de novo missense HCN1 mutations. Screening of follow-up cohorts comprising 157 cases in total identified 4 additional amino acid substitutions. Patch-clamp recordings of Ih currents in cells expressing wild-type or mutant human HCN1 channels showed that the mutations had striking but divergent effects on homomeric channels. Individuals with mutations had clinical features resembling those of Dravet syndrome with progression toward atypical absences, intellectual disability and autistic traits. These findings provide clear evidence that de novo HCN1 point mutations cause a recognizable early-onset epileptic encephalopathy in humans.

  10. Detection of Macromolecular Fractions in HCN Polymers Using Electrophoretic and Ultrafiltration Techniques.

    Science.gov (United States)

    Marín-Yaseli, Margarita R; Cid, Cristina; Yagüe, Ana I; Ruiz-Bermejo, Marta

    2017-02-01

    Elucidating the origin of life involves synthetic as well as analytical challenges. Herein, for the first time, we describe the use of gel electrophoresis and ultrafiltration to fractionate HCN polymers. Since the first prebiotic synthesis of adenine by Oró, HCN polymers have gained much interest in studies on the origins of life due to the identification of biomonomers and related compounds within them. Here, we demonstrate that macromolecular fractions with electrophoretic mobility can also be detected within HCN polymers. The migration of polymers under the influence of an electric field depends not only on their sizes (one-dimensional electrophoresis) but also their different isoelectric points (two-dimensional electrophoresis, 2-DE). The same behaviour was observed for several macromolecular fractions detected in HCN polymers. Macromolecular fractions with apparent molecular weights as high as 250 kDa were detected by tricine-SDS gel electrophoresis. Cationic macromolecular fractions with apparent molecular weights as high as 140 kDa were also detected by 2-DE. The HCN polymers synthesized were fractionated by ultrafiltration. As a result, the molecular weight distributions of the macromolecular fractions detected in the HCN polymers directly depended on the synthetic conditions used to produce these polymers. The implications of these results for prebiotic chemistry will be discussed. © 2017 Wiley-VHCA AG, Zurich, Switzerland.

  11. Hyperfine anomalies of HCN in cold dark clouds

    International Nuclear Information System (INIS)

    Walmsley, C.M.; Churchwell, E.; Nash, A.; Fitzpatrick, E.; and Physics Department, University of Illinois at Urbana-Champaign)

    1982-01-01

    We report observations of the J = 1→0 line of HCN measured toward six positions in nearby low-temperature dark clouds. The measured relative intensities of the hyperfine components of the J = 1→0 line are anomalous in that the F = 0→1 transition is stronger than would be expected if all three components (F = 2→1, F = 1→1, F = 0→1) had equal excitation temperatures. Differences of approximately 20% in the populations per sublevel of J = 1 could account for the observations. The results are in contrast to the situation observed in warmer molecular clouds associated with H II regions where the F = 1→1 line is anomalously weak. The apparent overpopulation of J = 1, F = 0 in dark clouds may be related to the phenomenon observed in the J = 1→0 transitions of HCO + and HNC in the same objects where 13 C substituted version of these species is found to be stronger than the 12 C species

  12. A Functional Analysis of Circadian Pacemakers in Nocturnal Rodents. IV. Entrainment : Pacemaker as Clock

    NARCIS (Netherlands)

    Pittendrigh, Colin S.; Daan, Serge

    1976-01-01

    1. In the first part of the paper, the model of non-parametric entrainment of circadian pacemakers is tested for the case of nocturnal rodents. The model makes use of the available data on freerunning period (τ) in constant darkness and on phase response curves (PRC) for short light pulses. It is

  13. Cardiovascular patients' experiences of living with pacemaker: Qualitative study.

    Science.gov (United States)

    Ghojazadeh, Morteza; Azami-Aghdash, Saber; Sohrab-Navi, Zahra; Kolahdouzan, Kasra

    2015-09-01

    A pacemaker implantation is considered major life event for cardiovascular patients, so they will probably have very interesting experiences of living with this device. The aim of this study was to explore the experiences of cardiovascular patients living with the pacemaker. In this qualitative study, 27 patients were chosen through purposive sampling to achieve data saturation, and their experiences were examined using semi-structured interviews. The patients' statements were recorded with their consent and analyzed using content analysis method. Participants' experiences included three main themes: "Problems and limitations," "feeling and dealing with pacemaker", and "sources of comfort" and 10 sub-themes including: physical problems, financial problems, social problems, the first encounter, the feeling of living with the pacemaker, how to cope with pacemaker, satisfaction with pacemaker, good family support, hospital and hospital staff performance, and role of religious beliefs. Planning to solve social problems, identifying and changing feelings of patients using pacemakers, reinforcing the resources of comfort especially family support seem to be necessary steps for improving quality of life and impact of using pacemaker.

  14. The cardiac pacemaker patient. Might the pacer be directly irradiated?

    International Nuclear Information System (INIS)

    Tsekos, A.; Momm, F.; Brunner, M.; Guttenberger, R.

    2000-01-01

    According to recommendations listed in a recent review, pacemakers generally should not be irradiated directly. They should be shielded from ionizing radiation or their position changed. Direct irradiation can cause pacemaker failure. There are no clinical signals to indicate a near failure. When controlling pacemaker function, there is often a change in the magnetic frequency before malfunction occurs. If a malfunction results in a partial heart failure only, there would be enough time to implant another pacemaker. As can be seen from a case described here, a policy of 'wait and see' may be adopted even if there are changes in the magnetic frequency. if there is any danger to the patient's life, the feasibility of using an external pacemaker system may be explored, especially in cases where there is a strong need for radiotherapy (severe pain, infiltration of plexus). Risks and benefits should be carefully weighed and discussed with the patient

  15. Clear cell hidradenocarcinoma developing in pacemaker pocket.

    Science.gov (United States)

    Reyes, Cesar V

    2008-11-01

    An octagenerian woman developed clear cell hidradenocarcinoma, a rare neoplasm of eccrine sweat gland origin, 4 years following pacemaker implantation in her right lateral chest. The tumor immunohistochemically mimicked a metastatic lobular breast carcinoma, for example, strongly positive estrogen, weakly positive progesterone, and weakly reactive mammoglobin. A complete surgical excision of the tumor was complemented with ipsilateral dissection of involved adjacent axillary lymph nodes. Recommended irradiation was refused by the patient. Retrospective 3-year mammogram review, 2-year postsurgery follow-up, and complete postmortem evaluation failed to prove a primary breast malignancy or other metastatic lesion elsewhere.

  16. Pacemaker syndrome with sub-acute left ventricular systolic dysfunction in a patient with a dual-chamber pacemaker: consequence of lead switch at the header.

    Science.gov (United States)

    Khurwolah, Mohammad Reeaze; Vezi, Brian Zwelethini

    In the daily practice of pacemaker insertion, the occurrence of atrial and ventricular lead switch at the pacemaker box header is a rare and unintentional phenomenon, with less than five cases reported in the literature. The lead switch may have dire consequences, depending on the indication for the pacemaker. One of these consequences is pacemaker syndrome, in which the normal sequence of atrial and ventricular activation is impaired, leading to sub-optimal ventricular filling and cardiac output. It is important for the attending physician to recognise any worsening of symptoms in a patient who has recently had a permanent pacemaker inserted. In the case of a dual-chamber pacemaker, switching of the atrial and ventricular leads at the pacemaker box header should be strongly suspected. We present an unusual case of pacemaker syndrome and right ventricular-only pacinginduced left ventricular systolic dysfunction in a patient with a dual-chamber pacemaker.

  17. Genetic variation in Hyperpolarization-activated cyclic nucleotide-gated (HCN channels and its relationship with neuroticism, cognition and risk of depression

    Directory of Open Access Journals (Sweden)

    Andrew Mark Mcintosh

    2012-07-01

    Full Text Available Hyperpolarization-activated cyclic nucleotide-gated (HCN channels are encoded by four genes (HCN1-4 and, through activation by cyclic AMP (cAMP, represent a point of convergence for several psychosis risk genes. On the basis of positive preliminary data, we sought to test whether genetic variation in HCN1-4 conferred risk of depression or cognitive impairment in the Generation Scotland: Scottish Family Health Study. HCN1, HCN2, HCN3 and HCN4 were genotyped for 43 haplotype-tagging SNPs and tested for association with DSM-IV depression, neuroticism and a battery of cognitive tests assessing cognitive ability, memory, verbal fluency and psychomotor performance. No association was found between any HCN channel gene SNP and risk of depression, neuroticism or on any cognitive measure. The current study does not support a genetic role for HCN channels in conferring risk of depression or cognitive impairment in human subjects within the Scottish population.

  18. Pacemaker implantation complication rates in elderly and young patients

    Directory of Open Access Journals (Sweden)

    Özcan KS

    2013-08-01

    Full Text Available Kazim Serhan Özcan, Damirbek Osmonov, Servet Altay, Cevdet Dönmez, Ersin Yildirim, Ceyhan Türkkan, Baris Güngör, Ahmet Ekmekçi, Ahmet Taha Alper, Kadir Gürkan, İzzet ErdinlerDepartment of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, TurkeyAims: To evaluate the complication rate differences between elderly and younger patients who receive a permanent pacemaker implantation.Methods: We reviewed all cases admitted to our institution between January 2008 and June 2009 with symptomatic bradyarrhythmia for whom a permanent pacemaker was implanted. Beginning in June 2009, we prospectively collected data from all patients with the same diagnosis and procedure. The frequency of complications due to the pacemaker implantation procedure was evaluated and compared between young (<70 years old and elderly (≥70 years old patients.Results: Among 574 patients with a permanent pacemaker, 259 patients (45.1% were below and 315 patients (54.9% were above or at 70 years of age. There were 240 (92.7% and 19 (7.3% dual-chamber pacemaker (DDD and single-chamber pacemaker (VVI implanted patients in the younger group, and 291 (76.8% and 73 (23.2% DDD and VVI pacemaker implanted patients in the elderly group, respectively. The complication rate was 39 (15.1% out of 259 young patients and 24 (7.6% out of 315 elderly patients. Postprocedural complications were statistically lower in the elderly patients than in younger patients (P = 0.005.Conclusion: A pacemaker implantation performed by an experienced operator is a safe procedure for patients of advanced age. The patients who are above 70 years old may have less complication rates than the younger patients.Keywords: complications of pacemaker implantation, elderly patients, permanent pacemaker

  19. HCN Channel Modulation of Synaptic Integration in GABAergic Interneurons in Malformed Rat Neocortex

    Directory of Open Access Journals (Sweden)

    John J. Hablitz

    2017-04-01

    Full Text Available Cortical malformations are often associated with pharmaco-resistant epilepsy. Alterations in hyperpolarization-activated, cyclic nucleotide-gated, non-specific cation (HCN channels have been shown to contribute to malformation associated hyperexcitability. We have recently demonstrated that expression of HCN channels and Ih current amplitudes are reduced in layer (L 5 pyramidal neurons of rats with freeze lesion induced malformations. These changes were associated with an increased EPSP temporal summation. Here, we examine the effects of HCN channel inhibition on synaptic responses in fast spiking, presumptive basket cells and accommodating, presumptive Martinotti, GABAergic interneurons in slices from freeze lesioned animals. In control animals, fast spiking cells showed small sag responses which were reduced by the HCN channel antagonist ZD7288. Fast spiking cells in lesioned animals showed absent or reduced sag responses. The amplitude of single evoked EPSPs in fast spiking cells in the control group was not affected by HCN channel inhibition with ZD7288. EPSP ratios during short stimulus trains at 25 Hz were not significantly different between control and lesion groups. ZD7288 produced an increase in EPSP ratios in the control but not lesion groups. Under voltage clamp conditions, ZD7288 did not affect EPSC ratios. In the control group, accommodating interneurons showed robust sag responses which were significantly reduced by ZD7288. HCN channel inhibition increased EPSP ratios and area in controls but not the lesioned group. The results indicate that HCN channels differentially modulate EPSPs in different classes of GABAergic interneurons and that this control is reduced in malformed rat neocortex.

  20. 76 FR 47085 - Effective Date of Requirement for Premarket Approval for a Pacemaker Programmer

    Science.gov (United States)

    2011-08-04

    ... Approval for a Pacemaker Programmer AGENCY: Food and Drug Administration, HHS. ACTION: Proposed rule... preamendments device pacemaker programmers. The agency is also summarizing its proposed findings regarding the... Subject to This Proposal--Pacemaker Programmers (21 CFR 870.3700) A. Identification A pacemaker programmer...

  1. 21 CFR 870.3680 - Cardiovascular permanent or temporary pacemaker electrode.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiovascular permanent or temporary pacemaker... § 870.3680 Cardiovascular permanent or temporary pacemaker electrode. (a) Temporary pacemaker electrode—(1) Identification. A temporary pacemaker electrode is a device consisting of flexible insulated...

  2. Organics Produced by Irradiation of Frozen and Liquid HCN Solutions: Implications for Chemical Evolution Studies

    Science.gov (United States)

    Colín-García, M.; Negrón-Mendoza, A.; Ramos-Bernal, S.

    2009-04-01

    Hydrogen cyanide (HCN), an important precursor of organic compounds, is widely present in extraterrestrial environments. HCN is also readily synthesized in prebiotic simulation experiments. To gain insight into the radiation chemistry of one of the most important and highly versatile constituents of cometary ices, we examined the behavior of over-irradiated frozen and liquid HCN solutions under ionizing radiation. The samples were exposed to gamma radiation at a dose range from 0 up to 419 kGy. Ultraviolet spectroscopy and gas chromatography were used to follow the process. The analyses confirmed that gamma-ray irradiation of liquid HCN solutions generates several organic products. Many of them are essential to life; we verified the presence of carboxylic acids (some of them members of the Krebs cycle) as well as free amino acids and urea. These are the first studies to reveal the presence of these compounds in experiments performed at low temperatures and bulk irradiation. Organic material was produced even at low temperatures and low radiation doses. This work strongly supports the presumption that, as a parent molecule, HCN played a central essential role in the process of chemical evolution on early Earth, comets, and other extraterrestrial environments.

  3. Development of a high power HCN waveguide laser for plasma diagnostic

    International Nuclear Information System (INIS)

    Deng Zhongchao; Zhou Yan; Tang Yiwu; Yi Jiang; Gao Bingyi; Tian Chongli

    2007-06-01

    Both design and development of a high power cw HCN waveguide laser is described for multichannel FIR laser interferometer on the HL-2A divertor tokamak. The geometry parameters of stracture of the HCN laser are calculated according to scaling laws for cw 337 μm HCN waveguide laser offered by P. Belland et al. The designed value of output power of the laser that is more than 400 mW with discharge length of 5.6 m and 6.3 cm inner diameter of tube have been chosen in case of external loss of the cavity of 2%. At the same time, in order to get a laser system of stable output both of configuration and operating condition is discussed. In developed laser a hot LaB 6 cathode is employed to en- sure a stable discharge, the cavity mirrors are spaced using four invar rod of φ25 mm in diameter and an structure of adjusting machine for axially movable flat mirror in cavity has been also designed, and that it can be taken down many times without badly destroying alignment of the cavity etc.. A suit of pipes sys- tem of cw HCN laser is schemed out so that some experiments of operating parameter optimization can be done. The results of primary test of operating waveguide HCN laser are briefly showed. (authors)

  4. Neck Pain One Week after Pacemaker Generator Replacement.

    Science.gov (United States)

    Graham, Ross F; Wightman, John M

    2015-07-01

    The incidence of cardiac pacemaker implantation has risen markedly in the past three decades, making awareness of possible postprocedural complications critical to the emergency physician. This case is the first documented instance of internal jugular (IJ) deep vein thrombosis (DVT) from an uncomplicated pacemaker generator replacement. A patient presented to an Emergency Department with a 2-day history of mild left temporal headache migrating to his left neck. The patient did not volunteer this information, but review of systems revealed a temporary transvenous pacemaker inserted through the right IJ vein 1 week previously during a routine exchange of a left-sided cardiac pacemaker generator. Manipulation of the existing pacemaker wires entering the left subclavian vein was minimal. Computed tomographic angiography of the neck demonstrated near-complete thrombotic occlusion of the entire length of his left IJ vein. This required hospital admission for observation and treatment with anticoagulation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: DVT, with thrombotic extension into adjacent vessels anywhere along the course of pacemaker wires, should be considered by the emergency provider in the evaluation of head, neck, or upper extremity symptoms after recent or remote implantation or manipulation of a transvenous cardiac pacemaker, including generator replacement. Failure to identify and treat appropriately could result in significant morbidity and mortality from airway edema, septic thrombophlebitis, superior vena cava syndrome, superior sagittal sinus thrombosis, or pulmonary embolism. Published by Elsevier Inc.

  5. Modern Perspectives on Numerical Modeling of Cardiac Pacemaker Cell

    Science.gov (United States)

    Maltsev, Victor A.; Yaniv, Yael; Maltsev, Anna V.; Stern, Michael D.; Lakatta, Edward G.

    2015-01-01

    Cardiac pacemaking is a complex phenomenon that is still not completely understood. Together with experimental studies, numerical modeling has been traditionally used to acquire mechanistic insights in this research area. This review summarizes the present state of numerical modeling of the cardiac pacemaker, including approaches to resolve present paradoxes and controversies. Specifically we discuss the requirement for realistic modeling to consider symmetrical importance of both intracellular and cell membrane processes (within a recent “coupled-clock” theory). Promising future developments of the complex pacemaker system models include the introduction of local calcium control, mitochondria function, and biochemical regulation of protein phosphorylation and cAMP production. Modern numerical and theoretical methods such as multi-parameter sensitivity analyses within extended populations of models and bifurcation analyses are also important for the definition of the most realistic parameters that describe a robust, yet simultaneously flexible operation of the coupled-clock pacemaker cell system. The systems approach to exploring cardiac pacemaker function will guide development of new therapies, such as biological pacemakers for treating insufficient cardiac pacemaker function that becomes especially prevalent with advancing age. PMID:24748434

  6. Routine chest radiography after permanent pacemaker implantation: Is it necessary?

    Directory of Open Access Journals (Sweden)

    Edwards N

    2005-01-01

    Full Text Available Background and Aims: Chest radiographs (CXRs are performed routinely after permanent pacemaker implantation to identify pacemaker lead position and exclude pneumothorax. We assessed the clinical value and need for this procedure. Design: Retrospective analysis of pacemaker data and CXRs following permanent pacemaker insertion between December 2002 and February 2004. Materials and Methods: Post-procedural CXRs were available in 125/126 consecutive patients after either first endocardial pacemaker implantation or insertion of at least one new lead. Subclavian vein puncture was used for venous access in all cases. CXRs were examined to establish the incidence of pneumothorax and assess pacing lead positions. The clinical records were examined in all patients who had subsequent CXRs or a further pacemaker procedure to identify the indication for these and to establish whether CXR had influenced patient management. Results: In total, 192 post-procedural CXRs were performed, either postero-anterior (PA and/or lateral views. Ventricular and/or atrial pacing lead contour and electrode position was considered radiographically appropriate in 86% CXRs. Fourteen per cent of post-procedural radiographs were considered to have radiologically sub-optimal pacemaker lead positioning. None of the patients with these "abnormal" radiographs experienced subsequent pacemaker complications or had further radiographs recorded at a later date. Later repeat CXRs were performed in 16 patients (13% but only 3 patients (2% had pacing abnormalities as the primary indication. All three had satisfactory pacing lead position on initial post-implantation and later radiographs, but required further procedures for lead re-positioning. Iatrogenic pneumothorax occurred in one patient (incidence 0.8% in our series. CXR confirmed the clinical diagnosis and allowed an assessment of size to guide treatment. Conclusion: Routine CXR after permanent pacemaker insertion is not necessary in

  7. Of pacemakers and statistics: the actuarial method extended.

    Science.gov (United States)

    Dussel, J; Wolbarst, A B; Scott-Millar, R N; Obel, I W

    1980-01-01

    Pacemakers cease functioning because of either natural battery exhaustion (nbe) or component failure (cf). A study of four series of pacemakers shows that a simple extension of the actuarial method, so as to incorporate Normal statistics, makes possible a quantitative differentiation between the two modes of failure. This involves the separation of the overall failure probability density function PDF(t) into constituent parts pdfnbe(t) and pdfcf(t). The approach should allow a meaningful comparison of the characteristics of different pacemaker types.

  8. Acute pericarditis with cardiac tamponade induced by pacemaker implantation.

    Science.gov (United States)

    Shingaki, Masami; Kobayashi, Yutaka; Suzuki, Haruo

    2015-11-01

    An 87-year-old woman was diagnosed with third-degree atrioventricular block and underwent pacemaker implantation. On postoperative day 12, she experienced cardiac tamponade that was suspected on computed tomography to be caused by lead perforation; therefore, we performed open-heart surgery. However, we could not identify a perforation site on the heart, and drained a 400-mL exudative pericardial effusion. Subsequently, we diagnosed the pericardial effusion as due to pericarditis induced by pacemaker implantation. It is sometimes difficult to distinguish pericarditis from pacemaker lead perforation, so both should be included in the differential diagnosis. © The Author(s) 2014.

  9. Allergy to pacemaker silicone compounds: recognition and surgical management.

    Science.gov (United States)

    Oprea, Mihaela L; Schnöring, Heike; Sachweh, Jörg S; Ott, Hagen; Biertz, Julia; Vazquez-Jimenez, Jaime F

    2009-04-01

    Silicone is a widely used biomaterial. Contact allergy, particularly to silicone components of pacemaker coatings, is uncommon. We present a 12-year-old girl with a history of complex congenital heart disease and acquired complete heart block excluding transvenous lead placement. Contact allergy to silicone led to multiple surgical interventions until the etiology for recurrent pacemaker wound complications was discovered. The key to diagnosis was a specific manufacturer's patch test. Complete removal of the former pacing system and placement of custom-made silicone free pacemaker components and epicardial use of silicone free transvenous leads were essential for successful therapy.

  10. [Twiddler's syndrome as the cause of pacemaker electrode displacement].

    Science.gov (United States)

    Grønbech, Keea Treu; Hansen, Michael Gilså

    2013-04-08

    Twiddler's syndrome is a rare cause of pacemaker electrode displacement. The displacement is caused by the patient's manipulation with the pacemaker, so the electrode is retracted. We describe a case of a 79-year-old overweight woman with a known psychiatric anamnesis, who was admitted twice with twiddler's syndrome. Age and overweight are known risk factors for twiddler's syndrome; and in this case the patient's psychiatric habitus was probably an additional risk factor. Before performing a pacemaker implantation it is important to take the patient's risk factors into account, and thus consider submuscular implantation.

  11. Experimental conditions affecting the kinetics of aqueous HCN polymerization as revealed by UV-vis spectroscopy

    Science.gov (United States)

    Marín-Yaseli, Margarita R.; Moreno, Miguel; de la Fuente, José L.; Briones, Carlos; Ruiz-Bermejo, Marta

    2018-02-01

    HCN polymerization is one of the most important and fascinating reactions in prebiotic chemistry, and interest in HCN polymers in the field of materials science is growing. However, little is known about the kinetics of the HCN polymerization process. In the present study, a first approach to the kinetics of two sets of aqueous HCN polymerizations, from NH4CN and NaCN, at middle temperatures between 4 and 38 °C, has been carried out. For each series, the presence of air and salts in the reaction medium has been systematically explored. A previous kinetic analysis was conducted during the conversion of the insoluble black HCN polymers obtained as gel fractions in these precipitation polymerizations for a reaction of one month, where a limit conversion was achieved at the highest polymerization temperature. The kinetic description of the gravimetric data for this complex system shows a clear change in the linear dependence with the polymerization temperature for the reaction from NH4CN, besides a relevant catalytic effect of ammonium, in comparison with those data obtained from the NaCN series. These results also demonstrated the notable influence of air, oxygen, and the saline medium in HCN polymer formation. Similar conclusions were reached when the sol fractions were monitored by UV-vis spectroscopy, and a Hill type correlation was used to describe the polymerization profiles obtained. This technique was chosen because it provides an easy, prompt and fast method to follow the evolution of the liquid or continuous phase of the process under study.

  12. Endocardial Pacemaker Implantation in Neonates and Infants

    Directory of Open Access Journals (Sweden)

    Canan Ayabakan

    2006-04-01

    Full Text Available Transvenous pacemaker lead implantation is the preferred method of pacing in adult patients. Lead performance and longevity are superior and the implantation approach can be performed under local anaesthetic with a very low morbidity. In children, and especially in neonates and infants, the epicardial route was traditionally chosen until the advent of smaller generators and lead implantation techniques that allowed growth of the child without lead displacement. Endocardial implantation is not universally accepted, however, as there is an incidence of venous occlusion of the smaller veins of neonates and infants with concerns for loss of venous access in the future. Growing experience with lower profile leads, however, reveals that endocardial pacing too can be performed with low morbidity and good long-term results in neonates and infants.

  13. Negative ion mass spectrometry and the detection of carbonyls and HCN from clover

    Science.gov (United States)

    Custer, Thomas G.; Kato, Shuji; Fall, Ray; Bierbaum, Veronica M.

    2000-12-01

    We have demonstrated that negative ion-chemical ionization mass spectrometry (NI-CIMS) can be used to distinguish several isomeric volatile organic compounds (VOCs) that are emitted from wounded plants. Reaction chemistry with HO-, hydrogen/deuterium exchange patterns, and collision-induced dissociation spectra allow identification of the isomers. Laboratory studies of emissions from wounded clover using NI-CIMS show several previously detected VOCs, but also clearly demonstrate the emission of HCN. This compound is presumably formed by the decomposition of cyanogenic glycosides which also form aldehyde and ketone byproducts. These results suggest that NI-CIMS may be a valuable tool for investigating VOCs and HCN release from vegetation.

  14. Neutron absorbed dose in a pacemaker CMOS

    Energy Technology Data Exchange (ETDEWEB)

    Borja H, C. G.; Guzman G, K. A.; Valero L, C. Y.; Banuelos F, A.; Hernandez D, V. M.; Vega C, H. R. [Universidad Autonoma de Zacatecas, Unidad Academica de Estudios Nucleares, Calle Cipres No. 10, Fracc. La Penuela, 98068 Zacatecas (Mexico); Paredes G, L., E-mail: candy_borja@hotmail.com [ININ, Carretera Mexico-Toluca s/n, 52750 Ocoyoacac, Estado de Mexico (Mexico)

    2011-11-15

    The absorbed dose due to neutrons by a Complementary Metal Oxide Semiconductor (CMOS) has been estimated using Monte Carlo methods. Eventually a person with a pacemaker becomes a patient that must be treated by radiotherapy with a linear accelerator; the pacemaker has integrated circuits as CMOS that are sensitive to intense and pulsed radiation fields. When the Linac is working in Bremsstrahlung mode an undesirable neutron field is produced due to photoneutron reactions; these neutrons could damage the CMOS putting the patient at risk during the radiotherapy treatment. In order to estimate the neutron dose in the CMOS a Monte Carlo calculation was carried out where a full radiotherapy vault room was modeled with a W-made spherical shell in whose center was located the source term of photoneutrons produced by a Linac head operating in Bremsstrahlung mode at 18 MV. In the calculations a phantom made of tissue equivalent was modeled while a beam of photoneutrons was applied on the phantom prostatic region using a field of 10 x 10 cm{sup 2}. During simulation neutrons were isotropically transported from the Linac head to the phantom chest, here a 1 {theta} x 1 cm{sup 2} cylinder made of polystyrene was modeled as the CMOS, where the neutron spectrum and the absorbed dose were estimated. Main damages to CMOS are by protons produced during neutron collisions protective cover made of H-rich materials, here the neutron spectrum that reach the CMOS was calculated showing a small peak around 0.1 MeV and a larger peak in the thermal region, both connected through epithermal neutrons. (Author)

  15. Biological Rhythms Workshop IB: neurophysiology of SCN pacemaker function.

    Science.gov (United States)

    Kuhlman, S J

    2007-01-01

    Pacemakers are functional units capable of generating oscillations that synchronize downstream rhythms. In mammals, the suprachiasmatic nucleus (SCN) of the hypothalamus is a circadian pacemaker composed of individual neurons that intrinsically express a near 24-hour rhythm in gene expression. Rhythmic gene expression is tightly coupled to a rhythm in spontaneous firing rate via intrinsic daily regulation of potassium current. Recent progress in the field indicates that SCN pacemaking is a specialized property that emerges from intrinsic features of single cells, structural connectivity among cells, and activity dynamics within the SCN. The focus of this chapter is on how Nature built a functional pacemaker from many individual oscillators that is capable of coordinating the daily timing of essential brain and physiological processes.

  16. Intra-cardiac pacemaker infection: Surgical management and outcome

    Directory of Open Access Journals (Sweden)

    Sameh Elameen

    2016-05-01

    Conclusion: Explantation of the complete pacemaker system has proved a reliable method to eradicate infection. Complications were rare, except in patients who present lately in a critically ill condition and septic shock.

  17. Successful pacing using a batteryless sunlight-powered pacemaker.

    Science.gov (United States)

    Haeberlin, Andreas; Zurbuchen, Adrian; Schaerer, Jakob; Wagner, Joerg; Walpen, Sébastien; Huber, Christoph; Haeberlin, Heinrich; Fuhrer, Juerg; Vogel, Rolf

    2014-10-01

    Today's cardiac pacemakers are powered by batteries with limited energy capacity. As the battery's lifetime ends, the pacemaker needs to be replaced. This surgical re-intervention is costly and bears the risk of complications. Thus, a pacemaker without primary batteries is desirable. The goal of this study was to test whether transcutaneous solar light could power a pacemaker. We used a three-step approach to investigate the feasibility of sunlight-powered cardiac pacing. First, the harvestable power was estimated. Theoretically, a subcutaneously implanted 1 cm(2) solar module may harvest ∼2500 µW from sunlight (3 mm implantation depth). Secondly, ex vivo measurements were performed with solar cells placed under pig skin flaps exposed to a solar simulator and real sunlight. Ex vivo measurements under real sunlight resulted in a median output power of 4941 µW/cm(2) [interquartile range (IQR) 3767-5598 µW/cm(2), median skin flap thickness 3.0 mm (IQR 2.7-3.3 mm)]. The output power strongly depended on implantation depth (ρSpearman = -0.86, P pacemaker powered by a 3.24 cm(2) solar module was implanted in vivo in a pig to measure output power and to pace. In vivo measurements showed a median output power of >3500 µW/cm(2) (skin flap thickness 2.8-3.84 mm). Successful batteryless VVI pacing using a subcutaneously implanted solar module was performed. Based on our results, we estimate that a few minutes of direct sunlight (irradiating an implanted solar module) allow powering a pacemaker for 24 h using a suitable energy storage. Thus, powering a pacemaker by sunlight is feasible and may be an alternative energy supply for tomorrow's pacemakers. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  18. ARTERIAL HYPERTENSION AND MEDICAL SUPPORT OF PATIENTS WITH PERMANENT PACEMAKERS

    Directory of Open Access Journals (Sweden)

    T. A. Derienko

    2016-06-01

    Full Text Available The review is devoted to clinical problems of arterial hypertension (AH in patients with implanted pacemakers (EKS and cardiac resynchronization therapy (CRT. Indications for pacemaker implantation and CRT are considered, especially the purpose and effectiveness of angiotensin-converting enzyme (ACE inhibitors, angiotensin II receptor antagonists (ARA, sartans, beta-blockers (BAB, diuretics, calcium channel blockers. We prove that the CRT and cardiac pacing and do not cancel, bur modify drug therapy of AH.

  19. ARTERIAL HYPERTENSION AND MEDICAL SUPPORT OF PATIENTS WITH PERMANENT PACEMAKERS

    OpenAIRE

    T. A. Derienko

    2016-01-01

    The review is devoted to clinical problems of arterial hypertension (AH) in patients with implanted pacemakers (EKS) and cardiac resynchronization therapy (CRT). Indications for pacemaker implantation and CRT are considered, especially the purpose and effectiveness of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists (ARA, sartans), beta-blockers (BAB), diuretics, calcium channel blockers. We prove that the CRT and cardiac pacing and do not cancel, bur modify...

  20. Pacemaker implantation after catheter ablation for atrial fibrillation.

    Science.gov (United States)

    Deshmukh, Abhishek J; Yao, Xiaoxi; Schilz, Stephanie; Van Houten, Holly; Sangaralingham, Lindsey R; Asirvatham, Samuel J; Friedman, Paul A; Packer, Douglas L; Noseworthy, Peter A

    2016-01-01

    Sinus node dysfunction requiring pacemaker implantation is commonly associated with atrial fibrillation (AF), but may not be clinically apparent until restoration of sinus rhythm with ablation or cardioversion. We sought to determine frequency, time course, and predictors for pacemaker implantation after catheter ablation, and to compare the overall rates to a matched cardioversion cohort. We conducted a retrospective analysis using a large US commercial insurance database and identified 12,158 AF patients who underwent catheter ablation between January 1, 2005 and December 31, 2012. Over an average of 2.4 years of follow-up, 5.6 % of the patients underwent pacemaker implantation. Using the Cox proportional hazards models, we found that risk of risks of pacemaker implantation was associated with older age (50-64 and ≥65 versus pacemaker implantation between ablation patients and propensity score (PS)-matched cardioversion groups (3.5 versus. 4.1 % at 1 year and 8.8 versus 8.3 % at 5 years). Overall, pacemaker implantation occurs in about 1/28 patients within 1 year of catheter ablation. The overall implantation rate decreased between 2005 and 2012. Furthermore, the risk after ablation is similar to cardioversion, suggesting that patients require pacing due to a common underlying electrophysiologic substrate, rather than the ablation itself.

  1. Impact of Pacemaker Lead Characteristics on Pacemaker Related Infection and Heart Perforation: A Nationwide Population-Based Cohort Study.

    Directory of Open Access Journals (Sweden)

    Yu-Sheng Lin

    Full Text Available Several risk factors for pacemaker (PM related complications have been reported. However, no study has investigated the impact of lead characteristics on pacemaker-related complications.Patients who received a new pacemaker implant from January 1997 to December 2011 were selected from the Taiwan National Health Insurance Database. This population was grouped according to the pacemaker lead characteristics in terms of fixation and insulation. The impact of the characteristics of leads on early heart perforation was analyzed by multivariable logistic regression analysis, while the impact of the lead characteristics on early and late infection and late heart perforation over a three-year period were analyzed using Cox regression. This study included 36,104 patients with a mean age of 73.4±12.5 years. In terms of both early and late heart perforations, there were no significant differences between groups across the different types of fixation and insulations. In the multivariable Cox regression analysis, the pacemaker-related infection rate was significantly lower in the active fixation only group compared to either the both fixation (OR, 0.23; 95% CI, 0.07-0.80; P = 0.020 or the passive fixation group (OR, 0.26; 95% CI, 0.08-0.83; P = 0.023.There was no difference in heart perforation between active and passive fixation leads. Active fixation leads were associated with reduced risk of pacemaker-related infection.

  2. Impact of Pacemaker Lead Characteristics on Pacemaker Related Infection and Heart Perforation: A Nationwide Population-Based Cohort Study.

    Science.gov (United States)

    Lin, Yu-Sheng; Chen, Tien-Hsing; Hung, Sheng-Ping; Chen, Dong Yi; Mao, Chun-Tai; Tsai, Ming-Lung; Chang, Shih-Tai; Wang, Chun-Chieh; Wen, Ming-Shien; Chen, Mien-Cheng

    2015-01-01

    Several risk factors for pacemaker (PM) related complications have been reported. However, no study has investigated the impact of lead characteristics on pacemaker-related complications. Patients who received a new pacemaker implant from January 1997 to December 2011 were selected from the Taiwan National Health Insurance Database. This population was grouped according to the pacemaker lead characteristics in terms of fixation and insulation. The impact of the characteristics of leads on early heart perforation was analyzed by multivariable logistic regression analysis, while the impact of the lead characteristics on early and late infection and late heart perforation over a three-year period were analyzed using Cox regression. This study included 36,104 patients with a mean age of 73.4±12.5 years. In terms of both early and late heart perforations, there were no significant differences between groups across the different types of fixation and insulations. In the multivariable Cox regression analysis, the pacemaker-related infection rate was significantly lower in the active fixation only group compared to either the both fixation (OR, 0.23; 95% CI, 0.07-0.80; P = 0.020) or the passive fixation group (OR, 0.26; 95% CI, 0.08-0.83; P = 0.023). There was no difference in heart perforation between active and passive fixation leads. Active fixation leads were associated with reduced risk of pacemaker-related infection.

  3. PEMISAHAN TANIN DAN HCN SECARA EKSTRAKSI DINGIN PADA PENGOLAHAN TEPUNG BUAH MANGROVE UNTUK SUBSTITUSI INDUSTRI PANGAN

    Directory of Open Access Journals (Sweden)

    Muryati Muryati

    2015-05-01

    Full Text Available             Tujuan dari penelitian ini adalah untuk mendapatkan kondisi optimal dalam  pemisahan tanin dan HCN pada pengolahan tepung buah tancang (Bruguiera gymnorhiza  sehingga dihasilkan tepung tancang yang aman digunakan untuk substitusi bahan baku industri pangan. Penelitian ini dilakukan dengan perlakuan pendahuluan yaitu diblansing dengan cara direndam dalam air panas suhu 95-100 0C dengan variabel waktu perendaman  5menit(mnt;  7,5 mnt; 10 mnt dan  15 mnt. Dari masing-masing  waktu blansing  dilanjutkan dengan pengupasan dan tanpa pengupasan (sebagai pembanding serta perendaman dan tanpa perendaman (pembanding. Ekstraksi dilakukan dengan perendaman dalam air selama 2 hari. Kondisi  penghilangan tanin dan HCN yang optimal dilakukan pada blansing 7,5 menit dilanjutkan pengupasan dan perendaman;  dihasilkan pengujian  kadar tanin 287,43 mg/kg; HCN 8,05 mg/kg dan karbohidrat 79,57 %. Hasil  pengujian tanin, HCN, cemaran  logam dan cemaran mikroba, memenuhi persyaratan mutu tepung singkong sehingga aman untuk bahan makanan.

  4. PEMISAHAN TANIN DAN HCN SECARA EKSTRAKSI DINGIN PADA PENGOLAHAN TEPUNG BUAH MANGROVE UNTUK SUBSTITUSI INDUSTRI PANGAN

    Directory of Open Access Journals (Sweden)

    Muryati Muryati

    2016-09-01

    Full Text Available             Tujuan dari penelitian ini adalah untuk mendapatkan kondisi optimal dalam  pemisahan tanin dan HCN pada pengolahan tepung buah tancang (Bruguiera gymnorhiza  sehingga dihasilkan tepung tancang yang aman digunakan untuk substitusi bahan baku industri pangan. Penelitian ini dilakukan dengan perlakuan pendahuluan yaitu diblansing dengan cara direndam dalam air panas suhu 95-100 0C dengan variabel waktu perendaman  5menit(mnt;  7,5 mnt; 10 mnt dan  15 mnt. Dari masing-masing  waktu blansing  dilanjutkan dengan pengupasan dan tanpa pengupasan (sebagai pembanding serta perendaman dan tanpa perendaman (pembanding. Ekstraksi dilakukan dengan perendaman dalam air selama 2 hari. Kondisi  penghilangan tanin dan HCN yang optimal dilakukan pada blansing 7,5 menit dilanjutkan pengupasan dan perendaman;  dihasilkan pengujian  kadar tanin 287,43 mg/kg; HCN 8,05 mg/kg dan karbohidrat 79,57 %. Hasil  pengujian tanin, HCN, cemaran  logam dan cemaran mikroba, memenuhi persyaratan mutu tepung singkong sehingga aman untuk bahan makanan. 

  5. Real-time monitoring of hydrogen cyanide (HCN) and ammonia (NH3) emitted by Pseudomonas aeruginosa

    NARCIS (Netherlands)

    Neerincx, A.H.; Mandon, J.; Ingen, J. van; Arslanov, D.D.; Mouton, J.W.; Harren, F.J.; Merkus, P.J.F.M.; Cristescu, S.M.

    2015-01-01

    We present the real-time monitoring of hydrogen cyanide (HCN) production from Pseudomonas aeruginosa (P. aeruginosa) strains in vitro, using laser-based photoacoustic spectroscopy. Simultaneously, the production of ammonia (NH3) was measured, and the influence of different factors (e.g. the medium,

  6. The HCN-Water Ratio in the Planet Formation Region of Disks

    NARCIS (Netherlands)

    Najita, J.; Carr, J.; Pontoppidan, K.; Salyk, C.; Dishoeck, van E.F.; Blake, G.

    2013-01-01

    We find a trend between the mid-infrared HCN/H$_{2}$O flux ratio and submillimeter disk mass among T Tauri stars in Taurus. While it may seem puzzling that the molecular emission properties of the inner disk ({lt}few AU) are related to the properties of the outer disk (beyond ~{}20 AU) probed by the

  7. Hypoosmotic cell swelling as a novel mechanism for modulation of cloned HCN2 channels

    DEFF Research Database (Denmark)

    Calloe, Kirstine; Elmedyb, Pernille; Olesen, Søren-Peter

    2005-01-01

    with hypoosmotic media. This indicates that cell swelling and not a change in ionic strength of the media, caused the observed swelling-induced increase in current. The increase in HCN2 current induced by cell swelling could be abolished by cytochalasin D treatment, indicating that an intact F-actin cytoskeleton...

  8. High Accuracy ab Initio Calculations of Rotational-Vibrational Levels of the HCN/HNC System.

    Science.gov (United States)

    Makhnev, Vladimir Yu; Kyuberis, Aleksandra A; Zobov, Nikolai F; Lodi, Lorenzo; Tennyson, Jonathan; Polyansky, Oleg L

    2018-02-08

    Highly accurate ab initio calculations of vibrational and rotational-vibrational energy levels of the HCN/HNC (hydrogen cyanide/hydrogen isocyanide) isomerising system are presented for several isotopologues. All-electron multireference configuration interaction (MRCI) electronic structure calculations were performed using basis sets up to aug-cc-pCV6Z on a grid of 1541 geometries. The ab initio energies were used to produce an analytical potential energy surface (PES) describing the two minima simultaneously. An adiabatic Born-Oppenheimer diagonal correction (BODC) correction surface as well as a relativistic correction surface were also calculated. These surfaces were used to compute vibrational and rotational-vibrational energy levels up to 25 000 cm -1 which reproduce the extensive set of experimentally known HCN/HNC levels with a root-mean-square deviation σ = 1.5 cm -1 . We studied the effect of nonadiabatic effects by introducing opportune radial and angular corrections to the nuclear kinetic energy operator. Empirical determination of two nonadiabatic parameters results in observed energies up to 7000 cm -1 for four HCN isotopologues (HCN, DCN, H 13 CN, and HC 15 N) being reproduced with σ = 0.37 cm -1 . The height of the isomerization barrier, the isomerization energy and the dissociation energy were computed using a number of models; our best results are 16 809.4, 5312.8, and 43 729 cm -1 , respectively.

  9. Electron-impact rotational and hyperfine excitation of HCN, HNC, DCN and DNC

    Science.gov (United States)

    Faure, Alexandre; Varambhia, Hemal N.; Stoecklin, Thierry; Tennyson, Jonathan

    2007-12-01

    Rotational excitation of isotopologues of HCN and HNC by thermal electron-impact is studied using the molecular R-matrix method combined with the adiabatic-nuclei-rotation approximation. Rate coefficients are obtained for electron temperatures in the range 5-6000 K and for transitions among all levels up to J = 8. Hyperfine rates are also derived using the infinite-order-sudden scaling method. It is shown that the dominant rotational transitions are dipole-allowed, that is, those for which ΔJ = 1. The hyperfine propensity rule ΔJ = ΔF is found to be stronger than that in the case of He-HCN collisions. For dipole-allowed transitions, electron-impact rates are shown to exceed those for excitation of HCN by He atoms by six orders of magnitude. As a result, the present rates should be included in any detailed population model of isotopologues of HCN and HNC in sources where the electron fraction is larger than 10-6, for example, in interstellar shocks and comets.

  10. Ab initio potential-energy surface and rovibrational states of the HCN-HCl complex

    NARCIS (Netherlands)

    Avoird, A. van der; Pedersen, T.B.; Dhont, G.S.F.; Fernandez, B.; Koch, H.

    2006-01-01

    A four-dimensional intermolecular potential-energy surface has been calculated for the HCN-HCl complex, with the use of the coupled cluster method with single and double excitations and noniterative inclusion of triples. Data for more than 13 000 geometries were represented by an angular expansion

  11. Photodissociation of HCN and HNC isomers in the 7-10 eV energy range

    Energy Technology Data Exchange (ETDEWEB)

    Chenel, Aurelie; Roncero, Octavio, E-mail: octavio.roncero@csic.es [Instituto de Física Fundamental (IFF-CSIC), C.S.I.C., Serrano 123, 28006 Madrid (Spain); Aguado, Alfredo [Departamento de Química Física Aplicada (UAM), Unidad Asociada a IFF-CSIC, Facultad de Ciencias Módulo 14, Universidad Autónoma de Madrid, 28049 Madrid (Spain); Agúndez, Marcelino; Cernicharo, José [Instituto de Ciencia de Materiales de Madrid, CSIC, C/ Sor Juana Inés de la Cruz 3, 28049 Cantoblanco (Spain)

    2016-04-14

    The ultraviolet photoabsorption spectra of the HCN and HNC isomers have been simulated in the 7-10 eV photon energy range. For this purpose, the three-dimensional adiabatic potential energy surfaces of the 7 lowest electronic states, and the corresponding transition dipole moments, have been calculated, at multireference configuration interaction level. The spectra are calculated with a quantum wave packet method on these adiabatic potential energy surfaces. The spectra for the 3 lower excited states, the dissociative electronic states, correspond essentially to predissociation peaks, most of them through tunneling on the same adiabatic state. The 3 higher electronic states are bound, hereafter electronic bound states, and their spectra consist of delta lines, in the adiabatic approximation. The radiative lifetime towards the ground electronic states of these bound states has been calculated, being longer than 10 ns in all cases, much longer that the characteristic predissociation lifetimes. The spectra of HCN is compared with the available experimental and previous theoretical simulations, while in the case of HNC there are no previous studies to our knowledge. The spectrum for HNC is considerably more intense than that of HCN in the 7-10 eV photon energy range, which points to a higher photodissociation rate for HNC, compared to HCN, in astrophysical environments illuminated by ultraviolet radiation.

  12. Final generic environmental statement on the routine use of plutonium-powered cardiac pacemakers. Update of information on power sources for pacemakers

    International Nuclear Information System (INIS)

    1979-05-01

    The Final Environmental Statement on Routine Use of Plutonium-Powered Cardiac Pacemakers (FES) was issued in July 1976. Supplement 1, prepared in 1978, updates the FES with respect to power sources for pacemakers. Particular attention is given to the non-nuclear lithium batteries as alternatives to 238-Pu power sources in pacemakers. Supplement 1 also considers the current extent of pacemaker use and makeup of the patient population and concludes that the FES' conclusion is still valid that distribution of 238-Pu powered pacemakers for routine use should be authorized subject to specific conditions

  13. Probing highly obscured, self-absorbed galaxy nuclei with vibrationally excited HCN

    Science.gov (United States)

    Aalto, S.; Martín, S.; Costagliola, F.; González-Alfonso, E.; Muller, S.; Sakamoto, K.; Fuller, G. A.; García-Burillo, S.; van der Werf, P.; Neri, R.; Spaans, M.; Combes, F.; Viti, S.; Mühle, S.; Armus, L.; Evans, A.; Sturm, E.; Cernicharo, J.; Henkel, C.; Greve, T. R.

    2015-12-01

    We present high resolution (0.̋4) IRAM PdBI and ALMA mm and submm observations of the (ultra) luminous infrared galaxies ((U)LIRGs) IRAS 17208-0014, Arp220, IC 860 and Zw049.057 that reveal intense line emission from vibrationally excited (ν2 = 1) J = 3-2 and 4-3 HCN. The emission is emerging from buried, compact (r 5 × 1013 L⊙ kpc-2. These nuclei are likely powered by accreting supermassive black holes (SMBHs) and/or hot (>200 K) extreme starbursts. Vibrational, ν2 = 1, lines of HCN are excited by intense 14 μm mid-infrared emission and are excellent probes of the dynamics, masses, and physical conditions of (U)LIRG nuclei when H2 column densities exceed 1024 cm-2. It is clear that these lines open up a new interesting avenue to gain access to the most obscured AGNs and starbursts. Vibrationally excited HCN acts as a proxy for the absorbed mid-infrared emission from the embedded nuclei, which allows for reconstruction of the intrinsic, hotter dust SED. In contrast, we show strong evidence that the ground vibrational state (ν = 0), J = 3-2and 4-3 rotational lines of HCN and HCO+ fail to probe the highly enshrouded, compact nuclear regions owing to strong self- and continuum absorption. The HCN and HCO+ line profiles are double-peaked because of the absorption and show evidence of non-circular motions - possibly in the form of in- or outflows. Detections of vibrationally excited HCN in external galaxies are so far limited to ULIRGs and early-type spiral LIRGs, and we discuss possible causes for this. We tentatively suggest that the peak of vibrationally excited HCN emission is connected to a rapid stage of nuclear growth, before the phase of strong feedback. Based on observations carried out with the IRAM Plateau de Bure and ALMA Interferometers. IRAM is supported by INSU/CNRS (France), MPG (Germany), and IGN (Spain). ALMA is a partnership of ESO (representing its member states), NSF (USA), and NINS (Japan), together with NRC (Canada) and NSC and ASIAA

  14. Fourier-Transform Microwave and Millimeterwave Spectroscopy of the H2-HCN Molecular Complex

    Science.gov (United States)

    Tanaka, Keiichi; Harada, Kensuke; Sumiyoshi, Yoshihiro; Nakajima, Masakazu; Endo, Yasuki

    2015-06-01

    Fourier-Transform microwave (FTMW) spectroscopy has been applied to observe the J = 1 - 0 rotational transitions of the H2-HCN/DCN complexes containing both the para-H2 (IH2=0) and ortho-H2 (IH2=1) molecule Rotational spectra of H2-HCN/DCN up to J = 5 - 4 were also observed in the millimeter-wave (MMW) region below 180 GHz. Observed FTMW lines for H2-HCN/DCN split into hyperfine components due to the nuclear quadrupole interaction of N and D nuclei. For the ortho-H2 species, the hyperfine splitting due to the magnetic interaction between the hydrogen nuclear spin of ortho-H2 part (jH2=1, IH2=1) was also observed, but not for the para-H2 species (jH2=0, IH2=0). From the observed nuclear spin-spin coupling constants of ortho-H2 species, d = 21.90(47) and 24.66(68) kHz for HCN and DCN complexes, respectively, the average values of = 0.380(8) and 0.439(10) were derived indicating the nearly free rotation of H2 in the complex with jH2= 1 and kH2= 0. The nuclear quadrupole interaction constants due to N and D nuclei show that the HCN/DCN part executes a floppy motion with a large mean square amplitude of about 29/25 and 33/30 degree in the para and ortho species, respectively. From the observed rotational constants, the center-of-mass distances of H2 and HCN/DCN were derived to be 3.9617(5)/4.00356 (43) Å for the ortho species and 4.1589(13)/4.1596 (36) Å for the para species. The isotope effect on rotational constants confirmed the totally different configurations in the ortho and para species: H2 is attached to the H/D end of HCN/DCN for the para species, while to the N end for the ortho species, as suggested by IR spectroscopy and theoretical study. M. Ishiguro et al., Chem. Phys. Lett. 554, 33 (2012). M. Ishiguro et al., J. Chem. Phys. 115, 5155 (2001).

  15. Structural Insight into the Gene Expression Profiling of the hcn Operon in Pseudomonas aeruginosa.

    Science.gov (United States)

    Chowdhury, Nilkanta; Bagchi, Angshuman

    2017-07-01

    Pseudomonas aeruginosa is a common opportunistic human pathogen. It generally attacks immunosuppressed patients like AIDS, cancer, cystic fibrosis, etc. The virulence of P. aeruginosa is mediated by various virulence factors. One of such potential virulence factors is HCN synthesized by HCN synthase enzyme, which is encoded by the hcnABC operon. The expressions of the genes of this operon are regulated by three transcriptional regulators, viz., LasR, ANR, and RhlR. In our previous work, we analyzed the molecular details of the functionalities of LasR. In this work, we focused on ANR. ANR is a regulatory protein which belongs to the FNR family and works in anaerobic condition. ANR binds to the promoter DNA, named ANR box, as a dimer. The dimerization of this ANR protein is regulated by Fe 4 S 4 , an iron-sulfur cluster. This dimer of ANR (ANR-Fe 4 S 4 /ANR-Fe 4 S 4 ) recognizes and binds the promoter DNA sequence and regulates the transcription of this hcnABC operon. Till date, the biomolecular details of the interactions of ANR dimer with the promoter DNA are not fully understood. Thus, we built the molecular model of ANR-Fe 4 S 4 /ANR-Fe 4 S 4 . We docked the complex with the corresponding promoter DNA region. We analyzed the mode of interactions with the promoter DNA under different conditions. Thus, we tried to analyze the functionality of the ANR protein during the expressions of the genes of the hcnABC operon. So far, this is the first report to detail the molecular mechanism of the gene expression in P. aeruginosa.

  16. Identification of the molecular site of ivabradine binding to HCN4 channels.

    Science.gov (United States)

    Bucchi, Annalisa; Baruscotti, Mirko; Nardini, Marco; Barbuti, Andrea; Micheloni, Stefano; Bolognesi, Martino; DiFrancesco, Dario

    2013-01-01

    Ivabradine is a specific heart rate-reducing agent approved as a treatment of chronic stable angina. Its mode of action involves a selective and specific block of HCN channels, the molecular components of sinoatrial "funny" (f)-channels. Different studies suggest that the binding site of ivabradine is located in the inner vestibule of HCN channels, but the molecular details of ivabradine binding are unknown. We thus sought to investigate by mutagenesis and in silico analysis which residues of the HCN4 channel, the HCN isoform expressed in the sinoatrial node, are involved in the binding of ivabradine. Using homology modeling, we verified the presence of an inner cavity below the channel pore and identified residues lining the cavity; these residues were replaced with alanine (or valine) either alone or in combination, and WT and mutant channels were expressed in HEK293 cells. Comparison of the block efficiency of mutant vs WT channels, measured by patch-clamp, revealed that residues Y506, F509 and I510 are involved in ivabradine binding. For each mutant channel, docking simulations correctly explain the reduced block efficiency in terms of proportionally reduced affinity for ivabradine binding. In summary our study shows that ivabradine occupies a cavity below the channel pore, and identifies specific residues facing this cavity that interact and stabilize the ivabradine molecule. This study provides an interpretation of known properties of f/HCN4 channel block by ivabradine such as the "open channel block", the current-dependence of block and the property of "trapping" of drug molecules in the closed configuration.

  17. [Right heart failure after pacemaker implantation].

    Science.gov (United States)

    Gallego Galiana, Juan; López Castellanos, Genoveva; Gioia, Francesca; Ruiz Ortega, Raúl Antonio; Cobo Reinoso, Maria Eugenia; Manzano Espinosa, Luis

    2015-06-22

    Severe tricuspid regurgitation (TR) secondary to interference pacemaker (PM) cable is a rare cause of progressive right heart failure (HF), which can worsen patient outcomes. We present 3 clinical cases of right HF secondary to TR after PM implantation. In these patients the clinic is right HF, which can appear early, as in our second patient, or after years of implementation of the PM, as in the first and third patients. The diagnosis is confirmed by echocardiography, the most accurate 3D, followed by transesophageal. The 2D transthoracic can not detect it, because it has low sensitivity for TR associated with PM. Medical treatment is always the first choice, since any other procedure carries significant morbidity and mortality. Probably this is a condition that we will diagnose with increasing frequency, because there are more and more patients with devices and, at the same time, the diagnostic tools are improving. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  18. Patients exposure from fluoroscopic guided pacemaker implantation procedures

    Energy Technology Data Exchange (ETDEWEB)

    Alkhorayef, M.; Babikir, E. [King Saud University, College of Applied Sciences, Radiological Sciences Department, P. O. Box 10219, Riyadh 11433 (Saudi Arabia); Sulieman, A. [Prince Sattam bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P. O. Box 422, Alkharj 11942 (Saudi Arabia); Daar, E. [University of Jordan, Faculty of Science, Department of Physics, Amman 11942 (Jordan); Alnaaimi, M.; Alduaij, M. [Kuwait Cancer Control Centre, Department of Nuclear Medicine, Shwiekh (Kuwait); Bradley, D., E-mail: malkhorayef@ksu.edu.sa [University of Surrey, Centre for Nuclear and Radiation Physics, Guildford, Surrey, GU2 7XH (United Kingdom)

    2016-10-15

    A pacemaker, which is used for heart re synchronization with electrical impulses, is used to manage many clinical conditions. Recently, the frequency of the pacemaker implantation procedures increased 50% worldwide. During this procedure, patients and staff can be exposed to excessive radiation exposure. Wide range of doses was reported in previous studies, suggesting that optimization of this procedure is not fulfilled yet. This study aims to evaluate the patient and staff radiation doses during cardiac pacemaker procedure and quantify the patient effective dose. A total of 145 procedures were performed for five pacemakers procedures (VVI, VVIR, VVD, VVDR and DDDR) two hospitals were evaluated. Patients doses were measured using the kerma-area product meter. Effective doses were estimated using software based on Monte Carlo simulation from National Radiological Protection Board. The effective dose values were used to estimate the cancer risk from pacemaker procedure. Patients demographic data, exposure parameters for both fluoroscopy and radiography were quantified. The mean patients doses (Gy. cm{sup 2}) for VVI, VVIR, VVD, VVDR and DDDR was 1.52±0.13 (1.43-1.61), 3.28±2.34 (0.29-8.73), 3.04±1.67 (1.57-4.86), 6.04±2.326 and 19.2±3.6 (5.43-30.2), respectively, per procedure. The overall patients effective dose is 1.1 mSv per procedure. (Author)

  19. Effects of irradiation on the components of implantable pacemakers

    CERN Document Server

    Kawamura, S; Kuga, N; Shiba, T; Hirose, T; Fujimoto, H; Toyoshima, T; Hyodo, K; Matoba, M

    2003-01-01

    The purpose of this study was to examine the effects of irradiation on implantable pacemaker components. The pacemaker was divided into three components: lead wire and electrode, battery, and electrical circuit, and each component was irradiated by X-ray and electron beams, respectively. The pacemaker parameters were measured by both telemetry data of the programmer and directly measured data from the output terminal. The following results were obtained. For the lead wire and electrode, there was no effect on the pacemaker function due to irradiation by X-ray and electron beams. In the case of battery irradiation, there was no change in battery voltage or current up to 236 Gy X-ray dose. In the electrical circuit, the pacemaker reverted to the regular beating rate (fixed-rate mode) immediately after the start of X-ray irradiation, and it continued in this mode during irradiation. In patients with their own heartbeat rhythm, changing to the fixed-rate mode may cause dangerous conditions such as ventricular fib...

  20. Implantable Cardiac Pacemakers – 50 Years from the First Implantation

    Directory of Open Access Journals (Sweden)

    Ratko Magjarević

    2010-01-01

    Overview: Development of implantable cardiac pacemaker was enabled by another important invention, the silicon transistor. h ough the invention of suitable lithium cells as appropriate power supply was essential for prolongation of battery life cycle and for increased reliability of pacemakers, main milestones in the development were associated with technological breakthroughs in electronics: from transistors, which introduced such features as small size and low power consumption, to hybrid and integrated circuits, which enabled programmability, microprocessors, which added more options in programming (multiprogrammability, diagnostics and telemetry, and the ICT (information communication technology that enabled physicians remote access to patients and interrogation of their implantable devices. Conclusions: Implantable pacemakers are reliable devices indicated for a wide range of dif erent therapies of cardiac rhythm disorders and heart failure. h ere is still a lot to learn about the physiology of a normal heart and even more about the failing heart. Modern pacemakers provide physicians valuable information from pacemakers’ memory via the built-in telemetry system. h ese information help physicians to better understand pathologic processes within the heart, thus contributing to the development of new ideas for treatment of diseases and for precise tailoring of the therapy to the patient’s needs. Although implantable pacemakers have reached the level of mature technology, they will continue to develop with therapies and diagnostics to facilitate a higher quality of life.

  1. Safety of Laser Interstitial Thermal Therapy in Patients With Pacemakers.

    Science.gov (United States)

    Grewal, Sanjeet S; Gorny, Krzysztof R; Favazza, Christopher P; Watson, Robert E; Kaufmann, Timothy J; Van Gompel, Jamie J

    2018-02-10

    Laser interstitial thermal therapy (LiTT) has increasingly been used as a treatment option for medically refractory epilepsy, tumors, and radiation necrosis. The use of LiTT requires intraoperative magnetic resonance (MR) thermography. This can become an issue in patients with other implanted therapeutic devices such as pacemakers and vagal nerve stimulators due to concerns regarding increases in the specific absorption rate (SAR). This is a technical case report demonstrating a successfully and safely performed LiTT in a 1.5-T magnetic resonance imaging (MRI) in a patient with a pacemaker for mesial temporal sclerosis. An 83-yr-old gentleman who had an implanted cardiac pacemaker presented with medically intractable epilepsy and was confirmed to have mesial temporal sclerosis on imaging. Video electroencephalography demonstrated concordant ipsilateral seizures and semiology. He underwent LiTT for ablation of the mesial temporal lobe. This was performed with the below described protocol with a cardiology nurse monitoring the patient's cardiac condition and a physicist monitoring SAR, and MR imaging quality without any adverse events. This study reports on a protocol of cardiac and MR SAR to safely perform MR-guided LiTT in the setting of traditional pacemakers in patients who are not pacemaker dependent. Copyright © 2018 by the Congress of Neurological Surgeons

  2. Pacemaker Dependency after Cardiac Surgery: A Systematic Review of Current Evidence.

    Science.gov (United States)

    Steyers, Curtis M; Khera, Rohan; Bhave, Prashant

    2015-01-01

    Severe postoperative conduction disturbances requiring permanent pacemaker implantation frequently occur following cardiac surgery. Little is known about the long-term pacing requirements and risk factors for pacemaker dependency in this population. We performed a systematic review of the literature addressing rates and predictors of pacemaker dependency in patients requiring permanent pacemaker implantation after cardiac surgery. Using a comprehensive search of the Medline, Web of Science and EMBASE databases, studies were selected for review based on predetermined inclusion and exclusion criteria. A total of 8 studies addressing the endpoint of pacemaker-dependency were identified, while 3 studies were found that addressed the recovery of atrioventricular (AV) conduction endpoint. There were 10 unique studies with a total of 780 patients. Mean follow-up ranged from 6-72 months. Pacemaker dependency rates ranged from 32%-91% and recovery of AV conduction ranged from 16%-42%. There was significant heterogeneity with respect to the definition of pacemaker dependency. Several patient and procedure-specific variables were found to be independently associated with pacemaker dependency, but these were not consistent between studies. Pacemaker dependency following cardiac surgery occurs with variable frequency. While individual studies have identified various perioperative risk factors for pacemaker dependency and non-resolution of AV conduction disease, results have been inconsistent. Well-conducted studies using a uniform definition of pacemaker dependency might identify patients who will benefit most from early permanent pacemaker implantation after cardiac surgery.

  3. 77 FR 39924 - Effective Date of Requirement for Premarket Approval for Cardiovascular Permanent Pacemaker...

    Science.gov (United States)

    2012-07-06

    ... Approval for Cardiovascular Permanent Pacemaker Electrode AGENCY: Food and Drug Administration, HHS. ACTION... protocol (PDP) for the cardiovascular permanent pacemaker electrode. The Agency has summarized its findings... cardiovascular permanent pacemaker electrode. In accordance with section 515(b)(2)(A) of the FD&C Act, FDA...

  4. [TRENDS OF PERMANENT PACEMAKER IMPLANTATION IN A SINGLE CENTER OVER A 20-YEAR PERIOD].

    Science.gov (United States)

    Antonelli, Dante; Ilan, Limor Bushar; Freedberg, Nahum A; Feldman, Alexander; Turgeman, Yoav

    2015-05-01

    To review the changes in permanent pacemaker implantation indications, pacing modes and patients' demographics over a 20-year period. We retrospectively retrieved data on patients who underwent first implantation of the pacemaker between 1-1-1991 and 31-12-2010. One thousand and nine (1,009) patients underwent a first pacemaker implantation during that period; 535 were men (53%), their mean age was 74.6±19.5 years; the highest rate of implanted pacemaker was in patients ranging in age from 70-79 years, however there was an increasing number of patients aged over 80 years. The median survival time after initial pacemaker implantation was 8 years. Syncope was the most common symptom (62.5%) and atrioventricular block was the most common electrocardiographic indication (56.4%) leading to pacemaker implantation. There was increased utilization of dual chamber and rate responsive pacemakers over the years. There was no difference regarding mode selection between genders. Pacemaker implantation rates have increased over a 20-year period. Dual chamber replaced most of the single ventricular chamber pacemaker and rate responsive pacemakers became the norm. The data of a small volume center are similar to those reported in pacemaker surveys of high volume pacemaker implantation centers. They confirm adherence to the published guidelines for pacing.

  5. 77 FR 37570 - Effective Date of Requirement for Premarket Approval for a Pacemaker Programmer

    Science.gov (United States)

    2012-06-22

    ... Approval for a Pacemaker Programmer AGENCY: Food and Drug Administration, HHS. ACTION: Final rule. SUMMARY... approval application (PMA) or a notice of completion of a product development protocol (PDP) for pacemaker... for the pacemaker programmer (the August 2011 proposed rule). In accordance with section 515(b)(2)(A...

  6. Hyperpolarization-activated current, If, in mathematical models of rabbit sinoatrial node pacemaker cells

    NARCIS (Netherlands)

    Verkerk, Arie O.; Wilders, Ronald

    2013-01-01

    A typical feature of sinoatrial (SA) node pacemaker cells is the presence of an ionic current that activates upon hyperpolarization. The role of this hyperpolarization-activated current, If, which is also known as the "funny current" or "pacemaker current," in the spontaneous pacemaker activity of

  7. Radioisotope-powered cardiac pacemaker program. Clinical studies of the nuclear pacemaker model NU-5. Final report

    International Nuclear Information System (INIS)

    1980-06-01

    Beginning in February, 1970, the Nuclear Materials and Equipment Corporation (NUMEC) undertook a program to design, develop and manufacture a radioisotope powered cardiac pacemaker system. The scope of technical work was specified to be: establish system, component, and process cost reduction goals using the prototype Radioisotope Powered Cardiac Pacemaker (RCP) design and develop production techniques to achieve these cost reduction objectives; fabricate radioisotope powered fueled prototype cardiac pacemakers (RCP's) on a pilot production basis; conduct liaison with a Government-designated fueling facility for purposes of defining fueling requirements, fabrication and encapsulation procedures, safety design criteria and quality control and inspection requirements; develop and implement Quality Assurance and Reliability Programs; conduct performance, acceptance, lifetime and reliability tests of fueled RCP's in the laboratory; conduct liaison with the National Institutes of Health and with Government specified medical research institutions selected for the purpose of undertaking clinical evaluation of the RCP in humans; monitor and evaluate, on a continuing basis, all test data; and perform necessary safety analyses and tests. Pacemaker designs were developed and quality assurance and manufacturing procedures established. Prototype pacemakers were fabricated. A total of 126 radioisotope powered units were implanted and have been followed clinically for approximately seven years. Four (4) of these units have failed. Eighty-three (83) units remain implanted and satisfactorily operational. An overall failure rate of less than the target 0.15% per month has been achieved

  8. Automatic Capture Verification in Pacemakers (Autocapture – Utility and Problems

    Directory of Open Access Journals (Sweden)

    Ruth Kam

    2004-04-01

    Full Text Available The concept of a closed – loop feedback system, that would automatically assess pacing threshold and self -adjust pacing output to ensure consistent myocardial capture, has many appeals. Enhancing patient safety in cases of an unexpected rise in threshold, reduced current drain, hence prolonging battery longevity and reducing the amount of physician intervention required are just some of the advantages. Autocapture (AC is a proprietary algorithm developed by St Jude Medical CRMD, Sylmar, CA, USA, (SJM that was the first to commercially provide these automatic functions in a single chamber pacemaker (Microny and Regency, and subsequently in a dual chamber pacemaker (Affinity, Entity and Identity family of pacemakers. This article reviews the conditions necessary for AC verification and performance and the problems encountered in clinical practice.

  9. Pacemaker Placement in Patients with Stroke-Mediated Autonomic Dysregulation

    Directory of Open Access Journals (Sweden)

    Ali A. Alsaad

    2017-01-01

    Full Text Available Lateral medullary syndrome (LMS is an ischemic disease of the medulla oblongata, which involves the territory of the posterior inferior cerebellar artery. Lateral medullary syndrome is often missed as the cause of autonomic dysregulation in patients with recent brain stem stroke. Due to the location of the baroreceptor regulatory center in the lateral medulla oblongata, patients with LMS occasionally have autonomic dysregulation-associated clinical manifestations. We report a case of LMS-associated autonomic dysregulation. The case presented as sinus arrest and syncope, requiring permanent pacemaker placement. A dual-chamber pacemaker was placed, after failure of conservative measures to alleviate the patient’s symptoms. Our case shows the importance of recognizing LMS as a potential cause for life-threatening arrhythmias, heart block, and symptomatic bradycardia. Placement of permanent pacemaker may be necessary in some patients with LMS presenting with syncope, secondary to sinus arrest.

  10. Energy yields for hydrogen cyanide and formaldehyde syntheses - The HCN and amino acid concentrations in the primitive ocean

    Science.gov (United States)

    Stribling, Roscoe; Miller, Stanley L.

    1987-01-01

    Simulated prebiotic atmospheres containing either CH4, CO, or CO2, in addition to N2, H2O, and variable amounts of H2, were subjected to the spark from a high-frequency Tesla coil, and the energy yields for the syntheses of HCN and H2CO were estimated from periodic (every two days) measurements of the compound concentrations. The mixtures with CH4 were found to yield the highest amounts of HCN, whereas the CO mixtures produced the highest yields of H2CO. These results model atmospheric corona discharges. From the yearly energy yields calculated and the corona discharge available on the earth, the yearly production rate of HCN was estimated; using data on the HCN production rates and the experimental rates of decomposition of amino acids through the submarine vents, the steady state amino acid production rate in the primitive ocean was calculated to be about 10 nmoles/sq cm per year.

  11. Pacemaker patients' perception of unsafe activities: a survey

    Directory of Open Access Journals (Sweden)

    Shafquat Azam

    2008-11-01

    Full Text Available Abstract Background Cardiac pacing is a recognized and widely used treatment for patients presenting with bradycardia. Physicians expect patients to return to normal activities almost immediately post implantation. However, patients themselves may perceive interference to pacemaker function by various routine activities and devices, and hence continue to lead restricted, disabled lives. The aim of this study is to determine if routine activities are perceived by pacemaker patients to interfere with their device function. Methods A descriptive cross sectional survey was carried out on consecutive patients at the pacemaker clinic at a public hospital in Karachi, Pakistan. A 47-question tool was developed and tested. Patients' perceptions of safety of performing various routine activities, along with socio-demographic data were recorded. Results The final sample included 93 adult patients (45% males. 41% were illiterate. 77.4% recalled receiving counselling at implantation, predominantly from the implanting physician and house staff. A considerable proportion of patients considered many routine activities unsafe including driving automobiles (28%, passing through metal detectors (31%, bending over (37%, and sleeping on the side of the pacemaker (30%. Also considered unsafe were operation of household appliances- TV/VCR (television/video cassette recorders (53%, irons (55% and electrical wall switches (56%. For nearly all variables neither literacy nor history of counselling improved incorrect perceptions. Conclusion This study shows that our pacemaker patients perceive many routine activities as unsafe, potentially leading to disabling life style modifications. The tremendous investment in pacemaker technology to improve patient performance is not going to pay dividends if patients continue to remain disabled due to incorrect perceptions. Further studies are required to determine the reasons for these misperceptions, and to determine if these

  12. [Development and research of temporary demand pacemaker with electrocardiosignal display].

    Science.gov (United States)

    Fan, Shounian; Jiang, Chenxi; Cai, Yunchang; Pan, Yangzhong; Yang, Tianhe; Wu, Qiang; Zheng, Yaxi; Liu, Xiaoqiao; Li, Shiying

    2004-08-01

    A temporary demand pacemaker with electrocardiosignal display is introduced in this paper. Double way low-noise electrocardiosignal preamplifier, amplitude limiter, high and low pass filter, 50 Hz notch filter, TTL level generator and stimulating pulse formation circuit are components of the hardware electrocircuit. The demand pacing and the electrocardiosignal display are separately controlled by the software in which the double microcontrollers communications technique is used. In this study, liquid crystal display is firstly used in body surface electrocardiosignal display or intracardial electrophysiologic signal display when the temporary demand pacemaker is installed and put into use. The machine has proven clinically useful and can be of wide appliation.

  13. Interference with the pacemakers of two workers at electricity substations.

    Science.gov (United States)

    Butrous, G S; Bexton, R S; Barton, D G; Male, J C; Camm, A J

    1983-11-01

    Pacemaker function was tested in two electricity substation workers exposed to high tension electric fields. High intensity electric fields induced reversion to the interference mode, producing in one case competitive rhythm and in the other inappropriately slow pacing which resulted in asymptomatic pauses of up to 2.5 s. A suit designed to shield the body from the effects of high intensity electric fields was tried and proved to be effective in protecting the pacemaker, allowing it to function normally in the substations.

  14. Navigating the Chemical Space of HCN Polymerization and Hydrolysis: Guiding Graph Grammars by Mass Spectrometry Data

    Directory of Open Access Journals (Sweden)

    Peter F. Stadler

    2013-09-01

    Full Text Available Polymers of hydrogen cyanide and their hydrolysis products constitute a plausible, but still poorly understood proposal for early prebiotic chemistry on Earth. HCN polymers are generated by the interplay of more than a dozen distinctive reaction mechanisms and form a highly complex mixture. Here we use a computational model based on graph grammars as a means of exploring the chemical spaces of HCN polymerization and hydrolysis. A fundamental issue is to understand the combinatorial explosion inherent in large, complex chemical systems. We demonstrate that experimental data, here obtained by mass spectrometry, and computationally predicted free energies together can be used to guide the exploration of the chemical space and makes it feasible to investigate likely pathways and chemical motifs even in potentially open-ended chemical systems.

  15. Transcatheter leadless pacemaker implantation in a patient with a transvenous dual-chamber pacemaker already in place.

    Science.gov (United States)

    Karjalainen, Pasi P; Nammas, Wail; Paana, Tuomas

    2016-01-01

    An 83-year-old lady had a DDDR pacemaker inserted in 1997 for symptomatic atrioventricular block. She underwent battery replacement in 2008. In 2010, she developed atrial fibrillation; the pacemaker was switched to VVIR mode. During the last 2years, ventricular lead threshold increased progressively. In December 2015, she presented for elective battery replacement. After successful battery replacement, the ventricular lead threshold remained high; therefore, we implanted a leadless transcatheter pacemaker, via femoral vein access, using a dedicated catheter delivery system. Electrical measurements at this stage revealed a pacing threshold of 0.28V at 0.24msec, and an impedance of 650Ω. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Chemical evolution. XXI - The amino acids released on hydrolysis of HCN oligomers

    Science.gov (United States)

    Ferris, J. P.; Wos, J. D.; Nooner, D. W.; Oro, J.

    1974-01-01

    Major amino acids released by hydrolysis of acidic and basic HCN oligomers are identified by chromatography as Gly, Asp, and diaminosuccinic acid. Smaller amounts of Ala, Ile and alpha-aminoisobutyric acid are also detected. The amino acids released did not change appreciably when the hydrolysis medium was changed from neutral to acidic or basic. The presence of both meso and d, l-diaminosuccinic acids was established by paper chromatography and on an amino acid analyzer.

  17. Lamellar γ-AlOOH architectures: Synthesis and application for the removal of HCN

    International Nuclear Information System (INIS)

    Hou Hongwei; Zhu You; Tang Gangling; Hu Qingyuan

    2012-01-01

    Using hexadecyl trimethyl ammonium bromide (CTAB) as a structure-directing agent and precipitator, the complete synthesis of lamellar γ-AlOOH architectures was successfully accomplished via a hydrothermal route. Different product structures were obtained by varying the molar ratio of aluminum nitrate and CTAB. Several techniques, including X-ray powder diffraction, Fourier transform infrared spectroscopy, field-emission scanning electron microscopy, transmission electron microscopy, and differential scanning calorimetry thermal analysis, were used to characterize the products. The effects of CTAB concentration, reaction temperature and time, and the molar ratio of Al 3+ /CTAB on the product morphologies were investigated. The nitrogen adsorption and desorption measurements indicated that the γ-AlOOH architectures possess a Brunauer–Emmett–Teller surface area of approximately 75.02 m 2 /g. It was also demonstrated that 10 mg γ-AlOOH architectures can remove 45.3% of the HCN (1.68 μg/mL) from model wastewater. When 0.03 mg/cig γ-AlOOH architectures were combined with cigarette paper, 8.12% of the present HCN was adsorbed. These results indicate that lamellar γ-AlOOH architectures may be a potential adsorbent for removing HCN from highly toxic pollutant solutions and harmful cigarette smoke. Highlights: ► Hexadecyl trimethyl ammonium bromide (CTAB) was used as a structure-directing agent and precipitator. ► Hydrothermal treatment enables growth of lamellar γ-AlOOH architectures. ► Lamellar γ-AlOOH architectures were demonstrated to exhibit high BET surface area and excellent adsorptive capacity. ► HCN in contaminated water and cigarette smoke can be effectively removed by the prepared lamellar γ-AlOOH superstructures.

  18. 'A pacemaker in my heart' -- classification of questions asked by pacemaker patients as a basis for intervention.

    Science.gov (United States)

    Rassin, Michal; Zilcha, Lia; Gross, Dalia

    2009-01-01

    The research aimed to identify the information patients find necessary, following pacemaker implantation. Although pacemaker devices do not have an adverse impact on lifestyle, they evoke anxiety related to the patient's activities and lifestyle. Survey. A convenience sample of participants was taken from the entire population of patients who attended the cardiology clinic between January-June 2007; 274 individual meetings were held with 123 pacemaker patients in three periods, reflecting different stages of recovery. In the meeting, patients were invoked to ask any question they may have regarding pacemaker implantation. The questions were collected from the patients and categorised chronologically, in accordance with their frequency in three periods, reflecting different stages of recovery. Eight categories, representing common issues and content were raised: motion and effort, environmental influences, personal hygiene, knowledge concerning the pacemaker operation, medical treatment, eating and drinking, clothing and general questions. Findings show that the common factor for most of the questions was the loss of confidence in the various aspects of life. The largest relative question proportion was in the motion and effort (27%) (e.g. may I swim? how many kg may I lift?) and environmental influences (26%) (e.g. may I use a cellular phone? may I use a shaving machine?). A coherent, continuous pattern was found, characterising the different points of measurement where, at the first point, questions were characterised as more existential, related to daily routine activities and as time passed and patients were exposed to non-daily activities and conditions, other questions were raised. Pacemaker implant guidance should be based upon experimental evidence, arranged according to each category's relative weight and take into account the patient's point of view.

  19. United States Historical Climatology Network (US HCN) monthly temperature and precipitation data

    Energy Technology Data Exchange (ETDEWEB)

    Daniels, R.C. [ed.] [Univ. of Tennessee, Knoxville, TN (United States). Energy, Environment and Resources Center; Boden, T.A. [ed.] [Oak Ridge National Lab., TN (United States); Easterling, D.R.; Karl, T.R.; Mason, E.H.; Hughes, P.Y.; Bowman, D.P. [National Climatic Data Center, Asheville, NC (United States)

    1996-01-11

    This document describes a database containing monthly temperature and precipitation data for 1221 stations in the contiguous United States. This network of stations, known as the United States Historical Climatology Network (US HCN), and the resulting database were compiled by the National Climatic Data Center, Asheville, North Carolina. These data represent the best available data from the United States for analyzing long-term climate trends on a regional scale. The data for most stations extend through December 31, 1994, and a majority of the station records are serially complete for at least 80 years. Unlike many data sets that have been used in past climate studies, these data have been adjusted to remove biases introduced by station moves, instrument changes, time-of-observation differences, and urbanization effects. These monthly data are available free of charge as a numeric data package (NDP) from the Carbon Dioxide Information Analysis Center. The NDP includes this document and 27 machine-readable data files consisting of supporting data files, a descriptive file, and computer access codes. This document describes how the stations in the US HCN were selected and how the data were processed, defines limitations and restrictions of the data, describes the format and contents of the magnetic media, and provides reprints of literature that discuss the editing and adjustment techniques used in the US HCN.

  20. An unusual case of pacemaker failure: complete disconnection of connector block and battery of a subpectorally implanted dual chamber pacemaker.

    Science.gov (United States)

    Mellert, Fritz; Esmailzadeh, Bahman; Schneider, Christian; Haushofer, Marcus; Schimpf, Rainer; Wolpert, Christian; Preusse, Claus J; Lüderitz, Berndt; Welz, Armin

    2002-04-01

    Local trauma to patients with implanted pacemaker devices may result in lead fracture or breakage of the lead socket with leakage of fluid into the connector system. This report describes an unusual case of complete entrance and exit block in a subpectorally implanted dual chamber pacemaker due to total disconnection and dislodgement of header block and battery part. Damage may be caused by an interaction of machine fatigue/manufacturing defective and fixation of the header with unusual movability of the battery, leading to breakage with intermittent malfunction and consecutive bradycardia and syncope.

  1. Prophylactic antibiotic for pacemaker surgery: what is optimal ...

    African Journals Online (AJOL)

    One of them, a bed-ridden patient developed severe pocket infection necessitating explantation and replacement 3 weeks later. Conclusions: We noted with satisfaction that short regime of prophylactic parentral ceftriaxone is effective in preventing pacemaker infection and there is no need for the long regimen. Niger Med J.

  2. 238Pu sources for cardiac pacemakers. II. Control

    International Nuclear Information System (INIS)

    Pottier, R.; Merigot, S.

    1976-01-01

    The method and the apparatus used for thermal (power) and radioactive control of radioisotopic sources for pacemakers are briefly described. The cybernetic system is also presented, which assumes almost automatically the monitoring of control, mechanical and electronic works, data processing, the measurements and computations, and the works related to quality control [fr

  3. A pacemaker for asystole in breath-holding spells

    OpenAIRE

    Legge, Leah M; Kantoch, Michal J; Seshia, Shashi S; Soni, Reeni

    2002-01-01

    Two cases of young children with frequent severe breath-holding spells complicated by prolonged asystole and seizures are reported. A ventricular pacemaker was implanted in each child, and both have subsequently remained free of syncope, although they continue to exhibit breath-holding behaviour.

  4. Deactivation of Pacemaker: Ethical Approach or Managerial Failure?

    Directory of Open Access Journals (Sweden)

    Macková Marie

    2017-12-01

    Full Text Available The decision about the deactivation of a pacemaker must be the result of a multicriteria decision-making process where the legal, ethical and effectiveness aspects must be taken into account and delicately balanced, while also considering the risk of managerial failure. Academic as well as professional discussion is necessary because there is a whole range of question marks on this topic and all the aspects mentioned above. The aim of this paper is to contribute to the debate by presenting the views of Czech physicians about the possibility of deactivation of the pacemaker in patients in terminal states. Based on the results of our research, the following steps are recommended to enable the deactivation of pacemakers in the Czech environment. Before the patient’s own indication of pacemaker therapy, treatment should be discussed with the patient in detail, including complications and deactivation options. Czech ethical consultant services should be set up in Czech hospitals. And last but not least, they should take an opinion on this issue as well as the professional society.

  5. [Mid-dermal elastolysis after insertion of a pacemaker].

    Science.gov (United States)

    Kottler, D; Lefèvre, A; Balme, B; Martin-Bourret, V; Zaharia, D; Skowron, F

    2015-11-01

    Mid-dermal elastolysis (MDE) is a rare acquired disease of elastic tissue histologically characterized by focal loss of elastic fibres within the mid-dermis. While the mechanisms leading to MDE remain unknown, increased degradation of elastic fibres may be involved. Many factors potentially triggering such degradation have been suggested. A 58-year-old man consulted for an asymptomatic reticulated eruption that began in the area of a pacemaker implanted six weeks earlier. The eruption consisted of erythematous polycyclic and coalescing macules with a wrinkled centre. Histopathology with orcein staining revealed focal loss of elastic fibres in the superficial reticular dermis only. Hypersensitivity reaction to any components of the pacemaker was ruled out by means of allergy exploration. Laboratory investigations including autoimmunological and haematological factors were unremarkable. A diagnosis was made of a reticular variant of MDE following insertion of a pacemaker. We report the second case of MDE following the insertion of a pacemaker, which could have triggered an inflammatory response directed specifically towards the elastic fibres. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  6. A pacemaker for asystole in breath-holding spells

    Science.gov (United States)

    Legge, Leah M; Kantoch, Michal J; Seshia, Shashi S; Soni, Reeni

    2002-01-01

    Two cases of young children with frequent severe breath-holding spells complicated by prolonged asystole and seizures are reported. A ventricular pacemaker was implanted in each child, and both have subsequently remained free of syncope, although they continue to exhibit breath-holding behaviour. PMID:20046299

  7. THE VARIABILITY OF HCN IN TITAN’S UPPER ATMOSPHERE AS IMPLIED BY THE CASSINI ION-NEUTRAL MASS SPECTROMETER MEASUREMENTS

    Energy Technology Data Exchange (ETDEWEB)

    Cui, J.; Cao, Y.-T. [National Astronomical Observatories, Chinese Academy of Sciences, Beijing 100012 (China); Lavvas, P. P. [Groupe de Spectroscopie Moleculaire et Atmospherique, Universite de Reims, Champagne-Ardenne, CNRS UMR F-7331 (France); Koskinen, T. T. [Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ 85721 (United States)

    2016-07-20

    HCN is an important constituent in Titan’s upper atmosphere, serving as the main coolant in the local energy budget. In this study, we derive the HCN abundance at the altitude range of 960–1400 km, combining the Ion-Neutral Mass Spectrometer data acquired during a large number of Cassini flybys with Titan. Typically, the HCN abundance declines modestly with increasing altitude and flattens to a near constant level above 1200 km. The data reveal a tendency for dayside depletion of HCN, which is clearly visible below 1000 km but weakens with increasing altitude. Despite the absence of convincing anti-correlation between HCN volume mixing ratio and neutral temperature, we argue that the variability in HCN abundance makes an important contribution to the large temperature variability observed in Titan’s upper atmosphere.

  8. ALMA INVESTIGATION OF VIBRATIONALLY EXCITED HCN/HCO{sup +}/HNC EMISSION LINES IN THE AGN-HOSTING ULTRALUMINOUS INFRARED GALAXY IRAS 20551−4250

    Energy Technology Data Exchange (ETDEWEB)

    Imanishi, Masatoshi [Subaru Telescope, 650 North A’ohoku Place, Hilo, HI 96720 (United States); Nakanishi, Kouichiro [National Astronomical Observatory of Japan, 2-21-1 Osawa, Mitaka, Tokyo 181-8588 (Japan); Izumi, Takuma, E-mail: masa.imanishi@nao.ac.jp [Institute of Astronomy, School of Science, The University of Tokyo, 2-21-1 Osawa, Mitaka, Tokyo 181-0015 (Japan)

    2016-07-01

    We present the results of ALMA Cycle 2 observations of the ultraluminous infrared galaxy IRAS 20551−4250 at HCN/HCO{sup +}/HNC J = 3–2 lines at both vibrational ground ( v = 0) and vibrationally excited ( v {sub 2} = 1) levels. This galaxy contains a luminous buried active galactic nucleus (AGN), in addition to starburst activity, and our ALMA Cycle 0 data revealed a tentatively detected vibrationally excited HCN v {sub 2} = 1f J = 4–3 emission line. In our ALMA Cycle 2 data, the HCN/HCO{sup +}/HNC J = 3–2 emission lines at v = 0 are clearly detected. The HCN and HNC v {sub 2} = 1f J = 3–2 emission lines are also detected, but the HCO{sup +} v {sub 2} = 1f J = 3–2 emission line is not. Given the high energy level of v {sub 2} = 1 and the resulting difficulty of collisional excitation, we compared these results with those of the calculation of infrared radiative pumping, using the available infrared 5–35 μ m spectrum. We found that all of the observational results were reproduced if the HCN abundance was significantly higher than that of HCO{sup +} and HNC. The flux ratio and excitation temperature between v {sub 2} = 1f and v = 0, after correction for possible line opacity, suggests that infrared radiative pumping affects rotational ( J -level) excitation at v = 0 at least for HCN and HNC. The HCN-to-HCO{sup +} v = 0 flux ratio is higher than those of starburst-dominated regions, and will increase even more when the derived high HCN opacity is corrected. The enhanced HCN-to-HCO{sup +} flux ratio in this AGN-hosting galaxy can be explained by the high HCN-to-HCO{sup +} abundance ratio and sufficient HCN excitation at up to J = 4, rather than the significantly higher efficiency of infrared radiative pumping for HCN than HCO{sup +}.

  9. In situ measurements of HCN and CH3CN over the Pacific Ocean: Sources, sinks, and budgets

    Science.gov (United States)

    Singh, H. B.; Salas, L.; Herlth, D.; Kolyer, R.; Czech, E.; Viezee, W.; Li, Q.; Jacob, D. J.; Blake, D.; Sachse, G.; Harward, C. N.; Fuelberg, H.; Kiley, C. M.; Zhao, Y.; Kondo, Y.

    2003-10-01

    We report the first in situ measurements of hydrogen cyanide (HCN) and methyl cyanide (CH3CN, acetonitrile) from the Pacific troposphere (0-12 km) obtained during the NASA Transport and Chemical Evolution over the Pacific (TRACE-P) airborne mission (February-April 2001). Mean HCN and CH3CN mixing ratios of 243 ± 118 (median 218) ppt and 149 ± 56 (median 138) ppt, respectively, were measured. These in situ observations correspond to a mean tropospheric HCN column of 4.2 × 1015 molecules cm-2 and a CH3CN column of 2.5 × 1015 molecules cm-2. This is in good agreement with the 0-12 km HCN column of 4.4 (±0.6) × 1015 molecules cm-2 derived from infrared solar spectroscopic observations over Japan. Mixing ratios of HCN and CH3CN were greatly enhanced in pollution outflow from Asia and were well correlated with each other as well as with known tracers of biomass combustion (e.g., CH3Cl, CO). Volumetric enhancement (or emission) ratios (ERs) relative to CO in free tropospheric plumes, likely originating from fires, were 0.34% for HCN and 0.17% for CH3CN. ERs with respect to CH3Cl and CO in selected biomass burning (BB) plumes in the free troposphere and in boundary layer pollution episodes are used to estimate a global BB source of 0.8 ± 0.4 Tg (N) yr-1 for HCN and 0.4 ± 0.1 Tg (N) yr-1 for CH3CN. In comparison, emissions from industry and fossil fuel combustion are quite small (atmospheric residence time of 5.0 months for HCN and 6.6 months for CH3CN is calculated. A global budget analysis shows that the sources and sinks of HCN and CH3CN are roughly in balance but large uncertainties remain in part due to a lack of observational data from the atmosphere and the oceans. Pathways leading to the oceanic (and soil) degradation of these cyanides are poorly known but are expected to be biological in nature.

  10. HCN elimination from vinyl cyanide: product energy partitioning, the role of hydrogen-deuterium exchange reactions and a new pathway.

    Science.gov (United States)

    Vázquez, Saulo A; Martínez-Núñez, Emilio

    2015-03-14

    The different HCN elimination pathways from vinyl cyanide (VCN) are studied in this paper using RRKM, Kinetic Monte Carlo (KMC), and quasi-classical trajectory (QCT) calculations. A new HCN elimination pathway proves to be very competitive with the traditional 3-center and 4-center mechanisms, particularly at low excitation energies. However, low excitation energies have never been experimentally explored, and the high and low excitation regions are dynamically different. The KMC simulations carried out using singly deuterated VCN (CH2=CD-CN) at 148 kcal mol(-1) show the importance of hydrogen-deuterium exchange reactions: both DCN and HCN will be produced in any of the 1,1 and 1,2 elimination pathways. The QCT simulation results obtained for the 3-center pathway are in agreement with the available experimental results, with the 4-center results showing much more excitation of the products. In general, our results seem to be consistent with a photodissociation mechanism at 193 nm, where the molecule dissociates (at least the HCN elimination pathways) in the ground electronic state. However, our simulations assume that internal conversion is a fully statistical process, i.e., the HCN elimination channels proceed on the ground electronic state according to RRKM theory, which might not be the case. In future studies it would be of interest to include the photo-prepared electronically excited state(s) in the dynamics simulations.

  11. HCN and HNC in comets C/2000 WM1 (Linear) and C/2002 C1 (Ikeya-Zhang).

    Science.gov (United States)

    Irvine, William M; Bergman, Per; Lowe, Thomas B; Matthews, Henry; McGonagle, Douglas; Nummelin, Albert; Owen, Toby

    2003-12-01

    Comets have been suggested as a possibly significant source of organic molecules to the early Earth. Hydrogen cyanide (HCN) is important in models of prebiotic chemistry, but may be difficult to form in the early terrestrial environment, while hydrogen isocyanide (HNC) is a 'classical' tracer of interstellar ion-molecule chemistry. We have observed both HCN and HNC in 2 recent comets, bringing the number of comets with published measurements of the HNC/HCN abundance ratio to 6. The HNC/HCN ratio in comet Ikeya-Zhang appears to increase with decreasing heliocentric distance, as was previously observed for comet Hale-Bopp, indicating that the HNC is produced at least in part by processes in the cometary coma (atmosphere) and is not simply a constituent of the nuclear ices. Both comets C/2000 WMI (Linear) and C/2002 C1 (Ikeya-Zhang) exhibit values of the HNC/HCN ratio that appear to be too large (approximately 0.09-0.19) to be matched by current models of coma chemistry. Cometary HNC may be a photodissociation product of organic grains or large organic polymers stored in the nucleus. We have also set a limit on the emission from the NO radical in comet WM1.

  12. Subjective consequences of permanent pacemaker therapy in patients under the age of retirement

    DEFF Research Database (Denmark)

    Mickley, H; Petersen, J; Nielsen, B L

    1989-01-01

    During a 5-year period, 81 patients ages 20 to 60 years old had implantation of a permanent cardiac pacemaker at the University Hospital, Odense. At follow-up, during 1985, the 73 survivors received a semi-structured questionnaire regarding subjective consequences of pacemaker therapy, and 72...... people (98.6%) agreed to participate. The mean pacing period (range) was 33.8 (11-72) months. Surgical intervention was required in 14 patients (19.4%) during follow-up. Regarding all symptoms 67 patients (93.1%) perceived benefit from the pacemaker. The effectiveness of cardiac pacing was most...... or a sensation of "impulses"/palpitations. To the majority (49 patients or 68.1%) pacemaker treatment did not influence quality of sexual activity. Six patients (8.3%) perceived an improvement, whereas a corresponding number felt deterioration in sexual activity following pacemaker implantation. Pacemaker...

  13. [Use of a temporal cardiac pacemaker in patients undergoing a major non-cardiac surgery].

    Science.gov (United States)

    Robles González, L; Vázquez Cabrales, A; Chiw Castillo, G; Sánchez Ibarra, J H; Pérez Redondo, H

    1978-01-01

    This is a report of the use of transvenous temporal pacemaker in 18 patients, with an average age of 59.3 years, that under want non cardiac major surgery. They did not have cardiac simptoms but had conduction abnormalities in the preoperative electrocardiogram. A pacemaker was implanted as a prophylaxis against arrythmia during the transoperative and postoperative periods. There was no incidence of transoperative arrythmia. Three patients died in the immediate postoperative period, two due to duffuse carcinomatosis and one due to diabetic acidosis. The average duration of the implanted pacemaker was 12.7 days, and three patients required a permanent pacemaker. Case five is exemplificative of the benefits of the temporal pacemaker, he had a preoperative electrocardiogram showing trifascicular block, he was taken to the operating room and anesthesia was induced, the patient had a cardiac arrest but recovered without secuela; latter on a temporal pacemaker was inserted and the patient had surgery without cardiac problems.

  14. Complex regional pain syndrome type I following pacemaker implantation

    Directory of Open Access Journals (Sweden)

    Sangita Kamath

    2015-12-01

    Full Text Available A 70-year-old woman presented with burning pain and swelling over dorsum of right hand and small joints of the fingers, associated with redness, feeling of warmth, and stiffness of the fingers, with inability to bend the fingers since 2 months. The symptoms were progressively increasing in intensity for the past 1 month. There was no history of fever or trauma to the hand. Two months before her symptoms started, she had permanent pacemaker implanted for complete heart block with syncope. She was hypertensive and was on regular medication. Her X-ray of right hand showed decreased bone density (demineralisation, suggestive of osteopenia. A diagnosis of reflex sympathetic dystrophy syndrome or complex regional pain syndrome type I induced by pacemaker insertion was made. She was treated with amitriptyline and steroids, after which her symptoms improved dramatically.

  15. Ventricular perforation by pacemaker lead repaired with two hemostatic devices.

    Science.gov (United States)

    Prestipino, Filippo; Nenna, Antonio; Casacalenda, Adele; Chello, Massimo

    2014-01-01

    Cardiac perforation is a rare, but potentially serious, complication of pacemaker implantation that may develop days or weeks after implantation. In the current case, 92-year-old man underwent permanent pacemaker implantation, but he presented 3 weeks later with severe symptoms. Computed tomography showed protrusion of the tip of the ventricular electrode through the right ventricle and into the chest wall. During an urgent surgical intervention, the lead was disconnected and extracted. A sealing hemostatic device and an hemostatic patch were applied to repair the ventricle; the procedure was uneventfull. This case demonstrates how the correct diagnosis of ventricular perforation is crucial, and should be followed immediately by surgical planning. The hemostatic patch is a valuable alternative to sutures in patients with thin and fragile ventricular wall, unable to undergo stitching. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. Transient apical dyskinesia with a pacemaker: Electrocardiographic features.

    Science.gov (United States)

    Núñez-Gil, Iván J; Feltes, Gisela I; Mejía-Rentería, Hernán D; Biagioni, Corina; De Agustín, J Alberto; Vivas, David; Fernández-Ortiz, Antonio

    2015-04-01

    Transient apical dyskinesia syndromes present features similar to acute coronary syndromes, but with normal coronary arteries and rapid complete resolution of wall motion alterations. We report the case of a 73-year-old woman who was admitted to hospital because of typical chest pain at rest after her brother's death. She had had a pacemaker implanted in 2001. Troponin levels were elevated and apical hypokinesia was shown by ventriculography and echocardiography, with normal coronary arteries. Evolving ECG alterations were observed in spite of the continued pacing rhythm. All these alterations were fully resolved after discharge. This case shows that, even in the presence of a pacemaker, evolving ECG alterations can be observed in Takotsubo syndrome. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  17. Leadless pacemaker extraction from a single-center perspective.

    Science.gov (United States)

    González Villegas, Elkin; Al Razzo, Omar; Silvestre García, Jorge; Mesa García, José

    2018-02-01

    Leadless pacemaker can be considered as a technical revolution in cardiac pacing devices, with clear advantages over conventional pacemakers in overcoming all lead-related complications. However, the management of these devices once they reach the end of life (EOL) of the battery is still controversial. In the next years, there will be an increase in the need to define a clear strategy in the management of leadless PM once they reach their EOL. Safe extraction of these devices will define in a great manner this strategy METHODS: We performed the extraction of three functioning Nanostim leadless pacemaker prophylactically in two females and one male patients as part of the Nanostim battery depletion field action recommendation. All patients had a prior transesophageal 3D echocardiography to determine the device intracardiac mobility and the extent of possible endothelialization. For the extractions, we used the Nanostim Retrieval Catheter S1RSIN (St. Jude Medical, St. Paul, MN, USA), which is a proprietary catheter provided by the manufacturing company based on a lasso. Complete extraction of the devices was achieved in all patients using a relatively short fluoroscopic time (16, 19, and 12 minutes). The extraction of leadless pacemakers can be considered as a safe and feasible procedure using the tools provided by the manufacturer and designed for the extraction. However, a very low threshold must be maintained to avoid any risk to the patients. Our extraction time ranges are between 983 and 1,070 days, nevertheless it is necessary to gather more long-term data to assess the feasibility and safety of these procedures. © 2017 Wiley Periodicals, Inc.

  18. Plethyzmography in assessment of hemodynamic results of pacemaker functions programming

    Science.gov (United States)

    Wojciechowski, Dariusz; Sionek, Piotr; Peczalski, Kazimierz; Janusek, Dariusz

    2011-01-01

    The paper presents potential role of plethyzmography in optimization of heart hemodynamic function during pacemaker programming. The assessment of optimal stroke volume in patients, with implanted dual chamber pacemaker (DDD), by plethyzmography was a goal of the study. The data were collected during pacing rhythm. 20 patients (8 female and 12 male, average 77.4+/-4.6 years) with dual chamber pacemaker (DDD) and with pacing rhythm during routine pacemaker control and study tests were incorporated in the study group. Hemodynamic parameters were assessed during modification of atrio-ventricular delay (AVD) for pacing rhythm of 70 bpm and 90 bpm. The time of atrioventricular was programmed with 20 ms steps within range 100-200 ms and data were recorded with two minutes delay between two consecutive measurements. Stroke volume (SV) and cardiac output (CO) were calculated from plethyzmographic signal by using Beatscope software (TNO Holand). Highest SV calculated for given pacing rhythm was named optimal stroke volume (OSV) and consequently highest cardiac output was named maximal cardiac output (MCO). The time of atrio-ventricular delay for OSV was named optimal atrioventricular delay (OAVD). The results have showed: mean values of OAVD for 70 bpm - 152+/-33 ms and for 90 bpm -149+/-35 ms, shortening of the mean OAVD time caused by increase of pacing rate from 70 bpm to 90 bpm what resulted in statistically significant decrease of OSV with not statistically significant increase of MCO. The analysis of consecutive patients revealed three types of response to increase of pacing rhythm: 1. typical-shortening of OAVD, 2. neutral-no change of OAVD and 3.atypical-lengthening of OAVD.

  19. Identification and functional characterization of cardiac pacemaker cells in zebrafish.

    Directory of Open Access Journals (Sweden)

    Federico Tessadori

    Full Text Available In the mammalian heart a conduction system of nodes and conducting cells generates and transduces the electrical signals evoking myocardial contractions. Specialized pacemaker cells initiating and controlling cardiac contraction rhythmicity are localized in an anatomically identifiable structure of myocardial origin, the sinus node. We previously showed that in mammalian embryos sinus node cells originate from cardiac progenitors expressing the transcription factors T-box transcription factor 3 (Tbx3 and Islet-1 (Isl1. Although cardiac development and function are strikingly conserved amongst animal classes, in lower vertebrates neither structural nor molecular distinguishable components of a conduction system have been identified, questioning its evolutionary origin. Here we show that zebrafish embryos lacking the LIM/homeodomain-containing transcription factor Isl1 display heart rate defects related to pacemaker dysfunction. Moreover, 3D reconstructions of gene expression patterns in the embryonic and adult zebrafish heart led us to uncover a previously unidentified, Isl1-positive and Tbx2b-positive region in the myocardium at the junction of the sinus venosus and atrium. Through their long interconnecting cellular protrusions the identified Isl1-positive cells form a ring-shaped structure. In vivo labeling of the Isl1-positive cells by transgenic technology allowed their isolation and electrophysiological characterization, revealing their unique pacemaker activity. In conclusion we demonstrate that Isl1-expressing cells, organized as a ring-shaped structure around the venous pole, hold the pacemaker function in the adult zebrafish heart. We have thereby identified an evolutionary conserved, structural and molecular distinguishable component of the cardiac conduction system in a lower vertebrate.

  20. Modeling the dual pacemaker system of the tau mutant hamster.

    Science.gov (United States)

    Oda, G A; Menaker, M; Friesen, W O

    2000-06-01

    Circadian pacemakers in many animals are compound. In rodents, a two-oscillator model of the pacemaker composed of an evening (E) and a morning (M) oscillator has been proposed based on the phenomenon of "splitting" and bimodal activity peaks. The authors describe computer simulations of the pacemaker in tau mutant hamsters viewed as a system of mutually coupled E and M oscillators. These mutant animals exhibit normal type 1 PRCs when released into DD but make a transition to a type 0 PRC when held for many weeks in DD. The two-oscillator model describes particularly well some recent behavioral experiments on these hamsters. The authors sought to determine the relationships between oscillator amplitude, period, PRC, and activity duration through computer simulations. Two complementary approaches proved useful for analyzing weakly coupled oscillator systems. The authors adopted a "distinct oscillators" view when considering the component E and M oscillators and a "system" view when considering the system as a whole. For strongly coupled systems, only the system view is appropriate. The simulations lead the authors to two primary conjectures: (1) the total amplitude of the pacemaker system in tau mutant hamsters is less than in the wild-type animals, and (2) the coupling between the unit E and M oscillators is weakened during continuous exposure of hamsters to DD. As coupling strength decreases, activity duration (alpha) increases due to a greater phase difference between E and M. At the same time, the total amplitude of the system decreases, causing an increase in observable PRC amplitudes. Reduced coupling also increases the relative autonomy of the unit oscillators. The relatively autonomous phase shifts of E and M oscillators can account for both immediate compression and expansion of activity bands in tau mutant and wild-type hamsters subjected to light pulses.

  1. Brain magnetic resonance imaging examination in a patient with non-magnetic resonance conditional pacemaker

    Directory of Open Access Journals (Sweden)

    Toshiko Nakai, MD

    2017-10-01

    Full Text Available Clinical dilemmas arise when patients with a non-magnetic resonance (MR conditional pacemaker are required to undergo magnetic resonance imaging (MRI. We encountered a pacemaker patient with debilitating non-motor symptoms of Parkinson׳s disease, who required an MRI prior to deep brain stimulation (DBS surgery. MRI was performed safely without adverse events despite the presence of a conventional pacemaker.

  2. Physiological effects of light on the human circadian pacemaker

    Science.gov (United States)

    Shanahan, T. L.; Czeisler, C. A.

    2000-01-01

    The physiology of the human circadian pacemaker and its influence and on the daily organization of sleep, endocrine and behavioral processes is an emerging interest in science and medicine. Understanding the development, organization and fundamental properties underlying the circadian timing system may provide insight for the application of circadian principles to the practice of clinical medicine, both diagnostically (interpretation of certain clinical tests are dependent on time of day) and therapeutically (certain pharmacological responses vary with the time of day). The light-dark cycle is the most powerful external influence acting upon the human circadian pacemaker. It has been shown that timed exposure to light can both synchronize and reset the phase of the circadian pacemaker in a predictable manner. The emergence of detectable circadian rhythmicity in the neonatal period is under investigation (as described elsewhere in this issue). Therefore, the pattern of light exposure provided in the neonatal intensive care setting has implications. One recent study identified differences in both amount of sleep time and weight gain in infants maintained in a neonatal intensive care environment that controlled the light-dark cycle. Unfortunately, neither circadian phase nor the time of day has been considered in most clinical investigations. Further studies with knowledge of principles characterizing the human circadian timing system, which governs a wide array of physiological processes, are required to integrate these findings with the practice of clinical medicine.

  3. Percutaneous Extraction of Transvenous Permanent Pacemaker/Defibrillator Leads

    Directory of Open Access Journals (Sweden)

    Stylianos Paraskevaidis

    2014-01-01

    Full Text Available Background. Widespread use of cardiovascular implantable electronic devices has inevitably increased the need for lead revision/replacement. We report our experience in percutaneous extraction of transvenous permanent pacemaker/defibrillator leads. Methods. Thirty-six patients admitted to our centre from September 2005 through October 2012 for percutaneous lead extraction were included. Lead removal was attempted using Spectranetics traction-type system (Spectranetics Corp., Colorado, CO, USA and VascoExtor countertraction-type system (Vascomed GmbH, Weil am Rhein, Germany. Results. Lead extraction was attempted in 59 leads from 36 patients (27 men, mean ± SD age 61±5 years, with permanent pacemaker (n=25, defibrillator (n=8, or cardiac resynchronisation therapy (n=3 with a mean ± SD implant duration of 50±23 months. The indications for lead removal included pocket infection (n=23, endocarditis (n=2, and ventricular (n=10 and atrial lead dysfunction (n=1. Traction device was used for 33 leads and countertraction device for 26 leads. Mean ± SD fluoroscopy time was 4±2 minutes/lead for leads implanted 48 months (n=21, P=0.03. Complete procedural success rate was 91.7% and clinical procedural success rate was 100%, while lead procedural success rate was 95%. Conclusions. In conclusion, percutaneous extraction of transvenous permanent pacemaker/defibrillator leads using dedicated removal tools is both feasible and safe.

  4. Minimally invasive resynchronization pacemaker: a pediatric animal model.

    Science.gov (United States)

    Jordan, Christopher P; Wu, Kyle; Costello, John P; Ishibashi, Nobuyuki; Krieger, Axel; Kane, Timothy D; Kim, Peter; Berul, Charles I

    2013-12-01

    We developed a minimally invasive epicardial pacemaker implantation method for infants and congenital heart disease patients for whom a transvenous approach is contraindicated. The piglet is an ideal model for technical development. In 5 piglets we introduced a needle through subxiphoid approach under thoracoscopic guidance, inserting a wire into the pericardial space. Pacing leads were affixed to the left ventricular free wall and left atrial appendage. After verifying functionality with atrial and ventricular pacing and sensing, animals were euthanized. Pacemaker monitoring occurred daily for 4 days in the fifth animal. Through minimally invasive pericardial access, we directly visualized and fixated pacing leads to the left ventricle and left atrial appendage, successfully pacing atrium and ventricle. Epicardial structures were visualized. One piglet had contralateral pneumothorax, which resolved with needle decompression. No other adverse events occurred. Minimally invasive epicardial pacemaker implantation in an infant model is feasible and effective. This innovation may be of value for pacing and resynchronization in infants and congenital heart disease patients. Survival studies with permanent generator implantation are under way. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. A Systematic Review of Economic Evaluations of Pacemaker Telemonitoring Systems.

    Science.gov (United States)

    López-Villegas, Antonio; Catalán-Matamoros, Daniel; Martín-Saborido, Carlos; Villegas-Tripiana, Irene; Robles-Musso, Emilio

    2016-02-01

    Over the last decade, telemedicine applied to pacemaker monitoring has undergone extraordinary growth. It is not known if telemonitoring is more or less efficient than conventional monitoring. The aim of this study was to carry out a systematic review analyzing the available evidence on resource use and health outcomes in both follow-up modalities. We searched 11 databases and included studies published up until November 2014. The inclusion criteria were: a) experimental or observational design; b) studies based on complete economic evaluations; c) patients with pacemakers, and d) telemonitoring compared with conventional hospital monitoring. Seven studies met the inclusion criteria, providing information on 2852 patients, with a mean age of 81 years. The main indication for device implantation was atrioventricular block. With telemonitoring, cardiovascular events were detected and treated 2 months earlier than with conventional monitoring, thus reducing length of hospital stay by 34% and reducing routine and emergency hospital visits as well. There were no significant intergroup differences in perceived quality of life or number of adverse events. The cost of telemonitoring was 60% lower than that of conventional hospital monitoring. Compared with conventional monitoring, cardiovascular events were detected earlier and the number or hospitalizations and hospital visits was reduced with pacemaker telemonitoring. In addition, the costs associated with follow-up were lower with telemonitoring. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  6. Aldosterone-Sensing Neurons in the NTS Exhibit State-Dependent Pacemaker Activity and Drive Sodium Appetite via Synergy with Angiotensin II Signaling.

    Science.gov (United States)

    Resch, Jon M; Fenselau, Henning; Madara, Joseph C; Wu, Chen; Campbell, John N; Lyubetskaya, Anna; Dawes, Brian A; Tsai, Linus T; Li, Monica M; Livneh, Yoav; Ke, Qingen; Kang, Peter M; Fejes-Tóth, Géza; Náray-Fejes-Tóth, Anikó; Geerling, Joel C; Lowell, Bradford B

    2017-09-27

    Sodium deficiency increases angiotensin II (ATII) and aldosterone, which synergistically stimulate sodium retention and consumption. Recently, ATII-responsive neurons in the subfornical organ (SFO) and aldosterone-sensitive neurons in the nucleus of the solitary tract (NTS HSD2 neurons) were shown to drive sodium appetite. Here we investigate the basis for NTS HSD2 neuron activation, identify the circuit by which NTS HSD2 neurons drive appetite, and uncover an interaction between the NTS HSD2 circuit and ATII signaling. NTS HSD2 neurons respond to sodium deficiency with spontaneous pacemaker-like activity-the consequence of "cardiac" HCN and Na v 1.5 channels. Remarkably, NTS HSD2 neurons are necessary for sodium appetite, and with concurrent ATII signaling their activity is sufficient to produce rapid consumption. Importantly, NTS HSD2 neurons stimulate appetite via projections to the vlBNST, which is also the effector site for ATII-responsive SFO neurons. The interaction between angiotensin signaling and NTS HSD2 neurons provides a neuronal context for the long-standing "synergy hypothesis" of sodium appetite regulation. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Pacemaker lead perforation of the right ventricle associated with Moraxella phenylpyruvica infection in a dog.

    Science.gov (United States)

    Ciavarella, A; Nimmo, J; Hambrook, L

    2016-04-01

    A 13-year-old neutered male Border Collie was presented with acute onset syncope, weakness and anorexia 10 months after transvenous pacemaker implantation. The patient was laterally recumbent, bradycardic (36 beats/min) and febrile (40.7°C) on presentation. An electrocardiogram (ECG) revealed recurrence of third-degree atrioventricular block with a ventricular escape rhythm. Fluoroscopy identified migration of the pacemaker tip through the apex of the right ventricle. Echocardiography failed to reveal any evidence of pericardial effusion or cardiac tamponade. Full postmortem was performed after euthanasia. The pacemaker lead had perforated the apex of the right ventricle and lodged in the right pleural space. Culture of blood (taken antemortem), pericardial sac, right ventricular wall (surrounding pacemaker lead), pacemaker lead tip and pericardial fluid revealed a pure growth of Moraxella phenylpyruvica. Bacteraemia associated with M. phenylpyruvica has never been reported in the dog, but sporadic cases are reported in humans. Infection could have resulted from either pre-existing myocarditis or opportunistic infection and bacteraemia post pacemaker implantation. Evaluation of the pacemaker function at regular intervals would allow early detection of poor pacemaker-to-myocardium contact, which would prompt further investigation of pacemaker lead abnormalities such as perforation. © 2016 Australian Veterinary Association.

  8. Interference of cardiac pacemaker and implantable cardioverter-defibrillator activity during electronic dental device use.

    Science.gov (United States)

    Roedig, Jason J; Shah, Jignesh; Elayi, Claude Samy; Miller, Craig S

    2010-05-01

    The authors conducted a study to determine if electromagnetic interference of cardiac pacemaker and implantable cardioverter-defibrillator (ICD) activity occurs during the operation of electronic dental devices. The authors tested nine electronic dental devices in vitro to assess their ability to interfere with the function of two pacemakers and two ICDs as determined by electrocardiographic telemetry. The pacing activity of both pacemakers and the dual-chamber ICD were inhibited during operation of the battery-operated composite curing light at between 2 and 10 centimeters from the generator or leads. The use of the ultrasonic scaler interfered with the pacing activity of the dual-chamber pacemaker at between 17 and 23 cm from the generator or leads, the single-chamber pacemaker at 15 cm from the generator or leads and both ICDs at 7 cm from the leads. The operation of the ultrasonic cleaning system interfered with the activity of the dual-chamber pacemaker at between 15 and 23 cm from the generator or leads, and of the single-chamber pacemaker at 12 cm. Operation of the electric toothbrush, electrosurgical unit, electric pulp tester, high- and low-speed handpieces, and an amalgamator did not alter pacing function. Select electronic dental devices interfere with pacemakers' and ICDs' sensing and pacing activity in vitro. Use of the ultrasonic scaler, ultrasonic cleaning system and battery-operated composite curing light may produce deleterious effects in patients who have pacemakers or ICDs.

  9. Successful Interventional Management for Pulmonary Arterial Injury Secondary to Pacemaker Implantation

    Directory of Open Access Journals (Sweden)

    Hiroyuki Tokue

    2016-01-01

    Full Text Available Subclavian vein puncture is a relatively fast and safe technique to access the right heart for placement of pacemaker leads. Hemothorax related to injury of the pulmonary artery (PA is a rare complication of subclavian vein access but can be life-threatening. We report a case of hemothorax occurring after subclavian vein puncture for pacemaker implantation. No cases of transcatheter arterial embolization for PA injury secondary to pacemaker implantation have been reported. Understanding of this rare complication after pacemaker implantation along with its specific clinical presentation may lead to early diagnosis and intervention.

  10. Multiple photoreceptor systems control the swim pacemaker activity in box jellyfish

    DEFF Research Database (Denmark)

    Garm, Anders Lydik; Mori, S.

    2009-01-01

    Like all other cnidarian medusae, box jellyfish propel themselves through the water by contracting their bell-shaped body in discrete swim pulses. These pulses are controlled by a swim pacemaker system situated in their sensory structures, the rhopalia. Each medusa has four rhopalia each...... with a similar set of six eyes of four morphologically different types. We have examined how each of the four eye types influences the swim pacemaker. Multiple photoreceptor systems, three of the four eye types, plus the rhopalial neuropil, affect the swim pacemaker. The lower lens eye inhibits the pacemaker...

  11. Increased HCN channel driven inward rectification in benign cramp fasciculation syndrome.

    Science.gov (United States)

    Czesnik, Dirk; Howells, James; Negro, Francesco; Wagenknecht, Melanie; Hanner, Susanne; Farina, Dario; Burke, David; Paulus, Walter

    2015-11-01

    Muscle cramps are a common complaint associated with sudden painful involuntary contractions of a muscle. The mechanisms responsible for muscle cramps are still not clear. Axonal excitability and multi-unit electromyography studies were performed in 20 patients suffering from benign cramp fasciculation syndrome, not currently on medication. The measures of axonal excitability suggested greater inward rectification, indicative of an increase in Ih. Mathematical modelling suggested that the data were best explained by depolarization of the voltage dependence of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels. Parameters associated with polarization of resting membrane potential were not changed. These findings suggest that a role for HCN channels may become apparent during the rhythmic discharge associated with a voluntary contraction. Consistent with this view, patients had higher motor unit discharge rates than healthy controls during maximal voluntary effort. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  12. Signal detection circuit design of HCN measurement system based on TDLAS

    Science.gov (United States)

    He, Chungui; Zhang, Yujun; Chen, Chen; Lu, Yibing; Liu, Guohua; Gao, Yanwei; You, Kun; He, Ying; Zhang, Kai; Liu, Wenqing

    2016-10-01

    Hydrogen cyanide gas leakage may exist in the petrochemical industry, smelting plant, and other industrial processes, causing serious harm to the environment, and even threatening the safety of personnel. So the continuous detection of HCN gas plays an important role in the prevention of risk in production process and storage environment that existing hydrogen cyanide gas. The Tunable Diode Laser Technology (TDLAS) has advantages of non-contact, high sensitivity, high selectivity, and fast response time, etc., which is one of the ideal method of gas detection technologies and can be used to measure the hydrogen cyanide concentration. This paper studies the HCN detection system based on TDLAS technology, selects the absorption lines of hydrogen cyanide in 6539.12cm-1, and utilizes the center wavelength of 1.529μm distributed feedback (DFB) laser as a light source. It is discussed in detail on technical requirements of a high frequency modulated laser signal detection circuit, including noise level, gain, and bandwidth. Based on the above theory, the high frequency modulation preamplifier circuit and main amplifier circuit are designed for InGaAs photoelectric detector. The designed circuits are calculation analyzed with corresponding formula and simulation analyzed based on the Multisim software.

  13. The 7-channel FIR HCN interferometer on J-TEXT tokamak

    Science.gov (United States)

    Chen, W.; Gao, L.; Chen, J.; Li, Q.; Wang, Z. J.; Zhuang, G.

    2012-01-01

    A seven-channel far-infrared hydrogen cyanide (HCN) laser interferometer has been established aiming to provide the line integrated plasma density for the J-TEXT experimental scenarios. A continuous wave glow discharge HCN laser designed with a cavity length 3.4 m is used as the laser source with a wavelength of 337 μm and an output power up to 100 mW. The system is configured as a Mach-Zehnder type interferometer. Phase modulation is achieved by a rotating grating, with a modulation frequency of 10 kHz which corresponds to the temporal resolution of 0.1 ms. The beat signal is detected by TGS detector. The phase shift induced by the plasma is derived by the comparator with a phase sensitivity of 0.06 fringe. The experimental results measured by the J-TEXT interferometer are presented in details. In addition, the inversed electron density profile done by a conventional approach is also given. The kinematic viscosity of dimethyl silicone and vibration control is key issues for the system performance. The laser power stability under different kinematic viscosity of silicone oil is presented. A visible improvement of measured result on vibration reduction is shown in the paper.

  14. Measurements of hydrogen cyanide (HCN) and acetylene (C2H2) from the Infrared Atmospheric Sounding Interferometer (IASI)

    OpenAIRE

    Duflot V.; Hurtmans D.; Clarisse L.; R'honi Y.; Vigouroux C.; de Maziere M.; Mahieu E.; Servais C.; Clerbaux C.; Coheur P. F.

    2012-01-01

    Hydrogen cyanide (HCN) and acetylene (C2H2) are ubiquitous atmospheric trace gases with medium lifetime, which are frequently used as indicators of combustion sources and as tracers for atmospheric transport and chemistry. Because of their weak infrared absorption, overlapped by the CO2 Q branch near 720 cm−1, nadir sounders have up to now failed to measure these gases routinely. Taking into account CO2 line mixing, we provide for the first time extensive measurements of HCN and C2H2 total co...

  15. P-Loop Residues Critical for Selectivity in K+ Channels Fail to Confer Selectivity to Rabbit HCN4 Channels

    OpenAIRE

    D'Avanzo, Nazzareno; Pekhletski, Roman; Backx, Peter H.

    2009-01-01

    HCN channels are thought to be structurally similar to Kv channels, but show much lower selectivity for K+. The approximately 3.3 A selectivity filter of K+ channels is formed by the pore-lining sequence XT(V/I)GYG, with X usually T, and is held stable by key residues in the P-loop. Differences in the P-loop sequence of HCN channels (eg. the pore-lining sequence L478C479IGYG) suggest these residues could account for differences in selectivity between these channel families. Despite being expr...

  16. DFT coupled with NEGF study of ultra-sensitive HCN and HNC gases detection and distinct I-V response based on phosphorene.

    Science.gov (United States)

    Pang, Jiu; Yang, Qun; Ma, Xiaosong; Wang, Liming; Tan, Chunjian; Xiong, Daxi; Ye, Huaiyu; Chen, Xianping

    2017-11-22

    The sensing performances of pristine and X-doped phosphorene substrates (X = Al, Si, and S atoms) toward the adsorption of the toxic gases HCN and HNC were systematically investigated by first-principles simulations. The numerical results show that the pristine phosphorene is sensitive to HCN and HNC molecules with moderate adsorption energy, excellent charge transfer, high sensitivity and selectivity, implying its potential applications as excellent HCN and HNC sensors. In addition, the Al-doped phosphorene exhibits extremely high reactive activity toward HCN and HNC gases; thus, it has potential for use as a metal-free catalyst for activating or catalyzing HCN or HNC adsorbates. Moreover, the transport properties, i.e., current-voltage (I-V) characteristics, were calculated by the non-equilibrium Green's function (NEGF) method within the framework of the density functional theory (DFT). The obtained results reveal that the adsorbed HCN or HNC gas molecules have a remarkable impact on the electronic conductivity of phosphorene, and the zigzag direction of phosphorene is more sensitive to gas molecules than the armchair direction. The combination of the high sensitivity, superior selectivity, and moderate adsorption energy of pristine phosphorene toward HCN or HNC gas molecules adsorption, makes phosphorene an excellent candidate for HCN and HNC sensors.

  17. Connectivity of Pacemaker Neurons in the Neonatal Rat Superficial Dorsal Horn

    Science.gov (United States)

    Ford, Neil C.; Arbabi, Shahriar; Baccei, Mark L.

    2014-01-01

    Pacemaker neurons with an intrinsic ability to generate rhythmic burst-firing have been characterized in lamina I of the neonatal spinal cord, where they are innervated by high-threshold sensory afferents. However, little is known about the output of these pacemakers, as the neuronal populations which are targeted by pacemaker axons have yet to be identified. The present study combines patch clamp recordings in the intact neonatal rat spinal cord with tract-tracing to demonstrate that lamina I pacemaker neurons contact multiple spinal motor pathways during early life. Retrograde labeling of premotor interneurons with the trans-synaptic virus PRV-152 revealed the presence of burst-firing in PRV-infected lamina I neurons, thereby confirming that pacemakers are synaptically coupled to motor networks in the spinal ventral horn. Notably, two classes of pacemakers could be distinguished in lamina I based on cell size and the pattern of their axonal projections. While small pacemaker neurons possessed ramified axons which contacted ipsilateral motor circuits, large pacemaker neurons had unbranched axons which crossed the midline and ascended rostrally in the contralateral white matter. Recordings from identified spino-parabrachial and spino-PAG neurons indicated the presence of pacemaker activity within neonatal lamina I projection neurons. Overall, these results show that lamina I pacemakers are positioned to regulate both the level of activity in developing motor circuits as well as the ascending flow of nociceptive information to the brain, thus highlighting a potential role for pacemaker activity in the maturation of pain and sensorimotor networks in the CNS. PMID:25380417

  18. ALMA HCN AND HCO{sup +} J  = 3 − 2 OBSERVATIONS OF OPTICAL SEYFERT AND LUMINOUS INFRARED GALAXIES: CONFIRMATION OF ELEVATED HCN-TO-HCO{sup +} FLUX RATIOS IN AGNS

    Energy Technology Data Exchange (ETDEWEB)

    Imanishi, Masatoshi; Nakanishi, Kouichiro [National Astronomical Observatory of Japan, National Institutes of Natural Sciences (NINS), 2-21-1 Osawa, Mitaka, Tokyo 181-8588 (Japan); Izumi, Takuma, E-mail: masa.imanishi@nao.ac.jp [Institute of Astronomy, School of Science, The University of Tokyo, 2-21-1 Osawa, Mitaka, Tokyo 181-0015 (Japan)

    2016-12-01

    We present the results of our ALMA observations of three active galactic nucleus (AGN)-dominated nuclei in optical Seyfert 1 galaxies (NGC 7469, I Zw 1, and IC 4329 A) and eleven luminous infrared galaxies (LIRGs) with various levels of infrared estimated energetic contributions by AGNs at the HCN and HCO{sup +} J  = 3 − 2 emission lines. The HCN and HCO{sup +} J  = 3 − 2 emission lines are clearly detected at the main nuclei of all sources, except for IC 4329 A. The vibrationally excited ( v {sub 2} = 1f) HCN J  = 3 − 2 and HCO{sup +} J  = 3 − 2 emission lines are simultaneously covered, and HCN v {sub 2} = 1f J  = 3 − 2 emission line signatures are seen in the main nuclei of two LIRGs, IRAS 12112+0305 and IRAS 22491–1808, neither of which shows clear buried AGN signatures in the infrared. If the vibrational excitation is dominated by infrared radiative pumping, through the absorption of infrared 14 μ m photons, primarily originating from AGN-heated hot dust emission, then these two LIRGs may contain infrared-elusive, but (sub)millimeter-detectable, extremely deeply buried AGNs. These vibrationally excited emission lines are not detected in the three AGN-dominated optical Seyfert 1 nuclei. However, the observed HCN v {sub 2} = 1f to v  = 0 flux ratios in these optical Seyferts are still consistent with the intrinsic flux ratios in LIRGs with detectable HCN v {sub 2} = 1f emission lines. The observed HCN-to-HCO{sup +} J  = 3 − 2 flux ratios tend to be higher in galactic nuclei with luminous AGN signatures compared with starburst-dominated regions, as previously seen at J  = 1 − 0 and J  = 4 − 3.

  19. Ab initio treatment of the chemical reaction precursor complex Br(2P)-HCN. 1. Adiabatic and diabatic potential surfaces

    NARCIS (Netherlands)

    Fishchuk, A.V.; Merritt, J.M.; Avoird, A. van der

    2007-01-01

    The three adiabatic potential surfaces of the Br(P-2)-HCN complex that correlate to the P-2 ground state of the Br atom were calculated ab initio. With the aid of a geometry-dependent diabatic mixing angle, also calculated ab initio, these adiabatic potential surfaces were transformed into a set of

  20. Interference of apex locator, pulp tester and diathermy on pacemaker function.

    Science.gov (United States)

    Sriman, Narayanan; Prabhakar, V; Bhuvaneswaran, J S; Subha, N

    2015-01-01

    The purpose of this study was to evaluate the effects of three electronic apex locators (EAL), electric pulp tester (EPT) and diathermy on pacemaker function in vitro. Three EALs: Root ZX (J. Morita Co., Tustin, CA, U.S.A.), Propex (Dentsply), Mini Apex locator (SybronEndo, Anaheim, CA, USA), EPT (Parkell pulp vitality tester Farmingdale, NY, USA) and Diathermy (Neomed 250 B) were tested for any interference with one pacemaker (A medtronic kappa KVDD901-serial number: PLE734632S). Directly connecting the pacemaker lead with the EAL/EPT/diathermy operating on a flat bench top, the telemetry wand was held directly over the pacemaker to monitor the pacing pattern for a period of 30 s. Pacemaker activity was continuously recorded on the telemetric programmer and electro gram (EGM) readings examined for pacer inhibition, noise reversion or inappropriate pacemaker pulses. All the three apex locators showed no pacing interference or background noise during its function or at rest. The EGM readings of EPT showed varying levels of background noise in between pacing however, this did not affect the normal pacing pattern and the pacing interval remained constant. EGM readings of diathermy showed an increase in the pacing interval (irregular pacing pattern) followed by complete inhibition of the pacing system. The tested EALs do not interfere with cardiac pacemaker function. The tested EPT showed varying levels of background noise but does not interfere with cardiac pacemaker function. Use of Diathermy interfered with the normal pacing, leading to complete inhibition of the pacing system.

  1. Sinus venosus atrial septal defect: a rare cause of misplacement of pacemaker leads

    Directory of Open Access Journals (Sweden)

    Bodian M

    2013-07-01

    Full Text Available Malick Bodian,1 Fatou Aw,1 Mouhamadou Bamba Ndiaye,1 Adama Kane,1 Modou Jobe,1 Alioune Tabane,1 Alassane Mbaye,2 Simon Antoine Sarr,1 Maboury Diao,1 Moustapha Sarr,1 Serigne Abdou Bâ1 1Department of Cardiology, Aristide Le Dantec Teaching Hospital, 2Grand Yoff General Hospital, Dakar, Senegal Abstract: Routine implantation of pacemakers and implantable cardioverter defibrillators is not commonly associated with complications. However, in some cases we see misplacement of pacemaker leads which is most often related to the presence of underlying cardiac anomalies. We report the case of misplacement of a pacemaker lead into the left ventricle of a 56-year-old patient paced in VVI/R mode and with a tined type pacemaker lead because of a symptomatic complete atrioventricular block. Electrocardiogram showed a pacemaker-generated rhythm with a right bundle branch block pattern. Chest X-ray showed the pacemaker lead located relatively high in relation to the diaphragm. Echocardiography visualized the pacemaker lead in the left heart chambers (atrium and ventricle, hence confirming its aberrant course. Further, the defect causing its passage to the left heart chambers was a sinus venosus atrial septal defect. The patient reported no complication related to the misplacement of the lead. After a brief period of oral anticoagulation, the lead was inserted into the right ventricle by percutaneous technique. Keywords: pacemaker, lead misplacement, sinus venosus atrial septal defect

  2. Pacemaker and radiotherapy in breast cancer: is targeted intraoperative radiotherapy the answer in this setting?

    International Nuclear Information System (INIS)

    Keshtgar, Mohammed RS; Eaton, David J; Reynolds, Claire; Pigott, Katharine; Davidson, Tim; Gauter-Fleckenstein, Benjamin; Wenz, Frederik

    2012-01-01

    We present the case of an 83 year old woman with a cardiac pacemaker located close in distance to a subsequently diagnosed invasive ductal carcinoma of the left breast. Short range intraoperative radiotherapy was given following wide local excision and sentinel node biopsy. The challenges of using ionising radiation with pacemakers is also discussed

  3. Dizzy Spells in a Patient with Hypertrophic Obstructive Cardiomyopathy and a Pacemaker

    OpenAIRE

    Wilschut, J. M.; de Voogt, W. G.

    2010-01-01

    Pacemaker syndrome represents the clinical consequences of the haemodynamic adverse effects of atrioventricular asynchrony during pacing. Patients suffering from hypertrophic cardiomyopathy may be particularly sensitive to these effects because of the importance of atrial systolic contribution to left ventricular diastolic filling. In this case report, we describe the symptoms and cause of pacemaker syndrome in a patient with hypertrophic obstructive cardiomyopathy.

  4. Subacute Right Ventricle Perforation by Pacemaker Lead Presenting with Left Hemothorax and Shock

    Directory of Open Access Journals (Sweden)

    Julianne Nichols

    2015-01-01

    Full Text Available Cardiac perforation by pacemaker is a rare but potentially fatal complication. Acute perforations occurring within twenty-four hours of insertion of pacemaker can lead to hemopericardium, cardiac tamponade, and death. Hemothorax occurring as an acute complication of pacemaker insertion is reported but extremely rare. Previously, hemothorax and shock as a subacute complication following pacemaker insertion have not been reported. We report the case of an 85-year-old patient who presented with shock from hemothorax caused by pacemaker perforation, two weeks after insertion. Device interrogation showed normal function. Chest X-ray and echocardiogram missed lead dislocation and the diagnosis was made on computed tomogram (CT of the chest. Following surgical repair, a new ventricular pacemaker was placed transvenously in the right ventricular septum. This case illustrates that CT scan of the chest should be performed in all patients in whom cardiac perforation by pacemaker is suspected but not diagnosed on chest X-ray and echocardiogram. Normal functioning of pacemaker on device interrogation does not exclude perforation.

  5. Subacute right ventricle perforation by pacemaker lead presenting with left hemothorax and shock.

    Science.gov (United States)

    Nichols, Julianne; Berger, Natalie; Joseph, Praveen; Datta, Debapriya

    2015-01-01

    Cardiac perforation by pacemaker is a rare but potentially fatal complication. Acute perforations occurring within twenty-four hours of insertion of pacemaker can lead to hemopericardium, cardiac tamponade, and death. Hemothorax occurring as an acute complication of pacemaker insertion is reported but extremely rare. Previously, hemothorax and shock as a subacute complication following pacemaker insertion have not been reported. We report the case of an 85-year-old patient who presented with shock from hemothorax caused by pacemaker perforation, two weeks after insertion. Device interrogation showed normal function. Chest X-ray and echocardiogram missed lead dislocation and the diagnosis was made on computed tomogram (CT) of the chest. Following surgical repair, a new ventricular pacemaker was placed transvenously in the right ventricular septum. This case illustrates that CT scan of the chest should be performed in all patients in whom cardiac perforation by pacemaker is suspected but not diagnosed on chest X-ray and echocardiogram. Normal functioning of pacemaker on device interrogation does not exclude perforation.

  6. Zebrafish heart as a model to study the integrative autonomic control of pacemaker function

    Science.gov (United States)

    Stoyek, Matthew R.; Quinn, T. Alexander; Croll, Roger P.

    2016-01-01

    The cardiac pacemaker sets the heart's primary rate, with pacemaker discharge controlled by the autonomic nervous system through intracardiac ganglia. A fundamental issue in understanding the relationship between neural activity and cardiac chronotropy is the identification of neuronal populations that control pacemaker cells. To date, most studies of neurocardiac control have been done in mammalian species, where neurons are embedded in and distributed throughout the heart, so they are largely inaccessible for whole-organ, integrative studies. Here, we establish the isolated, innervated zebrafish heart as a novel alternative model for studies of autonomic control of heart rate. Stimulation of individual cardiac vagosympathetic nerve trunks evoked bradycardia (parasympathetic activation) and tachycardia (sympathetic activation). Simultaneous stimulation of both vagosympathetic nerve trunks evoked a summative effect. Effects of nerve stimulation were mimicked by direct application of cholinergic and adrenergic agents. Optical mapping of electrical activity confirmed the sinoatrial region as the site of origin of normal pacemaker activity and identified a secondary pacemaker in the atrioventricular region. Strong vagosympathetic nerve stimulation resulted in a shift in the origin of initial excitation from the sinoatrial pacemaker to the atrioventricular pacemaker. Putative pacemaker cells in the sinoatrial and atrioventricular regions expressed adrenergic β2 and cholinergic muscarinic type 2 receptors. Collectively, we have demonstrated that the zebrafish heart contains the accepted hallmarks of vertebrate cardiac control, establishing this preparation as a viable model for studies of integrative physiological control of cardiac function by intracardiac neurons. PMID:27342878

  7. Iatrogenic perforation of the posterior mitral valve leaflet: a rare complication of pacemaker lead placement

    NARCIS (Netherlands)

    Konings, Thelma C.; Koolbergen, Dave R.; Bouma, Berto J.; Groenink, Maarten; Mulder, Barbara J.

    2008-01-01

    An inadvertently placed pacing lead in the left ventricle (LV) is a rare and often underdiagnosed complication of pacemaker implantation. We present a case of a 73-year-old woman who was evaluated for dyspnea, 10 years after transvenous pacemaker implantation. Transthoracic and transesophageal

  8. Twiddler-syndrom er en årsag til pacemaker elektrode displacering

    DEFF Research Database (Denmark)

    Grønbech, Keea Treu; Hansen, Michael Gilså

    2013-01-01

    Twiddler's syndrome is a rare cause of pacemaker electrode displacement. The displacement is caused by the patient's manipulation with the pacemaker, so the electrode is retracted. We describe a case of a 79-year-old overweight woman with a known psychiatric anamnesis, who was admitted twice...

  9. A forced desynchrony study of circadian pacemaker characteristics in seasonal affective disorder

    NARCIS (Netherlands)

    Koorengevel, Kathelijne M.; Beersma, Domien G.M.; den Boer, Johan; Hoofdakker, Rutger H. van den

    2002-01-01

    The circadian pacemaker is an endogenous clock that regulates oscillations in most physiological and psychological processes with a near 24-h period. In many species, this pacemaker triggers seasonal changes in behavior. The seasonality of symptoms and the efficacy of light therapy suggest

  10. Noise-induced effects on multicellular biopacemaker spontaneous activity: Differences between weak and strong pacemaker cells

    Science.gov (United States)

    Aghighi, Alireza; Comtois, Philippe

    2017-09-01

    Self-organization of spontaneous activity of a network of active elements is important to the general theory of reaction-diffusion systems as well as for pacemaking activity to initiate beating of the heart. Monolayer cultures of neonatal rat ventricular myocytes, consisting of resting and pacemaker cells, exhibit spontaneous activation of their electrical activity. Similarly, one proposed approach to the development of biopacemakers as an alternative to electronic pacemakers for cardiac therapy is based on heterogeneous cardiac cells with resting and spontaneously beating phenotypes. However, the combined effect of pacemaker characteristics, density, and spatial distribution of the pacemaker cells on spontaneous activity is unknown. Using a simple stochastic pattern formation algorithm, we previously showed a clear nonlinear dependency of spontaneous activity (occurrence and amplitude of spontaneous period) on the spatial patterns of pacemaker cells. In this study, we show that this behavior is dependent on the pacemaker cell characteristics, with weaker pacemaker cells requiring higher density and larger clusters to sustain multicellular activity. These multicellular structures also demonstrated an increased sensitivity to voltage noise that favored spontaneous activity at lower density while increasing temporal variation in the period of activity. This information will help researchers overcome the current limitations of biopacemakers.

  11. Infrared beat detection. Application to studying continuous HCN lasers (lambda=337μ)

    International Nuclear Information System (INIS)

    Mamadou El-Hadj Tidjani.

    1977-09-01

    The sensitivity of three detectors is compared using the beat detection of the continuous HCN laser (337μ). These three detectors are: a pyroelectric detector (T.G.S.), a tungsten-graphite needle-contact diode working at room temperature, and a GaAs photoconductor crystal working at liquid helium temperature (4.2K). The results obtained confirm that the respective detector sensitivity is better in beat detection than in video detection. Furthermore, among the three detectors investigated, the liquid helium cooled GaAs detector is the only one to be possibly envisaged for Thomson scattering experiments on Tokamaks. A systematic investigation of the laser stability shows that the sharpness of the line can be improved when increasing the mechanical stability or the laser support and in function of the pressure of the gas mixture inside the cavity, and the discharge current [fr

  12. Observation of the Formation of 0-π Pulses in Rotation Spectra of HCN and HBr

    Science.gov (United States)

    Chesnokov, E. N.; Kubarev, V. V.; Koshlyakov, P. V.

    We present the first experimental study of the formation of 0-π pulses in the far infrared region. Experiments were made in rotation spectra of HCN and HBr molecules using a Novosibirsk terahertz free electron laser (NovoFEL) as a source of optical pulses and ultra-fast Schottky diode as detector. Transformation of the shape of 0-π pulses was explored within a wide range of optical density. Throughout the range of experimental conditions, the observed pulse shape is well described by the analytical formula of Grisp (Phys. Rev. A 1 (1970) 1604). The observed effect can be used for time-domain measurements of the oscillator strength of the absorption line.

  13. A size upper limit and position for the HCN maser in CIT 6

    International Nuclear Information System (INIS)

    Carlstrom, J.E.; Welch, W.J.; Goldsmith, P.F.; Lis, D.C.

    1990-01-01

    A size upper limit and position for the HCN maser in CIT 6 were determined from interferometric observations with the Hat Creek millimeter array. The maser is located at alpha(1950) = 10 h 13 m 10.942 + or - 0.012 s and delta(1950) = + 30 deg 49 arcmin 16.75 arcsec + or - 0.15, coincident with the optical image taken from the Palomar plates, within the 3 arcsec uncertainty of the latter. The size of the maser emission region is less than 0.45 arcsec, approximately 180 AU at the distance estimated for CIT 6. The small size and strong emission (40 Jy) set a lower limit to the brightness temperature of 44,000 K, further strengthening the maser interpretation. 14 refs

  14. Diagnostics of a stationary MPD-type plasma jet with a HCN laser interferometer

    International Nuclear Information System (INIS)

    Graser, W.; Hoffmann, P.

    1975-01-01

    A HCN laser interferometer of the Ashby-Jephcott type operating at a wavelength of 337 μm was used to measure spatially resolved electron densities in a stationary MPD-type plasma jet with non-LTE behavior. Experiments were performed with and without superimposed magnetic fields up to 0.1 T at the exit of the plasma accelerator. Electron densities were obtained within the limits of 5times10 12 and 10 15 cm -3 with an accuracy better than 10%. Within the axially symmetric expanding plasma of about 15-cm average diameter and 50-cm length the radial resolving power came to less than 1 cm. So this technique has proved to be suitable to fill a gap in the diagnostics of stationary magnetized plasmas in the mean range of electron densities. (auth)

  15. PENGARUH LAMA PERENDAMAN KORO BENGU (Mucuna pruriens DALAM AIR KAPUR (Ca(OH2 TERHADAP KADAR ASAM SIANIDA (HCN

    Directory of Open Access Journals (Sweden)

    Arif Nurmawan Toro

    2014-03-01

    Full Text Available Latar belakang: Masyarakat Indonesia masih menitikberatkan pada komoditas kacang kedelai sebagai sumber utama protein, sedangkan pemanfaatan komoditas lain seperti koro benguk masih sangat minim. Minimnya pemanfaatan koro benguk ini karena di dalamnya terkandung senyawa alami berupa glokusida sianogenik yang dapat mengalami hidrolisis enzimatis menjadi asam sianida (HCN yang bersifat racun. Karena asam sianida bersifat asam yang sangat mudah larut dalam air, maka dilakukan perendaman menggunakan air kapur (Ca(OH2 bersifat basa yang dirasa cukup efektif menetralkan HCN dalam koro benguk.   Tujuan Penelitian: Mengetahui pengaruh lama perendaman koro benguk dalam air kapur terhadap kadar asam sianida dan mengetahui apakah air kapur lebih efektif dibandingkan air biasa dalam menetralkan HCN koro benguk.   Metode Penelitian: Penelitian dengan desain post test with control group. Obyek penelitian ini adalah koro benguk varietas benguk putih berumur 4-6 bulan yang diperoleh di Dusun Nogosari, Desa Purwosari, Kecamatan Girimulyo, Kabupaten Kulon Progo, DIY yang dilakukan perendaman dalam air sebagai kelompok kontrol dan air kapur 100 mg/L sebagai kelompok perlakuan selama 12, 24 dan 36 jam kemudian dilakukan destilasi. Destilat direaksikan dengan asam pikrat 1% kemudia diukur kadar HCN secara spektrofotometri.   Hasil: Kadar HCN  koro benguk pada perendaman dalam air selama 12 jam adalah 20,736 mg/kg, selama 24 jam adalah 19,348 mg/kg dan selama 36 jam adalah 16,786 mg/kg. Sedangkan kadar HCN pada perendaman air kapur 100 mg/L selama 12 jam adalah 19,020 mg/kg, selama 24 jam adalah 1,635 mg/kg dan selama 36 jam adalah 9,307 mg/kg. Hasil Uji ANOVA satu jalan pada kelompok perlakuan didapatkan nilai signifikansi 0.000 (p< 0.05.   Kesimpulan: Ada pengaruh bermakna lama perendaman koro benguk dalam air kapur terhadap kadar asam sianida. Perendaman dalam air kapur terbukti lebih efektif menetralkan asam sianida koro benguk dibandingkan perendaman dalam

  16. Dormancy alleviation by NO or HCN leading to decline of protein carbonylation levels in apple (Malus domestica Borkh.) embryos.

    Science.gov (United States)

    Krasuska, Urszula; Ciacka, Katarzyna; Dębska, Karolina; Bogatek, Renata; Gniazdowska, Agnieszka

    2014-08-15

    Deep dormancy of apple (Malus domestica Borkh.) embryos can be overcome by short-term pre-treatment with nitric oxide (NO) or hydrogen cyanide (HCN). Dormancy alleviation of embryos modulated by NO or HCN and the first step of germination depend on temporary increased production of reactive oxygen species (ROS). Direct oxidative attack on some amino acid residues or secondary reactions via reactive carbohydrates and lipids can lead to the formation of protein carbonyl derivatives. Protein carbonylation is a widely accepted covalent and irreversible modification resulting in inhibition or alteration of enzyme/protein activities. It also increases the susceptibility of proteins to proteolytic degradation. The aim of this work was to investigate protein carbonylation in germinating apple embryos, the dormancy of which was removed by pre-treatment with NO or HCN donors. It was performed using a quantitative spectrophotometric method, while patterns of carbonylated protein in embryo axes were analyzed by immunochemical techniques. The highest concentration of protein carbonyl groups was observed in dormant embryos. It declined in germinating embryos pre-treated with NO or HCN, suggesting elevated degradation of modified proteins during seedling formation. A decrease in the concentration of carbonylated proteins was accompanied by modification in proteolytic activity in germinating apple embryos. A strict correlation between the level of protein carbonyl groups and cotyledon growth and greening was detected. Moreover, direct in vitro carbonylation of BSA treated with NO or HCN donors was analyzed, showing action of both signaling molecules as protein oxidation agents. Copyright © 2014 Elsevier GmbH. All rights reserved.

  17. Stroke rehabilitation therapy in a patient with a cardiac pacemaker for chronic atrial fibrillation.

    Science.gov (United States)

    Muramatsu, Hikaru; Koike, Kimiko

    2003-12-01

    A 65-year-old man was implanted with an artificial pacemaker for chronic bradycardic atrial fibrillation associated with hypertensive heart disease. Five years after the pacemaker implantation, he suffered from a cerebral embolism. Approximately 4.5 months after the ictus, he was transferred to the rehabilitation ward. He had flaccid left hemiplegia and severe disuse syndrome. He could not sit and could tilt his head up for only two minutes because of severe orthostatic hypotension. By modulating the rate-responsive mode of the pacemaker every 2-4 weeks, we were able to rehabilitate the patient. Thus, the patient could sit in a wheelchair for more than three hours. This case emphasizes the importance of examining the mode and function of a previously implanted artificial pacemaker. In accord with varying rehabilitation programs and gradual improvement in a patient's physical activities, periodic modulation of a programmable pacemaker can lead to a better functional outcome during rehabilitation therapy.

  18. Development of an HCN dual laser for the interferometer on EAST

    Science.gov (United States)

    Li, Gen; Wei, Xuechao; Liu, Haiqing; Shen, Junjie; Jie, Yinxian; Lian, Hui; Zeng, Long; Zou, Zhiyong; Zhang, Jibo; Wang, Shouxin

    2017-08-01

    A two-color continuous wave (CW) discharge-pumped far-infrared (FIR) hydrogen cyanide (HCN) laser was developed as the source of an interferometer for measuring the line-averaged electron density in the Experimental Advanced Superconducting Tokamak (EAST). The output power of the dual laser system was about 120 mW from each laser on the 337 μm (0.89 THz) line. The polarization of each output beam was fixed using thin tungsten filaments and oscillated in the EH11 mode. Different megahertz intermediate frequencies (IF) and a slight frequency offset (˜1 MHz) were generated in this system to replace the traditional rotating grating with ˜10 kHz IF, and this can improve the time resolution of the interferometer significantly. The experimental result showed that different IF signals were obtained by successfully adjusting the cavity length. In particular, the beat frequency was captured at ˜1.3 MHz by a Schottky mixer when the length of the resonant cavities was changed by 5 μm by an automatic adjustment system. In order to study the character of IF, a long time record of the IF signal was carried out, and the IF signal could be stabilized for a few minutes in the range of 2 MHz to 3 MHz. A real-time IF stability control system was initially designed for long pulse discharge experiments on the EAST. The ˜MHz frequency response and good phase sensitivity of the dual laser HCN interferometer will allow the system to track fast density profiles and resolve fast MHD events, such as tearing/neoclassical tearing, disruptions, etc. Contributed paper, published as part of the Proceedings of the 3rd Domestic Electromagnetic Plasma Diagnostics Workshop, September 2016, Hefei, China.

  19. ALMA IMAGING OF HCN, CS, AND DUST IN ARP 220 AND NGC 6240

    Energy Technology Data Exchange (ETDEWEB)

    Scoville, Nick; Manohar, Swarnima; Murchikova, Lena [California Institute of Technology, MC 249-17, 1200 East California Boulevard, Pasadena, CA 91125 (United States); Sheth, Kartik [North American ALMA Science Center, National Radio Astronomy Observatory, 520 Edgemont Road, Charlottesville, VA 22901 (United States); Walter, Fabian; Zschaechner, Laura [Max-Planck-Institut fur Astronomie, Konigstuhl 17, D-69117 Heidelberg (Germany); Yun, Min [Department of Astronomy, University of Massachusetts, Amherst, MA 01003 (United States); Koda, Jin [Department of Physics and Astronomy, Stony Brook University, Stony Brook, NY 11794 (United States); Sanders, David; Barnes, Joshua [Institute for Astronomy, 2680 Woodlawn Drive, University of Hawaii, Honolulu, Hawaii, HI 96822 (United States); Thompson, Todd [Department of Astronomy, The Ohio State University, 140 West 18th Avenue, Columbus, OH 43210 (United States); Robertson, Brant; Tacconi, Linda; Narayanan, Desika [Department of Astronomy and Steward Observatory, University of Arizona, Tucson AZ 85721 (United States); Genzel, Reinhard; Davies, Richard [Max-Planck-Institut fur extraterrestrische Physik (MPE), Giessenbachstrasse, D-85748 Garching (Germany); Hernquist, Lars [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); Brown, Robert [National Radio Astronomy Observatory, 520 Edgemont Road, Charlottesville, VA 22901 (United States); Hayward, Christopher C. [TAPIR 350-17, California Institute of Technology, 1200 East California Boulevard, Pasadena, CA 91125 (United States); Kartaltepe, Jeyhan [National Optical Astronomy Observatory, 950 North Cherry Avenue, Tucson, AZ 85719 (United States); and others

    2015-02-10

    We report ALMA Band 7 (350 GHz) imaging at 0.''4-0.''6 resolution and Band 9 (696 GHz) at ∼0.''25 resolution of the luminous IR galaxies Arp 220 and NGC 6240. The long wavelength dust continuum is used to estimate interstellar medium masses for Arp 220 east and west and NGC 6240 of 1.9, 4.2, and 1.6 × 10{sup 9} M {sub ☉}within radii of 69, 65, and 190 pc. The HCN emission was modeled to derive the emissivity distribution as a function of radius and the kinematics of each nuclear disk, yielding dynamical masses consistent with the masses and sizes derived from the dust emission. In Arp 220, the major dust and gas concentrations are at radii less than 50 pc in both counter-rotating nuclear disks. The thickness of the disks in Arp 220 estimated from the velocity dispersion and rotation velocities are 10-20 pc and the mean gas densities are n{sub H{sub 2}}∼10{sup 5} cm{sup –3} at R <50 pc. We develop an analytic treatment for the molecular excitation (including photon trapping), yielding volume densities for both the HCN and CS emission with n {sub H2} ∼ 2 × 10{sup 5} cm{sup –3}. The agreement of the mean density from the total mass and size with that required for excitation suggests that the volume is essentially filled with dense gas, i.e., it is not cloudy or like swiss cheese.

  20. SUBMILLIMETER-HCN DIAGRAM FOR ENERGY DIAGNOSTICS IN THE CENTERS OF GALAXIES

    Energy Technology Data Exchange (ETDEWEB)

    Izumi, Takuma; Kohno, Kotaro [Institute of Astronomy, School of Science, The University of Tokyo, 2-21-1 Osawa, Mitaka, Tokyo 181-0015 (Japan); Aalto, Susanne [Department of Earth and Space Sciences, Chalmers University of Technology, Onsala Observatory, SE-439 94 Onsala (Sweden); Espada, Daniel; Martín, Sergio; Nakanishi, Kouichiro [Joint ALMA Observatory, Alonso de Córdova, 3107, Vitacura, Santiago 763-0355 (Chile); Fathi, Kambiz [Stockholm Observatory, Department of Astronomy, Stockholm University, AlbaNova Centre, SE-106 91 Stockholm (Sweden); Harada, Nanase; Hsieh, Pei-Ying; Matsushita, Satoki [Academia Sinica, Institute of Astronomy and Astrophysics, P.O. Box 23-141, Taipei 10617, Taiwan (China); Hatsukade, Bunyo; Imanishi, Masatoshi [National Astronomical Observatory of Japan, 2-21-1 Osawa, Mitaka, Tokyo 181-8588 (Japan); Krips, Melanie [Institut de Radio Astronomie Millimétrique, 300 rue de la Piscine, Domaine Universitaire, F-38406 St. Martin d’Hères (France); Meier, David S. [Department of Physics, New Mexico Institute of Mining and Technology, 801 Leroy Place, Soccoro, NM 87801 (United States); Nakai, Naomasa [Department of Physics, Faculty of Pure and Applied Sciences, University of Tsukuba, 1-1-1 Ten-nodai, Tsukuba, Ibaraki 305-8571 (Japan); Schinnerer, Eva [Max Planck Institute for Astronomy, Königstuhl 17, Heidelberg D-69117 (Germany); Sheth, Kartik [NASA, 300 E Street SW, Washington, DC 20546 (United States); Terashima, Yuichi [Department of Physics, Ehime University, 2-5 Bunkyo-cho, Matsuyama, Ehime 790-8577 (Japan); Turner, Jean L., E-mail: takumaizumi@ioa.s.u-tokyo.ac.jp [Department of Physics and Astronomy, UCLA, 430 Portola Plaza, Los Angeles, CA 90095-1547 (United States)

    2016-02-10

    Compiling data from literature and the Atacama Large Millimeter/submillimeter Array archive, we show enhanced HCN(4–3)/HCO{sup +}(4–3) and/or HCN(4–3)/CS(7–6) integrated intensity ratios in circumnuclear molecular gas around active galactic nuclei (AGNs) compared to those in starburst (SB) galaxies (submillimeter HCN enhancement). The number of sample galaxies is significantly increased from our previous work. We expect that this feature could potentially be an extinction-free energy diagnostic tool of nuclear regions of galaxies. Non-LTE radiative transfer modelings of the above molecular emission lines involving both collisional and radiative excitation, as well as a photon trapping effect, were conducted to investigate the cause of the high line ratios in AGNs. As a result, we found that enhanced abundance ratios of HCN to HCO{sup +} and HCN to CS in AGNs as compared to SB galaxies by a factor of a few to even ≳10 are a plausible explanation for the submillimeter HCN enhancement. However, a counterargument of a systematically higher gas density in AGNs than in SB galaxies can also be a plausible scenario. Although we cannot fully distinguish these two scenarios at this moment owing to an insufficient amount of multi-transition, multi-species data, the former scenario is indicative of abnormal chemical composition in AGNs. Regarding the actual mechanism to realize the composition, we suggest that it is difficult with conventional gas-phase X-ray-dominated region ionization models to reproduce the observed high line ratios. We might have to take into account other mechanisms such as neutral–neutral reactions that are efficiently activated in high-temperature environments and/or mechanically heated regions to further understand the high line ratios in AGNs.

  1. A leadless pacemaker in the real-world setting

    DEFF Research Database (Denmark)

    Roberts, Paul R.; Clementy, Nicolas; Al Samadi, Faisal

    2017-01-01

    -approval setting. The safety end point was system- or procedure-related major complications at 30 days post implant. We compared the major complication rate with that of the 726 patients from the investigational study. Electrical performance was also characterized. Results The device was successfully implanted...... were low and stable. Conclusion Performance of the Micra transcatheter pacemaker in a real-world setting demonstrates a high rate (99.6%) of implant success and low rate (1.51%) of major complications through 30 days post implant. In particular, the rates of pericardial effusion, device dislodgement...

  2. Complications of pacemaker therapy in adults with congenital heart disease: a multicenter study.

    Science.gov (United States)

    Opić, Petra; van Kranenburg, Matthijs; Yap, Sing-Chien; van Dijk, Arie P; Budts, Werner; Vliegen, Hubert W; van Erven, Lieselot; Can, Anil; Sahin, Gulhan; Theuns, Dominic A M J; Witsenburg, Maarten; Roos-Hesselink, Jolien W

    2013-10-09

    This study aims to investigate indications and complications of permanent cardiac pacing in adults with congenital heart disease (CHD). Two-hundred and seventy-four CHD patients were identified who underwent permanent pacemaker implantation between 1972 and 2009. The indication for pacing was acquired sinus node or AV node conduction disease (63%), sinus node or AV node conduction disease after cardiac surgery (28%), and drug/arrhythmia-related indications (9%). Patients with complex CHD received a pacemaker at younger age (23 versus 31 years, ppacemaker implantation (general population: 5.2%). The most common acute complications were lead dysfunction (4.0%), bleeding (2.6%), pocket infection (1.5%) and pneumothorax (1.5%). During a median follow-up of 12 years, pacemaker-related complications requiring intervention occurred in 95 patients (34.6%). The most common late pacemaker-related complications included lead failure (24.8%), pacemaker dysfunction/early battery depletion (5.1%), pacemaker migration (4.7%) and erosion (4.7%). Pacemaker implantation at younger age (pacemaker-related complication (adjusted hazard ratio 1.68, 95% confidence interval 1.07 to 2.63, p=0.023). The risk of periprocedural complications seems higher in the CHD population compared to the general population and more than one-third of CHD patients encountered a pacemaker-related complication during long-term follow-up. This risk increases for those who receive a pacemaker at younger age. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

  3. Large-scale upper tropospheric pollution observed by MIPAS HCN and C2H6 global distributions

    Science.gov (United States)

    Glatthor, N.; von Clarmann, T.; Stiller, G. P.; Funke, B.; Koukouli, M. E.; Fischer, H.; Grabowski, U.; Höpfner, M.; Kellmann, S.; Linden, A.

    2009-12-01

    We present global upper tropospheric HCN and C2H6 amounts derived from MIPAS/ENVISAT limb emission spectra. HCN and C2H6 are retrieved in the spectral regions 715.5-782.7 cm-1 and 811.5-835.7 cm-1, respectively. The datasets consist of 54 days between September 2003 and March 2004. This period covers the peak and decline of the southern hemispheric biomass burning period and some months thereafter. HCN is a nearly unambiguous tracer of biomass burning with an assumed tropospheric lifetime of several months. Indeed, the most significant feature in the MIPAS HCN dataset is an upper tropospheric plume of enhanced values caused by southern hemispheric biomass burning, which in September and October 2003 extended from tropical South America over Africa, Australia to the Southern Pacific. The spatial extent of this plume agrees well with the MOPITT CO distribution of September 2003. Further there is good agreement with the shapes and mixing ratios of the southern hemispheric HCN and C2H6 fields measured by the ACE experiment between September and November 2005. The MIPAS HCN plume extended from the lowermost observation height of 8 km up to about 16 km altitude, with maximum values of 500-600 pptv in October 2003. It was still clearly visible in December 2003, but had strongly decreased by March 2004, confirming the assumed tropospheric lifetime. The main sources of C2H6 are production and transmission of fossil fuels, followed by biofuel use and biomass burning. The C2H6 distribution also clearly reflected the southern hemispheric biomass burning plume and its seasonal variation, with maximum amounts of 600-700 pptv. Generally there was good spatial overlap between the southern hemispheric distributions of both pollution tracers, except for the region between Peru and the mid-Pacific. Here C2H6was considerably enhanced, whereas the HCN amounts were low. Backward trajectory calculations suggested that industrial pollution was responsible for the elevated C2H6

  4. Large-scale upper tropospheric pollution observed by MIPAS HCN and C2H6 global distributions

    Directory of Open Access Journals (Sweden)

    A. Linden

    2009-12-01

    Full Text Available We present global upper tropospheric HCN and C2H6 amounts derived from MIPAS/ENVISAT limb emission spectra. HCN and C2H6 are retrieved in the spectral regions 715.5–782.7 cm−1 and 811.5–835.7 cm−1, respectively. The datasets consist of 54 days between September 2003 and March 2004. This period covers the peak and decline of the southern hemispheric biomass burning period and some months thereafter. HCN is a nearly unambiguous tracer of biomass burning with an assumed tropospheric lifetime of several months. Indeed, the most significant feature in the MIPAS HCN dataset is an upper tropospheric plume of enhanced values caused by southern hemispheric biomass burning, which in September and October 2003 extended from tropical South America over Africa, Australia to the Southern Pacific. The spatial extent of this plume agrees well with the MOPITT CO distribution of September 2003. Further there is good agreement with the shapes and mixing ratios of the southern hemispheric HCN and C2H6 fields measured by the ACE experiment between September and November 2005. The MIPAS HCN plume extended from the lowermost observation height of 8 km up to about 16 km altitude, with maximum values of 500–600 pptv in October 2003. It was still clearly visible in December 2003, but had strongly decreased by March 2004, confirming the assumed tropospheric lifetime. The main sources of C2H6 are production and transmission of fossil fuels, followed by biofuel use and biomass burning. The C2H6 distribution also clearly reflected the southern hemispheric biomass burning plume and its seasonal variation, with maximum amounts of 600–700 pptv. Generally there was good spatial overlap between the southern hemispheric distributions of both pollution tracers, except for the region between Peru and the mid-Pacific. Here C2H6was considerably enhanced, whereas the HCN amounts were low. Backward trajectory calculations suggested that industrial pollution was responsible

  5. Excitation model of pacemaker cardiomyocytes of cardiac conduction system

    Science.gov (United States)

    Grigoriev, M.; Babich, L.

    2015-11-01

    Myocardium includes typical and atypical cardiomyocytes - pacemakers, which form the cardiac conduction system. Excitation from the atrioventricular node in normal conditions is possible only in one direction. Retrograde direction of pulses is impossible. The most important prerequisite for the work of cardiomyocytes is the anatomical integrity of the conduction system. Changes in contractile force of the cardiomyocytes, which appear periodically, are due to two mechanisms of self-regulation - heterometric and homeometric. Graphic course of the excitation pulse propagation along the heart muscle more accurately reveals the understanding of the arrhythmia mechanism. These models have the ability to visualize the essence of excitation dynamics. However, they do not have the proper forecasting function for result estimation. Integrative mathematical model enables further investigation of general laws of the myocardium active behavior, allows for determination of the violation mechanism of electrical and contractile function of cardiomyocytes. Currently, there is no full understanding of the topography of pacemakers and ionic mechanisms. There is a need for the development of direction of mathematical modeling and comparative studies of the electrophysiological arrangement of cells of atrioventricular connection and ventricular conduction system.

  6. Transvenous permanent pacemaker implantation in dextrocardia: technique, challenges, outcome, and a brief review of literature.

    Science.gov (United States)

    Shenthar, Jayaprakash; Rai, Maneesh K; Walia, Rohit; Ghanta, Somasekhar; Sreekumar, Praveen; Reddy, Satish S

    2014-09-01

    Dextrocardia is a rare congenital anomaly. Pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy and associated anomalies. The literature regarding implantation of pacemaker in dextrocardia is scarce. The study involved retrospective analysis of records of patients with dextrocardia who had undergone pacemaker implantation between January 2006 and July 2013 from a single centre. Six patients with dextrocardia (five males and one female) underwent permanent pacemaker implantation (PPI) between January 2006 and July 2013. Of them, three had situs solitus dextrocardia and three situs inversus dextrocardia. All three patients with situs solitus dextrocardia had associated corrected transposition of great arteries. The indication for pacemaker implantation was symptomatic complete atrioventricular (AV) block in four, high-grade AV block in one, and sinus node dysfunction in one patient. A favourable outcome was noted during a mean follow-up of 3.9 years (4 months to 7 years) with one patient needing a pulse generator replacement. Permanent pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy. Use of a technique employing angiography to delineate chamber anatomy and relationship can assist the operator during such difficult PPIs. The medium- and long-term survival after a successful pacemaker implantation in dextrocardia is favourable. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  7. Rhabdomyosarcoma associated with the lead wire of a pacemaker generator implant.

    Science.gov (United States)

    Thieman Mankin, Kelley M; Dunbar, Mark D; Toplon, David; Ginn, Pamela; Maisenbacher, Herbert W; Risselada, Marije

    2014-06-01

    An 11-year-old female spayed Labrador Retriever was presented for a draining, painful subcutaneous mass palpated over a previously implanted pacemaker generator. Infection was suspected and the mass was removed surgically. On cut surface, the mass was friable and mottled tan to brown with firm pale tan nodules, surrounding the pacemaker lead wire adjacent to the pacemaker generator. Cytologic interpretation of impression smears was consistent with a sarcoma, and suggestive of a rhabdomyosarcoma due to the presence of strap-like cells. On histopathologic examination, a highly invasive nodular mass surrounded the pacemaker lead, composed of pleomorphic round, spindle and strap cells, and multinucleated giant cells. The population exhibited microscopic invasion into the deep portion of the fibrous capsule surrounding the pacemaker generator. There were tumor emboli within small to medium subcutaneous veins adjacent to the mass. Immunohistochemically, the neoplastic cells stained positive for α-sarcomeric actin and vimentin, and negative for α-smooth muscle actin, consistent with a rhabdomyosarcoma arising at the site of the pacemaker generator. To our knowledge, this is the first report of a rhabdomyosarcoma associated with the lead wire of a pacemaker generator in a dog. © 2014 American Society for Veterinary Clinical Pathology and European Society for Veterinary Clinical Pathology.

  8. Evaluation of Death among the Patients Undergoing Permanent Pacemaker Implantation: A Competing Risks Analysis.

    Science.gov (United States)

    Ghaem, Haleh; Ghorbani, Mohammad; Zare Dorniani, Samira

    2017-06-01

    Permanent artificial pacemaker is one of the important therapies for treatment of cardiac conduction system problems. The present study aimed to determine the association between some predictive variables and all-cause and cause-specific mortality in the patients who had undergone pacemaker implantation. This study was conducted on 1207 patients who had undergone permanent pacemaker implantation in the hospitals affiliated with Shiraz University of Medical Sciences, Iran, from Mar 2002 to Mar 2012. The variables that existed in the patients' medical records included sex, diabetes mellitus, obesity, cerebrovascular accident, cardiomegaly, smoking, hypertension, ischemic heart disease, congenital heart disease, sick sinus syndrome, and atrial fibrillation. Competing risks model was used to assess the association between the predictive variables and cause-specific (i.e., cardiac and vascular) mortality. The patients' mean age was 66.32±17.92 yr (70.62±14.45 yr in the patients with single-chamber pacemakers vs. 61.91±17.69 yr in those with two-chamber pacemakers) ( P pacemaker decreased this risk. Obesity increased the risk of cardiac death, and diabetes mellitus and heart valve disease increased the risk of vascular death. The variables predicting mortality in all-cause model were completely different from those in cause-specific model. Moreover, death in such patients may occur due to reasons other than pacemaker. Therefore, future studies, particularly prospective ones, are recommended to use competing risks models.

  9. Survival time with pacemaker implantation for dogs diagnosed with persistent atrial standstill.

    Science.gov (United States)

    Cervenec, R M; Stauthammer, C D; Fine, D M; Kellihan, H B; Scansen, B A

    2017-06-01

    To evaluate survival time in dogs with persistent atrial standstill after pacemaker implantation and to compare the survival times for cardiac-related vs. non-cardiac deaths. Secondary objectives were to evaluate the effects of breed and the presence of congestive heart failure (CHF) at the time of diagnosis on survival time. Twenty dogs with persistent atrial standstill and pacemaker implantation. Medical records were searched to identify dogs diagnosed with persistent atrial standstill based on electrocardiogram that underwent pacemaker implantation. Survival after pacemaker implantation was analyzed using the Kaplan-Meier method. The median survival time after pacemaker implantation for all-cause mortality was 866 days. There was no significant difference (p=0.573) in median survival time for cardiac (506 days) vs. non-cardiac deaths (400 days). The presence of CHF at the time of diagnosis did not affect the survival time (P=0.854). No difference in median survival time was noted between breeds (P=0.126). Dogs with persistent atrial standstill have a median survival time of 866 days with pacemaker implantation, though a wide range of survival times was observed. There was no difference in the median survival time for dogs with cardiac-related deaths and those without. Patient breed and the presence of CHF before pacemaker implantation did not affect median survival time. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Outcome and management of pacemaker-induced superior vena cava syndrome.

    Science.gov (United States)

    Fu, Hai-Xia; Huang, Xin-Miao; Zhong, Li; Osborn, Michael J; Bjarnason, Haraldur; Mulpuru, Siva; Zhao, Xian-Xian; Friedman, Paul A; Cha, Yong-Mei

    2014-11-01

    We aimed to determine the long-term outcomes of percutaneous lead extraction and stent placement in patients with pacemaker-induced superior vena cava (SVC) syndrome. The study retrospectively screened patients who underwent lead extraction followed by central vein stent implantation at Mayo Clinic (Rochester, MN, USA), from January 2005 to December 2012, to identify the patients with pacemaker-induced SVC syndrome. Demographic, clinical, and follow-up characteristics of those patients were collected from electronic medical records. Six cases were identified. The mean (standard deviation) age was 56 (15) years (male, 67%). All patients had permanent dual-chamber pacemakers, with a mean 11-year history of pacemaker placement. The entire device system was explanted in five patients; one patient had a 21-year-old pacemaker lead that could not be removed. Eight stents were implanted in six patients: five patients had one stent, one patient had three. A new pacemaker system was reimplanted through the stented vein in five patients. Technical success was achieved in all patients, without any complication. Symptoms rapidly resolved in all patients after stent deployment. The mean follow-up duration was 48 months (range, 10-100 months). Three patients remained symptom free. Reintervention with percutaneous balloon venoplasty was successful in three patients with symptom recurrence. Percutaneous stent implantation after lead removal followed by reimplantation of leads is a feasible alternative therapy for pacemaker-induced SVC syndrome, although some cases may require repeat intervention. ©2014 Wiley Periodicals, Inc.

  11. Evaluation of cumulative effects of MR imaging on pacemaker systems at 1.5 Tesla.

    Science.gov (United States)

    Naehle, Claas P; Zeijlemaker, Volkert; Thomas, Daniel; Meyer, Carsten; Strach, Katharina; Fimmers, Rolf; Schild, Hans; Sommer, Torsten

    2009-12-01

    The purpose of this study was to evaluate possible cumulative effects of repeated magnetic resonance imaging (MRI) examinations on pacemaker systems in patients with cardiac pacemakers. The records of pacemaker patients who underwent repetitive MRI examinations in our institution were reviewed to identify patients who underwent two or more MRI examinations at 1.5T of any anatomical region. Using these criteria, a total of 47 patients who underwent a total 171 MRI examinations were identified and included in this study. Institutional Review Board approval for all pacemaker investigations was obtained. Written informed consent was obtained from all patients. Pacemakers were interrogated immediately before and after MR imaging, and after 3 months, including measurement of pacing capture threshold (PCT), lead impedance (LI), and battery voltage (BV). PCT, LI, and BV were analyzed for changes dependant on the number of MRI exams performed. Mean changes over time and changes between first and last pacemaker interrogation of PCT, LI, and BV were calculated. A statistically significant (P < 0.05), but clinically irrelevant trend for decrease in PCT and BV was found. No significant or clinically relevant changes in LI were observed. In this first study, no clinically relevant, cumulative changes in PCT, LI, or BV could be detected in PM patients who underwent two or more MRI examinations. However, a careful benefit/risk evaluation, among other MRI- and pacemaker-related safety precautions, remains mandatory, as clinically relevant alterations to the PM system cannot be excluded by all means.

  12. Placement Of Cardiac PacemaKEr Trial (POCKET) - rationale and design: a randomized controlled trial.

    Science.gov (United States)

    Magnusson, Peter; Wennström, Leo; Kastberg, Robert; Liv, Per

    2017-01-01

    A pacemaker system consists of one or two leads connected to a device that is implanted into a pocket formed just below the collarbone. This pocket is typically subcutaneous, that is, located just above the pectoral fascia. Even though the size of pacemakers has decreased markedly, complications due to superficial implants do occur. An alternative technique would be intramuscular placement of the pacemaker device, but there are no randomized controlled trials (RCTs) to support this approach, which is the rationale for the Placement Of Cardiac PacemaKEr Trial (POCKET). The aim is to study if intramuscular is superior to subcutaneous placement of a pacemaker pocket. In October 2016, we started to enroll 200 consecutive patients with an indication for bradycardia pacemaker implantation. Patients are randomized to random block sizes, stratified by age group (cut-off: 65 years) and sex, and then randomized to either subcutaneous or intramuscular implant. A concealed allocation procedure is employed, using sequentially numbered, sealed envelopes. Pocket site is blinded to the patient and in all subsequent care. The primary endpoint is patient overall satisfaction with the pocket location at 24 months as measured using a visual analog scale (VAS) 0-10. Secondary endpoints are: complications, patient-reported satisfaction at 1, 12, and 24 months (overall satisfaction, pain, discomfort, degree of unsightly appearance, movement problems, and sleep problems due to device). POCKET is a prospective interventional RCT designed to evaluate if intramuscular is superior to subcutaneous placement of a bradycardia pacemaker during a two-year follow-up.

  13. Influence of D-net (EUROPEAN GSM-standard) cellular telephones on implanted pacemakers in children.

    Science.gov (United States)

    Elshershari, Huda; Celiker, Alpay; Ozer, Sema; Ozme, Sencan

    2002-09-01

    This study was designed to evaluate possible interactions between digital cellular telephones and implanted pacemakers in children. The study comprised 95 patients (53 males and 42 females) with a mean age of 11.5 +/- 4.6 years (range 1-22 years). The average time from pacemaker implantation was 2.5 years (range 1 month-12 years). Fourteen (15%) devices were dual chamber and the remaining were single chamber pacemakers. The following companies manufactured the pacemakers tested: Medtronic (n = 42), Telectronics (n = 9), Vitatron (n = 16), Pacesetter (n = 19), CPI (n = 8), and Biotronik (n = 1). All the patients were tested in the supine position during continuous ECG monitoring. After completion of the routine pacemaker check, the effects of the European Global system for mobile communication (GSM) was tested using two cellular telephone models (Ericsson GA 628 and Siemens S 25, 2-W power). For this purpose, atrial and ventricular sensitivity settings were programmed to the most sensitive values, and the tests were carried out in the unipolar and bipolar sensing modes. The evaluation was performed during ringing, switching on/off, and conversation phase with the cellular telephone positioned over the pulse generator and around the pacemaker pocket. A malfunction of the pacemaker was not observed in any patient. Only 1 (1%) of 95 patients showed a brief oversensing problem during calls with the cellular telephone. In this case, an AAIR pacemaker was implanted transvenously in a subcutaneous pocket and the sensing defect occurred only with the unipolar sensing mode and was not reproducible. Once the source of interference was removed, no sensing defect was detected and the patient remained asymptomatic. No symptoms were experienced in this study. The authors believe that pacemaker dependent patients with nonprotected pulse generators manufactured at the beginning of 1990s may be tested by their physicians for possible interferences before they use a digital cellular

  14. Predictors for permanent pacemaker implantation after concomitant surgical ablation for atrial fibrillation.

    Science.gov (United States)

    Pecha, Simon; Schäfer, Timm; Yildirim, Yalin; Ahmadzade, Teymour; Willems, Stephan; Reichenspurner, Hermann; Wagner, Florian Mathias

    2014-03-01

    Concomitant surgical atrial fibrillation (AF) ablation is a safe and feasible procedure, recommended in guidelines. Pacemaker dependency is a known complication of AF ablation. We sought to determine independent predictors for pacemaker implantation after surgical AF ablation. Between January 2003 and November 2012, 594 patients underwent concomitant surgical AF ablation. Various energy sources, including cryoablation (n = 139), unipolar radiofrequency (n = 278), and bipolar radiofrequency (n = 177), were used. Left atrial (n = 463, 77.9%) and biatrial (n = 131, 22.1%) ablation was performed. Univariate and multivariate logistic regression analysis was used to identify independent predictors for pacemaker implantation within 30 days after surgical AF ablation. The mean patient's age was 68.6 ± 9.4 years, and 66.8% were male. No major ablation-related complications occurred. A total of 41 (6.9%) of patients received pacemaker implantation during the 30-day follow-up period. Indications for pacemaker implantation were atrioventricular block in 25 (60.9%) of patients, sinus bradycardia or sinus arrest in 9 (22.0%) of patients, and bradyarrhythmia in 7 (17.1%) of patients. Demographic data, type of surgical procedure, and type of energy source did not have a significant impact on pacemaker implantation rate. However, biatrial ablation led to a significant pacemaker implantation rate compared with isolated left-sided ablation (6.3% vs 13.6%; P = .028). Concomitant surgical AF ablation showed a pacemaker implantation rate of 6.9% after 30-day follow-up. Univariate and multivariate analysis showed biatrial lesion set as the only statistically significant predictor for pacemaker implantation after surgical AF ablation. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  15. Ab initio calculation of a global potential, vibrational energies, and wave functions for HCN/HNC, and a simulation of the (A-tilde)-(X-tilde) emission spectrum

    Science.gov (United States)

    Bowman, Joel M.; Gazdy, Bela; Bentley, Joseph A.; Lee, Timothy J.; Dateo, Christopher E.

    1993-01-01

    A potential energy surface for the HCN/HNC system which is a fit to extensive, high-quality ab initio, coupled-cluster calculations is presented. All HCN and HNC states with energies below the energy of the first delocalized state are reported and characterized. Vibrational transition energies are compared with all available experimental data on HCN and HNC, including high CH-overtone states up to 23,063/cm. A simulation of the (A-tilde)-(X-tilde) stimulated emission pumping (SEP) spectrum is also reported, and the results are compared to experiment. Franck-Condon factors are reported for odd bending states of HCN, with one quantum of vibrational angular momentum, in order to compare with the recent assignment by Jonas et al. (1992), on the basis of axis-switching arguments of a number of previously unassigned states in the SEP spectrum.

  16. In-Situ Measurements of HCN and CH3CN in the Pacific Troposphere: Sources, Sinks, and Comparisons with Spectroscopic Observations

    Science.gov (United States)

    Singh, Hanwant B.; Salas, L.; Herlth, D.; Czech, E.; Viezee, W.; Li, Q.; Jacob, D. J.; Blake, D.; Sachse, G.; Harward, C. N.; hide

    2002-01-01

    We report the first in-situ measurements of hydrogen cyanide (HCN) and acetonitrile (CH3CN) from the Pacific troposphere (0-12 km) obtained during the NASA/Trace-P mission (Feb.-April, 2001). Mean HCN and CH3CN mixing ratios of 243 (+/-118) ppt and 149 (+/-56) ppt respectively, were measured. The in-situ observations correspond to a total HCN column of 4.4-4.9 x 10(exp 15) molec. cm(exp -2) and a CH3CN column of 2.8-3.0 x 10(exp 15) molec. cm(exp -2). This HCN column is in good agreement with available spectroscopic observations. The atmospheric concentrations of HCN and CH3CN were greatly influenced by outflow of pollution from Asia. There is a linear relationship between the mixing ratios of HCN and CH3CN, and in turn these are well correlated with tracers of biomass combustion (e.g. CH3Cl, CO). Relative enhancements with respect to known tracers of biomass combustion within selected plumes in the free troposphere, and pollution episodes in the boundary layer allow an estimation of a global biomass burning source of 0.8+/-0.4 Tg (N)/y for HCN and 0.4+/-0.1 Tg (N)/y for CH3CN. In comparison, emissions from automobiles and industry are quite small (in the MBL (Marine Boundary Layer). Using, a simple box model, the observed gradients across the top of the MBL are used to derive an oceanic flux of 6.7 x 10(exp -15) g (N) cm(exp -2)/s for HCN and 4.8 x 10(exp -15) g (N) cm(exp -2)/s for CH3CN. An air-sea exchange model is used to conclude that this flux can be maintained if the oceans are under-saturated in HCN and CH3CN by 23% and 17%, respectively. It is inferred that oceanic loss is a dominant sink for these nitrites, and they deposit some 1.3 Tg (N) of nitrogen annually to the oceans. Assuming reaction with OH radicals and loss to the oceans as the major removal processes, a mean atmospheric residence time of 4.7 months for HCN and 5.1 months for CH3CN is calculated. A global budget analysis shows that the sources and sinks of HCN and CH3CN are roughly in balance

  17. Ventricular oversensing of atrial electrical activity that inhibits VVI pacemaker and causes syncope

    Directory of Open Access Journals (Sweden)

    Elibet Chávez González

    2015-10-01

    Full Text Available Far-field oversensing of atrial electrical activity caused by a VVI pacemaker is a rare phenomenon; however, it may have serious clinical consequences. It has several causes and its timely identification may avoid a possible ventricular asystole. This article reports the case of a 72-year-old male who had a Biotronik Axios SR pacemaker implanted, in VVIR mode, six years ago, due to blocked atrial fibrillation. He suffered syncope due to pacemaker inhibition caused by ventricular oversensing of atrial electrical activity.

  18. W/kit gene required for interstitial cells of Cajal and for intestinal pacemaker activity

    DEFF Research Database (Denmark)

    Huizinga, J D; Thuneberg, L; Klüppel, M

    1995-01-01

    The pacemaker activity in the mammalian gut is responsible for generating anally propagating phasic contractions. The cellular basis for this intrinsic activity is unknown. The smooth muscle cells of the external muscle layers and the innervated cellular network of interstitial cells of Cajal......, which is closely associated with the external muscle layers of the mammalian gut, have both been proposed to stimulate pacemaker activity. The interstitial cells of Cajal were identified in the last century but their developmental origin and function have remained unclear. Here we show...... of Cajal associated with Auerbach's nerve plexus and intestinal pacemaker activity....

  19. Retrieving molecular structural information and tracking HNC/HCN isomerization process with high harmonic generation by ultrashort laser pulses

    International Nuclear Information System (INIS)

    Nguyen Ngoc Ty; Le Van Hoang; Vu Ngoc Tuoc; Le Anh Thu

    2010-01-01

    We investigate the possibility of applying the iterative method, suggested in our previous work, for HCN molecule and its HNC isomer. We found that the high-order harmonic generation (HHG) spectra are quite insensitive to the change of H-C (or H-N) bond length so that only the inter-nuclear C-N distance can be retrieved from the high-order harmonic spectra using ultrashort intense lasers. Furthermore, by analyzing the HHG spectra emitted by HCN during the chemical reaction path of isomerization we identify the intensity peaks nearby the stable, metastable and transition states. this finding can be useful for tracking the HNC/HNC isomerization process. (author)

  20. HCN4 ion channel function is required for early events that regulate anatomical left-right patterning in a nodal and lefty asymmetric gene expression-independent manner

    Directory of Open Access Journals (Sweden)

    Vaibhav P. Pai

    2017-10-01

    Full Text Available Laterality is a basic characteristic of all life forms, from single cell organisms to complex plants and animals. For many metazoans, consistent left-right asymmetric patterning is essential for the correct anatomy of internal organs, such as the heart, gut, and brain; disruption of left-right asymmetry patterning leads to an important class of birth defects in human patients. Laterality functions across multiple scales, where early embryonic, subcellular and chiral cytoskeletal events are coupled with asymmetric amplification mechanisms and gene regulatory networks leading to asymmetric physical forces that ultimately result in distinct left and right anatomical organ patterning. Recent studies have suggested the existence of multiple parallel pathways regulating organ asymmetry. Here, we show that an isoform of the hyperpolarization-activated cyclic nucleotide-gated (HCN family of ion channels (hyperpolarization-activated cyclic nucleotide-gated channel 4, HCN4 is important for correct left-right patterning. HCN4 channels are present very early in Xenopus embryos. Blocking HCN channels (Ih currents with pharmacological inhibitors leads to errors in organ situs. This effect is only seen when HCN4 channels are blocked early (pre-stage 10 and not by a later block (post-stage 10. Injections of HCN4-DN (dominant-negative mRNA induce left-right defects only when injected in both blastomeres no later than the 2-cell stage. Analysis of key asymmetric genes' expression showed that the sidedness of Nodal, Lefty, and Pitx2 expression is largely unchanged by HCN4 blockade, despite the randomization of subsequent organ situs, although the area of Pitx2 expression was significantly reduced. Together these data identify a novel, developmental role for HCN4 channels and reveal a new Nodal-Lefty-Pitx2 asymmetric gene expression-independent mechanism upstream of organ positioning during embryonic left-right patterning.

  1. First-principle study of structural, electronic, vibrational and magnetic properties of HCN adsorbed graphene doped with Cr, Mn and Fe

    International Nuclear Information System (INIS)

    Shi, Li Bin; Wang, Yong Ping; Dong, Hai Kuan

    2015-01-01

    Graphical abstract: - Highlights: • Cr, Mn and Fe doped graphene is more active to adsorb HCN molecule than pristine graphene. • The conductivity of Fe and Mn doped graphene hardly changes after adsorption HCN molecule. • The conductivity of Cr doped graphene can be affected significantly due to HCN adsorption. • The Cr, Mn and Fe may destroy the long range order in graphene. • Phonon density of states suggests that Cr doped graphene is stable. - Abstract: The adsorption energy, electronic structure, lattice vibration and magnetic properties of Cr, Mn and Fe doped graphene with and without HCN adsorption are investigated by the first principles based on density functional theory. The physisorption and chemisorption have been identified. In the paper, Cr-NG, Mn-NG and Fe-NG denote HCN adsorption on Cr, Mn and Fe doped graphene with N atom toward the adsorption site. It is found that the adsorption energy is −1.36 eV for Fe-NG, −0.60 eV for Mn-NG and −0.86 eV for Cr-NG. The Cr-NG will convert from half-metallic behavior to semiconductor after adsorbing HCN molecule, which indicates that the conductivity changes significantly. Phonon density of states (PDOS) shows that the long range order in graphene can be destroyed by doping Fe, Mn and Cr. The imaginary frequency mode in PDOS suggests that Fe and Mn doped graphene is unstable, while Cr doped graphene is stable. The electronic properties are sensitive toward adsorbing HCN, indicating that Cr doped graphene is a promising sensor for detecting HCN molecule. This study provides a useful basis for understanding of a wide variety of physical properties on graphene

  2. In-Situ Measurements of HCN and CH3CN In the Pacific Troposphere: Sources, Sinks, and Comparisons with Satellite Observations

    Science.gov (United States)

    Singh, Hanwant B.; Salas, L.; Herlth, D.; Viezee, W.; Jacob, D.; Blake, D.; Sachse, G.; Hipskind, R. Stephen (Technical Monitor)

    2002-01-01

    A new capillary gas chromatographic method using a Reduction Gas Detector was developed to measure HCN and CH3CN in the remote troposphere. This instrumental configuration was deployed for the very first time in the Trace-P field mission performed during the spring of 2001. The NASA DC-8 aircraft afforded an opportunity to measure HCN and CH3CN in polluted and pristine environments over the Pacific to a maximum altitude of 12 km. These are some of the first in situ measurements of the distribution of HCN and CH3CN over the Pacific. Large background concentrations of both nitriles were found to be present and significant variability was observed. The abundance of HCN and CH3CN was strongly impacted by outflow of pollution from Asia. In general there appeared to be a direct but nonlinear relationship between the mixing ratios of HCN and CH3CN. The vertical structure of these chemicals shows direct evidence of the presence of a significant oceanic sink. These observations will be compared with the column content HCN data from satellites and other available measurements. A large body of data have been collected and are being analyzed, both statistically and with the help of models, to better understand the sources and sinks of these nitriles. These results will be presented.

  3. Measurements of hydrogen cyanide (HCN and acetylene (C2H2 from the Infrared Atmospheric Sounding Interferometer (IASI

    Directory of Open Access Journals (Sweden)

    V. Duflot

    2013-04-01

    Full Text Available Hydrogen cyanide (HCN and acetylene (C2H2 are ubiquitous atmospheric trace gases with medium lifetime, which are frequently used as indicators of combustion sources and as tracers for atmospheric transport and chemistry. Because of their weak infrared absorption, overlapped by the CO2 Q branch near 720 cm−1, nadir sounders have up to now failed to measure these gases routinely. Taking into account CO2 line mixing, we provide for the first time extensive measurements of HCN and C2H2 total columns at Reunion Island (21° S, 55° E and Jungfraujoch (46° N, 8° E in 2009–2010 using observations from the Infrared Atmospheric Sounding Interferometer (IASI. A first order comparison with local ground-based Fourier transform infraRed (FTIR measurements has been carried out allowing tests of seasonal consistency which is reasonably captured, except for HCN at Jungfraujoch. The IASI data shows a greater tendency to high C2H2 values. We also examine a nonspecific biomass burning plume over austral Africa and show that the emission ratios with respect to CO agree with previously reported values.

  4. Coupling catalytic hydrolysis and oxidation of HCN over HZSM-5 modified by metal (Fe,Cu) oxides

    Science.gov (United States)

    Hu, Yanan; Liu, Jiangping; Cheng, Jinhuan; Wang, Langlang; Tao, Lei; Wang, Qi; Wang, Xueqian; Ning, Ping

    2018-01-01

    In this work, a series of metal oxides (Fe,Cu) modified HZSM-5 catalysts were synthesized by incipient-wetness impregnation method and then characterized by XRD, N2 adsorption-desorption, H2-TPR, NH3-TPD, UV-vis, FT-IR and XPS measurements. The catalytic hydrolysis and oxidation behaviors toward HCN were investigated. The results indicated that the Fe-Cu/HZSM-5 catalysts exhibited more excellent performence on coupling catalytic hydrolysis and oxidation of HCN than HZSM-5, Fe/HZSM-5, Cu/HZSM-5, and both nearly 100% HCN conversion and 80% N2 selectivity were obtained at about 250 °C. The improved catalytic performance could be ascribed to the creation of highly dispersed iron and copper composites on the surface of the HZSM-5 support, the excellent redox and regulated acid properties of the active ingredients. Moreover, the highly N2 selectivity could be attributed to the good interaction between the Fe and Cu nanocomposites which was facilitated to the NH3-SCR (selective catalytic reduction of NO by NH3) reaction.

  5. Benchmark, DFT assessments, cooperativity, and energy decomposition analysis of the hydrogen bonds in HCN/HNC oligomeric complexes.

    Science.gov (United States)

    de Oliveira, Paulo McMiller C; Silva, Juliana A B; Longo, Ricardo L

    2017-02-01

    Hydrogen cyanide (HCN) and its tautomer hydrogen isocyanide (HNC) are relevant for extraterrestrial chemistry and possible relation to the origin of biomolecules. Several processes and reactions involving these molecules depend on their intermolecular interactions that can lead to aggregates and liquids especially due to the hydrogen bonds. It is thus important to comprehend, to describe, and to quantify their hydrogen bonds, mainly their nature and the cooperativity effects. A systematic study of all linear complexes up to pentamers of HCN and HNC is presented. CCSD(T)/CBS energy calculations, with and without basis set superposition error (BSSE) corrections for energies and geometries, provided a suitable set of benchmarks. Approximated methods based on the density functional theory (DFT) such as BP86, PBE, TPSS, B3LYP, CAM-B3LYP with and without dispersion corrections and long-range corrections, were assessed to describe the interaction energies and cooperativity effects. These assessments are relevant to select DFT functionals for liquid simulations. Energy decomposition analysis was performed at the PBE/STO-TZ2P level and provided insights into the nature of the hydrogen bonds, which are dominated by the electrostatic component. In addition, several linear relationships between the various energy components and the interaction energy were obtained. The cooperativity energy was also found to be practically linear with respect to the interaction energy, which may be relevant for designing and/or correcting empirical force fields. Graphical Abstract Hydrogen bonds in HCN/HNC oligomeric complexesᅟ.

  6. Pacemakers in large arrays of oscillators with nonlocal coupling

    Science.gov (United States)

    Jaramillo, Gabriela; Scheel, Arnd

    2016-02-01

    We model pacemaker effects of an algebraically localized heterogeneity in a 1 dimensional array of oscillators with nonlocal coupling. We assume the oscillators obey simple phase dynamics and that the array is large enough so that it can be approximated by a continuous nonlocal evolution equation. We concentrate on the case of heterogeneities with positive average and show that steady solutions to the nonlocal problem exist. In particular, we show that these heterogeneities act as a wave source. This effect is not possible in 3 dimensional systems, such as the complex Ginzburg-Landau equation, where the wavenumber of weak sources decays at infinity. To obtain our results we use a series of isomorphisms to relate the nonlocal problem to the viscous eikonal equation. We then use Fredholm properties of the Laplace operator in Kondratiev spaces to obtain solutions to the eikonal equation, and by extension to the nonlocal problem.

  7. Unusual Treatment of Pacemaker Pocket Infection: A Case Report

    Directory of Open Access Journals (Sweden)

    Ali Kazemisaeed

    2010-12-01

    Full Text Available Pocket infection of a cardiac device is usually treated by removing the device and re-implanting it in a new site after complete treatment of the infection. This report illustrates a complicated case of pocket infection in the wake of the implantation of a permanent pacemaker (cardiac resynchronization therapy. The patient was treated conservatively through daily irrigation and dressing, broad-spectrum antibiotics, and debridement without the device being removed; the generator was kept out of the pocket for 5 weeks and then re-implanted in the same location successfully. The method of treatment presented herein can be of value, not least in the elderly population who might experience life-threatening events following the replacement of their cardiac devices.

  8. Percutaneously injectable fetal pacemaker: electronics, pacing thresholds, and power budget.

    Science.gov (United States)

    Nicholson, Adriana; Chmait, Ramen; Bar-Cohen, Yaniv; Zheng, Kaihui; Loeb, Gerald E

    2012-01-01

    We are developing a cardiac pacemaker that is designed to be implanted percutaneously into a fetus to treat complete heart block and consequent hydrops fetalis, which is otherwise fatal. One of the most significant considerations for this device is the technical challenges presented by the battery and charging system. The size of the device is limited to about 3 mm in diameter; batteries on this scale have very small charge capacities. The smaller capacity means that the device needs to be designed so that it uses as little current as possible and so that its battery can be recharged wirelessly. We determined the pacing thresholds for a simple relaxation oscillator that can be assembled from discrete, surface mount components and analyzed the power consumption of the device given different electrode configurations and stimulus parameters. An inductive recharging system will be required for some patients; it is feasible within the package constraints and under development.

  9. A novel non invasive measurement of hemodynamic parameters: Comparison of single-chamber ventricular and dual-chamber pacemaker

    Directory of Open Access Journals (Sweden)

    Ingrid M. Pardede

    2008-03-01

    Full Text Available We carried out a cross sectional study to analyze hemodynamic parameters of single-chamber ventricular pacemaker compared with dual-chamber pacemaker by using thoracic electrical bioimpedance monitoring method (Physio Flow™ - a novel simple non-invasive measurement. A total of 48 consecutive outpatients comprised of 27 single chamber pacemaker and 21 dual chamber were analyzed. We measured cardiac parameters: heart rate, stroke volume index, cardiac output index, estimated ejection fraction, end diastolic volume, early diastolic function ratio, thoracic fluid index, and systemic parameters: left cardiac work index and systemic vascular resistance index. Baseline characteristic and pacemaker indication were similar in both groups. Cardiac parameters assessment revealed no significant difference between single-chamber pacemaker and dual-chamber pacemaker in heart rate, stroke volume index, cardiac index, estimated ejection fraction, end-diastolic volume, thoracic fluid index. There was significantly higher early diastolic function ratio in single-chamber pacemaker compared to dual-chamber pacemaker: 92% (10.2-187.7% vs. 100.6% (48.7-403.2%; p=0.006. Systemic parameters assessment revealed significantly higher left cardiac work index in single-chamber group than dual-chamber group 4.9 kg.m/m² (2.8-7.6 kg.m/m² vs. 4.3 kg.m/m² (2.9-7.2 kg.m/m²; p=0.004. There was no significant difference on systemic vascular resistance in single-chamber compared to dual-chamber pacemaker. Single-chamber ventricular pacemaker provides similar stroke volume, cardiac output and left cardiac work, compared to dual-chamber pacemaker. A non-invasive hemodynamic measurement using thoracic electrical bioimpedance is feasible for permanent pacemaker outpatients. (Med J Indones 2008; 17: 25-32Keywords: Permanent pacemaker, single chamber, dual chamber, thoracic electrical bioimpedance, hemodynamic parameter

  10. Analysis of a five year experience of permanent pacemaker implantation at a Nigerian Teaching Hospital: need for a national database

    Science.gov (United States)

    Falase, Bode; Sanusi, Michael; Johnson, Adeyemi; Akinrinlola, Fola; Ajayi, Reina; Oke, David

    2013-01-01

    Introduction Permanent pacemaker implantation is available in Nigeria. There is however no national registry or framework for pacemaker data collection. A pacemaker database has been developed in our institution and the results are analyzed in this study. Methods The study period was between January 2008 and December 2012. Patient data was extracted from a prospectively maintained database which was designed to include the fields of the European pacemaker patient identification code. Results Of the 51 pacemaker implants done, there were 29 males (56.9%) and 22 females (43.1%). Mean age was 68.2±12.7 years. Clinical indications were syncopal attacks in 25 patients (49%), dizzy spells in 15 patients (29.4%), bradycardia with no symptoms in 10 patients (17.7%) and dyspnoea in 2 patients (3.9%). The ECG diagnosis was complete heart block in 27 patients (53%), second degree heart block in 19 patients (37.2%) and sick sinus syndrome with bradycardia in 5 patients (9.8%). Pacemaker modes used were ventricular pacing in 29 patients (56.9%) and dual chamber pacing in 22 patients (43.1%). Files have been closed in 20 patients (39.2%) and 31 patients (60.8%) are still being followed up with median follow up of 26 months, median of 5 visits and 282 pacemaker checks done. Complications seen during follow up were 3 lead displacements (5.9%), 3 pacemaker infections (5.9%), 2 pacemaker pocket erosions (3.9%), and 1 pacemaker related death (2%). There were 5 non-pacemaker related deaths (9.8%). Conclusion Pacemaker data has been maintained for 5 years. We urge other implanting institutions in Nigeria to maintain similar databases and work towards establishment of a national pacemaker registry. PMID:24498465

  11. Psychosocial aspects and mental health in children after permanent pacemaker implantation

    DEFF Research Database (Denmark)

    Andersen, C; Hørder, K; Kristensen, L

    1994-01-01

    The present study was designed to evaluate the psychosocial status and the mental health of children receiving a permanent pacemaker during childhood. Nineteen children under the age of 19 years had a permanent pacemaker implanted. Contact was established to 15 of these patients, 7 girls and 8 boys......, and they were given a child-psychiatric evaluation consisting of a semi-structured and a child-psychiatric interview. The psychological interview used intelligence tests and the Draw-A-Person test as well as the Rorschach test. The patients had had their pacemakers during an average of 6.7 years (range 3......-14). Generally the psychological condition was strained in 7 families, in which psychiatric and social therapy had been necessary. The children's intelligence was within normal ranges, average IQ being 110 (range 80-135). The children had abnormal body image related to the pacemaker. Adults virtually incorporate...

  12. Machines in our hearts: the cardiac pacemaker, the implantable defibrillator, and American health care

    National Research Council Canada - National Science Library

    Jeffrey, Kirk

    2001-01-01

    ... A Device Reliability, Qualification Tests, and Improvements 291 APPENDIX B Number of Implantations 294 APPENDIX C ICHD Pacemaker Identification Code 296 Abbreviations 297 Notes 299 Bibliographical N...

  13. An Unusual Cause of Transient Ischemic Attack in a Patient with Pacemaker

    Directory of Open Access Journals (Sweden)

    Jagadeesh Kumar Kalavakunta

    2014-01-01

    Full Text Available Pacemaker lead malposition in various locations has been described in the literature. Lead malposition in left ventricle is a rare and an underdiagnosed complication. We present a 77-year-old man with history of atrial fibrillation and pacemaker placement who was admitted for transient ischemic attack. He was on aspirin, beta blocker, and warfarin with subtherapeutic international normalized ratio. His paced electrocardiogram showed right bundle-branch block, rather than the typical pattern of left bundle-branch block, suggesting pacemaker lead malposition. Further, his chest X-ray and echocardiogram confirmed the pacemaker lead position in the left ventricle instead of right ventricle. He refused surgical removal of the lead and we increased his warfarin dose. Diagnosis of lead malposition in left ventricle, though easy to identify in echocardiogram, requires high index of clinical suspicion. In asymptomatic patients, surgical removal may be deferred for treatment with lifelong anticoagulation.

  14. Magnetic Resonance Imaging in a Patient with a Dual Chamber Pacemaker

    Science.gov (United States)

    Millar, Lynne Martina; Robinson, Andrew George; O'Flaherty, Maurice Thomas; Eames, Niall; Johnston, Nicola; Heyburn, Gary

    2010-01-01

    Having a pacemaker has been seen an absolute contraindication to having an MRI scan. This has become increasingly difficult in clinical practice as insertion of pacemakers and implantable cardiac defibrillators is at an all time high. Here we outline a case where a 71-year-old male patient with a permanent pacemaker needed to have an MRI scan to ascertain the aetiology of his condition and help guide further management. Given this clinical dilemma, an emergency clinical ethics consultation was arranged. As a result the patient underwent an MRI scan safely under controlled conditions with a consultant cardiologist and radiologist present. The results of the MRI scan were then able to tailor further treatment. This case highlights that in certain conditions an MRI can be performed in patients with permanent pacemakers and outlines the role of clinical ethics committees in complex medical decision making. PMID:21331383

  15. Sikkerhed af magnetisk resonans-skanning hos patienter med pacemaker og implanterbar defibrillator

    DEFF Research Database (Denmark)

    Al-Sabagh, Kifah Hekmat; Christensen, Britta Ege; Thøgersen, Anna Margrethe

    2010-01-01

    INTRODUCTION: The presence of a cardiac implantable device is ICD considered an absolute contraindication to magnetic resonance imaging (MRI). The purpose of this study was to evaluate the safety of performing MRI in patients with cardiac pacemakers and ICDs that had a compelling clinical need...... for MRI examination. MATERIAL AND METHODS: During a period of nine years we have included 65 patients with cardiac devices (60 pacemakers and five ICDs) who underwent a total of 73 MRI examinations at 1.5 T. All pacemakers were reprogrammed before MRI to asynchronous mode to avoid MRI-induced inhibition...... safely in 63 patients. Inhibition of pacemaker output was observed in one patient and induction of ventricular fibrillation was observed in another with ICD. A significant increase in PCT was rare and only detected in 1% of all electrodes. CONCLUSION: MRI can be performed safely in patients...

  16. 76 FR 48058 - Effective Date of Requirement for Premarket Approval for Cardiovascular Permanent Pacemaker...

    Science.gov (United States)

    2011-08-08

    ...-documented case histories conducted by qualified experts, and reports of significant human experience with a... case reports, random experience, reports lacking sufficient details to permit scientific evaluation... Approval for Cardiovascular Permanent Pacemaker Electrode AGENCY: Food and Drug Administration, HHS. ACTION...

  17. The Improvement of the Atrial Flutter Rhythm upon the Removal of the Infected Permanent Pacemaker Lead

    Directory of Open Access Journals (Sweden)

    Ali Azari

    2015-06-01

    Full Text Available Pacemaker infection has multiple risk factors. Its presentation is most often similar to infected endocarditis and the diagnosis is made through studying blood cultures. Transesophageal echocardiography can confirm the diagnosis. The most common microorganisms are staphylococcus speciesis. As a matter of fact, complete pacemaker removal appears to be the only definite treatment. We presented a case of infected pacemaker lead which was firstly referred with fever and nephritic syndrome. She had intermittent atrial flutterrhythm. Therefore, a total infected pacemaker system was removed under cardiopulmonary bypass support. Yet, the lead was firmly attached to the septal leaflet of tricuspid valve while leaflet repair was needed. As a result, atrial flutter rhythm was converted into sinus rhythm after an incidental interruption of the macroreentrant circuit in the process of the tricuspid leaflet surgery.

  18. Magnetic Resonance Imaging in a Patient with a Dual Chamber Pacemaker

    Directory of Open Access Journals (Sweden)

    Lynne Martina Millar

    2010-01-01

    Full Text Available Having a pacemaker has been seen an absolute contraindication to having an MRI scan. This has become increasingly difficult in clinical practice as insertion of pacemakers and implantable cardiac defibrillators is at an all time high. Here we outline a case where a 71-year-old male patient with a permanent pacemaker needed to have an MRI scan to ascertain the aetiology of his condition and help guide further management. Given this clinical dilemma, an emergency clinical ethics consultation was arranged. As a result the patient underwent an MRI scan safely under controlled conditions with a consultant cardiologist and radiologist present. The results of the MRI scan were then able to tailor further treatment. This case highlights that in certain conditions an MRI can be performed in patients with permanent pacemakers and outlines the role of clinical ethics committees in complex medical decision making.

  19. Interference of apex locator, pulp tester and diathermy on pacemaker function

    OpenAIRE

    Narayanan Sriman; V Prabhakar; J S Bhuvaneswaran; N Subha

    2015-01-01

    Aim: The purpose of this study was to evaluate the effects of three electronic apex locators (EAL), electric pulp tester (EPT) and diathermy on pacemaker function in vitro. Materials and Methods: Three EALs: Root ZX (J. Morita Co., Tustin, CA, U.S.A.), Propex (Dentsply), Mini Apex locator (SybronEndo, Anaheim, CA, USA), EPT (Parkell pulp vitality tester Farmingdale, NY, USA) and Diathermy (Neomed 250 B) were tested for any interference with one pacemaker (A medtronic kappa KVDD901-serial ...

  20. A Fully Implantable Pacemaker for the Mouse: From Battery to Wireless Power

    Science.gov (United States)

    Zellmer, Erik R.; Weinheimer, Carla J.; MacEwan, Matthew R.; Cui, Sophia X.; Nerbonne, Jeanne M.; Efimov, Igor R.

    2013-01-01

    Animal models have become a popular platform for the investigation of the molecular and systemic mechanisms of pathological cardiovascular physiology. Chronic pacing studies with implantable pacemakers in large animals have led to useful models of heart failure and atrial fibrillation. Unfortunately, molecular and genetic studies in these large animal models are often prohibitively expensive or not available. Conversely, the mouse is an excellent species for studying molecular mechanisms of cardiovascular disease through genetic engineering. However, the large size of available pacemakers does not lend itself to chronic pacing in mice. Here, we present the design for a novel, fully implantable wireless-powered pacemaker for mice capable of long-term (>30 days) pacing. This design is compared to a traditional battery-powered pacemaker to demonstrate critical advantages achieved through wireless inductive power transfer and control. Battery-powered and wireless-powered pacemakers were fabricated from standard electronic components in our laboratory. Mice (n = 24) were implanted with endocardial, battery-powered devices (n = 14) and epicardial, wireless-powered devices (n = 10). Wireless-powered devices were associated with reduced implant mortality and more reliable device function compared to battery-powered devices. Eight of 14 (57.1%) mice implanted with battery-powered pacemakers died following device implantation compared to 1 of 10 (10%) mice implanted with wireless-powered pacemakers. Moreover, device function was achieved for 30 days with the wireless-powered device compared to 6 days with the battery-powered device. The wireless-powered pacemaker system presented herein will allow electrophysiology studies in numerous genetically engineered mouse models as well as rapid pacing-induced heart failure and atrial arrhythmia in mice. PMID:24194832

  1. Tilt-table testing of patients with pacemaker and recurrent syncope

    DEFF Research Database (Denmark)

    Nielsen, Christian E. Haarmark; Kanters, Jørgen K; Mehlsen, Jesper

    2016-01-01

    The diagnosis of recurrent syncope in patients with pacemakers (PM) is quite challenging and the etiology of syncope is often multifactorial. To portray the mechanism of syncope in PM patients, we report the results of head-up tilt table testing (HUT) in a series of patients with PM, originally...... with pacemakers has a high diagnostic yield. Although, the majority of patients had a vasodepressor or orthostatic hypotensive response, cardioinhibitory response leading to syncope was also seen....

  2. Inward-rectifying potassium (Kir) channels regulate pacemaker activity in spinal nociceptive circuits during early life

    Science.gov (United States)

    Li, Jie; Blankenship, Meredith L.; Baccei, Mark L.

    2013-01-01

    Pacemaker neurons in neonatal spinal nociceptive circuits generate intrinsic burst-firing and are distinguished by a lower “leak” membrane conductance compared to adjacent, non-bursting neurons. However, little is known about which subtypes of leak channels regulate the level of pacemaker activity within the developing rat superficial dorsal horn (SDH). Here we demonstrate that a hallmark feature of lamina I pacemaker neurons is a reduced conductance through inward-rectifying potassium (Kir) channels at physiological membrane potentials. Differences in the strength of inward rectification between pacemakers and non-pacemakers indicate the presence of functionally distinct Kir currents in these two populations at room temperature. However, Kir currents in both groups showed high sensitivity to block by extracellular Ba2+ (IC50 ~ 10 µM), which suggests the presence of ‘classical’ Kir (Kir2.x) channels in the neonatal SDH. The reduced Kir conductance within pacemakers is unlikely to be explained by an absence of particular Kir2.x isoforms, as immunohistochemical analysis revealed the expression of Kir2.1, Kir2.2 and Kir2.3 within spontaneously bursting neurons. Importantly, Ba2+ application unmasked rhythmic burst-firing in ~42% of non-bursting lamina I neurons, suggesting that pacemaker activity is a latent property of a sizeable population of SDH cells during early life. In addition, the prevalence of spontaneous burst-firing within lamina I was enhanced in the presence of high internal concentrations of free Mg2+, consistent with its documented ability to block Kir channels from the intracellular side. Collectively, the results indicate that Kir channels are key modulators of pacemaker activity in newborn central pain networks. PMID:23426663

  3. Frequency of pacemaker malfunction associated with monopolar electrosurgery during pulse generator replacement or upgrade surgery.

    Science.gov (United States)

    Lin, Yun; Melby, Daniel P; Krishnan, Balaji; Adabag, Selcuk; Tholakanahalli, Venkatakrishna; Li, Jian-Ming

    2017-08-01

    The aim of this study is to investigate the frequency of electrosurgery-related pacemaker malfunction. A retrospective study was conducted to investigate electrosurgery-related pacemaker malfunction in consecutive patients undergoing pulse generator (PG) replacement or upgrade from two large hospitals in Minneapolis, MN between January 2011 and January 2014. The occurrence of this pacemaker malfunction was then studied by using MAUDE database for all four major device vendors. A total of 1398 consecutive patients from 2 large tertiary referral centers in Minneapolis, MN undergoing PG replacement or upgrade surgery were retrospectively studied. Four patients (0.3% of all patients), all with pacemakers from St Jude Medical (2.8%, 4 of 142) had output failure or inappropriately low pacing rate below 30 bpm during electrosurgery, despite being programmed in an asynchronous mode. During the same period, 1174 cases of pacemaker malfunctions were reported on the same models in MAUDE database, 37 of which (3.2%) were electrosurgery-related. Twenty-four cases (65%) had output failure or inappropriate low pacing rate. The distribution of adverse events was loss of pacing (59.5%), reversion to backup pacing (32.4%), inappropriate low pacing rate (5.4%), and ventricular fibrillation (2.7%). The majority of these (78.5%) occurred during PG replacement at ERI or upgrade surgery. No electrosurgery-related malfunction was found in MAUDE database on 862 pacemaker malfunction cases during the same period from other vendors. Electrosurgery during PG replacement or upgrade surgery can trigger output failure or inappropriate low pacing rate in certain models of modern pacemakers. Cautions should be taken for pacemaker-dependent patients.

  4. Development of pacemaker properties and rhythmogenic mechanisms in the mouse embryonic respiratory network

    Science.gov (United States)

    Chevalier, Marc; Toporikova, Natalia; Simmers, John; Thoby-Brisson, Muriel

    2016-01-01

    Breathing is a vital rhythmic behavior generated by hindbrain neuronal circuitry, including the preBötzinger complex network (preBötC) that controls inspiration. The emergence of preBötC network activity during prenatal development has been described, but little is known regarding inspiratory neurons expressing pacemaker properties at embryonic stages. Here, we combined calcium imaging and electrophysiological recordings in mouse embryo brainstem slices together with computational modeling to reveal the existence of heterogeneous pacemaker oscillatory properties relying on distinct combinations of burst-generating INaP and ICAN conductances. The respective proportion of the different inspiratory pacemaker subtypes changes during prenatal development. Concomitantly, network rhythmogenesis switches from a purely INaP/ICAN-dependent mechanism at E16.5 to a combined pacemaker/network-driven process at E18.5. Our results provide the first description of pacemaker bursting properties in embryonic preBötC neurons and indicate that network rhythmogenesis undergoes important changes during prenatal development through alterations in both circuit properties and the biophysical characteristics of pacemaker neurons. DOI: http://dx.doi.org/10.7554/eLife.16125.001 PMID:27434668

  5. Pacemaker rate and depolarization block in nigral dopamine neurons: a somatic sodium channel balancing act

    Science.gov (United States)

    Tucker, Kristal R.; Huertas, Marco A.; Horn, John P.; Canavier, Carmen C.; Levitan, Edwin S.

    2012-01-01

    Midbrain dopamine (DA) neurons are slow intrinsic pacemakers that undergo depolarization (DP) block upon moderate stimulation. Understanding DP block is important because it has been correlated with the clinical efficacy of chronic antipsychotic drug treatment. Here we describe how voltage-gated sodium (NaV) channels regulate DP block and pacemaker activity in DA neurons of the substantia nigra using rat brain slices. The distribution, density and gating of NaV currents were manipulated by blocking native channels with tetrodotoxin and by creating virtual channels and anti-channels with dynamic clamp. Although action potentials initiate in the axon initial segment (AIS) and NaV channels are distributed in multiple dendrites, selective reduction of NaV channel activity in the soma was sufficient to decrease pacemaker frequency and increase susceptibility to DP block. Conversely, increasing somatic NaV current density raised pacemaker frequency and lowered susceptibility to DP block. Finally, when NaV currents were restricted to the soma, pacemaker activity occurred at abnormally high rates due to excessive local subthreshold NaV current. Together with computational simulations, these data show that both the slow pacemaker rate and the sensitivity to DP block that characterizes DA neurons result from the low density of somatic NaV channels. More generally, we conclude that the somatodendritic distribution of NaV channels is a major determinant of repetitive spiking frequency. PMID:23077037

  6. The East Asian Summer Monsoon in pacemaker experiments driven by ENSO

    Science.gov (United States)

    Ding, Hui; Greatbatch, Richard J.; Lu, Jian; Cash, Ben

    2015-03-01

    The variability of the East Asian summer monsoon (EASM) is studied using a pacemaker technique driven by ENSO in an atmospheric general circulation model (AGCM) coupled to a slab mixed layer model. In the pacemaker experiments, sea surface temperature (SST) is constrained to observations in the eastern equatorial Pacific through a q- flux that measures the contribution of ocean dynamics to SST variability, while the AGCM is coupled to the slab model. An ensemble of pacemaker experiments is analyzed using a multivariate EOF analysis to identify the two major modes of variability of the EASM. The results show that the pacemaker experiments simulate a substantial amount (around 45 %) of the variability of the first mode (the Pacific-Japan pattern) in ERA40 from 1979 to 1999. Different from previous work, the pacemaker experiments also simulate a large part (25 %) of the variability of the second mode, related to rainfall variability over northern China. Furthermore, we find that the lower (850 hPa) and the upper (200 hPa) tropospheric circulation of the first mode display the same degree of reproducibility whereas only the lower part of the second mode is reproducible. The basis for the success of the pacemaker experiments is the ability of the experiments to reproduce the observed relationship between El Niño Southern Oscillation (ENSO) and the EASM.

  7. Biological pacemaker created by minimally invasive somatic reprogramming in pigs with complete heart block

    Science.gov (United States)

    Hu, Yu-Feng; Dawkins, James Frederick; Cho, Hee Cheol; Marbán, Eduardo; Cingolani, Eugenio

    2016-01-01

    Somatic reprogramming by reexpression of the embryonic transcription factor T-box 18 (TBX18) converts cardiomyocytes into pacemaker cells. We hypothesized that this could be a viable therapeutic avenue for pacemaker-dependent patients afflicted with device-related complications, and therefore tested whether adenoviral TBX18 gene transfer could create biological pacemaker activity in vivo in a large-animal model of complete heart block. Biological pacemaker activity, originating from the intramyocardial injection site, was evident in TBX18-transduced animals starting at day 2 and persisted for the duration of the study (14 days) with minimal backup electronic pacemaker use. Relative to controls transduced with a reporter gene, TBX18-transduced animals exhibited enhanced autonomic responses and physiologically superior chronotropic support of physical activity. Induced sinoatrial node cells could be identified by their distinctive morphology at the site of injection in TBX18-transduced animals, but not in controls. No local or systemic safety concerns arose. Thus, minimally invasive TBX18 gene transfer creates physiologically relevant pacemaker activity in complete heart block, providing evidence for therapeutic somatic reprogramming in a clinically relevant disease model. PMID:25031269

  8. RESOLVING THE BRIGHT HCN(1–0) EMISSION TOWARD THE SEYFERT 2 NUCLEUS OF M51: SHOCK ENHANCEMENT BY RADIO JETS AND WEAK MASING BY INFRARED PUMPING?

    International Nuclear Information System (INIS)

    Matsushita, Satoki; Trung, Dinh-V-; Boone, Frédéric; Krips, Melanie; Lim, Jeremy; Muller, Sebastien

    2015-01-01

    We present high angular resolution observations of the HCN(1-0) emission (at ∼1'' or ∼34 pc), together with CO J = 1-0, 2-1, and 3-2 observations, toward the Seyfert 2 nucleus of M51 (NGC 5194). The overall HCN(1-0) distribution and kinematics are very similar to that of the CO lines, which have been indicated as the jet-entrained molecular gas in our past observations. In addition, high HCN(1-0)/CO(1-0) brightness temperature ratio of about unity is observed along the jets, similar to that observed at the shocked molecular gas in our Galaxy. These results strongly indicate that both diffuse and dense gases are entrained by the jets and outflowing from the active galactic nucleus. The channel map of HCN(1-0) at the systemic velocity shows a strong emission right at the nucleus, where no obvious emission has been detected in the CO lines. The HCN(1-0)/CO(1-0) brightness temperature ratio at this region reaches >2, a value that cannot be explained considering standard physical/chemical conditions. Based on our calculations, we suggest infrared pumping and possibly weak HCN masing, but still requiring an enhanced HCN abundance for the cause of this high ratio. This suggests the presence of a compact dense obscuring molecular gas in front of the nucleus of M51, which remains unresolved at our ∼1'' (∼34 pc) resolution, and consistent with the Seyfert 2 classification picture

  9. Maturation and processing of the amyloid precursor protein is regulated by the potassium/sodium hyperpolarization-activated cyclic nucleotide-gated ion channel 2 (HCN2).

    Science.gov (United States)

    Frykman, Susanne; Inoue, Mitsuhiro; Ikeda, Atsushi; Teranishi, Yasuhiro; Kihara, Takahiro; Lundgren, Jolanta L; Yamamoto, Natsuko G; Bogdanovic, Nenad; Winblad, Bengt; Schedin-Weiss, Sophia; Tjernberg, Lars O

    2017-01-29

    The toxic amyloid β-peptide (Aβ) is a key player in Alzheimer Disease (AD) pathogenesis and selective inhibition of the production of this peptide is sought for. Aβ is produced by the sequential cleavage of the Aβ precursor protein (APP) by β-secretase (to yield APP-C-terminal fragment β (APP-CTFβ) and soluble APPβ (sAPPβ)) and γ-secretase (to yield Aβ). We reasoned that proteins that associate with γ-secretase are likely to regulate Aβ production and to be targets of pharmaceutical interventions and therefore performed a pull-down assay to screen for such proteins in rat brain. Interestingly, one of the purified proteins was potassium/sodium hyperpolarization-activated cyclic nucleotide-gated ion channel 2 (HCN2), which has been shown to be involved in epilepsy. We found that silencing of HCN2 resulted in decreased secreted Aβ levels. To further investigate the mechanism behind this reduction, we also determined the levels of full-length APP, sAPP and APP-CTF species after silencing of HCN2. A marked reduction in sAPP and APP-CTF, as well as glycosylated APP levels was detected. Decreased Aβ, sAPP and APP-CTF levels were also detected after treatment with the HCN2 inhibitor ZD7288. These results indicate that the effect on Aβ levels after HCN2 silencing or inhibition is due to altered APP maturation or processing by β-secretase rather than a direct effect on γ-secretase. However, HCN2 and γ-secretase were found to be in close proximity, as evident by proximity ligation assay and immunoprecipitation. In summary, our results indicate that silencing or inhibition of HCN2 affects APP processing and thereby could serve as a potential treatment strategy. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Use of an active fixation lead and a subpectoral pacemaker pocket may not avoid Twiddler′s syndrome

    Directory of Open Access Journals (Sweden)

    Floris E A Udink ten Cate

    2012-01-01

    Full Text Available Manipulation of a pacemaker with consequent malfunction of the device has been called Twiddler′s syndrome. Use of active-fixation leads and subpectoral pacemaker pockets has been considered to help in avoiding this problem. We describe a child in whom twiddling was not prevented despite implantation of a lumenless atrial lead and insertion of the pacemaker generator in a subpectoral pocket.

  11. Data processing with PC-9801 micro-computer for HCN laser scattering experiments

    International Nuclear Information System (INIS)

    Iwasaki, T.; Okajima, S.; Kawahata, K.; Tetsuka, T.; Fujita, J.

    1986-09-01

    In order to process the data of HCN laser scattering experiments, a micro-computer software has been developed and applied to the measurements of density fluctuations in the JIPP T-IIU tokamak plasma. The data processing system consists of a spectrum analyzer, SM-2100A Signal Analyzer (IWATSU ELECTRIC CO., LTD.), PC-9801m3 micro-computer, a CRT-display and a dot-printer. The output signals from the spectrum analyzer are A/D converted, and stored on a mini-floppy-disk equipped to the signal analyzer. The software to process the data is composed of system-programs and several user-programs. The real time data processing is carried out for every shot of plasma at 4 minutes interval by the micro-computer connected with the signal analyzer through a GP-IB interface. The time evolutions of the frequency spectrum of the density fluctuations are displayed on the CRT attached to the micro-computer and printed out on a printer-sheet. In the case of the data processing after experiments, the data stored on the floppy-disk of the signal analyzer are read out by using a floppy-disk unit attached to the micro-computer. After computation with the user-programs, the results, such as monitored signal, frequency spectra, wave number spectra and the time evolutions of the spectrum, are displayed and printed out. In this technical report, the system, the software and the directions for use are described. (author)

  12. Passivation of Si-based structures in HCN and KCN solutions

    Energy Technology Data Exchange (ETDEWEB)

    Pincik, Emil, E-mail: emil.pincik@savba.sk [Institute of Physics SAS, Dubravska cesta 9, 845 11 Bratislava (Slovakia); Kobayashi, Hikaru [ISIR of Osaka University, and CREST, Japan Science and Technology Organization, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047 (Japan); Rusnak, Jaroslav [Institute of Physics SAS, Dubravska cesta 9, 845 11 Bratislava (Slovakia); Takahashi, Masao [ISIR of Osaka University, and CREST, Japan Science and Technology Organization, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047 (Japan); Mikula, Milan [Faculty of Chemical and Food Technology of SUT, Radlinskeho 9, 812 37 Bratislava (Slovakia); Kim, Woo Byoung [ISIR of Osaka University, and CREST, Japan Science and Technology Organization, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047 (Japan); Kucera, Michal [Institute of Electrical Engineering SAS, Dubravska cesta 9, 841 04 Bratislava (Slovakia); Brunner, Robert [Institute of Physics SAS, Dubravska cesta 9, 845 11 Bratislava (Slovakia); Jurecka, Stanislav [DEF FEE University of Zilina, kpt. Nalepku 1390, 03101 Liptovsky Mikulas (Slovakia)

    2012-08-15

    The contribution deals with passivation of surfaces of c-Si and 6H-SiC by formation of very thin SiO{sub 2} films in boiling HNO{sub 3} solutions and by passivation of a-Si based double and triple layer structures deposited on Corning glass and c-Si by KCN solutions. The structures are investigated by spectroscopic ellipsometry, charge version of DLTS, C-V, FTIR-DRIFT, and by photoluminescence measuremets at 6 K. Newly developed 2nd generation of MOS structures prepared on c-Si with an approx. 3 nm SiO{sub 2} layer gives typical density of interface defect states of 5 Multiplication-Sign 10{sup 10} eV{sup -1} cm{sup -2}. Real part of complex refractive index of approx. 3 nm thick SiO{sub 2} layers is about 1.75. Application of HCN solutions to structure approx. 3 nm SiO{sub 2}/Si (applied as the last technological step) leads to remarkable lowering of absorbance in wavelength region 4000 cm{sup -1}-2500 cm{sup -1}. This result indicates a decrease of number of non- radiation transitions in the surface region of oxide/Si structures. Such structures have also the lowest density of interface defect states (observed by Q-DLTS). Application of boiling KCN solutions considerably increases amplitudes of photoluminescence signals coming from different double and triple a-Si based layers deposited on Corning glass. We relate this effect predominantly with reduction of non-radiation transitions in excited region of amorphous structures - with passivation of corresponding defect states in a-Si structures in boiling KCN solutions.

  13. Reinterpreting the infrared spectrum of H + HCN: Methylene amidogen radical and its coproducts

    Science.gov (United States)

    Wiens, Avery E.; Copan, Andreas V.; Rossomme, Elliot C.; Aroeira, Gustavo J. R.; Bernstein, Olivia M.; Agarwal, Jay; Schaefer, Henry F.

    2018-01-01

    The methylene amidogen radical (H2CN) plays a role in high-energy material combustion and extraterresterial atmospheres. Recent theoretical work has struggled to match experimental assignments for its CN and antisymmetric CH2 stretching frequencies (ν2 and ν5), which were reported to occur at 1725 and 3103 cm-1. Herein, we compute the vibrational energy levels of this molecule by extrapolating quadruples-level coupled-cluster theory to the complete basis limit and adding corrections for vibrational anharmonicity. This level of theory predicts that ν2 and ν5 should occur at 1646 and 2892 cm-1, at odds with the experimental assignments. To investigate the possibility of defects in our theoretical treatment, we analyze the sensitivity of our approach to each of its contributing approximations. Our analysis suggests that the observed deviation from experiment is too large to be explained as an accumulation of errors, leading us to conclude that these transitions were misassigned. To help resolve this discrepancy, we investigate possible byproducts of the H + HCN reaction, which was the source of H2CN in the original experiment. In particular, we predict vibrational spectra for cis-HCNH, trans-HCNH, and H2CNH using high-level coupled-cluster computations. Based on these results, we reassign the transition at 1725 cm-1 to ν3 of trans-HCNH, yielding excellent agreement. Supporting this identification, we assign a known contaminant peak at 886 cm-1 to ν5 of the same conformer. Our computations suggest that the peak observed at 3103 cm-1, however, does not belong to any of the aforementioned species. To facilitate further investigation, we use structure and bonding arguments to narrow the range of possible candidates. These arguments lead us to tentatively put forth formaldazine [(H2CN) 2] as a suggestion for further study, which we support with additional computations.

  14. Test and Evaluation of the Zoll Medical Inc., PD2OOO Cardiac Monitor/Pacemaker/Defibrillator System

    National Research Council Canada - National Science Library

    Hade, Edward

    1997-01-01

    The Zoll PD2000 is a portable cardiac monitor, defibrillator and pacemaker that offers synchronized defibrillation, electrocardiogram monitoring, noninvasive temporary pacing and advisory capability...

  15. Clinical application of transvenous temporary cardiac pacemaker in performing extra-cranial carotid angiography and stent implantation

    International Nuclear Information System (INIS)

    Liu Juan; Yao Guoen; Zhou Huadong; Jiang Xiaojiang; Chen Qiao

    2012-01-01

    Objective: To assess the safety and effectiveness of transvenous temporary cardiac pacemaker in preventing hemodynamic instability occurred during the perioperative period of extra-cranial carotid angiography and stent implantation. Methods: Preoperative install of temporary cardiac pacemaker via left femoral vein was carried out in 41 patients who were at high risk for developing hemodynamic instability, which was followed by extra-cranial carotid angiography and stent implantation. The pacing rhythm of the pacemaker was fixed at 60 beats/min. During and after the procedure the patients were under close observation for the signs of discomfort symptoms as well as the changes in blood pressure and heart rate. The working condition of the pacemaker was also monitored. Results: All the installed pacemakers were technically and hemodynamically effective in producing electrical ventricular responses in all 25 patients who had received balloon dilatation of carotid in advance. Transient pacemaker activation appeared in 25 patients. The longest activation time was one day. During pacemaker activation, one patient developed symptomatic hypotension. The longest duration of hypotension lasted for 4 days. No pacemaker-related or procedure-related complications occurred. Conclusion: Hemodynamic instability is a common complication occurred during perioperative period of extra-cranial carotid angiography and stent implantation. As a prophylactic measure, preoperative placement of temporary cardiac pacemaker can promptly and effectively correct the hemodynamic disorders and prevent perioperative complications such as stroke, etc. Therefore, this technique is worth employing in clinical practice, and it is especially useful for patients with high risks. (authors)

  16. Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients and procedures.

    Science.gov (United States)

    Greenspon, Arnold J; Patel, Jasmine D; Lau, Edmund; Ochoa, Jorge A; Frisch, Daniel R; Ho, Reginald T; Pavri, Behzad B; Kurtz, Steven M

    2012-10-16

    This study sought to define contemporary trends in permanent pacemaker use by analyzing a large national database. The Medicare National Coverage Determination for permanent pacemaker, which emphasized single-chamber pacing, has not changed significantly since 1985. We sought to define contemporary trends in permanent pacemaker use by analyzing a large national database. We queried the Nationwide Inpatient Sample to identify permanent pacemaker implants between 1993 and 2009 using the International Classification of Diseases-Ninth Revision-Clinical Modification procedure codes for dual-chamber (DDD), single-ventricular (VVI), single-atrial (AAI), or biventricular (BiV) devices. Annual permanent pacemaker implantation rates and patient demographics were analyzed. Between 1993 and 2009, 2.9 million patients received permanent pacemakers in the United States. Overall use increased by 55.6%. By 2009, DDD use increased from 62% to 82% (p pacemaker use fell from 36% to 14% (p = 0.01). Use of DDD devices was higher in urban, nonteaching hospitals (79%) compared with urban teaching hospitals (76%) and rural hospitals (72%). Patients with private insurance (83%) more commonly received DDD devices than Medicaid (79%) or Medicare (75%) recipients (p pacemakers in the United States. Although DDD device use is increasing, whereas single-chamber ventricular pacemaker use is decreasing. Patients are becoming older and have more medical comorbidities. These trends have important health care policy implications. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  17. Is metabolic rate a universal 'pacemaker' for biological processes?

    Science.gov (United States)

    Glazier, Douglas S

    2015-05-01

    A common, long-held belief is that metabolic rate drives the rates of various biological, ecological and evolutionary processes. Although this metabolic pacemaker view (as assumed by the recent, influential 'metabolic theory of ecology') may be true in at least some situations (e.g. those involving moderate temperature effects or physiological processes closely linked to metabolism, such as heartbeat and breathing rate), it suffers from several major limitations, including: (i) it is supported chiefly by indirect, correlational evidence (e.g. similarities between the body-size and temperature scaling of metabolic rate and that of other biological processes, which are not always observed) - direct, mechanistic or experimental support is scarce and much needed; (ii) it is contradicted by abundant evidence showing that various intrinsic and extrinsic factors (e.g. hormonal action and temperature changes) can dissociate the rates of metabolism, growth, development and other biological processes; (iii) there are many examples where metabolic rate appears to respond to, rather than drive the rates of various other biological processes (e.g. ontogenetic growth, food intake and locomotor activity); (iv) there are additional examples where metabolic rate appears to be unrelated to the rate of a biological process (e.g. ageing, circadian rhythms, and molecular evolution); and (v) the theoretical foundation for the metabolic pacemaker view focuses only on the energetic control of biological processes, while ignoring the importance of informational control, as mediated by various genetic, cellular, and neuroendocrine regulatory systems. I argue that a comprehensive understanding of the pace of life must include how biological activities depend on both energy and information and their environmentally sensitive interaction. This conclusion is supported by extensive evidence showing that hormones and other regulatory factors and signalling systems coordinate the processes of

  18. Placement Of Cardiac PacemaKEr Trial (POCKET – rationale and design: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Peter Magnusson

    2017-04-01

    Full Text Available Background: A pacemaker system consists of one or two leads connected to a device that is implanted into a pocket formed just below the collarbone. This pocket is typically subcutaneous, that is, located just above the pectoral fascia. Even though the size of pacemakers has decreased markedly, complications due to superficial implants do occur. An alternative technique would be intramuscular placement of the pacemaker device, but there are no randomized controlled trials (RCTs to support this approach, which is the rationale for the Placement Of Cardiac PacemaKEr Trial (POCKET. The aim is to study if intramuscular is superior to subcutaneous placement of a pacemaker pocket. Methods: In October 2016, we started to enroll 200 consecutive patients with an indication for bradycardia pacemaker implantation. Patients are randomized to random block sizes, stratified by age group (cut-off: 65 years and sex, and then randomized to either subcutaneous or intramuscular implant. A concealed allocation procedure is employed, using sequentially numbered, sealed envelopes. Pocket site is blinded to the patient and in all subsequent care. The primary endpoint is patient overall satisfaction with the pocket location at 24 months as measured using a visual analog scale (VAS 0-10. Secondary endpoints are: complications, patient-reported satisfaction at 1, 12, and 24 months (overall satisfaction, pain, discomfort, degree of unsightly appearance, movement problems, and sleep problems due to device. Conclusions: POCKET is a prospective interventional RCT designed to evaluate if intramuscular is superior to subcutaneous placement of a bradycardia pacemaker during a two-year follow-up.

  19. Pacemakers in patients with familial dysautonomia--a review of experience with 20 patients.

    Science.gov (United States)

    Gold-von Simson, Gabrielle; Rutkowski, Monika; Berlin, Dena; Axelrod, Felicia B

    2005-02-01

    Familial dysautonomia (FD) is a genetic disease associated with a high incidence of sudden death. If fatal bradyarrhythmia is an etiological factor then the incidence of sudden death should decrease after pacemaker placement. Retrospective review of 596 registered FD patients revealed that 22 FD patients (3.7%) had pacemakers placed between December 1984 and June 2003. Clinical and electrocardiographic indications for placement and demographic data were assessed for 20 of the 22 patients (10 males, 10 females, ages 4 to 48 years). Two patients were excluded because of insufficient data. Prior to pacemaker placement, presenting symptoms were syncope and cardiac arrest, 16/20 (80%) and 6/20 (30 %), respectively. Asystole was the most frequent electrocardiographic finding and was documented in 17/20 patients (85 %). Other electrocardiographic abnormalities included bradycardia, AV block, prolonged QTc and prolonged JTc. The average duration of pacemaker utilization was 5.7 years (range 5 months to 14.5 years). Complications included infection (1 patient) and wire migration (2 patients). In the one patient with infection, the pacemaker was permanently removed. This patient then experienced multiple syncopal episodes and death. There were 7 other deaths. Three deaths occurred suddenly without preceding events, and 4 patients had non-cardiac causes of death. None of these 7 deceased patients had recurrence of syncope after pacemaker placement. In the 12 surviving patients, 6 had recurrence of syncope but none had cardiac arrest. Pacemaker placement may protect FD patients from fatal bradyarrhythmia and may decrease the incidence of syncope. However, data are limited and prospective analysis is needed.

  20. Placement Of Cardiac PacemaKEr Trial (POCKET – rationale and design: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Peter Magnusson

    2017-04-01

    Full Text Available BackgroundA pacemaker system consists of one or two leads connected to a device that is implanted into a pocket formed just below the collarbone. This pocket is typically subcutaneous, that is, located just above the pectoral fascia. Even though the size of pacemakers has decreased markedly, complications due to superficial implants do occur. An alternative technique would be intramuscular placement of the pacemaker device, but there are no randomized controlled trials (RCTs to support this approach, which is the rationale for the Placement Of Cardiac PacemaKEr Trial (POCKET. The aim is to study if intramuscular is superior to subcutaneous placement of a pacemaker pocket.MethodsIn October 2016, we started to enroll 200 consecutive patients with an indication for bradycardia pacemaker implantation. Patients are randomized to random block sizes, stratified by age group (cut-off: 65 years and sex, and then randomized to either subcutaneous or intramuscular implant. A concealed allocation procedure is employed, using sequentially numbered, sealed envelopes. Pocket site is blinded to the patient and in all subsequent care. The primary endpoint is patient overall satisfaction with the pocket location at 24 months as measured using a visual analog scale (VAS 0-10. Secondary endpoints are: complications, patient-reported satisfaction at 1, 12, and 24 months (overall satisfaction, pain, discomfort, degree of unsightly appearance, movement problems, and sleep problems due to device.ConclusionsPOCKET is a prospective interventional RCT designed to evaluate if intramuscular is superior to subcutaneous placement of a bradycardia pacemaker during a two-year follow-up.

  1. Long-Term Mortality Effect of Early Pacemaker Implantation After Surgical Aortic Valve Replacement.

    Science.gov (United States)

    Greason, Kevin L; Lahr, Brian D; Stulak, John M; Cha, Yong-Mei; Rea, Robert F; Schaff, Hartzell V; Dearani, Joseph A

    2017-10-01

    The need for pacemaker implantation is a well-described complication of aortic valve replacement. Not so well described is the effect such an event has on long-term outcome. This study reviewed a 21-year experience at the Mayo Clinic (Rochester, Minnesota) with aortic valve replacement to understand the influence of early postoperative pacemaker implantation on long-term mortality rates more clearly. This study retrospectively reviewed the records of 5,842 patients without previous pacemaker implantation who underwent surgical aortic valve replacement from January 1993 through June 2014. The median age of these patients was 73 years (range, 65 to 79 years), the median ejection fraction was 62% (range, 53% to 68%), 3,853 patients were male (66%), and coronary artery bypass graft operation was performed in 2,553 (44%) of the patients studied. Early pacemaker implantation occurred in 146 patients (2.5%) within 30 days of surgical aortic valve replacement. The median follow-up of patients was 11.1 years (range, 5.8 to 16.5 years), and all-cause mortality rates were 2.4% at 30 days, 6.4% at 1 year, 23.1% at 5 years, 48.3% at 10 years, and 67.9% at 15 years postoperatively. Early pacemaker implantation was associated with an increased risk of death after multivariable adjustment for baseline patients' characteristics (hazard ratio, 1.49; 95% confidence interval, 1.20, 1.84; p pacemaker implantation as a complication of surgical aortic valve replacement is associated with an increased risk of long-term death. Valve replacement-related pacemaker implantation rates should be important considerations with respect to new valve replacement paradigms, especially in younger and lower-risk patients. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Case study thoracic radiotherapy in an elderly patient with pacemaker: The issue of pacing leads

    Energy Technology Data Exchange (ETDEWEB)

    Kirova, Youlia M., E-mail: youlia.kirova@curie.net [Department of Radiation Oncology, Institut Curie, Paris (France); Menard, Jean; Chargari, Cyrus; Mazal, Alejandro [Department of Radiation Oncology, Institut Curie, Paris (France); Kirov, Krassen [Department of Anesthesiology and Reanimation, Institut Curie, Paris (France)

    2012-07-01

    To assess clinical outcome of patients with pacemaker treated with thoracic radiation therapy for T8-T9 paravertebral chloroma. A 92-year-old male patient with chloroma presenting as paravertebral painful and compressive (T8-T9) mass was referred for radiotherapy in the Department of Radiation Oncology, Institut Curie. The patient presented with cardiac dysfunction and a permanent pacemaker that had been implanted prior. The decision of Multidisciplinary Meeting was to deliver 30 Gy in 10 fractions for reducing the symptoms and controlling the tumor growth. The patient received a total dose of 30 Gy in 10 fractions using 4-field conformal radiotherapy with 20-MV photons. The dose to pacemaker was 0.1 Gy but a part of the pacing leads was in the irradiation fields. The patient was treated the first time in the presence of his radiation oncologist and an intensive care unit doctor. Moreover, the function of his pacemaker was monitored during the entire radiotherapy course. No change in pacemaker function was observed during any of the radiotherapy fractions. The radiotherapy was very well tolerated without any side effects. The function of the pacemaker was checked before and after the radiotherapy treatment by the cardiologist and no pacemaker dysfunction was observed. Although updated guidelines are needed with acceptable dose criteria for implantable cardiac devices, it is possible to treat patients with these devices and parts encroaching on the radiation field. This case report shows we were able to safely treat our patient through a multidisciplinary approach, monitoring the patient during each step of the treatment.

  3. Case study thoracic radiotherapy in an elderly patient with pacemaker: The issue of pacing leads

    International Nuclear Information System (INIS)

    Kirova, Youlia M.; Menard, Jean; Chargari, Cyrus; Mazal, Alejandro; Kirov, Krassen

    2012-01-01

    To assess clinical outcome of patients with pacemaker treated with thoracic radiation therapy for T8-T9 paravertebral chloroma. A 92-year-old male patient with chloroma presenting as paravertebral painful and compressive (T8-T9) mass was referred for radiotherapy in the Department of Radiation Oncology, Institut Curie. The patient presented with cardiac dysfunction and a permanent pacemaker that had been implanted prior. The decision of Multidisciplinary Meeting was to deliver 30 Gy in 10 fractions for reducing the symptoms and controlling the tumor growth. The patient received a total dose of 30 Gy in 10 fractions using 4-field conformal radiotherapy with 20-MV photons. The dose to pacemaker was 0.1 Gy but a part of the pacing leads was in the irradiation fields. The patient was treated the first time in the presence of his radiation oncologist and an intensive care unit doctor. Moreover, the function of his pacemaker was monitored during the entire radiotherapy course. No change in pacemaker function was observed during any of the radiotherapy fractions. The radiotherapy was very well tolerated without any side effects. The function of the pacemaker was checked before and after the radiotherapy treatment by the cardiologist and no pacemaker dysfunction was observed. Although updated guidelines are needed with acceptable dose criteria for implantable cardiac devices, it is possible to treat patients with these devices and parts encroaching on the radiation field. This case report shows we were able to safely treat our patient through a multidisciplinary approach, monitoring the patient during each step of the treatment.

  4. Increased expression of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels in reactive astrocytes following ischemia

    Czech Academy of Sciences Publication Activity Database

    Honsa, Pavel; Pivoňková, Helena; Harantová, Lenka; Butenko, Olena; Kriška, Ján; Džamba, Dávid; Rusňáková, Vendula; Valihrach, Lukáš; Kubista, Mikael; Anděrová, Miroslava

    2014-01-01

    Roč. 62, č. 12 (2014), s. 2004-2021 ISSN 0894-1491 R&D Projects: GA ČR GA13-02154S; GA ČR(CZ) GBP304/12/G069; GA MŠk(CZ) ED1.1.00/02.0109 Grant - others:GA MŠk(CZ) CZ.1.07/2.3.00/30.0045 Institutional support: RVO:68378041 ; RVO:86652036 Keywords : Astrocytes * focal and global cerebral ischemia * HCN channels Subject RIV: FH - Neurology Impact factor: 6.031, year: 2014

  5. Interference of neodymium magnets with cardiac pacemakers and implantable cardioverter-defibrillators: an in vitro study.

    Science.gov (United States)

    Ryf, Salome; Wolber, Thomas; Duru, Firat; Luechinger, Roger

    2008-01-01

    Permanent magnets may interfere with the function of cardiac pacemakers and implantable cardioverter-defibrillators (ICDs). Neodymium-iron-boron (NdFeB) magnets have become widely available in recent years and are incorporated in various articles of daily life. We conducted an in-vitro study to evaluate the ability of NdFeB magnets for home and office use to cause interference with cardiac pacemakers and ICDs. The magnetic fields of ten NdFeB magnets of different size and shape were measured at increasing distances beginning from the surface until a field-strength (B-field) value of 0.5 mT was reached. Furthermore, for each magnet the distance was determined at which a sample pacemaker switched from magnet mode to normal mode. Depending on the size and remanence of individual magnets, a B-field value of 0.5 mT was found at distances ranging from 1.5 cm to 30 cm and a value of 1 mT at distances from 1 cm to 22 cm. The pacemaker behavior was influenced at distances from 1 cm to 24 cm. NdFeB magnets for home and office use may cause interference with cardiac pacemakers and ICDs at distances up to 24 centimeters. Patient education and product declarations should include information about the risk associated with these magnets.

  6. Pre-ejection period by radial artery tonometry supplements echo doppler findings during biventricular pacemaker optimization

    Directory of Open Access Journals (Sweden)

    Qamruddin Salima

    2011-07-01

    Full Text Available Abstract Background Biventricular (Biv pacemaker echo optimization has been shown to improve cardiac output however is not routinely used due to its complexity. We investigated the role of a simple method involving computerized pre-ejection time (PEP assessment by radial artery tonometry in guiding Biv pacemaker optimization. Methods Blinded echo and radial artery tonometry were performed simultaneously in 37 patients, age 69.1 ± 12.8 years, left ventricular (LV ejection fraction (EF 33 ± 10%, during Biv pacemaker optimization. Effect of optimization on echo derived velocity time integral (VTI, ejection time (ET, myocardial performance index (MPI, radial artery tonometry derived PEP and echo-radial artery tonometry derived PEP/VTI and PEP/ET indices was evaluated. Results Significant improvement post optimization was achieved in LV ET (286.9 ± 37.3 to 299 ± 34.6 ms, p Conclusion An acute shortening of PEP by radial artery tonometry occurs post Biv pacemaker optimization and correlates with improvement in hemodynamics by echo Doppler and may provide a cost-efficient approach to assist with Biv pacemaker echo optimization.

  7. Early Performance and Safety of the Micra Transcatheter Pacemaker in Pigs.

    Science.gov (United States)

    Bonner, Matthew; Eggen, Michael; Haddad, Tarek; Sheldon, Todd; Williams, Eric

    2015-11-01

    The Micra® Transcatheter Pacing System (TPS; Medtronic Inc., Minneapolis, MN, USA) is a miniaturized single-chamber pacemaker system that is delivered via catheter through the femoral vein. In this study, the electrical performance was compared between the TPS and a traditional leaded pacemaker. In addition, the safety profile of the two systems was compared by thorough monitoring for a number of adverse events. The TPS was implanted in the right ventricular apex of 10 Yucatan mini pigs and a Medtronic single-lead pacemaker (SLP) was implanted in the right ventricular apex of another 10 pigs and connected to a traditional pacemaker. The electrical performance of all devices was monitored for 12 weeks. The safety profile of each system was characterized using x-ray, computed tomography, ultrasound, blood work, and necropsy to monitor for a variety of adverse events. At implant the mean pacing thresholds were 0.58 ± 0.17 V @0.24 ms and 0.75 ± 0.29 V @0.21 ms for the TPS and the SLP respectively. After 12 weeks, mean thresholds were 0.94 ± 0.46 V and 1.85 ± 0.75 V (P pacemaker system. © 2015 Medtronic PLC. Pacing and Clinical Electrophysiology published by Wiley Periodicals, Inc.

  8. Characteristics and Prognosis of Pacemaker-Identified New-Onset Atrial Fibrillation in Japanese People.

    Science.gov (United States)

    Ogino, Yutaka; Ishikawa, Toshiyuki; Ishigami, Tomoaki; Matsumoto, Katsumi; Hosoda, Junya; Iguchi, Kouhei; Matsushita, Hirooki; Taguchi, Yuka; Horiguchi, Yoriko; Kimura, Kazuo

    2017-05-25

    The characteristics and prognosis of implanted pacemaker-identified new-onset atrial fibrillation (AF) in Japanese people has not been well evaluated.Methods and Results:A total of 395 consecutive patients with newly implanted pacemakers were retrospectively analyzed between January 2010 and December 2015 at Yokohama City University Hospital. Patients with a prior history of AF, VVI mode pacemaker, congenital heart disease, severe valvular heart disease, and cardiovascular surgery before pacemaker implantation were excluded. Among the remaining patients, 44 (21.3%) developed new AF during follow-up (mean follow-up, 1,115±651 days; range, 9-2,176 days). Patients with new-onset AF had a significantly higher CHADS 2 score (2.09±1.27 vs. 1.31±1.08, Ppacemaker-implanted patients with high CHADS 2 and CHA 2 DS 2 -VASc scores developed new-onset AF during a mean follow-up of 3.1 years; and pacemaker-identified AF was associated with an increased risk of worsening heart failure.

  9. Surgical outcome of Fontan conversion and arrhythmia surgery: Need a pacemaker?

    Science.gov (United States)

    Terada, Takafumi; Sakurai, Hajime; Nonaka, Toshimichi; Sakurai, Takahisa; Sugiura, Junya; Taneichi, Tetsuyoshi; Ohtsuka, Ryohei

    2014-07-01

    Atrial tachyarrhythmias are frequent complications in the late period after the Fontan procedure, and important risk factors for a poor prognosis. The impact of Fontan conversion and arrhythmia surgery in failed Fontan patients has been described in many reports. We evaluated our experience with Fontan conversion procedures, concomitant arrhythmia surgery, and pacemaker implantation. We reviewed the hospital records of 25 consecutive patients who underwent a Fontan conversion procedure from January 2004 to March 2012. Twenty-four patients had arrhythmia surgery using cryoablation and radiofrequency ablation at the time of conversion. A bilateral atrial maze procedure was performed in 6 patients, right-side maze in 15, and isthmus block in 3. Three patients with a diagnosis of corrected transposition of the great arteries underwent simultaneous pacemaker implantation electively. There was no early death and one late death during a mean follow-up period of 21.2 months. Three tachyarrhythmia recurrences developed, and there were 4 occurrences of sinus bradycardia. Five of these patients required postoperative pacemaker implantation. The mid-term results of Fontan conversion and arrhythmia surgery in our institute were satisfactory. The occurrence of unexpected postoperative pacemaker requirement was high in the patients who underwent a right atrial or bilateral atrial maze procedure. Pacemaker or lead implantation is recommended for patients planned to undergo a right-side or full maze procedure. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  10. Pacemaker System Malfunction Resulting from External Electrical Cardioversion: A Case Report

    Directory of Open Access Journals (Sweden)

    Taku Nishida, MD

    2009-01-01

    Full Text Available In May 2005 a 68-year-old woman received a VDD pacemaker implantation in the right pectoral region at our hospital for the treatment of complete atrioventricular block. In July 2008, she was diagnosed with dilated cardiomyopathy based on histological testing. In November 2008, she developed syncope due to ventricular tachycardia while at another hospital. She underwent external electrical cardioversion with an anterior-lateral paddle position using a single shock of 100 J. This shock led to severe bradycardia resulting in a transfer to our hospital. The physician who provided the shock could not have been aware that the patient had an implanted pacemaker. The skin above the pulse generator was burned. The electrocardiogram showed no pacing spikes or ventricular escape rhythm. Investigation of the pacemaker 3 hours after cardioversion revealed reprogramming of the device and a marked rise in the lead impedance (>3,000 ohm. Removal of the generator and implantation of a biventricular cardioverter defibrillator were required. The emergency situation, the small size of the generator, the small incision made using the buried suture method, and the patient's obesity all probably contributed to the physician's not noticing the implanted pacemaker. It is important to increase awareness of the severe consequences that may follow if the physician administering external defibrillation does not know about the patient's implanted pacemaker.

  11. Recovery of Ventriculo-Atrial Conduction after Adrenaline in Patients Implanted with Pacemakers.

    Science.gov (United States)

    Cismaru, Gabriel; Gusetu, Gabriel; Muresan, Lucian; Rosu, Radu; Andronache, Marius; Matuz, Roxana; Puiu, Mihai; Mester, Petru; Miclaus, Maria; Pop, Dana; Mircea, Petru Adrian; Zdrenghea, Dumitru

    2015-07-01

    Ventriculo-atrial (VA) conduction can have negative consequences for patients with implanted pacemakers and defibrillators. There is concern whether impaired VA conduction could recover during stressful situations. Although the influence of isoproterenol and atropine are well established, the effect of adrenaline has not been studied systematically. The objective of this study was to determine if adrenaline can facilitate recovery of VA conduction in patients implanted with pacemakers. A prospective study was conducted on 61 consecutive patients during a 4-month period (April-July 2014). The presence of VA conduction was assessed during the pacemaker implantation procedure. In case of an impaired VA conduction, adrenaline infusio was used as a stress surrogate to test conduction recovery. The indications for pacemaker implantation were: sinus node dysfunction in 18 patients, atrioventricular (AV) block in 40 patients, binodal dysfunction (sinus node+ AV node) in two patients and other (carotid sinus syndrome) in one patient. In the basal state, 15/61 (24.6%) presented spontaneous VA conduction and 46/61 (75.4%) had no VA conduction. After administration of adrenaline, there was VA conduction recovery in 5/46 (10.9%) patients. Adrenaline infusion produced recovery of VA conduction in 10.9% of patients with absent VA conduction in a basal state. Recovery of VA conduction during physiological or pathological stresses could be responsible for the pacemaker syndrome, PMT episodes, or certain implantable cardiac defibrillator detection issues. © 2015 Wiley Periodicals, Inc.

  12. Complete Congenital Heart Block in a Neonatal Lupus Erythematosus Associated with Pulmonary Involvement without Pacemaker Implantation: A Case Report

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    Yazdan Ghandi

    2016-10-01

    Conclusion: This case report was conducted on a newborn with CCHB associated with pulmonary disorder. The newborn was intubated due to respiratory distress and did not need pacemaker implantation; however, after 8-month follow up, excellent outcomes were observed. It seems that atelectasis and mechanical ventilation can intolerance, and pacemaker implantation did not need in NLE with CCHB with narrowing QRS complex.

  13. Trends in service time of pacemakers in the Netherlands : A long-term nationwide follow-up study

    NARCIS (Netherlands)

    de Vries, L. M.; Leening, M. J. G.; Dijk, W. A.; Hooijschuur, C. A. M.; Stricker, B. H. C.; van Hemel, N. M.

    2017-01-01

    Aims: After decades of experience and strongly improved technology, service time of pacemaker generators is expected to increase. To test this hypothesis, we conducted a retrospective review of a large cohort of patients with a pacemaker. Methods: We reviewed data collected between 1984 and 2006 in

  14. Trends in service time of pacemakers in the Netherlands: A long-term nationwide follow-up study

    NARCIS (Netherlands)

    L.M. de Vries (Laura); M.J.G. Leening (Maarten); W.A. Dijk (Arnold); C.A.M. Hooijschuur (C. A M); B.H.Ch. Stricker (Bruno); N.M. van Hemel (Norbert)

    2017-01-01

    textabstractAims After decades of experience and strongly improved technology, service time of pacemaker generators is expected to increase. To test this hypothesis, we conducted a retrospective review of a large cohort of patients with a pacemaker. Methods We reviewed data collected between 1984

  15. Short- and long-term need for permanent pacemaker after transcatheter implantation of the Edwards Sapien aortic valve prosthesis.

    Science.gov (United States)

    Moreno, Raúl; Calvo, Luis; Sánchez-Recalde, Angel; Galeote, Guillermo; Jiménez-Valero, Santiago; López, Teresa; Plaza, Ignacio; González-Davia, Rosa; Ramírez, Ulises; Mesa, Jose Maria; Moreno-Gomez, Isidro; López-Sendón, José-Luis

    2015-11-01

    A permanent pacemaker is frequently needed after transcatheter aortic valve implantation, but the available data are mainly on the CoreValve system. To evaluate the need for new permanent pacemaker after implantation of the Edwards Sapien device, as well as related factors. We included the first 100 patients treated with the Edwards Sapien device at our institution. Of these, 12 had a permanent pacemaker before the procedure, and thus our study population was the remaining 88 patients. A permanent pacemaker was indicated in eight patients (9.1%) during hospitalization or at 30 days. After discharge, another four patients needed a pacemaker (at 42 days and three, 18, and 30 months). Two variables were associated with the need for pacemaker during hospitalization: previous dialysis (13% vs. 1%, p=0.042) and complete right bundle branch block before the procedure (25% vs. 5%, p=0.032). More than one month after the procedure, the characteristics associated with the need for pacemaker were plasma creatinine level (2.5±1.7 vs. 1.3±0.6 mg/dl, p=0.001) and previous myocardial infarction (50% vs. 10%, p=0.013). The rate of pacemaker implantation with the Edwards Sapien device was 9.1%. Right bundle branch block and dialysis were associated with this complication.

  16. Cardiac MRI in patients with complex CHD following primary or secondary implantation of MRI-conditional pacemaker system.

    Science.gov (United States)

    Al-Wakeel, Nadya; O h-Ici, Darach; Schmitt, Katharina R; Messroghli, Daniel R; Riesenkampff, Eugénie; Berger, Felix; Kuehne, Titus; Peters, Bjoern

    2016-02-01

    In patients with CHD, cardiac MRI is often indicated for functional and anatomical assessment. With the recent introduction of MRI-conditional pacemaker systems, cardiac MRI has become accessible for patients with pacemakers. The present clinical study aims to evaluate safety, susceptibility artefacts, and image reading of cardiac MRI in patients with CHD and MRI-conditional pacemaker systems. Material and methods CHD patients with MRI-conditional pacemaker systems and a clinical need for cardiac MRI were examined with a 1.5-T MRI system. Lead function was tested before and after MRI. Artefacts and image readings were evaluated using a four-point grading scale. A total of nine patients with CHD (mean age 34.0 years, range 19.5-53.6 years) received a total of 11 cardiac MRI examinations. Owing to clinical indications, seven patients had previously been converted from conventional to MRI-conditional pacemaker systems. All MRI examinations were completed without adverse effects. Device testing immediately after MRI and at follow-up showed no alteration of pacemaker device and lead function. Clinical questions could be addressed and answered in all patients. Cardiac MRI can be performed safely with high certainty of diagnosis in CHD patients with MRI-conditional pacemaker systems. In case of clinically indicated lead and box changing, CHD patients with non-MRI-conditional pacemaker systems should be considered for complete conversion to MRI-conditional systems.

  17. The proportion of asymptomatic recurrence after catheter ablation of atrial fibrillation in patients with a pacemaker for sick sinus syndrome

    Directory of Open Access Journals (Sweden)

    Yuki Osaka

    2017-09-01

    Conclusions: One-third of PAF patients with SSS and pacemakers recurred after multiple CA sessions. However, 65% of them were asymptomatic and difficult to be identified with conventional follow-up. Pacemaker interrogation significantly increased the detection rate of AF-recurrence.

  18. Noise-induced plasticity of KCNQ2/3 and HCN channels underlies vulnerability and resilience to tinnitus

    Science.gov (United States)

    Li, Shuang; Kalappa, Bopanna I; Tzounopoulos, Thanos

    2015-01-01

    Vulnerability to noise-induced tinnitus is associated with increased spontaneous firing rate in dorsal cochlear nucleus principal neurons, fusiform cells. This hyperactivity is caused, at least in part, by decreased Kv7.2/3 (KCNQ2/3) potassium currents. However, the biophysical mechanisms underlying resilience to tinnitus, which is observed in noise-exposed mice that do not develop tinnitus (non-tinnitus mice), remain unknown. Our results show that noise exposure induces, on average, a reduction in KCNQ2/3 channel activity in fusiform cells in noise-exposed mice by 4 days after exposure. Tinnitus is developed in mice that do not compensate for this reduction within the next 3 days. Resilience to tinnitus is developed in mice that show a re-emergence of KCNQ2/3 channel activity and a reduction in HCN channel activity. Our results highlight KCNQ2/3 and HCN channels as potential targets for designing novel therapeutics that may promote resilience to tinnitus. DOI: http://dx.doi.org/10.7554/eLife.07242.001 PMID:26312501

  19. Reduction of nitrogen compounds in oceanic basement and its implications for HCN formation and abiotic organic synthesis

    Directory of Open Access Journals (Sweden)

    Neubeck Anna

    2009-10-01

    Full Text Available Abstract Hydrogen cyanide is an excellent organic reagent and is central to most of the reaction pathways leading to abiotic formation of simple organic compounds containing nitrogen, such as amino acids, purines and pyrimidines. Reduced carbon and nitrogen precursor compounds for the synthesis of HCN may be formed under off-axis hydrothermal conditions in oceanic lithosphere in the presence of native Fe and Ni and are adsorbed on authigenic layer silicates and zeolites. The native metals as well as the molecular hydrogen reducing CO2 to CO/CH4 and NO3-/NO2- to NH3/NH4+ are a result of serpentinization of mafic rocks. Oceanic plates are conveyor belts of reduced carbon and nitrogen compounds from the off-axis hydrothermal environments to the subduction zones, where compaction, dehydration, desiccation and diagenetic reactions affect the organic precursors. CO/CH4 and NH3/NH4+ in fluids distilled out of layer silicates and zeolites in the subducting plate at an early stage of subduction will react upon heating and form HCN, which is then available for further organic reactions to, for instance, carbohydrates, nucleosides or even nucleotides, under alkaline conditions in hydrated mantle rocks of the overriding plate. Convergent margins in the initial phase of subduction must, therefore, be considered the most potent sites for prebiotic reactions on Earth. This means that origin of life processes are, perhaps, only possible on planets where some kind of plate tectonics occur.

  20. Measurements of hydrogen cyanide (HCN) and acetylene (C2H2) from the Infrared Atmospheric Sounding Interferometer (IASI)

    OpenAIRE

    C. Clerbaux; C. Servais; M. De Mazière; E. Mahieu; C. Vigouroux; Y. R'honi; D. Hurtmans; L. Clarisse; V. Duflot; P.-F. Coheur

    2012-01-01

    Hydrogen cyanide (HCN) and acetylene (C2H2) are ubiquitous atmospheric trace gases with medium lifetime, which are frequently used as indicators of combustion sources and as tracers for atmospheric transport and chemistry. Because of their weak infrared absorption, overlapped by the CO2 Q-branch near 720 cm−1, nadir sounders have up to now failed to measure these gases routinely. Taking into account CO2 line mixing we provide for the first time extensive measurements of HCN and C2H2 total col...

  1. [The computer assisted pacemaker clinic at the regional hospital of Udine (author's transl)].

    Science.gov (United States)

    Feruglio, G A; Lestuzzi, L; Carminati, D

    1978-01-01

    For a close follow-up of large groups of pacemaker patients and for evaluation of long term pacing on a reliable statistical basis, many pacemaker centers in the world are now using computer systems. A patient data system with structured display records, designed to give complete, comprehensive and surveyable information and which are immediately retrievable 24 hours a day, on display or printed sets, seems to offer an ideal solution. The pacemaker clinic at the Regional Hospital of Udine has adopted this type of system. The clinic in linked to a live, on-line patient data system (G/3, Informatica Friuli-Venezia Giulia). The input and retrieval of information are made through a conventional keyboard. The input formats have fixed headings with coded alternatives and a limited space for comments in free text. The computer edits the coded information to surveyable reviews. Searches can be made on coded information and data of interest.

  2. A Parametric Computational Model of the Action Potential of Pacemaker Cells.

    Science.gov (United States)

    Ai, Weiwei; Patel, Nitish D; Roop, Partha S; Malik, Avinash; Andalam, Sidharta; Yip, Eugene; Allen, Nathan; Trew, Mark L

    2018-01-01

    A flexible, efficient, and verifiable pacemaker cell model is essential to the design of real-time virtual hearts that can be used for closed-loop validation of cardiac devices. A new parametric model of pacemaker action potential is developed to address this need. The action potential phases are modeled using hybrid automaton with one piecewise-linear continuous variable. The model can capture rate-dependent dynamics, such as action potential duration restitution, conduction velocity restitution, and overdrive suppression by incorporating nonlinear update functions. Simulated dynamics of the model compared well with previous models and clinical data. The results show that the parametric model can reproduce the electrophysiological dynamics of a variety of pacemaker cells, such as sinoatrial node, atrioventricular node, and the His-Purkinje system, under varying cardiac conditions. This is an important contribution toward closed-loop validation of cardiac devices using real-time heart models.

  3. Pacemaker optimization guided by echocardiography in cardiac resynchronization therapy

    Directory of Open Access Journals (Sweden)

    Trifunović Danijela

    2009-01-01

    Full Text Available Introduction. Cardiac resynchronization therapy (CRT or biventricular pacing is a contemporary treatment in the management of advanced heart failure. Echocardiography plays an evolving and important role in patient selection for CRT, follow-up of acute and chronic CRT effects and optimization of device settings after biventricular pacemaker implantation. In this paper we illustrate usefulness of echocardiography for successful AV and VV timing optimization in patients with CRT. A review of up-to-date literature concerning rationale for AV and VV delay optimization, echocardiographic protocols and current recommendations for AV and VV optimization after CRT are also presented. Outline of Cases. The first case is of successful AV delay optimization guided by echocardiography in a patient with dilated cardiomyopathy treated with CRT is presented. Pulsed blood flow Doppler was used to detect mitral inflow while programming different duration of AV delay. The AV delay with optimal transmittal flow was established. The optimal mitral flow was the one with clearly defined E and A waves and maximal velocity time integral (VTI of the mitral flow. Improvement in clinical status and reverse left ventricle remodelling with improvement of ejection fraction was registered in our patient after a month. The second case presents a patient with heart failure caused by dilated cardiomyopathy; six months after CRT implantation the patient was still NYHA class III and with a significantly depressed left ventricular ejection fraction. Optimization of VV interval guided by echocardiography was undertaken measuring VTI of the left ventricular outflow tract (LVOT during programming of different VV intervals. The optimal VV interval was determined using a maximal LVOT VTI. A month after VV optimization our patient showed improvement in LV ejection fraction. Conclusion. Optimal management of patients treated with CRT integrate both clinical and echocardiographic follow

  4. Setups for in vitro assessment of RFID interference on pacemakers

    International Nuclear Information System (INIS)

    Mattei, E; Censi, F; Delogu, A; Ferrara, A; Calcagnini, G

    2013-01-01

    The aim of this study is to propose setups for in vitro assessment of RFID (radiofrequency identification) interference on pacemakers (PM). The voltage induced at the input stage of the PM by low-frequency (LF) and high-frequency (HF) RFID transmitters has been used to quantify the amount of the interference. A commercial PM was modified in order to measure the voltage at its input stage when exposed to a sinusoidal signal at 125 kHz and 13.56 MHz. At both frequencies, two antennas with different dimensions (diameter = 10 cm and 30 cm, respectively) were used to generate the interfering field, and the induced voltage was measured between the lead tip and the PM case (unipolar voltage), and between the tip and ring electrodes (bipolar voltage). The typical lead configurations adopted in similar studies or proposed by international standards, as well as lead paths closer to actual physiological implants were tested. At 125 kHz, the worst-case condition differs for the two antennas: the 10 cm antenna induced the highest voltage in the two-loop spiral configuration, whereas the 30 cm antenna in the 225 cm 2 loop configuration. At 13.56 MHz, the highest voltage was observed for both the antennas in the 225 cm 2 loop configuration. Bipolar voltages were found to be lower than the unipolar voltages induced in the same configurations, this difference being not as high as one could expect from theoretical considerations. The worst-case scenario, in terms of the induced voltage at the PM input stage, has been identified both for LF and HF readers, and for two sizes of transmitting antennas. These findings may provide the basis for the definition of a standard implant configuration and a lead path to test the EMI effects of LF and HF RFID transmitters on active implantable devices. (paper)

  5. Electrophysiological Evidence for Intrinsic Pacemaker Currents in Crayfish Parasol Cells.

    Directory of Open Access Journals (Sweden)

    DeForest Mellon

    Full Text Available I used sharp intracellular electrodes to record from parasol cells in the semi-isolated crayfish brain to investigate pacemaker currents. Evidence for the presence of the hyperpolarization-activated inward rectifier potassium current was obtained in about half of the parasol cells examined, where strong, prolonged hyperpolarizing currents generated a slowly-rising voltage sag, and a post-hyperpolarization rebound. The amplitudes of both the sag voltage and the depolarizing rebound were dependent upon the strength of the hyperpolarizing current. The voltage sag showed a definite threshold and was non-inactivating. The voltage sag and rebound depolarization evoked by hyperpolarization were blocked by the presence of 5-10 mM Cs2+ ions, 10 mM tetraethyl ammonium chloride, and 10 mM cobalt chloride in the bathing medium, but not by the drug ZD 7288. Cs+ ions in normal saline in some cells caused a slight increase in mean resting potential and a reduction in spontaneous burst frequency. Many of the neurons expressing the hyperpolarization-activated inward potassium current also provided evidence for the presence of the transient potassium current IA, which was inferred from experimental observations of an increased latency of post-hyperpolarization response to a depolarizing step, compared to the response latency to the depolarization alone. The latency increase was reduced in the presence of 4-aminopyridine (4-AP, a specific blocker of IA. The presence of 4-AP in normal saline also induced spontaneous bursting in parasol cells. It is conjectured that, under normal physiological conditions, these two potassium currents help to regulate burst generation in parasol cells, respectively, by helping to maintain the resting membrane potential near a threshold level for burst generation, and by regulating the rate of rise of membrane depolarizing events leading to burst generation. The presence of post-burst hyperpolarization may depend upon IA channels in

  6. Superior transseptal approach to mitral valve is associated with a higher need for pacemaker implantation than the left atrial approach

    DEFF Research Database (Denmark)

    Lukac, Peter; Hjortdal, Vibeke E; Pedersen, Anders K

    2006-01-01

    retrospectively evaluated. The surgeons used either the superior transseptal (group A) or left atrial approach (group B). The risk of pacemaker implantation associated with the superior transseptal approach as compared with the left atrial approach was estimated using the multivariate Cox regression analysis...... to adjust for possible confounders. RESULTS: We included 577 patients, 150 in group A and 427 in group B. Forty-four patients had a pacemaker implanted after the surgery; 17 in group A and 27 in group B (p = 0.010). The superior transseptal approach was an independent risk factor of pacemaker implantation...... in multivariate analysis (hazard ratio 2.2 [1.2 to 4.1], p = 0.014). Nineteen patients had a pacemaker implanted because of sinus node dysfunction; 9 in group A and 10 in group B (p = 0.017). Group A was an independent predictor of pacemaker implantation because of sinus node dysfunction in bivariate analyses...

  7. Risk of pacemaker implantation subsequent to radiotherapy for early-stage breast cancer in Denmark, 1982-2005

    DEFF Research Database (Denmark)

    Rehammar, Jens Christian; Videbaek, L.; Brock Johansen, J.

    2015-01-01

    . Objectives: The aim of this study was to examine the risk of severe conduction abnormalities evaluated by implantation of a pacemaker, subsequent to breast cancer radiotherapy. Methods: From the database of the Danish Breast Cancer Collaborative Group, we identified women treated with radiotherapy for early......-stage breast cancer in Denmark from 1982 to 2005. By record linkage to the Danish Pacemaker and ICD Registry information was retrieved on pacemaker implants subsequent to radiotherapy. Rate ratios (RR) of pacemaker implantation for left versus right sided breast cancer were calculated. Results: Among 18......,308 women treated with radiotherapy for early-stage breast cancer, 179 women had a pacemaker implanted subsequent to radiotherapy, 90 in 9,315 left sided and 89 in 8,993 right sided breast cancers. The unadjusted RR was 1.02 (0.76-1.36 95% CI, p=0.91) and the RR adjusted for year, age and time since...

  8. Gene- and cell-based bio-artificial pacemaker: what basic and translational lessons have we learned?

    Science.gov (United States)

    Li, R A

    2012-06-01

    Normal rhythms originate in the sino-atrial node, a specialized cardiac tissue consisting of only a few thousands of nodal pacemaker cells. Malfunction of pacemaker cells due to diseases or aging leads to rhythm generation disorders (for example, bradycardias and sick-sinus syndrome (SSS)), which often necessitate the implantation of electronic pacemakers. Although effective, electronic devices are associated with such shortcomings as limited battery life, permanent implantation of leads, lead dislodging, the lack of autonomic responses and so on. Here, various gene- and cell-based approaches, with a particular emphasis placed on the use of pluripotent stem cells and the hyperpolarization-activated cyclic nucleotide-gated-encoded pacemaker gene family, that have been pursued in the past decade to reconstruct bio-artificial pacemakers as alternatives will be discussed in relation to the basic biological insights and translational regenerative potential.

  9. Pacemaker neuron and network oscillations depend on a neuromodulator-regulated linear current

    Directory of Open Access Journals (Sweden)

    Shunbing Zhao

    2010-05-01

    Full Text Available Linear leak currents have been implicated in the regulation of neuronal excitability, generation of neuronal and network oscillations, and network state transitions. Yet, few studies have directly tested the dependence of network oscillations on leak currents or explored the role of leak currents on network activity. In the oscillatory pyloric network of decapod crustaceans neuromodulatory inputs are necessary for pacemaker activity. A large subset of neuromodulators is known to activate a single voltage-gated inward current IMI, which has been shown to regulate the rhythmic activity of the network and its pacemaker neurons. Using the dynamic clamp technique, we show that the crucial component of IMI for the generation of oscillatory activity is only a close-to-linear portion of the current-voltage relationship. The nature of this conductance is such that the presence or the absence of neuromodulators effectively regulates the amount of leak current and the input resistance in the pacemaker neurons. When deprived of neuromodulatory inputs, pyloric oscillations are disrupted; yet, a linear reduction of the total conductance in a single neuron within the pacemaker group recovers not only the pacemaker activity in that neuron, but also leads to a recovery of oscillations in the entire pyloric network. The recovered activity produces proper frequency and phasing that is similar to that induced by neuromodulators. These results show that the passive properties of pacemaker neurons can significantly affect their capacity to generate and regulate the oscillatory activity of an entire network, and that this feature is exploited by neuromodulatory inputs.

  10. Autaptic pacemaker mediated propagation of weak rhythmic activity across small-world neuronal networks

    Science.gov (United States)

    Yilmaz, Ergin; Baysal, Veli; Ozer, Mahmut; Perc, Matjaž

    2016-02-01

    We study the effects of an autapse, which is mathematically described as a self-feedback loop, on the propagation of weak, localized pacemaker activity across a Newman-Watts small-world network consisting of stochastic Hodgkin-Huxley neurons. We consider that only the pacemaker neuron, which is stimulated by a subthreshold periodic signal, has an electrical autapse that is characterized by a coupling strength and a delay time. We focus on the impact of the coupling strength, the network structure, the properties of the weak periodic stimulus, and the properties of the autapse on the transmission of localized pacemaker activity. Obtained results indicate the existence of optimal channel noise intensity for the propagation of the localized rhythm. Under optimal conditions, the autapse can significantly improve the propagation of pacemaker activity, but only for a specific range of the autaptic coupling strength. Moreover, the autaptic delay time has to be equal to the intrinsic oscillation period of the Hodgkin-Huxley neuron or its integer multiples. We analyze the inter-spike interval histogram and show that the autapse enhances or suppresses the propagation of the localized rhythm by increasing or decreasing the phase locking between the spiking of the pacemaker neuron and the weak periodic signal. In particular, when the autaptic delay time is equal to the intrinsic period of oscillations an optimal phase locking takes place, resulting in a dominant time scale of the spiking activity. We also investigate the effects of the network structure and the coupling strength on the propagation of pacemaker activity. We find that there exist an optimal coupling strength and an optimal network structure that together warrant an optimal propagation of the localized rhythm.

  11. Runtime Verification of Pacemaker Functionality Using Hierarchical Fuzzy Colored Petri-nets.

    Science.gov (United States)

    Majma, Negar; Babamir, Seyed Morteza; Monadjemi, Amirhassan

    2017-02-01

    Today, implanted medical devices are increasingly used for many patients and in case of diverse health problems. However, several runtime problems and errors are reported by the relevant organizations, even resulting in patient death. One of those devices is the pacemaker. The pacemaker is a device helping the patient to regulate the heartbeat by connecting to the cardiac vessels. This device is directed by its software, so any failure in this software causes a serious malfunction. Therefore, this study aims to a better way to monitor the device's software behavior to decrease the failure risk. Accordingly, we supervise the runtime function and status of the software. The software verification means examining limitations and needs of the system users by the system running software. In this paper, a method to verify the pacemaker software, based on the fuzzy function of the device, is presented. So, the function limitations of the device are identified and presented as fuzzy rules and then the device is verified based on the hierarchical Fuzzy Colored Petri-net (FCPN), which is formed considering the software limits. Regarding the experiences of using: 1) Fuzzy Petri-nets (FPN) to verify insulin pumps, 2) Colored Petri-nets (CPN) to verify the pacemaker and 3) To verify the pacemaker by a software agent with Petri-network based knowledge, which we gained during the previous studies, the runtime behavior of the pacemaker software is examined by HFCPN, in this paper. This is considered a developing step compared to the earlier work. HFCPN in this paper, compared to the FPN and CPN used in our previous studies reduces the complexity. By presenting the Petri-net (PN) in a hierarchical form, the verification runtime, decreased as 90.61% compared to the verification runtime in the earlier work. Since we need an inference engine in the runtime verification, we used the HFCPN to enhance the performance of the inference engine.

  12. Permanent Pacemaker-Induced Superior Vena Cava Syndrome: Successful Treatment by Endovascular Stent

    International Nuclear Information System (INIS)

    Lanciego, Carlos; Rodriguez, Mario; Rodriguez, Adela; Carbonell, Miguel A.; Garcia, Lorenzo Garcia

    2003-01-01

    The use of metallic stents in the management of benign and malignant superior vena cava syndrome (SVCS) is well documented. Symptomatic stenosis or occlusion of the SVC is a rare complication of a transvenous permanent pacemaker implant. Suggested treatments have included anticoagulation therapy, thrombolysis, balloon angioplasty and surgery. More recently, endovascular stenting has evolved as an attractive alternative but the data available in the literature are limited. We describe a case in which venous stenting with a Wallstent endoprosthesis was used successfully. The patient remains symptom free and with normal pacemaker function 36 months later

  13. Pacemaker activity and inhibitory neurotransmission in the colon of Ws/Ws mutant rats

    DEFF Research Database (Denmark)

    Albertí, Elena; Mikkelsen, Hanne Birte; Wang, Xuanyu

    2007-01-01

    The aim of this study was to characterize the pacemaker activity and inhibitory neurotransmission in the colon of Ws/Ws mutant rats, which harbor a mutation in the c-kit gene that affects development of interstitial cells of Cajal (ICC). In Ws/Ws rats, the density of KIT-positive cells was markedly...... as indirect innervation via ICC. In summary, loss of ICC markedly affects pacemaker and motor activities of the rat colon. Inhibitory innervation is largely maintained but nitrergic innervation is reduced possibly related to the loss of ICC-mediated relaxation....

  14. Nitrogen and hydrogen fractionation in high-mass star-forming cores from observations of HCN and HNC

    Science.gov (United States)

    Colzi, L.; Fontani, F.; Caselli, P.; Ceccarelli, C.; Hily-Blant, P.; Bizzocchi, L.

    2018-02-01

    The ratio between the two stable isotopes of nitrogen, 14N and 15N, is well measured in the terrestrial atmosphere ( 272), and for the pre-solar nebula ( 441, deduced from the solar wind). Interestingly, some pristine solar system materials show enrichments in 15N with respect to the pre-solar nebula value. However, it is not yet clear if and how these enrichments are linked to the past chemical history because we have only a limited number of measurements in dense star-forming regions. In this respect, dense cores, which are believed to be the precursors of clusters and also contain intermediate- and high-mass stars, are important targets because the solar system was probably born within a rich stellar cluster, and such clusters are formed in high-mass star-forming regions. The number of observations in such high-mass dense cores has remained limited so far. In this work, we show the results of IRAM-30 m observations of the J = 1-0 rotational transition of the molecules HCN and HNC and their 15N-bearing counterparts towards 27 intermediate- and high-mass dense cores that are divided almost equally into three evolutionary categories: high-mass starless cores, high-mass protostellar objects, and ultra-compact HII regions. We have also observed the DNC(2-1) rotational transition in order to search for a relation between the isotopic ratios D/H and 14N/15N. We derive average 14N/15N ratios of 359 ± 16 in HCN and of 438 ± 21 in HNC, with a dispersion of about 150-200. We find no trend of the 14N/15N ratio with evolutionary stage. This result agrees with what has been found for N2H+ and its isotopologues in the same sources, although the 14N/15N ratios from N2H+ show a higher dispersion than in HCN/HNC, and on average, their uncertainties are larger as well. Moreover, we have found no correlation between D/H and 14N/15N in HNC. These findings indicate that (1) the chemical evolution does not seem to play a role in the fractionation of nitrogen, and that (2) the

  15. High Resolution Spectroscopy of HCN Isotopomers: H13CN, HC15N, and H13C15N in the Ground and First Excited Bending Vibrational State

    Czech Academy of Sciences Publication Activity Database

    Fuchs, U.; Brünken, S.; Fuchs, G. W.; Thorwirth, S.; Ahrens, V.; Lewen, F.; Urban, Štěpán

    59a, č. 11 (2004), s. 861-872 ISSN 0932-0784 R&D Projects: GA ČR GA203/01/1274; GA MŠk ME 445 Institutional research plan: CEZ:AV0Z4040901 Keywords : molecular spectroscopy * sub-Doppler spectroscopy * HCN Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 0.799, year: 2004

  16. Filamin A promotes dynamin-dependent internalization of hyperpolarization-activated cyclic nucleotide-gated type 1 (HCN1) channels and restricts /h in hippocampal neurons

    NARCIS (Netherlands)

    Noam, Y.; Ehrengruber, M.U.; Koh, A.; Feyen, P.; Manders, E.M.M.; Abbott, G.W.; Wadman, W.J.; Baram, T.Z.

    2014-01-01

    The actin-binding protein filamin A (FLNa) regulates neuronal migration during development, yet its roles in the mature brain remain largely obscure. Here, we probed the effects of FLNa on the regulation of ion channels that influence neuronal properties. We focused on the HCN1 channels that conduct

  17. LASER APPLICATIONS AND OTHER TOPICS IN QUANTUM ELECTRONICS: Use of a submillimetre HCN laser in determination of the concentration of methane in air

    Science.gov (United States)

    Kamenev, Yu E.

    1996-01-01

    The feasibility of determination of the concentration of methane in air with the aid of an HCN laser emitting at the wavelength 337 μm was demonstrated under laboratory conditions. The method used is based on a change in the intensity of the output radiation of this laser associated with of a change in the methane content in air.

  18. Interference with cardiac pacemakers by magnetic resonance imaging: are there irreversible changes at 0.5 Tesla?

    Science.gov (United States)

    Vahlhaus, C; Sommer, T; Lewalter, T; Schimpf, R; Schumacher, B; Jung, W; Lüderitz, B

    2001-04-01

    The safety and feasibility of magnetic resonance imaging (MRI) in patients with cardiac pacemakers is an issue of gaining significance. The effect of MRI on patients' pacemaker systems has only been analyzed retrospectively in some case reports. Therefore, this study prospectively investigated if MRI causes irreversible changes in patients' pacemaker systems. The effect of MRI at 0.5 Tesla on sensing and stimulation thresholds, lead impedance and battery voltage, current, and impedance was estimated during 34 MRI examinations in 32 patients with implanted pacemakers. After measurements at baseline and with documentation of intrinsic rhythm and modification of the pacing mode, patients underwent MRI. The rest of the function time of the pacemaker was calculated. Measurements were again performed after 99.5 +/- 29.6 minutes (mean +/- SD), immediately after MRI examination, and 3 months later. Lead impedance and sensing and stimulation thresholds did not change after MRI. Battery voltage decreased immediately after MRI and recovered 3 months later. Battery current and impedance tended to increase. The calculated rest of function time did not change immediately after MRI. MRI affected neither pacemaker programmed data, nor the ability to interrogate, program, or use telemetry. Surprisingly, in the gantry of the scanner, temporary deactivation of the reed switch occurred in 12 of 32 patients when positioned in the center of the magnetic field. Missing activation of the reed switch through the static magnetic field at 0.5 Tesla is not unusual. MRI at 0.5 Tesla does not cause irreversible changes in patients' pacemaker systems.

  19. Sikkerhed af magnetisk resonans-skanning hos patienter med pacemaker og implanterbar defibrillator

    DEFF Research Database (Denmark)

    Al-Sabagh, Kifah Hekmat; Christensen, Britta Ege; Thøgersen, Anna Margrethe

    2010-01-01

    INTRODUCTION: The presence of a cardiac implantable device is ICD considered an absolute contraindication to magnetic resonance imaging (MRI). The purpose of this study was to evaluate the safety of performing MRI in patients with cardiac pacemakers and ICDs that had a compelling clinical need fo...

  20. Sikkerhed af magnetisk resonans-skanning hos patienter med pacemaker og implanterbar defibrillator

    DEFF Research Database (Denmark)

    Al-Sabagh, Kifah Hekmat; Christensen, Britta Ege; Thøgersen, Anna Margrethe

    2010-01-01

    The presence of a cardiac implantable device is ICD considered an absolute contraindication to magnetic resonance imaging (MRI). The purpose of this study was to evaluate the safety of performing MRI in patients with cardiac pacemakers and ICDs that had a compelling clinical need for MRI examinat...

  1. Dragoljub (Bata Adamov (1927-1996: The first pacemaker implantation in Serbia

    Directory of Open Access Journals (Sweden)

    Pavlović Siniša U.

    2017-01-01

    Full Text Available It has been over half a century since the implementation of pacemaker therapy in our country and the region. The first successful implantation of a pacemaker in former Yugoslavia and in Serbia took place on September 16, 1965 in “Dr. Dragiša Mišović” Clinical Hospital Centre, and this operation, with a team of doctors of the institution, was performed by surgeon Dragoljub (Bata Adamov (1927–1996. The first permanent pacemaker implantation was with epicardial leads with thoracotomy approach. The patient was operated on under general anesthesia, administered by anesthesiologist Predrag Lalević (1927–, and Dr. Adamov was assisted by Dr. Miša Albrecht (1933– and Dr. Milan Dragović (1933–2009. Although pacemaker therapy has since been widely proven and confirmed, it is necessary to remember the pioneers who introduced this kind of therapy to the region, as they deserve a distinguished place in the history of medicine in Serbia.

  2. Computational Model of Rabbit SA Node Pacemaker Activity Probed with Action Potential and Calcium Transient Clamp

    NARCIS (Netherlands)

    van Borren, Marcel M. J.; Zegers, Jan G.; Verkerk, Arie O.; Wilders, Ronald

    2007-01-01

    In the past decades, various computational models of the pacemaker activity of single sinoatrial (SA) nodal cells have been developed, building on data obtained in patch-clamp experiments on isolated SA nodal myocytes. These models show widely different results regarding the contribution of

  3. Potential interference of small neodymium magnets with cardiac pacemakers and implantable cardioverter-defibrillators.

    Science.gov (United States)

    Wolber, Thomas; Ryf, Salome; Binggeli, Christian; Holzmeister, Johannes; Brunckhorst, Corinna; Luechinger, Roger; Duru, Firat

    2007-01-01

    Magnetic fields may interfere with the function of cardiac pacemakers and implantable cardioverter-defibrillators (ICDs). Neodymium-iron-boron (NdFeB) magnets, which are small in size but produce strong magnetic fields, have become widely available in recent years. Therefore, NdFeB magnets may be associated with an emerging risk of device interference. We conducted a clinical study to evaluate the potential of small NdFeB magnets to interfere with cardiac pacemakers and ICDs. The effect of four NdFeB magnets (two spherical magnets 8 and 10 mm in diameter, a necklace made of 45 spherical magnets, and a magnetic name tag) was tested in forty-one ambulatory patients with a pacemaker and 29 patients with an ICD. The maximum distance at which the magnetic switch of a device was influenced was observed. Magnetic interference was observed in all patients. The maximum distance resulting in device interference was 3 cm. No significant differences were found with respect to device manufacturer and device types. Small NdFeB magnets may cause interference with cardiac pacemakers and ICDs. Patients should be cautioned about the interference risk associated with NdFeB magnets during daily life.

  4. Safety of magnetic resonance scanning without monitoring of patients with pacemakers

    DEFF Research Database (Denmark)

    Bertelsen, Litten; Petersen, Helen Høgh; Philbert, Berit Thornvig

    2017-01-01

    AIMS: The objective of this study was to investigate whether it is safe to perform 1.5-Tesla magnetic resonance imaging (MRI) scans in pacemaker (PM) patients without pulse oximetry or electrocardiogram monitoring and with no special specific absorption rate (SAR) or time limits, provided...

  5. Chronic performance of a leadless cardiac pacemaker: 1-year follow-up of the LEADLESS trial

    NARCIS (Netherlands)

    Knops, Reinoud E.; Tjong, Fleur V. Y.; Neuzil, Petr; Sperzel, Johannes; Miller, Marc A.; Petru, Jan; Simon, Jaroslav; Sediva, Lucie; de Groot, Joris R.; Dukkipati, Srinivas R.; Koruth, Jacob S.; Wilde, Arthur A. M.; Kautzner, Josef; Reddy, Vivek Y.

    2015-01-01

    A leadless cardiac pacemaker (LCP) system was recently introduced to overcome lead-related complications of conventional pacing systems. To date, long-term results of an LCP system are unknown. The aim of this study was to assess the complication incidence, electrical performance, and rate response

  6. Leadless pacemaker implantation in a patient with complex congenital heart disease and limited vascular access

    Directory of Open Access Journals (Sweden)

    Paolo Ferrero

    2016-11-01

    Full Text Available Management of rhythm related issues might be particularly challenging in patients with congenital heart disease due to complex anatomy and restricted vascular access. The leadless technology appears a suitable and attractive alternative for this population. We describe a patient with single ventricle physiology who successfully underwent implantation of a leadless pacemaker.

  7. Cardiac Pacemaker Insertion in the South-South Region of Nigeria ...

    African Journals Online (AJOL)

    TNHJOURNALPH

    MEMORIA. URT. L. TEACHING. SPECIALI. HOSPITAL. ST. HOSPITAL. (BMSH). The Challenges To Pacemaker Insertion. In South-South Nigeria. The challenges based on the current state are that medical tourism booms to the detriment of capacity and infrastructural development in the sub region. In addition many tertiary.

  8. No impact of physical activity on the period of the circadian pacemaker in humans

    NARCIS (Netherlands)

    Beersma, DGM; Hiddinga, AE

    1998-01-01

    The intrinsic period tau of the circadian pacemaker in humans was investigated by means of forced desynchrony. In this protocol, during 6 scheduled days, the sleep-wake alternation was forced to a period of 20h (i.e., 13.5h for wakefulness and 6.5h for sleep). Light intensity was kept below 10 lux.

  9. Improvement of computed tomography scans quality for cancer patients with pacemakers

    Science.gov (United States)

    Kurzyukova, Anastasia; Odlozhilikova, Anna; Sepsi, Milan; Pospisil, David

    2017-09-01

    An increasing number of patients undergoing radiotherapy have pacemakers. The problem is planning computed tomography scans for the patients having metal artifacts. To improve image quality we have tested metal artifacts deletion technique in Masaryk Memorial Cancer Institute (Brno, Czech Republic). The data obtained from this experiment is important for minimizing the dose received by cardiac devices.

  10. Assessment of BNP Level in Patients with Single Chamber and Dual Chamber Pacemakers

    Directory of Open Access Journals (Sweden)

    J Kojuri

    2010-09-01

    Full Text Available Background: Recent years, have witnessed extended and continuous indication of cardiac pacing. However, increasing number of patients suffered new congestive heart failure (CHF and aggravated CHF after pacing therapy. We used blood B type nutriuretic peptide (BNP to predict the occurrence of CHF in patients with different types of pacemakers. To assess single N-terminal brain nutriuretic peptide (NT-pro BNP as a predictor tool for ventricular dysfunction in different cardiac pacing mode.Methods: Out of 480 consecutive patients with pacemaker more than 6 months, 79 patients with average age of 65±13, and more than 90% ventricular pacing participated in the present study. Those with CHF prior to pacemaker insertion were excluded. The patients underwent medical history and examination, echocardiography (M-mode, Doppler, and Tissue imaging and blood sampling for pro-BNP. Twenty five, 12, and 42 patients had Dual chamber (DDDR, single chamber pacing with dual chamber sensing ( VDDR, and Single chamber (VVIR pacemakers respectivelyResults: Single pro-BNP level in patient with DDDR and VDDR pacing was lower than in those with VVIR pacing (P< 0.0001 but in Echocardiography left ventricular (LV dysfunction was not lower in DDDR than VDDR and VVIR pacing patients (P= 0.190. Conclusion: Single level of pro-BNP is lower in double chamber pacing in comparison with single chamber pacing. Therefore, it seems that dual chamber pacing causes less LV dysfunction.

  11. Complications of pacemaker therapy in adults with congenital heart disease: A multicenter study

    NARCIS (Netherlands)

    Opic, P.; Kranenburg, M. van; Yap, S.C.; Dijk, A.P.J. van; Budts, W.; Vliegen, H.W.; Erven, L. van; Can, A.; Sahin, G.; Theuns, D.A.; Witsenburg, M.; Roos-Hesselink, J.W.

    2013-01-01

    BACKGROUND: This study aims to investigate indications and complications of permanent cardiac pacing in adults with congenital heart disease (CHD). METHODS AND RESULTS: Two-hundred and seventy-four CHD patients were identified who underwent permanent pacemaker implantation between 1972 and 2009. The

  12. Cardiac pacemaker insertion in the South-South Region of Nigeria ...

    African Journals Online (AJOL)

    The disease trends in the region have resulted in increasing demand for invasive cardiac procedures which are largely unavailable in this subregion. This review examines the prospects and possible challenges of interventional cardiology care in South-South Nigeria, using cardiac pacemaker implantation as a surrogate.

  13. Cardiac pacemaker treatement of heart block in Enugu: a 5 year ...

    African Journals Online (AJOL)

    Background: Symptomatic heart block is a treatable cardiac cause of death which occurs globally. In Nigeria it is increasingly diagnosed and treated with permanent artificial cardiac pacemaker insertion and pulse generator implantation, sometimes after a period of misdiagnosis and inappropriate treatment. Methods: ...

  14. Reevaluation of the indications for permanent pacemaker implantation after transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Bjerre Thygesen, Julie; Loh, Poay Huan; Cholteesupachai, Jiranut

    2014-01-01

    AIMS: Conduction abnormalities (CA) requiring permanent pacemaker (PPM) are a well-known complication after transcatheter aortic valve implantation (TAVI). This study aimed to determine the incidence of TAVI-related PPM and reevaluate the indications for PPM after the periprocedural period. METHODS...

  15. Early performance of a miniaturized leadless cardiac pacemaker: the Micra Transcatheter Pacing Study

    NARCIS (Netherlands)

    Ritter, Philippe; Duray, Gabor Z.; Steinwender, Clemens; Soejima, Kyoko; Omar, Razali; Mont, Lluís; Boersma, Lucas V. A.; Knops, Reinoud E.; Chinitz, Larry; Zhang, Shu; Narasimhan, Calambur; Hummel, John; Lloyd, Michael; Simmers, Timothy Alexander; Voigt, Andrew; Laager, Verla; Stromberg, Kurt; Bonner, Matthew D.; Sheldon, Todd J.; Reynolds, Dwight; Kypta, Alexander; Vamos, Mate; Bordachar, Pierre; El Chami, Mikhael; Hussin, Azlan; Mont Girbau, Josep Lluís; Tolosana, José María; Morgan, John M.; Roberts, Paul; de Groot, Joris R.; Tjong, Fleur V. Y.; Sato, Toshiaki; Bongiorni, Maria Grazia; Soldati, Ezio; Augostini, Ralph; Love, Charles; Neuzil, Petr; Reddy, Vivek; Bracke, Frank A. L. E.; Sagi, Venkata; Lee, Scott; Gornick, Charles; Remole, Stephen; Sra, Jasbir; Nangia, Vikram; Shehata, Michael; Swerdlow, Charles; Schoenhard, John; Milstein, Simon; Saba, Samir; Bernabei, Matthew; Bansal, Sandeep; Stavrakis, Stavros

    2015-01-01

    Permanent cardiac pacing is the only effective treatment for symptomatic bradycardia, but complications associated with conventional transvenous pacing systems are commonly related to the pacing lead and pocket. We describe the early performance of a novel self-contained miniaturized pacemaker.

  16. 77 FR 37573 - Effective Date of Requirement for Premarket Approval for an Implantable Pacemaker Pulse Generator

    Science.gov (United States)

    2012-06-22

    ... Pulse Generator AGENCY: Food and Drug Administration, HHS. ACTION: Final rule. SUMMARY: The Food and... pulse generators. The Agency has summarized its findings regarding the degree of risk of illness or... of a PDP for the implantable pacemaker pulse generator. In accordance with section 515(b)(2)(A) of...

  17. QTC INTERVAL DURATION CLASS AND DRUG THERAPY OF PATIENCE IN A FIRST YEAR AFTER PACEMAKER IMPLANTATION

    Directory of Open Access Journals (Sweden)

    M. S. Brynza

    2016-12-01

    Full Text Available 49 patients (28 female, 21 male with implanted DDD/DDDR, VVI/VVIR and CRT pacemakers are investigated. Purpose frequency and dose rate of anticoagulants, antiplatelet agents, direct thrombin inhibitors, cardiac glycosides, amiodarone; ivabradine, diuretics, aldosterone antagonists, beta-adrenergic blockers, calcium channel blockers, angiotensin-converting enzyme (ACE inhibitors, angiotensin II receptor blockers (ARBs, statins were evaluated before, in acute postoperative period (3–5 days, 6 months and 1 year after pacemaker implantation. Patients were divided into classes 1 (normal QTc (320–440 ms – 24 (49 % patients and 2 (long QTc (> 440 msec – 25 (51 % patients of QTc interval duration. To process the data using standard statistical procedures using Microsoft Excel. It was more often prescriptions of new anticoagulants, beta-adrenergic blockers, ARBs, statins to patients in the first year after pacemaker implantation. QTc interval duration lengthening was associated with a greater purpose frequency and doses of amiodarone, diuretics, beta-adrenergic blockers, ACE inhibitors, ARBs and statins. Patients with implanted pacemaker need individualized drug therapy according to QTc interval duration, in particular, enhancing antiischemic, antihypertensive, antiarrhythmic therapy and therapy of chronic heart failure in patients with QTc interval duration lengthening.

  18. Combined leadless pacemaker and subcutaneous implantable defibrillator therapy: feasibility, safety, and performance

    NARCIS (Netherlands)

    Tjong, F. V. Y.; Brouwer, T. F.; Smeding, L.; Kooiman, K. M.; de Groot, J. R.; Ligon, D.; Sanghera, R.; Schalij, M. J.; Wilde, A. A. M.; Knops, R. E.

    2016-01-01

    The subcutaneous implantable cardioverter-defibrillator (S-ICD) and leadless pacemaker (LP) are evolving technologies that do not require intracardiac leads. However, interactions between these two devices are unexplored. We investigated the feasibility, safety, and performance of combined LP and

  19. Pacemaker Implantation Associated Myocardial Micro-Damage: A Randomised Comparison between Active and Passive Fixation Leads.

    Science.gov (United States)

    Blažek, Patrick; Ferri-Certić, Jerko; Vražić, Hrvoje; Lennerz, Carsten; Grebmer, Christian; Kaitani, Kazuaki; Karch, Martin; Starčević, Boris; Semmler, Verena; Kolb, Christof

    2018-03-20

    Fixation of the pacemaker leads during pacemaker implantation leads to an increase of cardiac Troponin T (cTnT) that can be interpreted as a sign of minimal myocardial damage. This trial evaluates whether the mechanism type of lead fixation influences the magnitude of cTnT release. Patients having a de-novo cardiac pacemaker implantation or a lead revision were centrally randomized to receive either a ventricular lead with an active (screw) or passive (tine) fixation mechanism. High-sensitive Troponin T (hsTnT) was determined on the day of the procedure beforehand and on the following day. 326 Patients (median age (IQR) 75.0 (69.0-80.0) years, 64% male) from six international centers were randomized to receive ventricular leads with an active (n = 166) or passive (n = 160) fixation mechanism. Median (IQR) hsTnT levels increased by 0.009 (0.004-0.021) ng/ml in the group receiving screw-in ventricular leads and by 0.008 (0.003-0.030) ng/ml in the group receiving tined ventricular leads (n.s.). In conclusion pacemaker implantations are followed by a release of hsTnT. The choice between active or passive fixation ventricular leads does not have a significant influence on the extent of myocardial injury and the magnitude of hsTnT release.

  20. Patterns of Abnormal Gastric Pacemaking After Sleeve Gastrectomy Defined by Laparoscopic High-Resolution Electrical Mapping.

    Science.gov (United States)

    Berry, Rachel; Cheng, Leo K; Du, Peng; Paskaranandavadivel, Niranchan; Angeli, Timothy R; Mayne, Terence; Beban, Grant; O'Grady, Gregory

    2017-08-01

    Laparoscopic sleeve gastrectomy (LSG) is increasingly being applied to treat obesity. LSG includes excision of the normal gastric pacemaker, which could induce electrical dysrhythmias impacting on post-operative symptoms and recovery, but these implications have not been adequately investigated. This study aimed to define the effects of LSG on gastric slow-wave pacemaking using laparoscopic high-resolution (HR) electrical mapping. Laparoscopic HR mapping was performed before and after LSG using flexible printed circuit arrays (64-96 electrodes; 8-12 cm 2 ; n = 8 patients) deployed through a 12 mm trocar and positioned on the gastric serosa. An additional patient with chronic reflux, nausea, and dysmotility 6 months after LSG also underwent gastric mapping while undergoing conversion to gastric bypass. Slow-wave activity was quantified by propagation pattern, frequency, velocity, and amplitude. Baseline activity showed exclusively normal propagation. Acutely after LSG, all patients developed either a distal unifocal ectopic pacemaker with retrograde propagation (50%) or bioelectrical quiescence (50%). Propagation velocity was abnormally rapid after LSG (12.5 ± 0.8 vs baseline 3.8 ± 0.8 mm s -1 ; p = 0.01), whereas frequency and amplitude were unchanged (2.7 ± 0.3 vs 2.8 ± 0.3 cpm, p = 0.7; 1.7 ± 0.2 vs 1.6 ± 0.6 mV, p = 0.7). In the patient with chronic dysmotility after LSG, mapping also revealed a stable antral ectopic pacemaker with retrograde rapid propagation (12.6 ± 4.8 mm s -1 ). Resection of the gastric pacemaker during LSG acutely resulted in aberrant distal ectopic pacemaking or bioelectrical quiescence. Ectopic pacemaking can persist long after LSG, inducing chronic dysmotility. The clinical and therapeutic significance of these findings now require further investigation.

  1. German Roentgen Society Statement on MR Imaging of Patients with Cardiac Pacemakers.

    Science.gov (United States)

    Sommer, T; Luechinger, R; Barkhausen, J; Gutberlet, M; Quick, H H; Fischbach, K

    2015-09-01

    The aim of this paper is to inform physicians, especially radiologists and cardiologists, about the technical and electrophysiological background of MR imaging of patients with implanted cardiac pacemakers (PM) and to provide dedicated clinical practice guidelines how to perform MR exams in this patient group. The presence of a conventional PM system is not any more considered an absolute contraindication for MR imaging. The prerequisites for MR imaging on pacemaker patients include the assessment of the individual risk/benefit ratio as well as to obtain full informed consent about the off label character of the procedure and all associated risks. Furthermore the use of special PM-related (e.g. re-programming of the PM) and MRI-related (e.g. limitation of whole body SAR to 2 W/kg) precautions is required and needs to be combined with adequate monitoring during MR imaging using continuous pulsoximetry. MR conditional PM devices are tested and approved for the use in the MR environment under certain conditions, including the field strength and gradient slew rate of the MR system, the maximum whole body SAR value and the presence of MR imaging exclusion zones. Safe MR imaging of patients with MR conditional PM requires the knowledge of the specific conditions of each PM system. If MR imaging within these specific conditions cannot be guaranteed in a given patient, the procedure guidelines for conventional PM should be used. The complexity of MR imaging of PM patients requires close cooperation of radiologists and cardiologists. Conventional pacemaker systems are no longer an absolute but rather a relative contraindication for performing an MR examination. The procedural management of conventional pacemaker includes the assessment of the individual risk/benefit ratio, comprehensive patient informed consent about specific related risks and "off label" use, extensive PM- and MRI-related safety precautions as well as adequate monitoring techniques during the MR exam

  2. Pacemaker Use in New Zealand - Data From the New Zealand Implanted Cardiac Device Registry (ANZACS-QI 15).

    Science.gov (United States)

    Larsen, P D; Kerr, A J; Hood, M; Harding, S A; Hooks, D; Heaven, D; Lever, N A; Sinclair, S; Boddington, D; Tang, E W; Swampillai, J; Stiles, M K

    2017-03-01

    The New Zealand Cardiac Implanted Device Registry (Device) has recently been developed under the auspices of the New Zealand Branch of the Cardiac Society of Australia and New Zealand. This study describes the initial Device registry cohort of patients receiving a new pacemaker, their indications for pacing and their perioperative complications. The Device Registry was used to audit patients receiving a first pacemaker between 1 st January 2014 and 1 st June 2015. We examined 1611 patients undergoing first pacemaker implantation. Patients were predominantly male (59%), and had a median age of 70 years. The most common symptom for pacemaker implantation was syncope (39%), followed by dizziness (30%) and dyspnoea (12%). The most common aetiology for a pacemaker was a conduction tissue disorder (35%), followed by sinus node dysfunction (22%). Atrioventricular (AV) block was the most common ECG abnormality, present in 44%. Dual chamber pacemakers were most common (62%), followed by single chamber ventricular pacemakers (34%), and cardiac resynchronisation therapy - pacemakers (CRT-P) (2%). Complications within 24hours of the implant procedure were reported in 64 patients (3.9%), none of which were fatal. The most common complication was the need for reoperation to manipulate a lead, occurring in 23 patients (1.4%). This is the first description of data entered into the Device registry. Patients receiving a pacemaker were younger than in European registries, and there was a low use of CRT-P devices compared to international rates. Complications rates were low and compare favourably to available international data. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  3. Correlation analysis of the relationship between B-type natriuretic peptide and selected echocardiographic parameters in patients with permanent pacemakers

    Directory of Open Access Journals (Sweden)

    Janusz Sielski

    2016-01-01

    Full Text Available Introduction: The present study was undertaken to evaluate the practical value of BNP measurements and echocardiographic left ventricular volume index in patients with permanent pacemakers because there are no such reports in the literature. Aim of the research: The aim of the study was to reveal multiple correlations between BNP levels and selected echocardiographic parameters of the left atrium in patients with permanent pacemakers. In the literature there are reports on the significance of BNP values and left atrial size in patients with permanent pacemakers. The results of the present study appear to be of value in the outpatient assessment of these patients. Material and methods: We analysed a group of 117 patients with permanent pacemakers (AAI/R 21 patients, DDD/R 59 patients, VVI/R 37 patients and 48 healthy volunteers serving as the control group. BNP measurements were performed on venous blood samples using Triage meters. The Simpson method and the ellipse method were used to assess the left atrium on echocardiography. Results: There was a significant correlation between BNP and maximum left atrial volume, minimum left atrial volume, and left atrial volume index in patients with AAI/R, DDD/R, and VVI/R pacemakers at 3 and 6 months after the implantation. Conclusions : In patients after implantation of permanent pacemakers there are correlations between BNP values and echocardiographic left atrial parameters, especially in patients with DDD/R pacemakers. Left atrial function improves in patients with DDD/R pacemakers. Pacemaker check-up should be extended to include BNP measurements and echocardiographic assessment of the left atrium.

  4. Searching for Faint Traces of CO(2-1) and HCN(4-3) Gas In Debris Disks

    Science.gov (United States)

    Stafford Lambros, Zachary; Hughes, A. Meredith

    2018-01-01

    The surprising presence of molecular gas in the debris disks around main sequence stars provides an opportunity to study the dissipation of primordial gas and, potentially, the composition of gas in other solar systems. Molecular gas is not expected to survive beyond the pre-main sequence phase, and it is not yet clear whether the gas is a remnant of the primordial protoplanetary material or whether the gas, like the dust, is second-generation material produced by collisional or photodesorption from planetesimals, exocomets, or the icy mantles of dust grains. Here we present two related efforts to characterize the prevalence and properties of gas in debris disks. First, we place the lowest limits to date on the CO emission from an M star debris disk, using 0.3" resolution observations of CO(2-1) emission from the AU Mic system with the Atacama Large Millimeter/submillimeter Array (ALMA). We place a 3-sigma upper limit on the integrated flux of 0.39 Jy km/s, corresponding to a maximum CO mass of 5e10-6 (Earth Masses) if the gas is in LTE. We also present the results of an ALMA search for HCN(4-3) emission from the prototypical gas-rich debris disk around 49 Ceti at a spatial resolution of 0.3". Despite hosting one of the brightest CO-rich debris disks yet discovered, our observations of 49 Ceti also yield a low upper limit of 0.057 Jy km/s in the HCN line, leaving CO as the only molecule clearly detected in emission from a debris disk. We employ several methods of detecting faint line emission from debris disks, including a model based on Keplerian kinematics as well as a spectral shifting method previously used to detect faint CO emission from the Fomalhaut debris disk, and compare our results.

  5. Novel approach to epicardial pacemaker implantation in patients with limited venous access.

    Science.gov (United States)

    Costa, Roberto; Scanavacca, Mauricio; da Silva, Kátia Regina; Martinelli Filho, Martino; Carrillo, Roger

    2013-11-01

    Limited venous access in certain patients increases the procedural risk and complexity of conventional transvenous pacemaker implantation. The purpose of this study was to determine a minimally invasive epicardial approach using pericardial reflections for dual-chamber pacemaker implantation in patients with limited venous access. Between June 2006 and November 2011, 15 patients underwent epicardial pacemaker implantation. Procedures were performed through a minimally invasive subxiphoid approach and pericardial window with subsequent fluoroscopy-assisted lead placement. Mean patient age was 46.4 ± 15.3 years (9 male [(60.0%], 6 female [40.0%]). The new surgical approach was used in patients determined to have limited venous access due to multiple abandoned leads in 5 (33.3%), venous occlusion in 3 (20.0%), intravascular retention of lead fragments from prior extraction in 3 (20.0%), tricuspid valve vegetation currently under treatment in 2 (13.3%), and unrepaired intracardiac defects in 2 (13.3%). All procedures were successful with no perioperative complications or early deaths. Mean operating time for isolated pacemaker implantation was 231.7 ± 33.5 minutes. Lead placement on the superior aspect of right atrium, through the transverse sinus, was possible in 12 patients. In the remaining 3 patients, the atrial lead was implanted on the left atrium through the oblique sinus, the postcaval recess, or the left pulmonary vein recess. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 36.8 ± 25.1 months. Epicardial pacemaker implantation through pericardial reflections is an effective alternative therapy for those patients requiring physiologic pacing in whom venous access is limited. © 2013 Heart Rhythm Society. All rights reserved.

  6. Minimally Invasive Epicardial Pacemaker Implantation in Neonates with Congenital Heart Block.

    Science.gov (United States)

    Costa, Roberto; Silva, Katia Regina da; Martinelli Filho, Martino; Carrillo, Roger

    2017-10-01

    Few studies have characterized the surgical outcomes following epicardial pacemaker implantation in neonates with congenital complete atrioventricular block (CCAVB). This study sought to assess the long-term outcomes of a minimally invasive epicardial approach using a subxiphoid access for pacemaker implantation in neonates. Between July 2002 and February 2015, 16 consecutive neonates underwent epicardial pacemaker implantation due to CCAVB. Among these, 12 (75.0%) had congenital heart defects associated with CCAVB. The patients had a mean age of 4.7 ± 5.3 days and nine (56.3%) were female. Bipolar steroid-eluting epicardial leads were implanted in all patients through a minimally invasive subxiphoid approach and fixed on the diaphragmatic ventricular surface. The pulse generator was placed in an epigastric submuscular position. All procedures were successful, with no perioperative complications or early deaths. Mean operating time was 90.2 ± 16.8 minutes. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 4.1 ± 3.9 years. Three children underwent pulse generator replacement due to normal battery depletion at 4.0, 7.2, and 9.0 years of age without the need of ventricular lead replacement. There were two deaths at 12 and 325 days after pacemaker implantation due to bleeding from thrombolytic use and progressive refractory heart failure, respectively. Epicardial pacemaker implantation through a subxiphoid approach in neonates with CCAVB is technically feasible and associated with excellent surgical outcomes and pacing lead longevity.

  7. Permanent pacemaker implantation in octogenarians with unexplained syncope and positive electrophysiologic testing.

    Science.gov (United States)

    Giannopoulos, Georgios; Kossyvakis, Charalampos; Panagopoulou, Vasiliki; Tsiachris, Dimitrios; Doudoumis, Konstantinos; Mavri, Maria; Vrachatis, Dimitrios; Letsas, Konstantinos; Efremidis, Michael; Katsivas, Apostolos; Lekakis, John; Deftereos, Spyridon

    2017-05-01

    Syncope is a common problem in the elderly, and a permanent pacemaker is a therapeutic option when a bradycardic etiology is revealed. However, the benefit of pacing when no association of symptoms to bradycardia has been shown is not clear, especially in the elderly. The aim of this study was to evaluate the effect of pacing on syncope-free mortality in patients aged 80 years or older with unexplained syncope and "positive" invasive electrophysiologic testing (EPT). This was an observational study. A positive EPT for the purposes of this study was defined by at least 1 of the following: a corrected sinus node recovery time of >525 ms, a basic HV interval of >55 ms, detection of infra-Hisian block, or appearance of second-degree atrioventricular block on atrial decremental pacing at a paced cycle length of >400 ms. Among the 2435 screened patients, 228 eligible patients were identified, 145 of whom were implanted with a pacemaker. Kaplan-Meier analysis determined that time to event (syncope or death) was 50.1 months (95% confidence interval 45.4-54.8 months) with a pacemaker vs 37.8 months (95% confidence interval 31.3-44.4 months) without a pacemaker (log-rank test, P = .001). The 4-year time-dependent estimate of the rate of syncope was 12% vs 44% (P cause death was 41% vs 56% (P = .023), respectively. The multivariable odds ratio was 0.25 (95% confidence interval 0.15-0.40) after adjustment for potential confounders. In patients with unexplained syncope and signs of sinus node dysfunction or impaired atrioventricular conduction on invasive EPT, pacemaker implantation was independently associated with longer syncope-free survival. Significant differences were also shown in the individual components of the primary outcome measure (syncope and death from any cause). Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  8. Conduction Abnormalities and Pacemaker Implantations After SAPIEN 3 Vs SAPIEN XT Prosthesis Aortic Valve Implantation.

    Science.gov (United States)

    Husser, Oliver; Kessler, Thorsten; Burgdorf, Christof; Templin, Christian; Pellegrini, Costanza; Schneider, Simon; Kasel, Albert Markus; Kastrati, Adnan; Schunkert, Heribert; Hengstenberg, Christian

    2016-02-01

    Transcatheter aortic valve implantation is increasingly used in patients with aortic stenosis. Post-procedural intraventricular conduction abnormalities and permanent pacemaker implantations remain a serious concern. Recently, the Edwards SAPIEN 3 prosthesis has replaced the SAPIEN XT. We sought to determine the incidences of new-onset intraventricular conduction abnormalities and permanent pacemaker implantations by comparing the 2 devices. We analyzed the last consecutive 103 patients undergoing transcatheter aortic valve implantation with SAPIEN XT before SAPIEN 3 was used in the next 105 patients. To analyze permanent pacemaker implantations and new-onset intraventricular conduction abnormalities, patients with these conditions at baseline were excluded. Electrocardiograms were recorded at baseline, after the procedure, and before discharge. SAPIEN 3 was associated with higher device success (100% vs 92%; P=.005) and less paravalvular leakage (0% vs 7%; P<.001). The incidence of permanent pacemaker implantations was 12.6% (23 of 183) with no difference between the 2 groups (SAPIEN 3: 12.5% [12 of 96] vs SAPIEN XT: 12.6% [11 of 87]; P=.99). SAPIEN 3 was associated with a higher rate of new-onset intraventricular conduction abnormalities (49% vs 27%; P=.007) due to a higher rate of fascicular blocks (17% vs 5%; P=.021). There was no statistically significant difference in transient (29% [20 of 69] vs persistent 19% [12 of 64]; P=.168) left bundle branch blocks (28% [19 of 69] vs 17% [11 of 64]; P=.154) when SAPIEN 3 was compared with SAPIEN XT. We found a trend toward a higher rate of new-onset intraventricular conduction abnormalities with SAPIEN 3 compared with SAPIEN XT, although this did not result in a higher permanent pacemaker implantation rate. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  9. Utility of the NavX® Electroanatomic Mapping System for Permanent Pacemaker Implantation in a Pregnant Patient with Chagas Disease

    Directory of Open Access Journals (Sweden)

    Alejandro Velasco, MD

    2013-01-01

    Full Text Available Chagas disease is a highly prevalent zoonosis in Mexico, Central, and South America. Early cardiac involvement is one of the most serious complications of this disease, and conduction disturbances may occur at an early age. We describe a young pregnant woman with Chagas disease and a high degree atrioventricular block, who required implantation of a permanent dual chamber pacemaker. Using an electroanatomic navigation EnSite NavX® system the pacemaker was successfully implanted with minimal fluoroscopic exposure. This case demonstrates the safety and feasibility of using an electroanatomic navigation system to guide permanent pacemaker implantation minimizing x-ray exposure in pregnant patients.

  10. Evaluation of Safety and Efficacy of Qinming8631 DR Implantable Cardiac Pacemaker in Chinese Patients: A Prospective, Multicenter, Randomized Controlled Trial of the First Domestically Developed Pacemaker of China

    Directory of Open Access Journals (Sweden)

    Mei-Xiang Xiang

    2016-01-01

    Conclusions: This study established the noninferiority of Qinming8631 DR to Talos DR. The safety and efficacy of Qinming8631 DR pacemaker were comparable to those of Talos DR in treating patients with cardiac bradyarrhythmia.

  11. Test and Evaluation of the Hewlett-Packard CodeMaster 100 Cardiac Monitor/Pacemaker/Defibrillator System

    National Research Council Canada - National Science Library

    Hade, Edward

    1997-01-01

    The CodeMaster 100 is a portable cardiac monitor, defibrillator and pacemaker that offers synchronized defibrillation, electrocardiogram monitoring, noninvasive temporary pacing and pulse oximetery (SpO2) capabilities...

  12. Risk of pacemaker or implantable cardioverter defibrillator after radiotherapy for early-stage breast cancer in Denmark, 1982-2005

    DEFF Research Database (Denmark)

    Rehammar, Jens Christian; Johansen, Jens Brock; Jensen, Maj-Britt

    2017-01-01

    BACKGROUND AND PURPOSE: To examine the risk of cardiac conduction abnormalities or severe ventricular arrhythmias requiring implantation of a cardiac implantable electronic device (CIED), either a pacemaker or an implantable cardioverter-defibrillator, subsequent to breast cancer (BC) radiotherapy...

  13. Testing and Evaluation of the Medical Research Laboratories, Inc., 360SLX Cardiac Monitor/Pacemaker/Defibrillator System

    National Research Council Canada - National Science Library

    Hade, Edward

    1998-01-01

    The Medical Research Laboratories (MRL), Inc., model 360 SLx is a portable cardica monitor, defibrillator, and pacemaker that offers synchronized defibrillator, electrocardiogram monitoring, and non-invasive temporary pacing...

  14. Management of radiation oncology patients with a pacemaker or ICD : A new comprehensive practical guideline in The Netherlands

    NARCIS (Netherlands)

    Hurkmans, Coen W.; Knegjens, Joost L.; Oei, Bing S.; Maas, Ad J. J.; Uiterwaal, G. J.; van der Borden, Arnoud J.; Ploegmakers, Marleen M. J.; van Erven, Lieselot

    2012-01-01

    Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient's perspective into account.

  15. [Chronic transvenous pacemaker/implantable cardioverter defibrillator leads implantation induced pathological changes].

    Science.gov (United States)

    Li, Yanhui; Dykoski, Richard; Li, Jianming

    2015-05-01

    Widely pacemaker/implantable cardioverter defibrillator (ICD) implantation is also related to an increasing need for transvenous lead extraction. Understanding the location and extent of pathological changes, including adhesions and fibrous tissue formation along the course of chronic pacemaker/ICD leads, are essential for operators performing lead extraction operations in order to reduce the potential life threatening complications. Three parts are included in the research, pathological examination on 83 extracted pacemaker/ICD leads using excimer laser technique from March 2008 to March 2011, autopsy examination of one died patient during lead extraction for lead-related infective endocarditis, and anatomical analysis on pacemaker/ICD leads from 10 patients died of other non-cardiac causes. Extensive encapsulated fibrous tissue around the leads and extensive adhesion/fibrosis along the course of the leads from venous entry site to the lead/myocardial interface could be detected on transvenous pacemaker/ICD leads. Since the tissue at the junction between superior vena cava (SVC) and right atrium (RA) is very thin, free of pericardium, thus, this is a common place for extensive adhesion/fibrosis and myocardial perforation/tear during lead extraction, which accounted for one death during extraction in our cohort. Extensive adhesion and fibrosis were also observed at the tricuspid valve and subvalvular structures. Leads implanted to the right ventricular apex were close to the epicardial surface and prone to perforation through myocardium. It is common to observe thrombus on the leads or at the interface between leads and myocardial tissue, especially at right atrial appendage (RAA) at the site of lead insertion. Extensive adhesions and fibrosis can be commonly seen along the course of pacemaker/ICD leads, and at SVC to RA junction, the tricuspid valve/subvalvular structures, and RA/RV lead interface. The tissue at SVC to RA junction is very thin, making it

  16. Pacemaker replacement in nonagenarians: Procedural safety and long-term follow-up.

    Science.gov (United States)

    Loirat, Aurélie; Fénéon, Damien; Behaghel, Albin; Behar, Nathalie; Le Helloco, Alain; Mabo, Philippe; Daubert, Jean-Claude; Leclercq, Christophe; Martins, Raphaël P

    2015-01-01

    The rate of pacemaker implantation is rising. Given that the life expectancy of the population is projected to increase, a large number of elderly patients are likely to be implanted in the future. As pacemaker batteries can last for 8-10years, an increasing number of pacemaker recipients will require replacement of their devices when they become nonagenarians. To analyse the short- and long-term outcomes after device replacement in nonagenarians. Patients aged≥90years referred to a tertiary centre for pacemaker replacement from January 2004 to July 2014 were included retrospectively. Clinical follow-up data were obtained from clinical visits or telephone interviews with patients or their families. The primary clinical endpoint was total mortality. Secondary endpoints included early and delayed procedure-related complications and predictive risk factors for total mortality. Sixty-two patients were included (mean age 93.3±2.9years at time of pacemaker replacement). Mean procedure duration was 35.7±17.2minutes. Mean hospital stay was 2.2±1.1days. One patient died from a perioperative complication. Thirty-seven patients (59.7%) died during a median follow-up of 22.1months (interquartile range, 11.8-39.8months). Survival rates were 84.2% (95% confidence interval [CI] 71.8-91.5%) at 1year, 66.9% (95% CI 51.8-78.2%) at 2years and 22.7% (95% CI 10.6-37.7%) at 5years. Atrial fibrillation (hazard ratio 2.47, 95% CI 1.1-5.6) and non-physiological pacing (i.e. VVI pacing in patients in sinus rhythm) (hazard ratio 2.20, 95% CI 1.0-4.9) were predictors of mortality. Pacemaker replacement in nonagenarians is a safe and straightforward procedure. These data suggest that procedures can be performed securely in this old and frail population, with patients living for a median of 30months afterwards. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  17. Feasibility and safety of adenosine cardiovascular magnetic resonance in patients with MR conditional pacemaker systems at 1.5 Tesla.

    Science.gov (United States)

    Klein-Wiele, Oliver; Garmer, Marietta; Urbien, Rhyan; Busch, Martin; Kara, Kaffer; Mateiescu, Serban; Grönemeyer, Dietrich; Schulte-Hermes, Michael; Garbrecht, Marc; Hailer, Birgit

    2015-12-22

    Cardiovascular Magnetic Resonance (CMR) with adenosine stress is a valuable diagnostic tool in coronary artery disease (CAD). However, despite the development of MR conditional pacemakers CMR is not yet established in clinical routine for pacemaker patients with known or suspected CAD. A possible reason is that adenosine stress perfusion for ischemia detection in CMR has not been studied in patients with cardiac conduction disease requiring pacemaker therapy. Other than under resting conditions it is unclear whether MR safe pacing modes (paused pacing or asynchronous mode) can be applied safely because the effect of adenosine on heart rate is not precisely known in this entity of patients. We investigate for the first time feasibility and safety of adenosine stress CMR in pacemaker patients in clinical routine and evaluate a pacing protocol that considers heart rate changes under adenosine. We retrospectively analyzed CMR scans of 24 consecutive patients with MR conditional pacemakers (mean age 72.1 ± 11.0 years) who underwent CMR in clinical routine for the evaluation of known or suspected CAD. MR protocol included cine imaging, adenosine stress perfusion and late gadolinium enhancement. Pacemaker indications were sinus node dysfunction (n = 18) and second or third degree AV block (n = 6). Under a pacing protocol intended to avoid competitive pacing on the one hand and bradycardia due to AV block on the other no arrhythmia occurred. Pacemaker stimulation was paused to prevent competitive pacing in sinus node dysfunction with resting heart rate >45 bpm. Sympatho-excitatory effect of adenosine led to a significant acceleration of heart rate by 12.3 ± 8.3 bpm (p pacemakers. Heart rate response to adenosine has to be considered for the choice of pacing modes during CMR.

  18. Improved quality of life after treatment of prolonged asystole during breath holding spells with a cardiac pacemaker

    Directory of Open Access Journals (Sweden)

    Bruno Kolterer

    2015-01-01

    Conclusion: Cardiac pacing using appropriate pacemaker settings seems effective in the prevention of LOC and reduction of the frequency of BHS. Our results imply a reduction of subjective stress levels of patients and parents as well as an increased quality of everyday life. After all, randomized controlled trials of the influence of cardiac pacemaker implantation on subjective stress levels in patients with BHS are needed.

  19. Real-time relationship between PKA biochemical signal network dynamics and increased action potential firing rate in heart pacemaker cells: Kinetics of PKA activation in heart pacemaker cells.

    Science.gov (United States)

    Yaniv, Yael; Ganesan, Ambhighainath; Yang, Dongmei; Ziman, Bruce D; Lyashkov, Alexey E; Levchenko, Andre; Zhang, Jin; Lakatta, Edward G

    2015-09-01

    cAMP-PKA protein kinase is a key nodal signaling pathway that regulates a wide range of heart pacemaker cell functions. These functions are predicted to be involved in regulation of spontaneous action potential (AP) generation of these cells. Here we investigate if the kinetics and stoichiometry of increase in PKA activity match the increase in AP firing rate in response to β-adrenergic receptor (β-AR) stimulation or phosphodiesterase (PDE) inhibition, that alters the AP firing rate of heart sinoatrial pacemaker cells. In cultured adult rabbit pacemaker cells infected with an adenovirus expressing the FRET sensor AKAR3, the EC50 in response to graded increases in the intensity of β-AR stimulation (by Isoproterenol) the magnitude of the increases in PKA activity and the spontaneous AP firing rate were similar (0.4±0.1nM vs. 0.6±0.15nM, respectively). Moreover, the kinetics (t1/2) of the increases in PKA activity and spontaneous AP firing rate in response to β-AR stimulation or PDE inhibition were tightly linked. We characterized the system rate-limiting biochemical reactions by integrating these experimentally derived data into a mechanistic-computational model. Model simulations predicted that phospholamban phosphorylation is a potent target of the increase in PKA activity that links to increase in spontaneous AP firing rate. In summary, the kinetics and stoichiometry of increases in PKA activity in response to a physiological (β-AR stimulation) or pharmacological (PDE inhibitor) stimuli match those of changes in the AP firing rate. Thus Ca(2+)-cAMP/PKA-dependent phosphorylation limits the rate and magnitude of increase in spontaneous AP firing rate. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. A Review on Pacemakers: Device Types, Operating Modes and Pacing Pulses. Problems Related to the Pacing Pulses Detection

    Directory of Open Access Journals (Sweden)

    Valentin Tsibulko

    2014-06-01

    Full Text Available A pacemaker is a small battery-operated medical device that delivers electrical impulses to the heart in order to guarantee regular contractions. Depending on the number of active leads the pacemakers are single chamber, dual chamber and bi-ventricular. According to their programming the devices could be with fixed-rate, 'on demand' and rate-responsitive. The operating mode of the pacemaker depends on the paced chamber, the sensed chamber, the response to a sensed electrical signal and the rate modulation. Two types of pacing are recognized - unipolar and bipolar, represented with different pacing artifacts in the ECG signal. The pacing pulse on the skin surface usually have very fast rising edges of the order of 10 µs or less and could be as small as few hundreds µV. The pacing artifacts detection is important since they indicate the presence of a pacemaker and help to evaluate the reaction of the heart. All pertinent medical standards require the pacing artifacts to be captured and indicated on the screen of the device. This paper presents a short review on pacemakers - reasons for implementation, device types, different operation modes and pacing pulses. It reveals some common problems with the detection of pacemaker's artifacts.

  1. Risk of pacemaker implantation after uneventful successful cavotricuspid isthmus radiofrequency ablation in patients with common atrial flutter.

    Science.gov (United States)

    Rodríguez-Mañero, Moisés; González-Melchor, Layla; Ballesteros, Gabriel; Raposeiras-Roubín, Sergio; García-Seara, Javier; López, Xesús Alberte Fernández; Cambeiro, Cristina González; Alcalde, Oscar; García-Bolao, Ignacio; Martínez-Sande, Luis; González-Juanatey, José Ramón

    2016-01-01

    Little is known about the risk of pacemaker implantation after common atrial flutter ablation in the long-term. We retrospectively reviewed the electrophysiology laboratory database at two Spanish University Hospitals from 1998 to 2012 to identify patients who had undergone successful ablation for cavotricuspid dependent atrial flutter. Cox regression analysis was used to examine the risk of pacemaker implantation. A total of 298 patients were considered eligible for inclusion. The mean age of the enrolled patients was 65.7±11. During 57.7±42.8 months, 30 patients (10.1%) underwent pacemaker implantation. In the stepwise multivariate models only heart rate at the time of the ablation (OR: 0.96; 95% CI: 0.93-0.98; ppacemaker implantation. A heart rate of ≤65 bpm was identified as the optimal cut-off value to predict the need of pacemaker implantation in the follow-up (sensitivity: 79%, specificity: 74%) by ROC curve analyses. This is the first study of an association between the slow conducting common atrial flutter and subsequent risk of pacemaker implantation. In light of these findings, assessing it prior to ablation can be helpful for the risk stratification of sinus node disease or atrioventricular conduction disease requiring a pacemaker implantation in patients with persistent atrial flutter. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Pacing system malfunction is a rare cause of hospital admission for syncope in patients with a permanent pacemaker.

    Science.gov (United States)

    Ofman, Peter; Rahilly-Tierney, Catherine; Djousse, Luc; Peralta, Adelqui; Hoffmeister, Peter; Gaziano, J Michael; Weiss, Alexey; Lotan, Chaim; Rosenheck, Shimon

    2013-01-01

    Few studies have examined the prevalence of permanent pacemaker (PPM) malfunction among patients with a previously implanted pacemaker admitted to the hospital with syncope. This study sought to examine causes of syncope in patients with a previously implanted pacemaker admitted to our hospital with syncope. We retrospectively reviewed our hospital admission database for patients who had both keywords "syncope" and "pacemaker" as their diagnoses from January 1, 1995 until June 1, 2012. One hundred and sixty-two patients who were admitted to the hospital because of syncope and had a PPM implanted prior to the index syncopal episode were included. All patients had pacemakers interrogated during the admission. Two independent physicians examined the discharge summary of each patient and determined the cause of syncope in each case. Of the 162 patients studied, eight (4.9%) were found to have pacemaker system malfunction as a cause of syncope. In 96 patients (59.2%), the cause of syncope could not be determined prior to hospital discharge. Among the identifiable causes of syncope, orthostatic hypotension was most prevalent (16%) followed by vasovagal (6%), severe aortic stenosis (4.3%), atrial arrhythmia (3.1%), acute and subacute infection (3.1%), and other less prevalent causes (3.1%). In this study, PPM system malfunction was rarely a cause of syncope in patients admitted to the hospital with a previously implanted device. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

  3. Spanish pacemaker registry. 10th official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2012).

    Science.gov (United States)

    Coma Samartín, Raúl; Ruiz Mateas, Francisco; Fidalgo Andrés, María Luisa; Leal del Ojo González, Juan; Pérez Álvarez, Luisa

    2013-12-01

    Our aim was to analyze the pacemaker implantations and replacements reported to the Spanish Pacemaker Registry in 2012 with special reference to the selection of pacing modes. The analysis was based on information provided by the European Pacemaker Patient Identification Card. Data were received from 115 hospitals, with a total of 12 856 cards. An estimated 745.8 pacemaker generators and 53.1 resynchronization devices were implanted per million population. Active fixation leads were implanted in more than 70% of the patients; of these leads, more than 20% were safe for use with magnetic resonance. The most common electrocardiographic indication for pacemaker implantation was atrioventricular block (56%). In all, 28% of the patients with sick sinus syndrome were paced in VVIR mode. The use of conventional pacemakers remained stable, whereas the implantation of resynchronization devices increased. Active fixation leads are now employed in most patients. The findings of this study confirm the higher incidence of implantation in men and at an earlier age due to the higher rate of conduction disorders. Age is a factor that influences the choice of the appropriate pacing mode. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  4. Spanish Pacemaker Registry. 14th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2016).

    Science.gov (United States)

    Cano Pérez, Óscar; Pombo Jiménez, Marta; Fidalgo Andrés, María Luisa; Lorente Carreño, Diego; Coma Samartín, Raúl

    2017-12-01

    This report describes the results of analysis of implanted pacemakers reported to the Spanish Pacemaker Registry. The analysis was based on information provided by the European Pacemaker Identification Card. Information was received from 115 hospitals, with a total of 12 697 cards, representing 32.3% of the estimated activity. Use of conventional and resynchronization pacemakers was 818 and 79 units per million inhabitants, respectively. A total of 200 leadless pacemakers were implanted. The mean age of the patients receiving an implant was 77.8 years, and 52% of devices were implanted in persons older than 80 years. In all, 74.9% were first implants and 23.4% corresponded to generator exchange. Endocardial leads were bipolar, 82.9% with active fixation, and 16.1% had magnetic resonance imaging protection. Most patients received bicameral sequential pacing, although single chamber pacing VVI(R) was used in 26.7% of the patients with sick sinus syndrome and in 23.8% of those with atrioventricular block, despite sinus rhythm. Total use of pacemaker generators in Spain has increased by 1.6% compared with 2015. Most implanted leads have active fixation and less than 20% have magnetic resonance imaging protection. Age and sex directly influenced pacing mode selection, which could be improved in around 32% of patients. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  5. Trends and variations in CO, C2H6, and HCN in the Southern Hemisphere point to the declining anthropogenic emissions of CO and C2H6

    Science.gov (United States)

    Zeng, G.; Wood, S. W.; Morgenstern, O.; Jones, N. B.; Robinson, J.; Smale, D.

    2012-08-01

    We analyse the carbon monoxide (CO), ethane (C2H6) and hydrogen cyanide (HCN) partial columns (from the ground to 12 km) derived from measurements by ground-based solar Fourier Transform Spectroscopy at Lauder, New Zealand (45° S, 170° E), and at Arrival Heights, Antarctica (78° S, 167° E), from 1997 to 2009. Significant negative trends are calculated for all species at both locations, based on the daily-mean observed time series, namely CO (-0.94 ± 0.47% yr-1), C2H6 (-2.37 ± 1.18% yr-1) and HCN (-0.93 ± 0.47% yr-1) at Lauder and CO (-0.92 ± 0.46% yr-1), C2H6 (-2.82 ± 1.37% yr-1) and HCN (-1.41 ± 0.71% yr-1) at Arrival Heights. The uncertainties reflect the 95% confidence limits. However, the magnitudes of the trends are influenced by the anomaly associated with the 1997-1998 El Niño Southern Oscillation event at the beginning of the time series reported. We calculate trends for each month from 1997 to 2009 and find negative trends for all months. The largest monthly trends of CO and C2H6 at Lauder, and to a lesser degree at Arrival Heights, occur during austral spring during the Southern Hemisphere tropical and subtropical biomass burning period. For HCN, the largest monthly trends occur in July and August at Lauder and around November at Arrival Heights. The correlations between CO and C2H6 and between CO and HCN at Lauder in September to November, when the biomass burning maximizes, are significantly larger that those in other seasons. A tropospheric chemistry-climate model is used to simulate CO, C2H6, and HCN partial columns for the period of 1997-2009, using interannually varying biomass burning emissions from GFED3 and annually periodic but seasonally varying emissions from both biogenic and anthropogenic sources. The model-simulated partial columns of these species compare well with the measured partial columns and the model accurately reproduces seasonal cycles of all three species at both locations. However, while the model satisfactorily

  6. Hydrogen constituents of the mesosphere inferred from positive ions - H2O, CH4, H2CO, H2O2, and HCN

    Science.gov (United States)

    Kopp, E.

    1990-01-01

    The concentrations in the mesosphere of H2O, CH4, H2CO, H2O2, and HCN were inferred from data on positive ion compositions, obtained from one mid-latitude and four high-latitude rocket flights. The inferred concentrations were found to agree only partially with the ground-based microwave measurements and/or model prediction by Garcia and Solomon (1985). The CH4 concentration was found to vary between 70 and 4 ppb in daytime and 900 and 100 ppbv at night, respectively. Unexpectedly high H2CO concentrations were obtained, with H2CO/H2O ratios between 0.0006 and 0.1, and a mean HCN volume mixing ratio of 6 x 10 to the -10th was inferred.

  7. Trends and variations in CO, C2H6, and HCN in the Southern Hemisphere point to the declining anthropogenic emissions of CO and C2H6

    Directory of Open Access Journals (Sweden)

    N. B. Jones

    2012-08-01

    Full Text Available We analyse the carbon monoxide (CO, ethane (C2H6 and hydrogen cyanide (HCN partial columns (from the ground to 12 km derived from measurements by ground-based solar Fourier Transform Spectroscopy at Lauder, New Zealand (45° S, 170° E, and at Arrival Heights, Antarctica (78° S, 167° E, from 1997 to 2009. Significant negative trends are calculated for all species at both locations, based on the daily-mean observed time series, namely CO (−0.94 ± 0.47% yr−1, C2H6 (−2.37 ± 1.18% yr−1 and HCN (−0.93 ± 0.47% yr−1 at Lauder and CO (−0.92 ± 0.46% yr−1, C2H6 (−2.82 ± 1.37% yr−1 and HCN (−1.41 ± 0.71% yr−1 at Arrival Heights. The uncertainties reflect the 95% confidence limits. However, the magnitudes of the trends are influenced by the anomaly associated with the 1997–1998 El Niño Southern Oscillation event at the beginning of the time series reported. We calculate trends for each month from 1997 to 2009 and find negative trends for all months. The largest monthly trends of CO and C2H6 at Lauder, and to a lesser degree at Arrival Heights, occur during austral spring during the Southern Hemisphere tropical and subtropical biomass burning period. For HCN, the largest monthly trends occur in July and August at Lauder and around November at Arrival Heights. The correlations between CO and C2H6 and between CO and HCN at Lauder in September to November, when the biomass burning maximizes, are significantly larger that those in other seasons. A tropospheric chemistry-climate model is used to simulate CO, C2H6, and HCN partial columns for the period of 1997–2009, using interannually varying biomass burning emissions from GFED3 and annually periodic but seasonally varying emissions from both biogenic and anthropogenic sources. The model-simulated partial columns of these species compare well with the measured partial columns and the model accurately reproduces seasonal cycles of all three species at both locations. However

  8. Polytetrafluoroethylene-coated pacemaker leads as surgical management of contact allergy to silicone.

    Science.gov (United States)

    Vodiskar, Janez; Schnöring, Heike; Sachweh, Jörg S; Mühler, Eberhard; Vazquez-Jimenez, Jaime F

    2014-01-01

    We have previously reported an 18-year-old girl with a congenital heart defect who developed complete heart block after one of her corrective surgeries and who needed an epicardial pacemaker implantation. She developed contact sensitivity to silicone compounds. The problem was solved by implanting a silicone-free pacemaker system utilizing silicone-free transvenous leads. The patient was readmitted 2 years later due to lead failure. As no silicone-free epicardial leads were available, we decided to use standard silicone epicardial leads and enclose the whole system in Gore-Tex material (W.L. Gore & Associates, Flagstaff, AZ). Based on our experience we would discourage the use of silicone-free transvenous pacing leads for epicardial use. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Successful percutaneous retrieval of a leadless pacemaker due to an acute rise in pacing threshold

    Directory of Open Access Journals (Sweden)

    Ngai-yin Chan

    2017-11-01

    Full Text Available Leadless cardiac pacemakers (LCP have become available recently. Both its acute and long-term performance in a large population of patients remain to be tested. Subacute rise in pacing threshold has been reported as an uncommon complication. On the other hand, the retrieval technique for LCP with passive fixation mechanism has not been previously described in details. Herein we report a newly recognized complication of an acute rise in pacing threshold very soon after implantation of an LCP without radiographic dislodgement. Percutaneous retrieval of this LCP with passive fixation mechanism was successful using a novel technique with the cryoballoon steerable sheath and a snare. Keywords: Leadless pacemaker, Percutaneous retrieval, Pacing threshold, Bradycardia, Dislodgement

  10. Pacemakers and implantable cardioverter defibrillators, unknown to chest radiography: Review, complications and systematic reading

    Energy Technology Data Exchange (ETDEWEB)

    Alandete Germán, Salvador Pascual, E-mail: salaiger@gmail.com; Isarria Vidal, Santiago, E-mail: isarria@comv.es; Domingo Montañana, María Luisa, E-mail: domingo.luimon@gmail.com; De la vía Oraá, Esperanza, E-mail: esviao82@gmail.com; Vilar Samper, José, E-mail: vilarsamper@gmail.com

    2015-03-15

    Highlights: •Radiologists have an important function in the evaluation of these devices. •We revise their radiological appearances and possible complications. •The knowledge in normal aspects and complications is important for radiologist. •To ensure an accurate reading of the chest x-ray, we present a systematic approach. -- Abstract: Chest X-ray is the imaging technique of choice for an initial study of pacemakers and implantable cardio-defibrillators (ICD). Radiologists have an important role in the evaluation of its initial placement and in the assessment during its follow-up. For this reason, it is necessary to know not only the different existing devices and its components but also the reasons of malfunction or possible complications. The purpose of this article is to do a systematic review of the different types of pacemakers and ICD. We review their usual radiological appearances, the possible complications which might take place and its causes of malfunctioning.

  11. Combined application of extracorporeal membrane oxygenation and an artificial pacemaker in fulminant myocarditis in a child.

    Science.gov (United States)

    Ye, Sheng; Zhu, Lvchan; Ning, Botao; Zhang, Chenmei

    2017-06-01

    Fulminant myocarditis is severe and aggressive, but it is self-limited and usually has a favorable prognosis if the patients can survive the acute phase. When drug treatment is not effective, extracorporeal membrane oxygenation technology should be applied to support cardiopulmonary function. Extracorporeal membrane oxygenation can simultaneously support function of the left ventricle, right ventricle, and lungs, and provide stable blood circulation for patients with heart and respiratory failure, which allows sufficient time for the cardiopulmonary system to recover. Fulminant myocarditis affects cardiac systolic function, as well as the function of autorhythmic cells and the conduction system. If severe bradycardia or atrioventricular block appears, a pacemaker needs to be installed. We report a child with fulminant myocarditis who was treated with extracorporeal membrane oxygenation combined with an artificial pacemaker.

  12. Rate Coefficients for Reactions of Ethynyl Radical (C2H) With HCN and CH3CN: Implications for the Formation of Comples Nitriles on Titan

    Science.gov (United States)

    Hoobler, Ray J.; Leone, Stephen R.

    1997-01-01

    Rate coefficients for the reactions of C2H + HCN yields products and C2H + CH3CN yields products have been measured over the temperature range 262-360 K. These experiments represent an ongoing effort to accurately measure reaction rate coefficients of the ethynyl radical, C2H, relevant to planetary atmospheres such as those of Jupiter and Saturn and its satellite Titan. Laser photolysis of C2H2 is used to produce C2H, and transient infrared laser absorption is employed to measure the decay of C2H to obtain the subsequent reaction rates in a transverse flow cell. Rate constants for the reaction C2H + HCN yields products are found to increase significantly with increasing temperature and are measured to be (3.9-6.2) x 10(exp 13) cm(exp 3) molecules(exp -1) s(exp -1) over the temperature range of 297-360 K. The rate constants for the reaction C2H + CH3CN yields products are also found to increase substantially with increasing temperature and are measured to be (1.0-2.1) x 10(exp -12) cm(exp 3) molecules(exp -1) s(exp -1) over the temperature range of 262-360 K. For the reaction C2H + HCN yields products, ab initio calculations of transition state structures are used to infer that the major products form via an addition/elimination pathway. The measured rate constants for the reaction of C2H + HCN yields products are significantly smaller than values currently employed in photochemical models of Titan, which will affect the HC3N distribution.

  13. Formation of hydroxyacetonitrile (HOCH2CN) and polyoxymethylene (POM)-derivatives in comets from formaldehyde (CH2O) and hydrogen cyanide (HCN) activated by water.

    Science.gov (United States)

    Danger, Grégoire; Rimola, Albert; Abou Mrad, Ninette; Duvernay, Fabrice; Roussin, Gaël; Theule, Patrice; Chiavassa, Thierry

    2014-02-28

    Studying chemical reactivity is an important way to improve our understanding of the origin of organic matter in astrophysical environments such as molecular clouds, protoplanetary disks, and possibly, as a final destination, in our solar system bodies such as in comets. Laboratory simulations on the reactivity of ice analogs can provide important insights into this complex reactivity. Here, the role of water as a catalytic agent is investigated under the conditions of simulated interstellar and cometary grains in the formation of complex organic molecules: the hydroxyacetonitrile (HOCH2CN) and formaldehyde polymers (polyoxymethylene POM). Using infrared spectroscopy and mass spectrometry, we show that HCN reacts with CH2O only in the presence of H2O, whereas in the absence of H2O, HCN is not sufficiently reactive to promote this reaction. Furthermore, depending on the dilution of CH2O and HCN in the water matrix, 1-cyanopolyoxymethylene polymers can also be formed (H-(O-CH2)n-CN, POM-CN), as confirmed by mass spectrometry using the HC(15)N isotopologue. Moreover, quantum chemical calculations allowed us to suggest mechanistic proposals for these reactions, the first step being the activation of HCN by water forming H3O(+) and CN(-), which subsequently condense on a neighbouring CH2O promoting the formation of (-)OCH2CN. Once (-)OCH2CN is formed, it can either recover a proton by reacting with H3O(+) or condense on CH2O molecules leading to POM-CN structures. Implications of this work for the forthcoming Rosetta mission are also addressed.

  14. Generation of locomotion rhythms without inhibition in vertebrates: the search for pacemaker neurons.

    Science.gov (United States)

    Li, Wen-Chang

    2011-12-01

    Locomotion rhythms are thought to be generated by neurons in the central-pattern-generator (CPG) circuit in the spinal cord. Synaptic connections in the CPG and pacemaker properties in certain CPG neurons, both may contribute to generation of the rhythms. In the half-center model proposed by Graham Brown a century ago, reciprocal inhibition plays a critical role. However, in all vertebrate preparations examined, rhythmic motor bursts can be induced when inhibition is blocked in the spinal cord. Without inhibition, neuronal pacemaker properties may become more important in generation of the rhythms. Pacemaker properties have been found in motoneurons and some premotor interneurons in different vertebrates and they can be dependent on N-Methyl-d-aspartate (NMDA) receptors (NMDAR) or rely on other ionic currents like persistent inward currents. In the swimming circuit of the hatchling Xenopus tadpole, there is substantial evidence that emergent network properties can give rise to swimming rhythms. During fictive swimming, excitatory interneurons (dINs) in the caudal hindbrain fire earliest on each swimming cycle and their spikes drive the firing of other CPG neurons. Regenerative dIN firing itself relies on reciprocal inhibition and background excitation. We now find that the activation of NMDARs can change dINs from firing singly at rest to current injection to firing repetitively at swimming frequencies. When action potentials are blocked, some intrinsic membrane potential oscillations at about 10 Hz are revealed, which may underlie repetitive dIN firing during NMDAR activation. In confirmation of this, dIN repetitive firing persists in NMDA when synaptic transmission is blocked by Cd(2+). When inhibition is blocked, only dINs and motoneurons are functional in the spinal circuit. We propose that the conditional intrinsic NMDAR-dependent pacemaker firing of dINs can drive the production of swimming-like rhythms without the participation of inhibitory

  15. Twenty-Seven Years Experience With Transvenous Pacemaker Implantation in Children Weighing <10 kg.

    Science.gov (United States)

    Konta, Laura; Chubb, Mark Henry; Bostock, Julian; Rogers, Jan; Rosenthal, Eric

    2016-02-01

    Epicardial pacemaker implantation is the favored approach in children weighing 5 kg during long-term follow-up. After a median of 14.3 (range, 13.4-17.6) years of pacing, 7 patients continue with their original lead. Transvenous pacing in infants <10 kg results in encouraging short- and long-term clinical outcomes. Subclavian vein occlusion remains an important complication, occurring predominantly in those weighing <5 kg. © 2016 American Heart Association, Inc.

  16. Pacemaker in complicated and refractory breath-holding spells: when to think about it?

    Science.gov (United States)

    Sartori, Stefano; Nosadini, Margherita; Leoni, Loira; de Palma, Luca; Toldo, Irene; Milanesi, Ornella; Cerutti, Alessia; Suppiej, Agnese

    2015-01-01

    Breath-holding spells (BHS) are benign non-epileptic paroxysmal events of infancy, rarely occurring with high frequency and complicated by prolonged syncope, convulsions and even status epilepticus. In these cases response to medical treatment is often unsatisfactory. Pacemaker implantation is a possible therapeutic option, but its indications, efficacy and complications have not been clarified yet. To report a new case of BHS treated with pacemaker and to review its indications and efficacy in patients with severe BHS. We extensively searched the literature in PubMed on cardiac pacing in patients with BHS and we described a new case. A previously healthy boy presented at the age of 4 months with frequent BHS inconstantly associated to prolonged syncope and post-anoxic non-epileptic and epileptic seizures. Parental reassurance, iron supplementation and piracetam were ineffective. After cardiac pacing at the age of 16 months, BHS and their complications disappeared. We identified 47 patients with BHS treated with pacemaker in the literature. Based on the available data, in all patients asystole or marked bradycardia were documented during BHS or stimulating maneuvers; syncope complicated BHS in 100% of cases and post-anoxic convulsions in 78.3%. Medical treatment before pacing, when administered, was ineffective or poorly tolerated. After pacing, BHS complications disappeared in 86.4% of cases, and decreased in 13.6%. Technical problems with the device were reported in 25.7% of patients and mild medical complications in 11.4%. Pacemaker could be reasonably considered in subjects with frequent and severe BHS, poor response to medications, and demonstration of cardioinhibition during spells. Copyright © 2014 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  17. [Safety of implantation permanent pacemaker at different times in patients with dual antiplatelet therapy].

    Science.gov (United States)

    Wang, Zhanqi; Cong, Hongliang; Li, Zheng; Zhang, Lanfang; Zhang, Fang; Li, Xiangxin

    2016-05-10

    To investigate the safety of implantation permanent pacemaker (PM) at different times in patients with dual antiplatelet (DAPT) therapy after implantation of drug-eluting stent (DES). A total of 105 patients who implanted pacemakers with DAPT therapy (clopidogrel and aspirin) after implantation of DES admitted to our hospital from January 2009 to January 2015 were enrolled in the study. The patients were divided into 3 groups: dual antiplatelet therapy (DAP) group: implanting PM within 3 months after coronary stenting, continuous DAPT during perioperative period; low molecular weight heparin (LMWH) bridging group: implanting PM within 3 to 6 months after coronary stenting, DAPT interruption for 5 days replaced with subcutaneous injection of enoxaparin (1 mg/kg), twice per day, enoxaparin was stopped 12 h before operation; asprin group, implanting PM after coronary stenting 6 months, clopidogrel interruption for 5 days. Oral DAPT was returned 12-24 after operation according to the patients' condition. Peri-operative cardiovascular events and bleedings, infections were observed. There was no major adverse cardiac event (MACE) and pouch infection were observed among 3 groups in perioperation. The incidence of pocket hemorrhage and errhysis in bridging group was significantly higher than that of DAP group and asprin group (16.7%, 8.0%, 0.0% χ(2)=10.431, P=0.005 and 29.2%, 12.0%, 7.1% χ(2)=6.321, P=0.042 respectively). 3 patients had severe bleeding (12.5%, 3/24) in bridging group; compared with the other 2 groups, there were significant difference (χ(2)=9.161, P=0.010). The incidence of hematoma and hemorrhage of asprin group was lowest. LMWH bridging therapy significantly increases the risk of pacemaker pocket hematoma and hemorrhage, and the pacemaker implantation may be safer after DES implantation 6 months.

  18. Utilization of Electrocardiographic P-wave Duration for AV Interval Optimization in Dual-Chamber Pacemakers.

    Science.gov (United States)

    Sorajja, Dan; Bhakta, Mayurkumar D; Scott, Luis Rp; Altemose, Gregory T; Srivathsan, Komandoor

    2010-09-05

    Empiric programming of the atrio-ventricular (AV) delay is commonly performed during pacemaker implantation. Transmitral flow assessment by Doppler echocardiography can be used to find the optimal AV delay by Ritter's method, but this cannot easily be performed during pacemaker implantation. We sought to determine a non-invasive surrogate for this assessment. Since electrocardiographic P-wave duration estimates atrial activation time, we hypothesized this measurement may provide a more appropriate basis for programming AV intervals. A total of 19 patients were examined at the time of dual chamber pacemaker implantation, 13 (68%) being male with a mean age of 77. Each patient had the optimal AV interval determined by Ritter's method. The P-wave duration was measured independently on electrocardiograms using MUSE® Cardiology Information System (version 7.1.1). The relationship between P-wave duration and the optimal AV interval was analyzed. The P-wave duration and optimal AV delay were related by a correlation coefficient of 0.815 and a correction factor of 1.26. The mean BMI was 27. The presence of hypertension, atrial fibrillation, and valvular heart disease was 13 (68%), 3 (16%), and 2 (11%) respectively. Mean echocardiographic parameters included an ejection fraction of 58%, left atrial index of 32 ml/m(2), and diastolic dysfunction grade 1 (out of 4). In patients with dual chamber pacemakers in AV sequentially paced mode and normal EF, electrocardiographic P-wave duration correlates to the optimal AV delay by Ritter's method by a factor of 1.26.

  19. Atrio-ventricular junction ablation and pacemaker treatment: a comparison between men and women.

    Science.gov (United States)

    Carnlöf, Carina; Insulander, Per; Jensen-Urstad, Mats; Iwarzon, Marie; Gadler, Fredrik

    2018-03-14

    To explore sex differences regarding indication for atrio-ventricular junction ablation (AVJ), choice of pacing system, complications to pacemaker treatment, long-term outcome, and cause of death after AVJ ablation. 700 patients who had undergone AVJ ablation between January 1990 and December 2010 were included. Data were retrieved from the patients´ medical records and the Swedish Pacemaker and Implantable Cardioverter-Defibrillator Registry. Information about admission to hospital and cause of death was retrieved from the National Board of Health and Welfare. Mean follow-up was 90 ± 64 months. Indication for AVJ ablation, choice of pacing system, and outcome after AVJ ablation differed between the sexes. The men had more often permanent atrial fibrillation, p = .0001, and a VVIR pacemaker or cardiac resynchronization therapy (CRT) implanted prior to ablation, p = .0001. Heart failure was present in 44% of the men vs. 28% of the women, p = .0001. LVEF decreased slightly in the whole cohort after the AVJ ablation. There were no sex differences in complication rates due to the pacemaker/ICD treatment, p = .3 or mortality due to AVJ ablation. In this long-term follow-up in patients with atrial fibrillation treated with AVJ ablation and pacing, indication, choice of pacing system, and morbidity differed but there were no sex differences regarding survival or primary cause of death found. The main factor influencing survival was age at the time of ablation. Women less often received treatment with ICD and/or CRT when indication was present compared with men.

  20. Treatment of pacemaker-induced superior vena cava syndrome by balloon angioplasty and stenting.

    LENUS (Irish Health Repository)

    Klop, B

    2011-01-01

    Superior vena cava (SVC) syndrome is a rare but serious complication after pacemaker implantation. This report describes three cases of SVC syndrome treated with venoplasty and venous stenting, with an average follow-up of 30.7 (±3.1) months. These cases illustrate that the definitive diagnosis, and the extent and location of venous obstruction, can only be determined by venography.

  1. Kearns-Sayre syndromes an absolute indication for prophylactic implantation of definitive pacemaker?

    Science.gov (United States)

    Barragán-Campos, H M; Barrera-Ramírez, C F; Iturralde Torres, P; Ilarraza-Lomelí, H; Avila-Casado, M C; Estañol, B; Dorantes, J; Oseguera, J

    1999-01-01

    Kearns-Sayre syndrome is a mitochondrial cytopathy characterized by chronic progressive external ophthalmoplegia, retinitis pigmentosa and heart block, the last of which determines the survival of these patients. The case of a 23 year old man with Kearns-Sayre syndrome, conduction disturbances and mitral valve prolapse is presented. The characteristics of this syndrome are described and the criteria for prophylactic installation of a pacemaker discussed.

  2. Can a Self-Diagnostic Digitally Controlled Pacemaker/Defibrillator Device be Used for Alerting Military Personnel When a Soldier Health Condition Becomes Compromised Out in the Field

    Science.gov (United States)

    2007-01-26

    function. In 1947 Dr. Claude Beck defibrillated the first human heart. Dr. John Hopps’ concepts, innovation, and theory of the pacemaker came to...5000 ABSTRACT The Self-Diagnostic Digitally Controlled Pacemaker/ Defibrillator Device (SDDCPDD) has several features that I think may be...very useful to the Armed Services. Even though this device is designed as a pacemaker/ defibrillator device; its applications can be used as a

  3. Safety of the Wearable Cardioverter Defibrillator (WCD) in Patients with Implanted Pacemakers.

    Science.gov (United States)

    Schmitt, Joern; Abaci, Guezine; Johnson, Victoria; Erkapic, Damir; Gemein, Christopher; Chasan, Ritvan; Weipert, Kay; Hamm, Christian W; Klein, Helmut U

    2017-03-01

    The wearable cardioverter defibrillator (WCD) is an important approach for better risk stratification, applied to patients considered to be at high risk of sudden arrhythmic death. Patients with implanted pacemakers may also become candidates for use of the WCD. However, there is a potential risk that pacemaker signals may mislead the WCD detection algorithm and cause inappropriate WCD shock delivery. The aim of the study was to test the impact of different types of pacing, various right ventricular (RV) lead positions, and pacing modes for potential misleading of the WCD detection algorithm. Sixty patients with implanted pacemakers received the WCD for a short time and each pacing mode (AAI, VVI, and DDD) was tested for at least 30 seconds in unipolar and bipolar pacing configuration. In case of triggering the WCD detection algorithm and starting the sequence of arrhythmia alarms, shock delivery was prevented by pushing of the response buttons. In six of 60 patients (10%), continuous unipolar pacing in DDD mode triggered the WCD detection algorithm. In no patient, triggering occurred with bipolar DDD pacing, unipolar and bipolar AAI, and VVI pacing. Triggering was independent of pacing amplitude, RV pacing lead position, and pulse generator implantation site. Unipolar DDD pacing bears a high risk of false triggering of the WCD detection algorithm. Other types of unipolar pacing and all bipolar pacing modes do not seem to mislead the WCD detection algorithm. Therefore, patients with no reprogrammable unipolar DDD pacing should not become candidates for the WCD. © 2016 Wiley Periodicals, Inc.

  4. Magnetic resonance imaging safety in pacemaker and implantable cardioverter defibrillator patients: how far have we come?

    Science.gov (United States)

    Nordbeck, Peter; Ertl, Georg; Ritter, Oliver

    2015-01-01

    Magnetic resonance imaging (MRI) has long been regarded a general contraindication in patients with cardiovascular implanted electronic devices such as cardiac pacemakers or cardioverter defibrillators (ICDs) due to the risk of severe complications and even deaths caused by interactions of the magnetic resonance (MR) surrounding and the electric devices. Over the last decade, a better understanding of the underlying mechanisms responsible for such potentially life-threatening complications as well as technical advances have allowed an increasing number of pacemaker and ICD patients to safely undergo MRI. This review lists the key findings from basic research and clinical trials over the last 20 years, and discusses the impact on current day clinical practice. With ‘MR-conditional’ devices being the new standard of care, MRI in pacemaker and ICD patients has been adopted to clinical routine today. However, specific precautions and specifications of these devices should be carefully followed if possible, to avoid patient risks which might appear with new MR technology and further increasing indications and patient numbers. PMID:25796053

  5. Pacemaker lead fracture without an increase in lead impedance caused by cardiac fibroma

    Directory of Open Access Journals (Sweden)

    Daisuke Sato

    2013-12-01

    Full Text Available We report the case of a 64-year-old man who had a permanent pacemaker with a unipolar silicone electrode positioned in the right ventricle in 1989 for sinus node dysfunction. On a routine checkup in June 2011, a 28-mm-diameter mass was discovered, which appeared to adhere to the tricuspid valve and the ventricular lead. The size of the mass did not change for the next 6 months, and the lead impedance was maintained at around 500–600 Ω. Because pacing failure was observed in January 2012, he underwent an urgent pacemaker check; however, the lead impedance was found not to have increased greatly (689 Ω. Nevertheless, the pacemaker lead was noted to be fractured at the tricuspid level. His echocardiogram showed new severe tricuspid regurgitation and a floating mass around the lead. We extracted the fractured lead, enucleated the tumor, replaced the tricuspid valve, and placed an epicardial lead. Macroscopic examination revealed that the tumor surrounded the fractured lead and covered the stump. Pathological examination revealed that the tumor was composed of fibrous connective tissue. We presumed that electric current continued to flow through the stump of the fractured unipolar lead to the generator, and this might have caused the limited increase in lead impedance.

  6. Powering a leadless pacemaker using a PiezoMEMS energy harvester

    Science.gov (United States)

    Jackson, Nathan; Olszewski, Oskar; O'Murchu, Cian; Mathewson, Alan

    2017-06-01

    MEMS based vibrational energy harvesting devices have been a highly researched topic over the past decade. The application targeted in this paper focuses on a leadless pacemaker that will be implanted in the right ventricle of the heart. A leadless pacemaker requires the same functionality as a normal pacemaker, but with significantly reduced volume. The reduced volume limits the space for a battery; therefore an energy harvesting device is required. This paper compares varying the dimensions of a linear MEMS based piezoelectric energy harvester that can harvest energy from the mechanical vibrations of the heart due to shock induced vibration. Typical MEMS linear energy harvesting devices operate at high frequency (<50 Hz) with low acceleration (< 1g). The force generated from the heart acts as a series of impulses as opposed to traditional sinusoidal vibration force with high acceleration (1-4 g). Therefore the design of a MEMS harvester that is based on shock-induced vibration is necessary. PiezoMEMS energy harvesting devices consisting of a silicon substrate and mass with aluminium nitride piezoelectric material were developed and characterized using acceleration forces that mimic the heartbeat. Peak powers of up to 25μW were obtained at 1 g acceleration with a powder density of approximately 1.5 mW cm-3.

  7. From two competing oscillators to one coupled-clock pacemaker cell system

    Science.gov (United States)

    Yaniv, Yael; Lakatta, Edward G.; Maltsev, Victor A.

    2015-01-01

    At the beginning of this century, debates regarding “what are the main control mechanisms that ignite the action potential (AP) in heart pacemaker cells” dominated the electrophysiology field. The original theory which prevailed for over 50 years had advocated that the ensemble of surface membrane ion channels (i.e., “M-clock”) is sufficient to ignite rhythmic APs. However, more recent experimental evidence in a variety of mammals has shown that the sarcoplasmic reticulum (SR) acts as a “Ca2+-clock” rhythmically discharges diastolic local Ca2+ releases (LCRs) beneath the cell surface membrane. LCRs activate an inward current (likely that of the Na+/Ca2+ exchanger) that prompts the surface membrane “M-clock” to ignite an AP. Theoretical and experimental evidence has mounted to indicate that this clock “crosstalk” operates on a beat-to-beat basis and determines both the AP firing rate and rhythm. Our review is focused on the evolution of experimental definition and numerical modeling of the coupled-clock concept, on how mechanisms intrinsic to pacemaker cell determine both the heart rate and rhythm, and on future directions to develop further the coupled-clock pacemaker cell concept. PMID:25741284

  8. Rechargeable silver-modified mercuric oxide-zinc cell for cardiac pacemakers.

    Science.gov (United States)

    Tyers, G F; Hughes, H C; Brownlee, R R; Manley, N J; Gorman, I N

    1976-11-04

    Tests were conducted on rechargeable mercury-zinc pacemaker batteries under simulated and actual biologic conditions, using a variety of discharge rates and charging schedules. In tests on 96 cells at a 6.4 milliampere (ma) discharge, recharging once every 15 months of simulated pacing at a 25 microampere (mua) drain, the earliest cell failure occurred after an equivalent of 50 years of pacing. The mean pacing equivalent for all 96 cells was more than 140 years. In 6.4 ma discharge tests on 24 cells, recharging once every 8 days of simulated pacing, only 1 cell in 24 failed after an equivalent of more than 500 years of pacing (actual time 2 years). In tests on 13 cells pacing at a 200 mua drain without recharging, the simulated mean duration of pacing before total discharge was 4.8 years. Seven other cells at a 200 mua drain with periodic recharging continue to function normally after more than 7 years of actual time, simulating 56 years of pacing at a 25 mua drain. Cardiac pacemakers using the rechargeable mercury-zinc cell have been implanted in animals for more than 2 1/2 years and in patients for more than 1 year with all units continuing to function satisfactorily. It has been demonstrated unequivocally that a rechargeable mercury-zinc pacemaker will function continuously for more than 4 years without recharging and that periodic recharging will extend pacing life far beyond that predicted for lithium and nuclear primary power sources.

  9. Ictal asystole in temporal lobe epilepsy before and after pacemaker implantation.

    Science.gov (United States)

    Strzelczyk, Adam; Bauer, Sebastian; Knake, Susanne; Oertel, Wolfgang H; Hamer, Hajo M; Rosenow, Felix

    2008-03-01

    Events of ictal bradycardia or asystole may be of relevance in epilepsy patients presenting with ictal falls, and are a potential contributor to SUDEP. The literature on ictal bradycardia or asystole is anecdotal and consists of case reports and small case series. There are no guidelines for the care of patients with ictal arrhythmias. Insertion of cardiac pacemakers may prevent life-threatening cardiac arrest, syncope and trauma. We report the case of a 41-year-old man who presented with refractory partial seizures resulting in syncope leading to severe head trauma, as the only ictal semiology. During presurgical video-EEG monitoring, two episodes of ictal bradycardia followed by asystole and syncope were recorded. A cardiac pacemaker was implanted. At the nine-month follow-up, the patient reported no overt seizures, syncopes or traumatic falls. Our case demonstrates that implantation of a cardiac pacemaker while continuing AEDs may render a patient free from ictal symptoms and prevent ictal syncope and subsequent trauma. [Published with video sequences].

  10. Low frequency magnetic emissions and resulting induced voltages in a pacemaker by iPod portable music players

    Directory of Open Access Journals (Sweden)

    Bassen Howard

    2008-02-01

    Full Text Available Abstract Background Recently, malfunctioning of a cardiac pacemaker electromagnetic, caused by electromagnetic interference (EMI by fields emitted by personal portable music players was highly publicized around the world. A clinical study of one patient was performed and two types of interference were observed when the clinicians placed a pacemaker programming head and an iPod were placed adjacent to the patient's implanted pacemaker. The authors concluded that "Warning labels may be needed to avoid close contact between pacemakers and iPods". We performed an in-vitro study to evaluate these claims of EMI and present our findings of no-effects" in this paper. Methods We performed in-vitro evaluations of the low frequency magnetic field emissions from various models of the Apple Inc. iPod music player. We measured magnetic field emissions with a 3-coil sensor (diameter of 3.5 cm placed within 1 cm of the surface of the player. Highly localized fields were observed (only existing in a one square cm area. We also measured the voltages induced inside an 'instrumented-can' pacemaker with two standard unipolar leads. Each iPod was placed in the air, 2.7 cm above the pacemaker case. The pacemaker case and leads were placed in a saline filled torso simulator per pacemaker electromagnetic compatibility standard ANSI/AAMI PC69:2000. Voltages inside the can were measured. Results Emissions were strongest (≈ 0.2 μT pp near a few localized points on the cases of the two iPods with hard drives. Emissions consisted of 100 kHz sinusoidal signal with lower frequency (20 msec wide pulsed amplitude modulation. Voltages induced in the iPods were below the noise level of our instruments (0.5 mV pp in the 0 – 1 kHz band or 2 mV pp in the 0 – 5 MHz bandwidth. Conclusion Our measurements of the magnitude and the spatial distribution of low frequency magnetic flux density emissions by 4 different models of iPod portable music players. Levels of less than 0.2

  11. Ca2+-clock-dependent pacemaking in the sinus node is impaired in mice with a cardiac specific reduction in SERCA2 abundance

    Directory of Open Access Journals (Sweden)

    Sunil Jit Ramamoorthy Jeewanlal Logantha

    2016-06-01

    Full Text Available Background: The sarcoplasmic reticulum Ca2+-ATPase (SERCA2 pump is an important component of the Ca2+-clock pacemaker mechanism that provides robustness and flexibility to sinus node pacemaking. We have developed transgenic mice with reduced cardiac SERCA2 abundance (Serca2 KO as a model for investigating SERCA2’s role in sinus node pacemaking.Methods and Results: In Serca2 KO mice, ventricular SERCA2a protein content measured by Western blotting was 75% (P70% Serca2 downregulation.Conclusions: Serca2 KO mice show a disrupted Ca2+-clock-dependent pacemaker mechanism contributing to impaired sinus node and atrioventricular node function.

  12. Radiotherapy with linear accelerator in a patient with permanent pacemaker, methodology and results of dose determination in a case in vivo

    International Nuclear Information System (INIS)

    Diaz A, P.; Dominguez O, X.; Toledo B, V.; Nungaray, H.; Zazueta L, F.

    2010-09-01

    This work presents the methodology used by the radiotherapy department of the Hospital San Javier in the patients handling with pacemaker. By means of dosimetry to the implant area of the pacemaker together with electrocardiography measurements during the radiotherapy sessions, the pacemaker performance is evaluated with the objective of detecting any anomaly to the same caused by electromagnetic interference and/or accumulated dose. It is necessary to follow specific protocols in these patients type that guarantee their security during the exposition to ionizing radiation since a definitive consent that allows to calculate the failure probability of pacemaker in this therapeutic condition does not exist. (Author)

  13. SU-D-18C-06: Initial Experience with Implementing MRI Safety Guidelines for Patients with Pacemakers - Medical Physicist Perspective

    Energy Technology Data Exchange (ETDEWEB)

    James, J; Place, V; Panda, A [Mayo Clinic, Scottsdale, AZ (United States); Edmonson, H [Mayo Clinic College of Medicine, Rochester, MN (United States); Felmlee, J [Mayo Clinic, Rochester, MN (United States); Pooley, R [Mayo Clinic, Jacksonville, FL (United States)

    2014-06-01

    Purpose: Several institutions have developed MRI guidelines for patients with MR-unsafe or MR-conditional pacemakers. Here we highlight the role of a medical physicist in implementing these guidelines for non-pacemaker dependent patients. Guidelines: Implementing these guidelines requires involvement from several medical specialties and a strong collaboration with the site MRI supervisor to develop a structured workflow. A medical physicist is required to be present during the scan to supervise the MR scanning and to maintain a safety checklist that ensures: 1) uninterrupted patient communication with the technologist, 2) continuous patient physiologic monitoring (e.g. blood pressure and electrocardiography) by a trained nurse, 3) redundant patient vitals monitoring (e.g. pulse oximetry) due to the possibility of in vivo electrocardiography reading fluctuations during image acquisition. A radiologist is strongly recommended to be available to review the images before patients are discharged from the scanner. Pacemaker MRI should be restricted to 1.5T field strength. The MRI sequences should be optimized by the physicist with regards to: a) SAR: limited to <1.5 W/Kg for MR-unsafe pacemakers in normal operating mode, b) RF exposure time: <30 min, c) Coils: use T/R coils but not restricted to such, d) Artifacts: further optimization of sequences whenever image quality is compromised due to the pacemaker. In particular, cardiac, breast and left-shoulder MRIs are most susceptible to these artifacts. Possible strategies to lower the SAR include: a) BW reduction, 2) echo-train-length reduction, 3) increase TR, 4) decrease number of averages, 5) decrease flip angle, 6) reduce slices and/or a combination of all the options. Conclusion: A medical physicist in collaboration with the MR supervisor plays an important role in the supervision/implementation of safe MR scanning of pacemaker patients. Developing and establishing a workflow has enabled our institution to scan over

  14. The circadian neuropeptide PDF signals preferentially through a specific adenylate cyclase isoform AC3 in M pacemakers of Drosophila.

    Directory of Open Access Journals (Sweden)

    Laura B Duvall

    Full Text Available The neuropeptide Pigment Dispersing Factor (PDF is essential for normal circadian function in Drosophila. It synchronizes the phases of M pacemakers, while in E pacemakers it decelerates their cycling and supports their amplitude. The PDF receptor (PDF-R is present in both M and subsets of E cells. Activation of PDF-R stimulates cAMP increases in vitro and in M cells in vivo. The present study asks: What is the identity of downstream signaling components that are associated with PDF receptor in specific circadian pacemaker neurons? Using live imaging of intact fly brains and transgenic RNAi, we show that adenylate cyclase AC3 underlies PDF signaling in M cells. Genetic disruptions of AC3 specifically disrupt PDF responses: they do not affect other Gs-coupled GPCR signaling in M cells, they can be rescued, and they do not represent developmental alterations. Knockdown of the Drosophila AKAP-like scaffolding protein Nervy also reduces PDF responses. Flies with AC3 alterations show behavioral syndromes consistent with known roles of M pacemakers as mediated by PDF. Surprisingly, disruption of AC3 does not alter PDF responses in E cells--the PDF-R(+ LNd. Within M pacemakers, PDF-R couples preferentially to a single AC, but PDF-R association with a different AC(s is needed to explain PDF signaling in the E pacemakers. Thus critical pathways of circadian synchronization are mediated by highly specific second messenger components. These findings support a hypothesis that PDF signaling components within target cells are sequestered into "circadian signalosomes," whose compositions differ between E and M pacemaker cell types.

  15. The rationale and design of the Micra Transcatheter Pacing Study: safety and efficacy of a novel miniaturized pacemaker.

    Science.gov (United States)

    Ritter, Philippe; Duray, Gabor Z; Zhang, Shu; Narasimhan, Calambur; Soejima, Kyoko; Omar, Razali; Laager, Verla; Stromberg, Kurt; Williams, Eric; Reynolds, Dwight

    2015-05-01

    Recent advances in miniaturization technologies and battery chemistries have made it possible to develop a pacemaker small enough to implant within the heart while still aiming to provide similar battery longevity to conventional pacemakers. The Micra Transcatheter Pacing System is a miniaturized single-chamber pacemaker system that is delivered via catheter through the femoral vein. The pacemaker is implanted directly inside the right ventricle of the heart, eliminating the need for a device pocket and insertion of a pacing lead, thereby potentially avoiding some of the complications associated with traditional pacing systems. The Micra Transcatheter Pacing Study is currently undergoing evaluation in a prospective, multi-site, single-arm study. Approximately 720 patients will be implanted at up to 70 centres around the world. The study is designed to have a continuously growing body of evidence and data analyses are planned at various time points. The primary safety and efficacy objectives at 6-month post-implant are to demonstrate that (i) the percentage of Micra patients free from major complications related to the Micra system or implant procedure is significantly higher than 83% and (ii) the percentage of Micra patients with both low and stable thresholds is significantly higher than 80%. The safety performance benchmark is based on a reference dataset of 977 subjects from 6 recent pacemaker studies. The Micra Transcatheter Pacing Study will assess the safety and efficacy of a miniaturized, totally endocardial pacemaker in patients with an indication for implantation of a single-chamber ventricular pacemaker. NCT02004873. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  16. Structural Insights into the Functional Role of the Hcn Sub-domain of the Receptor-Binding Domain of the Botulinum Neurotoxin Mosaic Serotype C/D

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Yanfeng; Gardberg, Anna; Edwards, Tom E.; Sankaran, Banumathi; Robinson, Howard; Varnum, Susan M.; Buchko, Garry W.

    2013-07-01

    Botulinum neurotoxin (BoNT), the causative agent of the deadly neuroparalytic disease botulism, is the most poisonous protein known for humans. Produced by different strains of the anaerobic bacterium Clostridium botulinum, BoNT effects cellular intoxication via a multistep mechanism executed by the three modules of the activated protein. Endocytosis, the first step of cellular intoxication, is triggered by the ~50 kDa, heavy-chain receptor-binding module (HCR) that is specific for a ganglioside and a protein receptor on neuronal cell surfaces. This dual receptor recognition mechanism between BoNT and the host cell’s membrane is well documented and occurs via specific intermolecular interactions with the C-terminal sub-domain, Hcc, of BoNT-HCR. The N-terminal sub-domain of BoNT-HCR, Hcn, comprises ~50% of BoNT-HCR and adopts a B-sheet jelly roll fold. While suspected in assisting cell surface recognition, no unambiguous function for the Hcn sub-domain in BoNT has been indentified. To obtain insights into the potential function of the Hcn sub-domain in BoNT, the first crystal structure of a BoNT with an organic ligand bound to the Hcn sub-domain has been obtained. Here, we describe the crystal structure of BoNT/CD-HCR determined at 1.70 Å resolution with a tetraethylene glycol (PG4) molecule bound in an hydrophobic cleft between B-strands in the B-sheet jelly fold roll of the Hcn sub-domain. The molecule is completely engulfed in the cleft, making numerous hydrophobic (Y932, S959, W966, and D1042) and hydrophilic (S935, W977, L979, N1013, and I1066) contacts with the protein’s side chain and backbone that may mimic in vivo interactions with the phospholipid membranes on neuronal cell surfaces. A sulfate ion was also observed bound to residues T1176, D1177, K1196, and R1243 in the Hcc sub-domain of BoNT/CD-HCR. In the crystal structure of a similar protein, BoNT/D-HCR, a sialic acid

  17. Chemical content of the circumstellar envelope of the oxygen-rich AGB star R Doradus. Non-LTE abundance analysis of CO, SiO, and HCN

    Science.gov (United States)

    Van de Sande, M.; Decin, L.; Lombaert, R.; Khouri, T.; de Koter, A.; Wyrowski, F.; De Nutte, R.; Homan, W.

    2018-01-01

    Context. The stellar outflows of low- to intermediate-mass stars are characterised by a rich chemistry. Condensation of molecular gas species into dust grains is a key component in a chain of physical processes that leads to the onset of a stellar wind. In order to improve our understanding of the coupling between the micro-scale chemistry and macro-scale dynamics, we need to retrieve the abundance of molecules throughout the outflow. Aims: Our aim is to determine the radial abundance profile of SiO and HCN throughout the stellar outflow of R Dor, an oxygen-rich AGB star with a low mass-loss rate. SiO is thought to play an essential role in the dust-formation process of oxygen-rich AGB stars. The presence of HCN in an oxygen-rich environment is thought to be due to non-equilibrium chemistry in the inner wind. Methods: We analysed molecular transitions of CO, SiO, and HCN measured with the APEX telescope and all three instruments on the Herschel Space Observatory, together with data available in the literature. Photometric data and the infrared spectrum measured by ISO-SWS were used to constrain the dust component of the outflow. Using both continuum and line radiative transfer methods, a physical envelope model of both gas and dust was established. We performed an analysis of the SiO and HCN molecular transitions in order to calculate their abundances. Results: We have obtained an envelope model that describes the dust and the gas in the outflow, and determined the abundance of SiO and HCN throughout the region of the stellar outflow probed by our molecular data. For SiO, we find that the initial abundance lies between 5.5 × 10-5 and 6.0 × 10-5 with respect to H2. The abundance profile is constant up to 60 ± 10 R∗, after which it declines following a Gaussian profile with an e-folding radius of 3.5 ± 0.5 × 1013 cm or 1.4 ± 0.2 R∗. For HCN, we find an initial abundance of 5.0 × 10-7 with respect to H2. The Gaussian profile that describes the decline

  18. Development of selective catalytic oxidation (SCO) for NH{sub 3} and HCN removal from gasification gas; Selektiivisen katalyyttisen hapetusprosessin (SCO) kehittaeminen kaasutuskaasun NH{sub 3}:n ja HCN:n poistoon

    Energy Technology Data Exchange (ETDEWEB)

    Leppaelahti, J.; Koljonen, T.; Heiskanen, K. [VTT Energy, Espoo (Finland)

    1997-10-01

    In gasification, reactive nitrogen compounds (mainly NH{sub 3} and HCN) are formed from fuel nitrogen. If the gas containing NH{sub 3} is burned, a high NO{sub x} emission may be formed. The content of nitrogen compounds of the hot gasification gas could be reduced in Selective Catalytic Oxidation (SCO) process. In this process small amounts of reactive oxidisers are injected into the gas in order to convert NH{sub 3} to N{sub 2}. The utilization of SCO process together with low NO{sub x} burners in advanced gasification power stations might offer an alternative for flue gas treatment technologies like SCR (Selective Catalytic Reduction). In the earlier research, conditions were found, where oxidizers reacted selectively with ammonia in the gasification gas. Highest ammonia reduction took place in the aluminium oxide bed in the presence of NO and O{sub 2}. The aim of this study is to examine the reaction mechanism in order to be able to further evaluate the development possibilities of this kind process. The effect of composition and the amount of added oxidizer, the content of combustible gas components, space velocity, pressure and temperature will be studied. The experiments are carried out with the laboratory scale high pressure flow reactor of VTT Energy. Kinetic modelling of the experimental results is carried out in co-operation with the combustion chemistry group of Aabo Akademi. The aim of the modelling work is to bring insight to the gas-phase reactions that are important for the SCO-process. (orig.)

  19. Role of sinoatrial node architecture in maintaining a balanced source-sink relationship and synchronous cardiac pacemaking.

    Science.gov (United States)

    Unudurthi, Sathya D; Wolf, Roseanne M; Hund, Thomas J

    2014-01-01

    Normal heart rhythm (sinus rhythm) depends on regular activity of the sinoatrial node (SAN), a heterogeneous collection of specialized myocytes in the right atrium. SAN cells, in general, possess a unique electrophysiological profile that promotes spontaneous electrical activity (automaticity). However, while automaticity is required for normal pacemaking, it is not necessarily sufficient. Less appreciated is the importance of the elaborate structure of the SAN complex for proper pacemaker function. Here, we review the important structural features of the SAN with a focus on how these elements help manage a precarious balance between electrical charge generated by the SAN ("source") and the charge needed to excite the surrounding atrial tissue ("sink"). We also discuss how compromised "source-sink" balance due, for example to fibrosis, may promote SAN dysfunction, characterized by slow and/or asynchronous pacemaker activity and even failure, in the setting of cardiovascular disease (e.g., heart failure, atrial fibrillation). Finally, we discuss implications of the "source-sink" balance in the SAN complex for cell and gene therapies aimed at creating a biological pacemaker as replacement or bridge to conventional electronic pacemakers.

  20. From beat rate variability in induced pluripotent stem cell-derived pacemaker cells to heart rate variability in human subjects.

    Science.gov (United States)

    Ben-Ari, Meital; Schick, Revital; Barad, Lili; Novak, Atara; Ben-Ari, Erez; Lorber, Avraham; Itskovitz-Eldor, Joseph; Rosen, Michael R; Weissman, Amir; Binah, Ofer

    2014-10-01

    We previously reported that induced pluripotent stem cell-derived cardiomyocytes manifest beat rate variability (BRV) resembling heart rate variability (HRV) in the human sinoatrial node. We now hypothesized the BRV-HRV continuum originates in pacemaker cells. To investigate whether cellular BRV is a source of HRV dynamics, we hypothesized 3 levels of interaction among different cardiomyocyte entities: (1) single pacemaker cells, (2) networks of electrically coupled pacemaker cells, and (3) the in situ sinoatrial node. We measured BRV/HRV properties in single pacemaker cells, induced pluripotent stem cell-derived contracting embryoid bodies (EBs), and electrocardiograms from the same individual. Pronounced BRV/HRV was present at all 3 levels. The coefficient of variance of interbeat intervals and Poincaré plot indices SD1 and SD2 for single cells were 20 times greater than those for EBs (P heart (the latter two were similar; P > .05). We also compared BRV magnitude among single cells, small EBs (~5-10 cells), and larger EBs (>10 cells): BRV indices progressively increased with the decrease in the cell number (P heart rhythm. The decreased BRV magnitude in transitioning from the single cell to the EB suggests that the HRV of in situ hearts originates from the summation and integration of multiple cell-based oscillators. Hence, complex interactions among multiple pacemaker cells and intracellular Ca(2+) handling determine HRV in humans and cardiomyocyte networks. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  1. Spanish Pacemaker Registry. Eleventh official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2013).

    Science.gov (United States)

    Coma Samartín, Raúl; Cano Pérez, Óscar; Pombo Jiménez, Marta

    2014-12-01

    The present report summarizes the analysis of pacemaker implantation and replacement data sent to the Spanish Pacemaker Registry in 2013, with specific discussion of pacing mode selection. This study was based on information obtained from the European Pacemaker Patient Identification Card. Information was received on 118 hospital centers, with a total of 12 831 cards, or 35% of the estimated activity. There were 755 and 58.1 conventional and resynchronization devices per million population, respectively. The mean age of patients receiving an implant was 77.4 years. Men received 59.5% of first implantations and 56.6% of replacements. Most implantations and generator replacements were performed in patients older than 80 years. Almost all endocardial leads used were bipolar, and 78.7% of leads had an active fixation mechanism. Despite being in sinus rhythm, 24% of patients with sick sinus syndrome and 25% of those with atrioventricular block were paced in VVIR mode. The use of pacemaker generators and resynchronization devices per million population continues to increase in Spain. Active fixation mechanisms predominate for leads but just 20% of leads are compatible with magnetic resonance imaging. The factors influencing the correct selection of pacing mode were age and, to a lesser extent, the type of atrioventricular block, and sex. Implementation of home monitoring of pacemakers remains low. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  2. Adsorption behavior of Co anchored on graphene sheets toward NO, SO2, NH3, CO and HCN molecules

    International Nuclear Information System (INIS)

    Tang, Yanan; Chen, Weiguang; Li, Chenggang; Pan, Lijun; Dai, Xianqi; Ma, Dongwei

    2015-01-01

    Graphical abstract: - Highlights: • In contrast to the pristine graphene, a vacancy defect in graphene strongly stabilizes the Co atom. • The positively charged of Co atom on graphene can regulate the stability of gas molecules. • Different gas molecules can modulate the electronic structure of Co–graphene systems. • The adsorbed NO on Co–graphene can effectively regulate the magnetic properties of systems. - Abstract: Based on the first-principles of density-functional theory (DFT), the effects of gas adsorption on the change in geometric stability, electronic structure and magnetic properties of graphene with anchored Co (Co–graphene) systems were investigated. A single Co adatom interacts much weaker with pristine graphene (Co/pri–graphene) than with the graphene containing a single vacancy (Co/SV–graphene). The Co dopant provides more electrons to the dangling bonds of carbon atom at defective site and exhibits more positive charges, which makes Co/SV–graphene less prone to be adsorbed by gas molecules in comparison to Co/pri–graphene. It is found that the electronic structure and magnetic properties of Co–graphene systems can be modulated by adsorbing gas molecules. Except the NH 3 molecule, the adsorbed NO, SO 2 , CO or HCN as electron acceptors on the Co/pri–graphene can exhibit semiconducting properties. Among the gas molecules, the strong adsorption of NO molecule can effectively regulate the magnetic properties of Co–graphene systems. Moreover, the stable configuration of Co/SV–graphene is more likely to be the gas sensor for detecting NO and SO 2 . The results validate that the reactivity of atomic-scale catalyst is supported on graphene sheets, which is expected to be potentially efficient in the gas sensors and electronic device

  3. Pacemaker Implants in Children and Adolescents with Chagas Disease in Brazil: 18-Year Incidence.

    Science.gov (United States)

    Mizzaci, Carolina Christianini; Souza, Thiago Gonçalves Schroder E; Targueta, Gabriel Pelegrineti; Tótora, Ana Paula Frederico; Mateos, Juan Carlos Pachón; Mateos, José Carlos Pachon

    2017-06-01

    Chagas disease continues to be a serious public health problem, and accounts for 25-30% of the indications for cardiac stimulation in Brazil. To assess clinical and epidemiological characteristics of patients with Chagas disease, younger than 18 years, who had undergone pacemaker implantation in Brazil between 1994 and 2011, and its temporal trend. This was a cross-sectional analysis of data from the Brazilian Pacemaker Registry database. The following variables were analyzed: year when pacemaker was implanted, location, age, sex, ethnic group, functional class and the main electrocardiographic findings at baseline. In a total of 183,123 implants performed between 1994 and 2011, 214 implants of cardiac stimulation device in Chagas disease patients aged younger than 18 years were identified. Mean age at implantation was 5.6 ± 6.2 years. Second- and third-degree atrioventricular blocks corresponded to 71% of indications for pacemaker implantation. Fifty-six percent of the procedures were performed in the southeast region. Regarding the total number of pacemaker implants per year, there was a remarkable increase in the implants for all causes. However, time series analysis of the implants in Chagas disease patients younger than 18 years revealed a significant reduction in the annual number of implants. There has been an important reduction in the number of pacemaker implantations among children and adolescents with Chagas disease, suggesting a reduction in the vertical transmission of the parasite. A doença de Chagas mantém-se como sério problema de saúde pública e tem sido responsável por aproximadamente 25% a 30% das indicações de estimulação cardíaca no Brasil. Estudar as características clínicas e epidemiológicas dos pacientes menores de 18 anos portadores de doença de Chagas submetidos a implante de marca-passo no território brasileiro entre 1994 e 2011, e sua tendência temporal. Trata-se de um estudo retrospectivo que utilizou informa

  4. Surgical management of superior vena cava syndrome following pacemaker lead infection: a case report and review of the literature.

    Science.gov (United States)

    Kokotsakis, John; Chaudhry, Umar A R; Tassopoulos, Dimitris; Harling, Leanne; Ashrafian, Hutan; Vernandos, Michail; Kanakis, Meletis; Athanasiou, Thanos

    2014-06-19

    Superior vena cava (SVC) syndrome is a known but rare complication of pacemaker lead implantation, accounting for approximately less than 0.5% of cases. Its pathophysiology is due to either infection or endothelial mechanical stress, causing inflammation and fibrosis leading to thrombosis, and therefore stenosis of the SVC. Due to the various risks including thrombo-embolic complications and the need to provide symptomatic relief, medical and surgical interventions are sought early. We present the case of a 48-year Caucasian male who presented with localised swelling and pain at the site of pacemaker implantation. Inflammatory markers were normal, but diagnostic imaging revealed three masses along the pacemaker lead passage. A surgical approach using cardiopulmonary bypass and circulatory arrest was used to remove the vegetations. Culture from the vegetations showed Staphylococcus epidermidis. The technique presented here allowed for safe and effective removal of both the thrombus and infected pacing leads, with excellent exposure and minimal post-procedure complications.

  5. A successful insertion of PICC in patient with cardiac angiosarcoma and neoplasty of right atrium and pacemaker: A case report.

    Science.gov (United States)

    Liu, Bing; Sun, Wenyan; Wang, Kai

    2017-12-01

    Primary cardiac angiosarcoma is a rare tumor and the common treatment is surgical resection followed by chemotherapy. Peripherally inserted central venous catheters (PICCs) are widely used in cancer patients and ultrasound-guided PICC insertion could improve success rate especially in patient with abnormal anatomy structure. Reports about PICCs being placed in patient who had suffered from the cardiac angiosarcoma and neoplasty of right atrium with an ipsilateral cardiac permanent pacemaker are rarely.After patient's informed consent, we present a case of the successful insertion of PICC into a patient with the ipsilateral cardiac disease with a pacemaker placement, which has not been previously reported. This report highlights PICC could be used in patient with cardiac disease with a pacemaker placement for chemotherapy. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  6. A successful insertion of PICC in patient with cardiac angiosarcoma and neoplasty of right atrium and pacemaker

    Science.gov (United States)

    Liu, Bing; Sun, Wenyan; Wang, Kai

    2017-01-01

    Abstract Introduction: Primary cardiac angiosarcoma is a rare tumor and the common treatment is surgical resection followed by chemotherapy. Peripherally inserted central venous catheters (PICCs) are widely used in cancer patients and ultrasound-guided PICC insertion could improve success rate especially in patient with abnormal anatomy structure. Reports about PICCs being placed in patient who had suffered from the cardiac angiosarcoma and neoplasty of right atrium with an ipsilateral cardiac permanent pacemaker are rarely. After patient's informed consent, we present a case of the successful insertion of PICC into a patient with the ipsilateral cardiac disease with a pacemaker placement, which has not been previously reported. Conclusions: This report highlights PICC could be used in patient with cardiac disease with a pacemaker placement for chemotherapy. PMID:29390474

  7. Identification of bacteriology and risk factor analysis of asymptomatic bacterial colonization in pacemaker replacement patients.

    Directory of Open Access Journals (Sweden)

    Xian-Ming Chu

    Full Text Available Recent researches revealed that asymptomatic bacterial colonization on PMs might be ubiquitous and increase the risk of clinical PM infection. Early diagnosis of patients with asymptomatic bacterial colonization could provide opportunity for targeted preventive measures.The present study explores the incidence of bacterial colonization of generator pockets in pacemaker replacement patients without signs of infection, and to analyze risk factors for asymptomatic bacterial colonization.From June 2011 to December 2013, 118 patients underwent pacemaker replacement or upgrade. Identification of bacteria was carried out by bacterial culture and 16S rRNA sequencing. Clinical risk characteristics were analyzed.The total bacterial positive rate was 37.3% (44 cases, and the coagulase-negative Staphylococcus aureus detection rate was the highest. Twenty two (18.6% patients had positive bacterial culture results, of which 50% had coagulase-negative staphylococcus. The bacterial DNA detection rate was 36.4 % (43 cases. Positive bacterial DNA results from pocket tissues and the surface of the devices were 22.0% and 29.7%, respectively. During follow-up (median, 27.0 months, three patients (6.8%, 3/44 became symptomatic with the same genus of microorganism, S. aureus (n=2 and S. epidermidis (n=1. Multivariable logistic regression analysis showed that history of bacterial infection, use of antibiotics, application of antiplatelet drugs, replacement frequency were independent risk factors for asymptomatic bacterial colonization.There was a high incidence of asymptomatic bacterial colonization in pacemaker patients with independent risk factors. Bacterial culture combined genetic testing could improve the detection rate.

  8. Association of sleep-wake habits in older people with changes in output of circadian pacemaker

    Science.gov (United States)

    Czeisler, C. A.; Dumont, M.; Duffy, J. F.; Steinberg, J. D.; Richardson, G. S.; Brown, E. N.; Sanchez, R.; Rios, C. D.; Ronda, J. M.

    1992-01-01

    Many elderly people complain of disturbed sleep patterns but there is not evidence that the need to sleep decreases with age; it seems rather that the timing and consolidation of sleep change. We tried to find out whether there is a concurrent change in the output of the circadian pacemaker with age. The phase and amplitude of the pacemaker's output were assessed by continuous measurement of the core body temperature during 40 h of sustained wakefulness under constant behavioural and environmental conditions. 27 young men (18-31 years) were compared with 21 older people (65-85 years; 11 men, 10 women); all were healthy and without sleep complaints. The mean amplitude of the endogenous circadian temperature oscillation (ECA) was 40% greater in young men than in the older group. Older men had a lower mean temperature ECA than older women. The minimum of the endogenous phase of the circadian temperature oscillation (ECP) occurred 1 h 52 min earlier in the older than in the young group. Customary bedtimes and waketimes were also earlier in the older group, as was their daily alertness peak. There was a close correlation between habitual waketime and temperature ECP in young men, which may lose precision with age, especially among women. These findings provide evidence for systematic age-related changes in the output of the human circadian pacemaker. We suggest that these changes may underlie the common complaints of sleep disturbance among elderly people. These changes could reflect the observed age-related deterioration of the hypothalamic nuclei that drive mammalian circadian rhythms.

  9. The Composition and Structure of Biofilms Developed by Propionibacterium acnes Isolated from Cardiac Pacemaker Devices

    Directory of Open Access Journals (Sweden)

    Ken-ichi Okuda

    2018-02-01

    Full Text Available The present study aimed to understand the biofilm formation mechanism of Propionibacterium acnes by analyzing the components and structure of the biofilms. P. acnes strains were isolated from the surface of explanted cardiac pacemaker devices that exhibited no clinical signs of infection. Culture tests using a simple stamp culture method (pressing pacemakers against the surface of agar plates revealed frequent P. acnes colonization on the surface of cardiac pacemaker devices. P. acnes was isolated from 7/31 devices, and the isolates were categorized by multilocus sequence typing into five different sequence types (STs: ST4 (JK18.2, ST53 (JK17.1, ST69 (JK12.2 and JK13.1, ST124 (JK5.3, ST125 (JK6.2, and unknown ST (JK19.3. An in vitro biofilm formation assay using microtiter plates demonstrated that 5/7 isolates formed biofilms. Inhibitory effects of DNase I and proteinase K on biofilm formation varied among isolates. In contrast, dispersin B showed no inhibitory activity against all isolates. Three-dimensional live/dead imaging of P. acnes biofilms with different biochemical properties using confocal laser microscopy demonstrated different distributions and proportions of living and dead cells. Additionally, it was suggested that extracellular DNA (eDNA plays a role in the formation of biofilms containing living cells. Ultrastructural analysis of P. acnes biofilms using a transmission electron microscope and atmospheric scanning electron microscope revealed leakage of cytoplasmic components along with cell lysis and fibrous structures of eDNA connecting cells. In conclusion, the biochemical properties and structures of the biofilms differed among P. acnes isolates. These findings may provide clues for establishing countermeasures against biofilm-associated infection by P. acnes.

  10. Lmo mutants reveal a novel role for circadian pacemaker neurons in cocaine-induced behaviors.

    Directory of Open Access Journals (Sweden)

    Linus T-Y Tsai

    2004-12-01

    Full Text Available Drosophila has been developed recently as a model system to investigate the molecular and neural mechanisms underlying responses to drugs of abuse. Genetic screens for mutants with altered drug-induced behaviors thus provide an unbiased approach to define novel molecules involved in the process. We identified mutations in the Drosophila LIM-only (LMO gene, encoding a regulator of LIM-homeodomain proteins, in a genetic screen for mutants with altered cocaine sensitivity. Reduced Lmo function increases behavioral responses to cocaine, while Lmo overexpression causes the opposite effect, reduced cocaine responsiveness. Expression of Lmo in the principal Drosophila circadian pacemaker cells, the PDF-expressing ventral lateral neurons (LN(vs, is sufficient to confer normal cocaine sensitivity. Consistent with a role for Lmo in LN(vfunction,Lmomutants also show defects in circadian rhythms of behavior. However, the role for LN(vs in modulating cocaine responses is separable from their role as pacemaker neurons: ablation or functional silencing of the LN(vs reduces cocaine sensitivity, while loss of the principal circadian neurotransmitter PDF has no effect. Together, these results reveal a novel role for Lmo in modulating acute cocaine sensitivity and circadian locomotor rhythmicity, and add to growing evidence that these behaviors are regulated by shared molecular mechanisms. The finding that the degree of cocaine responsiveness is controlled by the Drosophila pacemaker neurons provides a neuroanatomical basis for this overlap. We propose that Lmo controls the responsiveness of LN(vs to cocaine, which in turn regulate the flies' behavioral sensitivity to the drug.

  11. Evaluation of patients' quality of life aspects after cardiac pacemaker implantation

    Science.gov (United States)

    de Barros, Rubens Tofano; de Carvalho, Sebastião Marcos Ribeiro; Silva, Marcos Augusto de Moraes; Borges, Juliana Bassalobre Carvalho

    2014-01-01

    Objective To evaluate patients' quality of life aspects after pacemaker implantation, relating it to gender, age, and implantation timespan. Methods A total of 107 clinically stable patients of both genders (49.5% women and 50.5% men) over 18 years old (average 69.3±12.6 years) and presenting an implantation timespan of three to 12 months (average 6.36±2.99 months) were evaluated. The evaluation included personal, clinical, and implant data as well as quality of life questionnaires (AQUAREL and SF-36). Statistical analysis was conducted using the t test and Pearson correlation, with a 5% significance level. Results The lowest SF-36 score referred to physical aspects, and the highest score referred to social aspects. In AQUAREL, the lowest score referred to dyspnea, and the highest referred to discomfort. There was a significant association between gender and quality of life in SF-36 (physical functioning and emotional aspects) and in AQUAREL (dyspnea). A negative correlation was observed between age and quality of life (functional capacity in SF-36, and discomfort in AQUAREL) in relation to implantation timespan, a correlation with vitality from SF-36. Conclusion Lower quality of life scores were found in physical aspects and dyspnea; and higher scores in social aspects and discomfort. Men presented higher quality of life scores related to physical functioning, emotional aspects and dyspnea. As age increases, quality of life worsens regarding functional capacity and discomfort; and the longer the pacemaker implantation timespan, the worse quality of life when it comes to vitality. Gender, age, and implantation timespan influence quality of life; thus, these variables must be considered in strategies for improving quality of life of patients with pacemakers. PMID:24896161

  12. What Pacemakers Can Teach Us about the Ethics of Maintaining Artificial Organs.

    Science.gov (United States)

    Hutchison, Katrina; Sparrow, Robert

    2016-11-01

    One day soon it may be possible to replace a failing heart, liver, or kidney with a long-lasting mechanical replacement or perhaps even with a 3-D printed version based on the patient's own tissue. Such artificial organs could make transplant waiting lists and immunosuppression a thing of the past. Supposing that this happens, what will the ongoing care of people with these implants involve? In particular, how will the need to maintain the functioning of artificial organs over an extended period affect patients and their doctors and the responsibilities of those who manufacture such devices? Drawing on lessons from the history of the cardiac pacemaker, this article offers an initial survey of the ethical issues posed by the need to maintain and service artificial organs. We briefly outline the nature and history of cardiac pacemakers, with a particular focus on the need for technical support, maintenance, and replacement of these devices. Drawing on the existing medical literature and on our conversations and correspondence with cardiologists, regulators, and manufacturers, we describe five sources of ethical issues associated with pacemaker maintenance: the location of the devices inside the human body, such that maintenance generates surgical risks; the complexity of the devices, which increases the risk of harms to patients as well as introducing potential injustices in access to treatment; the role of software-particularly software that can be remotely accessed-in the functioning of the devices, which generates privacy and security issues; the impact of continual development and improvement of the device; and the influence of commercial interests in the context of a medical device market in which there are several competing products. Finally, we offer some initial suggestions as to how these questions should be answered. © 2016 The Hastings Center.

  13. Beam Profile Disturbances from Implantable Pacemakers or Implantable Cardioverter-Defibrillator Interactions

    Energy Technology Data Exchange (ETDEWEB)

    Gossman, Michael S., E-mail: mgossman@tsrcc.com [Tri-State Regional Cancer Center, Medical Physics Section, Ashland, KY (United States); Comprehensive Heart and Vascular Associates, Heart and Vascular Center, Ashland, KY (United States); Medtronic, Inc., External Research Program, Mounds View, MN (United States); Nagra, Bipinpreet; Graves-Calhoun, Alison; Wilkinson, Jeffrey [Tri-State Regional Cancer Center, Medical Physics Section, Ashland, KY (United States); Comprehensive Heart and Vascular Associates, Heart and Vascular Center, Ashland, KY (United States); Medtronic, Inc., External Research Program, Mounds View, MN (United States)

    2011-01-01

    The medical community is advocating for progressive improvement in the design of implantable cardioverter-defibrillators and implantable pacemakers to accommodate elevations in dose limitation criteria. With advancement already made for magnetic resonance imaging compatibility in some, a greater need is present to inform the radiation oncologist and medical physicist regarding treatment planning beam profile changes when such devices are in the field of a therapeutic radiation beam. Treatment plan modeling was conducted to simulate effects induced by Medtronic, Inc.-manufactured devices on therapeutic radiation beams. As a continuation of grant-supported research, we show that radial and transverse open beam profiles of a medical accelerator were altered when compared with profiles resulting when implantable pacemakers and cardioverter-defibrillators are placed directly in the beam. Results are markedly different between the 2 devices in the axial plane and the sagittal planes. Vast differences are also presented for the therapeutic beams at 6-MV and 18-MV x-ray energies. Maximum changes in percentage depth dose are observed for the implantable cardioverter-defibrillator as 9.3% at 6 MV and 10.1% at 18 MV, with worst distance to agreement of isodose lines at 2.3 cm and 1.3 cm, respectively. For the implantable pacemaker, the maximum changes in percentage depth dose were observed as 10.7% at 6 MV and 6.9% at 18 MV, with worst distance to agreement of isodose lines at 2.5 cm and 1.9 cm, respectively. No differences were discernible for the defibrillation leads and the pacing lead.

  14. Assessing the Risks Associated with MRI in Patients with a Pacemaker or Defibrillator.

    Science.gov (United States)

    Russo, Robert J; Costa, Heather S; Silva, Patricia D; Anderson, Jeffrey L; Arshad, Aysha; Biederman, Robert W W; Boyle, Noel G; Frabizzio, Jennifer V; Birgersdotter-Green, Ulrika; Higgins, Steven L; Lampert, Rachel; Machado, Christian E; Martin, Edward T; Rivard, Andrew L; Rubenstein, Jason C; Schaerf, Raymond H M; Schwartz, Jennifer D; Shah, Dipan J; Tomassoni, Gery F; Tominaga, Gail T; Tonkin, Allison E; Uretsky, Seth; Wolff, Steven D

    2017-02-23

    The presence of a cardiovascular implantable electronic device has long been a contraindication for the performance of magnetic resonance imaging (MRI). We established a prospective registry to determine the risks associated with MRI at a magnetic field strength of 1.5 tesla for patients who had a pacemaker or implantable cardioverter-defibrillator (ICD) that was "non-MRI-conditional" (i.e., not approved by the Food and Drug Administration for MRI scanning). Patients in the registry were referred for clinically indicated nonthoracic MRI at a field strength of 1.5 tesla. Devices were interrogated before and after MRI with the use of a standardized protocol and were appropriately reprogrammed before the scanning. The primary end points were death, generator or lead failure, induced arrhythmia, loss of capture, or electrical reset during the scanning. The secondary end points were changes in device settings. MRI was performed in 1000 cases in which patients had a pacemaker and in 500 cases in which patients had an ICD. No deaths, lead failures, losses of capture, or ventricular arrhythmias occurred during MRI. One ICD generator could not be interrogated after MRI and required immediate replacement; the device had not been appropriately programmed per protocol before the MRI. We observed six cases of self-terminating atrial fibrillation or flutter and six cases of partial electrical reset. Changes in lead impedance, pacing threshold, battery voltage, and P-wave and R-wave amplitude exceeded prespecified thresholds in a small number of cases. Repeat MRI was not associated with an increase in adverse events. In this study, device or lead failure did not occur in any patient with a non-MRI-conditional pacemaker or ICD who underwent clinically indicated nonthoracic MRI at 1.5 tesla, was appropriately screened, and had the device reprogrammed in accordance with the prespecified protocol. (Funded by St. Jude Medical and others; MagnaSafe ClinicalTrials.gov number, NCT

  15. Improved quality of life after treatment of prolonged asystole during breath holding spells with a cardiac pacemaker.

    Science.gov (United States)

    Kolterer, Bruno; Gebauer, Roman Antonin; Janousek, Jan; Dähnert, Ingo; Riede, Frank Thomas; Paech, Christian

    2015-01-01

    To validate the physical and psychological effectiveness of cardiac pacing in pediatric patients with breath-holding spells (BHS) and prolonged asystole. The records and clinical data of all the patients with BHS who presented to our center in the period of 2001-2013 were reviewed. All patients who received cardiac pacemaker implantation for prolonged asystole during BHS were included. In addition, the parents were asked to fill out a standardized quality of life (QOL) questionnaire. Seven patients were identified. The mean onset of symptoms was 7 month (1-12 months) of age, documented asystole was 12-21 seconds, and a permanent cardiac pacemaker device was implanted at a mean age of 23 months (8 months-3.9 years). No pacemaker related adverse events were recorded. Follow up showed immediate resolution from spells in four cases (4/7). Two patients (2/7) showed significant reduction of frequency and severity of spells, with complete elimination of loss of consciousness (LOC). One patient (1/7) with an additional neurologic disorder continued to have minor pallid BHS and eventually switched from pallid to cyanotic spells without further detection of bradycardia or asystole in holter examination. QOL questionnaire revealed significant reduction in subjective stress levels of patients (P = 0.012) and parents (P = 0.007) after pacemaker implantation. Cardiac pacing using appropriate pacemaker settings seems effective in the prevention of LOC and reduction of the frequency of BHS. Our results imply a reduction of subjective stress levels of patients and parents as well as an increased quality of everyday life. After all, randomized controlled trials of the influence of cardiac pacemaker implantation on subjective stress levels in patients with BHS are needed.

  16. Safety of implantable pacemakers and cardioverter defibrillators in the magnetic field of a novel remote magnetic navigation system.

    Science.gov (United States)

    Jilek, Clemens; Tzeis, Stylianos; Reents, Tilko; Estner, Heidi-Luise; Fichtner, Stephanie; Ammar, Sonia; Wu, Jinjin; Hessling, Gabriele; Deisenhofer, Isabel; Kolb, Christof

    2010-10-01

    Electromagnetic interference with pacemaker and implantable cardioverter defibrillator (ICD) systems may cause temporary or permanent system malfunction of implanted devices. The aim of this study was to evaluate potential interference of a novel magnetic navigation system with implantable rhythm devices. A total of 121 devices (77 pacemakers, 44 ICDs) were exposed to an activated NIOBE II® Magnetic Navigation System (Stereotaxis, St. Louis, MO, USA) at the maximal magnetic field strength of 0.1 Tesla and evaluated in vitro with respect to changes in parameter settings of the device, changes of the battery status/detection of elective replacement indication, or alterations of data stored in the device. A total of 115 out of 121 (95%) devices were free of changes in parameter settings, battery status, and internally stored data after repeated exposition to the electromagnetic field of the remote magnetic navigation system. Interference with the magnetic navigation field was observed in 6 pacemakers, resulting in reprogramming to a power-on-reset mode with or without detection of the elective replacement indication in 5 devices and abnormal variance of battery status in one device. All pacemakers could be reprogrammed to the initial modes and the battery status proved to be normal some minutes after the pacemakers had been removed from the magnetic field. Interference of a remote magnetic navigation system (at maximal field strength) with pacemakers and ICDs not connected to leads with antitachycardic detection and therapies turned off is rare. Occurring functional abnormalities could be reprogrammed in our sample. An in vitro study will give information about interference of devices connected to leads. © 2010 Wiley Periodicals, Inc.

  17. Improved quality of life after treatment of prolonged asystole during breath holding spells with a cardiac pacemaker

    Science.gov (United States)

    Kolterer, Bruno; Gebauer, Roman Antonin; Janousek, Jan; Dähnert, Ingo; Riede, Frank Thomas; Paech, Christian

    2015-01-01

    Objectives: To validate the physical and psychological effectiveness of cardiac pacing in pediatric patients with breath-holding spells (BHS) and prolonged asystole. Materials and Methods: The records and clinical data of all the patients with BHS who presented to our center in the period of 2001–2013 were reviewed. All patients who received cardiac pacemaker implantation for prolonged asystole during BHS were included. In addition, the parents were asked to fill out a standardized quality of life (QOL) questionnaire. Results: Seven patients were identified. The mean onset of symptoms was 7 month (1–12 months) of age, documented asystole was 12–21 seconds, and a permanent cardiac pacemaker device was implanted at a mean age of 23 months (8 months–3.9 years). No pacemaker related adverse events were recorded. Follow up showed immediate resolution from spells in four cases (4/7). Two patients (2/7) showed significant reduction of frequency and severity of spells, with complete elimination of loss of consciousness (LOC). One patient (1/7) with an additional neurologic disorder continued to have minor pallid BHS and eventually switched from pallid to cyanotic spells without further detection of bradycardia or asystole in holter examination. QOL questionnaire revealed significant reduction in subjective stress levels of patients (P = 0.012) and parents (P = 0.007) after pacemaker implantation. Conclusion: Cardiac pacing using appropriate pacemaker settings seems effective in the prevention of LOC and reduction of the frequency of BHS. Our results imply a reduction of subjective stress levels of patients and parents as well as an increased quality of everyday life. After all, randomized controlled trials of the influence of cardiac pacemaker implantation on subjective stress levels in patients with BHS are needed. PMID:26085761

  18. Venous Obstruction Following Pacemaker or Implantable Cardioverter-Defibrillator Implantation, Mini Review

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Akbarzadeh

    2016-08-01

    Full Text Available Venous obstruction is relatively frequent following permanent pacemaker or implantable cardioverter-defibrillator (ICD implantation. However, most of them are asymptomatic. Although the exact risk factor for this complication is not known, number of leads, heart failure and infection may prone the patient to this complication. The goal standard for detection of vein stenosis is venography; however, ultrasound sonography has an acceptable accuracy. Anticoagulant therapy may be considered for symptomatic patients. For device upgrading, non-functional leads removal, venoplasty and rarely surgical treatment may be indicated.

  19. CaV3.1 is a tremor rhythm pacemaker in the inferior olive

    OpenAIRE

    Park, Young-Gyun; Park, Hye-Yeon; Lee, C. Justin; Choi, Soonwook; Jo, Seonmi; Choi, Hansol; Kim, Yang-Hann; Shin, Hee-Sup; Llinas, Rodolfo R.; Kim, Daesoo

    2010-01-01

    The rhythmic motor pathway activation by pacemaker neurons or circuits in the brain has been proposed as the mechanism for the timing of motor coordination, and the abnormal potentiation of this mechanism may lead to a pathological tremor. Here, we show that the potentiation of CaV3.1 T-type Ca2+ channels in the inferior olive contributes to the onset of the tremor in a pharmacological model of essential tremor. After administration of harmaline, 4- to 10-Hz synchronous neuronal activities ar...

  20. MR Imaging in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators.

    Science.gov (United States)

    Sommer, Torsten; Bauer, Wolfgang; Fischbach, Katharina; Kolb, Christof; Luechinger, Roger; Wiegand, Uwe; Lotz, Joachim; Eitel, Ingo; Gutberlet, Matthias; Thiele, Holger; Schild, Hans H; Kelm, Malte; Quick, Harald H; Schulz-Menger, Jeanette; Barkhausen, Jörg; Bänsch, Dietmar

    2017-03-01

    This joint consensus paper of the German Roentgen Society and the German Cardiac Society provides physical and electrophysiological background information and specific recommendations for the procedural management of patients with cardiac pacemakers (PM) and implantable cardioverter defibrillators (ICD) undergoing magnetic resonance (MR) imaging. The paper outlines the responsibilities of radiologists and cardiologists regarding patient education, indications, and monitoring with modification of MR sequences and PM/ICD reprogramming strategies being discussed in particular. The aim is to optimize patient safety and to improve legal clarity in order to facilitate the access of SM/ICD patients to MR imaging. Key Points:   · Conventional PM and ICD systems are no longer an absolute but rather a relative contraindication for performing an MR examination. Procedural management includes the assessment of the individual risk/benefit ratio, comprehensive patient informed consent about specific risks and "off label" use, extensive PM/ICD-related and MR-related safety precautions to reduce these risks to the greatest extent possible, as well as adequate monitoring techniques.. · MR conditional pacemaker and ICD systems have been tested and approved for MR examination under specific conditions ("in-label" use). Precise understanding of and compliance with the terms of use for the specific pacemaker system are essential for patient safety.. · The risk for an ICD patient during MR examinations is to be considered significantly higher compared to PM patients due to the higher vulnerability of the structurally damaged myocardium and the higher risk of irreversible damage to conventional ICD systems. The indication for a MR examination of an ICD patient should therefore be determined on a stricter basis and the expected risk/benefit ratio should be critically reviewed.. · This complex subject requires close collaboration between radiology and cardiology.. Citation Format

  1. Sikkerhed af magnetisk resonans-skanning hos patienter med pacemaker og implanterbar defibrillator

    DEFF Research Database (Denmark)

    Al-Sabagh, Kifah Hekmat; Christensen, Britta Ege; Thøgersen, Anna Margrethe

    2010-01-01

    INTRODUCTION: The presence of a cardiac implantable device is ICD considered an absolute contraindication to magnetic resonance imaging (MRI). The purpose of this study was to evaluate the safety of performing MRI in patients with cardiac pacemakers and ICDs that had a compelling clinical need...... or to sense only mode to avoid MRI-induced competitive pacing and potential pro-arrhythmia. All devices were interrogated immediately before and after the MRI examination, which included measurement of sensitivity, pacing capture threshold (PCT) and lead impedance. RESULTS: MRI examinations were completed...

  2. Right ventricular perforation by a passive-fixation pacemaker lead two weeks after implantation

    Directory of Open Access Journals (Sweden)

    Azeem S. Sheikh, BSc, MBBS, FCPS, MRCP

    2014-12-01

    Full Text Available Myocardial perforation is a rare complication of permanent pacemaker implantation. While most of the perforations occur at the time of implantation or within the first 24 h, delayed myocardial perforations are very rare. The clinical course is extremely variable with some patients presenting completely asymptomatic, while others can develop cardiac tamponade and haemodynamic instability. We report an unusual case of a subacute ventricular perforation caused by a passive-fixation lead two weeks after implantation and we successfully managed to extract the lead under local anaesthesia, without the patient undergoing surgery, as recommended in the previously published reports.

  3. Automatic implantable cardioverter/defibrillator: inadvertent discharges during permanent pacemaker magnet tests.

    Science.gov (United States)

    Kim, S G; Furman, S; Matos, J A; Waspe, L E; Brodman, R; Fisher, J D

    1987-05-01

    A patient with an automatic implantable cardioverter defibrillator (AICD) received two inadvertent shocks when a magnet was placed over the pacer during a routine permanent pacer check. Analysis of the rhythm strip suggested that both patients' QRS complexes (133 beats/minute) and asynchronous pacer artifacts (70 beats/minute) were counted by the AICD sensing system and exceeded the rate criteria of 153 beats/minute. This resulted in shocks from the AICD during sinus rhythm at 133 beats/minute. To avoid possible inadvertent shocks, an AICD should be deactivated while a magnet is placed over the pacemaker during a permanent pacer check.

  4. Molecular Reconnaissance of the β Pictoris Gas Disk with the SMA: A Low HCN/(CO+CO2) Outgassing Ratio and Predictions for Future Surveys

    Science.gov (United States)

    Matrà, L.; Wilner, D. J.; Öberg, K. I.; Andrews, S. M.; Loomis, R. A.; Wyatt, M. C.; Dent, W. R. F.

    2018-02-01

    The exocometary origin of CO gas has been confirmed in several extrasolar Kuiper belts, with CO ice abundances consistent with solar system comets. We here present a molecular survey of the β Pictoris belt with the Submillimeter Array (SMA), reporting upper limits for CN, HCN, HCO+, N2H+, and H2CO, as well as for H2S, CH3OH, SiO, and DCN from archival ALMA data. Nondetections can be attributed to rapid molecular photodissociation due to the A-star’s strong UV flux. CN is the longest lasting and most easily detectable molecule after CO in this environment. We update our nonlocal thermodynamic equilibrium excitation model to include UV fluorescence, finding it plays a key role in CO and CN excitation, and we use it to turn the SMA CN/CO flux ratio constraint into an upper limit of value is consistent with, but at the low end of, the broad range observed in solar system comets. If sublimation dominates outgassing, then this low value may be caused by decreased outgassing for the less volatile molecule HCN compared to CO. If instead UV photodesorption or collisional vaporization of unbound grains dominates outgassing, then this low ratio of rates would imply a low ice abundance ratio, which would in turn indicate a variation in cometary cyanide abundances across planetary systems. To conclude, we make predictions for future molecular surveys and show that CN and HCN should be readily detectable with ALMA around β Pictoris for solar-system-like exocometary compositions.

  5. [Study on Chaotic Detection Method of Pacemaker Contact-Less Power Supply].

    Science.gov (United States)

    Zhou, Chenghu; Huang, Mingming; Li, Songtao

    2015-12-01

    In order to improve the reliability of cardiac pacemaker contact-less power supply technology, this paper proposes a novel application of wireless feedback voltage stabilizing technology to adjust heart disease patients with inner power supply filter circuit output voltage and current control method, to keep the output voltage stability, and to ensure that the super capacitor and cardiac pacemaker to get a stable power supply. To implement the real-time accurate voltage control with considering the primary and secondary side inductance coupling coefficient changes, the change of the external power supply voltage and load, it is necessary to test thee real-time and accurate output voltage and current value after rectifying filtering. Therefore, based on the chaotic control theory, we adopted method of phase diagram on the basis of the quick observation after rectifying filtering, so that the method of voltage and current could improve the detection time of the circuit. The phase diagram of proposed control method can be divided into 8 segments, and we got 7 zero-extreme points. When these zero-extreme points are detected, according to extreme points of the zero instantaneous values, the corresponding average values of voltage and current were obtained. Simulation and experimental results showed that using the above method can shorten the response time to less than switch devices 1/2 switching cycles, thus validating the effectiveness and feasibility of the proposed detection algorithm.

  6. CLINICAL FEATURES OF PATIENTS WITH PERMANENT PACEMAKERS DEPENDING ON THE STAGE OF ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    T. Derienko

    2015-12-01

    Full Text Available The study included 131 patients (70 men and 61 women aged 69,5 ± 11,6 years who underwent permanent pacing because of atrio-ventricular block(AV, permanent atrial fibrillation(AF and sick sinus node syndrome(SSS with pacing modes DDD/DDDR and VVI /VVIR as well as chronic heart failure (CHF with cardiac resynchronization therapy (CRT-P and CRT-D. Clinical features of patients were evaluated according to the stage of arterial hypertension (AH. The results showed that all patients with implanted pacemakers had hypertension the II and III stages with their ratio 1:2.5. Stable angina, diabetes mellitus (DM, AF, heart failure (HF II A and moderate degree of AH were associated with the II stage of AH. The III stage of AH was associated with persistent AF and postinfarction cardiosclerosis, while the frequency of occurrence moderate and severe degree of AH were the same. The high frequency of AH in patients with implanted pacemakers and their relationship with other disorders in the health of patients, requires optimization of blood pressure control.

  7. Intrinsically active and pacemaker neurons in pluripotent stem cell-derived neuronal populations.

    Science.gov (United States)

    Illes, Sebastian; Jakab, Martin; Beyer, Felix; Gelfert, Renate; Couillard-Despres, Sébastien; Schnitzler, Alfons; Ritter, Markus; Aigner, Ludwig

    2014-03-11

    Neurons generated from pluripotent stem cells (PSCs) self-organize into functional neuronal assemblies in vitro, generating synchronous network activities. Intriguingly, PSC-derived neuronal assemblies develop spontaneous activities that are independent of external stimulation, suggesting the presence of thus far undetected intrinsically active neurons (IANs). Here, by using mouse embryonic stem cells, we provide evidence for the existence of IANs in PSC-neuronal networks based on extracellular multielectrode array and intracellular patch-clamp recordings. IANs remain active after pharmacological inhibition of fast synaptic communication and possess intrinsic mechanisms required for autonomous neuronal activity. PSC-derived IANs are functionally integrated in PSC-neuronal populations, contribute to synchronous network bursting, and exhibit pacemaker properties. The intrinsic activity and pacemaker properties of the neuronal subpopulation identified herein may be particularly relevant for interventions involving transplantation of neural tissues. IANs may be a key element in the regulation of the functional activity of grafted as well as preexisting host neuronal networks.

  8. A novel approach to the pacemaker infection with non-thermal atmospheric pressure plasma

    Science.gov (United States)

    Zhang, Yuchen; Li, Yu; Li, Yinglong; Yu, Shuang; Li, Haiyan; Zhang, Jue

    2017-08-01

    Although the pacemaker (PM) is a key cardiac implantable electrical device for life-threatening arrhythmias treatment, the related infection is a challenge. Thus, the aim of this study is to validate cold plasma as a potential technology for the disinfection of infected pacemakers. Fifty donated PMs were cleaned and sterilized before use and then infected with Staphylococcus aureus ( S. aureus). Then, each experimental group was treated with cold plasma treatment for 1 min, 3 min, 5 min and 7 min, while the control group was immersed with sterilized water. Effectiveness of disinfection was evaluated by using CFU counting method and confocal laser scanning microscopy (CLSM). The physicochemical properties of water treated with cold plasma at different time were evaluated, including water temperature change and oxidation reduction potential (ORP). The major reactive species generated by the cold plasma equipment during cold plasma were analyzed with optical emission spectroscopy (OES). No live bacteria were detected with CFU counting method after 7 min of cold plasma treatment, which matches with the CLSM results. The ORP value of water and H2O2 concentration changed significantly after treating with cold plasma. Furthermore, reactive oxygen species (ROS) and reactive nitrogen species (RNS), especially NO, O (777 nm) and O (844 nm) were probably key inactivation agents in cold plasma treatment. These results indicate that cold plasma could be an effective technology for the disinfection of implantable devices.

  9. Experimental investigation of fan-folded piezoelectric energy harvesters for powering pacemakers

    Science.gov (United States)

    Ansari, M. H.; Karami, M. Amin

    2017-06-01

    This paper studies the fabrication and testing of a magnet free piezoelectric energy harvester (EH) for powering biomedical devices and sensors inside the body. The design for the EH is a fan-folded structure consisting of bimorph piezoelectric beams folding on top of each other. An actual size experimental prototype is fabricated to verify the developed analytical models. The model is verified by matching the analytical results of the tip acceleration frequency response functions (FRF) and voltage FRF with the experimental results. The generated electricity is measured when the EH is excited by the heartbeat. A closed loop shaker system is utilized to reproduce the heartbeat vibrations. Achieving low fundamental natural frequency is a key factor to generate sufficient energy for pacemakers using heartbeat vibrations. It is shown that the natural frequency of the small-scale device is less than 20 {{Hz}} due to its unique fan-folded design. The experimental results show that the small-scale EH generates sufficient power for state of the art pacemakers. The 1 cm3 EH with 18.4 {{g}}{{r}} tip mass generates more than 16 μ {{W}} of power from a normal heartbeat waveform. The robustness of the device to the heart rate is also studied by measuring the relation between the power output and the heart rate.

  10. Intracardiac Origin of Heart Rate Variability, Pacemaker Funny Current and their Possible Association with Critical Illness

    Science.gov (United States)

    Papaioannou, Vasilios E; Verkerk, Arie O; Amin, Ahmed S; de Bakker, Jaques MT

    2013-01-01

    Heart rate variability (HRV) is an indirect estimator of autonomic modulation of heart rate and is considered a risk marker in critical illness, particularly in heart failure and severe sepsis. A reduced HRV has been found in critically ill patients and has been associated with neuro-autonomic uncoupling or decreased baroreflex sensitivity. However, results from human and animal experimental studies indicate that intracardiac mechanisms might also be responsible for interbeat fluctuations. These studies have demonstrated that different membrane channel proteins and especially the so-called ‘funny’ current (If), an hyperpolarization-activated, inward current that drives diastolic depolarization resulting in spontaneous activity in cardiac pacemaker cells, are altered during critical illness. Furthermore, membrane channels kinetics seem to have significant impact upon HRV, whose early decrease might reflect a cellular metabolic stress. In this review article we present research findings regarding intracardiac origin of HRV, at the cellular level and in both isolated sinoatrial node and whole ex vivo heart preparations. In addition, we will review results from various experimental studies that support the interrelation between If and HRV during endotoxemia. We suggest that reduced HRV during sepsis could also be associated with altered pacemaker cell membrane properties, due to ionic current remodeling. PMID:22920474

  11. Recurrent syncope in a hypertensive subject with vascular cognitive impairment and permanent pacemaker

    Directory of Open Access Journals (Sweden)

    Alberto Mazza

    2012-09-01

    Full Text Available Syncope following permanent pacemaker (PM implantation is a nightmare for electrophysiologists. We describe a case of daily recurrent syncope in an 84-year-old man having a dual-chamber pacemaker implanted for complete atrio-ventricular block occurred 4 years before the admission to our department. He had a history of arterial hypertension, parossistic atrial fibrillation, chronic obstructive pulmonary disease, stage-III chronic renal failure, mild vascular cognitive impairment and glaucoma. The initial work-up including electrocardiogram (ECG, repeated PM inter- rogations, Holter electrocardiogram, blood pressure measurement in orthostatic position, complete blood count, serum glycaemia, electrolytes and thyroid function tests showed normal findings. Syncope occurred in lying position and during 90° left clockwise neck rotation and was associated to pallor, sweating, tonic-clonic seizures and transient self-limited loss of consciousness lasting a few seconds. Electroencephalogram was normal. During continuous ECG monitoring, the right rotation of the head determined a ventricular asystolic pause lasting 9 seconds associated with loss of consciousness. Restoration of sinus rhythm was observed after bringing back the head in axis. The PM interrogation, performed during pacing failure, recorded low impedance of bipolar ventricular lead, suggesting a damage in lead insulation. It is likely that lead movements during clockwise neck rotation produced an intermittent short circuit that prevented sufficient energy delivery to the myocardium with a consequence of sudden loss of capture.

  12. Three-dimensional autonomous pacemaker in the photosensitive Belousov-Zhabotinsky medium

    Science.gov (United States)

    Azhand, A.; Totz, J. F.; Engel, H.

    2014-10-01

    In experiments with the photosensitive Belousov-Zhabotinsky reaction (PBZR) we found a stable three-dimensional organizing center that periodically emits trigger waves of chemical concentration. The experiments are performed in a parameter regime with negative line tension using an open gel reactor to maintain stationary non-equilibrium conditions. The observed periodic wave source is formed by a scroll ring stabilized due to its interaction with a no-flux boundary. Sufficiently far from the boundary, the scroll ring expands and undergoes the negative line tension instability before it finally develops into scroll wave turbulence. Our experimental results are reproduced by numerical integration of the modified Oregonator model for the PBZR. Stationary and breathing self-organized pacemakers have been found in these numerical simulations. In the latter case, both the radius of the scroll ring and the distance of its filament plane to the no-flux boundary after some transient undergo undamped stable limit cycle oscillations. So far, contrary to their stationary counterpart, the numerically predicted breathing autonomous pacemaker has not been observed in the chemical experiment.

  13. Reflex vasovagal syncope--is there a benefit in pacemaker therapy?

    Science.gov (United States)

    Sousa, Pedro Alexandre; Candeias, Rui; Marques, Nuno; Jesus, Ilídio

    2014-05-01

    Reflex vasovagal syncope often affects young populations and is associated with a benign prognosis in terms of mortality. However, a minority of patients have recurrent episodes, with a considerable impact on their quality of life. Pacemaker therapy has been an option in these patients since the 1990s if a conservative strategy fails. Initially, non-randomized and open-label randomized trials showed promising results, but these studies were associated with a significant placebo effect. Recently, an approach based on the use of implantable loop recorders has shown that some patients with reflex vasovagal syncope could benefit from implantation with dual-chamber pacemakers, particularly patients aged >40 years, with recurrent syncopal episodes resulting in frequent injuries, in whom a long asystole (≥3 s asystole with syncope or ≥6 s asystole without syncope) has been documented with an implantable loop recorder. The authors present a literature review on the role of cardiac pacing in reflex vasovagal syncope and propose a diagnostic and therapeutic decision flowchart for patients with syncope of probable reflex etiology. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  14. Gate Engineering in SOI LDMOS for Device Reliability

    Directory of Open Access Journals (Sweden)

    Aanand

    2016-01-01

    Full Text Available A linearly graded doping drift region with step gate structure, used for improvement of reduced surface field (RESURF SOI LDMOS transistor performance has been simulated with 0.35µm technology in this paper. The proposed device has one poly gate and double metal gate arranged in a stepped manner, from channel to drift region. The first gate uses n+ poly (near source where as other two gates of aluminium. The first gate with thin gate oxide has good control over the channel charge. The third gate with thick gate oxide at drift region reduce gate to drain capacitance. The arrangement of second and third gates in a stepped manner in drift region spreads the electric field uniformly. Using two dimensional device simulations, the proposed SOI LDMOS is compared with conventional structure and the extended metal structure. We demonstrate that the proposed device exhibits significant enhancement in linearity, breakdown voltage, on-resistance and HCI. Double metal gate reduces the impact ionization area which helps to improve the Hot Carrier Injection effect..

  15. Subclavian Vein Stenosis/Occlusion Following Transvenous Cardiac Pacemaker and Defibrillator Implantation: Incidence, Pathophysiology and Current Management

    Directory of Open Access Journals (Sweden)

    Brian O'Leary

    2015-08-01

    Full Text Available Subclavian vein stenosis is a common, but usually asymptomatic, complication following cardiac device placement. In addition to reviewing the literature on incidence, pathogenesis and management options for this important clinical problem, we describe two cases of symptomatic subclavian vein occlusion following pacemaker/defibrillator placement and successful treatment with venoplasty and stenting.

  16. Video-assisted thoracoscopic implantation of a diaphragmatic pacemaker in a child with tetraplegia: indications, technique, and results.

    Science.gov (United States)

    Filho Pinto, Darcy Ribeiro; Tedde, Miguel Lia; Avino, Alexandre José Gonçalves; Brandão, Suzan Lúcia Brancher; Zanatta, Iuri; Hahn, Rafael

    2015-01-01

    We report the case of a child with tetraplegia after cervical trauma, who subsequently underwent diaphragmatic pacemaker implantation. We reviewed the major indications for diaphragmatic pacing and the types of devices employed. We highlight the unequivocal benefit of diaphragmatic pacing in the social and educational reintegration of individuals with tetraplegia.

  17. Video-assisted thoracoscopic implantation of a diaphragmatic pacemaker in a child with tetraplegia: indications, technique, and results*

    Science.gov (United States)

    Pinto, Darcy Ribeiro; Tedde, Miguel Lia; Avino, Alexandre José Gonçalves; Brandão, Suzan Lúcia Brancher; Zanatta, Iuri; Hahn, Rafael

    2015-01-01

    We report the case of a child with tetraplegia after cervical trauma, who subsequently underwent diaphragmatic pacemaker implantation. We reviewed the major indications for diaphragmatic pacing and the types of devices employed. We highlight the unequivocal benefit of diaphragmatic pacing in the social and educational reintegration of individuals with tetraplegia. PMID:25750678

  18. Video-assisted thoracoscopic implantation of a diaphragmatic pacemaker in a child with tetraplegia: indications, technique, and results

    Directory of Open Access Journals (Sweden)

    Darcy Ribeiro Pinto Filho

    2015-02-01

    Full Text Available We report the case of a child with tetraplegia after cervical trauma, who subsequently underwent diaphragmatic pacemaker implantation. We reviewed the major indications for diaphragmatic pacing and the types of devices employed. We highlight the unequivocal benefit of diaphragmatic pacing in the social and educational reintegration of individuals with tetraplegia.

  19. Automaticity: design of a registry to assess long-term acceptance and clinical impact of Automatic Algorithms in Insignia pacemakers.

    Science.gov (United States)

    Alings, Marco; Vorstenbosch, Jan-Mark; Reeve, Helen

    2009-03-01

    Worldwide, the number of implants of pacemakers is steadily increasing and this poses an incremental burden on outpatient clinics. While device manufacturers have developed safe and effective automatic algorithms to lighten this workload, the clinical utilization of these algorithms has not been well studied. The Automaticity study is the first large-scale, worldwide registry to evaluate physician's acceptance of automatic algorithms for ventricular capture, automatic sensing, and automatic optimization of sensor settings. The primary objective of the registry is to determine the percentage of patients who have any of the 'Automaticity Algorithms' reprogrammed within 12 months of pacemaker implant. Patients will be implanted with a commercially available pacemaker (Insignia I/Nexus I Ultra or Insignia I/Nexus I AVT, Boston Scientific CRM, St Paul, MN, USA). At discharge, all the 'Automaticity Algorithms' are to be programmed to 'Auto/On'. Data collection on changes in device programming, physician's perception of algorithm function, and adverse events will occur for 12 months following device implant. The Automaticity study is the first large-scale, prospective, multi-site, international registry designed to assess the long-term acceptance of automatic pacemaker algorithms for adjustment of the ventricular output, atrial and ventricular sensitivity, and optimization of minute ventilation and accelerometer settings.

  20. Biochemical and biomechanical properties of the pacemaking sinoatrial node extracellular matrix are distinct from contractile left ventricular matrix.

    Directory of Open Access Journals (Sweden)

    Jessica M Gluck

    Full Text Available Extracellular matrix plays a role in differentiation and phenotype development of its resident cells. Although cardiac extracellular matrix from the contractile tissues has been studied and utilized in tissue engineering, extracellular matrix properties of the pacemaking sinoatrial node are largely unknown. In this study, the biomechanical properties and biochemical composition and distribution of extracellular matrix in the sinoatrial node were investigated relative to the left ventricle. Extracellular matrix of the sinoatrial node was found to be overall stiffer than that of the left ventricle and highly heterogeneous with interstitial regions composed of predominantly fibrillar collagens and rich in elastin. The extracellular matrix protein distribution suggests that resident pacemaking cardiomyocytes are enclosed in fibrillar collagens that can withstand greater tensile strength while the surrounding elastin-rich regions may undergo deformation to reduce the mechanical strain in these cells. Moreover, basement membrane-associated adhesion proteins that are ligands for integrins were of low abundance in the sinoatrial node, which may decrease force transduction in the pacemaking cardiomyocytes. In contrast to extracellular matrix of the left ventricle, extracellular matrix of the sinoatrial node may reduce mechanical strain and force transduction in pacemaking cardiomyocytes. These findings provide the criteria for a suitable matrix scaffold for engineering biopacemakers.

  1. [Complete atrio-ventricular block as a first symptom of borreliosis: antibiotic treatment instead of pacemaker implantation].

    Science.gov (United States)

    Kaczmarek, Krzysztof; Deroń, Zbigniew; Janiszewski, Tomasz; Supeł, Karolina; Ptaszyński, Paweł; Ruta, Jan; Cygankiewicz, Iwona

    2013-01-01

    We present a 46-year-old male patient with complete atrio-ventricular block. A inflammatory etiology was suspected and finally lyme carditis was diagnosed. The conduction abnormalities disappeared with antibiotic treatment and a pacemaker implantation was not needed. Further follow-up of two years was uneventful.

  2. Normal D-dimer ved dyb venøs trombose i en overekstremitet hos to patienter med pacemaker

    DEFF Research Database (Denmark)

    Byrne, Christina; Abdulla, Jawdat; Christensen, Jan Kim

    2015-01-01

    Danish guidelines recommend the use of D-dimer to exclude deep venous thrombosis (DVT) in the lower extremities. However, guidelines are lacking for DVT in the upper extremities. We describe two young women with transvenous pacemaker electrodes and symptomatic DVT in related veins. Despite a normal...

  3. Under-utilization of pacemaker therapy for sinus node dysfunction – Real world data from South Asia

    Directory of Open Access Journals (Sweden)

    C. Narasimhan

    2017-09-01

    Conclusions: In a care pathway assessment for the diagnosis and treatment of symptomatic SND in South Asia only 1 in 6 patients received pacemaker indicated therapy, largely due to patient refusal and physician decision. Phase II of the study will be aimed to improve this treatment rate.

  4. Spanish Pacemaker Registry. Twelfth Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2014).

    Science.gov (United States)

    Cano Pérez, Óscar; Pombo Jiménez, Marta; Coma Samartín, Raúl

    2015-12-01

    This report describes the results of the analysis of pacemaker implant and replacement data submitted to the Spanish Pacemaker Registry in 2014, with special reference to pacing mode selection. The report is based on the processing of information provided by the European Pacemaker Patient Identification Card. Information was received from 117 hospitals, with a total of 12 358 cards, representing 34% of estimated activity. Use of conventional generators and resynchronization devices was 784 and 64.4 units per million population, respectively. The mean age of patients receiving an implant was 77.3 years. Men received 59% of implants and 56.4% of replacements. Most patients receiving generator implants and replacements were in the age range 80 to 89 years. Most endocardial leads used were bipolar, and 84.2% had an active fixation system. Pacing was in VVI/R mode despite being in sinus rhythm in 24.7% of patients with sick sinus syndrome and 24% of those with atrioventricular block. The use of pacemaker generators and resynchronization devices per million population continued to increase. Most implanted leads had active fixation and approximately 20% had magnetic resonance imaging protection. Age and sex directly influenced pacing mode selection, which could have been improved in more than 20% of cases. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  5. Campylobacter fetus infection presenting with bacteremia and cellulitis in a 72-year-old man with an implanted pacemaker: a case report

    Directory of Open Access Journals (Sweden)

    Ledina Dragan

    2012-11-01

    Full Text Available Abstract Introduction Campylobacter is an important causative agent of intestinal infections in humans. Bacteremia is detected in less than 1% of patients, mainly in immunocompromised patients and in extreme age groups. Cellulitis is a relatively common manifestation of Campylobacter infection, but concomitant bacteremia is a rare event. Infections of the pacemaker area are caused primarily by staphylococci, followed by fungi, streptococci and Gram-negative rods. To the best of our knowledge, this is the first case report of pacemaker pocket infection and bacteremia caused by Campylobacter fetus. Case presentation A 72-year-old Croatian Caucasian man with myelodysplasia, impaired fasting glucose levels and a recently implanted permanent pacemaker was admitted to hospital after six days of fever, development of red swelling of the pacemaker pocket area and worsening of his general condition. No antibiotic therapy was introduced in the outpatient setting. He denied any recent gastrointestinal disturbances. With the exception of an elevated leukocyte count, erythrocyte sedimentation rate, and C-reactive protein and blood glucose levels, other laboratory findings were normal. Treatment with vancomycin plus netilmicin was introduced, and a surgical incision with drainage of the pacemaker pocket was performed. The entire pacemaker system was removed and a new one re-implanted after 14 days of antibiotic therapy. Transesophageal echocardiography showed no pathological findings. Three subsequent blood cultures obtained on admission as well as swab culture of the incised pacemaker area revealed Campylobacter fetus; stool and pacemaker lead cultures were negative. According to the microbiological results, antibiotic therapy was changed to ciprofloxacin plus netilmicin. A clinical examination and the results of a laboratory analysis performed after two weeks of therapy were within normal limits. Conclusion Myelodysplasia, impaired fasting glucose levels

  6. Conceptual design of GaN betavoltaic battery using in cardiac pacemaker

    International Nuclear Information System (INIS)

    Mohamadian, M.; Feghhi, S.A. H.; Afarideh, H.

    2007-01-01

    Introduction: Pacemaker is an electronic biomedical device which stimulates and regulates or amplify the human heartbeat by delivering weak electrical pulses to the cardiac muscle at regular intervals when its natural regulating mechanisms break down. Developments in design and implementation of power source in adjacent to advances in electronic circuitry is an important aspect in optimization of pacemakers. For instance, many implant patients continue to outlive their batteries and require costly and risky replacement surgery. So such device needs to have high energy density power source and maintain a stable current and voltage for a long period of time to avoid frequent replacements. In addition, the size is also an important consideration for implantable batteries. Betavoltaic batteries are being researched as a suitable source for these applications. Also, these batteries have vast application in which the replacement of batteries is highly inconvenient, such as in oil and mining industries, which often place sensors in dangerous or hard-to-reach locations. The purpose of the present investigation is determination of the optimal parameters of low energy GaN betavoltaic battery in artificial cardiac pacemakers using MCNP code which have higher efficiency than those available with previous devices, especially thermoelectric converters (∼15%). Material and Methods: In this design, two p-n diode structures from GaN semiconductor were used to collect the charge from a layer of 6 3Ni as a source which is centered between the two p-n junctions. MCNP simulation results have been used to determine the amount of electron current from interaction of beta particles in p-n junctions. Results and Discussion: Calculation results indicate that the short circuit current, open circuit voltage and efficiency of a single device are 1.1 μA/cm 2 , 2.7 volt and 25%, respectively. Also, it's concluded that with suitable arrangement of these single devices, one could construct a

  7. FUNCTIONAL CLASS OF CHRONIC HEART FAILURE AND CLINICAL FEATURES OF PATIENTS WITH PERMANENT PACEMAKERS

    Directory of Open Access Journals (Sweden)

    I. M. Kolomytseva

    2014-06-01

    Full Text Available The study included 162 patients (89 men and 73 women aged 69 ± 10 years who underwent permanent pacing about atrio-ventricular block, permanent atrial fibrillation and sick sinus node syndrome with pacing modes DDD/DDDR and VVI/VVIR as well as chronic heart failure (CHF with cardiac resynchronization therapy (CRT-P and CRT-D. Clinical features of patients were evaluated according to the functional class (FC CHF. Patients with pacemakers the most frequent had II and III CHF FC which more often associated with myocardial infarction, stable angina, diabetes mellitus, atrial fibrillation, stage IIA and IIB CHF. It is concluded that patients with ECS require optimization of medical interventions.

  8. Why We Have to Use Cardiac Resynchronization Therapy-Pacemaker More.

    Science.gov (United States)

    Daubert, Jean-Claude; Martins, Raphaël; Leclercq, Christophe

    2015-12-01

    Both cardiac resynchronization therapy with a pacemaker (CRT-P) and with a biventricular implantable cardioverter-defibrillator (CRT-D) are electrical treatment modalities validated for the management of chronic heart failure. There is no strong scientific evidence that a CRT-D must be offered to all candidates. Common sense should limit the prescription of these costly and complicated devices. The choice of CRT-P is currently acceptable. A direction to explore could be to downgrade from CRT-D to CRT-P at the time of battery depletion in patients with large reverse remodeling and no ventricular tachycardia and ventricular fibrillation detected. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Reevaluation of the indications for permanent pacemaker implantation after transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Bjerre Thygesen, Julie; Loh, Poay Huan; Cholteesupachai, Jiranut

    2014-01-01

    AIMS: Conduction abnormalities (CA) requiring permanent pacemaker (PPM) are a well-known complication after transcatheter aortic valve implantation (TAVI). This study aimed to determine the incidence of TAVI-related PPM and reevaluate the indications for PPM after the periprocedural period. METHODS...... AND RESULTS: A total of 258 consecutive patients underwent TAVI with the Medtronic CoreValve (MCV), whereas 24 patients were excluded from the study. TAVI-related PPM was defined as PPM implantation ≤30 days after the procedure and due to atrioventricular block (AVB). Third-degree AVB, second-degree type......-II, or advanced second-degree AVB were considered as absolute indications for PPM. The incidence of TAVI-related PPM implantation was 27.4%. Forty-six patients (19.7%) had an absolute indication for PPM, but CA had resolved in 50% beyond the periprocedural period. Electrocardiographic analysis of the patients who...

  10. Echocardiography in patients with complications related to pacemakers and cardiac defibrillators.

    Science.gov (United States)

    Almomani, Ahmed; Siddiqui, Khadija; Ahmad, Masood

    2014-03-01

    The evolving indications and uses for implantable cardiac devices have led to a significant increase in the number of implanted devices each year. Implantation of endocardial leads for permanent pacemakers and cardiac defibrillators can cause many delayed complications. Complications may be mechanical and related to the interaction of the device leads with the valves and endomyocardium, e.g., perforation, infection, and thrombosis, or due to the electrical pacing of the myocardium and conduction abnormalities, e.g., left ventricular dyssynchrony. Tricuspid regurgitation, another delayed complication in these patients, may be secondary to both mechanical and pacing effects of the device leads. Echocardiography plays an important role in the diagnosis of these device-related complications. Both two-dimensional transthoracic echocardiography and transesophageal echocardiography provide useful diagnostic information. Real time three-dimensional echocardiography is a novel technique that can further enhance the detection of lead-related complications. © 2013, Wiley Periodicals, Inc.

  11. Stability, precision, and near-24-hour period of the human circadian pacemaker

    Science.gov (United States)

    Czeisler, C. A.; Duffy, J. F.; Shanahan, T. L.; Brown, E. N.; Mitchell, J. F.; Rimmer, D. W.; Ronda, J. M.; Silva, E. J.; Allan, J. S.; Emens, J. S.; hide

    1999-01-01

    Regulation of circadian period in humans was thought to differ from that of other species, with the period of the activity rhythm reported to range from 13 to 65 hours (median 25.2 hours) and the period of the body temperature rhythm reported to average 25 hours in adulthood, and to shorten with age. However, those observations were based on studies of humans exposed to light levels sufficient to confound circadian period estimation. Precise estimation of the periods of the endogenous circadian rhythms of melatonin, core body temperature, and cortisol in healthy young and older individuals living in carefully controlled lighting conditions has now revealed that the intrinsic period of the human circadian pacemaker averages 24.18 hours in both age groups, with a tight distribution consistent with other species. These findings have important implications for understanding the pathophysiology of disrupted sleep in older people.

  12. Shortest loops are pacemakers in random networks of electrically coupled axons

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    Nikita eVladimirov

    2012-04-01

    Full Text Available High-frequency oscillations (HFOs are an important part of brain activity in health and disease. However, their origins remain obscure and controversial. One possible mechanism depends on the presence of sparsely distributed gap junctions that electrically couple the axons of principal cells. A plexus of electrically coupled axons is modeled as a random network with bidirectional connections between its nodes. Under certain conditions the network can demonstrate one of two types of oscillatory activity. Type I oscillations (100-200 Hz are predicted to be caused by spontaneously spiking axons in a network with strong (high-conductance gap junctions. Type II oscillations (200-300 Hz require no spontaneous spiking and relatively weak (low-conductance gap junctions, across which spike propagation failures occur. The type II oscillations are reentrant and self-sustained. Here we examine what determines the frequency of type II oscillations. Using simulations we show that the distribution of loop lengths is the key factor for determining frequency in type II network oscillations. We first analyze spike failure between two electrically coupled cells using a model of anatomically reconstructed CA1 pyramidal neuron. Then network oscillations are studied by a cellular automaton model with random network connectivity, in which we control loop statistics. We show that oscillation periods can be predicted from the network's loop statistics. The shortest loop, around which a spike can travel, is the most likely pacemaker candidate.The principle of one loop as a pacemaker is remarkable, because random networks contain a large number of loops juxtaposed and superimposed, and their number rapidly grows with network size. This principle allows us to predict the frequency of oscillations from network connectivity and visa versa. We finally propose that type I oscillations may correspond to ripples, while type II oscillations correspond to so-called fast ripples.

  13. Magnetic resonance imaging in patients with cardiac pacemakers: era of "MR Conditional" designs

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    Shellock Frank G

    2011-10-01

    Full Text Available Abstract Advances in cardiac device technology have led to the first generation of magnetic resonance imaging (MRI conditional devices, providing more diagnostic imaging options for patients with these devices, but also new controversies. Prior studies of pacemakers in patients undergoing MRI procedures have provided groundwork for design improvements. Factors related to magnetic field interactions and transfer of electromagnetic energy led to specific design changes. Ferromagnetic content was minimized. Reed switches were modified. Leads were redesigned to reduce induced currents/heating. Circuitry filters and shielding were implemented to impede or limit the transfer of certain unwanted electromagnetic effects. Prospective multicenter clinical trials to assess the safety and efficacy of the first generation of MR conditional cardiac pacemakers demonstrated no significant alterations in pacing parameters compared to controls. There were no reported complications through the one month visit including no arrhythmias, electrical reset, inhibition of generator output, or adverse sensations. The safe implementation of these new technologies requires an understanding of the well-defined patient and MR system conditions. Although scanning a patient with an MR conditional device following the strictly defined patient and MR system conditions appears straightforward, issues related to patients with pre-existing devices remain complex. Until MR conditional devices are the routine platform for all of these devices, there will still be challenging decisions regarding imaging patients with pre-existing devices where MRI is required to diagnose and manage a potentially life threatening or serious scenario. A range of other devices including ICDs, biventricular devices, and implantable physiologic monitors as well as guidance of medical procedures using MRI technology will require further biomedical device design changes and testing. The development and

  14. A novel curve fitting method for AV optimisation of biventricular pacemakers.

    Science.gov (United States)

    Dehbi, Hakim-Moulay; Jones, Siana; Sohaib, S M Afzal; Finegold, Judith A; Siggers, Jennifer H; Stegemann, Berthold; Whinnett, Zachary I; Francis, Darrel P

    2015-09-01

    In this study, we designed and tested a new algorithm, which we call the 'restricted parabola', to identify the optimum atrioventricular (AV) delay in patients with biventricular pacemakers. This algorithm automatically restricts the hemodynamic data used for curve fitting to the parabolic zone in order to avoid inadvertently selecting an AV optimum that is too long.We used R, a programming language and software environment for statistical computing, to create an algorithm which applies multiple different cut-offs to partition curve fitting of a dataset into a parabolic and a plateau region and then selects the best cut-off using a least squares method. In 82 patients, AV delay was adjusted and beat-to-beat systolic blood pressure (SBP) was measured non-invasively using our multiple-repetition protocol. The novel algorithm was compared to fitting a parabola across the whole dataset to identify how many patients had a plateau region, and whether a higher hemodynamic response was achieved with one method.In 9/82 patients, the restricted parabola algorithm detected that the pattern was not parabolic at longer AV delays. For these patients, the optimal AV delay predicted by the restricted parabola algorithm increased SBP by 1.36 mmHg above that predicted by the conventional parabolic algorithm (95% confidence interval: 0.65 to 2.07 mmHg, p-value = 0.002).AV optima selected using our novel restricted parabola algorithm give a greater improvement in acute hemodynamics than fitting a parabola across all tested AV delays. Such an algorithm may assist the development of automated methods for biventricular pacemaker optimisation.

  15. One-Year Follow-Up of Patients Undergoing Transvenous Extraction of Pacemaker and Defibrillator Leads.

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    Maciej Kempa

    Full Text Available The number of pacemaker and ICD implantations has increased substantially in the recent years. Therefore, complications are also observed in a greater number. In many cases, transvenous extraction of the previously implanted device (pacemaker or ICD is the only solution. One may find in the literature information about the efficacy and safety of that procedure, but data concerning the results of long-term follow up are still limited.The aim of the study was to assess the one-year mortality in the cohort of patients undergoing transvenous lead extraction procedures in our centre.Records of the patients undergoing transvenous lead removal in the Department of Cardiology and Electrotherapy of the Medical University of Gdańsk were analyzed. We collected detailed information about 192 patients that had undergone the procedure from January 2003 until June 2012. Data were collected from medical and surgical records. We analyzed concomitant diseases, indications, and possible complications. Long-term follow-up data were gathered in the follow-up ambulatory records and over-the-phone interviews with patients or families. In several cases, we consulted the database of the Polish National Health Fund.During the early post-operative period 5 patients died, although none of those deaths was associated with the procedure itself. No other major complications were observed. During one-year follow-up other 5 patients died, which gave the overall one-year survival rate of 92.7%. Heart failure, renal failure and an infective indication showed significant association with increased mortality.Results of transvenous lead extraction, a relatively safe procedure, should be assessed over time extending beyond the sole perioperative period. Some complications may be delayed in their nature, and may be observed only during the long-term follow up.

  16. CaV3.1 is a tremor rhythm pacemaker in the inferior olive

    Science.gov (United States)

    Park, Young-Gyun; Park, Hye-Yeon; Lee, C. Justin; Choi, Soonwook; Jo, Seonmi; Choi, Hansol; Kim, Yang-Hann; Shin, Hee-Sup; Llinas, Rodolfo R.; Kim, Daesoo

    2010-01-01

    The rhythmic motor pathway activation by pacemaker neurons or circuits in the brain has been proposed as the mechanism for the timing of motor coordination, and the abnormal potentiation of this mechanism may lead to a pathological tremor. Here, we show that the potentiation of CaV3.1 T-type Ca2+ channels in the inferior olive contributes to the onset of the tremor in a pharmacological model of essential tremor. After administration of harmaline, 4- to 10-Hz synchronous neuronal activities arose from the IO and then propagated to cerebellar motor circuits in wild-type mice, but those rhythmic activities were absent in mice lacking CaV3.1 gene. Intracellular recordings in brain-stem slices revealed that the CaV3.1-deficient inferior olive neurons lacked the subthreshold oscillation of membrane potentials and failed to trigger 4- to 10-Hz rhythmic burst discharges in the presence of harmaline. In addition, the selective knockdown of CaV3.1 gene in the inferior olive by shRNA efficiently suppressed the harmaline-induced tremor in wild-type mice. A mathematical model constructed based on data obtained from patch-clamping experiments indicated that harmaline could efficiently potentiate CaV3.1 channels by changing voltage-dependent responsiveness in the hyperpolarizing direction. Thus, CaV3.1 is a molecular pacemaker substrate for intrinsic neuronal oscillations of inferior olive neurons, and the potentiation of this mechanism can be considered as a pathological cause of essential tremor. PMID:20498062

  17. Safety and effectiveness of a 6-French MRI conditional pacemaker lead: The INGEVITYTMclinical investigation study results.

    Science.gov (United States)

    Nielsen, Jens C; Giudici, Michael; Tolasana Viu, Jose Maria; Chew, Engwooi; Sommerijns, Elke; Wold, Nicholas; Evert, Linda; Love, Charles J; Stein, Kenneth; Olaf, Hedrich

    2017-10-01

    The design of pacemaker leads has continued to evolve; ease of lead handling, improved electrical performance, and magnetic resonance imaging (MRI) conditional aspects have become more important, while safety remains critical. The INGEVITY™ family leads was designed to provide MRI conditional aspects, decreased diameter, and improved performance of pacemaker leads. The INGEVITY study is an investigational device exemption trial evaluating the acute and chronic safety and effectiveness of these leads. Consecutive patients were included in 77 institutions worldwide, where 1,657 leads (846 right ventricular active fixation leads, 213 right ventricular passive fixation leads, 121 right atrial passive fixation preformed J-leads, and 477 right atrial active fixation leads) were implanted or attempted in 1,060 subjects. At 3-month follow-up, the electrical performance were: mean pacing threshold 0.67 V at 0.5-ms pulse width, pacing impedance 773 ohms, mean P-wave amplitude 4.8 mV, and R-wave amplitude 16.5 ± 6.5 mV. Over a median follow-up of 31 months, 93 subjects died and 33 subjects reported lead-related complications. Lead-related complication-free rate from 0 to 3 months and 3 to 12 months for all leads was 98.4% and 99.7%, respectively. The hazard of lead-related complications was observed to be decelerating over the course of follow-up (Weibull shape = 0.23). The overall lead dislodgment rate observed in the study was 1.3%, the perforation rate was 0.0%, and the pericardial effusion rate was 0.3%. The clinical performance of the INGEVITY lead demonstrated a high lead-related complication-free rate over 12 months of follow-up and excellent electrical characteristics. © 2017 Wiley Periodicals, Inc.

  18. Unravelling the (arte)fact of increased pacemaker rate with the Edwards SAPIEN 3 valve.

    Science.gov (United States)

    Tarantini, Giuseppe; Mojoli, Marco; Purita, Paola; Napodano, Massimo; D'Onofrio, Augusto; Frigo, Annachiara; Covolo, Elisa; Facchin, Michela; Isabella, Giambattista; Gerosa, Gino; Iliceto, Sabino

    2015-07-01

    Early data on the Edwards SAPIEN 3 valve (S3-THV) have shown low rates of paravalvular leaks and vascular complications but relatively high 30-day permanent pacemaker implantation (PPMI) rates. No direct comparisons on clinical outcomes including PPMI rates are available for the S3-THV and the Edwards SAPIEN XT (XT-THV). We aimed to compare the 30-day PPMI rates in patients treated with the two prostheses and to assess the interplay among valve type, depth of implantation and PPMI rate. Two hundred and nine patients treated by TAVI were considered. The S3-THV was associated with higher PPMI rates compared to the XT-THV, both overall and in subgroups matched for several predictors of PPMI. However, in the S3-THV group, 30-day PPMI was strictly associated with deep valve implantation, and PPMI risk of high-implanted S3-THVs was similar to that of the overall XT-THV matched group. No cases of significant paravalvular leak were observed in the S3-THV group. The S3-THV was associated with a higher incidence of PPMI compared to the XT-THV. In the S3-THV group, pacemaker implantation was strictly associated with deep valve implantation. An implantation technique involving higher initial placement of the central marker (from 0 to 3 mm above the base of the aortic cusps) and, as a consequence, higher final valve depth might help in preventing post-TAVI PPMI with the S3-THV, without affecting the risk of paravalvular leak.

  19. Anticoagulation management in patients with mechanical heart valves having pacemaker or defibrillator insertion.

    Science.gov (United States)

    Schulman, S; Schoenberg, J; Divakara Menon, S; Spyropoulos, A C; Healey, J S; Eikelboom, J W

    2013-04-01

    In patients with a high risk for stroke and having invasive procedures with a high risk for bleeding it is unclear how anticoagulant therapy should be managed. We reviewed data from all patients with mechanical heart valves, who had elective insertion or replacement of pacemaker or implantable cardioverter defibrillator (ICD) during the past 8years at our hospital. Data on anticoagulant treatment, pocket hematoma and thromboembolic complications were captured. Of the 111 patients reviewed, 68 (61%) had a mechanical valve in the mitral position with or without other valves replaced and 43 (39%) had a mechanical valve only in the aortic position. Fifty-nine (53%) were undergoing replacement for their device. Six patients received a tapered warfarin regimen and 102 received preoperative bridging anticoagulation of whom 12 also received postoperative bridging. One stroke occurred 40days after pacemaker replacement in a patient with mitral mechanical valve and without postoperative bridging. Six patients (5.5%) developed pocket hematoma without a significant association to postoperative bridging, type of mechanical valve or to type of device. Predictors for pocket hematoma appeared to be replacement surgery (odds ratio 12.5; 95% confidence interval [CI], 0.69-228) and an international normalized ratio of 1.5 or higher on the day of surgery (odds ratio 8.4; 95% CI, 0.96-68.1). We found a low risk for stroke in the absence of postoperative bridging. For patients with device replacement surgery reversal of the anticoagulant effect at the time of procedure might reduce the risk for pocket hematoma, but this requires prospective evaluation including the risk of thromboembolism. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. A pacemaker magnet check alone is sufficient for the majority of patients postpacemaker implant.

    Science.gov (United States)

    Jones, Michael A; Wong, Kelvin C K; Qureshi, Norman; Rajappan, Kim; Bashir, Yaver; Betts, Timothy R

    2014-12-01

    Patients postpacemaker implant can undergo a full assessment by pacing system programmer (PSP) or a magnet check. The former takes longer, but provides more detailed information; a magnet-mode assessment is faster, but provides only capture data in an asynchronous pacing mode. A magnet-mode assessment alone may be sufficient in most cases, and current clinical practice varies considerably. A retrospective single-center assessment of all pacemaker implants receiving PSP and magnet checks between September 2009 and April 2010. Patient records were reviewed. The results of PSP and magnet checks and any subsequent device-related management were noted. A total of 168 patients underwent pacemaker implantation, magnet-mode assessment, and then PSP interrogation during this period. Magnet-mode assessment revealed a problem in only one patient-failure of atrial capture, leading to subsequent atrial lead repositioning. None of the remaining 167 patients have a serious problem at PSP interrogation; six had minor issues at PSP check, none of which required repeat surgical intervention. The magnet-mode test only provides information on lead capture in an asynchronous pacing mode, which is the most essential data postoperatively. Our study has suggested that a magnet-mode assessment without PSP interrogation may be sufficient in the immediate postimplant assessment of these patients. Routine postimplant PSP interrogation is time consuming, labor intensive, and adds only minimal additional benefit to the safe management of these patients above and beyond a magnet check, coupled with informed assessment of the associated electrocardiogram/rhythm strip, clinical examination, and chest x-ray. ©2014 Wiley Periodicals, Inc.