Factors affecting electrogram sensing in an insertable cardiac monitor: Insights from surface electrocardiogram mapping analysis.

BACKGROUND: Fidelity of electrogram sensing may reduce false alerts from an insertable cardiac monitor (ICM). OBJECTIVE: The purpose of this study was to assess the effect of vector length, implant angle, and patient factors on electrogram sensing using surface electrocardiogram (ECG) mapping. METHODS: Twelve separate precordial single-lead surface ECGs were acquired from 150 participants at 2 interelectrode distances (75 and 45 mm), at 3 vector angles (vertical, oblique, and horizontal), and in 2 postures (upright and supine). A subset of 50 patients also received a clinically indicated ICM implant in 1:1 ratio (Reveal LINQ [Medtronic, Minneapolis, MN]/BIOMONITOR III [Biotronik, Berlin, Germany]). All ECGs and ICM electrograms were analyzed by blinded investigators using DigitizeIt software (V2.3.3, Braunschweig, Germany). The P-wave visibility threshold was set at > 0.015 mV. Logistic regression was used to identify factors affecting P-wave amplitude. RESULTS: A total of 1800 tracings from 150 participants (44.5% [n = 68] female; median age 59 [35-73] years) were assessed. The median P- and R-wave amplitudes were 45% and 53% larger with vector lengths of 75 and 45 mm, respectively (P < .001 for both). The oblique orientation yielded the best P- and R-wave amplitudes, while posture change did not affect P-wave amplitude. Mixed effects modeling found that visible P-waves occur more frequently with a vector length of 75 mm than with 45 mm (86% vs 75%, respectively; P < .0001). A longer vector length improved both P-wave amplitude and visibility in all body mass index categories. There was a moderate correlation of P- and R-wave amplitudes from the ICM electrograms to those from surface ECG recordings (intraclass correlation coefficient 0.74 and 0.80, respectively). CONCLUSION: Longer vector length and oblique implant angle yielded the best electrogram sensing and are relevant considerations for ICM implantation procedures.

Decoupling Lattice and Magnetic Instabilities in Frustrated CuMnO2.

The AMnO2 delafossites (A = Na, Cu) are model frustrated antiferromagnets, with triangular layers of Mn3+ spins. At low temperatures (TN = 65 K), a C2/m → P1̅ transition is found in CuMnO2, which breaks frustration and establishes magnetic order. In contrast to this clean transition, A = Na only shows short-range distortions at TN. Here, we report a systematic crystallographic, spectroscopic, and theoretical investigation of CuMnO2. We show that, even in stoichiometric samples, nonzero anisotropic Cu displacements coexist with magnetic order. Using X-ray/neutron diffraction and Raman scattering, we show that high pressures act to decouple these degrees of freedom. This manifests as an isostuctural phase transition at ∼10 GPa, with a reversible collapse of the c-axis. This is shown to be the high-pressure analogue of the c-axis negative thermal expansion seen at ambient pressure. Density functional theory (DFT) simulations confirm that dynamical instabilities of the Cu+ cations and edge-shared MnO6 layers are intertwined at ambient pressure. However, high pressure selectively activates the former, before an eventual predicted reemergence of magnetism at the highest pressures. Our results show that the lattice dynamics and local structure of CuMnO2 are quantitatively different from nonmagnetic Cu delafossites and raise questions about the role of intrinsic inhomogeneity in frustrated antiferromagnets.

The role of outpatient ambulatory electroencephalography in the diagnosis and management of adults with epilepsy or nonepileptic attack disorder: A systematic literature review.

Electroencephalography (EEG) is an established diagnostic tool with important implications for the clinical management of patients with epilepsy or nonepileptic attack disorder. Different types of long-term EEG recording strategies have been developed over the last decades, including the widespread use of ambulatory electroencephalography (AEEG), which holds great potential in terms of both clinical usefulness and cost-effectiveness. In this paper, we present the results of a systematic review of the scientific literature on the use of AEEG in the diagnosis of epilepsy and nonepileptic attacks in adult patients. Taken together, our findings confirmed that AEEG is a useful diagnostic tool in patients with equivocal findings on routine EEG studies and influences management decisions in the majority of studies. There is evidence that AEEG is also more likely to capture events than sleep-deprived EEG; however, there are currently insufficient data available to compare the diagnostic utility of modern AEEG technology with inpatient video-telemetry. Further research on the combined use of AEEG and home-video recording is, therefore, warranted.

An "off-axis" Mn-Mn bond in Mn2(CO)10 at high pressure.

At variance with what was previously reported, Mn2(CO)10 does not transform its conformation from staggered to eclipsed in the high pressure crystal form. X-ray powder diffraction, DFT calculations and Raman spectroscopy show that the staggered conformation is retained. Instead, a rotation and a translation of the Mn(CO)5 pyramidal units produce an "off-axis" and rather shorter Mn-Mn bond.

Giant pressure-induced volume collapse in the pyrite mineral MnS2.

Dramatic volume collapses under pressure are fundamental to geochemistry and of increasing importance to fields as diverse as hydrogen storage and high-temperature superconductivity. In transition metal materials, collapses are usually driven by so-called spin-state transitions, the interplay between the single-ion crystal field and the size of the magnetic moment. Here we show that the classical S = 5/2 mineral hauerite (MnS2) undergoes an unprecedented (ΔV ~ 22%) collapse driven by a conceptually different magnetic mechanism. Using synchrotron X-ray diffraction we show that cold compression induces the formation of a disordered intermediate. However, using an evolutionary algorithm we predict a new structure with edge-sharing chains. This is confirmed as the thermodynamic ground state using in situ laser heating. We show that magnetism is globally absent in the new phase, as low-spin quantum S = 1/2 moments are quenched by dimerization. Our results show how the emergence of metal-metal bonding can stabilize giant spin-lattice coupling in Earth's minerals.