The back-up lead in his bundle pacing: evolution over the years

Background His bundle pacing (HBP) can be affected by high thresholds and low sensing. Thus, in selected patients including a back-up lead is advisable. Objective Single-centre retrospective analysis of a large HBP experience, focusing on the back-up lead utilization over the years. Methods 677 pts (76±8 years; 433 males) were implanted with HBP from 2004 to 2019 July. The pts received S-HBP (67%) or NS-HBP by the 3830 lead. The pacing indications were AV block 54%, sinus node disease 17%, slow atrial fibrillation 23%, heart failure 6%. Ischemic cardiopathy was found in 26%; hypertension in 83%, diabetes in28% pts. Baseline QRS duration was 123±32 ms and EF 56±12%. Results 266 (39%) pts received the back-up lead. In sinus rhythm we implanted 3-chamber PM (His lead:LV port; VV delay 80 ms: His pulses and apical pacing during the refractory period). 30 pts (11%) received a particular type of 3-chamber PM which provides back-up pacing only if His capture fails, thus saving energy. In atrial fibrillation 2-chamber PM was implanted (His lead: atrial port, DVI). We recorded a significant decrease of back-up lead use over the years, strictly related to operators/centre experience (>70% during the first years, nearly 10% during the last year). The C315 fixed curve sheath, strongly contributed to the rapid reduction of back-up lead use thanks to better lead fixation and stability. Conclusion The back-up lead utilization is progressively decreasing. It is strictly related to the operator/centre experience. The presence of the back-up lead could strengthen the Hisian pacing reliability, potentially impacting pacing indication even in advanced conduction disturbances and saving device longevity. Funding Acknowledgement Type of funding source: None

Reprocessing of electrophysiology material in EHRA countries: an EHRA Young EP survey

Data on reprocessing of electrophysiology (EP) materials are sparse. Reprocessing of catheters and other materials in daily routine varies through countries and may depend on specific material characteristics, supplier, or federal law. The aim of this study was to collect data on reprocessing usage through EHRA countries. An online survey consisting of 27 questions was distributed to EHRA Young EP members and members of national EP working groups. Two hundred and two participants from 34 EHRA countries completed the survey. One hundred and seven respondents (53.0%) reported having used and using reprocessed EP material, 30 (14.9%) respondents have used reprocessed EP material in the past but not at the time of the survey, 65 (32.2%) had never used reprocessed EP material. The most reprocessed EP materials include cables (70%), diagnostic EP catheters with deflectable (64%) or fixed curve (63%), non-irrigated ablation catheters (51%), and other conventional diagnostic catheters (41%). The most durable material was diagnostic EP catheters with a fixed curve (61%), the most sensitive material was ablation catheters with contact force sensors (21%). Important benefits were seen in reducing costs for the providing hospital (65%) and the healthcare provider (42%) and making EP procedures available for a greater number of patients (42%). Main concerns were on quality aspects (58%), contamination (52%), and loss of precision (47%). Reprocessing of EP materials is heterogeneously managed among EHRA countries. The present survey shows that European electrophysiologists consider the use of reprocessed EP material as generally safe and cost-effective.

1324Reprocessing of electrophysiology catheters in EHRA countries. An EHRA Young EP survey

Introduction Reprocessing of electrophysiology (EP) catheters in daily routine varies through countries and may depend on national laws, catheter (cath.) models or supplier. Data on reprocessing of EP materials is sparse and remains a matter of controversy. The aim of this study is to collect data on reprocessing usage through EHRA countries. Methods and results A structured online questionnaire comprising 27 questions was distributed among electrophysiologists in EHRA countries. Two-hundred-and-two participants from 34 countries completed the survey (161 males, 36.8 ± 5.8 years old). Overall, 111 (55%) of respondents currently use reprocessed materials and 30 (15%) have used them in the past. Cables, diagnostic cath. with deflectable curve and diagnostic cath. with fixed curve were the most frequently reprocessed materials (87%, 80% and 78% respondents, respectively). Maximum number of times (median) a cath. was usually reprocessed was 6 for diagnostic cath. and 5 for ablation cath. Among potential benefits of reprocessing, cost reduction for the providing hospital (65%), cost reduction for the health provider (42%) and making EP procedure available for more patients (42%) were most frequently reported. Respondents reported a need to change the reprocessed material due to its insufficient functionality in around 15% of cases. They were also concerned about the quality of the reprocessed material (58%), contamination issues (52%) and loss of precision (47%). Nineteen (17%) users of reprocessed EP material reported at least one complication potentially related to the reprocessing during their whole reprocessing experience. Sixty-six (73%) respondents who did not use reprocessed EP material would consider using it in the future. Conclusions Reprocessing of EP material is heterogeneously managed among the EHRA countries, as wide differences are present in terms of national and local regulations, clinical practice and technical aspects. Nonetheless, the current data show that European electrophysiologists consider the use of reprocessed EP material as generally safe and cost-effective.

Full reconstruction of a vector field from restricted Doppler and first integral moment transforms in ℝn

We show that a vector field in {\mathbb{R}^{n}} can be reconstructed uniquely from the knowledge of restricted Doppler and first integral moment transforms. The line complex we consider consists of all lines passing through a fixed curve {\gamma\subset\mathbb{R}^{n}}. The question of reconstruction of a symmetric m-tensor field from the knowledge of the first {m+1} integral moments was posed by Sharafutdinov [Integral Geometry of Tensor Fields, Inverse Ill-posed Probl. Ser. 1, De Gruyter, Berlin, 1994, p. 78]. In this work, we provide an answer to Sharafutdinov’s question for the case of vector fields from restricted data comprising of the first two integral moment transforms.

Robustness of the controllability for the strongly damped wave equation under the influence of impulses, delays and nonlocal conditions

This work proves the following conjecture: impulses, delays, and nonlocal conditions, under some assumptions, do not destroy some posed system qualitative properties since they are themselves intrinsic to it. we verified that the property of controllability is robust under this type of disturbances for the strongly damped wave equation. Specifically, we prove that the interior approximate controllability of linear strongly damped wave equation is not destroyed if we add impulses, nonlocal conditions and a nonlinear perturbation with delay in state. This is done by using new techniques avoiding fixed point theorems employed by A.E. Bashirov et al. In this case the delay help us to prove the approximate controllability of this system by pulling back the control solution to a fixed curve in a short time interval, and from this position, we are able to reach a neighborhood of the final state in time t by using that the corresponding linear strongly damped wave equation is approximately controllable on any interval {t0,T}, 0 < t0 < T.

MODELOS DE REGRESSÃO ALEATÓRIA ATRAVÉS DO PESO CORPORAL EM CURVAS DE CRESCIMENTO DE AVES

In modern genetic evaluations, random regression models have been used as a custom tool in order to analyze longitudinal traits such as the ones involved in animal growth. Such traits as body weight have an easy mensuration and an excellent response to selection, which is a suitable and important feature for animal breeding programs. The purpose of this review is to discuss about different random regression models that are involved in farm bird growth. The random regression models are recommended as an alternative to genetic evaluation of traits that are regularly measured during the animal life. These models allow the prediction of regression coefficients that represent the behavior of the additive genetic value for each animal in the specific evaluated trait in relation to time (age). Thus, interminable values for the independent variable are considered 340 Colloquium Agrariae, vol. 13, n. Especial, Jan–Jun, 2017, p. 321-347 ISSN: 1809-8215. DOI: 10.5747/ca.2017.v13.nesp.000238 within a defined interval, through deviations of each animal in relation to an estimated and fixed curve. The covariance component estimates assigned to random regression coefficients allow the covariance estimation between any values of the independent variable for a modeled random effect, which is accomplished by the covariance function. Therefore, random regression models improve the use of the weight information, when covariance structures between the studied ages are taken into account during the evaluation. They also allow the description of the estimated variance components that are involved in growth, besides granting presumptions for others in the curve inside the interval estimation.

Interatrial Septum Motion but Not Doppler Assessment Predicts Elevated Pulmonary Capillary Wedge Pressure in Patients Undergoing Cardiac Surgery

Background: Left atrial pressure and its surrogate, pulmonary capillary wedge pressure (PCWP), are important for determining diastolic function. The role of transthoracic echocardiography (TTE) in assessing diastolic function is well established in awake subjects. The objective was to assess the accuracy of predicting PCWP by TTE and transesophageal echocardiography (TEE) during coronary artery surgery. Methods: In 27 adult patients undergoing on-pump coronary artery surgery, simultaneous echocardiographic and hemodynamic measurements were obtained immediately before anesthesia (TTE), after anesthesia and mechanical ventilation (TTE and TEE), during conduit harvest (TEE), and after separation from cardiopulmonary bypass (TEE). Results: Twenty patients had an ejection fraction (EF) of 0.5 or greater. With the exception of E/e′ and S/D ratios, echocardiographic values changed over the echocardiographic studies. In patients with low EF, E velocity, deceleration time, pulmonary vein D, S/D, and E/e′ ratios correlated well with PCWP before anesthesia. After induction of anesthesia using TTE or TEE, correlations were poor. In normal EF patients, correlations were poor for both TEE and TTE at all five stages. The sensitivity and specificity of echocardiographic values were not high enough to predict raised PCWP except for a fixed curve pattern of interatrial septum (area under the curve 0.89 for PCWP ≥17, and 0.98 for ≥18 mmHg) and S/D less than 1 (area under the curve 0.74 for PCWP ≥17, and 0.78 for ≥18 mmHg). Conclusion: Doppler assessment of PCWP was neither sensitive nor specific enough to be clinically useful in anesthetized patients with mechanical ventilation. The fixed curve pattern of the interatrial septum was the best predictor of raised PCWP.