The power of three: Atrial rate limit power-on-reset - A non-electromagnetic cause of pacemaker-induced extracardiac stimulation.

BACKGROUND: Power-on reset (PoR) is most commonly due to electromagnetic interference. Full PoR results in a switch to an inhibited mode (VVI) pacing and resets pacing outputs to maximal unipolar settings, leading to extracardiac stimulation. METHODS: We present a case of PoR occurrence in the absence of electromagnetic interference, resulting in pectoral stimulation triggered by violation of the atrial rate limit. CONCLUSIONS: It is useful for clinicians to recognizethe occurrence of PoR in the setting of atrial limit violation andthe appropriate management in such circumstances.

Cardiac Resynchronization Therapy with Defibrillator in Ischemic Versus Nonischemic Cardiomyopathy.

Cardiac resynchronization therapy with implantable cardioverter defibrillators (CRT-Ds) are established therapy options for patients suffering from heart failure (HF). Several aspects of HF modification have yet to be described regarding etiology-dependent outcome differences in the long-term.The Mannheim CArdiac Resynchronization TherApy RetrospeCtive ObservAtioNAl (MARACANA) Registry retrospectively included all patients provided with CRTs in our center from 2013 to 2021. CRT-D recipients (n = 380) were grouped to either ischemic cardiomyopathy (ICM, n = 206) or nonischemic cardiomyopathy (NICM, n = 174). Both groups were compared regarding survival, left ventricular ejection fraction (LVEF), hospitalizations due to HF, intrinsic and paced QRS width, NYHA classification, and several further aspects of HF modification in the long-term (59.1 ± 4.81 months).Patients with ICM were older (73.3 ± 8.4 versus 67.7 ± 10.8 years) and predominantly male (86.4 versus 74.7%) and presented with higher creatinine values (1.57 ± 0.92 versus 1.31 ± 0.66 mg/dL, each P < 0.05) at baseline. The mean survival for patients with NICM was better (51.9 ± 1.2 versus 54.4 ± 1.1 months, P = 0.03). Improvements in NYHA (2.93 ± 0.4 versus 2.79 ± 0.5-2.19 ± 0.7 versus 1.79 ± 0.7) and LVEF (26.4 ± 6.8 versus 27% ± 6.9% to 35.7 ± 9.6 versus 44 ± 11%, each P < 0.05) were similar for both groups after 5 years. Patients with ICM experienced more hospitalizations due to HF within the first year (odds ratio 1.9, P < 0.05), whereas electrical remodeling was more impressive for NICM (QRS width 157.1 ± 19.4 milliseconds versus intrinsic 116.6 ± 12.7 milliseconds and paced 131.9 ± 21 milliseconds after 5 years, both P < 0.05).Patients with HF might experience long-term improvements in functional status and left ventricular reverse remodeling following CRT-D, regardless of underlying etiology. Alterations in some aspects of HF modification could be influenced by time- and etiology-associated comorbidities.

Potential of electronic devices for detection of health problems in older adults at home: A systematic review and meta-analysis.

OBJECTIVE: The aim of this review was to evaluate the overall diagnostic performance of e-devices for detection of health problems in older adults at home. METHODS: A systematic review was conducted following the PRISMA-DTA guidelines. RESULTS: 31 studies were included with 24 studies included in meta-analysis. The included studies were divided into four categories according to the signals detected: physical activity (PA), vital signs (VS), electrocardiography (ECG) and other. The meta-analysis showed the pooled estimates of sensitivity and specificity were 0.94 and 0.98 respectively in the 'VS' group. The pooled sensitivity and specificity were 0.97 and 0.98 respectively in the 'ECG' group. CONCLUSIONS: All kinds of e-devices perform well in diagnosing the common health problems. While ECG-based health problems detection system is more reliable than VS-based ones. For sole signal detection system has limitation in diagnosing specific health problems, more researches should focus on developing new systems combined of multiple signals.

Crystal Engineering of BiVO4 for Photochemical Sensing of H2 S Gas at Ultra-low Concentration.

We report a photochemical bismuth vanadate (BiVO4 ) sensing material, which possesses a large proportion of (110) and (011) facets combined with the additional (111) facets, for the selective detection of ultra-low concentration hydrogen sulfide (H2 S) driven by visible light. Specifically, the obtained octadecahedron BiVO4 (Octa-BiVO4 ) performs a high response value (67) and short response time (47.4 s) to 100 ppm H2 S with good stability for nearly 100 days, as well as undisturbedness by moist air. With the combination of experimental and theoretical calculation results, the adsorption and carrier transfer behaviors of H2 S molecules on the Octa-BiVO4 crystal surface are investigated. By adjusting the ratio of different crystal facets and controlling the facets with characteristic adsorption, we achieve improved anisotropic photoinduced carrier separation and high selectivity for a specific gas. Furthermore, this facial facet engineering can be extended to the synthesis of other sensing materials, offering huge opportunities for fundamental research and technological applications.

A Humidity-Induced Large Electronic Conductivity Change of 107 on a Metal-Organic Framework for Highly Sensitive Water Detection.

The electronic conductivity (EC) of metal-organic frameworks (MOFs) is sensitive to strongly oxidizing guest molecules. Water is a relatively mild species, however, the effect of H2 O on the EC of MOFs is rarely reported. We explored the effect of H2 O on the EC in the MOFs (NH2 )2 -MIL-125 and its derivatives with experimental and theoretical investigations. Unexpectedly, a large EC increase of 107 on H2 SO4 @(NH2 )2 -MIL-125 by H2 O was observed. Brønsted acid-base pairs formed with the -NH2 groups, and H2 SO4 played an important role in promoting the charge transfer from H2 O to the MOF. Based on H2 SO4 @(NH2 )2 -MIL-125, a high-performance chemiresistive humidity sensor was developed with the highest sensitivity, broadest detection range, and lowest limit of detection amongst all reported sensing materials to date. This work not only demonstrated that H2 O can remarkably influence the EC of MOFs, but it also revealed that post-modification of the structure of MOFs could enhance the influence of the guest molecule on their EC to design high-performance sensing materials.

Emerging Synthesis Strategies of 2D MOFs for Electrical Devices and Integrated Circuits.

The development of advanced electronic devices is boosting many aspects of modern technology and industry. The ever-increasing demand for advanced electrical devices and integrated circuits calls for the design of novel materials, with superior properties for the improvement of working performance. In this review, a detailed overview of the synthesis strategies of 2D metal organic frameworks (MOFs) acquiring growing attention is presented, as a basis for expansion of novel key materials in electrical devices and integrated circuits. A framework of controllable synthesis routes to be implanted in the synthesis strategies of 2D materials and MOFs is described. In short, the synthesis methods of 2D MOFs are summarized and discussed in depth followed by the illustrations of promising applications relating to various electrical devices and integrated circuits. It is concluded by outlining how 2D MOFs can be synthesized in a simpler, highly efficient, low-cost, and more environmentally friendly way which can open up their applicable opportunities as key materials in advanced electrical devices and integrated circuits, enabling their use in broad aspects of the society.

Electrical devices designed based on inorganic clusters.

The idea of exploring the bottom brink of material science has been carried out for more than two decades. Clusters science is the frontmost study of all nanoscale structures. Being an example of 0-dimensional quantum dot, nanocluster serves as the bridge between atomic and conventionally understood solid-state physics. The forming mechanism of clusters is found to be the mutual effects of electronic and geometric configuration. It is found that electronic shell structure influences the properties and geometric structure of the cluster until its size becomes larger, where electronic effects submerge in geometric structure. The discrete electronic structures depend on the size and conformation of clusters, which can be controlled artificially for potential device applications. Especially, small clusters with a size of 1-2 nm, whose electronic states are possibly discrete enough to overcome thermal fluctuations, are expected to build a single-electron transistor with room temperature operation. However, exciting as the progress may be seen, cluster science still falls within the territory of merely the extension of atomic and molecular science. Its production rate limits the scientific and potential application research of nanoclusters. It is suggested in this review that the mass-produce ability without losing the atomic precision selectivity would be the milestone for nanoclusters to advance to material science.

A Covalent Organic-Inorganic Hybrid Superlattice Covered with Organic Functional Groups for Highly Sensitive and Selective Gas Sensing.

Organic-inorganic hybrid superlattices (OIHSLs) hold attractive physical and chemical properties, while the construction of single-crystal covalent OIHSLs has not been achieved. Herein a coordination assembly strategy was proposed to create a single-crystal covalent OIHSL PbBDT (BDT=1,4-benzenedithiolate), where layered [PbS2 ] sublattice covalently connects with benzene sublattice. The covalent bonding offers better thermo-/chemi-stability, inter-sublattice electron transport, and unique organic-group-functionalized surface, which may enable better performances in chemical applications than non-covalent OIHSL. These features endow PbBDT with the highest sensitivity, the lowest detection limit and excellent selectivity towards NO2 at room temperature among all chemiresistive gas-sensing materials with reported response time less than 2 min without the need of light assistance.

Layer-by-Layer Growth of Preferred-Oriented MOF Thin Film on Nanowire Array for High-Performance Chemiresistive Sensing.

High-quality MOF thin films with high orientation and controlled thickness are extremely desired for applications. However, they have been only successfully fabricated on flat substrates. Those MOF 2D thin films are limited by low exposed area and slow mass transport. To overcome these issues, MOF 3D thin films with good crystallinity, preferred orientation, and precisely controllable thickness in nanoscale were successfully prepared in a controllable layer-by-layer manner on nanowire array substrate for the first time. The as-prepared Cu-HHTP 3D thin film is superior to corresponding 2D thin films and showed one of the highest sensitivity, lowest LOD, and fastest response among all reported chemiresistive NH3 sensing materials at RT. This work provides a feasible approach to grow preferred-oriented 3D MOF thin film, offering new perspectives for constructing MOF-based heterostructures for advanced applications.

Feasibility, safety, and utility of brain MRI for patients with non-MRI-conditioned CIED.

Feasibility, safety, and utility of brain MRI for patients with non-MRI-conditioned cardiac implantable electrical devices (CIEDs) remains controversial. While a growing number of studies have shown safe employment in select patients under strict protocols, there is an increasing clinical need for further off-label investigations. To assess the feasibility and utility of brain MRI in neurological and neurosurgical patients with non-MRI-conditioned CIEDs using off-label protocol. We retrospectively evaluated 126 patients with non-MRI-conditioned CIEDs referred to our hospital between 2014 to 2018 for MRI under an IRB-approved protocol. A total of 126 off-label brain MRI scans were performed. The mean age was 67.5 ± 13.0. Seventy percent of scans were performed on female patients. Indications for MRI are neurosurgical (45.2%), neurological (51.6%), and others (3.2%). MRI utilization for tumor cases was highest for tumor cases (68.3%), but employment was valuable for vascular (12.7%), deep brain stimulators (3.2%), and other cases (15.9%). In the tumor category, (37.2%) of the scans were performed for initial diagnosis and pre-surgical planning, (47.7%) for post-intervention evaluation/surveillance, (15.1%) for stereotactic radiosurgery treatment (CyberKnife). No clinical complications were encountered. No functional device complications of the CIED were identified during and after the MRI in 96.9% of the studies. A 49.6% of the off-label brain MRI scans performed led to a clinically significant decision and/or intervention for the patients. A 42.9% of obtained MRI studies did not change the plan of care. A 7.9% of post-scan decision-making data was not available. We demonstrate that off-label brain MRI scans performed on select patients under a strict protocol is feasible, safe, and relevant. Almost 50% of scans provided critical information resulting in clinical intervention of the patients.

A Feature-Based Model for the Identification of Electrical Devices in Smart Environments.

Smart Homes (SHs) represent the human side of a Smart Grid (SG). Data mining and analysis of energy data of electrical devices in SHs, e.g., for the dynamic load management, is of fundamental importance for the decision-making process of energy management both from the consumer perspective by saving money and also in terms of energy redistribution and reduction of the carbon dioxide emission, by knowing how the energy demand of a building is composed in the SG. Advanced monitoring and control mechanisms are necessary to deal with the identification of appliances. In this paper, a model for their automatic identification is proposed. It is based on a set of 19 features that are extracted by analyzing energy consumption, time usage and location from a set of device profiles. Then, machine learning approaches are employed by experimenting different classifiers based on such model for the identification of appliances and, finally, an analysis on the feature importance is provided.

In-vivo compatibility between pacemakers and dental equipment.

In-vitro studies suggest that electromagnetic interference can occur under specific conditions involving proximity between electronic dental equipment and pacemakers. At present, in-vivo investigations to verify the effect of using electronic dental equipment in clinical conditions on patients with pacemakers are scarce. This study aimed to evaluate, in vivo, the effect of three commonly used electronic dental instruments - ultrasonic dental scaler, electric pulp tester, and electronic apex locator - on patients with different pacemaker brands and configurations. Sixty-six consecutive non-pacemaker-dependent patients were enrolled during regular electrophysiology follow-up visits. Electronic dental tools were operated while the pacemaker was interrogated, and the intracardiac electrogram and electrocardiogram were recorded. No interferences were detected in the intracardiac electrogram of any patient during the tests with dental equipment. No abnormalities in pacemaker pacing and sensing function were observed, and no differences were found with respect to the variables, pacemaker brands, pacemaker configuration, or mode of application of the dental equipment. Electromagnetic interferences affecting the surface electrocardiogram, but not the intracardiac electrogram, were found in 25 (37.9%) patients, especially while using the ultrasonic dental scaler; the intrinsic function of the pacemakers was not affected. Under real clinical conditions, none of the electronic dental instruments tested interfered with pacemaker function.

Frailty syndrome: an emerging clinical problem in the everyday management of clinical arrhythmias. The results of the European Heart Rhythm Association survey.

The age of patients presenting with complex arrhythmias is increasing. Frailty is a multifaceted syndrome characterized by an increased vulnerability to stressors and a decreased ability to maintain homeostasis. The prevalence of frailty is associated with age. The aims of this European Heart Rhythm Association (EHRA) EP Wire survey were to evaluate the proportion of patients with frailty and its influence on the clinical management of arrhythmias. A total of 41 centres-members of the EHRA Electrophysiology Research Network-in 14 European countries completed the web-based questionnaire in June 2017. Patients over 70 years represented 53% of the total treated population, with the proportion of frail elderly individuals reaching approximately 10%; 91.7% of the responding centres reported treating frail subjects in the previous year. The respondents usually recognized frailty based on the presence of problems of mobility, nutrition, and cognition and inappropriate loss of body weight and muscle mass. Renal failure, dementia, disability, atrial fibrillation, heart failure, falls, and cancer were reported to characterize the elderly frail individuals. Atrial fibrillation was considered the prevalent arrhythmia associated with frailty by 72% of the responding centres, and for stroke prevention, non-vitamin K antagonist oral anticoagulants were preferred. None of the respondents considered withholding the prevention of thrombo-embolic events in subjects with a history of falls. All participants have agreed that cardiac resynchronization therapy exerts positive effects including improvement in cardiac, physical, and cognitive performance and quality of life. The majority of respondents preferred an Arrhythmia Team to manage this special population of elderly patients, and many would like having a simple tool to quickly assess the presence of frailty to guide their decisions, particularly on the use of complex cardiac implantable electrical devices (CIEDs). In conclusion, the complex clinical condition in frail patients presenting with arrhythmias warrants an integrated multidisciplinary approach both for the management of rhythm disturbances and for the decision on using CIEDs.

Magnetic resonance examination of patients with implanted pacemakers: An evaluation of magnetic field gradients slew rate.

Performing safe magnetic resonance imaging of patients with "MR conditional" pacemakers needs to meet some specific restrictions. One of these is related to the slew rate (SR) parameter, defined as the speed of magnetic field gradients rising up to their required strengths. Unfortunately, SR values cannot be easily checked at the tomograph console. The present work provides an accurate evaluation of the maximum SR for a set of widely used clinical MR sequences. The experimental approach is based on indirect measurement of time-varying spatial magnetic field gradients. All MR sequences evaluated match safety SR prescriptions. Moreover, an appropriate choice of sequence scan parameters defines some optimized scan protocols tailored for the tomograph considered in the present study. Bioelectromagnetics. 38:307-314, 2017. © 2017 Wiley Periodicals, Inc.

Capacity of dental equipment to interfere with cardiac implantable electrical devices.

Patients with cardiac implantable electrical devices should take precautions when exposed to electromagnetic fields. Possible interference as a result of proximity to electromagnets or electricity flow from electronic tools employed in clinical odontology remains controversial. The objective of this study was to examine in vitro the capacity of dental equipment to provoke electromagnetic interference in pacemakers and implantable cardioverter defibrillators. Six electronic dental instruments were tested on three implantable cardioverter defibrillators and three pacemakers from different manufacturers. A simulator model, submerged in physiological saline, with elements that reproduced life-size anatomic structures was used. The instruments were analyzed at differing distances and for different time periods of application. The dental instruments studied displayed significant differences in their capacity to trigger electromagnetic interference. Significant differences in the quantity of registered interference were observed with respect to the variables manufacturer, type of cardiac implant, and application distance but not with the variable time of application. The electronic dental equipment tested at a clinical application distance (20 cm) provoked only slight interference in the pacemakers and implantable cardioverter defibrillators employed, irrespective of manufacturer.

The Use of Polyimide as a Bonding Material to Improve the Mechanical Stability, Magnetic and Acoustic Properties of the Transformer Core Based on Amorphous Steel.

The constantly evolving electrification also entails an increase in requirements for the effective and efficient distribution of electricity with the lowest possible power losses. Such needs can be met by highly effective electrical devices, and one of them is a transformer whose main component is a magnetic core. Currently, one of the soft magnetic materials used alternatively for the production of transformer cores are amorphous metal strips with competitive losses. However, to successfully use these materials, a key problem must be solved: limited mechanical stability. The presented article describes the development and application of a polyimide-based binder for efficient bonding of an amorphous metal ribbon. The layered binder was characterized using confocal microscopy, scanning electron microscopy and Raman spectroscopy, and its anticorrosion and mechanical properties were examined. As a final step, a prototype of a toroidal magnetic core bonded with the binder was manufactured and subjected to the evaluation of no-load loss and the analysis of the emitted noise. It was confirmed that the proposed polyimide binder tremendously improved the mechanical stability while reducing core losses and audible noise.

Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement.

In children with structurally normal hearts, the mechanisms of arrhythmias are usually the same as in the adult patient. Some arrhythmias are particularly associated with young age and very rarely seen in adult patients. Arrhythmias in structural heart disease may be associated either with the underlying abnormality or result from surgical intervention. Chronic haemodynamic stress of congenital heart disease (CHD) might create an electrophysiological and anatomic substrate highly favourable for re-entrant arrhythmias. As a general rule, prescription of antiarrhythmic drugs requires a clear diagnosis with electrocardiographic documentation of a given arrhythmia. Risk-benefit analysis of drug therapy should be considered when facing an arrhythmia in a child. Prophylactic antiarrhythmic drug therapy is given only to protect the child from recurrent supraventricular tachycardia during this time span until the disease will eventually cease spontaneously. In the last decades, radiofrequency catheter ablation is progressively used as curative therapy for tachyarrhythmias in children and patients with or without CHD. Even in young children, procedures can be performed with high success rates and low complication rates as shown by several retrospective and prospective paediatric multi-centre studies. Three-dimensional mapping and non-fluoroscopic navigation techniques and enhanced catheter technology have further improved safety and efficacy even in CHD patients with complex arrhythmias. During last decades, cardiac devices (pacemakers and implantable cardiac defibrillator) have developed rapidly. The pacing generator size has diminished and the pacing leads have become progressively thinner. These developments have made application of cardiac pacing in children easier although no dedicated paediatric pacing systems exist.

Stepwise Approach for Transvenous Lead Extraction in a Large Single Centre Cohort.

BACKGROUND: Infection, lead dysfunction and system upgrades are all reasons that transvenous lead extraction is being performed more frequently. Many centres focus on a single method for lead extraction, which can lead to either lower success rates or higher rates of major complications. We report our experience with a systematic approach from a less invasive to a more invasive strategy without the use of laser sheaths. METHODS: Consecutive extraction procedures performed over a period of seven years in our electrophysiology laboratory were included. We performed a stepwise approach with careful traction, lead locking stylets (LLD), mechanical non-powered dilator sheaths, mechanical powered sheaths and, if needed, femoral snares. RESULTS: In 463 patients (age 69.9 ± 12.3, 31.3% female) a total of 780 leads (244 ICD leads) with a mean lead dwelling time of 5.4 ± 4.9 years were identified for extraction. Success rates for simple traction, LLD, mechanical non-powered sheaths and mechanical powered sheaths were 31.5%, 42.7%, 84.1% and 92.6%, respectively. A snare was used for 40 cases (as the primary approach for 38 as the lead structure was not intact and stepwise approach was not feasible) and was successful for 36 leads (90.0% success rate). Total success rate was 93.1%, clinical success rate was 94.1%. Rate for procedural failure was 1.1%. Success for less invasive steps and overall success for extraction was associated with shorter lead dwelling time (p < 0.001). Major procedure associated complications occurred in two patients (0.4%), including one death (0.2%). A total of 36 minor procedure-associated complications occurred in 30 patients (6.5%). Pocket hematoma correlated significantly with uninterrupted dual antiplatelet therapy (p = 0.001). Pericardial effusion without need for intervention was associated with long lead dwelling time (p = 0.01) and uninterrupted acetylsalicylic acid (p < 0.05). CONCLUSION: A stepwise approach with a progressive invasive strategy is effective and safe for transvenous lead extraction.

Feasibility and Efficacy of Transcatheter Tricuspid Valve Repair in Patients with Cardiac Implanted Electrical Devices and Trans-Tricuspid Leads.

BACKGROUND: Transcatheter tricuspid valve repair using the edge-to-edge-technique (TEER) has emerged as an alternative therapy in patients with severe tricuspid regurgitation (TR) and high surgical risk. This study aimed to evaluate the feasibility and efficacy of tricuspid valve TEER in patients with cardiac implanted electric devices (CIEDs). METHODS: All patients who underwent tricuspid valve TEER at our center were retrospectively included. Patients were classified according to the presence of CIEDs. Procedure success was defined as implantation of at least one clip and the reduction of TR of at least one grade. Procedure success and intrahospital outcome were compared between the two groups. RESULTS: One-hundred and six consecutive patients underwent tricuspid TEER (age 80.1 ± 6.4 years, male = 42; 39.6%). Among them, 25 patients (23.6%, age 80.6 ± 7.3 years, male = 14; 56%) had CIEDs. Patients with CIEDs had a significantly lower left ventricular ejection fraction (LV-EF) compared to those without CIEDs (47.2 ± 15% vs. 56.2 ± 8.2%, p = 0.004, respectively). Moreover, arterial hypertension was more common in patients with CIEDs (96% vs. 79%, p = 0.048). The success of the procedure did not differ between the non-CIED vs. CIED group (93.8% vs. 92%, p = 0.748). Furthermore, the number and position of implanted clips, the duration of the procedure, the post-procedural pressure gradient across the tricuspid valve, and post-procedural TR severity were comparable between both groups. CONCLUSION: Tricuspid valve TEER is feasible and efficient in patients with CIEDs. The success of the procedure, as well as the intrahospital outcome were comparable between patients with and without CIEDs.