Pacing Spikes All Over.
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ABSTRACT:
SUBMITTER: Shurrab M
PROVIDER: S-EPMC5484548 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:Background:In cardiac implantable electronic device management, confused electrocardiograms are sometimes encountered. Case summary:We experienced a case of dizziness and presyncope, which was accompanied by irregular pacing spikes following QRS complexes, pacing failure, sensing failure, or something else. The patient's second active pacemaker in her left chest was functioning normally. However, her old abdominal pacemaker had automatically changed from the OVO to VVI mode because of an elective replacement indicator. As a result, her old and second pacemakers had an interaction. Old invalid pacing spikes induced oversensing of the current pacemaker, which interfered with valid pacing. Discussion:We experienced a rare case of dizziness and presyncope with confused pacing spikes. Physicians should be aware of the unexpected interactions that are possible with devices with automatic mode changes.
| S-EPMC7319825 | biostudies-literature
Project description:The location of interictal spikes is used to aid surgical planning in patients with medically refractory epilepsy; however, their spatial and temporal dynamics are poorly understood. In this study, we analysed the spatial distribution of interictal spikes over time in 20 adult and paediatric patients (12 females, mean age = 34.5 years, range = 5-58) who underwent intracranial EEG evaluation for epilepsy surgery. Interictal spikes were detected in the 24 h surrounding each seizure and spikes were clustered based on spatial location. The temporal dynamics of spike spatial distribution were calculated for each patient and the effects of sleep and seizures on these dynamics were evaluated. Finally, spike location was assessed in relation to seizure onset location. We found that spike spatial distribution fluctuated significantly over time in 14/20 patients (with a significant aggregate effect across patients, Fisher's method: P < 0.001). A median of 12 sequential hours were required to capture 80% of the variability in spike spatial distribution. Sleep and postictal state affected the spike spatial distribution in 8/20 and 4/20 patients, respectively, with a significant aggregate effect (Fisher's method: P < 0.001 for each). There was no evidence of pre-ictal change in the spike spatial distribution for any patient or in aggregate (Fisher's method: P = 0.99). The electrode with the highest spike frequency and the electrode with the largest area of downstream spike propagation both localized the seizure onset zone better than predicted by chance (Wilcoxon signed-rank test: P = 0.005 and P = 0.002, respectively). In conclusion, spikes localize seizure onset. However, temporal fluctuations in spike spatial distribution, particularly in relation to sleep and post-ictal state, can confound localization. An adequate duration of intracranial recording-ideally at least 12 sequential hours-capturing both sleep and wakefulness should be obtained to sufficiently sample the interictal network.
| S-EPMC7537381 | biostudies-literature
Project description:BackgroundPredicting which individuals will have a decline in left ventricular (LV) function after pacemaker implantation remains an important challenge. We investigated whether LV global longitudinal strain (GLS), measured by 2D speckle tracking strain echocardiography, can identify patients at risk of pacing-induced left ventricular dysfunction (PIVD) or pacing-induced cardiomyopathy (PICMP).MethodsFifty-five patients with atrioventricular block and preserved LV function underwent dual-chamber pacemaker implantation and were followed with serial transthoracic echocardiography for 12 months for the development of PIVD (defined as a reduction in LV ejection fraction (LVEF) ≥5 percentage points at 12 months) or PICMP (reduction in LVEF to <45%).ResultsAt 12 months, 15 (27%) patients developed PIVD; of these, 4 patients developed PICMP. At one month, GLS was significantly lower in the 15 patients who subsequently developed PIVD, compared to those who did not (n = 40) (GLS -12.6 vs. -16.4 respectively; p = 0.022). When patients with PICMP were excluded, one month GLS was significantly reduced compared to baseline whereas LVEF was not. One-month GLS had high predictive accuracy for determining subsequent development of PIVD or PICMP (AUC = 0.80, optimal GLS threshold: <-14.5, sensitivity 82%, specificity 75%); and particularly PICMP (AUC = 0.86, optimal GLS threshold: <-13.5, sensitivity 100%, specificity 71%).ConclusionsGLS is a novel predictor of decline in LV systolic function following pacemaker implantation, with the potential to identify patients at risk of PIVD before measurable changes in LVEF are apparent. GLS measured one month after implantation has high predictive accuracy for identifying patients who later develop PIVD or PICMP.
| S-EPMC5240943 | biostudies-literature
Project description:The Intertropical Convergence Zone (ITCZ) encompasses the heaviest rain belt on the Earth. Few direct long-term records, especially in the Pacific, limit our understanding of long-term natural variability for predicting future ITCZ migration. Here we present a tropical precipitation record from the Southern Hemisphere covering the past 282,000 years, inferred from a marine sedimentary sequence collected off the eastern coast of Papua New Guinea. Unlike the precession paradigm expressed in its East Asian counterpart, our record shows that the western Pacific ITCZ migration was influenced by combined precession and obliquity changes. The obliquity forcing could be primarily delivered by a cross-hemispherical thermal/pressure contrast, resulting from the asymmetric continental configuration between Asia and Australia in a coupled East Asian-Australian circulation system. Our finding suggests that the obliquity forcing may play a more important role in global hydroclimate cycles than previously thought.
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Project description:Atrial fibrillation (AF) and heart failure (HF) are associated with high morbidity and mortality, which is particularly detrimental when patients develop rapid ventricular rates (RVR). Atrioventricular junction (AVJ) ablation with pacemaker implantation has been used as a method of achieving rate control in patients with incessant AF with RVR. Right ventricular only pacing is known to be harmful in the setting of HF. His bundle pacing (HBP) and biventricular (BiV) pacing both offer durable pacing solutions that offer more physiologic activation. This review describes the benefits and drawbacks of HBP and BiV pacing in HF patients after AVJ ablation.
| S-EPMC6442941 | biostudies-literature
Project description:During His-Purkinje conduction system (HPS) pacing, it is crucial to confirm capture of the His bundle or left bundle branch versus myocardialonly capture. For this, several methods and criteria for differentiation between non-selective (ns) capture - capture of the HPS and the adjacent myocardium - and myocardial-only capture were developed. HPS capture results in faster and more homogenous depolarisation of the left ventricle than right ventricular septal (RVS) myocardial-only capture. Specifically, the depolarisation of the left ventricle (LV) does not require slow cell-to-cell spread of activation from the right side to the left side of the interventricular septum but begins simultaneously with QRS onset as in native depolarisation. These phenomena greatly influence QRS complex morphology and form the basis of electrocardiographic differentiation between HPS and myocardial paced QRS. Moreover, the HPS and the working myocardium are different tissues within the heart muscle that vary not only in conduction velocities but also in refractoriness and capture thresholds. These last two differences can be exploited for the diagnosis of HPS capture using dynamic pacing manoeuvres, namely differential output pacing, programmed stimulation and burst pacing. This review summarises current knowledge of this subject.
| S-EPMC8576513 | biostudies-literature
Project description:The dominant controls on global paleomonsoon strength include summer insolation driven by precession cycles, ocean circulation through its influence on atmospheric circulation, and sea-surface temperatures. However, few records from the summer North American Monsoon system are available to test for a synchronous response with other global monsoons to shared forcings. In particular, the monsoon response to widespread atmospheric reorganizations associated with disruptions of the Atlantic Meridional Overturning Circulation (AMOC) during the deglacial period remains unconstrained. Here, we present a high-resolution and radiometrically dated monsoon rainfall reconstruction over the past 22,000 y from speleothems of tropical southwestern Mexico. The data document an active Last Glacial Maximum (18-24 cal ka B.P.) monsoon with similar ?(18)O values to the modern, and that the monsoon collapsed during periods of weakened AMOC during Heinrich stadial 1 (ca. 17 ka) and the Younger Dryas (12.9-11.5 ka). The Holocene was marked by a trend to a weaker monsoon that was paced by orbital insolation. We conclude that the Mesoamerican monsoon responded in concert with other global monsoon regions, and that monsoon strength was driven by variations in the strength and latitudinal position of the Intertropical Convergence Zone, which was forced by AMOC variations in the North Atlantic Ocean. The surprising observation of an active Last Glacial Maximum monsoon is attributed to an active but shallow AMOC and proximity to the Intertropical Convergence Zone. The emergence of agriculture in southwestern Mexico was likely only possible after monsoon strengthening in the Early Holocene at ca. 11 ka.
| S-EPMC3677500 | biostudies-literature
Project description:Mice were electrically stimulated by implanting a pacer. The hindlimb muscles received low frequency stimulation for three hours and the tibialis anterior muscle was harvested at different time points after the stimulation. Sham operated control mice were included in the experiment. mRNA was pooled from 6 mice at each time point and hybridized to the arrays together with mRNA from untreated mice (reference). Keywords: time-course
2004-12-24 | GSE1564 | GEO
Project description:To describe the natural history of electroencephalography (EEG) changes in patients with benign epilepsy with centrotemporal spikes (BECTS) over 1 year.Centrotemporal spikes were visually evaluated based on 24-h ambulatory EEG studies to determine the total, left, right, and bilateral centrotemporal spikes patients were awake and asleep. These spike rates were then used to compare the entire night of sleep to the first 2 h of sleep, the repeatability of spike frequency over two recordings (done within days to weeks), and longitudinal changes in spike rate over 6 and 12 months.Nineteen children with newly diagnosed and untreated BECTS were included in this analysis. An excellent correlation was found between the centrotemporal spike rate during the entire duration of sleep and the first 2 h of sleep (intraclass correlation [ICC] 0.87, 95% confidence interval [CI] 0.67-0.95). In addition, an excellent correlation was found between two recordings completed an average of 23 days apart while patients were asleep (ICC 0.92, 95% CI 0.80-0.97) and good correlation while patients were awake (ICC 0.70, 95% CI 0.39-0.87). The average change in spike rate between recordings at baseline and at 6 months was a decrease of 64.7% (range -100% to +51.5%, p = 0.01) and the average change in rate between recordings at baseline and at 12 months was a decrease of 57.7% (range -100% to +29.1%, p = 0.01). In addition, within 6 months, most children had decreased centrotemporal rates, with 30% of children being spike-free. This absence of spikes did not continue in all children, since the majority (60%) had some spikes at 1 year following diagnosis.Centrotemporal spike rates during sleep are stable when compared over days to weeks; however, when comparing spike rates over months there is a larger degree of variability.
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