Detection of Pedestrians in Reverse Camera Using Multimodal Convolutional Neural Networks.

In recent years, the application of artificial intelligence (AI) in the automotive industry has led to the development of intelligent systems focused on road safety, aiming to improve protection for drivers and pedestrians worldwide to reduce the number of accidents yearly. One of the most critical functions of these systems is pedestrian detection, as it is crucial for the safety of everyone involved in road traffic. However, pedestrian detection goes beyond the front of the vehicle; it is also essential to consider the vehicle's rear since pedestrian collisions occur when the car is in reverse drive. To contribute to the solution of this problem, this research proposes a model based on convolutional neural networks (CNN) using a proposed one-dimensional architecture and the Inception V3 architecture to fuse the information from the backup camera and the distance measured by the ultrasonic sensors, to detect pedestrians when the vehicle is reversing. In addition, specific data collection was performed to build a database for the research. The proposed model showed outstanding results with 99.85% accuracy and 99.86% correct classification performance, demonstrating that it is possible to achieve the goal of pedestrian detection using CNN by fusing two types of data.

Hard Voting Ensemble Approach for the Detection of Type 2 Diabetes in Mexican Population with Non-Glucose Related Features.

Type 2 diabetes mellitus (T2DM) represents one of the biggest health problems in Mexico, and it is extremely important to early detect this disease and its complications. For a noninvasive detection of T2DM, a machine learning (ML) approach that uses ensemble classification models with dichotomous output that is also fast and effective for early detection and prediction of T2D can be used. In this article, an ensemble technique by hard voting is designed and implemented using generalized linear regression (GLM), support vector machines (SVM) and artificial neural networks (ANN) for the classification of T2DM patients. In the materials and methods as a first step, the data is balanced, standardized, imputed and integrated into the three models to classify the patients in a dichotomous result. For the selection of features, an implementation of LASSO is developed, with a 10-fold cross-validation and for the final validation, the Area Under the Curve (AUC) is used. The results in LASSO showed 12 features, which are used in the implemented models to obtain the best possible scenario in the developed ensemble model. The algorithm with the best performance of the three is SVM, this model obtained an AUC of 92% ± 3%. The ensemble model built with GLM, SVM and ANN obtained an AUC of 90% ± 3%.

Classification of Depressive and Schizophrenic Episodes Using Night-Time Motor Activity Signal.

Major depressive disorder (MDD) is the most recurrent mental illness globally, affecting approximately 5% of adults. Furthermore, according to the National Institute of Mental Health (NIMH) of the U.S., calculating an actual schizophrenia prevalence rate is challenging because of this illness's underdiagnosis. Still, most current global metrics hover between 0.33% and 0.75%. Machine-learning scientists use data from diverse sources to analyze, classify, or predict to improve the psychiatric attention, diagnosis, and treatment of MDD, schizophrenia, and other psychiatric conditions. Motor activity data are gaining popularity in mental illness diagnosis assistance because they are a cost-effective and noninvasive method. In the knowledge discovery in databases (KDD) framework, a model to classify depressive and schizophrenic patients from healthy controls is constructed using accelerometer data. Taking advantage of the multiple sleep disorders caused by mental disorders, the main objective is to increase the model's accuracy by employing only data from night-time activity. To compare the classification between the stages of the day and improve the accuracy of the classification, the total activity signal was cut into hourly time lapses and then grouped into subdatasets depending on the phases of the day: morning (06:00-11:59), afternoon (12:00-17:59), evening (18:00-23:59), and night (00:00-05:59). Random forest classifier (RFC) is the algorithm proposed for multiclass classification, and it uses accuracy, recall, precision, the Matthews correlation coefficient, and F1 score to measure its efficiency. The best model was night-featured data and RFC, with 98% accuracy for the classification of three classes. The effectiveness of this experiment leads to less monitoring time for patients, reducing stress and anxiety, producing more efficient models, using wearables, and increasing the amount of data.

In-Vehicle Alcohol Detection Using Low-Cost Sensors and Genetic Algorithms to Aid in the Drinking and Driving Detection.

Worldwide, motor vehicle accidents are one of the leading causes of death, with alcohol-related accidents playing a significant role, particularly in child death. Aiming to aid in the prevention of this type of accidents, a novel non-invasive method capable of detecting the presence of alcohol inside a motor vehicle is presented. The proposed methodology uses a series of low-cost alcohol MQ3 sensors located inside the vehicle, whose signals are stored, standardized, time-adjusted, and transformed into 5 s window samples. Statistical features are extracted from each sample and a feature selection strategy is carried out using a genetic algorithm, and a forward selection and backwards elimination methodology. The four features derived from this process were used to construct an SVM classification model that detects presence of alcohol. The experiments yielded 7200 samples, 80% of which were used to train the model. The rest were used to evaluate the performance of the model, which obtained an area under the ROC curve of 0.98 and a sensitivity of 0.979. These results suggest that the proposed methodology can be used to detect the presence of alcohol and enforce prevention actions.

Deep artificial neural network based on environmental sound data for the generation of a children activity classification model.

Children activity recognition (CAR) is a subject for which numerous works have been developed in recent years, most of them focused on monitoring and safety. Commonly, these works use as data source different types of sensors that can interfere with the natural behavior of children, since these sensors are embedded in their clothes. This article proposes the use of environmental sound data for the creation of a children activity classification model, through the development of a deep artificial neural network (ANN). Initially, the ANN architecture is proposed, specifying its parameters and defining the necessary values for the creation of the classification model. The ANN is trained and tested in two ways: using a 70-30 approach (70% of the data for training and 30% for testing) and with a k-fold cross-validation approach. According to the results obtained in the two validation processes (70-30 splitting and k-fold cross validation), the ANN with the proposed architecture achieves an accuracy of 94.51% and 94.19%, respectively, which allows to conclude that the developed model using the ANN and its proposed architecture achieves significant accuracy in the children activity classification by analyzing environmental sound.

A Case⁻Control Study of Socio-Economic and Nutritional Characteristics as Determinants of Dental Caries in Different Age Groups, Considered as Public Health Problem: Data from NHANES 2013⁻2014.

One of the principal conditions that affects oral health worldwide is dental caries, occurring in about 90% of the global population. This pathology has been considered a challenge because of its high prevalence, besides being a chronic but preventable disease which can be caused by a series of different demographic, dietary" among others. Based on this problem, in this research a demographic and dietary features analysis is performed for the classification of subjects according to their oral health status based on caries, according to the age group where the population belongs, using as feature selector a technique based on fast backward selection (FBS) approach for the development of three predictive models, one for each age range (group 1: 10⁻19; group 2: 20⁻59; group 3: 60 or more years old). As validation, a net reclassification improvement (NRI), AUC, ROC, and OR values are used to evaluate their classification accuracy. We analyzed 189 demographic and dietary features from National Health and Nutrition Examination Survey (NHANES) 2013⁻2014. Each model obtained statistically significant results for most features and narrow OR confidence intervals. Age group 2 obtained a mean NRI = -0.080 and AUC = 0.933; age group 3 obtained a mean NRI = -0.024 and AUC = 0.787; and age group 4 obtained a mean NRI = -0.129 and AUC = 0.735. Based on these results, it is concluded that these specific demographic and dietary features are significant determinants for estimating the oral health status in patients based on their likelihood of developing caries, and the age group could imply different risk factors for subjects.

Speed Bump Detection Using Accelerometric Features: A Genetic Algorithm Approach.

Among the current challenges of the Smart City, traffic management and maintenance are of utmost importance. Road surface monitoring is currently performed by humans, but the road surface condition is one of the main indicators of road quality, and it may drastically affect fuel consumption and the safety of both drivers and pedestrians. Abnormalities in the road, such as manholes and potholes, can cause accidents when not identified by the drivers. Furthermore, human-induced abnormalities, such as speed bumps, could also cause accidents. In addition, while said obstacles ought to be signalized according to specific road regulation, they are not always correctly labeled. Therefore, we developed a novel method for the detection of road abnormalities (i.e., speed bumps). This method makes use of a gyro, an accelerometer, and a GPS sensor mounted in a car. After having the vehicle cruise through several streets, data is retrieved from the sensors. Then, using a cross-validation strategy, a genetic algorithm is used to find a logistic model that accurately detects road abnormalities. The proposed model had an accuracy of 0.9714 in a blind evaluation, with a false positive rate smaller than 0.018, and an area under the receiver operating characteristic curve of 0.9784. This methodology has the potential to detect speed bumps in quasi real-time conditions, and can be used to construct a real-time surface monitoring system.

Incidence and predictors of clinically relevant cardiac perforation associated with systematic implantation of active-fixation pacing and defibrillation leads: a single-centre experience with over 3800 implanted leads.

AIMS: Active-fixation leads have been associated with higher incidence of cardiac perforation. Large series specifically evaluating this complication are lacking. We sought to evaluate the incidence and predictors of clinically relevant cardiac perforation in a consecutive series of patients implanted with active-fixation pacing and defibrillation leads. METHODS AND RESULTS: We conducted a retrospective observational study including all consecutive patients implanted with an active-fixation pacing/defibrillation lead at our institution from July 2008 to July 2015. The incidence of clinically relevant cardiac perforation and cardiac tamponade was evaluated. Univariate and multivariate analyses were used to identify predictors of cardiac perforation. Acute and long-term management of these patients was also investigated. A total of 3822 active-fixation pacing (n = 3035) and defibrillation (n = 787) leads were implanted in 2200 patients. Seventeen patients (0.8%) had clinically relevant cardiac perforation (13 acute and 4 subacute perforations), and 13 (0.5%) had cardiac tamponade resolved with pericardiocentesis. None of the patients with cardiac perforation required surgical treatment. In multivariate analysis, an age >80 years (OR 3.84, 95% CI 1.14-12.87, P = 0.029), female sex (OR 3.14, 95% CI 1.07-9.22, P = 0.037), and an apical position of the right ventricular lead (OR 3.37, 95% CI 1.17-9.67, P = 0.024) were independent predictors of cardiac perforation. CONCLUSIONS: Implantation of active-fixation leads is associated with a low incidence of clinically relevant cardiac perforation. Older and female patients have a higher risk of perforation as well as those patients receiving the ventricular lead in an apical position.

Aislamiento eléctrico venoso pulmonar con catéter láser en el tratamiento de la fibrilación auricular paroxística y persistente. Resultados a un año / Electrical isolation of pulmonary veins using laser catheter in the treatment of paroxysmal and persistent atrial fibrillation. One-year results

Introducción y objetivos: Recientemente se ha introducido un nuevo catéter-balón láser para el aislamiento eléctrico venoso pulmonar que permite la visualización del tejido auricular. El objetivo del presente trabajo es evaluar la seguridad y la eficacia a medio plazo de este catéter en el tratamiento de la fibrilación auricular. Métodos: Se realizó ablación con catéter-balón láser a 71 pacientes con fibrilación auricular paroxística (80%) y persistente (20%). Se consideró recurrencia arrítmica los episodios de duración > 30 s. Durante el seguimiento se realizaron visitas periódicas cada 3 meses con Holter 24-48 h. Resultados: Se logró aislar 275 de 278 (99%) de las venas pulmonares. Los tiempos medios de procedimiento y de fluoroscopia fueron 154 ± 25 y 34 ± 15 min respectivamente. Un 89% de las venas se aislaron en el primer intento. La complicación más frecuente fue la parálisis del nervio frénico (5,6%), que apareció solo en los primeros 18 casos. Se siguió a 59 pacientes durante una media de 420 ± 193 días, con una tasa de recurrencia arrítmica del 12 y el 30% respectivamente en fibrilación auricular paroxística y persistente (p = 0,155). Conclusiones: El catéter-balón láser es un sistema seguro y efectivo para lograr el aislamiento eléctrico de las venas pulmonares. Entre sus ventajas destaca la capacidad de adaptarse a la anatomía venosa pulmonar con un único catéter y la eficacia con que logra el aislamiento eléctrico de las venas pulmonares, con una evolución clínica favorable a medio plazo, incluso para los pacientes con fibrilación auricular persistente (AU)

Introduction and objectives: A new laser balloon that allows visualization of atrial tissue has recently been introduced for pulmonary vein electrical isolation. The aim of this study was to evaluate the mid-term safety and efficacy of this catheter in the treatment of atrial fibrillation. Methods: Laser balloon ablation was performed in 71 patients with paroxysmal (80%) or persistent (20%) atrial fibrillation. Arrhythmia recurrence was defined as any episode lasting longer than 30 seconds. During follow-up, regular visits were performed every 3 months with 24- to 48-hour Holter tests. Results: Isolation was possible in 275 of 278 (99%) of pulmonary veins. Mean procedure and fluoroscopy times were 154 ± 25 and 34 ± 15 minutes, respectively. A total of 89% of veins were isolated during the first attempt. The most common complication was phrenic nerve paralysis (5.6%), which appeared in only the first 18 cases. A total of 59 patients received follow-up for a mean of 420 ± 193 days, with a rate of arrhythmia recurrence of 12% and 30%, respectively, in paroxysmal and persistent atrial fibrillation (P = .155). Conclusions: The laser balloon is a safe and effective system for pulmonary vein electrical isolation. Its advantages include the capacity to adapt to pulmonary vein anatomy using a single catheter, the efficacy with which pulmonary vein electrical isolation is achieved, and the favorable mid-term clinical progress, even for patients with persistent atrial fibrillation (AU)

Safety and Feasibility of a Minimally Fluoroscopic Approach for Ventricular Tachycardia Ablation in Patients With Structural Heart Disease: Influence of the Ventricular Tachycardia Substrate.

BACKGROUND: We sought to evaluate the safety and feasibility of a minimally fluoroscopic approach using the CARTOUNIVU module during scar-related ventricular tachycardia (VT) ablation. METHODS AND RESULTS: Consecutive patients with structural heart disease undergoing VT ablation using the CARTOUNIVU module were prospectively included and classified depending on their VT substrate: (1) ischemic VT (IVT) and (2) nonischemic VT and depending on the presence of an epicardial access. Radiation exposure parameters and major and minor procedure-related complications were registered. A near-zero fluoroscopy exposure was defined as those procedures with an effective dose ≤1 mSv. A total of 44 VT ablation procedures were performed in 41 patients (22 IVT and 19 nonischemic VT). The use of the CARTOUNIVU module resulted in low levels of radiation exposure: median total fluoroscopy time and effective dose of 6.08 (1.51-12.36) minutes and 2.15 (0.58-8.22) mSv, respectively. Patients with IVT had lower radiation exposure than patients with nonischemic VT (total fluoroscopy time, 2.53 [1.22-11.22] versus 8.51 [5.55-17.34] minutes; P=0.016). Epicardial access was associated with significantly higher levels of radiation exposure. Complications occurred in 4.9% patients, none of them being related to the use of the image integration tool. A near-zero fluoroscopy ablation could be performed in 14 of 44 procedures (32%), 43% of IVT procedures, and 50% of procedures with endocardial access only. CONCLUSIONS: The use of the CARTOUNIVU module during scar-related VT ablation resulted in low levels of radiation exposure. A near-zero fluoroscopy approach can be achieved in up to half of the procedures, especially in IVT patients with endocardial ablation.

The use of multisite left ventricular pacing via quadripolar lead improves acute haemodynamics and mechanical dyssynchrony assessed by radial strain speckle tracking: initial results.

AIMS: The objective of the present study was to evaluate the effect of multipoint pacing (MPP) on acute haemodynamics, cardiac contractility, and left ventricle (LV) dyssynchrony, in comparison with conventional cardiac resynchronization therapy (CRT). METHODS AND RESULTS: An open-label, non-randomized, single-centre, prospective study was designed. Twenty-seven consecutive patients were included. Evaluation of pacing configurations was performed in a random order. Transthoracic echocardiography was used to obtain haemodynamic and dyssynchrony parameters. Left ventricular ejection fraction (LVEF) was significantly superior in MPP compared with baseline (38.4 ± 1.8% vs. 26.1 ± 2.2%; P < 0.001), and in conventional pacing configuration compared with baseline (33.2 ± 1.8% vs. 26.1 ± 2.2%; P = 0.007). Cardiac index (CI) was increased by 21.8 ± 5.4% and 34.7 ± 5.1% in conventional and MPP configurations, respectively (P = 0.19). Percentage of acute responders (CI increase ≥10%) was 62.9 and 85.2% in conventional and MPP, respectively (P < 0.001). LV dyssynchrony was defined by radial strain rate parameters. Baseline anteroseptal-to-posterior wall time delay was 168 ± 21 ms. It was reduced until 70.4 ± 29 ms in conventional and -6.6 ± 11 ms in MPP (conventional vs. baseline P = 0.04; MPP vs. conventional P = 0.05). Standard deviation of the time-to-peak radial strain of the 6 LV basal segments was 101 ± 9.7, 80.3 ± 9.2, and 66 ± 8.03 ms in baseline, conventional, and MPP configurations, respectively (MPP vs. basal P = 0.012). Finally, we observed a positive correlation (r = 0.69) between reduction in dyssynchrony and CI increase (P < 0.0001). CONCLUSION: MPP showed a further reduction in LV dyssynchrony compared with conventional biventricular pacing. Moreover, MPP resulted in an additional improvement in LVEF and in CI, and this was translated into a higher number of acute responders to CRT.

Electrical Isolation of Pulmonary Veins Using Laser Catheter in the Treatment of Paroxysmal and Persistent Atrial Fibrillation. One-year Results.

INTRODUCTION AND OBJECTIVES: A new laser balloon that allows visualization of atrial tissue has recently been introduced for pulmonary vein electrical isolation. The aim of this study was to evaluate the mid-term safety and efficacy of this catheter in the treatment of atrial fibrillation. METHODS: Laser balloon ablation was performed in 71 patients with paroxysmal (80%) or persistent (20%) atrial fibrillation. Arrhythmia recurrence was defined as any episode lasting longer than 30 seconds. During follow-up, regular visits were performed every 3 months with 24- to 48-hour Holter tests. RESULTS: Isolation was possible in 275 of 278 (99%) of pulmonary veins. Mean procedure and fluoroscopy times were 154 ± 25 and 34 ± 15minutes, respectively. A total of 89% of veins were isolated during the first attempt. The most common complication was phrenic nerve paralysis (5.6%), which appeared in only the first 18 cases. A total of 59 patients received follow-up for a mean of 420 ± 193 days, with a rate of arrhythmia recurrence of 12% and 30%, respectively, in paroxysmal and persistent atrial fibrillation (P = .155). CONCLUSIONS: The laser balloon is a safe and effective system for pulmonary vein electrical isolation. Its advantages include the capacity to adapt to pulmonary vein anatomy using a single catheter, the efficacy with which pulmonary vein electrical isolation is achieved, and the favorable mid-term clinical progress, even for patients with persistent atrial fibrillation.

Rasgos no ventriculares, clínicos y funcionales de la mutación RyR2 R420Q causante de taquicardia ventricular polimórfica catecolaminérgica / Non-ventricular, clinical, and functional features of the ryr2 r420q mutation causing catecholaminergic polymorphic ventricular tachycardia

Introducción y objetivos: La taquicardia ventricular polimórfica catecolaminérgica es una enfermedad maligna que se debe a mutaciones en las proteínas que controlan la homeostasis del Ca2+. Aunque el fenotipo se caracteriza por arritmias ventriculares polimórficas desencadenadas por el estrés, no se han caracterizado plenamente las arritmias supraventriculares que en ocasiones las acompañan. Métodos: Veinticinco miembros de una familia española en la que había habido varias muertes súbitas fueron evaluados mediante electrocardiograma, pruebas de esfuerzo y prueba de desenmascaramiento con adrenalina opcionalmente. Se realizó secuenciación selectiva deRyR2 en un miembro afectado y un cribado en cascada al resto de la familia. Se generó la mutación RyR2R420Q en células HEK-293 mediante mutagénesis dirigida, con objeto de realizar estudios funcionales in vitro. Resultados: Las pruebas de esfuerzo desenmascararon taquicardia ventricular polimórfica catecolaminérgica en 8 familiares (sensibilidad del 89%; valor predictivo positivo del 100%; valor predictivo negativo del 93%), todos ellos portadores de una mutación heterocigota RyR2R420Q, que estaba presente también en el caso probando y en una chica joven sin prueba de esfuerzo, lo que corresponde a una penetrancia del 91% al final del seguimiento. Es de destacar que en los pacientes se identificó bradicardia sinusal, arritmias auriculares y de la unión y/u ondas U gigantes tras esfuerzo. Tras la permeabilización y en las células intactas, las células que expresaban RyR2R420Q mostraron un pico de liberación de Ca2+ menor que el de las célulasRyR2 no mutado o wild-type. Sin embargo, a una concentración de Ca2+ intracelular fisiológica, equivalente a la concentración citosólica diastólica, las células RyR2R420Q liberaban más Ca2+ y oscilaban con mayor rapidez que las células con RyR2 no mutado o wild-type. Conclusiones: La mutación missense RyR2R420Q se identificó en el extremo aminoterminal del gen RyR2 en esta familia muy sintomática. Es de destacar que esta mutación se asocia a bradicardia sinusal, arritmias auriculares y de la unión y ondas U gigantes. En conjunto, los estudios de expresión heteróloga funcional indican que la mutación RyR2R420Q causa un comportamiento aberrante del canal, con pérdida o ganancia de función, según cuál sea la concentración de Ca2+ intracelular citosólica

Introduction and objectives: Catecholaminergic polymorphic ventricular tachycardia is a malignant disease, due to mutations in proteins controlling Ca2+ homeostasis. While the phenotype is characterized by polymorphic ventricular arrhythmias under stress, supraventricular arrhythmias may occur and are not fully characterized. Methods: Twenty-five relatives from a Spanish family with several sudden deaths were evaluated with electrocardiogram, exercise testing, and optional epinephrine challenge. Selective RyR2 sequencing in an affected individual and cascade screening in the rest of the family was offered. The RyR2R420Q mutation was generated in HEK-293 cells using site-directed mutagenesis to conduct in vitro functional studies. Results: The exercise testing unmasked catecholaminergic polymorphic ventricular tachycardia in 8 relatives (sensitivity = 89%; positive predictive value = 100%; negative predictive value = 93%), all of them carrying the heterozygous RyR2R420Q mutation, which was also present in the proband and a young girl without exercise testing, a 91% penetrance at the end of the follow-up. Remarkably, sinus bradycardia, atrial and junctional arrhythmias, and/or giant post-effort U-waves were identified in patients. Upon permeabilization and in intact cells, the RyR2R420Q expressing cells showed a smaller peak of Ca2+ release than RyR2 wild-type cells. However, at physiologic intracellular Ca2+ concentration, equivalent to the diastolic cytosolic concentration, the RyR2R420Q released more Ca2+ and oscillated faster than RyR2 wild-type cells. Conclusions The missense RyR2R420Q mutation was identified in the N-terminus of the RyR2 gene in this highly symptomatic family. Remarkably, this mutation is associated with sinus bradycardia, atrial and junctional arrhythmias, and giant U-waves. Collectively, functional heterologous expression studies suggest that the RyR2R420Q behaves as an aberrant channel, as a loss- or gain-of-function mutation depending on cytosolic intracellular Ca2+ concentration

Initial Experience with a New Image Integration Module Designed for Reducing Radiation Exposure During Electrophysiological Ablation Procedures.

INTRODUCTION: Reduction of radiation exposure during cardiac arrhythmia ablation procedures is desirable. We sought to evaluate the utility of a new image integration module (CARTOUNIVU(TM) ) in reducing fluoroscopy times and dosages during left atrial arrhythmia (LAA) and ventricular tachycardia (VT) ablation procedures. METHODS AND RESULTS: Consecutive patients undergoing LAA (n = 28)/VT (n = 13) ablation using the CARTOUNIVU(TM) module were included. Total fluoroscopy time, radiation dose (total dose area product [tDAP], effective dose [ED]), and procedure duration were evaluated. A retrospective cohort of patients who underwent LAA (n = 16)/VT(n = 8) ablation without the new image integration module served as a control group. The use of the new image integration module significantly reduced mean fluoroscopy time (5.2 minutes [IQR 1.9;6.8] in the LAA ablation UNIVU group vs. 28.2 minutes [IQR 15.3;37.8] in the control group, P<0.001; 9.8 minutes [IQR 4.5;13.1] vs. 25.5 minutes [IQR 14.1;30.9] for VT ablation, P = 0.013), tDAP (2,088 cGy*cm(2) [IQR 664;2911] vs. 5,893 cGy*cm(2) [IQR 3088;8483], P< 0.001 for LAA ablation; 3,917 cGy*cm(2) [IQR 948;4217] vs. 12,377 cGy*cm(2) (IQR 3385;23157) for VT ablation patients, P = 0.025) and ED (4.1 mSv [IQR 1;5.8] vs. 11.8 mSv [IQR 6.2;16.9] for LAA ablation patients, P< 0.001; 7.8 mSv [IQR 1.9;8.4] vs. 24.7 mSv [IQR 6.8;46.3] for VT ablation patients, P = 0.025). Procedure duration did not significantly change (174 ± 45 minutes vs. 197 ± 36 minutes for LAA ablation, P = 0.083; 201 ± 51 minutes vs. 201 ± 63 minutes for VT ablation, P = 0.860). No serious adverse events related to the use of the CARTOUNIVU(TM) module occurred. CONCLUSIONS: The new image integration module significantly reduced total fluoroscopy time and mean radiation dose without influence in procedure duration during ablation of complex atrial and ventricular arrhythmias.

Systematic Implantation of Pacemaker/ICDs under Active Oral Anticoagulation Irrespective of Patient's Individual Preoperative Thromboembolic Risk.

BACKGROUND: A wide variability in the perioperative management of oral anticoagulation (OAC) has been documented in patients receiving cardiac rhythm management devices (CRMDs). We sought to evaluate the safety and feasibility of a new perioperative strategy consisting in systematically continuing OAC in all patients irrespective of their individual thromboembolic (TE) risk. METHODS: A total of 278 consecutive patients on chronic OAC receiving CRMDs were prospectively included. Patients were classified in high and low TE risk according to current guidelines for the perioperative management of antithrombotic therapy, but underwent implantation under active OAC (international normalized ratio 2-4) irrespective of their preoperative TE risk. Bleeding and TE complications were evaluated as well as other procedure-related complications, hospital stays, and the feasibility of outpatient implantations. RESULTS: A total of 117 patients were considered at high TE risk and 161 at low TE risk. Overall, the incidence of pocket hematoma was 2.9% with only three patients requiring pocket revision. Low TE risk patients had a very low incidence of pocket hematoma (1.9%) without needing pocket revision. The mean hospital stay was 1.17 ± 1.8 days and 169 patients (61%) received their CRMD in an outpatient basis, including 77 patients who were implanted with an implantable cardioverter defibrillator. No TE events were detected during the 30-day postimplant observation period in any patient. No other significant complications related with the implant (pneumothorax, hemothorax, cardiac tamponade) were registered. CONCLUSIONS: Systematic continuation of OAC in all patients undergoing implantation of CRMDs is safe and feasible, thus simplifying and standardizing the perioperative management in this setting.

Non-ventricular, Clinical, and Functional Features of the RyR2(R420Q) Mutation Causing Catecholaminergic Polymorphic Ventricular Tachycardia.

INTRODUCTION AND OBJECTIVES: Catecholaminergic polymorphic ventricular tachycardia is a malignant disease, due to mutations in proteins controlling Ca(2+) homeostasis. While the phenotype is characterized by polymorphic ventricular arrhythmias under stress, supraventricular arrhythmias may occur and are not fully characterized. METHODS: Twenty-five relatives from a Spanish family with several sudden deaths were evaluated with electrocardiogram, exercise testing, and optional epinephrine challenge. Selective RyR2 sequencing in an affected individual and cascade screening in the rest of the family was offered. The RyR2(R420Q) mutation was generated in HEK-293 cells using site-directed mutagenesis to conduct in vitro functional studies. RESULTS: The exercise testing unmasked catecholaminergic polymorphic ventricular tachycardia in 8 relatives (sensitivity = 89%; positive predictive value = 100%; negative predictive value = 93%), all of them carrying the heterozygous RyR2(R420Q) mutation, which was also present in the proband and a young girl without exercise testing, a 91% penetrance at the end of the follow-up. Remarkably, sinus bradycardia, atrial and junctional arrhythmias, and/or giant post-effort U-waves were identified in patients. Upon permeabilization and in intact cells, the RyR2(R420Q) expressing cells showed a smaller peak of Ca(2+) release than RyR2 wild-type cells. However, at physiologic intracellular Ca(2+) concentration, equivalent to the diastolic cytosolic concentration, the RyR2(R420Q) released more Ca(2+) and oscillated faster than RyR2 wild-type cells. CONCLUSIONS: The missense RyR2(R420Q) mutation was identified in the N-terminus of the RyR2 gene in this highly symptomatic family. Remarkably, this mutation is associated with sinus bradycardia, atrial and junctional arrhythmias, and giant U-waves. Collectively, functional heterologous expression studies suggest that the RyR2(R420Q) behaves as an aberrant channel, as a loss- or gain-of-function mutation depending on cytosolic intracellular Ca(2+) concentration.

The use of quadripolar left ventricular leads improves the hemodynamic response to cardiac resynchronization therapy.

BACKGROUND: The objective of the present study was to evaluate the usefulness of a left ventricle (LV) quadripolar lead in improving the hemodynamic response to cardiac resynchronization therapy (CRT). METHODS AND RESULTS: We included 27 consecutive patients implanted with a CRT device with an LV quadripolar lead. Hemodynamic parameters were evaluated at 3-month follow-up by using impedance cardiography. We assessed the highest cardiac output and the highest stroke volume (SV) obtained after atrioventricular and interventricular optimization with pacing from each of the four electrodes of the LV lead. Each patient was evaluated according to three different pacing configurations: unipolar-simulated, bipolar, and quadripolar. Biventricular pacing improved hemodynamics in comparison to the nonpaced measurements: cardiac index (CI): 2.69 L/min/m(2) versus 2.17 L/min/m(2) (P = 0.001). The hemodynamic response was highest in the quadripolar in comparison to unipolar-simulated and bipolar configurations, with an increase of 29%, 23%, and 27%, respectively, in relation to the reference CI and with an increase of 22%, 11%, and 18%, respectively, in relation to the reference indexed SV (P < 0.05, for the comparison between unipolar-simulated and quadripolar configurations). Twelve patients (44%) showed the best hemodynamic response by pacing from any of the two distal electrodes and 15 patients (56%) by pacing from the two proximal electrodes. Finally, CRT responder rates were higher in quadripolar versus bipolar and unipolar-simulated configurations: 90%, 85%, and 75%, respectively. CONCLUSIONS: The quadripolar LV lead was associated with a better hemodynamic response and higher CRT responder rates when compared with unipolar-simulated and bipolar LV leads.