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The visualization of heart rhythm disturbance and atrial fibrillation therapy allow the optimization of new cardiac catheter ablations. With the simulation software CST (Computer Simulation Technology, Darmstadt) electromagnetic and thermal simulations can be carried out to analyze and optimize different heart rhythm disturbance and cardiac catheters for pulmonary vein isolation. Another form of visualization is provided by haptic, three-dimensional print models. These models can be produced using an additive manufacturing method, such as a 3D printer. The aim of the study was to produce a 3D print of the Offenburg heart rhythm model with a representation of an atrial fibrillation ablation procedure to improve the visualization of simulation of cardiac catheter ablation.
The basis of 3D printing was the Offenburg heart rhythm model and the associated simulation of cryoablation of the pulmonary vein. The thermal simulation shows the pulmonary vein isolation of the left inferior pulmonary vein with the cryoballoon catheter Arctic Front AdvanceTM from Medtronic. After running through the simulation, the thermal propagation during the procedure was shown in the form of different colors. The three-dimensional print models were constructed on the base of the described simulation in a CAD program. Four different 3D printers are available for this purpose in a rapid prototyping laboratory at the University of Applied Science Offenburg. Two different printing processes were used: 1. a binder jetting printer with polymer gypsum and 2. a multi-material printer with photopolymer. A final print model with additional representation of the esophagus and internal esophagus catheter was also prepared for printing.
With the help of the thermal simulation results and the subsequent evaluation, it was possible to make a conclusion about the propagation of the cold emanating from the catheter in the myocardium and the surrounding tissue. It could be measured that already 3 mm from the balloon surface into the myocardium the temperature drops to 25 °C. The simulation model was printed using two 3D printing methods. Both methods as well as the different printing materials offer different advantages and disadvantages. While the first model made of polymer gypsum can be produced quickly and cheaply, the second model made of photopolymer takes five times longer and was twice as expensive. On the other hand, the second model offers significantly better properties and was more durable overall. All relevant parts, especially the balloon catheter and the conduction, are realistically represented. Only the thermal propagation in the form of different colors is not shown on this model.
Three-dimensional heart rhythm models as well as virtual simulations allow a very good visualization of complex cardiac rhythm therapy and atrial fibrillation treatment methods. The printed models can be used for optimization and demonstration of cryoballoon catheter ablation in patients with atrial fibrillation.
In bimodal cochlear implant (CI) / hearing aid (HA) users a constant interaural time delay in the order of several milliseconds occurs due to differences in signal processing of the devices. For MED-EL CI systems in combination with different HA types, we have quantified the respective device delay mismatch (Zirn et al. 2015). In the current study, we investigate the effect of the device delay mismatch in simulated and actual bimodal listeners on sound localization accuracy.
To deal with the device delay mismatch in actual bimodal listeners we delayed the CI stimulation according to the measured HA processing delay and two other values. With all delay values highly significant improvements of the rms error in the localization task were observed compared to the test without the delay. The results help to narrow down the optimal patient-specific delay value.
Introduction: Cardiac resynchronization therapy (CRT) with biventricular (BV) pacing is an established therapy for heart failure (HF) patients with ventricular desynchronization and reduced left ventricular (LV) ejection fraction. The aim of this study was to evaluate electrical ventricular desynchronization with transthoracic and transesophageal signal averaging electrocardiography in HF, to better select patients for CRT.
Methods: 13 HF patients (age 68 ± 10 years; 2 females, 11 males) with New York Heart Association (NYHA) class 2.8 ± 0.5, 28.6 ± 12.6 % LV ejection fraction and 155 ± 24 ms QRS duration (QRSD) were analysed with transthoracic and transesophageal electrocardiogram recording and novel National Intruments LabView 2009 signal averaging software. Esophageal TO Osypka catheter was perorally applied to the esophagus and placed in the position of maximum LV de-flection. The 0.05-Hz high-pass filtered surface electrocardiogram and the 10-Hz high-pass filtered bipolar transesophageal electrocardiogram were recorded with Bard EP-System and 1000-Hz sampling rate.
Results: Transesophageal LV electrogram recording was possible in all HF patients (n=13). Transesophageal interventricular conduction delay (IVCD) was 51 ± 19 ms and measured between the earliest onset of QRS in the 12-channel surface electrocardiogram and the onset of the LV deflection in the transesophageal electrocardiogram. Transesophageal intra-left ventricular delay (LVCD) was 90 ± 16 ms and measured between the onset and offset of the LV deflection in the transesophageal electrocardiogram. QRSD to transesophageal IVCD ratio was 3.43 ± 1.31 ms, QRSD to transesophageal LVCD ratio was 1.75 ± 0.28 ms and QRSD was evaluated between onset and offset of QRS signal in the 12-channel surface electrocardiogram.
Conclusion: Determination of IVCD, LVCD, QRSD-to-IVCD-ratio and QRSD-to-LVCD-ratio by transesophageal LV electrogram recording with LabView 2009 signal averaging technique may be useful parameters of ventricular desynchronisation to improve patient selection for CRT.
Introduction: Cardiac resynchronization therapy (CRT) with biventricular (BV) pacing is an established therapy for heart failure (HF) patients with ventricular desynchronisation and reduced left ventricular (LV) function. The aim of this study was to evaluate preejection period (PEP) and left ventricular ejection time (LVET) with transthoracic signal averaging impedance and electrocardiography in HF patients with and without BV pacing.
Methods: 10 HF patients (age 68.9 ± 8 years; 2 females, 9 males) with New York Heart Association (NYHA) class 2,9 ± 0.5, 30.9 ± 10.5 % LV ejection fraction and 159.4 ± 22.9 ms QRS duration were analysed with transthoracic impedance and electrocardiography (Cardioscreen Medis, Ilmenau, Germany) and novel National Intruments LabView 2009 signal averaging software. One day after BV pacing device implantation, AV and VV delays were optimized by transthoracic impedance cardiography and stroke volume (SV) and cardiac output (CO) were gained by Cardioscreen.
Results: Transthoracic impedance and electrocardiography AV and VV delay opimization was possible in all HF patients with BV pacing devices (n= 10). PEP was 154 ± 24ms without BV pacing and measured between onset of QRS in the surface electrocardiogram and onset of ventricular deflection in the impedance cardiogram. LVET was 342 ± 65ms without BV pacing and measured between onset and offset of ventricular deflection in the impedance cardiogram. The use of optimal AV and VV delay BV pacing resulted in improvement of SV from 64.1 ± 26.5 ml to 94.1 ± 33.96 ml (P < 0.05) and CO from 4.05 ± 1.36 l/min to 6.44 ± 1.56 l/min (P < 0.05).
Conclusion: PEP and LVET may be useful parameters of ventricular Desynchronisation. AV and VV delay optimized BV pacing improve SV and CO. Impedance and electrocardiography with LabView 2009 signal averaging may be a simple and useful technique to optimize CRT.
BiCI users’ sensitivity to interaural phase differences for single- and multi-channel stimulation
(2016)
Das normalhörende auditorische System ist in der Lage, interaurale Zeit- bzw. Phasendifferenzen zur verbesserten Signaldetektion im Störgeräusch zu nutzen. Dieses Phänomen wird häufig als binaurale Entmaskierung bezeichnet und ist sowohl bei einfachen Signalen wie Sinustönen, als auch bei Sprachsignalen im Störgeräusch wirksam. Vorangegangene Studien haben gezeigt, dass binaurale Entmaskierung eingeschränkt auch bei bilateralen CI-Trägern beobachtbar ist (Zirn et al., 2016).
Aktuelle Ergebnisse zeigen, dass die binaurale Entmaskierung sensitiv gegenüber der bilateralen CI-Anpassung ist. So lässt sich der Effekt durch tonotopen Abgleich und Herausstellen eines apikalen Feinstrukturkanals modulieren. Steigerungen der binauralen Entmaskierung um bis zu 1,5 dB sind auf diese Weise gegenüber der konventionellen CI-Anpassung möglich. Allerdings variiert der Einfluss der CI-Anpassung interindividuell erheblich.
Biological in situ methanation: Gassing concept and feeding strategy for enhanced performance
(2017)
The expansion of fluctuating renewable electricity production from wind and solar energy requires huge storage capacities. Power-to-gas (PtG) can contribute to tackle that issue via a two-step process, the electrolytic production of hydrogen and a subsequent methanation step (with additional CO2). The resulting fully grid compatible methane, also known as synthetic natural gas (SNG), can be both stored and transported in the vast existing natural gas infrastructure.
To overcome current major drawbacks of PtG, the relatively low efficiency and the high costs, we developed an improved method for the methanation step. In our approach we use a further development of the biological in situ methanation of hydrogen in biogas plants. Because this strategy uses directly internal residual CO2 from the biogas process in the biogas plant, you neither need additional external CO2 nor special reactors. Thus, PtG is combined with the production of an upgraded highly methane rich raw biogas.
However, the low solubility of hydrogen in aqueous solutions and the exploitation of the maximum biological production rates are still an engineering challenge for high performance biological in situ methanation.
In our experiments a setup with membrane gassing turned out to be most promising to ensure a sufficient gas liquid mass transfer of the hydrogen. The monitoring of hydrogenotrophic and aceticlastic archaea showed some adaption of these microbial subgroups to the hydrogen feed.
In order to achieve high methane concentrations of more than 90 % in the raw biogas a CO2-controlled hydrogen feed flow rate is suggested. For methane concentrations lower than 90 % simple current controlled hydrogen supply can be applied.
Introduction: To simplify AV delay (AVD) optimization in cardiac resynchronization therapy (CRT), we reported that the hemodynamically optimal AVD for VDD and DDD mode CRT pacing can be approximated by individually measuring implant-related interatrial conduction intervals (IACT) in oesophageal electrogram (LAE) and adding about 50ms. The programmer-based St Jude QuickOpt algorithm is utilizing this finding. By automatically measuring IACT in VDD operation, it predicts the sensed AVD by adding either 30ms or 60ms. Paced AVD is strictly 50ms longer than sensed AVD. As consequence of those variations, several studies identified distinct inaccuracies of QuickOpt. Therefore, we aimed to seek for better approaches to automate AVD optimization.
Methods: In a study of 35 heart failure patients (27m, 8f, age: 67±8y) with Insync III Marquis CRT-D systems we recorded telemetric electrograms between left ventricular electrode and superior vena cava shock coil (LVtip/SVC = LVCE) simultaneously with LAE. By LVCE we measured intervals As-Pe in VDD and Ap-Pe in DDD operation between right atrial sense-event (As) or atrial stimulus (Ap), resp., and end of the atrial activity (Pe). As-Pe and Ap-Pe were compared with As-LA an Ap-LA in LAE, respectively.
Results: End of the left atrial activity in LVCE could clearly be recognized in 35/35 patients in VDD and 29/35 patients in DDD operation. We found mean intervals As-LA of 40.2±24.5ms and Ap-LA of 124.3±20.6ms. As-Pe was 94.8±24.1ms and Ap-Pe was 181.1±17.8ms. Analyzing the sums of As-LA + 50ms with duration of As-Pe and Ap-LA + 50ms with duration of Ap-Pe, the differences were 4.7±9.2ms and 4.2±8.6ms, resp., only. Thus, hemodynamically optimal timing of the ventricular stimulus can be triggered by automatically detecting Pe in LVCE.
Conclusion: Based on minimal deviations between LAE and LVCE approach, we proposed companies to utilize the LVCE in order to automate individual AVD optimization in CRT pacing.
Cell lifetime diagnostics and system be-havior of stationary LFP/graphite lithium-ion batteries
(2018)
Introduction: Cardiac resynchronisation therapy (CRT) with atrioventricular (AV) and interventricular (VV) optimized biventricular pacing (BV) is an established therapy for heart failure (HF) patients. The aim of the study was to compare AV and VV delay optimization with cardiac output (CO), cardiac index (CI), contractility index (IC) and acceleration index (ACI) impedance cardiographic (ICG) methods in CRT.
Methods: 15 HF patients (age 66 ± 10 years; 2 females, 13 males) in New York Heart Association (NYHA) class 3.1 ± 0.4, left ventricular (LV) ejection fraction 21.3 ± 7.8 % and QRS duration 176.1 ± 31.7 ms underwent AV and VV delay optimization with CO, CI, IC and ACI (Cardioscreen ®, Medis GmbH, Ilmenau, Germany) at different AV and VV delay BV pacing settings versus right ventricular (RV) pacing one day after implantation of a CRT device.
Results: Optimal AV delay after atrial sensing was 108.6 ± 20.3 ms (n=14) and optimal AV delay after atrial pacing 190 ± 14.1 ms (n=2) with AV delay range from 80 ms to 200 ms. Optimal VV delay was -12.3 ± 25.9 ms left ventricular before RV pacing. RV versus BV pacing mode resulted in improvement of CO from 3.4 ± 1.2 l/min to 4.4 ± 1.4 l/min (p<0.001), CI from 1.8 ± 0.64 l/min/m² to 2.4 ± 0.78 l/min/m² (p<0.001), IC from 0.028 ± 0.011 1/s to 0.036 ± 0.013 1/s (p<0.001) and ACI from 0.667 ± 0.227 1/s² to 0.834 ± 0.282 1/s² (p<0.002). During 34 ± 26 month BV pacing, the NYHA class improved from 3.1 ± 0.4 to 2.1 ± 0.4 (p<0.001).
Conclusion: AV and VV delay optimized BV pacing acutely improve hemodynamic parameters of transthoracic ICG and their NYHA class during long-term follow-up. ICG may be a simple and useful technique to optimize AV and VV delay in CRT.
Distribution of esophageal interventricular conduction delays in CRT patients and healthy subjects
(2015)
E-Tutoren-Ausbildung: Lernerfahrungen reflektieren – Lehrhandlungskompetenzen dialogisch aufbauen
(2014)
Background: Cardiac resynchronization therapy (CRT) is an established therapy for heart failure (HF) patients (P) with reduced left ventricular (LV) ejection fraction and electrical interventricular desynchronization, but not all P improved clinically. The aim of the study was to evaluate electrical interventricular delay (IVD) to LV delay (LVD) ratio in atrial fibrillation (AF) CRT responder (R) and non-responder (NR).
Methods: AF P (n = 18, age 60.6 ± 11.4 years, 1 female, 17 males) with HF New York Heart Association (NYHA) class 3.0 ± 0.2, 25.3 ± 5.9 % LV ejection fraction and 157.8 ± 24.4 ms QRS duration (QRSD) were measured by surface ECG and focused transesophageal bipolar LV ECG before implantation of CRT pacemaker (n = 2) or CRT defibrillator (n = 16). IVD was measured between onset of QRS in the surface ECG and onset of LV signal in the LV ECG. LVD was measured between onset and offset of LV signal in the LV ECG.
Results: Electrical ventricular desynchronization in AF CRT P were 61.9 ± 26.9ms IVD, 80.6 ± 24.3ms LVD, 0.85 ± 0.41 IVD-LVD-ratio (Figure), 3.12 ± 1.89 QRSD-IVD-ratio and 2.07 ± 0.47 QRSD-LVD-ratio. There were 72.2 % AF CRT R (n = 13) with 64.2 ± 24.6ms IVD and 77.8 ± 21.6ms LVD with Pearson correlation to 0.89 ± 0.39 IVD-LVD-ratio (r = 0.87, P < 0.01; r = -0.69, P < 0.01), 2.82 ± 1.32 QRSD-IVD-ratio (r = -0.76, P < 0.01; r = 0.67, P = 0.011) and 2.13 ± 0.46 QRSD-LVD-ratio (r = 0.57, P = 0.041; r = -0.85, P < 0.01). There were 27.8% AF CRT NR (n = 5) with 56.0 ± 34.5ms IVD and 87.8 ± 31.9ms LVD without correlation to 0.74 ± 0.48 IVD-LVD-ratio, 3.88 ± 2.98 QRSD-IVD-ratio and 1.90 ± 0.48 QRSD-LVD-ratio. During 15.3 ± 13.1 month CRT follow-up, the AF CRT R NYHA class improved from 3.0 ± 0.2 to 2.2 ± 0.3 (P < 0.001). During 18.8 ± 20.7 month CRT follow-up, the AF CRT NR NYHA class not improved from 3 to 3.3 ± 0.97.
Electrochemical impedance spectroscopy (EIS) is a widely-used diagnostic technique to characterize electrochemical processes. It is based on the dynamic analysis of two electrical observables, that is, current and voltage. Electrochemical cells with gaseous reactants or products (e.g., fuel cells, metal/air cells, electrolyzers) offer an additional observable, that is, the gas pressure. The dynamic coupling of current and/or voltage with gas pressure gives rise to a number of additional impedance definitions, for which we have introduced the term electrochemical pressure impedance spectroscopy (EPIS) [1,2]. EPIS shows a particular sensitivity towards transport processes of gas-phase or dissolved species, in particular, diffusion coefficients and transport pathway lengths. It is as such complementary to standard EIS, which is mainly sensitive towards electrochemical processes. This sensitivity can be exploited for model parameterization and validation. A general analysis of EPIS is presented, which shows the necessity of model-based interpretation of the complex EPIS shapes in the Nyquist plot (cf. Figure). We then present EPIS simulations for two different electrochemical cells: (1) a sodium/oxygen battery cell and (2) a hydrogen/air fuel cell. We use 1D or 2D electrochemical and transport models to simulate current excitation/pressure detection or pressure excitation/voltage detection. The results are compared to first EPIS experimental data available in literature [2,3].
Electrode modelling and simulation of diagnostic and pulmonary vein isolation in atrial fibrillation
(2022)
Background: Pulmonary vein isolation (PVI) using cryoballoon catheters are a recognized method for the treatment of atrial fibrillation (AF). This method offers shorter treatment duration in contrast to the classical therapy with high-frequency (HF) ablation.
Purpose: The aim of this study was to integrate different cryoballoon catheters and a HF catheter into a heart rhythm model and to compare them by means of static and dynamic electromagnetic and thermal simulation in use under AF.
Methods: The cryoballoon catheters from Medtronic and the HF ablation catheter from Osypka were modelled virtually with the aid of manufacturer specifications and the CST (Computer Simulation Technology, Darmstadt) simulation program. The cryoballoon catheter was located in the lower left pulmonary vein of the virtual heart rhythm model for the realization of pulmonary vein isolation (PVI) by cryoenergy. The simulated temperature at the balloon surface was -50°C during the simulation.
Results: During a simulated 20 second application of a cryoballoon catheter at -50°C, a temperature of -24°C was measured at a depth of 0.5 mm in the myocardium. At a depth of 1 mm the temperature was -3°C, at 2 mm depth 18°C and at 3 mm depth 29°C. Under the 15 second application of a RF catheter with a 8 mm electrode and a power of 5 W at 420 kHz, the temperature at the tip of the electrode was 110°C. At a depth of 0.5 mm in the myocardium, the temperature was 75°C, at a depth of 1 mm 58°C, at 2 mm depth 45°C and at 3 mm depth 38°C.
Conclusions: The simulation of temperature profiles during the virtual application of several catheter models in the heart rhythm model allows the static and dynamic simulation of PVI by cryoballoon ablation and RF ablation. The three-dimensional simulation can be used to improve ablation applications by creating a model in personalized cardiac rhythm therapy from MRI or CT data of a heart and finding a favourable position for ablation of AF.
Background: The application of high-frequency ablation is used for the treatment of tachycardia arrhythmias and is a respected method. Ablation with high frequency current leads to the targeted heat destruction of myocardial tissue at specific sites and thus prevents the pathological propagation of excitation through these structures.
Purpose: The aim of this study was to simulate heat propagation during RF ablation with modeled electrodes in different sizes and materials. The simulation was performed on atrioventricular node re-entry tachycardia (AVNRT), atrioventricular re-entry tachycardia (AVRT) and atrial flutter (AFL).
Methods: Using the modeling and simulation software CST, ablation catheters with 4 mm and 8 mm tip electrodes were modeled from gold and platinum for each. The designed catheters correspond to the manufacturer"s specifications of Medtronic, Biotronik and Osypka. The catheters were integrated into the Offenburg heart rhythm model to simulate and compare the heat propagation during an ablation application, which also takes into account the blood flow in the four heart chambers. A power of 5 W - 40 W was simulated for the 4 mm electrodes and a power of 50 W - 80 W for the 8 mm electrodes.
Results: During the simulated HF ablation application, the temperature at the ablation electrode was measured at different powers. This is 40.67°C at 5 W, 44.34°C at 10 W, 51.76°C at 20 W, 59.0°C at 30 W, and 66.33°C at 40 W. The measured temperature during 40 W application is 39.5°C at 0,5 mm depth in the myocardium and 37.5°C at 2 mm depth.
In the simulation, the 8 mm platinum electrode reached an ablation temperature of 72.85°C at its tip during an applied power of 60 W. In contrast, the 8 mm platinum electrode reached a depth of 5 mm at 39.5 C° and at a depth of 2 mm at 37.5 °C. In contrast, the 8 mm gold electrode reached a temperature of 64.66°C with the same performance. This is due to the thermal properties of gold, which has a better thermal conductivity than platinum.
Conclusions: CST offers the possibility to carry out a static and dynamic simulation of a heart model and the ablation electrodes integrated in it during an HF ablation. In variation with different electrode sizes and materials, therapy methods for the treatment of AVNRT, AVRT and AFL can be optimized
Energetische Aspekte gewinnen bei nachhaltig optimierten Systemen zunehmend an Bedeutung. Klassische Lösungen der Strömungsmechanik sind für viele technische Anwendungen von enormerWichtigkeit. In dieser Arbeit präsentieren wir energetische Analysen zu den unterschiedlichen Rayleigh-Stokes Problemen wie der plötzlich in Gang gesetzten oder gestoppten Platte sowie der periodisch oszillierenden Platte. Die in [1] beschriebenen klassischen Rayleigh-Stokes Probleme sind in vielfältigerWeise für verallgemeinerte Rand- und Anfangsbedingungen untersucht worden. Beispiele hierzu sind in [2, 3] dargestellt. Theoretische Grundlagen zu den folgenden energetischen Betrachtungen sind in [4, 5] enthalten.
Die drei großen Hersteller von Cochlea-Implantat (CI)-Systemen ermöglichen es klinischen Audiologen, die Mikrofoneigenschaften der meisten CI-Sprachprozessoren zu prüfen. Dazu können bei diesen Sprachprozessoren Monitorkopfhörer angeschlossen und das/die Mikrofon(e) inklusive eines Teils der Signalvorverarbeitung abgehört werden. Präzise Angaben dazu, mit welchen Stimuli, bei welchem Pegel und nach welchem Kriterium diese Prüfung stattfinden soll, machen die CI-Hersteller nicht. Auf Basis dieser Prüfung soll der Audiologe dann über die Funktion der Mikrofone und damit darüber entscheiden, ob der betreffende Sprachprozessor an den Hersteller eingeschickt wird oder nicht.
Zur Objektivierung der CI-Sprachprozessor-Mikrofon-Prüfung haben wir eine Testbox entwickelt, mit der alle abhörbaren aktuellen CI-Sprachprozessoren der drei großen Hersteller geprüft werden können. Die Box wurde im 3D-Druck-Verfahren hergestellt. Der zu prüfende Sprachprozessor wird in die Messbox eingehängt und über einen darin verbauten Lautsprecher mit definierten Prüfsignalen (Sinustöne unterschiedlicher Frequenz) beschallt. Das Mikrofonsignal wird über das Kabel der Monitorkopfhörer herausgeführt und mit einer Shifting- and Scaling-Schaltung in einen Spannungsbereich transformiert, der für die AD-Wandlung mit einem Mikrokontroller (ATmega1280 verbaut auf einem Arduino Mega) geeignet ist. Derselbe Mikrokontroller übernimmt über einen eigens gebauten DA-Wandler die Ausgabe der Sinustöne über den Lautsprecher. Signalaufnahme und –wiedergabe erfolgen mit jeweils 38,5 kHz Samplingrate. Der für jede Frequenz über mehrere Perioden des Prüfsignals ermittelte Effektivwert wird mit dem Effektivwert, der mit einem neuwertigen Referenzprozessor für diese Frequenz gemessen wurde, verglichen. Die Messergebnisse werden graphisch auf einem Display ausgegeben.
Derzeit läuft eine erste Datenerhebung mit in der Klinik subjektiv auffällig gewordenen CI-Sprachprozessoren, die anschließend in der Messbox untersucht werden. So sollen realistische Schwellen für kritische Abweichungen von den Referenz-Effektivwerten ermittelt werden. Im weiteren Verlauf sollen dann Hit und False Alarm-Raten der subjektiven Prüfung bestimmt werden.
Introduction: Despite lots of developments in the last years, radiofrequency ablation of rhythm diseases is a safe but still complex procedure that requires special experience and expertise of the physicians and biomedical engineers. Thus, there is a need of special trainings to become familiar with the different equipment and to explain several effects that can be observed during clinical routine.
Methods: The Offenburg University of Applied Sciences offers a biomedical engineering study path specialized in the fields of cardiology, electrophysiology and cardiac electronic implants. It`s Peter Osypka Institute for Pacing and Ablation provides teaching following the slogan “Learning by watching, touching and adjusting”. It conducts lots of trainings for students as well as young physicians interested in electrophysiology and radiofrequency ablation.
Results: In-vitro trainings will be provided using the Osypka HAT 200 and HAT300s, Stockert EPshuttle and SmartAblate system as well as the Boston EPT-1000XP and Maestro 3000 and the Radionics RFG-3E cardiac radio frequency ablation generators. All of them require different handling as well as special accessories like catheter connection cables or boxes and back plates. The participants will be trained in the setup of temperature, power and cut-off impedance dependent on different ablation catheters. Furthermore troubleshooting in hard- and software is part of the program. Performing procedures in pork or animal protein and using physiological saline solution to simulate the blood flow, they can study the influence of contact force and impedance on lesion geometry etc. and to avoid adverse effects like “plops”. Lots of catheter types are available: 4mm tip, 8mm standard and gold tip, open and closed irrigated tip ablation catheters of different companies. The experiments will be completed by measuring the lesion size dependent on the used catheter type and ablation settings.
Conclusion: In-vitro training in radiofrequency ablation is a challenge for biomedical engineering students and young physicians.
Spinal cord stimulation (SCS) is the most commonly used technique of neurostimulation. It involves the stimulation of the spinal cord and is therefore used to treat chronic pain. The existing esophageal catheters are used for temperature monitoring during an electrophysiology study with ablation and transesophageal echocardiography. The aim of the study was to model the spine and new esophageal electrodes for the transesophageal electrical pacing of the spinal cord, and to integrate them in the Offenburg heart rhythm model for the static and dynamic simulation of transesophageal neurostimulation. The modeling and simulation were both performed with the electromagnetic and thermal simulation software CST (Computer Simulation Technology, Darmstadt). Two new esophageal catheters were modelled as well as a thoracic spine based on the dimensions of a human skeleton. The simulation of directed transesophageal neurostimulation is performed using the esophageal balloon catheter with an electric pacing potential of 5 V and a trapezoidal signal. A potential of 4.33 V can be measured directly at the electrode, 3.71 V in the myocardium at a depth of 2 mm, 2.68 V in the thoracic vertebra at a depth of 10 mm, 2.1 V in the thoracic vertebra at a depth of 50 mm and 2.09 V in the spinal cord at a depth of 70 mm. The relation between the voltage delivered to the electrodes and the voltage applied to the spinal cord is linear. Virtual heart rhythm and catheter models as well as the simulation of electrical pacing fields and electrical sensing fields allow the static and dynamic simulation of directed transesophageal electrical pacing of the spinal cord. The 3D simulation of the electrical sensing and pacing fields may be used to optimize transesophageal neurostimulation.
This paper shows the results of the evaluation of two sets of mobile web design guidelines concerning mobile learning. The first set of guidelines is concerned with the usage of text on mobile device screens. The second set is concerned with the usage of images on mobile devices. The evaluation is performed by eye tracking (objective) as well as questionnaires and interviews (subjective) respectively.
Objective: Dickkopf 3 (DKK3) has been identified as a urinary biomarker. Values above 4000 pg/mg creatinine (Cr) were linked with a higher risk of short-term decline of kidney function (J Am Soc Nephrol 29: 2722–2733). However, as of today, there is little experience with DKK3 as a risk marker in everyday clinical practice. We used algorithm-based data analysis to evaluate the potential dependence of DKK3 in a cohort from a large single center in Germany.
Method: DKK3 was measured in all CKD patients in our center October 1 st 2018 till Dec. 31 2019, together with calculated GFR (eGFR) and urinary albumin/creatinine ratio (UACR). Kidney transplant patients were excluded. Until the end of follow-up Dec 31 st 2021, repeated measurements were performed for all parameters. Data analysis was performed using MD-Explorer (BioArtProducts, Rostock, Germany) and Python with multiple libraries. Linear regression models were applied in patients for DKK3, eGFR and UACR. Comparison of the models was performed with a twosided Kolmogorov-Smirnov test.
Results: 1206 DKK3 measurements were performed in 1103 patients (621 male, age 70yrs, eGFR 29,41 ml/min/1.73qm, UACR 800 mg/g). 134 patients died during follow-up. DKK3 mean was 2905 pg/mg Cr (max. 20000, 75 % percentile 3800). 121 pts had DKK3 > 4000. At the end of follow-up 7 % of patients with DKK3 < 4000 (initial eGFR 17.6) versus 39.6 % of patients with DDK3 > 4000 (initial eGFR 15.7) underwent dialysis. Compared to eGFR and UACR at baseline, DKK3 > 4000 performed best to predict eGFR loss over the next 12 months.
Conclusion: In this cohort of CKD patients, DKK3 > 4000 at baseline predicted the eGFR slope better than eGFR or UACR at baseline. DKK3 > 4000 reflected a higher risk of progression towards ESRD in patients with similar baseline eGFR levels.
Heart rhythm model and simulation of electrophysiological studies and high-frequency ablations
(2017)
Background: The simulation of complex cardiologic structures has the potential to replace clinical studies due to its high efficiency regarding time and costs. Furthermore, the method is more careful for the patients’ health than the conventional ways. The aim of the study was to create an anatomic CAD heart rhythm model (HRM) as accurate as possible, and to show its usefulness for cardiac electrophysiological studies (EPS) and high-frequency (HF) ablations.
Methods: All natural heart components of the new HRM were based on MRI records, which guaranteed electronic functionality. The software CST (Computer Simulation Technology, Darmstadt) was used for the construction, while CST’s material library assured genuine tissue properties. It should be applicable to simulate different heart rhythm diseases as well as various diffusions of electromagnetic fields, caused by electrophysiological conduction, inside the heart tissue.
Results: It was achievable to simulate normal sinus rhythm and fourteen different heart rhythm disturbance with different atrial and ventricular conduction delays. The simulated biological excitation of healthy and sick HRM were plotted by simulated electrodes of four polar right atrial catheter, six polar His bundle catheter, ten polar coronary sinus catheter, four polar ablation catheter and eight polar transesophageal left cardiac catheter (Fig.). Accordingly, six variables were rebuilt and inserted into the anatomic HRM in order to establish heart catheters for ECG monitoring and HF ablation. The HF ablation catheters made it possible to simulate various types of heart rhythm disturbance ablations with different HF ablation catheters and also showed a functional visualisation of tissue heating. The use of tetrahedral meshing HRM made it attainable to store the results faster accompanied by a higher degree of space saving. The smart meshing function reduced unnecessary high resolutions for coarse structures.
Conclusions: The new HRM for EPS simulation may be additional useful for simulation of heart rhythm disturbance, cardiac pacing, HF ablation and for locating and identification of complex fractioned signals within the atrium during atrial fibrillation HF ablation.
Heart rhythm model and simulation of electrophysiological studies and high-frequency ablations
(2017)
Background: The simulation of complex cardiologic structures has the potential to replace clinical studies due to its high efficiency regarding time and costs. Furthermore, the method is more careful for the patients’ health than the conventional ways. The aim of the study was to create an anatomic CAD heart rhythm model (HRM) as accurate as possible, and to show its usefulness for cardiac electrophysiological studies (EPS) and high-frequency (HF) ablations.
Methods: All natural heart components of the new HRM were based on MRI records, which guaranteed electronic functionality. The software CST (Computer Simulation Technology, Darmstadt) was used for the construction, while CST’s material library assured genuine tissue properties. It should be applicable to simulate different heart rhythm diseases as well as various diffusions of electromagnetic fields, caused by electrophysiological conduction, inside the heart tissue.
Results: It was achievable to simulate normal sinus rhythm and fourteen different heart rhythm disturbance with different atrial and ventricular conduction delays. The simulated biological excitation of healthy and sick HRM were plotted by simulated electrodes of four polar right atrial catheter, six polar His bundle catheter, ten polar coronary sinus catheter, four polar ablation catheter and eight polar transesophageal left cardiac catheter (Fig.). Accordingly, six variables were rebuilt and inserted into the anatomic HRM in order to establish heart catheters for ECG monitoring and HF ablation. The HF ablation catheters made it possible to simulate various types of heart rhythm disturbance ablations with different HF ablation catheters and also showed a functional visualisation of tissue heating. The use of tetrahedral meshing HRM made it attainable to store the results faster accompanied by a higher degree of space saving. The smart meshing function reduced unnecessary high resolutions for coarse structures.
Conclusions: The new HRM for EPS simulation may be additional useful for simulation of heart rhythm disturbance, cardiac pacing, HF ablation and for locating and identification of complex fractioned signals within the atrium during atrial fibrillation HF ablation.
Hintergrund: Richtung und Stärke des elektrischen Feldes (E-Feld) der biventrikulären (BV) Stimulation und elektrische interventrikuläre Desynchronisation sind bei Patienten mit Herzinsuffizienz und verbreitertem QRS Komplex von Bedeutung für den Erfolg der kardialen Resynchronisationstherapie (CRT). Das 3D Herzrhythmusmodell (HRM) ermöglicht die
Simulation von CRT und Hochfrequenz (HF) Ablation. Das Ziel der Studie besteht in der Integration von Schrittmacher- und Ablationselektroden in das HRM zur E-Feld Simulation der BV Stimulation und thermischen Feld (T-Feld) Simulation der HF Ablation von Vorhofflimmern (AF).
Methoden: Es wurden fünf multipolare linksventrikuläre (LV) Elektroden, eine epikardiale LV Elektrode, vier bipolare rechtsatriale (RA) Elektroden, zwei rechtsventrikuläre (RV) Elektroden und ein HF Ablationskatheter mit CST (Computer Simulation Technology, Darmstadt) modelliert und das HRM (Schalk et al: Clin Res Cardiol 106, Suppl 1, April 2017, P1812) um den Koronarvenensinus (CS) erweitert (HRM-CS). E-Feld Simulationen bei vorhofsynchroner BV Stimulation und bei RA Stimulation mit RV und LV Ableitung erfolgten mit den Elektroden Select Secure 3830, Capsure VDD-2 5038 und Attain OTW 4194 im HRM+CS (Fig.). F-Feld Simulationen der HF Ablation von AF bei CRT wurden mit integriertem Ablationskatheter AlCath G FullCircle (Biotronik) simuliert.
Ergebnisse: HRM-CS ermöglichte 3D E-Feld Simulationen bei vorhofsynchroner bipolarer BV Stimulation und bei bipolarer RA Stimulation mit bipolarer RV und LV Ableitung. RV und LV Stimulation erfolgten zeitgleich bei einer Amplitude von 3 V an der LV Elektrode und 1 V an der RV Elektrode mit einer Impulsbreite von jeweils 0,5 ms. Die von der BV Stimulationen erzeugten Fernpotentiale konnten von der RA Elektrode wahrgenommen werden. Das Fernpotential an der RA Elektrodenspitze betrug 32,86 mV und in 1 mm Abstand von der RA Elektrodenspitze ergab sich ein Fernpotential von 185,97 mV. HRM-CS ermöglichte 3D T-Feld Simulationen der HF Ablation von AF bei CRT. Das T-Feld bei HF Ablation des AV-Knotens wurde mit einer anliegenden Leistung von 5 W bei 420 kHz an der distalen 8 mm Ablationselektrode simuliert. Die Temperatur an der Katheterspitze betrug nach 5 s Ablationsdauer 88,66 °C, in 1 mm Abstand von der Katheterspitze im Myokard 42,17 °C und in 2 mm Abstand 37,49 °C.
Schlussfolgerungen: HRM-CS und Elektrodenmodelle ermöglichen die 3D Simulationen von E-Feldern bei vorhofsynchroner BV Stimulation, RA Stimulation mit RV und LV Wahrnehmung und von T-Feldern bei HF Ablation. E-Feld Simulationen von RA, RV und LV Stimulation und Sensing können möglicherweise zur Vorhersage von CRT Respondern genutzt werden.
Responder-rate in cardiac resynchronization therapy (CRT) of patients in sinus rhythm (SR) or atrial fibrillation (AF) mainly depends on accurat selection, optimal position of the left ventricular electrode and individualization of hemodynamical parameters of the implanted biventricular pacing system during follow-up. High resolution esophageal left heart electrocardiography offers a quick and semi-invasive approach to the electrical activity of left atrium and left ventricle. It was used in 62 heart failure patients in sinus rhythm and 11 in atrial fibrillation after implantation of CRT systems to compare the semi-invasive interventricular conduction delay (IVCDE) with QRS width. In all of the patients, guideline decision for CRT was linked with IVCDE of about 40ms and up. From logical point of view, IVCDE provides the minimal target interval for the left ventricular electrode placement in order to exclude non-responders. Esophageal measurement of interatrial conduction intervals in VDD and DDD pacing was utilized to individualize the AV delay and to exclude adverse hemodynamic effects.
Since direct current high energy shock fulguration was initially performed in the mid 1980s, ablation of cardiac arrhythmias has come to widespread use. Today the most frequently used energy source for catheter ablation is radio frequency (RF). It was the German engineer Peter Osypka who made available the HAT 100 as the first simple commercial RF ablator.
Nevertheless, in the first years of ablation, physicians were effectively working in the dark. Until today with an increasing understanding of arrhythmia mechanisms, both at the atrial and ventricular levels, this curative technology has made tremendous progress. Now, due to crucial improvement of RF ablation generators, temperature and contact force sensor catheters in combination with non-flouroscopic electroanatomical mapping technologies, computerized temperature and impedance controlled radiofrequency catheter ablation can be used to cure all types of arrhythmias including atrial and ventricular fibrillation. For the latter, cooled ablation by saline solution irrigated catheters has been developed to a widely used standard method. This procedure resulting in pulmonary vein isolation requires transseptal puncture and is technically demanding. Nevertheless, it has shown to be more effective than antiarrhythmic drug therapy.
While earliest RF ablations were performed with non-steerable catheters, today are used steerable sensor catheters without or with external and internal cooling and tips of 4mm or 8mm length. Further innovations like integration of mapping and cardiac imaging give exact information of the number of pulmonary veins and branching patterns and help to correlate electrical signals with anatomical structures.
The magnetic navigation significantly improved the success rates and safety of catheter ablation. Thus, in most cases RF catheter ablation has developed in the treatment of supraventricular arrhythmias from an alternative approach to drug therapy into the first therapeutic choice providing low complication rates.
In future, robotic navigation will further simplify procedures and reduce radiation exposure of this curative approach.
Non-responder rate in cardiac resynchronization therapy (CRT) could be partly decreased by individualized parameter optimization excluding adverse hemodynamic timing. In heart failure patients with sinus rhythm, an atrial kick enables the completion of atrial contraction and may significantly enhance the ventricular filling. Compared to that, exclusion of atrial kick is a sign of suboptimal atrioventricular timing. However, the recognition of atrial kick by echocardiography will be negatively affected in patients requiring a very short or long AV delays.
Introduction: Cardiac resynchronisation therapy (CRT) with atrioventricular (AV) and interventricular (VV) optimized biventricular pacing (BV) is an established therapy for heart failure (HF) patients with electrical interventricular conduction delay (IVCD). The aim of the study was to compare AV and VV delay optimization with cardiac output (CO) and acceleration index (ACI) impedance cardiographic (ICG) methods.
Methods: HF patients with IVCD 86.8 ± 33 ms (n=15, age 66 ± 10 years; 2 females, 13 males), New York Heart Association (NYHA) functional class 3.1 ± 0.4, left ventricular (LV) ejection fraction 21.3 ± 7.8 % and QRS duration 176.1 ± 31.7 ms underwent AV and VV delay optimization with CO and ACI methods (Cardioscreen, Medis GmbH, Ilmenau, Germany). After evaluation of optimal AV delay, we evaluated optimal VV delay during simultaneous LV and right ventricular (RV) pacing (LV=RV), LV before RV pacing (LV-RV) and RV before LV pacing (RV-LV).
Results: Optimal VV delay was -12.3 ± 25.9 ms LV-RV pacing with VV delay range from -80 ms LV-RV pacing to +20 ms RV-LV pacing and RV=LV pacing. Optimal AV delay after atrial sensing was 108.6 ± 20.3 ms (n=14) and optimal AV delay after atrial pacing 190 ± 14.1 ms (n=2) with AV delay range from 80 ms to 200 ms. RV versus BV pacing mode resulted in improvement of CO from 3.4 ± 1.2 l/min to 4.4 ± 1.4 l/min (p<0.001) and ACI from 0.667 ± 0.227 1/s² to 0.834 ± 0.282 1/s² (p<0.002). During 34 ± 26 month BV pacing, the NYHA class improved from 3.1 ± 0.4 to 2.1 ± 0.4 (p<0.001).
Conclusion: AV and VV delay optimized BV pacing acutely improve ICG CO and ACI and their NYHA class during long-term follow-up. ICG may be a simple and useful technique to optimize AV and VV delay in CRT.
In-vivo and in-vitro comparison of implant-based CRT optimization - What provide new algorithms?
(2011)
Introduction: In cardiac resynchronization therapy (CRT), individual AV delay (AVD) optimization can effectively increase hemodynamics and reduce non-responder rate. Accurate, automatic and easily comprehensible algorithms for the follow-up are desirable. QuickOpt is the first attempt of a semi-automatic intracardiac electrogram (IEGM) based AVD algorithm. We aimed to compare its accuracy and usefulness by in-vitro and in-vivo studies.
Methods: Using the programmable ARSI-4 four-chamber heart rhythm and IEGM simulator (HKP, Germany), the QuickOpt feature of an Epic HF system (St. Jude, USA) was tested in-vitro by simulated atrial IEGM amplitudes between 0.3 and 3.5mV during both, manual and automatic atrial sensing between 0.2 and 1.0mV. Subsequently, in 21 heart failure patients with implanted biventricular defibrillators, QuickOpt was performed in-vivo. Results of the algorithm for VDD and DDD stimulation were compared with echo AV delay optimization.
Results: In-vitro simulations demonstrated a QuickOpt measuring accuracy of ± 8ms. Depending on atrial IEGM amplitude, the algorithm proposed optimal AVD between 90 and 150ms for VDD and between 140 and 200ms for DDD operation, respectively. In-vivo, QuickOpt difference between individual AVD in DDD and VDD mode was either 50ms (20pts) or 40ms (1pt). QuickOpt and echo AVD differed by 41 ± 25ms (7 – 90ms) in VDD and by 18 ± 24ms (17-50ms) in DDD operation. Individual echo AVD difference between both modes was 73 ± 20ms (30-100ms).
Conclusion: The study demonstrates the value of in-vitro studies. It predicted QuickOpt deficiencies regarding IEGM amplitude dependent AVD proposals constrained to fixed individual differences between DDD and VDD mode. Consequently, in-vivo, the algorithm provided AVD of predominantly longer duration than echo in both modes. Accepting echo individualization as gold standard, QuickOpt should not be used alone to optimize AVD in CRT patients.
Landing heel first has been associated with elevated external knee abduction moments (KAM), thereby potentially increasing the risk of sustaining a non-contact ACL injury. Apart from the foot strike angle, knee valgus angle (VAL) and vertical center of mass velocity at initial ground contact (IC) have been associated with increased KAM in females across different sidestep cuts. While real-time biofeedback training has been proven effective for gait retraining [4], the highly dynamic, non-cyclical nature of cutting maneuvers makes real-time feedback unsuitable and alternative approaches necessary. This study aimed at assessing the efficacy of immediate software-aided feedback on cutting technique in reducing KAM during handball-specific cutting maneuvers.
Background: Cardiac resynchronization therapy (CRT) with biventricular (BV) pacing is an established therapy for heart failure (HF) patients (P) with sinus rhythm, reduced left ventricular (LV) ejection fraction (EF) and electrical ventricular desynchronization. The aim of the study was to evaluate electrical interventricular delay (IVD) and left ventricular delay (LVD) in right ventricular (RV) pacemaker pacing before upgrading to CRT BV pacing.
Methods: HF P (n=11, age 69.0 ± 7.9 years, 1 female, 10 males) with DDD pacemaker (n=10), DDD defibrillator (n=1), RV pacing, New York Heart Association (NYHA) class 3.0 ± 0.2 and 24.5 ± 4.9 % LVEF were measured by surface ECG and transesophageal bipolar LV ECG before upgrading to CRT defibrillator (n=8) and CRT pacemaker (n=3). IVD was measured between onset of QRS in the surface ECG and onset of LV signal in the transesophageal ECG. LVD was measured between onset and offset of LV signal in the transesophageal ECG. CRT atrioventricular (AV) and BV pacing delay were optimized by impedance cardiography.
Results: Interventricular and intraventricular desynchronization in RV pacemaker pacing were 228.2 ± 44.8 ms QRS duration, 86.5 ± 32.8ms IVD, 94.4 ± 23.8ms LVD, 2.6 ± 0.8 QRS-IVD-ratio with correlation between IVD and QRS-IVD-ratio (r=-0.668 P=0.0248) and 2.3 ± 0.7 QRS-LVD-ratio. The LVEF-IVD-ratio was 0.3 ± 0.1 with correlation between IVD and LVEF-IVD-ratio (r=-0.8063 P=0.00272) and with correlation between QRS duration and LVEF-IVD-ratio (r=-0.7251 P=0.01157). Optimal sensing and pacing AV delay were 128.3 ± 24.8 ms AV delay after atrial sensing (n=6) and 173.3 ± 40.4 ms AV delay after atrial pacing (n=3). Optimal BV pacing delay was -4.3 ± 11.3 ms between LV and RV pacing (n=7). During 30.4 ± 29.6 month CRT follow-up, the NYHA class improved from 3.1 ± 0.2 to 2.2 ± 0.3.
Conclusions: Transesophageal electrical IVD and LVD in RV pacemaker pacing may be additional useful ventricular desynchronization parameters to improve P selection for upgrading RV pacemaker pacing to CRT BV pacing.
Fallstudien sollen theoretische Lerninhalte zu Konzepten von Business Intelligence und Data Warehousing veranschaulichen und in einen praxisnahen Kontext bringen. Außerdem sollen Studierende umsetzungsorientierte Kompetenzen mit praxisrelevanten Systemen erwerben. Um diese Kompetenzen abzuprüfen und um die Auseinandersetzung mit Software und Konzepten zu vertiefen, haben sich Projekte als Ergänzung zu Fallstudien und Klausuren vielfach bewährt. Der Vortrag stellt dar, welche Möglichkeiten Dozierende im Rahmen der vom UCC zur Verfügung gestellten Plattform SAP Data Warehouse Cloud (SAP DWC) haben, um studentische Projekte zu Data Warehousing und Analytics durchzuführen. Der Autor berichtet über seine Erfahrung aus der Betreuung von über 30 Projekten mit SAP DWC aus verschiedenen Studiengängen seit 2020. Neben einer Übersicht über die von Studierenden gewählten Themen werden ausgewählte Projektergebnisse vorgestellt. Außerdem wird auf den Modus der Durchführung sowie existierende systemseitige Limitationen eingegangen. Für Dozierende, die mit ihren Studierenden eigene Projekte erfolgreich durchführen möchten, werden konkrete Hinweise und Maßnahmen dargestellt.
AV delay (AVD) optimization can improve hemodynamics and avoid nonresponding to cardiac resynchronization therapy (CRT). AVD can be approximated by the sum of the individual implant-related interatrial conduction interval and a mean electromechanical interval of about 50ms. We searched for methods to facilitate automatic, implant-based AV delay optimization. In 25 patients (19m, 6f, age: 65±8yrs.) with Medtronic Insync III Marquis CRT-D series systems and left ventricular electrode at lateral or posterolateral wall, we determined interatrial conduction intervals by telemetric left ventricular tip versus superior vena cava coil electrogram (LVCE). Compared with esophageal measurements, the duration of optimal AV delay by LVCE showed good correlation (k=0.98, p=0.01) with a difference of 1.5±4.9ms, only. Therefore, LVCE is feasible to determine interatrial conduction intervals in order to automate AV delay optimization in CRT-D pacing promising increased accuracy compared to other algorithms.
The identification and quantification of compounds in the gas phase becomes of increasing interest in the context of environmental protection, as well as in the analytical field. In this respect, the high extinction coefficients of vapours and gases in the ultraviolet wavelength region allow a very sensitive measurement system. In addition, the increased performance of the components necessary for setting up a measurement system, such as fibres, light sources and detectors has been improved. In particular the light sources and detectors offer improved stability, and the deep UV performance and solarisation resistance of fused silica fibres allow have been significantly optimized in the past years. Therefore a compact and reliable detection system with high measuring accuracy is developed. Within this paper possible applications of the system under development and recent results will be discussed.
Hintergrund: Die Pulmonalvenenisolation (PVI) mit Hilfe von Kryoballonkathetern ist eine anerkannte Methode zur Behandlung von Vorhofflimmern (AF). Diese Methode bietet eine kürzere Behandlungsdauer als die klassische Therapie durch die Hochfrequenzablation (HF). Ziel dieser Studie war es, verschiedene Kryoballonkatheter, HF-Katheter und Ösophaguskatheter in ein Herzrhythmusmodell zu integrieren und mittels statischer und dynamischer Simulation elektrische und thermische Felder bei PVI unter Vorhofflimmern zu untersuchen.
Methodik: Die Modellierung und Simulation erfolgte mit der elektromagnetischen und thermischen Simulationssoftware CST (CST Darmstadt). Zwei Kryoballons, ein HF-Ablationskatheter und ein Ösophaguskatheter wurden auf der Grundlage der technischen Handbücher der Hersteller Medtronic und Osypka modelliert. Der 23 mm Kryoballon und ein kreisförmiger Mappingkatheter wurden in das Offenburger Herzrhythmusmodell integriert, insbesondere die left inferior pulmonary vein (LIPV) zur Simulation der thermischen Feldausbreitung während einer PVI. Die Simulation einer PVI mit HF-Energie wurde mit dem integrierten HF-Ablationskatheter in der Nähe der LIPV durchgeführt. Der im Herzrhythmusmodell platzierte TO8 Ösophaguskatheter ermöglichte die Ableitung linksatrialer elektrischer Felder bei AF und die Analyse thermischer Felder während PVI.
Ergebnisse: Elektrische Felder konnten bei Sinusrhythmus und AF mit einem AF-Fokus in der LIVP statisch und dynamisch im Herzen und Ösophagus simuliert werden. Bei einer simulierten 20 Sekunden Applikation eines Kryoballon-Katheters bei -50°C wurde eine Temperatur von -24°C in einer Tiefe von 0,5 mm im Myokard gemessen. In einer Tiefe von 1 mm betrug die Temperatur -3°C, bei 2 mm Tiefe 18°C und bei 3 mm Tiefe 29°C. Unter der 15 sekündigen Anwendung eines HF-Katheters mit einer 8-mm-Elektrode und einer Leistung von 5 W bei 420 kHz betrug die Temperatur an der Spitze der Elektrode 110°C. In einer Tiefe von 0,5 mm im Myokard betrug die Temperatur 75°C, in einer Tiefe von 1 mm 58°C, in einer Tiefe von 2 mm 45°C und in einer Tiefe von 3 mm 38°C. Im Ösophagus konnte bei den meisten Simulationen eine konstante Temperatur von 37°C gemessen und die Gefahr einer Ösophagus-Fistel ausgeschlossen werden. Bei Kryoablation der LIPV wurde eine Abkühlung des Ösophagus auf 30°C gemessen.
Schlussfolgerungen: Die Herzrhythmussimulation elektrischer und thermaler Felder ermöglichen mit Anwendung unterschiedlicher Herzkatheter eine statische und dynamische Simulation von PVI durch Kryoablation, HF-Ablation und Temperaturanalyse im Ösophagus. Unter Einbeziehung von MRT- oder CT-Daten können elektrische und thermale Simulationen möglicherweise zur Optimierung von PVIs genutzt werden.
Modelling detailed chemistry in lithium-ion batteries: Insight into performance, ageing and safety
(2018)
Muli-scale thermos-electrochemical modelling of aging mechanisms in an LFP/graphite lithium-ion cell
(2017)
Non-esterified plant oils gain ecological and economical importance, particularly in the EU where it is intended to increase the share of renewable energies. Plant oils do not require any chemical treatment so do not cause secondary pollution. The importance of plant oil will increase in Germany for mobile and stationary applications. The generation co-generation of heat and power is subsidized by the German “Erneuerbares Energiegesetz” and the “Kraft-Wärme-Kopplungsgesetz” when renewable fuels are used such as plant oils..
Plant oils have a much higher viscosity than conventional gas oil. It is mandatory to decrease the oil viscosity by heating prior to injection to assure proper injection and to avoid engine damage due to coke formation in the combustion chamber and at the injection nozzle. The German quality standard of Weihenstephan (RK-Qualitätsstandard 05/2000) for rape seed oil should be followed for use as diesel fuel. The chemical composition of plant oils is appreciably different in comparison to diesel fuels derived from mineral oils suggesting also different emission behavior.
New frontiers of supraventricular tachycardia and atrial flutter evaluation and catheter ablation
(2012)
Radiofrequency catheter ablation (RFCA) has revolutionized treatment for tachyarrhythmias and has become first-line therapy for some tachycardias. Although developed in the 1980s and widely applied in the 1990s, the technique is still in development. Transesophageal atrial pacing (TAP) can used for initiation and termination of supraventricular tachycardia (SVT).
Methods: The paroxysmal SVT include a wide spectrum of disorders including, in descending order of frequency, atrial flutter, atrioventricular (AV) nodal reentry, Wolff-Parkinson-White syndrome, and atrial tachycardia. While not life-threatening in most cases, they may cause important symptoms, such as palpitations, chest discomfort, breathlessness, anxiety, and syncope, which significantly impair quality of life. Medical therapy has variable efficacy, and most patients are not rendered free of symptoms. Research over the past several decades has revealed fundamental mechanisms involved in the initiation and maintenance of all of these arrhythmias. Knowledge of mechanisms has in turn led to highly effective surgical and catheter-based treatments. The supraventricular arrhythmias and their treatment are described in this report. SVT initiation was analysed with programmed TAP in 49 patients with palpitations (age 47 ± 17 years, 24 females, 25 males).
Results: In comparison to antiarrhythmic drug therapy the radiofrequency catheter ablation in patients suffering from atrial flutter, atrioventricular nodal reentry, atrioventricular reentry and atrial tachycardia is the better choice in most cases. TAP SVT initiation was possible in 23 patients before RFCA. Atrial cycle length of SVT was 320 ± 59 ms. We initiated AV nodal reentrant tachycardia (AVNRT, n=15), atrial tachycardia (AT, n=6) and AV reentrant tachycardia with Kent pathway conduction (AVRT, n=2) before RFCA.
Conclusions: Radiofrequency catheter ablation is a successful and safe method to cure most patients with paroxysmal supraventricular tachycardias. TAP allowed initiation and termination of SVT especially in outpatients.
Plant oils may be used as a sustainable, nearly CO2neutral fuel for diesel engines. This work investigates experimentally the particulate and gaseous emissions of diesel engines fuelled with different non-esterified, pure plant oils. The data are collected from three engines: a) Common rail 1.7 liter passenger car engine from Opel AG b) 12.8 liter truck engine from VOLVO c) Truck engine from MAN AG.
The emissions of the MAN engine have been used to perform AMES tests to analyze possible health impacts of plant oil operation. Finally, all emission results with plant oils have been compared to traditional gas oils.
Non-fluoroscopic Imaging with MRT/CT Image Integration - Catheter Positioning with Double Precision
(2014)
Introduction: When antiarrhythmic drug therapy has failed, different approaches of pulmonary vein isolation are considered a reasonable option in the treatment of atrial fibrillation. It will be performed predominantly by radiofrequency catheter ablation. As the individual anatomy of left atrium and the pulmonary veins differs considerably, accurate visualization of these structures is essential during catheter positioning. Using non-fluoroscopic electroanatomic mapping system with image integration, electroanatomic mapping can be combined with highly detailed anatomical MRT or CT information on complex left atrial structures. This may facilitate catheter navigation during ablation for atrial fibrillation.
Methods: The CARTO XP electroanatomic system was used in a project during biomedical engineering study to practice image integration of anonymized real patients that underwent pulmonary vein isolation by CARTO XP and a MRT/CT procedure. Using the image integration software, MRT or CT images were imported into the CARTO XP system. The next process was segmentation of the acquired images. It involves dividing the images into different regions in order to select the structures of interest. In clinical routine, this segmentation has to be performed before catheter ablation. Then, the segmented images were aligned with the reconstructed electroanatomic maps. This consists of several steps, including selection of the left atrium, scaling of the reconstructed geometry, fusion of the structures using landmarks, and optimization of the integration by adjusting the reconstructed geometry of the left atrium.
Results: In the 3 months lasting period of the project, image integration was trained in 13 patients undergoing catheter ablation for atrial fibrillation. Within this period, time consumption for the process decreased from about 90 minutes at the beginning to about 35 minutes at the end for one patient.
Conclusion: Image integration into non-fluoroscopic electroanatomic map is a sophisticated tool in cardiac radiofrequency catheter ablation. Intensive training is necessary to control the procedure.
About 20% of those heart failure patients receiving cardiac resynchronization therapy (CRT) are in atrial fibrillation (AF). Current guidelines apply for patients in sinus rhythm only. Recent studies have shown again, that successful resynchronization is closely linked to a pre-existent ventricular desynchronization. In those studies, the interventricular conduction delay (IVCD) was determined prior to device implantation by ultrasound in patients with sinus rhythm (SR)only. In patients with AF this method ́s use is limited.
To implement left-heart electrogram (LHE) into standard programmers and to simplify IVCD measurement in heart failure patients with AF, LHE was recorded in 11 AF patients with heart failure by Biotronik ICS3000 programmer via a15Hz Butterworth high-pass filter. Therefore, TOslim esophageal electrode (Dr. Osypka GmbH, Rheinfelden, Germany) was perorally applied and fixed in position of maximal left ventricular defection. IVCD was measured between onset of QRS in surface ECG and left ventricular defection (LV) in LHE. In addition, intra-left ventricular conduction delay (ILVCD) was measured as duration of LV in LHE.
In all of the 11 AF patients, desynchronization was quantifiable by LHE. Mean QRS of 162 ± 27ms (120-206ms) was linked with IVCD of 62ms ± 27ms (37-98ms) and ILVCD of 110 ± 20ms (80-144ms), at mean. Correlation between IVCD and QRS was 0.39 (n. s.) with IVCD/QRS ratio of 0.38 ± 0.11 (0.22-0.81).
A 15Hz high-pass filtered LHE feature of the Biotronik ICS3000 programmer is feasible to quantify ventricular dyssynchrony in heart failure patients with AF in order to clearly indicate implantation of CRT systems. As relations between QRS duration, IVCD and ILVCD considerably differ interindividually, the predictive values of IVCD, ILVCD and IVCD/QRS ratio for individual CRT response or non-response shall be identified in follow-up studies.
Cardiac resynchronization therapy (CRT) with biventricular pacing is an established therapy for heart failure (HF) patients (P) with ventricular desynchronization and reduced left ventricular (LV) ejection fraction. The aim of this study was to evaluate electrical right atrial (RA), left atrial (LA), right ventricular (RV) and LV conduction delay with novel telemetric signal averaging electrocardiography (SAECG) in implantable cardioverter defibrillator (ICD) P to better select P for CRT and to improve hemodynamics in cardiac pacing.
Methods: ICD-P (n=8, age 70.8 ± 9.0 years; 2 females, 6 males) with VVI-ICD (n=4), DDD-ICD (n=3) and CRT-ICD (n=1) (Medtronic, Inc., Minneapolis, MN, USA) were analysed with telemetric ECG recording by Medronic programmer 2090, ECG cable 2090AB, PCSU1000 oscilloscope with Pc-Lab2000 software (Velleman®) and novel National Intruments LabView SAECG software.
Results: Electrical RA conduction delay (RACD) was measured between onset and offset of RA deflection in the RAECG. Interatrial conduction delay (IACD) was measured between onset of RA deflection and onset of far-field LA deflection in the RAECG. Interventricular conduction delay (IVCD) was measured between onset of RV deflection in the RVECG and onset of LV deflection in the LVECG. Telemetric SAECG recording was possible in all ICD-P with a mean of 11.7 ± 4.4 SAECG heart beats, 97.6 ± 33.7 ms QRS duration, 81.5 ± 44.6 ms RACD, 62.8 ± 28.4 ms RV conduction delay, 143.7 ± 71.4 ms right cardiac AV delay, 41.5 ms LA conduction delay, 101.6 ms LV conduction delay, 176.8 ms left cardiac AV delay, 53.6 ms IACD and 93 ms IVCD.
Conclusions: Determination of RA, LA, RV and LV conduction delay, IACD, IVCD, right and left cardiac AV delay by telemetric SAECG recording using LabView SAECG technique may be useful parameters of atrial and ventricular desynchronization to improve P selection for CRT and hemodynamics in cardiac pacing.
Cardiac resynchronization therapy with atrioventricular and interventricular pacing delay optimized biventricular pacing is an established therapy for heart failure patients with sinus rhythm and reduced left ventricular ejection fraction. The aim of the study was to evaluate atrioventricular and interventricular pacing delay optimization in cardiac resynchroniza-tion therapy by transthoracic impedance cardiography in biventricular pacing with different left ventricular electrode po-sition. In biventricular pacing heart failure patients with lateral, posterolateral and anterolateral left ventricular electrode position, the mean optimal atrioventricular sening delay was 108.6 ± 20.3 ms and the mean optimal interventricular pac-ing delay -12.3 ± 25.9 ms. Transthoracic impedance cardiography may be a useful technique to optimize atrioventricular and interventricular pacing delay in biventricular pacing with different left ventricular electrode position.