Systematic coronary physiology improves level of agreement in diagnostic coronary angiography.

OBJECTIVE: The training of interventional cardiologists (ICs), non-interventional cardiologists (NICs) and cardiac surgeons (CSs) differs, and this may be reflected in their interpretation of invasive coronary angiography (ICA) and management plan. Availability of systematic coronary physiology might result in more homogeneous interpretation and management strategy compared with ICA alone. METHODS: 150 coronary angiograms from patients with stable chest pain were presented independently to three NICs, three ICs and three CSs. By consensus, each group graded (1) coronary disease severity and (2) management plan, using options: (a) optimal medical therapy alone, (b) percutaneous coronary intervention, (c) coronary artery bypass graft or (d) more investigation required. Each group was then provided with fractional flow reserve (FFR) from all major vessels and asked to repeat the analysis. RESULTS: There was only 'fair' level of agreement of management plan among ICs, NICs and CSs (kappa 0.351, 95% CI 0.295-0.408, p<0.001) based on ICA alone (complete agreement in 35% of cases), which almost doubled to 'good' level (kappa 0.635, 95% CI 0.572-0.697, p<0.001) when comprehensive FFR was available (complete agreement in 66% of cases). Overall, the consensus management plan changed in 36.7%, 52% and 37.3% of cases for ICs, NICs and CSs, respectively, when FFR data were available. CONCLUSIONS: Compared with ICA alone, the availability of systematic FFR of all major coronary arteries produced a significantly more concordant interpretation and more homogeneous management plan among IC, NIC and CS specialists. Comprehensive physiological assessment may be of value in routine care for Heart Team decision-making. TRIAL REGISTRATION NUMBER: NCT01070771.

A direct discretization recurrent neurodynamics method for time-variant nonlinear optimization with redundant robot manipulators.

Discrete time-variant nonlinear optimization (DTVNO) problems are commonly encountered in various scientific researches and engineering application fields. Nowadays, many discrete-time recurrent neurodynamics (DTRN) methods have been proposed for solving the DTVNO problems. However, these traditional DTRN methods currently employ an indirect technical route in which the discrete-time derivation process requires to interconvert with continuous-time derivation process. In order to break through this traditional research method, we develop a novel DTRN method based on the inspiring direct discrete technique for solving the DTVNO problem more concisely and efficiently. To be specific, firstly, considering that the DTVNO problem emerging in the discrete-time tracing control of robot manipulator, we further abstract and summarize the mathematical definition of DTVNO problem, and then we define the corresponding error function. Secondly, based on the second-order Taylor expansion, we can directly obtain the DTRN method for solving the DTVNO problem, which no longer requires the derivation process in the continuous-time environment. Whereafter, such a DTRN method is theoretically analyzed and its convergence is demonstrated. Furthermore, numerical experiments confirm the effectiveness and superiority of the DTRN method. In addition, the application experiments of the robot manipulators are presented to further demonstrate the superior performance of the DTRN method.

High-density electroanatomic activation mapping to guide slow pathway modification in patients with persistent left superior vena cava.

BACKGROUND: Slow pathway (SP) mapping and modification can be challenging in patients with persistent left superior vena cava (PLSVC) due to anatomic variance of the Koch triangle (KT) and coronary sinus (CS) dilation. Studies using detailed 3-dimensional (3D) electroanatomic mapping (EAM) to investigate conduction characteristics and guide ablation targets in this condition are lacking. OBJECTIVES: The purpose of this study was to describe a novel technique of SP mapping and ablation in sinus rhythm using 3D EAM in patients with PLSVC after validation in a cohort with normal CS anatomy. METHODS: Seven patients with PLSVC and dual atrioventricular (AV) nodal physiology who underwent SP modification with the use of 3D EAM were included. Twenty-one normal heart patients with AV nodal reentrant tachycardias formed the validation group. High-resolution, ultra-high-density local activation timing mapping of the right atrial septum and proximal CS in sinus rhythm was performed. RESULTS: SP ablation targets were consistently identified by an area in the right atrial septum with the latest activation time and multicomponent atrial electrogram adjacent to a region with isochronal crowding (deceleration zone). In PLSVC patients, these targets were located at or within 1 cm of the midanterior CS ostium. Ablation in this area led to successful SP modification, reaching standard clinical endpoints with a median of 43 seconds of radiofrequency energy or 14 minutes of cryoablation without complications. CONCLUSION: High-resolution activation mapping of the KT in sinus rhythm can facilitate localization and safe SP ablation in patients with PLSVC.

Novel Discrete-Time Recurrent Neural Networks Handling Discrete-Form Time-Variant Multi-Augmented Sylvester Matrix Problems and Manipulator Application.

In this article, the discrete-form time-variant multi-augmented Sylvester matrix problems, including discrete-form time-variant multi-augmented Sylvester matrix equation (MASME) and discrete-form time-variant multi-augmented Sylvester matrix inequality (MASMI), are formulated first. In order to solve the above-mentioned problems, in continuous time-variant environment, aided with the Kronecker product and vectorization techniques, the multi-augmented Sylvester matrix problems are transformed into simple linear matrix problems, which can be solved by using the proposed discrete-time recurrent neural network (RNN) models. Second, the theoretical analyses and comparisons on the computational performance of the recently developed discretization formulas are presented. Based on these theoretical results, a five-instant discretization formula with superior property is leveraged to establish the corresponding discrete-time RNN (DTRNN) models for solving the discrete-form time-variant MASME and discrete-form time-variant MASMI, respectively. Note that these DTRNN models are zero stable, consistent, and convergent with satisfied precision. Furthermore, illustrative numerical experiments are given to substantiate the excellent performance of the proposed DTRNN models for solving discrete-form time-variant multi-augmented Sylvester matrix problems. In addition, an application of robot manipulator further extends the theoretical research and physical realizability of RNN methods.

UK multicenter retrospective comparison of novel active versus conventional passive fixation coronary sinus leads.

BACKGROUND: A novel active fixation coronary sinus (CS) lead, Attain Stability (AS), has been released aiming to improve targeted lead positioning. Rather than being wedged into the distal vessel, it relies on a side helix for fixation. We aimed to compare implant procedure parameters and electromechanical stability of the AS lead with passive CS leads. METHODS: A retrospective study involving six major UK cardiac centers. Patients who received active fixation leads were compared with passive fixation lead recipients in a 1:2 ratio. The primary outcome was total lead displacements (combined macrodisplacement/microdisplacement, defined as displacements requiring repositioning procedures, an increase in threshold ≥0.5 V or pulse width ≥0.5 ms, or a change in pacing polarity). RESULTS: A total of 761 patients were included (253 AS leads and 508 passive fixation leads), of which 736 had follow-up data. The primary endpoint rate was 31% (75/241) in the active and 43% (214/495) in the passive group (p = .002). Six patients (2.5%) in the active group and 14 patients (2.8%) in the passive group required CS lead repositioning procedures (p = 0.981). On multivariable analysis, active leads were associated with a reduction in lead displacements, odds ratio 0.66 (95% confidence interval: 0.46-0.95), p = .024. There were differences in favor of passive leads in procedure duration, 120 (96-149) versus 127 (105-155) min (p = .008), and fluoroscopy time, 17 (11-26) versus 18.5 (13-27) min (p = .0022). The median follow-up duration was similar (active vs. passive): 31 (17-47) versus 34 (16-71) weeks, (p = .052). CONCLUSION: AS CS leads had improved electromechanical stability compared with passive fixation leads, with only minimal increases in implant procedure and fluoroscopy times.