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Hintergrund: Das elektrische interventrikuläre Delay (IVD) ist bei Patienten (P) mit Herzinsuffizienz (HF), reduzierter linksventrikulärer (LV) Funktion und verbreitertem QRS Komplex von Bedeutung für den Erfolg der kardialen Resynchronisationstherapie (CRT). Die transösophageale LV Elektrokardiographie (EKG) ermöglicht die Bestimmung des elektrischen IVD und linksventrikulären Delays (LVD). Das Ziel der Studie besteht in der Untersuchung des transösophagealen elektrischen IVD, LVD und deren Verhältnis zur QRS Dauer bei rechtsventrikulärer (RV) Stimulation vor Aufrüstung auf eine biventrikuläre (BV) Stimulation.
Methoden: Bei 11 HF P (Alter 69,0 ± 7,9 Jahre; 10 Männer und 1 Frau) mit DDD Schrittmacher (n=10), DDD Defibrillator (n=1) und RV Stimulation, New York Heart Association (NYHA) Klasse 3,0 ± 0,2, LV Ejektionsfraktion 24,5 ± 4,9 % und QRS-Dauer 228,2 ± 44,8 ms wurden das elektrische IVD als Intervall zwischen Beginn des QRS-Komplexes im Oberflächen EKG und Beginn des LV Signals im transösophagealen LV EKG und das elektrische LVD als Intervall zwischen Beginn und Ende des LV Signals im transösophagealen LV EKG präoperativ vor Aufrüstung auf CRT Defibrillator (n=8) und CRT Schrittmacher (n=3) bestimmt. Der Anstieg des arteriellen Pulse Pressure (PP) wurde zwischen RV Stimulation und transösophagealer LV Stimulation mit unterschiedlichem AV-Delay (n=5) vor Aufrüstung von RV auf BV Stimulation getestet.
Ergebnisse: Bei RV Stimulation betrugen IVD 86,54 ± 32,80 ms, LVD 94,45 ± 23,80 ms, QRS-IVD-Verhältnis 2,63 ± 0,81 mit negativer Korrelation zwischen IVD und QRS-IVD-Verhältnis (r=-0,668 P=0,0248) (Fig.) und QRS-LVD-Verhältnis 2,33 ± 0,73. Vorhofsynchrone ventrikuläre Stimulation führte zu 63,6 ± 27,7 mmHg PP bei RV Stimulation und 80,6 ± 38,5 mmHg PP bei LV Stimulation und der PP erhöhte sich bei LV Stimulation mit optimalem AV Delay um 17 ± 11,2 mmHg gegenüber RV Stimulation (P<0,001). Nach Aufrüstung von RV Stimulation auf BV Stimulation verbesserten sich die NYHA Klasse von 3,1 ± 0,2 auf 2,2 ± 0,3 während 30,4 ± 29,6 Monaten CRT.
Schlussfolgerungen: Das transösophageale LV EKG ermöglicht die Bestimmung des elektrischen IVD und LVD bei RV Stimulation zur Evaluierung der interventrikulären und linksventrikulären elektrischen Desynchronisation. IVD, LVD und deren Verhältnis zur QRS Dauer können möglicherweise zur Vorhersage einer CRT Response vor Aufrüstung von RV auf BV Stimulation genutzt werden.
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.
Gelingt den Studienanfängern eine strukturierte Ergebnissicherung der Lehrveranstaltungen? Oder sind viele allein schon mit einem vollständigen Mitschrieb überfordert? Laufen aktivierende Methoden, Medienwechsel und der Wunsch nach strukturierter Sicherung der Inhalte des Lehrgesprächs teilweise sogar auseinander? Immer mehr Studierende (möchten) auch per Tablet mitschreiben. Wie könnte man in der Lehre auf diese Aspekte stärker eingehen?
Es wird ein praktischer Ansatz gezeigt, Mathematik-Vorlesungen über ein Tablet-basiertes Mitmach-Skript zu gestalten. Dieses dient als Schrittmacher zwischen Input- und Verarbeitungsphasen und unterstützt die strukturierte Verschriftlichung, indem es Vorteile von Tafel, PPT und klassischem Skript vereint. Traditionelle Methoden werden mit technologischen Möglichkeiten kombiniert, um die angesprochenen Herausforderungen bewusster im Lehrstil zu berücksichtigen. Verbindungen zu Virtual Classroom und Video-gestützter Lehre werden aufgezeigt.
Microscale trigeneration systems are highly flexible in their operation and thus offer the technical possibility for peak load shifting in building demand side management. However to harness their potential modern control methods such as model predictive control must be implemented for their optimal scheduling. In literature the need for experimental investigation of microscale trigeneration systems to identify typical characteristics of the components and their interactions has been identified. On a real-life setup control specific information of the components is collected and lessons learnt during commissioning of the equipment is shared. The data is analysed to draw the vital characteristics of the system and it will be used for creating models of the components that can be utilised for optimal control.
Modelling and Simulation of Microscale Trigeneration Systems Based on Real- Life Experimental Data
(2017)
For the shift of the energy grid towards a smarter decentralised system flexible microscale trigeneration systems will play an important role due to their ability to support the demand side management in buildings. However to harness their potential modern control methods like model predictive control must be implemented for their optimal scheduling and control. To implement such supervisory control methods, first, simple analytical models representing the behaviour of the components need to be developed. At the Institute of Energy System Technologies in Offenburg we have built a real-life microscale trigeneration plant and present in this paper the models based on experimental data. These models are qualitatively validated and their application in the future for the optimal scheduling problem is briefly motivated.
Within this work, the benefits of using predictive control methods for the operation of Adsorption Cooling Machines (ACMs) are shown on a simulation study. Since the internal control decisions of series-manufactured ACMs often cannot be influenced, the work focuses on optimized scheduling of an ACM considering its internal functioning as well as forecasts for load and driving energy occurrence. For illustration, an assumed solar thermal climate system is introduced and a system model suitable for use within gradient-based optimization methods is developed. The results of a system simulation using a conventional scheme for ACM scheduling are compared to the results of a predictive, optimization-based scheduling approach for the same exemplary scenario of load and driving energy occurrence. The benefits of the latter approach are shown and future actions for application of these methods for system control are addressed.
Sichere Detektion von Menschen in der Mensch-Roboter-Kollaboration mit Time-of-Flight Kameras
(2017)
In safety critical applications wireless technologies are not widely spread. This is mainly due to reliability and latency requirements. In this paper a new wireless architecture is presented which will allow for customizing the latency and reliability for every single participant within the network. The architecture allows for building up a network of inhomogeneous participants with different reliability and latency requirements. The used TDMA scheme with TDD as duplex method is acting gentle on resources. Therefore participants with different processing and energy resources are able to participate.
In medical applications wireless technologies are not widely spread. Today they are mainly used in non latency-critical applications where reliability can be guaranteed through retransmission protocols and error correction mechanisms. By using retransmission protocols within the disturbed shared wireless channel latency will increase. Therefore retransmission protocols are not sufficient for removing latency-critical wired connections within operating rooms such as foot switches. Todays research aims to improve reliability through the physical characteristics of the wireless channel by using diversity methods and more robust modulation. In this paper an Architecture for building up a reliable network is presented. The Architecture offers the possibility for devices with different reliability, latency and energy consumption requirements to participate. Furthermore reliability, latency and energy consumption are scalable for every single participant.