Electrocardiogram-based prediction of conduction disturbances after transcatheter aortic valve replacement with convolutional neural network.

Aims: Permanent pacemaker implantation and left bundle branch block are common complications after transcatheter aortic valve replacement (TAVR) and are associated with impaired prognosis. This study aimed to develop an artificial intelligence (AI) model for predicting conduction disturbances after TAVR using pre-procedural 12-lead electrocardiogram (ECG) images. Methods and results: We collected pre-procedural 12-lead ECGs of patients who underwent TAVR at West China Hospital between March 2016 and March 2022. A hold-out testing set comprising 20% of the sample was randomly selected. We developed an AI model using a convolutional neural network, trained it using five-fold cross-validation and tested it on the hold-out testing cohort. We also developed and validated an enhanced model that included additional clinical features. After applying exclusion criteria, we included 1354 ECGs of 718 patients in the study. The AI model predicted conduction disturbances in the hold-out testing cohort with an area under the curve (AUC) of 0.764, accuracy of 0.743, F1 score of 0.752, sensitivity of 0.876, and specificity of 0.624, based solely on pre-procedural ECG images. The performance was better than the Emory score (AUC = 0.704), as well as the logistic (AUC = 0.574) and XGBoost (AUC = 0.520) models built with previously identified high-risk ECG patterns. After adding clinical features, there was an increase in the overall performance with an AUC of 0.779, accuracy of 0.774, F1 score of 0.776, sensitivity of 0.794, and specificity of 0.752. Conclusion: Artificial intelligence-enhanced ECGs may offer better predictive value than traditionally defined high-risk ECG patterns.

RCS reduction of composite transparent flexible coding metasurface combined phase cancellation and absorption.

A wideband low-scattering metasurface with optical transparency and flexibility is proposed by using the combination of phase cancellation and absorption mechanisms. Electromagnetic (EM) diffusion is achieved through the random phase distribution design of the two coding elements. The enhanced energy absorption can be obtained in a wide spectrum by using indium tin oxide (ITO) with suitable sheet resistance in the supercells. The experimental results show that the radar cross section (RCS) reductions of less than -10 dB under the planar and conformal cases are in 6.65-19.40 GHz and 6.11-17.37 GHz, corresponding relative bandwidth are 97.89% and 95.91%, respectively. Both theoretical analysis and simulated results are good accordance with the experiment. Furthermore, the analyses of the surface current, EM field distribution and power loss density are given to explain the hybrid RCS reduction mechanism. The proposed composite transparent flexible coding metasurface (CTFCM) maintains good angular stability within 0°-60° oblique incidence and has polarization insensitivity. The CTFCM has excellent flexibility and high optical transparency, which provides a way to reduce RCS in a wider band and has important application potential for stealth aircraft cockpit and transparent radome.

Left Bundle Branch Area Pacing versus Right Ventricular Pacing in Patients with Atrioventricular Block: An Observational Cohort Study.

Objective: We aim to conduct a comparison of the safety and effectiveness performance between left bundle branch area pacing (LBBAP) and right ventricular pacing (RVP) regimens for patients with atrioventricular block (AVB). Methods: This observational cohort study included patients who underwent pacemaker implantations with LBBAP or RVP for AVB indications from the 1st of January 2018 to the 18th of November 2021 at West China Hospital. The primary composite outcome included all-cause mortality, lead failure, or heart failure hospitalization (HFH). The secondary outcome included periprocedure complication, cardiac death, or recurrent unexplained syncope. A 1 : 1 propensity score-matched cohort was conducted for left ventricular (LV) function analysis. Results: A total of 903 patients met the inclusion criteria and completed clinical follow-up. After adjusting for the possible confounders, LBBAP was independently associated with a lower risk of the primary outcome (OR 0.48, 95% CI 0.28 to 0.83, p = 0.009), including a lower risk of all-cause mortality and HFH. No significant difference in the secondary outcome was detected between the groups except that LBBAP was independently associated with a lower risk of recurrent unexplained syncope. In the propensity-score matching cohort of echocardiographic analysis, the LV systolic dyssynchrony index was lower in LBBAP compared with that in RVP (5.68 ± 1.92 vs. 6.50 ± 2.28%, p = 0.012). Conclusions: Compared to conventional RVP, LBBAP is a feasible novel pacing model associated with a significant reduction in the primary composite outcome. Moreover, LBBAP significantly reduces the risk of recurrent unexplained syncope and improves LV systolic synchrony. This study is registered with ClinicalTrials.gov NCT05722379.

Clinical use conditions of lead deployment and simulated lead fracture rate in left bundle branch area pacing.

INTRODUCTION: Left bundle branch area pacing (LBBAP) is achieved by advancing the lead tip deep in the septum. Most LBBAP implants are performed using the Medtronic SelectSecure™ MRI SecureScan™ Model 3830 featuring a unique 4 Fr fixed helix lumenless design. Details of lead use conditions and long-term reliability have not been reported. This study was designed to quantify the mechanical use conditions for the 3830 lead during and after LBBAP implant, and to evaluate reliability using bench testing and simulation. METHODS: Fifty bradycardia patients with implantation of the 3830 lead for LBBAP were enrolled. Use conditions of lead deployment at implantation were collected and computed tomography (CT) scans were performed at 3-month follow-up. Curvature amplitude along the pacing lead was determined with CT images. Fatigue bending was performed using accelerated testing in a more severe environment than routine clinical use conditions. Conductor fracture rate in a simulated patient population was estimated based on clinical use conditions and fatigue test results. RESULTS: The number of attempts to place the 3830 lead for LBBAP was 2.1 ± 1.3 (range: 1-7) with 13 ± 6 lead rotations at the final attempt. Extreme implant conditions were simulated in bench testing with 5 applications of 20 turns followed by up to 400 million bending cycles. Reliability modeling predicted a 10-year fracture rate of 0.02%. CONCLUSIONS: LBBAP implants require more lead rotations than standard pacing implants and result in unique lead bending. Application of simulated LBBAP use conditions to the 3830 lead in an accelerated in-vitro model does not produce excess conductor fractures. IMAGE-LBBP Study ID of ClinicalTrial.GOV: NCT04119323.

Improve the Prevention of Sudden Cardiac Arrest in Patients With Post-Acute Myocardial Infarction.

Background: Implantable cardioverter-defibrillator (ICD) implantation to prevent sudden cardiac death (SCD) in post-myocardial infarction (MI) patients varies by geography but remains low in many regions despite guideline recommendations. Objectives: This study aimed to characterize the care pathway of post-MI patients and understand barriers to referral for further SCD risk stratification and management in patients meeting referral criteria. Methods: This prospective, nonrandomized, multi-nation study included patients ≥18 years of age, with an acute MI ≤30 days and left ventricular ejection fraction <50% ≤14 days post-MI. The primary endpoint was defined as the physician's decision to refer a patient for SCD stratification and management. Results: In total, 1,491 post-MI patients were enrolled (60.2 ± 12.0 years of age, 82.4% male). During the study, 26.7% (n = 398) of patients met criteria for further SCD risk stratification; however, only 59.3% of those meeting criteria (n = 236; 95% CI: 54.4%-64.0%) were referred for a visit. Of patients referred for SCD risk stratification and management, 94.9% (n = 224) attended the visit of which 56.7% (n =127; 95% CI: 50.1%-63.0%) met ICD indication criteria. Of patients who met ICD indication criteria, 14.2% (n = 18) were implanted. Conclusions: We found that ∼40% of patients meeting criteria were not referred for further SCD risk stratification and management and ∼85% of patients who met ICD indications did not receive a guideline-directed ICD. Physician and patient reasons for refusing referral to SCD risk stratification and management or ICD implant varied by geography suggesting that improvement will require both physician- and patient-focused approaches. (Improve Sudden Cardiac Arrest [SCA] Bridge Study; NCT03715790).

Study of the optimum fluoroscopic angle for the implant fixation test of a leadless cardiac pacemaker.

The Micra TPS™ (Medtronic) is the first leadless pacemaker listed in China. The best fluoroscopic angle for the intraoperative fixation test is selected according to different implantation sites to reduce the fluoroscopy duration and radiation dose, and the test is based on the early safety and effectiveness of the device after implantation. A total of 110 patients who underwent Micra TPS™ implantation were selected. Eighty patients were in group A, and 30 patients were in group B. Under the guidance of the conclusions from group A, the fluoroscopy duration, radiation dose and number of fluoroscopic positions of the best fluoroscopic angle of the fixation test according to different positions of the implanted interventricular septum were compared. In 85.0% of the group A implants, these angles were based on the right interior oblique (RAO) angle, with 48.5% cranial (CRA) and 29.4% caudal (CAU) angles. The angle of the tilting head side of the RAO angle was prioritized in group B, and referring to the average angle data, the average fluoroscopy duration for finding the best angle of fixation test was 1.7 ± 0.6 vs. 3.2 ± 1.8 min (P < 0.001), the average radiation dose was 270.4 ± 56.3 vs. 338.1 ± 112.9 mGy (P = 0.002), and the average number of fluoroscopic positions was 2.2 ± 0.6 vs. 4.2 ± 2.1 (P < 0.001), which was significantly less than that in group A. This study found that there was regularity in the fluoroscopic angle for the fixation test during Micra TPS™ operation.Level of Evidence Level 3, local nonrandom sample.

Expert consensus on personalized initiation of glucose-lowering therapy in adults with newly diagnosed type 2 diabetes without clinical cardiovascular disease or chronic kidney disease.

Since it is difficult for clinicians to make a decision among the various types of antidiabetic medications due to their great discrepancy in mechanisms, pharmacological properties, and cardiovascular/renal protection, a relatively "precision" or personalized hypoglycemic treatment suggestion is practical for type 2 diabetes (T2D) management in adults. This expert consensus makes some recommendations based on the characteristics of adult T2D patients without clinical cardiovascular disease (CVD) or chronic kidney disease (CKD) by evidence from large-scale clinical trials. The main consideration for initiating antidiabetic medications is the safety and benefits for prevention of target organ damage, such as CVD and CKD. The choice of personalized glucose-lowering therapy regarding target organ protection is based on the various effects of antidiabetic medications, patients' clinical characteristics and their key risks, as well as the sociological factors. According to the effects on glucose reduction, cardiovascular protection, renal benefit, body weight change, hypoglycemic risk, and liver function impact, the antidiabetic medications are recategorized in this consensus. Combined with the glucose control target and the different effects of hypoglycemic agents, a significant body of recommendations have been developed for optimal T2D management according to the risk factors for atherosclerotic CVD, heart failure, CKD, primary fatty liver, and hypoglycemia. This consensus gives detailed guidance on personalized antidiabetic therapy initiation in newly diagnosed T2D adults, which attaches great importance to both glucose control and target organ protection.

Computed tomography imaging-identified location and electrocardiographic characteristics of left bundle branch area pacing in bradycardia patients.

INTRODUCTION: Left bundle branch area pacing (LBBAP) is a novel physiological pacing modality. The relationship between the pacing lead tip location and paced electrocardiographic (ECG) characteristics remains unclear. The objectives are to determine the lead tip location within the interventricular septum (IVS) and assess the location-based ECG QRS duration (QRSd) and left ventricular activation time (LVAT). METHODS: This multicenter study enrolled 50 consecutive bradycardia patients who met pacemaker therapy guidelines and received LBBAP implantation via the trans-ventricular septal approach. After at least 3 months postimplant, 12-lead ECGs and pacing parameters were obtained. Cardiac computed tomography (CT) imaging was performed to assess the LBBAP lead tip distance from the LV blood pool. RESULTS: Among the 50 patients, analyzable CT images were obtained in 42. In 23 of the 42 patients, the lead tips were within 2 mm to the LV blood pool (the LV subendocardial (LVSE) group), 13 between 2 and 4 mm (the Near-LVSE group), and the remaining 6 beyond 4 mm (the Mid-LV septal (Mid-LVS) group). No significant differences in paced QRSd were found among the three groups (LVSE, 107 ± 15 ms; Near-LVSE, 106 ± 13 ms; Mid-LVS, 104 ± 15 ms; p = .87). LVAT in the LVSE (64 ± 7 ms) was significantly shorter than in the Mid-LVS (72 ± 8 ms; p < .05), but not significantly different from that in the Near-LVSE (69 ± 8 ms; p > .05). CONCLUSION: In routine LBBAP practice, paced narrow QRSd and fast LVAT, indicative of physiological pacing, were consistently achieved for lead tip location in the LV subendocardial or near LV subendocardial region.

A new method to recommend left ventricular lead positions for improved CRT volumetric response and long-term prognosis.

OBJECTIVES: Using ECG-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), we sought to develop and validate a new method to recommend left ventricular (LV) lead positions in order to improve volumetric response and long-term prognosis after cardiac resynchronization therapy (CRT). METHODS: Seventy-nine patients received gated SPECT MPI at baseline, and echocardiography at baseline and follow-up. The volumetric response referred to a reduction of ≥ 15% in LV end-systolic volume 6 months after CRT. After excluding apical, septal, and scarred segments, there were three levels of recommended segments: (1) the optimal recommendation: the latest contracting viable segment; (2) the 2nd recommendation: the late contracting viable segments whose contraction delays were within 10° of the optimal recommendation; and (3) the 3rd recommendation: the viable segments adjacent to the optimal recommendation when there was no late contracting viable segment. RESULTS: After excluding 11 patients whose LV lead was placed in apical or scarred segments, 75.6% of the patients concordant to recommended LV segments (n = 41) responded to CRT while 51.9% of those with non-recommended LV lead locations (n = 27) were responders (P = .043). Response rates were 76.9%, 76.9% , and 73.3% (P = .967), respectively, when LV lead was implanted in the optimal recommendation (n = 13), the 2nd recommendation (n = 13), and the 3rd recommendation (n = 15). LV leads placed at recommended segments reduced composite events of all-cause mortality or heart failure (HF) rehospitalization compared with pacing at non-recommended segments (log-rank χ2 = 5.623, P = .018). CONCLUSIONS: Pacing in the recommended LV lead segments identified on gated SPECT MPI was associated with improved volumetric response to CRT and long-term prognosis.

Ventricular tachycardia and heart failure in a patient of mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm: A case report.

Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHC) with apical aneurysm is a rare type of cardiomyopathy. It is associated with an elevated risk of ventricular arrhythmias, thromboembolism, heart failure and sudden cardiac death. The present case study reports on a patient with MVOHC and apical aneurysm who developed ventricular arrhythmias and heart failure. The patient received an implantable cardioverter defibrillator for prevention of fatal arrhythmias. Ventricular tachycardia was terminated by increased doses of amiodarone and ß-blocker. Transthoracic echocardiography indicated a mid-ventricular gradient of 64 mmHg. The patient refused surgical treatment and opted for alcohol septal ablation (ASA). At the 6-month follow-up, a rebound of the gradient following ASA was observed on echocardiography. In the present study, timely recognition of MVOHC with apical aneurysm led to prompt defibrillator implantation for prophylaxis regarding further malignant arrhythmias. Surgical management should be considered in symptomatic patients with MVOHC and apical aneurysm.

Particle Image Velocimetry of Oil-Water Two-Phase Flow with High Water Cut and Low Flow Velocity in a Horizontal Small-Diameter Pipe.

Velocity and flow field are both parameters to measure flow characteristics, which can help determine the logging location and response time of logging instruments. Particle image velocimetry (PIV) is an intuitive velocity measurement method. However, due to the limitations of image acquisition equipment and the flow pipe environment, the velocity of a horizontal small-diameter pipe with high water cut and low flow velocity based on PIV has measurement errors in excess of 20%. To solve this problem, this paper expands one-dimensional displacement sub-pixel fitting to two dimensions and improves the PIV algorithm by Kriging interpolation. The improved algorithm is used to correct the blank and error vectors. The simulation shows that the number of blank and error vectors is reduced, and the flow field curves are smooth and closer to the actual flow field. The experiment shows that the improved algorithm has a maximum measurement error of 5.9%, which is much lower than that of PIV, and that it also has high stability and a repeatability of 3.14%. The improved algorithm can compensate for the local missing flow field and reduce the requirements related to the measurement equipment and environment. The findings of this study can be helpful for the interpretation of well logging data and the design of well logging instruments.

Detail-enhanced multimodality medical image fusion based on gradient minimization smoothing filter and shearing filter.

In this paper, a detail-enhanced multimodality medical image fusion algorithm is proposed by using proposed multi-scale joint decomposition framework (MJDF) and shearing filter (SF). The MJDF constructed with gradient minimization smoothing filter (GMSF) and Gaussian low-pass filter (GLF) is used to decompose source images into low-pass layers, edge layers, and detail layers at multiple scales. In order to highlight the detail information in the fused image, the edge layer and the detail layer in each scale are weighted combined into a detail-enhanced layer. As directional filter is effective in capturing salient information, so SF is applied to the detail-enhanced layer to extract geometrical features and obtain directional coefficients. Visual saliency map-based fusion rule is designed for fusing low-pass layers, and the sum of standard deviation is used as activity level measurement for directional coefficients fusion. The final fusion result is obtained by synthesizing the fused low-pass layers and directional coefficients. Experimental results show that the proposed method with shift-invariance, directional selectivity, and detail-enhanced property is efficient in preserving and enhancing detail information of multimodality medical images. Graphical abstract The detailed implementation of the proposed medical image fusion algorithm.

Double Quantum Image Encryption Based on Arnold Transform and Qubit Random Rotation.

Quantum image encryption offers major advantages over its classical counterpart in terms of key space, computational complexity, and so on. A novel double quantum image encryption approach based on quantum Arnold transform (QAT) and qubit random rotation is proposed in this paper, in which QAT is used to scramble pixel positions and the gray information is changed by utilizing random qubit rotation. Actually, the independent random qubit rotation operates once, respectively, in spatial and frequency domains with the help of quantum Fourier transform (QFT). The encryption process accomplishes pixel confusion and diffusion, and finally the noise-like cipher image is obtained. Numerical simulation and theoretical analysis verify that the method is valid and it shows superior performance in security and computational complexity.

Design and numerical simulation on an auto-cumulative flowmeter in horizontal oil-water two-phase flow.

In order to accurately measure the flow rate under the low yield horizontal well conditions, an auto-cumulative flowmeter (ACF) was proposed. Using the proposed flowmeter, the oil flow rate in horizontal oil-water two-phase segregated flow can be finely extracted. The computational fluid dynamics software Fluent was used to simulate the fluid of the ACF in oil-water two-phase flow. In order to calibrate the simulation measurement of the ACF, a novel oil flow rate measurement method was further proposed. The models of the ACF were simulated to obtain and calibrate the oil flow rate under different total flow rates and oil cuts. Using the finite-element method, the structure of the seven conductance probes in the ACF was simulated. The response values for the probes of the ACF under the conditions of oil-water segregated flow were obtained. The experiments for oil-water segregated flow under different heights of the oil accumulation in horizontal oil-water two-phase flow were carried out to calibrate the ACF. The validity of the oil flow rate measurement in horizontal oil-water two-phase flow was verified by simulation and experimental results.

Clinical investigation of left ventricular pacing using coronary sinus in patients with mechanical prosthetic tricuspid valve replacement.

BACKGROUND: Although transvenous right ventricular (RV) endocardial lead placement is routine practice in clinical pacing, RV inaccessibility in certain clinical situations mandates the search for other sites. HYPOTHESIS: This study is aimed to verify whether left ventricular lead through coronary sinus is safe and efficient. METHODS: Based on a retrospective analysis of a single-center series of 4 patients with inaccessibility for RV pacing, we report on the feasibility and reliability of coronary sinus (CS) pacing via left ventricular (LV) lead, which usually is used in cardiac resynchronization therapy. Four patients with valvular heart disease and bradycardias post-mechanical prosthetic tricuspid valve replacement were studied. The LV leads were implanted into the lateral vein or great cardiac vein of the CS, and all parameters were programmed postprocedure. RESULTS: In all cases procedures yielded favorable parameters, with 1 CS dissection. At long-term follow-up, there was no threshold increase or lead dislocation. CONCLUSIONS: LV lead implantation through the CS appears safe and efficacious in patients with inaccessibility for RV pacing.

Novel Downhole Electromagnetic Flowmeter for Oil-Water Two-Phase Flow in High-Water-Cut Oil-Producing Wells.

First, the measuring principle, the weight function, and the magnetic field of the novel downhole inserted electromagnetic flowmeter (EMF) are described. Second, the basic design of the EMF is described. Third, the dynamic experiments of two EMFs in oil-water two-phase flow are carried out. The experimental errors are analyzed in detail. The experimental results show that the maximum absolute value of the full-scale errors is better than 5%, the total flowrate is 5-60 m³/d, and the water-cut is higher than 60%. The maximum absolute value of the full-scale errors is better than 7%, the total flowrate is 2-60 m³/d, and the water-cut is higher than 70%. Finally, onsite experiments in high-water-cut oil-producing wells are conducted, and the possible reasons for the errors in the onsite experiments are analyzed. It is found that the EMF can provide an effective technology for measuring downhole oil-water two-phase flow.

The Finite Element Analysis for a Mini-Conductance Probe in Horizontal Oil-Water Two-Phase Flow.

Oil-water two-phase flow is widespread in petroleum industry processes. The study of oil-water two-phase flow in horizontal pipes and the liquid holdup measurement of oil-water two-phase flow are of great importance for the optimization of the oil production process. This paper presents a novel sensor, i.e., a mini-conductance probe (MCP) for measuring pure-water phase conductivity of oil-water segregated flow in horizontal pipes. The MCP solves the difficult problem of obtaining the pure-water correction for water holdup measurements by using a ring-shaped conductivity water-cut meter (RSCWCM). Firstly, using the finite element method (FEM), the spatial sensitivity field of the MCP is investigated and the optimized MCP geometry structure is determined in terms of the characteristic parameters. Then, the responses of the MCP for the oil-water segregated flow are calculated, and it is found that the MCP has better stability and sensitivity to the variation of water-layer thickness in the condition of high water holdup and low flow velocity. Finally, the static experiments for the oil-water segregated flow were carried out and a novel calibration method for pure-water phase conductivity measurements was presented. The validity of the pure-water phase conductivity measurement with segregated flow in horizontal pipes was verified by experimental results.