Effect of verapamil on immediate recurrence of atrial fibrillation.

PubMed

Daoud, E G; Hummel, J D; Augostini, R; Williams, S; Kalbfleisch, S J

2000-11-01

The purpose of this study was to assess the effect of verapamil on immediate recurrences of atrial fibrillation occurring after successful electrical cardioversion. The effect of verapamil on the recurrence of atrial fibrillation within 5 minutes after successful transthoracic cardioversion was assessed in 19 (5%) of 364 patients undergoing electrical cardioversion. The mean duration of atrial fibrillation was 4.44+/-3.0 months. In the 19 patients, cardioversion was successful after each of three consecutive cardioversion attempts per patient; however, atrial fibrillation recurred 0.4+/-0.3 minutes after cardioversion. Verapamil 10 mg was administered intravenously and a fourth cardioversion was performed. Cardioversion after verapamil was successful in each patient, and atrial fibrillation did not recur in 9 (47%) of 19 patients (P < 0.001 vs before verapamil). In the remaining 10 patients in whom atrial fibrillation recurred, the duration of sinus rhythm was significantly longer compared with before verapamil (3.6+/-2.4 min, P < 0.001). The density of atrial ectopy occurring after cardioversion was significantly less after verapamil (21+/-14 ectopic beats per min) compared with before verapamil (123+/-52 ectopic beats per min, P < 0.001). Among patients with immediate recurrence of atrial fibrillation after electrical cardioversion, acute calcium channel blockade by verapamil reduces recurrence of atrial fibrillation and extends the duration of sinus rhythm.

Cost-effectiveness of cardioversion and antiarrhythmic therapy in nonvalvular atrial fibrillation.

PubMed

Catherwood, E; Fitzpatrick, W D; Greenberg, M L; Holzberger, P T; Malenka, D J; Gerling, B R; Birkmeyer, J D

1999-04-20

Physicians managing patients with nonvalvular atrial fibrillation must consider the risks, benefits, and costs of treatments designed to restore and maintain sinus rhythm compared with those of rate control with antithrombotic prophylaxis. To compare the cost-effectiveness of cardioversion, with or without antiarrhythmic agents, with that of rate control plus warfarin or aspirin. A Markov decision-analytic model was designed to simulate long-term health and economic outcomes. Published literature and hospital accounting information. Hypothetical cohort of 70-year-old patients with different baseline risks for stroke. 3 months. Societal. Therapeutic strategies using different combinations of cardioversion alone, cardioversion plus amiodarone or quinidine therapy, and rate control with antithrombotic treatment. Expected costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness. Strategies involving cardioversion alone were more effective and less costly than those not involving this option. For patients at high risk for ischemic stroke (5.3% per year), cardioversion alone followed by repeated cardioversion plus amiodarone therapy on relapse was most cost-effective ($9300 per QALY) compared with cardioversion alone followed by warfarin therapy on relapse. This strategy was also preferred for the moderate-risk cohort (3.6% per year), but the benefit was more expensive ($18,900 per QALY). In the lowest-risk cohort (1.6% per year), cardioversion alone followed by aspirin therapy on relapse was optimal. The choice of optimal strategy and incremental cost-effectiveness was substantially influenced by the baseline risk for stroke, rate of stroke in sinus rhythm, efficacy of warfarin, and costs and utilities for long-term warfarin and amiodarone therapy. Cardioversion alone should be the initial management strategy for persistent nonvalvular atrial fibrillation. On relapse of arrhythmia, repeated cardioversion plus low-dose amiodarone is cost-effective for patients at moderate to high risk for ischemic stroke.

Early cardioversion of atrial fibrillation and atrial flutter guided by transoesophageal echocardiography: a single centre 8.5-year experience.

PubMed

Corrado, G; Santarone, M; Beretta, S; Tadeo, G; Tagliagambe, L M; Foglia-Manzillo, G; Spata, M; Miglierina, E; Acquati, F; Santarone, M

2000-04-01

To analyse the safety and impact on maintenance of sinus rhythm of transoesophageal echocardiographically guided early cardioversion associated with short-term anticoagulation in a large series of patients with atrial fibrillation and atrial flutter. Patients who were candidates for cardioversion were eligible for inclusion if they had atrial fibrillation or atrial flutter lasting longer than 2 days or of unknown duration. Patients received short-term anticoagulation with warfarin or heparin and underwent transthoracic echocardiography followed by transoesophageal echocardiography. Early cardioversion was performed if no thrombus was seen on the transoesophageal study. Warfarin was maintained for 1 month after cardioversion. In patients with atrial thrombi, cardioversion was deferred and prolonged anticoagulation was prescribed. The study population included 183 patients. One hundred and sixty nine patients without atrial thrombi underwent early cardioversion. Fourteen patients with atrial thrombi (7.6%) underwent a second transoesophageal echocardiogram after a median of 4 weeks of oral warfarin, and cardioversion was performed if clot regression was documented. No patient in our study population had a clinical thromboembolic event at 1 month follow-up (95% C.I. 0-0.016). The immediate success rate of cardioversion was better among patients with atrial fibrillation < 4 weeks duration compared with patients with atrial fibrillation of longer or of unknown duration: 96.6% vs 85%, respectively (P = 0.014). At 1 month follow-up, the percentage of arrhythmia relapses in patients with initially successful cardioversion was similar in the two groups (29% vs 26%, P = ns); thus the initial better outcome in patients with recent-onset arrhythmia was not lost. Transoesophageal echocardiography-guided early cardioversion in concert with short-term anticoagulation is safe. This approach permits abbreviation of the overall duration of atrial fibrillation and has a better impact on the maintenance of sinus rhythm for patients in whom the duration of atrial fibrillation is < 4 weeks.

Efficacy and safety of apixaban in patients after cardioversion for atrial fibrillation: insights from the ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation).

PubMed

Flaker, Greg; Lopes, Renato D; Al-Khatib, Sana M; Hermosillo, Antonio G; Hohnloser, Stefan H; Tinga, Brian; Zhu, Jun; Mohan, Puneet; Garcia, David; Bartunek, Jozef; Vinereanu, Dragos; Husted, Steen; Harjola, Veli Pekka; Rosenqvist, Marten; Alexander, John H; Granger, Christopher B

2014-03-25

The aim of this study was to determine the risk of major clinical and thromboembolic events after cardioversion for atrial fibrillation in subjects treated with apixaban, an oral factor Xa inhibitor, compared with warfarin. In patients with atrial fibrillation, thromboembolic events may occur after cardioversion. This risk is lowered with vitamin K antagonists and dabigatran. Using data from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, we conducted a post-hoc analysis of patients undergoing cardioversion. A total of 743 cardioversions were performed in 540 patients: 265 first cardioversions in patients assigned to apixaban and 275 in those assigned to warfarin. The mean time to the first cardioversion for patients assigned to warfarin and apixaban was 243 ± 231 days and 251 ± 248 days, respectively; 75% of the cardioversions occurred by 1 year. Baseline characteristics were similar between groups. In patients undergoing cardioversion, no stroke or systemic emboli occurred in the 30-day follow-up period. Myocardial infarction occurred in 1 patient (0.2%) receiving warfarin and 1 patient receiving apixaban (0.3%). Major bleeding occurred in 1 patient (0.2%) receiving warfarin and 1 patient receiving apixaban (0.3%). Death occurred in 2 patients (0.5%) receiving warfarin and 2 patients receiving apixaban (0.6%). Major cardiovascular events after cardioversion of atrial fibrillation are rare and comparable between warfarin and apixaban. (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation [ARISTOTLE]; NCT00412984). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

External cardioversion in patients with persistent atrial fibrillation: a reappraisal of the effects of electrode pad position and transthoracic impedance on cardioversion success.

PubMed

Chen, Chien-Jen; Guo, G Bih-Fang

2003-11-01

The optimal methods to perform external cardioversion of atrial fibrillation (AF) have yet to be conclusively determined. This study was performed to examine the relative efficacy of different pad positions on cardioversion success and the relationship between the transthoracic impedance (TTI) and energy requirement for AF cardioversion. Seventy patients with persistent AF undergoing elective cardioversion were randomly assigned to an electrode pad position situated either over the ventricular apex-right infraclavicular area (AL group, n = 31 ) or over the right lower sternal border-left infrascapular area close to the spine (AP group, n = 39). Energy was delivered at an initial 100 joules (J) and then increased to 150 J, 200 J, 300 J, and 360 J if needed. Energy and TTI readings were recorded. Mean TTI was significantly lower in the AP group than in the AL group. However, the cumulative success rates at each energy level were similar in the two groups (23% vs 19.4%, 41% vs 45.2%, 66.7% vs 74.2%, 79.5% vs 77.4%, and 84.6% vs 83.9% at 100 J, 150 J, 200 J, 300 J and 360 J, respectively). In the AP group, converters showed slightly lower TTI compared to nonconverters. In the AL group, converters showed significantly lower TTI compared to nonconverters. However, for all patients as a group, TTI was the only predictor for cardioversion success and showed a significant relationship to the energy required for cardioversion, which can be described by a quadratic equation. Rather than pad position. TTI is the single factor that significantly affects cardioversion and correlates with energy requirement. The relationship between energy requirement and TTI further allows estimation of energy requirements to achieve a successfil cardioversion.

Cardioversion

MedlinePlus

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Atrial fibrillation management in a breeding stallion.

PubMed

Heliczer, N; Mitchell, K; Lorello, O; Dauvillier, J; Burger, D; Schwarzwald, C C; Navas de Solis, C

2017-06-01

A 20-year-old warmblood breeding stallion presented to a University practice for semen collection and evaluation was incidentally diagnosed with atrial fibrillation (AF). Electrocardiogram recordings during breeding revealed inappropriately rapid tachycardia and occasional ventricular premature depolarizations/aberrant ventricular conduction. Transvenous electrical cardioversion was performed. After successful cardioversion the horse displayed supraventricular ectopy and atrial contractile dysfunction and was administered sotalol hydrochloride in an attempt to decrease the risk of AF recurrence. Supraventricular ectopy and echocardiographic evidence of atrial dysfunction gradually improved and normalized over 6 months. No direct adverse effects of the chronic anti-arrhythmic treatment were observed and libido and semen quality were unaffected. AF recurred 6 months after cardioversion and sotalol therapy was continued to control the ventricular ectopy/aberrant ventricular conduction during semen collection. Considerations regarding pathologic arrhythmias and inappropriately high heart rates in breeding stallions with AF may be similar to those in riding horses. Sotalol hydrochloride was a safe anti-arrhythmic drug in the management of this case. Copyright © 2017 Elsevier B.V. All rights reserved.

Recognition and treatment of unstable supraventricular tachycardia by pediatric residents in a simulation scenario.

PubMed

Shilkofski, Nicole A; Nelson, Kristen L; Hunt, Elizabeth A

2008-01-01

Supraventricular tachycardia (SVT) is the most frequent tachydysrhythmia in children. SVT with hemodynamic compromise should be terminated by immediate electrical cardioversion. Study objectives were to: (1) establish time to recognition and cardioversion of simulated unstable SVT; and (2) document delays and mistakes made during cardioversion. Ten teams of pediatric residents were presented with an unresponsive "patient" (Laerdal SimMan) in unstable SVT. Actions of team members and simulator timestamps of key events were recorded. A retrospective review of events and time logs was performed with primary outcome measure of time to successful cardioversion. Median time to cardioversion was 8.9 minutes (range, 5.3 minutes to unsuccessful scenario terminated at 15 minutes). In 20% of scenarios, the patient was never cardioverted. Ninety percent of teams administered adenosine, but 44% of attempts demonstrated incorrect administration technique. Other maneuvers before cardioversion: 70% administered fluid, 60% attempted vagal maneuvers, 30% requested electrocardiogram, 30% requested antiarrhythmics. In 20% of scenarios, the rhythm was misidentified. When cardioversion was performed, 25% failed to use gel, 37.5% failed to synchronize, 25% used inappropriate energy doses. In 60% of scenarios, no oxygen was administered. In 90% there was no assignment of Glasgow Coma Scale, and no assessment of mental status in 30%. In 60% perfusion was not assessed. Median time to cardioversion of 8.9 minutes is inconsistent with AHA recommendations for treatment of unstable SVT with "immediate cardioversion." Delays were secondary to lack of recognition of "unstable" SVT, due to failure to assess perfusion and mental status. Errors encountered during simulation identify curriculum reform targets.

[The risk of direct current countershock].

PubMed

Gajek, J; Zyśko, D

2001-07-01

Direct current cardioversion (DCC) is a procedure commonly used to restore the sinus rhythm in patients with supraventricular and ventricular arrhythmias. Its safety, regarding the use of electric current, is still a matter of controversy and debate. The patients with atrial fibrillation/flutter, supraventricular or ventricular tachycardia represent a broad spectrum of clinical conditions and it is difficult to draw the conclusions. The high success rate of DCC in restoring the sinus rhythm, may be partly responsible for enhancing and revealing proarrhythmic properties of antiarrhythmic drugs. The deaths described as a complications of DCC were mainly due to the proarrhythmia and less common to the progression of the pathologic process. The embolic, arrhythmic and anesthetic complications of DCC can be prevented if the known recommendations of performing the DCC are followed. The authors review critically the literature data about the complications of the procedure and come to the conclusion of safety of DCC.

Safety of transvenous low energy cardioversion of atrial fibrillation in patients with a history of ventricular tachycardia: effects of rate and repolarization time on proarrhythmic risk.

PubMed

Simons, G R; Newby, K H; Kearney, M M; Brandon, M J; Natale, A

1998-02-01

The objective of this study was to assess the safety and efficacy of transvenous low energy cardioversion of atrial fibrillation in patients with ventricular tachycardia and atrial fibrillation and to study the mechanisms of proarrhythmia. Previous studies have demonstrated that cardioversion of atrial fibrillation using low energy, R wave synchronized, direct current shocks applied between catheters in the coronary sinus and right atrium is feasible. However, few data are available regarding the risk of ventricular proarrhythmia posed by internal atrial defibrillation shocks among patients with ventricular arrhythmias or structural heart disease. Atrial defibrillation was performed on 32 patients with monomorphic ventricular tachycardia and left ventricular dysfunction. Shocks were administered during atrial fibrillation (baseline shocks), isoproterenol infusion, ventricular pacing, ventricular tachycardia, and atrial pacing. Baseline shocks were also administered to 29 patients with a history of atrial fibrillation but no ventricular arrhythmias. A total of 932 baseline shocks were administered. No ventricular proarrhythmia was observed after well-synchronized baseline shocks, although rare inductions of ventricular fibrillation occurred after inappropriate T wave sensing. Shocks administered during wide-complex rhythms (ventricular pacing or ventricular tachycardia) frequently induced ventricular arrhythmias, but shocks administered during atrial pacing at identical ventricular rates did not cause proarrhythmia. The risk of ventricular proarrhythmia after well-synchronized atrial defibrillation shocks administered during narrow-complex rhythms is low, even in patients with a history of ventricular tachycardia. The mechanism of proarrhythmia during wide-complex rhythms appears not to be related to ventricular rate per se, but rather to the temporal relationship between shock delivery and the repolarization time of the previous QRS complex.

Feasibility of a cardiologist-only approach to sedation for electrical cardioversion of atrial fibrillation: a randomized, open-blinded, prospective study.

PubMed

Guerra, Federico; Pavoni, Ilaria; Romandini, Andrea; Baldetti, Luca; Matassini, Maria Vittoria; Brambatti, Michela; Luzi, Mario; Pupita, Giuseppe; Capucci, Alessandro

2014-10-20

Sedation with propofol should be administered by personnel trained in advanced airway management. To overcome this limitation, the use of short acting benzodiazepines by cardiologists spread widely, causing concerns about the safety of this procedure in the absence of anesthesiology assistance. The aim of the study was to compare feasibility of a cardiologist-only approach with an anesthesiologist-assisted sedation protocol during elective direct-current cardioversion (DCC) of persistent atrial fibrillation (AF). This prospective, open-blinded, randomized study included 204 patients, which were admitted for scheduled cardioversion of persistent AF, and randomized in a 1:1 fashion to either propofol or midazolam treatment arm. Patients in the propofol group underwent DCC with anesthesiologist assistance, while patients in the midazolam group saw the cardiologist as the only responsible for both sedation and DCC. Twenty-three adverse events occurred: 13 in the propofol group and 10 in the midazolam group (p=NS). Most of them were related to bradyarrhythmias and respiratory depressions. There was no need of intubation or other advanced resuscitation techniques in any of these patients. No differences were found regarding procedure tolerability and safety endpoints between the two groups. DCC procedures with anesthesiology support were burdened by higher delay from scheduled time and higher costs. Sedation with midazolam administered by cardiologist-only appears to be as safe as sedation with propofol and anesthesiologist assistance. Adverse events were few in both groups and easily handled by the cardiologist alone. A cardiologist-only approach to sedation provides less procedural delay, thus being easier to schedule and correlated with fewer costs. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Advance Care Planning: Medical Issues to Consider

MedlinePlus

... deliver oxygen to the bloodstream; cardioversion (passing an electrical current through the heart to restart it or ... occur. This person will benefit from very invasive technology to reverse critical illness. Close monitoring of the ...

Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter.

PubMed

Stiell, Ian G; Clement, Catherine M; Perry, Jeffrey J; Vaillancourt, Christian; Symington, Cheryl; Dickinson, Garth; Birnie, David; Green, Martin S

2010-05-01

There is no consensus on the optimal management of recent-onset episodes of atrial fibrillation or flutter. The approach to these conditions is particularly relevant in the current era of emergency department (ED) overcrowding. We sought to examine the effectiveness and safety of the Ottawa Aggressive Protocol to perform rapid cardioversion and discharge patients with these arrhythmias. This cohort study enrolled consecutive patient visits to an adult university hospital ED for recent-onset atrial fibrillation or flutter managed with the Ottawa Aggressive Protocol. The protocol includes intravenous chemical cardioversion, electrical cardioversion if necessary and discharge home from the ED. A total of 660 patient visits were included, 95.2% involving atrial fibrillation and 4.9% involving atrial flutter. The mean age of patients enrolled was 64.5 years. In total, 96.8% were discharged home and, of those, 93.3% were in sinus rhythm. All patients were initially administered intravenous procainamide, with a 58.3% conversion rate. A total of 243 patients underwent subsequent electrical cardioversion with a 91.7% success rate. Adverse events occurred in 7.6% of cases: hypotension 6.7%, bradycardia 0.3% and 7-day relapse 8.6%. There were no cases of torsades de pointes, stroke or death. The median lengths of stay in the ED were as follows: 4.9 hours overall, 3.9 hours for those undergoing conversion with procainamide and 6.5 hours for those requiring electrical conversion. This is the largest study to date to evaluate the Ottawa Aggressive Protocol, a unique approach to cardioversion for ED patients with recent-onset episodes of atrial fibrillation and flutter. Our data demonstrate that the Ottawa Aggressive Protocol is effective, safe and rapid, and has the potential to significantly reduce hospital admissions and expedite ED care.

Impact of ED management on hospital quality measures: the negative case of atrial fibrillation.

PubMed

Piela, Nicole E; Sacchetti, Alfred; Sholevar, Darius; Blaber, Reginald; Levi, Steven

2013-05-01

Emergency department (ED) cardioversion and discharge of atrial fibrillation (AF) is an evolving treatment. Emergency department cardioversion patients have few comorbidities, and their discharge directly from the ED leads to a sicker in-patient population of AF patients. This study examines whether the quality care markers, hospital charges (HC) and length of stay (LOS), negatively reflect the practice of ED cardioversion. Median HC and LOS were determined for 2 different quality assessment reporting models. In a standard model (SM), patients discharged from the ED were not included in any hospital statistics and only admitted, or observation patients were used to calculate the HC and LOS of AF patients. In an inclusive model (IM), patients discharged from the ED were also included in the hospital statistics but given the same LOS as observation patients. Differences across medians were analyzed using Wilcoxon rank sum tests. A total of 312 patients were evaluated for AF over an 18-month period. Of these, 197 (62%) were admitted, 21 (7%) were placed in observation status, and 95 (31%) were discharged from the ED. Median values for LOS were 3 days (interquartile range [IQR], 1-5) for the SM and 1 day (IQR, 0-4) for the IM. Median values for HC were $33062 (IQR, $19267-$60614) for the SM and $20059 (IQR, $4249-$47195) for the IM. Emergency department cardioversion selects out a less sick cohort of patients whose removal from a hospital's admission numbers negatively skews quality performance profiles. Copyright © 2013 Elsevier Inc. All rights reserved.

Is discharge to home after emergency department cardioversion safe for the treatment of recent-onset atrial fibrillation?

PubMed

von Besser, Kiera; Mills, Angela M

2011-12-01

Recent-onset atrial fibrillation, defined as a first detected or recurrent episode of atrial fibrillation lasting less than 48 hours, is a commonly encountered dysrhythmia in the emergency department (ED). Cardioversion of stable patients in the ED with recent-onset atrial fibrillation without antecedent anticoagulation would allow for these patients to be discharged directly to home. We searched the literature to determine whether any studies have investigated the safety of this management strategy and identified five that addressed this question. These studies are reviewed herein; importantly, not one ED patient who was cardioverted in any of the five studies suffered a thromboembolic event - the feared complication responsible for most of the controversy surrounding the ED management of atrial fibrillation. According to the available evidence, we conclude that it would be within the standard of care to discharge home stable patients with recent-onset atrial fibrillation after cardioversion in the ED with adequate follow-up. It should be noted that although this strategy is safe and effective, the return visit rate for relapsed atrial fibrillation is 3% to 17%, and patients should be made aware of this possibility.

Synchronized emergency department cardioversion of atrial dysrhythmias saves time, money and resources.

PubMed

Jacoby, Jeanne L; Cesta, Mark; Heller, Michael B; Salen, Philip; Reed, James

2005-01-01

The strategy of elective synchronized cardioversion (EDCV) of new onset atrial fibrillation/flutter (AF/flutter) compares favorably to that of Emergency Department (ED) rate control and inpatient admission. This 1-year study comprised consecutive ED synchronized cardioversions performed on patients with new onset (< 48 h) AF/flutter; all were hemodynamically stable. A control group was obtained by chart review of all patients meeting the inclusion criteria admitted in the same year who were managed with rate control in the ED and inpatient admission. Thirty ED cardioversions were performed on 24 patients. Twenty-nine of 30 (97%) of ED cardioversions were successful. The mean hospital length of stay (LOS) for the EDCV group, including those admitted, was 22.8 h (95% CI: 1.7-44.0) compared to the control group: 55.6 h (all admitted) (95% CI: 41.6-69.6). Median LOS for the entire EDCV group was 4 h, compared with 39.3 h for the controls (p < 0.001). There was also a significant difference in median hospital charge, including ED care: EDCV group: $1598 vs. controls $4271 (p < 0.001). All of the study patients were contacted by telephone a minimum of 4 weeks after cardioversion to assess for complications, recidivism, and satisfaction. There were no complications in the EDCV group, and all expressed satisfaction with the procedure. Elective synchronized cardioversion in the ED is an effective strategy for management of new-onset AF/flutter and is associated with significant decreases in charges and length of stay as well as a high degree of patient satisfaction.

A randomized controlled trial of efficacy and ST change following use of the Welch-Allyn MRL PIC biphasic waveform versus damped sine monophasic waveform for external DC cardioversion.

PubMed

Ambler, Jonathan J S; Deakin, Charles D

2006-11-01

Biphasic waveforms have similar or greater efficacy at cardioverting atrial and ventricular arrhythmias at lower energy levels than monophasic waveforms, and cause less ST depression following defibrillation of ventricular fibrillation. No studies have investigated this effect on ST change with atrial arrhythmias. We studied the efficacy of the Welch Allyn-MRL PIC biphasic defibrillator. One hundred and thirty-nine patients undergoing elective DC cardioversion for atrial arrhythmias were randomised to cardioversion by monophasic (Hewlett Packard Codemaster XL; 100, 200, 300, 360 and 360J) or biphasic (Welch Allyn-MRL PIC; 70, 100, 150, 200 and 300J) defibrillator. We analysed success of cardioversion after 0 and 30min, cumulative energy, number of shocks and energy at successful cardioversion. The ST change in the recorded electrocardiogram was measured at 15s after all shocks using electronic callipers. Immediately after cardioversion 59/68 (86.8%) of the monophasic group versus 56/60 (93.3%) of the biphasic group were in sinus rhythm. Of the monophasic group, 55/67 (82.1%) remained in sinus rhythm at 30min versus 53/58 (91.4%) of the biphasic group. These differences were not significant at 0min (P=0.35) or 30min (P=0.21). The biphasic group required significantly fewer shocks (P=0.006), less cumulative energy (P<0.0001) and required lower total energy for successful cardioversion (P<0.0001). Of the 102 patients with electrocardiogram recordings suitable for analysis, ST segment change was greater in the monophasic group (P=0.037). The Welch Allyn-MRL biphasic waveform for DC cardioversion results in fewer shocks, with less cumulative energy delivered and less post shock ST change than with a Hewlett Packard Codemaster XL damped sine wave monophasic waveform.

Outcomes after cardioversion and atrial fibrillation ablation in patients treated with rivaroxaban and warfarin in the ROCKET AF trial.

PubMed

Piccini, Jonathan P; Stevens, Susanna R; Lokhnygina, Yuliya; Patel, Manesh R; Halperin, Jonathan L; Singer, Daniel E; Hankey, Graeme J; Hacke, Werner; Becker, Richard C; Nessel, Christopher C; Mahaffey, Kenneth W; Fox, Keith A A; Califf, Robert M; Breithardt, Günter

2013-05-14

This study sought to investigate the outcomes following cardioversion or catheter ablation in patients with atrial fibrillation (AF) treated with warfarin or rivaroxaban. There are limited data on outcomes following cardioversion or catheter ablation in AF patients treated with factor Xa inhibitors. We compared the incidence of electrical cardioversion (ECV), pharmacologic cardioversion (PCV), or AF ablation and subsequent outcomes in patients in a post hoc analysis of the ROCKET AF (Efficacy and Safety Study of Rivaroxaban With Warfarin for the Prevention of Stroke and Non-Central Nervous System Systemic Embolism in Patients With Non-Valvular Atrial Fibrillation) trial. Over a median follow-up of 2.1 years, 143 patients underwent ECV, 142 underwent PCV, and 79 underwent catheter ablation. The overall incidence of ECV, PCV, or AF ablation was 1.45 per 100 patient-years (n = 321; 1.44 [n = 161] in the warfarin arm, 1.46 [n = 160] in the rivaroxaban arm). The crude rates of stroke and death increased in the first 30 days after cardioversion or ablation. After adjustment for baseline differences, the long-term incidence of stroke or systemic embolism (hazard ratio [HR]: 1.38; 95% confidence interval [CI]: 0.61 to 3.11), cardiovascular death (HR: 1.57; 95% CI: 0.69 to 3.55), and death from all causes (HR: 1.75; 95% CI: 0.90 to 3.42) were not different before and after cardioversion or AF ablation. Hospitalization increased after cardioversion or AF ablation (HR: 2.01; 95% CI: 1.51 to 2.68), but there was no evidence of a differential effect by randomized treatment (p value for interaction = 0.58). The incidence of stroke or systemic embolism (1.88% vs. 1.86%) and death (1.88% vs. 3.73%) were similar in the rivaroxaban-treated and warfarin-treated groups. Despite an increase in hospitalization, there were no differences in long-term stroke rates or survival following cardioversion or AF ablation. Outcomes were similar in patients treated with rivaroxaban or warfarin. (An Efficacy and Safety Study of Rivaroxaban With Warfarin for the Prevention of Stroke and Non-Central Nervous System Systemic Embolism in Patients With Non-Valvular Atrial Fibrillation [ROCKET AF]; NCT00403767). Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Intravenous sotalol decreases transthoracic cardioversion energy requirement for chronic atrial fibrillation in humans: assessment of the electrophysiological effects by biatrial basket electrodes.

PubMed

Lai, L P; Lin, J L; Lien, W P; Tseng, Y Z; Huang, S K

2000-05-01

This study was undertaken to assess the effects of sotalol on the transthoracic cardioversion energy requirement for chronic atrial fibrillation (AF) and on the atrial electrograms during AF recorded by two basket electrodes. The effects of sotalol infusion on transthoracic electrical cardioversion for chronic atrial fibrillation in humans have not been well investigated. We included 18 patients with persistent AF for more than three months. Atrial electrograms were recorded by two basket electrodes positioned in each atrium respectively. Transthoracic cardioversion was performed before and after sotalol 1.5 mg/kg i.v. infusion. In the 14 patients whose AF could be terminated by cardioversion before sotalol infusion, the atrial defibrillation energy was significantly reduced after sotalol infusion (236 +/- 74 jules [J] vs. 186 +/- 77 J; p < 0.01). Atrial fibrillation was refractory to cardioversion in four patients at baseline and was converted to sinus rhythm by cardioversion after sotalol infusion in two of them. We further divided the patients into two groups. Group A consisted of 10 patients in whom the energy requirement was decreased by sotalol while group B consisted of eight patients in whom the energy requirement was not decreased. The mean A-A (atrial local electrogram) intervals during AF were significantly increased after sotalol infusion in both groups, but the increment of A-A interval was significantly larger in group A than it was in group B patients (36 +/- 13 ms vs. 22 +/- 8 ms for the right atrium; 19 +/- 7 ms vs. 9 +/- 7 ms for the left atrium; both p < 0.05). The spatial and temporal dispersions of A-A intervals were not significantly changed after sotalol infusion in both atria in both groups. Sotalol decreases the atrial defibrillation energy requirement by increasing atrial refractoriness but not by decreasing the dispersion of refractoriness.

Non-vitamin K antagonist oral anticoagulants versus warfarin for the prevention of spontaneous echo-contrast and thrombus in patients with atrial fibrillation or flutter undergoing cardioversion: A trans-esophageal echocardiography study.

PubMed

Kim, Yun Gi; Choi, Jong-Il; Kim, Mi-Na; Cho, Dong-Hyuk; Oh, Suk-Kyu; Kook, Hyungdon; Park, Hee-Soon; Lee, Kwang No; Baek, Yong-Soo; Roh, Seung-Young; Shim, Jaemin; Park, Seong-Mi; Shim, Wan Joo; Kim, Young-Hoon

2018-01-01

Spontaneous echo-contrast (SEC) and thrombus observed in trans-esophageal echocardiography (TEE) is known as a strong surrogate marker for future risk of ischemic stroke in patients with atrial fibrillation (AF) or atrial flutter (AFL). The efficacy of non-vitamin K antagonist oral anticoagulants (NOAC) compared to warfarin to prevent SEC or thrombus in patients with AF or AFL is currently unknown. AF or AFL patients who underwent direct current cardioversion (DCCV) and pre-DCCV TEE evaluation from January 2014 to October 2016 in a single center were analyzed. The prevalence of SEC and thrombus were compared between patients who received NOAC and those who took warfarin. NOAC included direct thrombin inhibitor and factor Xa inhibitors. Among 1,050 patients who were considered for DCCV, 424 patients anticoagulated with warfarin or NOAC underwent TEE prior to DCCV. Eighty patients who were anticoagulated for less than 21 days were excluded. Finally, 344 patients were included for the analysis (180 warfarin users vs. 164 NOAC users). No significant difference in the prevalence of SEC (44.4% vs. 43.9%; p = 0.919), dense SEC (13.9% vs. 15.2%; p = 0.722), or thrombus (2.2% vs. 4.3%; p = 0.281) was observed between the warfarin group and the NOAC group. In multivariate analysis, there was no association between NOAC and risk of SEC (odds ratio [OR]: 1.4, 95% CI: 0.796-2.297, p = 0.265) or thrombus (OR: 3.4, 95% CI: 0.726-16.039, p = 0.120). In conclusion, effectiveness of NOAC is comparable to warfarin in preventing SEC and thrombus in patients with AF or AFL undergoing DCCV. However, numerical increase in the prevalence of thrombus in NOAC group warrants further evaluation.

Non-vitamin K antagonist oral anticoagulants versus warfarin for the prevention of spontaneous echo-contrast and thrombus in patients with atrial fibrillation or flutter undergoing cardioversion: A trans-esophageal echocardiography study

PubMed Central

Kim, Yun Gi; Kim, Mi-Na; Cho, Dong-Hyuk; Oh, Suk-Kyu; Kook, Hyungdon; Park, Hee-Soon; Lee, Kwang No; Baek, Yong-Soo; Roh, Seung-Young; Shim, Jaemin; Park, Seong-Mi; Shim, Wan Joo; Kim, Young-Hoon

2018-01-01

Spontaneous echo-contrast (SEC) and thrombus observed in trans-esophageal echocardiography (TEE) is known as a strong surrogate marker for future risk of ischemic stroke in patients with atrial fibrillation (AF) or atrial flutter (AFL). The efficacy of non-vitamin K antagonist oral anticoagulants (NOAC) compared to warfarin to prevent SEC or thrombus in patients with AF or AFL is currently unknown. AF or AFL patients who underwent direct current cardioversion (DCCV) and pre-DCCV TEE evaluation from January 2014 to October 2016 in a single center were analyzed. The prevalence of SEC and thrombus were compared between patients who received NOAC and those who took warfarin. NOAC included direct thrombin inhibitor and factor Xa inhibitors. Among 1,050 patients who were considered for DCCV, 424 patients anticoagulated with warfarin or NOAC underwent TEE prior to DCCV. Eighty patients who were anticoagulated for less than 21 days were excluded. Finally, 344 patients were included for the analysis (180 warfarin users vs. 164 NOAC users). No significant difference in the prevalence of SEC (44.4% vs. 43.9%; p = 0.919), dense SEC (13.9% vs. 15.2%; p = 0.722), or thrombus (2.2% vs. 4.3%; p = 0.281) was observed between the warfarin group and the NOAC group. In multivariate analysis, there was no association between NOAC and risk of SEC (odds ratio [OR]: 1.4, 95% CI: 0.796–2.297, p = 0.265) or thrombus (OR: 3.4, 95% CI: 0.726–16.039, p = 0.120). In conclusion, effectiveness of NOAC is comparable to warfarin in preventing SEC and thrombus in patients with AF or AFL undergoing DCCV. However, numerical increase in the prevalence of thrombus in NOAC group warrants further evaluation. PMID:29360845

Activation of generalised inflammatory reaction following electrical cardioversion.

PubMed

Gajek, Jacek; Zyśko, Dorota; Mysiak, Andrzej; Mazurek, Walentyna

2004-09-01

Restoration of sinus rhythm in patients with atrial fibrillation (AF) is associated with an increased risk of thrombo-embolic complications due to delayed return of the left atrial and left atrial appendage systolic function. Direct current cardioversion (DC), used for AF termination, may cause myocardial injury and subsequent activation of inflammatory response. A C-reactive protein (CRP) is a non-specific marker of inflammation. To examine the effects of external DC of AF or atrial flutter (AFlut) on inflammatory processes. The study group consisted of 35 patients (20 females and 15 males, mean age 67.9+/-9.7 years, range 46-83 years) with paroxysmal or persistent AF/AFlut who underwent elective DC. CRP plasma concentration was measured before and 24 hours after DC. The mean total DC energy was 431.2 J. CRP plasma concentration increased significantly following DC - from 3.9+/-3.4 ng/ml before DC to 7.2+/-6.7 ng/ml after DC (p<0.0001). CRP level correlated with body mass index (r=0.34, p<0.05), however, this correlation became non-significant after inclusion of the presence of diabetes into the statistical model. There was also a positive correlation between CRP values before and after DC (r=0.72, p<0.0001). No correlation between CRP and gender, total power of DC nor the number of DC shocks was detected. External DC of AF/Aflut causes activation of inflammatory processes measured as a significant increase in the CRP plasma concentration.

Atrial anatomy and function postcardioversion: insights from transthoracic and transesophageal echocardiography.

PubMed

Manning, W J; Silverman, D I

1996-01-01

Echocardiography provides a valuable tool for the evaluation and assessment of atrial function in patients with atrial fibrilation (AF). Atrial morphology after restoration of sinus rhythm is dynamic, with a decrease in atrial size if sinus rhythm is maintained and atrial growth among those with sustained AF. Restoration of electrocardiographic sinus rhythm is frequently accompanied by relatively depressed atrial mechanical function, with recovery that appears to be related to multiple factors, including the duration of AF before cardioversion and the mode of cardioversion. Such delay appears to confer ongoing risk for thrombus formation and thromboembolism in the days after cardioversion and argues strongly for the need to maintain therapeutic anticoagulation during the pericardioversion and postcardioversion period.

Role of spiral wave pinning in inhomogeneous active media in the termination of atrial fibrillation by electrical cardioversion.

PubMed

Kuklik, Pawel; Wong, Christopher X; Brooks, Anthony G; Zebrowski, Jan Jacek; Sanders, Prashanthan

2010-03-01

Atrial fibrillation is the most common type of arrhythmia to affect humans. One of the treatment modalities for atrial fibrillation is an electrical cardioversion. Electrical cardioversion can result in one of three outcomes: an immediate termination of arrhythmic activity, a delayed termination or unsuccessful termination. The mechanism of delayed termination is unknown. Here we present a model of an atrial fibrillation as a coexistence of several spiral waves pinned to the inhomogeneities in active media. We show that in inhomogeneous system delayed termination can be explained as the unpinning of a spiral wave from inhomogeneities and its termination after collision with the edge of the system. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Heart failure and atrial fibrillation: current concepts and controversies.

PubMed Central

Van den Berg, M. P.; Tuinenburg, A. E.; Crijns, H. J.; Van Gelder, I. C.; Gosselink, A. T.; Lie, K. I.

1997-01-01

Heart failure and atrial fibrillation are very common, particularly in the elderly. Owing to common risk factors both disorders are often present in the same patient. In addition, there is increasing evidence of a complex, reciprocal relation between heart failure and atrial fibrillation. Thus heart failure may cause atrial fibrillation, with electromechanical feedback and neurohumoral activation playing an important mediating role. In addition, atrial fibrillation may promote heart failure; in particular, when there is an uncontrolled ventricular rate, tachycardiomyopathy may develop and thereby heart failure. Eventually, a vicious circle between heart failure and atrial fibrillation may form, in which neurohumoral activation and subtle derangement of rate control are involved. Treatment should aim at unloading of the heart, adequate control of ventricular rate, and correction of neurohumoral activation. Angiotensin converting enzyme inhibitors may help to achieve these goals. Treatment should also include an attempt to restore sinus rhythm through electrical cardioversion, though appropriate timing of cardioversion is difficult. His bundle ablation may be used to achieve adequate rate control in drug refractory cases. PMID:9155607

Anti-arrhythmic strategies for atrial fibrillation

PubMed Central

Grandi, Eleonora; Maleckar, Mary M.

2016-01-01

Atrial fibrillation (AF), the most common cardiac arrhythmia, is associated with increased risk of cerebrovascular stroke, and with several other pathologies, including heart failure. Current therapies for AF are targeted at reducing risk of stroke (anticoagulation) and tachycardia-induced cardiomyopathy (rate or rhythm control). Rate control, typically achieved by atrioventricular nodal blocking drugs, is often insufficient to alleviate symptoms. Rhythm control approaches include antiarrhythmic drugs, electrical cardioversion, and ablation strategies. Here, we offer several examples of how computational modeling can provide a quantitative framework for integrating multi scale data to: (a) gain insight into multi-scale mechanisms of AF; (b) identify and test pharmacological and electrical therapy and interventions; and (c) support clinical decisions. We review how modeling approaches have evolved and contributed to the research pipeline and preclinical development and discuss future directions and challenges in the field. PMID:27612549

[Low molecular weight heparin and non valvular atrial fibrillation].

PubMed

Ederhy, S; Di Angelantonio, E; Meuleman, C; Janower, S; Boccara, F; Cohen, A

2006-12-01

Low molecular weight heparin (LMWH) are obtained through chemical or enzyme depolymerisation of unfractioned heparins (UFH). LMWHs present several advantages over UFH: they exhibit a smaller interindividual variability of the anticoagulant effect, they have a greater bioavailability, a longer plasma half-life and do not require monitoring of the anticoagulant effect. LMWH have restrictive indications in AF patients, cardioversion (II level C and TEE for ACC/AHA/ESC and 2C for ACCP guidelines) or use as a bridge therapy (IIB, level C for ACC/AHA/ESC). The ACE study (Anticoagulation for cardioversion using enoxaparin), showed a reduction, though not statistically significant, of 42% of the composite end point (embolic event, major bleeding and death) 2.8% under enoxaparin vs. 4.8 % under conventional treatment, relative risk 0.58, CI 95% 0.23-1.46). Other studies, using dalteparin, confirmed that an anticoagulant treatment using LMWH followed by warfarin was at least as good as conventional management. ACUTE II (Assessment of cardioversion using transesophageal echochardiography), a randomized multicenter trial, compared the efficacy and tolerance of enoxaparin (1 mg/kg every 12 hours) and UFH in 155 patients eligible for a TEE-guided cardioversion. These patients were administered LMWH or UFH for 24 hours before TEE or cardioversion. There were no significative differences regarding the incidence of the study end points, in particular stroke and bleeding, and no death occurred. HAEST (Heparin in acute embolic stroke trial), a randomized, placebo-controlled, double blind trial failed to show the LMWH superiority over aspirin in patients with acute ischemic stroke and atrial fibrillation. Finally, LMWH have been proposed as a bridge therapy in patients under chronic VKA prior to surgery or invasive procedures. This strategy resulted in a low rate of thromboembolic events and major bleedings.

A new therapeutic strategy for electrical cardioversion of atrial fibrillation.

PubMed

de Luca, I; Sorino, M; Del Salvatore, B; de Luca, L

2001-11-01

The conventional approach to cardioversion of atrial fibrillation includes a period of anticoagulation with oral anticoagulant therapy (OAT) extending from 3 weeks precardioversion to 4 weeks postcardioversion. The protocol of rapid anticoagulation (such as that of the ACUTE study) consists of a precardioversion transesophageal echocardiography (TEE) followed by OAT for 4 weeks. In the last few years low-molecular-weight heparins have established themselves as a safe and efficacious alternative to traditional antithrombotic therapies. The aim of this study was to demonstrate that the exclusion of thrombi by precardioversion TEE together with the exclusion of atrial stunning by a second TEE performed after 1 week, to date not suggested in the literature, could reduce to 7 days the period of pericardioversion anticoagulation. This therapy would be carried out using low-molecular-weight heparins with no need for biological monitoring and with the possibility of self-administration. We have studied 57 consecutive patients who had atrial fibrillation or flutter with a history of atrial fibrillation lasting > 48 hours. All patients received enoxaparin at a dosage of 100 IU antiXa/kg twice daily before undergoing multiplane TEE. Previous informed consent and ethical committee authorization had been obtained. Twenty-four hours following TEE, in the absence of thrombi and/or spontaneous moderate/severe echocontrast in the atrial chambers, the patients underwent electrical cardioversion and were discharged within 24 hours of sinus rhythm restoration. These patients were prescribed enoxaparin at the indicated dosage twice daily until TEE, performed in an outpatients setting 7 days following cardioversion. In the absence of thrombi and/or atrial and/or left atrial appendage stunning, OAT was terminated. Enoxaparin was associated with OAT for the following 3 weeks if any of the following signs of stunning were present: A wave inferior to the normal value for age at transmitral Doppler; a left atrial appendage emptying velocity < 40 cm/s; the appearance or increase in the severity of spontaneous echocontrast. For all patients, clinical and electrocardiographic follow-up was carried out at 1 month. In one patient TEE was not tolerated and one refused it. In 7 patients cardioversion was not performed: 4 because of the presence of thrombi, 1 because of moderate/severe spontaneous echocontrast and 2 owing to spontaneous cardioversion. Of the remaining 48 patients, cardioversion proved to be efficacious in 38, with sustained sinus rhythm at 1 week in 33 patients. One of these refused the second TEE and of the remaining 32 patients, 24 (75%) showed no signs of stunning at the second TEE and so anticoagulation was terminated. Thus, after 1 week, 75% (24/33) of patients in sinus rhythm could benefit from a shortened anticoagulation therapy which lasted for a mean of only 8.5 days. No patients showed signs of a thromboembolic accident at 1 and 2 months of follow-up. Most patients undergoing electrical cardioversion for atrial fibrillation could benefit from a shorter period of anticoagulation with low-molecular-weight heparins for 1 week if TEE precardioversion and 7 days postcardioversion excludes thrombi and atrial stunning. The management of patients with atrial fibrillation would be greatly simplified.

Occult thyrotoxicosis: a correctable cause of idiopathic atrial fibrillation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Forfar, J.C.; Miller, H.C.; Toft, A.D.

1979-07-01

Serum total thyroxine, triiodothyronine and thyrotropin response to thyrotropin-releasing hormone were measured in 75 consecutive patients presenting to a cardiology clinic with atrial fibrillation with no obvious cardiovascular cause. A lack of response of serum thyrotropin to thyrotropin-releasing hormone, indicative of thyrotoxicosis, was found in 10 patients (13%), not all whom had raised serum thyroid hormone levels. These 10 patients were predominantly male, had no clinical signs of thyrotoxicosis and a relative excess of nonpalpable autonomous thyroid nodules demonstrated with scintigraphy. Eight of the 10 patients had reversion to stable sinus rhythm after treatment with iodine-131 or carbimazole, either spontaneouslymore » or after direct current cardioversion. It would appear that clinically occult thyrotoxicosis can be identified consistently only with the thyrotropin-releasing hormone test and is the cause of idiopathic atrial fibrillation in a significant proportion of patients.« less

Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

PubMed

Singer, Daniel E; Albers, Gregory W; Dalen, James E; Fang, Margaret C; Go, Alan S; Halperin, Jonathan L; Lip, Gregory Y H; Manning, Warren J

2008-06-01

This chapter about antithrombotic therapy in atrial fibrillation (AF) is part of the American College of Chest Physicians Evidence-Based Guidelines Clinical Practice Guidelines (8th Edition). Grade 1 recommendations indicate that most patients would make the same choice and Grade 2 suggests that individual patient's values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2008; 133[suppl]:123S-131S). Among the key recommendations in this chapter are the following (all vitamin K antagonist [VKA] recommendations have a target international normalized ratio [INR] of 2.5; range 2.0-3.0, unless otherwise noted). In patients with AF, including those with paroxysmal AF, who have had a prior ischemic stroke, transient ischemic attack (TIA), or systemic embolism, we recommend long-term anticoagulation with an oral VKA, such as warfarin, because of the high risk of future ischemic stroke faced by this set of patients (Grade 1A). In patients with AF, including those with paroxysmal AF, who have two or more of the risk factors for future ischemic stroke listed immediately below, we recommend long-term anticoagulation with an oral VKA (Grade 1A). Two or more of the following risk factors apply: age >75 years, history of hypertension, diabetes mellitus, moderately or severely impaired left ventricular systolic function and/or heart failure. In patients with AF, including those with paroxysmal AF, with only one of the risk factors listed immediately above, we recommend long-term antithrombotic therapy (Grade 1A), either as anticoagulation with an oral VKA, such as warfarin (Grade 1A), or as aspirin, at a dose of 75-325 mg/d (Grade 1B). In these patients at intermediate risk of ischemic stroke we suggest a VKA rather than aspirin (Grade 2A). In patients with AF, including those with paroxysmal AF, age < or =75 years and with none of the other risk factors listed above, we recommend long-term aspirin therapy at a dose of 75-325 mg/d (Grade 1B), because of their low risk of ischemic stroke. For patients with atrial flutter, we recommend that antithrombotic therapy decisions follow the same risk-based recommendations as for AF (Grade 1C). For patients with AF and mitral stenosis, we recommend long-term anticoagulation with an oral VKA (Grade 1B). For patients with AF and prosthetic heart valves we recommend long-term anticoagulation with an oral VKA at an intensity appropriate for the specific type of prosthesis (Grade 1B). See CHEST 2008; 133(suppl):593S-629S. For patients with AF of > or =48 h or of unknown duration for whom pharmacologic or electrical cardioversion is planned, we recommend anticoagulation with an oral VKA, such as warfarin, for 3 weeks before elective cardioversion and for at least 4 weeks after sinus rhythm has been maintained (Grade 1C). For patients with AF of > or = 48 h or of unknown duration undergoing pharmacological or electrical cardioversion, we also recommend either immediate anticoagulation with unfractionated IV heparin, or low-molecular-weight heparin (LMWH), or at least 5 days of warfarin by the time of cardioversion (achieving an INR of 2.0-3.0) as well as a screening multiplane transesophageal echocardiography (TEE). If no thrombus is seen, cardioversion is successful, and sinus rhythm is maintained, we recommend anticoagulation for at least 4 weeks. If a thrombus is seen on TEE, then cardioversion should be postponed and anticoagulation should be continued indefinitely. We recommend obtaining a repeat TEE before attempting later cardioversion (Grade 1B addressing the equivalence of TEE-guided vs non-TEE-guided cardioversion). For patients with AF of known duration <48 h, we suggest cardioversion without prolonged anticoagulation (Grade 2C). However, in patients without contraindications to anticoagulation, we suggest beginning IV heparin or LMWH at presentation (Grade 2C).

Termination of atrial fibrillation using pulsed low-energy far-field stimulation

PubMed Central

Fenton, Flavio H.; Luther, Stefan; Cherry, Elizabeth M.; Otani, Niels F.; Krinsky, Valentin; Pumir, Alain; Bodenschatz, Eberhard; Gilmour, Robert F.

2010-01-01

Background Electrically-based therapies for terminating atrial fibrillation (AF) currently fall into two categories: anti-tachycardia pacing (ATP) and cardioversion. ATP utilizes low-intensity pacing stimuli delivered via a single electrode and is effective for terminating slower tachycardias, but is less effective for treating AF. In contrast, cardioversion uses a single high-voltage shock to terminate AF reliably, but the voltages required produce undesirable side effects, including tissue damage and pain. We propose a new method to terminate AF called far-field anti-fibrillation pacing (FF-AFP), which delivers a short train of low-intensity electrical pulses at the frequency of ATP, but from field electrodes. Prior theoretical work has suggested that this approach can create a large number of activation sites (“virtual” electrodes) that emit propagating waves within the tissue without implanting physical electrodes and thereby may be more effective than point-source stimulation. Methods and Results Using optical mapping in isolated perfused canine atrial preparations, we show that a series of pulses at low field strength (0.9-1.4 V/cm) is sufficient to entrain and subsequently extinguish AF with a success rate of 93 percent (69/74 trials in 8 preparations). We further demonstrate that the mechanism behind FFAFP success is the generation of wave emission sites within the tissue by the applied electric field, which entrains the tissue as the field is pulsed. Conclusions AF in our model can be terminated by FF-AFP using only 13% of the energy required for cardioversion. Further studies are needed to determine whether this marked reduction in energy can increase the effectiveness and safety of terminating atrial tachyarrhythmias clinically. PMID:19635972

Atrial and ventricular function after cardioversion of atrial fibrillation.

PubMed Central

Xiong, C.; Sonnhag, C.; Nylander, E.; Wranne, B.

1995-01-01

OBJECTIVE--Previous studies on atrial recovery after cardioversion of atrial fibrillation have not taken into account new knowledge about the pathophysiology of transmitral and transtricuspid flow velocity patterns. It is possible to shed further light on this problem if atrioventricular inflow velocity, venous filling pattern, and atrioventricular annulus motion are recorded and interpreted together. DESIGN--Prospective examinations of mitral and tricuspid transvalvar flow velocities, superior caval and pulmonary venous filling, and mitral and tricuspid annulus motion were recorded using Doppler echocardiography. Examinations were performed before and 24 hours, 1 month, and 20 months after cardioversion. SETTING--Tertiary referral centre for cardiac disease with facilities for invasive and non-invasive investigation. PATIENTS--16 patients undergoing cardioversion of atrial fibrillation in whom sinus rhythm had persisted for 24 hours or more. RESULTS--Before conversion there was no identifiable A wave in transvalvar flow recordings. The total motion of the tricuspid and mitral annulus was subnormal and there was no identifiable atrial component. Venous flow patterns in general showed a low systolic velocity. After conversion, A waves and atrial components were seen in all patients and increased significantly (P < 0.01) with time. There was a similar time course for the amplitude of annulus atrial components, an increased systolic component of venous inflow, an increased A wave velocity, and a decreased E/A ratio of the transvalvar velocity curves. The ventricular component of annulus motion was unchanged. Changes in general occurred earlier on the right side than the left. CONCLUSIONS--This study indicates that, in addition to the previously known electromechanical dissociation of atrial recovery that exists after cardioversion of atrial fibrillation, there may also be a transient deterioration of ventricular function modulating the transvalvar inflow velocity recordings. Function on the right side generally becomes normal earlier than on the left. Integration of information from transvalvar inflow curves, annulus motion, and venous filling patterns gives additional insight into cardiac function. PMID:7547019

Dronedarone: an amiodarone analogue.

PubMed

Doggrell, Sheila A; Hancox, Jules C

2004-04-01

Of the antiarrhythmic drugs in current use, amiodarone is one of the most effective and is associated with a comparatively low risk of drug-induced pro-arrhythmia, probably due to its multiple pharmacological actions on cardiac ion channels and receptors. However, amiodarone is associated with significant extra-cardiac side effects and this has driven development of amiodarone analogues. These analogues include short acting analogues (e.g., AT-2001) with similar acute effects to amiodarone, the thyroid receptor antagonist KB-130015 and dronedarone. Dronedarone, (SR-33589; Sanofi-Synthelabo), is a non-iodinated amiodarone derivative that inhibits Na +, K + and Ca 2+ currents. It is a potent inhibitor of the acetylcholine-activated K + current from atrial and sinoatrial nodal tissue, and inhibits the rapid delayed rectifier more potently than slow and inward rectifier K + currents and inhibits L-type calcium current. Dronedarone is an antagonist at alpha- and beta-adrenoceptors and unlike amiodarone, has little effect at thyroid receptors. Dronedarone is more potent than amiodarone in inhibiting arrhythmias and death in animal models of ischaemia- and reperfusion-induced arrhythmias. In the Dronedarone Atrial Fibrillation Study After Electrical Cardioversion (DAFNE) clinical trial, dronedarone 800 mg/day appeared to be effective and safe for the prevention of atrial fibrillation relapses after cardioversion. The Antiarrhythmic Trial with Dronedarone in Moderate-to-Severe Congestive Heart Failure Evaluating Morbidity Decrease (ANDROMEDA) trial was stopped due to a potential increased risk of death in the dronedarone group. Trials of dronedarone in the maintenance of sinus rhythm in patients with atrial fibrillation and a safety and tolerability study in patients with an implantable cardioverter defibrillator are ongoing. Further experimental and clinical studies are required before we have a definitive answer to whether dronedarone has advantages over amiodarone and other amiodarone analogues.

Pacemaker implantation after catheter ablation for atrial fibrillation.

PubMed

Deshmukh, Abhishek J; Yao, Xiaoxi; Schilz, Stephanie; Van Houten, Holly; Sangaralingham, Lindsey R; Asirvatham, Samuel J; Friedman, Paul A; Packer, Douglas L; Noseworthy, Peter A

2016-01-01

Sinus node dysfunction requiring pacemaker implantation is commonly associated with atrial fibrillation (AF), but may not be clinically apparent until restoration of sinus rhythm with ablation or cardioversion. We sought to determine frequency, time course, and predictors for pacemaker implantation after catheter ablation, and to compare the overall rates to a matched cardioversion cohort. We conducted a retrospective analysis using a large US commercial insurance database and identified 12,158 AF patients who underwent catheter ablation between January 1, 2005 and December 31, 2012. Over an average of 2.4 years of follow-up, 5.6 % of the patients underwent pacemaker implantation. Using the Cox proportional hazards models, we found that risk of risks of pacemaker implantation was associated with older age (50-64 and ≥65 versus <50 years), female gender, higher CHADS2 score (≥2 and 1 versus 0), higher Charlson index (≥2 versus 0-1), certain baseline comorbidities (conduction disorder, coronary atherosclerosis, and congestive heart failure), and the year of ablation. There was no significant difference in the risk of pacemaker implantation between ablation patients and propensity score (PS)-matched cardioversion groups (3.5 versus. 4.1 % at 1 year and 8.8 versus 8.3 % at 5 years). Overall, pacemaker implantation occurs in about 1/28 patients within 1 year of catheter ablation. The overall implantation rate decreased between 2005 and 2012. Furthermore, the risk after ablation is similar to cardioversion, suggesting that patients require pacing due to a common underlying electrophysiologic substrate, rather than the ablation itself.

Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial.

PubMed

Goette, Andreas; Merino, Jose L; Ezekowitz, Michael D; Zamoryakhin, Dmitry; Melino, Michael; Jin, James; Mercuri, Michele F; Grosso, Michael A; Fernandez, Victor; Al-Saady, Naab; Pelekh, Natalya; Merkely, Bela; Zenin, Sergey; Kushnir, Mykola; Spinar, Jindrich; Batushkin, Valeriy; de Groot, Joris R; Lip, Gregory Y H

2016-10-22

Edoxaban, an oral factor Xa inhibitor, is non-inferior for prevention of stroke and systemic embolism in patients with atrial fibrillation and is associated with less bleeding than well controlled warfarin therapy. Few safety data about edoxaban in patients undergoing electrical cardioversion are available. We did a multicentre, prospective, randomised, open-label, blinded-endpoint evaluation trial in 19 countries with 239 sites comparing edoxaban 60 mg per day with enoxaparin-warfarin in patients undergoing electrical cardioversion of non-valvular atrial fibrillation. The dose of edoxaban was reduced to 30 mg per day if one or more factors (creatinine clearance 15-50 mL/min, low bodyweight [≤60 kg], or concomitant use of P-glycoprotein inhibitors) were present. Block randomisation (block size four)-stratified by cardioversion approach (transoesophageal echocardiography [TEE] or not), anticoagulant experience, selected edoxaban dose, and region-was done through a voice-web system. The primary efficacy endpoint was a composite of stroke, systemic embolic event, myocardial infarction, and cardiovascular mortality, analysed by intention to treat. The primary safety endpoint was major and clinically relevant non-major (CRNM) bleeding in patients who received at least one dose of study drug. Follow-up was 28 days on study drug after cardioversion plus 30 days to assess safety. This trial is registered with ClinicalTrials.gov, number NCT02072434. Between March 25, 2014, and Oct 28, 2015, 2199 patients were enrolled and randomly assigned to receive edoxaban (n=1095) or enoxaparin-warfarin (n=1104). The mean age was 64 years (SD 10·54) and mean CHA 2 DS 2 -VASc score was 2·6 (SD 1·4). Mean time in therapeutic range on warfarin was 70·8% (SD 27·4). The primary efficacy endpoint occurred in five (<1%) patients in the edoxaban group versus 11 (1%) in the enoxaparin-warfarin group (odds ratio [OR] 0·46, 95% CI 0·12-1·43). The primary safety endpoint occurred in 16 (1%) of 1067 patients given edoxaban versus 11 (1%) of 1082 patients given enoxaparin-warfarin (OR 1·48, 95% CI 0·64-3·55). The results were independent of the TEE-guided strategy and anticoagulation status. ENSURE-AF is the largest prospective randomised clinical trial of anticoagulation for cardioversion of patients with non-valvular atrial fibrillation. Rates of major and CRNM bleeding and thromboembolism were low in the two treatment groups. Daiichi Sankyo provided financial support for the study. Copyright © 2016 Elsevier Ltd. All rights reserved.

Heart rate variability parameters in horses distinguish atrial fibrillation from sinus rhythm before and after successful electrical cardioversion.

PubMed

Broux, B; De Clercq, D; Decloedt, A; Ven, S; Vera, L; van Steenkiste, G; Mitchell, K; Schwarzwald, C; van Loon, G

2017-11-01

Atrial fibrillation (AF) is the most common pathological arrhythmia in horses. After successful treatment, recurrence is common. Heart rate monitors are easily applicable in horses and some devices offer basic heart rate variability (HRV) calculations. If HRV can be used to distinguish between AF and sinus rhythm (SR), this could become a monitoring tool for horses at risk for recurrence of AF. The purpose of this study was to assess whether in horses AF (before cardioversion) and SR (after cardioversion) can be differentiated based upon HRV parameters. Cohort study with internal controls. Six HRV parameters were determined in 20 horses, both in AF and in SR, at rest (2- and 5-min and 1- and 4-h recordings) and during exercise (walk and trot, 2-min recordings). Time-domain (standard deviation of the NN intervals, root mean squared successive differences in NN intervals and triangular index), frequency domain (low/high frequency ratio) and nonlinear parameters (standard deviation of the Poincaré plot [SD]1 and SD2) were used. Statistical analysis was done using paired Wilcoxon signed rank tests and receiver operating characteristic curves. HRV was higher during AF compared to SR. Results for the detection of AF were good (area under the receiver operating characteristic curve [AUC] 0.8-1) for most HRV parameters. Root mean squared successive differences in NN intervals and SD1 yielded the best results (AUC 0.9-1). Sensitivity and specificity were high for all parameters at all recordings, but highest during exercise. Although AUCs improved with longer recordings, short recordings were also good (AUC 0.8-1) for the detection of AF. In horses with frequent second degree atrioventricular block, HRV at rest is increased and recordings at walk or trot are recommended. Animals served as their own controls and there was no long-term follow-up to identify AF recurrence. AF (before cardioversion) and SR (after cardioversion) could be distinguished with HRV. This technique has promise as a monitoring tool in horses at risk for AF development. © 2017 EVJ Ltd.

[The prediction of atrial fibrillation recurrence after electrical cardioversion with the chemoreflex sensitivity].

PubMed

Budeus, M; Hennersdorf, M; Perings, C; Strauer, B E

2004-04-01

Patients with paroxysmal atrial fibrillation have a lower chemoreflex sensitivity (CHRS) which is characterized as an autonomic dysfunction. Because of this observation we examined the theory of an autonomic dysfunction as the reason for the reccurrence of atrial fibrilation after electrical cardioversion. We measured the CHRS among 43 patients 24 h after successful electrical cardioversion and the patients were controlled for at least 6 months. During the six months of follow-up a recurrence was observed in 18 patients with a mean of 8.3 days. There was no difference in organic heart disease or in the use of drugs. Left atrial diameter was not significantly larger in patients with a recurrence. Patients with a recurrence have a significantly lower CHRS than patients with sinus rhythm (2.41 +/- 1.82 vs 5.62 +/- 3.02 ms/mmHg, p < 0.04). The diagnostic value of a CHRS below 3.0 ms/mmHg achieved a specificity of 68%, a sensitivity of 67%, a positive and negative predictive value of 60% and 74%. An analysis of CHRS seems to be an appropriate method to predict a recurrence of atrial fibrillation. The predictive power of the method has to be examined by prospective investigations of a larger patient population and a longer follow-up. Patients with paroxysmal atrial fibrillation have a lower chemoreflex sensitivity (CHRS) which is characterized as an autonomic dysfunction. Because of this observation we examined the theory of an autonomic dysfunction as the reason for the recurrence of atrial fibrillation after electrical cardioversion.

Hyperthyroidism and the management of atrial fibrillation.

PubMed

Shimizu, Taeko; Koide, Saori; Noh, Jaduk Yoshimura; Sugino, Kiminori; Ito, Kohichi; Nakazawa, Hiroe

2002-06-01

Atrial fibrillation is often induced in patients with hyperthyroidism and may trigger heart failure. Its prevalence and outcome were examined to obtain up-to-date information. Persistent atrial fibrillation was observed in approximately 1.7% of new hyperthyroid patients. It occurs more frequently in males (2.86%) than in females (1.36%), even though the number of male hyperthyroid patients is only one fifth of female patients. The rate increased with age, being 8% in the patients older than 70 years old. The initial treatment is to control the heart rate with routine pharmacologic therapy and to start antithyroid therapy as quickly as possible. Attempted cardioversion should be deferred until approximately the fourth month of maintaining a euthyroid state, because more than 56% of atrial fibrillation spontaneously reverts to sinus rhythm when the thyroid hormone levels start to decline. Elective cardioversion for those whose atrial fibrillation persists is highly effective and sinus rhythm maintenance rates were 56.7% and 47.6% at the 10th and the 14th year, respectively, even though the duration of atrial fibrillation prior to cardioversion was extremely long (35.0 +/- 29.0 months).

Platelet reactivity and mean platelet volume as risk markers of thrombogenesis in atrial fibrillation.

PubMed

Makowski, Marcin; Smorag, Ireneusz; Makowska, Joanna; Bissinger, Andrzej; Grycewicz, Tomasz; Paśnik, Jarek; Kidawa, Michal; Lubiński, Andrzej; Zielińska, Marzenna; Baj, Zbigniew

2017-05-15

Atrial fibrillation (AF) is associated with increased risk of thromboembolic complications. One of the markers of the increased risk of hypercoagulable state is platelet hyperreactivity. The aim of the study was to assess impact of arrhythmia on platelet reactivity. The study included 36 (mean age 48,3; range 21-60) male patients with lone atrial fibrillation, with exclusion of concomitant diseases known to trigger hypercoagulable state. The AF patients underwent cardioversion to restore sinus rhythm and were subsequently under observation for 1month. Echocardiography, ECG and blood collection was performed before cardioversion (T0) and 4weeks after successful cardioversion (T1). During the study period patients have been contacted and examined every week and 24h ECG monitoring was performed. Platelet reactivity was assessed based on changes of CD62 and CD42b expression on platelet surface after stimulation with thrombin. Also changes in MPV were assessed. In all patients sinus rhythm was maintained at the end of the study period, however in 14 patients recurrences of AF were observed, confirmed by 24h ECG monitoring (atrial fibrillation recurrence group - AFR) and 22 patients maintained sinus rhythm throughout the whole study period (SR group). Mean fluorescence intensity (MFI) of CD62 on thrombin stimulated platelets decreased significantly 4weeks after electrical cardioversion as compared to T0 (48.04±22.42 vs 41.47±16.03; p<0.01). Also MFI of CD42b on thrombin stimulated platelets decreased significantly 4weeks after electrical cardioversion as compared to T0 (22.16±10.82 vs 12.06±5.99; p<0.0001). Platelets reactivity estimated by CD 62 expression in SR group decreased significantly after 4weeks observation (58.01±15.26 vs 46.57±13.44; p<0.001) opposite to AFR group 35.66±21.87 vs 34.54±16.4; p-ns). Moreover there were significant differences between basal reactivity during AF between SR and AFR groups (58.01±15.26 vs 35.66±21.87; p-0.01). MFI of CD42b on thrombin stimulated platelets decreased significantly both in AFR and SR groups (22.05±11.36 vs 13.8±6.03; p<0.001 and 21.87±14.18 vs 10.04±5.09; p<0005). MPV decreased significantly 4weeks after electrical cardioversion as compared to T0 (8.81±0.19 vs 8.42±0.14; p<0.0001). The changes of platelet reactivity to thrombin observed after restoration of sinus rhythm in patients prove that arrhythmia intrinsically leads to increased reactivity of platelets. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Transesophageal echocardiography (TEE) in atrial fibrillation.

PubMed

Thamilarasan, M; Klein, A L

2000-11-01

Transesophageal echocardiography has given new insight into the pathogenesis of the thromboembolic sequelae of AF and expanded the available therapeutic options. Studies to date indicate that TEE-guided cardioversion is a safe and reasonable approach when the clinical situation warrants prompt restoration of sinus rhythm. Whether widespread use of this strategy offers further benefit remains to be established, although there are theoretical advantages to such an approach. The potential for earlier cardioversion using a TEE-guided approach may facilitate the achievement and maintenance of sinus rhythm. In the long term, earlier restoration of sinus rhythm prevents adverse atrial remodeling, lowers embolic risk, and may improve cardiac performance and functional status. Thromboembolic sequelae (either cardioversion-related or as a result of chronic AF) remain the most devastating complications of AF. Every attempt to minimize this risk should be pursued aggressively. Information gathered from TEE has helped to elucidate the mechanisms responsible for postcardioversion embolism and has emphasized the importance of anticoagulation during and after the restoration of sinus rhythm. TEE also has the potential to further risk stratify patients with AF. Ultimately, a subset of patients may be identified who require more intense anticoagulation (i.e., those with dense SEC or thrombus, or persistent thrombus after prolonged anticoagulation) or in whom cardioversion may be deferred entirely. Likewise, TEE also may prove to be useful in identifying patients with a low-clinical risk profile who may be treated with aspirin alone and patients in whom warfarin may be superior. The results of the ACUTE study should help to further define the role of TEE in the management of patients with AF. Additional clinical studies are needed to address some of the issues that have been raised and to allow for optimal use of TEE in this patient population.

Management of recent-onset sustained atrial fibrillation: pharmacologic and nonpharmacologic strategies.

PubMed

Lau, Dennis H; Kalman, Jonathan; Sanders, Prashanthan

2014-09-01

Recent studies have highlighted significant variations in the management of recent-onset sustained atrial fibrillation (AF). We aim to provide a succinct and clear management algorithm for physicians treating patients with recent-onset sustained AF. We performed a comprehensive search of the literature on the management of recent-onset sustained AF with focus on studies reporting cardioversion of AF, antiarrhythmic agents, and anticoagulation. We also reviewed recent practice guidelines on AF management. This review provides a guide on a tailored management approach of patients with recent-onset sustained AF. After initial detailed clinical assessment, optimal rate and rhythm control options can be provided, depending on hemodynamic stability, duration of AF episode, and AF stroke risk. Issues surrounding electrical and pharmacologic cardioversion are discussed in detail. We emphasize the importance of thromboembolic risk assessment and appropriate anticoagulation surrounding the point of cardioversion. Last, we highlighted the need for appropriate specialized follow-up care after acute AF management. Despite the highly heterogeneous clinical presentations, management of recent-onset sustained AF must include stroke risk assessment, appropriate anticoagulation, and follow-up care in all patients beyond optimum rate and rhythm control strategies. Copyright © 2014. Published by Elsevier Inc.

External defibrillation in the left lateral position--a comparison of manual paddles with self-adhesive pads.

PubMed

Dodd, Tamsin E L; Deakin, Charles D; Petley, Graham W; Clewlow, Frank

2004-12-01

Firm paddle force during defibrillation lowers transthoracic impedance (TTI) and increases transmyocardial current, increasing the chances of successful cardioversion. Current protocols recommend that if defibrillation using the anterior-apical (AA) paddle position fails, the anterior-posterior (AP) position should be used. This generally requires the patient to be placed in the left lateral position with the operator leaning over the patient. Avoiding physical contact with the patient during defibrillation subjectively makes application of firm paddle force difficult in the AP position. We compared TTI between the AA and AP positions and between manual paddles and self-adhesive pads to establish if the AP position precludes firm paddle force and to compare TTI between paddles and self-adhesive pads. Twenty-one consecutive patients undergoing elective cardioversion (age 39-82) were studied. TTI was measured between pairs of manually held paddles and self-adhesive pads using AA placement with the patient supine, and AP placement with the patient left lateral position. Mean TTI using the AP electrode position was lower using manual paddles (66.5 Omega; 95% CI 60.2-72.9 Omega) than that using self-adhesive pads (92.1 Omega; 95% CI 81.5-102.7 Omega; 95% CI between the mean =15.8-35.5 Omega; P <0.0001). TTI was significantly less using the manual paddles compared with self-adhesive pads in both AA and AP positions (P <0.0001). Despite the subjective difficulties of defibrillating patients in the AP position whilst leaning over them, use of manual paddles achieves a lower TTI than that achieved with self-adhesive pads.

[Atrial fibrillation].

PubMed

Spinar, J; Vítovec, J

2003-09-01

Atrial fibrilation is the most frequent arrhythmia, the occurrence increasing with age and associated diseases. The incidence at the age below 60 years is markedly lower than one per cent, whereas in persons above 80 years of age it exceeds six per cent. The occurrence in patients with heart failure is from 10% (NYHA II) up to 50% (NYHA IV). Atrial fibrillation is classified into that observed for the first time and permanent, respectively, while transient forms include paroxyzmal and persistent atrial fibrillation. The diagnosis is based on ECG recording, while echocardiography is most significant. The therapy includes two basic questions--anticoagulant or anti-aggregation treatment and the control of rhythm or frequency. The anticoagulant therapy should be introduced in all patients, where contraindications are not present, being necessary before every cardioversion, provided atrial fibrillation lasts more than two days. In patients without any heart disease and with a physiological echocardiogram it is possible to administer only anti-aggregation treatment. Cardioversion (the control of rhythm) is recommended to all symptomatic patients, in other cases and especially in older persons the control of frequency is safer and of more advantage. Electrical cardioversion is more effective that a pharmacological treatment, the sinus rhythm is preferably controlled by dofetilid, ibutilid, propafenon and amiodaron. For the control of heart rate beta-blockers, diltiazem, verapamil and digitalis are recommended.

[The contribution of inflammatory process in pathogenesis and natural history of atrial fibrillation].

PubMed

Zyśko, Dorota; Gajek, Jacek; Mazurek, Walentyna

2005-02-01

The inflammatory process plays important role in pathogenesis of some cardiovascular diseases. Atrial fibrillation is atrial arrhythmia with rapid, asynchronous activation of atrial myocytes. The inflammatory process can be responsible for atrial electrical and anatomical remodeling and therefore shifts towards arrhythmia persistence. The presence of systemic inflammation may be assessed by means of C-reactive protein (CRP) measurement. Maximal concentration of CRP coincidences with the peak of paroxysmal atrial fibrillation occurrence in patients after cardiac surgery. In patients with sinus rhythm the concentration of CRP is a risk factor for this arrhythmia in long-term follow-up. In patients with atrial fibrillation mean CRP concentration is 2-fold higher comparing to control group. CRP concentration is higher in patients with chronic than paroxysmal form of this arrhythmia. High CRP level predicts worse results of direct current cardioversion and more frequent paroxysms of atrial fibrillation during follow-up. Besides of, the patients with echocardiographic signs of thromboembolic risk have higher CRP levels than control subjects. There is no data about the influence of anti-inflammatory therapy on atrial fibrillation or its recurrences.

Chemical cardioversion of recent-onset atrial fibrillation in the emergency department using vernakalant hydrochloride achieves safe and rapid restoration of sinus rhythm and facilitates same day discharge.

PubMed

Stoneman, P; Gilligan, P; Mahon, P; Sheahan, R

2017-11-01

Vernakalant hydrochloride is a rapid-acting antiarrhythmic drug licensed in the EU since 2010 for the conversion of recent-onset atrial fibrillation with proven efficacy and safety when compared with placebo and amiodarone in randomized clinical trials. The aim of our study was to determine the feasibility of same day discharge (following 2 h monitoring) from the emergency department after successful cardioversion using vernakalant hydrochloride. Patients with recent-onset atrial fibrillation treated in the emergency department of a large Dublin academic teaching hospital. Patients received a maximum of two weight based 10 min infusions of vernakalant. Hypotensive events (>30% initial blood pressure), arrhythmias, conversion rates, and time to conversion were recorded. Sinus rhythm was restored in 35 out of 42 patients (83%) in an average of 8.8 min (median 8 min), average CHA2DS2-VASc of 0.92, HAS-BLED of 0.21 and average symptoms duration of 12 h. There were no hypotensive or arrhythmogenic events. 41 out of 42 patients were discharged after 2 h of monitoring. Vernakalant hydrochloride has provided a quick, safe, and practical means of achieving rapid restoration of sinus rhythm in our ED population with stable recent-onset AF who would otherwise not have undergone routine electrically cardioversion and same day discharge.

Role of Echocardiography in the Management and Prognosis of Atrial Fibrillation

PubMed Central

Silverman, David I; Ayirala, Srilatha R; Manning, Warren J

2012-01-01

Echocardiography plays a longstanding and vital role in the management of atrial fibrillation (AF). Advances in 2D imaging, Doppler echocardiography and strain imaging have all contributed to major progress in AF treatment. Echocardiographically measured left atrial (LA) volume is a powerful predictor of maintenance of sinus rhythm following cardioversion as well as risk of thrombus formation and thromboembolism. Doppler derived parameters of atrial mechanical function including atrial ejection force provide related prognostic information. Transesophageal echocardiocardiograpy (TEE) guided cardioversion of AF allows for rapid conversion to sinus rhythm without prolonged oral anticoagulation, and TEE serves as a useful tool during catheter ablation of AF and atrial flutter. Newer measures derived from speckle tracking offer great promise in further improving the care of patients with AF. PMID:28496715

A case of atrial tachycardia treated with ivabradine as bridge to ablation.

PubMed

Meles, Ester; Carbone, Claudio; Maggiolini, Stefano; Moretti, Paolo; DE Carlini, Caterina C; Gentile, Gaetano; Gnecchi-Ruscone, Tomaso

2015-05-01

Ivabradine is indicated in cardiac failure and ischemia to reduce sinus rate by inhibition of the pacemaker I(f) current in sinoatrial node. We report a case of an 18-year-old woman with left atrial tachyarrhythmia resistant to several antiarrhythmic drugs and to electric cardioversion who responded only to ivabradine, which significantly reduced heart rate without abolishing the arrhythmia itself. An ectopic focus in the ostium of left pulmonary veins was found and the patient was successfully ablated. We suggest that ivabradine might be therefore useful in the treatment of supraventricular tachyarrhythmias due to an enhanced automaticity. © 2015 Wiley Periodicals, Inc.

Management of supraventricular arrhythmias in adults with congenital heart disease.

PubMed

Wasmer, Kristina; Eckardt, Lars

2016-10-15

Supraventricular arrhythmias are a frequent complication in adults with congenital heart disease (ACHD). The prevalence increases with time since surgery, complexity of the underlying defect, type of repair and older age at surgery. Arrhythmias are the most frequent reason for hospital admission and along with heart failure the leading cause of death. The arrhythmia-associated increase in morbidity and mortality makes their management a key task in patients with ACHD. Intra-atrial re-entry is the most frequent arrhythmia mechanism. Less common arrhythmia mechanisms are supraventricular tachycardias in the presence of an accessory pathway, atrioventricular nodal re-entrant tachycardia or focal tachycardias. Patient management includes stroke prevention, acute termination and prevention of arrhythmia recurrence. Acute treatment depends on patients' symptoms. In cases of haemodynamic instability, immediate cardioversion is warranted. For stable patients, acute treatment includes rate control and termination by antiarrhythmic drugs or electrical cardioversion. Following a symptomatic arrhythmia, catheter ablation or treatment with antiarrhythmic drugs is recommended to prevent recurrences. Advances in mapping and ablation technology are now associated with high success rates of catheter ablation. In patients with a complex substrate recurrence rates of 50% remain high. However, in the presence of side effects and complications associated with long-term antiarrhythmic drug therapy, redo procedures are encouraged by current guidelines. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effect of Applying Force to Self-Adhesive Electrodes on Transthoracic Impedance: Implications for Electrical Cardioversion.

PubMed

Ramirez, F Daniel; Fiset, Sandra L; Cleland, Mark J; Zakutney, Timothy J; Nery, Pablo B; Nair, Girish M; Redpath, Calum J; Sadek, Mouhannad M; Birnie, David H

2016-10-01

Current guidelines disagree on the role for applying force to electrodes during electrical cardioversion (ECV) for atrial fibrillation, particularly when using self-adhesive pads. We evaluated the impact of this practice on transthoracic impedance (TTI) with varying force and in individuals with differing body mass indices (BMI). We additionally assessed whether specific prompts could improve physicians' ECV technique. The study comprised three parts: (1) TTI was measured in 11 participants throughout the respiratory cycle and with variable force applied to self-adhesive electrodes in anteroposterior (AP) and anterolateral (AL) configurations. (2) Three participants in different BMI classes then had TTI measured with prespecified incremental force applied. (3) Ten blinded cardiology trainees simulated ECV on one participant with and without prompting (guideline reminders and force analogies) while force applied and TTI were measured. The AP approach was associated with 13% lower TTI than AL (P < 0.001). Strongly negative correlations were observed between force applied and TTI in the AL position, irrespective of BMI (P ≤ 0.003). In all cases, 80% of the total reduction in TTI observed was achieved with 8 kg-force (∼80 N). All prompts resulted in significantly greater force applied and modest reductions in TTI. Applying force to self-adhesive electrodes reduces TTI and should be considered as a means of improving ECV success. Numerically greater mean force applied with a "push-up" force analogy suggests that "concrete" cues may be useful in improving ECV technique. © 2016 Wiley Periodicals, Inc.

Reentry Tachycardia in Children: Adenosine Can Make It Worse.

PubMed

Hien, Maximilian D; Benito Castro, Fernando; Fournier, Philippe; Filleron, Anne; Tran, Tu-Anh

2016-10-08

We report on a rare but severe complication of adenosine use in a child with reentry tachycardia. Treatment with adenosine, which is the standard medical therapy of atrioventricular reentry tachycardia, led to the development of an irregular wide complex tachycardia, caused by rapid ventricular response to atrial fibrillation. The girl was finally stabilized with electrical cardioversion. We analyze the pathomechanism and discuss possible treatment options. Atrial fibrillation, as well as its conduction to the ventricles, can be caused by adenosine. Rapid ventricular response in children with Wolff-Parkinson-White syndrome is more frequent than previously believed. A patient history of atrial fibrillation is a contraindication for cardioversion with adenosine and needs to be assessed in children with reentry tachycardia. High-risk patients may potentially profit from prophylactic comedication with antiarrhythmic agents, such as flecainide, ibutilide, or vernakalant, before adenosine administration.

Electroconvulsive therapy on Hungarian websites.

PubMed

Takács, Rozália; Ungvari, Gabor S; Gazdag, Gábor

2012-03-01

Although there are several similarities in terms of their equipment and the way they are performed, the social perception and public attitudes towards electroconvulsive therapy (ECT) and electric cardioversion (ECV) is entirely different. The aim of this study was to assess and compare the information on Hungarian Internet sites on ECT and ECV with respect to their depiction and acceptance by the public. An Internet search was undertaken with the Google search engine using the terms "ECT", "electroconvulsive therapy", "electroshock", "defibrillator" and "electric cardioversion". The search was restricted to information published in the Hungarian language from 1 January 2000 to 31 December 2010. All communications were classified into negative, neutral and positive groups depending on their attitude towards the aforementioned treatment methods. Professional or non-professional categories were also distinguished. The total number of communications, which appeared between 2000 and 2010 and contained one of the search words for ECT was 66. The majority of them portrayed ECT in a negative (24; 36.4%) or neutral (25; 37.9%) fashion. Most of the websites (139; 95.2%) related to ECV were reflected positive (120; 82.2%) and neutral opinions (19; 13.0%). Hungarian-language Internet sites mainly view ECT as negative or neutral in contrast to ECV cardioversion, which has almost entirely a positive reputation. Although the effectiveness of both therapies is equally well established, their public image as manifested on the Internet differs significantly. This may have a major impact on the frequency of their use.

Case 223: Arytenoid Dislocation.

PubMed

Oppenheimer, Avi G; Gulati, Vishal; Kirsch, Jacobo; Alemar, Gilberto O

2015-11-01

A 71-year-old man with a history of atrial fibrillation refractory to medical therapy and lung cancer status after left upper lobectomy presented to our hospital for elective cardioversion and rate control with tikosyn. Overnight, the patient became unresponsive and was found to be in a state of cardiogenic shock. A code was called, and he was stabilized after cardioversion and bedside intubation. His stay in the intensive care unit was complicated by ventilator-associated pneumonia. The patient subsequently underwent multiple failed extubation attempts, requiring two additional reintubations. He was finally extubated 18 days after his initial admission to the intensive care unit. After he was discharged, he reported a hoarse voice and was only able to whisper. His voice varied in timbre and volume, and it became hoarser with use. Otolaryngology evaluation, including laryngoscopy and video stroboscopy, showed immobility of the right vocal cord. He was referred for speech therapy, and a computed tomographic (CT) examination of the neck was ordered.

Value of high-sensitivity C-reactive protein assays in predicting atrial fibrillation recurrence: a systematic review and meta-analysis.

PubMed

Yo, Chia-Hung; Lee, Si-Huei; Chang, Shy-Shin; Lee, Matthew Chien-Hung; Lee, Chien-Chang

2014-02-20

We performed a systematic review and meta-analysis of studies on high-sensitivity C-reactive protein (hs-CRP) assays to see whether these tests are predictive of atrial fibrillation (AF) recurrence after cardioversion. Systematic review and meta-analysis. PubMed, EMBASE and Cochrane databases as well as a hand search of the reference lists in the retrieved articles from inception to December 2013. This review selected observational studies in which the measurements of serum CRP were used to predict AF recurrence. An hs-CRP assay was defined as any CRP test capable of measuring serum CRP to below 0.6 mg/dL. We summarised test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models. Meta-regression analysis was performed to explore the source of heterogeneity. We included nine qualifying studies comprising a total of 347 patients with AF recurrence and 335 controls. A CRP level higher than the optimal cut-off point was an independent predictor of AF recurrence after cardioversion (summary adjusted OR: 3.33; 95% CI 2.10 to 5.28). The estimated pooled sensitivity and specificity for hs-CRP was 71.0% (95% CI 63% to 78%) and 72.0% (61% to 81%), respectively. Most studies used a CRP cut-off point of 1.9 mg/L to predict long-term AF recurrence (77% sensitivity, 65% specificity), and 3 mg/L to predict short-term AF recurrence (73% sensitivity, 71% specificity). hs-CRP assays are moderately accurate in predicting AF recurrence after successful cardioversion.

Low energy transvenous cardioversion of short duration atrial tachyarrhythmias in humans using a single lead system.

PubMed

Heisel, A; Jung, J; Fries, R; Stopp, M; Sen, S; Schieffer, H; Ozbek, C

1997-01-01

The purpose of this study was to investigate the efficacy and safety of atrial cardioversion using an endocardial single lead system presently used for ventricular defibrillation. The study population consisted of 26 recipients of an ICD in combination with a conventional endocardial single lead system with the proximal spring electrode as anode in the SVC and the distal as cathode in the apex of the RV. Atrial tachyarrhythmias were induced by right atrial burst pacing. If the arrhythmia sustained > 1 minute, biphasic shocks synchronized with the R wave were delivered using the implanted device, beginning with an energy of 4 J. If 4 J failed to terminate the arrhythmia, energy was increased stepwise, if the first shock was successful, a step-down testing was performed after reinduction of atrial tachyarrhythmias. The mean atrial defibrillation threshold was 2.3 +/- 1.2 J (range, 0.5-5 J). A total of 154 shocks were delivered and no adverse effects were observed. The mean defibrillation threshold for atrial flutter was somewhat lower than that for AF (1.8 +/- 1 J vs 2.7 +/- 1.4 J, P = 0.08). There was no correlation between the atrial defibrillation threshold and a history of previously occurring atrial tachyarrhythmias, the kind of the underlying heart disease, a prescription of antiarrhythmic drugs, the dimension of the LA, the LVEF, or the ventricular DFT. Internal atrial cardioversion of short duration atrial tachyarrhythmias using a transvenous single lead system designed for ventricular defibrillation is feasible and safe at low energies, and may have important clinical applications.

WITHDRAWN: Pharmacological cardioversion for atrial fibrillation and flutter.

PubMed

Cordina, John; Mead, Gillian E

2017-11-15

Atrial fibrillation is the commonest cardiac dysrhythmia. It is associated with significant morbidity and mortality. There are two approaches to the management of atrial fibrillation: controlling the ventricular rate or converting to sinus rhythm in the expectation that this would abolish its adverse effects. To assess the effects of pharmacological cardioversion of atrial fibrillation in adults on the annual risk of stroke, peripheral embolism, and mortality. We searched the Cochrane Controlled Trials Register (Issue 3, 2002), MEDLINE (2000 to 2002), EMBASE (1998 to 2002), CINAHL (1982 to 2002), Web of Science (1981 to 2002). We hand searched the following journals: Circulation (1997 to 2002), Heart (1997 to 2002), European Heart Journal (1997-2002), Journal of the American College of Cardiology (1997-2002) and selected abstracts published on the web site of the North American Society of Pacing and Electrophysiology (2001, 2002). Randomised controlled trials or controlled clinical trials of pharmacological cardioversion versus rate control in adults (>18 years) with acute, paroxysmal or sustained atrial fibrillation or atrial flutter, of any duration and of any aetiology. One reviewer applied the inclusion criteria and extracted the data. Trial quality was assessed and the data were entered into RevMan. We identified two completed studies AFFIRM (n=4060) and PIAF (n=252). We found no difference in mortality between rhythm control and rate control relative risk 1.14 (95% confidence interval 1.00 to 1.31).Both studies show significantly higher rates of hospitalisation and adverse events in the rhythm control group and no difference in quality of life between the two treatment groups.In AFFIRM there was a similar incidence of ischaemic stroke, bleeding and systemic embolism in the two groups. Certain malignant dysrhythmias were significantly more likely to occur in the rhythm control group. There were similar scores of cognitive assessment.In PIAF, cardioverted patients enjoyed an improved exercise tolerance but there was no overall benefit in terms of symptom control or quality of life. There is no evidence that pharmacological cardioversion of atrial fibrillation to sinus rhythm is superior to rate control. Rhythm control is associated with more adverse effects and increased hospitalisation. It does not reduce the risk of stroke. The conclusions cannot be generalised to all people with atrial fibrillation. Most of the patients included in these studies were relatively older (>60 years) with significant cardiovascular risk factors.

Pharmacological cardioversion for atrial fibrillation and flutter.

PubMed

Cordina, J; Mead, G

2005-04-18

Atrial fibrillation is the commonest cardiac dysrhythmia. It is associated with significant morbidity and mortality. There are two approaches to the management of atrial fibrillation: controlling the ventricular rate or converting to sinus rhythm in the expectation that this would abolish its adverse effects. To assess the effects of pharmacological cardioversion of atrial fibrillation in adults on the annual risk of stroke, peripheral embolism, and mortality. We searched the Cochrane Controlled Trials Register (Issue 3, 2002), MEDLINE (2000 to 2002), EMBASE (1998 to 2002), CINAHL (1982 to 2002), Web of Science (1981 to 2002). We hand searched the following journals: Circulation (1997 to 2002), Heart (1997 to 2002), European Heart Journal (1997-2002), Journal of the American College of Cardiology (1997-2002) and selected abstracts published on the web site of the North American Society of Pacing and Electrophysiology (2001, 2002). Randomised controlled trials or controlled clinical trials of pharmacological cardioversion versus rate control in adults (>18 years) with acute, paroxysmal or sustained atrial fibrillation or atrial flutter, of any duration and of any aetiology. One reviewer applied the inclusion criteria and extracted the data. Trial quality was assessed and the data were entered into RevMan. We identified two completed studies AFFIRM (n=4060) and PIAF (n=252). We found no difference in mortality between rhythm control and rate control relative risk 1.14 (95% confidence interval 1.00 to 1.31). Both studies show significantly higher rates of hospitalisation and adverse events in the rhythm control group and no difference in quality of life between the two treatment groups. In AFFIRM there was a similar incidence of ischaemic stroke, bleeding and systemic embolism in the two groups. Certain malignant dysrhythmias were significantly more likely to occur in the rhythm control group. There were similar scores of cognitive assessment. In PIAF, cardioverted patients enjoyed an improved exercise tolerance but there was no overall benefit in terms of symptom control or quality of life. There is no evidence that pharmacological cardioversion of atrial fibrillation to sinus rhythm is superior to rate control. Rhythm control is associated with more adverse effects and increased hospitalisation. It does not reduce the risk of stroke. The conclusions cannot be generalised to all people with atrial fibrillation. Most of the patients included in these studies were relatively older (>60 years) with significant cardiovascular risk factors.

Oral anticoagulant use in cardiovascular disorders: a perspective on present and potential indications for rivaroxaban.

PubMed

Camm, A John; Fox, Keith A A

2018-05-21

Four non-vitamin-K-antagonist oral anticoagulants (NOACs) have been approved for use in various cardiovascular indications. The direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors apixaban, edoxaban and rivaroxaban are now increasingly used in clinical practice. For some of these agents, available data from real-world studies support the efficacy and safety data in phase III clinical trials. This review aims to summarize the current status of trials and observational studies of oral anticoagulant use over the spectrum of cardiovascular disorders (excluding venous thrombosis), provide a reference source beyond stroke prevention for atrial fibrillation (AF) and examine the potential for novel applications in the cardiovascular field. We searched the recent literature for data on completed and upcoming trials of oral anticoagulants with a particular focus on rivaroxaban. Recent data in specific patient subgroups, such as patients with AF undergoing catheter ablation or cardioversion, have led to an extended approval for rivaroxaban, whereas the other NOACs have ongoing or recently completed trials in this setting. However, there are unmet medical needs for several arterial thromboembolic-related conditions, including patients with: AF and acute coronary syndrome, AF and coronary artery disease undergoing elective percutaneous coronary intervention, coronary artery disease and peripheral artery disease, implanted cardiac devices, and embolic stroke of unknown source. NOACs may provide alternative treatment options in areas of unmet need, and numerous studies are underway to assess their benefit-risk profiles in these settings.

Primary and key secondary results from the ROCKET AF trial, and their implications on clinical practice.

PubMed

Shah, Rohan; Patel, Manesh R

2017-03-01

The safety and efficacy of the oral anticoagulant rivaroxaban were studied in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF trial). A number of subanalyses of the ROCKET AF trial have subsequently analyzed the use of rivaroxaban in special patient populations. The outcomes of the ROCKET AF trial were reviewed. The use of rivaroxaban in higher risk populations, as determined by the presence of co-morbidities included in the CHADS2 criteria, was analyzed. Requirements for dose adjustment in patients with renal impairment and in East Asian patients were described. Finally, clinical management challenges, including interruptions in therapy, drug discontinuation, management of bleeding events, drug interactions, and management of patients requiring cardioversion/ablation were reviewed. Rivaroxaban is efficacious in high-risk populations, including elderly patients, patients with diabetes, heart failure, history of stroke, prior myocardial infarction, or peripheral arterial disease (PAD). Patients with PAD have a higher risk of bleeding with rivaroxaban compared with warfarin. East Asian populations do not require a dose adjustment for rivaroxaban, while a reduced dose of 15 mg daily is required for patients with moderate renal impairment. Rivaroxaban remains effective with temporary interruptions in therapy and in patients requiring cardioversion/ablation. Rates of major bleeding and subsequent outcomes were similar in patients on warfarin and rivaroxaban, although rates of gastrointestinal bleeding were higher with rivaroxaban. Concurrent use of antiarrhythmic therapy was not associated with adverse outcomes. Rivaroxaban represents an efficacious alternative to warfarin in high-risk patients with AF. Dose adjustment is required for patients with moderate renal impairment. Rivaroxaban can be used safely in a number of challenging clinical management scenarios although the concurrent use of amiodarone requires more study.

Value of high-sensitivity C-reactive protein assays in predicting atrial fibrillation recurrence: a systematic review and meta-analysis

PubMed Central

Yo, Chia-Hung; Lee, Si-Huei; Chang, Shy-Shin; Lee, Matthew Chien-Hung; Lee, Chien-Chang

2014-01-01

Objectives We performed a systematic review and meta-analysis of studies on high-sensitivity C-reactive protein (hs-CRP) assays to see whether these tests are predictive of atrial fibrillation (AF) recurrence after cardioversion. Design Systematic review and meta-analysis. Data sources PubMed, EMBASE and Cochrane databases as well as a hand search of the reference lists in the retrieved articles from inception to December 2013. Study eligibility criteria This review selected observational studies in which the measurements of serum CRP were used to predict AF recurrence. An hs-CRP assay was defined as any CRP test capable of measuring serum CRP to below 0.6 mg/dL. Primary and secondary outcome measures We summarised test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models. Meta-regression analysis was performed to explore the source of heterogeneity. Results We included nine qualifying studies comprising a total of 347 patients with AF recurrence and 335 controls. A CRP level higher than the optimal cut-off point was an independent predictor of AF recurrence after cardioversion (summary adjusted OR: 3.33; 95% CI 2.10 to 5.28). The estimated pooled sensitivity and specificity for hs-CRP was 71.0% (95% CI 63% to 78%) and 72.0% (61% to 81%), respectively. Most studies used a CRP cut-off point of 1.9 mg/L to predict long-term AF recurrence (77% sensitivity, 65% specificity), and 3 mg/L to predict short-term AF recurrence (73% sensitivity, 71% specificity). Conclusions hs-CRP assays are moderately accurate in predicting AF recurrence after successful cardioversion. PMID:24556243

The role of HATCH score in predicting the success rate of sinus rhythm following electrical cardioversion of atrial fibrillation.

PubMed

Emren, Sadık Volkan; Kocabaş, Uğur; Duygu, Hamza; Levent, Fatih; Şimşek, Ersin Çağrı; Yapan Emren, Zeynep; Tülüce, Selcen

2016-01-01

The HATCH score predicts the development of persistent and permanent atrial fibrillation (AF) one year after spontaneous or pharmacological conversion to sinus rhythm in patients with AF. However, it remains unknown whether HATCH score predicts short-term success of the procedure at early stages for patients who have undergone electrical cardioversion (EC) for AF. The present study evaluated whether HATCH score predicts short-term success of EC in patients with AF. The study included patients aged 18 years and over, who had undergone EC due to AF lasting less than 12 months, between December 2011 and October 2013. HATCH score was calculated for all patients. The acronym HATCH stands for Hypertension, Age (above 75 years), Transient ischaemic attack or stroke, Chronic obstructive pulmonary disease, and Heart failure. This scoring system awards two points for heart failure and transient ischaemic attack or stroke and one point for the remaining items. The study included 227 patients and short-term EC was successful in 163 of the cases. The mean HATCH scores of the patients who had undergone successful or unsuccessful EC were 1.3 ± 1.4 and 2.9 ± 1.4, respectively (p < 0.001). The area of the HATCH score under the curve in receiver operating characteristics analysis was (AUC) 0.792 (95% CI 0.727-0.857, p < 0.001). A HATCH score of two and above yielded 77% sensitivity, 62% specificity, 56% positive predictive value, and 87% negative predictive value in predicting unsuccessful cardioversion. HATCH score is useful in predicting short-term success of EC at early stages for patients with AF, for whom the use of a rhythm-control strategy is planned.

Improvement of the myocardial performance index in atrial fibrilation patients treated with amiodarone after cardioversion.

PubMed

Besli, Feyzullah; Basar, Cengiz; Kecebas, Mesut; Turker, Yasin

2015-03-01

This study evaluated the response to electrical cardioversion (EC) and the effect on the myocardial performance index (MPI) in patients with persistent and long-standing persistent atrial fibrillation (AF). We enrolled 103 patients (mean age 69.6 ± 8.9 years, 40.7% males) with a diagnosis of persistent and long-standing persistent AF. EC was applied to all patients after one g of amiodarone administration. Echocardiographic findings before EC were compared in patients with successful versus unsuccessful cardioversions and in patients with maintained sinus rhythm (SR) versus those with AF recurrence at the end of the first month. We also compared echocardiographic data before EC versus at the end of the first month in the same patients with maintained SR. SR was achieved in 72.8% of patients and was continued at the end of the first month in 69.3% of the patients. The MPI value of all patients was found to be 0.73 ± 0.21. The size of the left atrium was determined to be an independent predictor of the maintenance of SR at 1 month. In subgroup analyses, when we compared echocardiographic findings before EC and at the end of the first month in patients with maintained SR, the MPI (0.66 ± 0.14 vs 0.56 ± 0.09, p < 0.001) values were significantly decreased. Our study is the first to show impairment of the MPI, which is an indicator of systolic and diastolic function, in patients with persistent and long-standing persistent AF and improvement of the MPI after successful EC.

Left atrial pressure pattern without a-wave in sinus rhythm after cardioversion affects the outcomes after catheter ablation for atrial fibrillation.

PubMed

Kishima, Hideyuki; Mine, Takanao; Takahashi, Satoshi; Ashida, Kenki; Ishihara, Masaharu; Masuyama, Tohru

2018-04-24

The a-wave in left atrial pressure (LAP) is often not observed after cardioversion (CV). We hypothesized that repeated atrial fibrillation (AF) occurs in patients who do not show a-wave pattern after CV. We investigated the impact of "LAP pattern without a-wave" on the outcome after catheter ablation (CA) for AF. We studied 100 patients (64 males, age 66 ± 8 years, 42 with non-paroxysmal AF) who underwent CA for AF. Sustained- or induced-AF were terminated with internal CV, and LAP was measured during sinus rhythm (SR) after CV. LAP pattern without a-wave was defined as absence of a-wave (the "a-wave" was defined as a protruding part by 0.2 mmHg or more from the baseline) in LAP wave form. AF was terminated with CV in all patients. Recurrent AF was detected in 35/100 (35%) during the follow-up period (13.1 ± 7.8 month). Univariate analysis revealed higher prevalence of LAP pattern without a-wave (71 vs. 17%, P < 0.0001), larger left atrial volume, elevated E wave, and decreased deceleration time as significant variables. On multivariate analysis, LAP pattern without a-wave was only independently associated with recurrent AF (P = 0.0014, OR 9.865, 95% CI 2.327-54.861). Moreover, patients with LAP pattern without a-wave had a higher risk of recurrent AF than patients with a-wave (25/36 patients, 69 vs. 10/64 patients, 16%, log-rank P < 0.0001). Left atrial pressure pattern without a-wave in sinus rhythm after cardioversion could predict recurrence after catheter ablation for AF.

Cost in the use of enoxaparin compared with unfractionated heparin in patients with atrial fibrillation undergoing a transesophageal echocardiography-guided cardioversion (from Assessment of Cardioversion using Transesophageal Echocardiography [ACUTE] II randomized multicenter study).

PubMed

Zhao, Liping; Zhang, Zefeng; Kolm, Paul; Jasper, Susan; Lewis, Cheryl; Klein, Allan; Weintraub, William

2008-02-01

The ACUTE II study demonstrated that transesophageal echocardiographically guided cardioversion with enoxaparin in patients with atrial fibrillation was associated with shorter initial hospital stay, more normal sinus rhythm at 5 weeks, and no significant differences in stroke, bleeding, or death compared with unfractionated heparin (UFH). The present study evaluated resource use and costs in enoxaparin (n=76) and UFH (n=79) during 5-week follow-up. Resources included initial and subsequent hospitalizations, study drugs, outpatient services, and emergency room visits. Two costing approaches were employed for the hospitalization costing. The first approach was based on the UB-92 formulation of hospital bill and diagnosis-related group. The second approach was based on UB-92 and imputation using multivariable linear regression. Costs for outpatient and emergency room visits were determined from the Medicare fee schedule. Sensitivity analysis was performed to assess the robustness of the results. A bootstrap resample approach was used to obtain the confidence interval (CI) for the cost differences. Costs of initial and subsequent hospitalizations, outpatient procedures, and emergency room visits were lower in the enoxaparin group. Average total costs remained significantly lower for the enoxaparin group for the 2 costing approaches ($5,800 vs $8,167, difference $2,367, 95% CI 855 to 4,388, for the first approach; $7,942 vs $10,076, difference $2,134, 95% CI 437 to 4,207, for the second approach). Sensitivity analysis showed that cost differences between strategies are robust to variation of drug costs. In conclusion, the use of enoxaparin as a bridging therapy is a cost-saving strategy (similar clinical outcomes and lower costs) for atrial fibrillation.

Contemporary stroke prevention strategies in 11 096 European patients with atrial fibrillation: a report from the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) Long-Term General Registry.

PubMed

Boriani, Giuseppe; Proietti, Marco; Laroche, Cécile; Fauchier, Laurent; Marin, Francisco; Nabauer, Michael; Potpara, Tatjana; Dan, Gheorghe-Andrei; Kalarus, Zbigniew; Diemberger, Igor; Tavazzi, Luigi; Maggioni, Aldo P; Lip, Gregory Y H

2018-05-01

Contemporary data regarding atrial fibrillation (AF) management and current use of oral anticoagulants (OACs) for stroke prevention are needed. The EURObservational Research Programme on AF (EORP-AF) Long-Term General Registry analysed consecutive AF patients presenting to cardiologists in 250 centres from 27 European countries. From 2013 to 2016, 11 096 patients were enrolled (40.7% female; mean age 69 ± 11 years). At discharge, OACs were used in 9379 patients (84.9%), with non-vitamin K antagonists (NOACs) accounting for 40.9% of OACs. Antiplatelet therapy alone was used by 20% of patients, while no antithrombotic treatment was prescribed in 6.4%. On multivariable analysis, age, hypertension, previous ischaemic stroke, symptomatic AF and planned cardioversion or ablation were independent predictors of OAC use, whereas lone AF, previous haemorrhagic events, chronic kidney disease and admission for acute coronary syndrome (ACS) or non-cardiovascular causes independently predicted OAC non-use. Regarding the OAC type, coronary artery disease, history of heart failure, or valvular heart disease, planned cardioversion and non-AF reasons for admission independently predicted the use of vitamin K antagonists (VKAs). Wide variability among the European regions was observed in the use of NOACs, independently from other clinical factors. The EORP-AF Long-Term General Registry provides a full picture of contemporary use of OAC in European AF patients. The overall rate of OACs use was generally high (84.9%), and a series of factors were associated with the prescription of OAC. A significant geographical heterogeneity in prescription of NOACs vs. VKAs was evident.

The relationship of renal function to outcome: A post hoc analysis from the EdoxabaN versus warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation (ENSURE-AF) study.

PubMed

Lip, Gregory Y H; Al-Saady, Naab; Ezekowitz, Michael D; Banach, Maciej; Goette, Andreas

2017-11-01

The ENSURE-AF study (NCT 02072434) of anticoagulation for electrical cardioversion in nonvalvular atrial fibrillation (NVAF) showed comparable low rates of bleeding and thromboembolism between the edoxaban and the enoxaparin-warfarin treatment arms. This post hoc analysis investigated the relationship between renal function and clinical outcomes. ENSURE-AF was a multicenter, PROBE evaluation trial of edoxaban 60 mg, or dose reduced to 30 mg/d for weight≤60 kg, creatinine clearance (CrCl; Cockcroft-Gault) ≤50 mL/min, or concomitant P-glycoprotein inhibitors compared with therapeutically monitored enoxaparin-warfarin in 2,199 NVAF patients undergoing electrical cardioversion. Efficacy and safety outcomes and time in therapeutic range in the warfarin arm were analyzed in relation to CrCl in prespecified ranges ≥15 and ≤30, >30 and ≤50, >50 and <80, and ≥80 mL/min, and an exploratory ≥95-mL/min analysis. A total of 1,095 subjects were randomized to edoxaban and 1,104 to enoxaparin-warfarin. Mean age was 64.3±10 and 64.2±11 years. Mean time in therapeutic range was progressively lower with reducing CrCl strata, being 66.8% in those with CrCl >30 to ≤50 compared with 71.8% in those with CrCl ≥80. The odds ratios for the primary efficacy and safety end points were comparable for the different predefined renal function strata; given the small numbers, the 95% CI included 1.0. In the subset of those with CrCl ≥95, the odds ratios showed consistency with the other CrCl strata. When CrCl was assessed as a continuous variable, there was a nonsignificant trend toward higher major or clinically relevant nonmajor bleeding with reducing CrCl levels, with no significant differences between the 2 treatment arms. When we assessed CrCl at baseline compared with end of treatment, there were no significant differences in CrCl change between the edoxaban and enoxaparin-warfarin arms. The proportions with worsening of renal function (defined as a decrease of >20% from baseline) were similar in the 2 treatment arms. Given the small number of events in ENSURE-AF, no effect of renal (dys)function was demonstrated in comparing edoxaban to enoxaparin-warfarin for cardioversion; efficacy and safety of edoxaban remained consistent even in patients with normal or supranormal renal function. Copyright © 2017 Elsevier Inc. All rights reserved.

Two hearts synchronized each other with a DDD pacemaker.

PubMed

Brunacci, Michele; Valbusa, Alberto; Brunelli, Claudio; Bertero, Giovanni

2016-12-01

: We describe the case of a patient with dyspnea and heterotopic cardiac transplant, ventricular fibrillation from the native heart and sinus rhythm from the transplanted one. The two hearts were synchronized with a pacemaker. Electric external cardioversion and a different type of pacemaker stimulation were successfully performed, with improving symptoms.

A Serious Cause of Panic Attack

PubMed Central

O'Connell, Michael; Bernard, Aaron

2012-01-01

We report on a case of a patient with atrial fibrillation in the setting of Wolff-Parkinson-White syndrome. The patient underwent synchronized electrical cardioversion, typically considered safe and effective, which resulted in a dangerous complication for the patient (degeneration into ventricular fibrillation). Discussion of common rhythm disturbances in WPW and management strategies are reviewed. PMID:23326712

Long-term clinical effects of ventricular pacing reduction with a changeover mode to minimize ventricular pacing in a general pacemaker population

PubMed Central

Stockburger, Martin; Boveda, Serge; Moreno, Javier; Da Costa, Antoine; Hatala, Robert; Brachmann, Johannes; Butter, Christian; Garcia Seara, Javier; Rolando, Mara; Defaye, Pascal

2015-01-01

Aim Right ventricular pacing (VP) has been hypothesized to increase the risk in heart failure (HF) and atrial fibrillation (AF). The ANSWER study evaluated, whether an AAI-DDD changeover mode to minimize VP (SafeR) improves outcome compared with DDD in a general dual-chamber pacemaker population. Methods and results ANSWER was a randomized controlled multicentre trial assessing SafeR vs. standard DDD in sinus node disease (SND) or AV block (AVB) patients. After a 1-month run-in period, they were randomized (1 : 1) and followed for 3 years. Pre-specified co-primary end-points were VP and the composite of hospitalization for HF, AF, or cardioversion. Pre-specified secondary end-points were cardiac death or HF hospitalizations and cardiovascular hospitalizations. ANSWER enrolled 650 patients (52.0% SND, 48% AVB) at 43 European centres and randomized in SafeR (n = 314) or DDD (n = 318). The SafeR mode showed a significant decrease in VP compared with DDD (11.5 vs. 93.6%, P < 0.0001 at 3 years). Deaths and syncope did not differ between randomization arms. No significant difference between groups [HR = 0.78; 95% CI (0.48–1.25); P = 0.30] was found in the time to event of the co-primary composite of hospitalization for HF, AF, or cardioversion, nor in the individual components. SafeR showed a 51% risk reduction (RR) in experiencing cardiac death or HF hospitalization [HR = 0.49; 95% CI (0.27–0.90); P = 0.02] and 30% RR in experiencing cardiovascular hospitalizations [HR = 0.70; 95% CI (0.49–1.00); P = 0.05]. Conclusion SafeR safely and significantly reduced VP in a general pacemaker population though had no effect on hospitalization for HF, AF, or cardioversion, when compared with DDD. PMID:25179761

Internal defibrillation: where we have been and where we should be going?

PubMed

Lévy, Samuel

2005-08-01

Internal cardioversion has been developed as an alternative technique for patients who are resistant to external DC cardioversion of atrial fibrillation (AF) and was found to be associated with higher success rates. It used initially high energies (200-300 J) delivered between an intracardiac catheter and a backplate. Subsequent studies have shown that it is possible to terminate with energies of 1 to 6 Joules, paroxysmal or induced AF in 90 percent of patients and persistent AF in 75 percent of patients, using biphasic shocks delivered between a right atrium-coronary sinus vectors. Consequently, internal atrial defibrillation can be performed under sedation only without the need for general anesthesia. Recently developed external defibrillators, capable of delivering biphasic shocks, have increased the success rates of external cardioversion and reduced the need for internal cardioversion. However, internal defibrillation is still useful in overweight or obese patients, in patients with chronic obstructive pulmonary disease or asthma who are more difficult to defibrillate, and in patients with implanted devices which may be injured by high energy shocks. Low energy internal defibrillation has also proven to be safe and this has prompted the development of implantable devices for terminating AF. The first device used was the Metrix system, a stand-alone atrial defibrillator (without ventricular defibrillation) which was found to be safe and effective in selected groups of patients. Unfortunately, this device is no longer being marketed. Only double chamber defibrillators with pacing capabilities are presently available: the Medtronic GEM III AT, an updated version of the Jewel AF and the Guidant PRIZM AVT. These devices can be patient-activated or programmed to deliver automatically ounce atrial tachyarrhythmias are detected, therapies including pacing or/and shocks. Attempts to define the group of patients who might benefit from these devices are described but the respective role of atrial defibrillators versus other non-pharmacologic therapies for AF, such as surgery and radiofrequency catheter ablation, remains to be determined. Advantages and limitations or atrial defibrillators and approaches to reduce shock related discomfort which may be a concern in some patients, are reviewed. Studies have shown that despite shock discomfort, quality of life was improved in patients with atrial defibrillators and the need for repeated hospitalizations was reduced. The cost of these devices remains a concern for the treatment of a non-lethal arrhythmia. Attention that atrial defibrillators will receive from cardiologists and from the industry in the future, will depend of the long-term results of other non-pharmacological options and of the identification of the group of AF patients which will require restoration and maintenance of sinus rhythm. But there is no doubt that selected subsets of patients with AF could benefit from atrial defibrillation.

Primary and key secondary results from the ROCKET AF trial, and their implications on clinical practice

PubMed Central

Shah, Rohan; Patel, Manesh R.

2016-01-01

Background: The safety and efficacy of the oral anticoagulant rivaroxaban were studied in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF trial). A number of subanalyses of the ROCKET AF trial have subsequently analyzed the use of rivaroxaban in special patient populations. Methods: The outcomes of the ROCKET AF trial were reviewed. The use of rivaroxaban in higher risk populations, as determined by the presence of co-morbidities included in the CHADS2 criteria, was analyzed. Requirements for dose adjustment in patients with renal impairment and in East Asian patients were described. Finally, clinical management challenges, including interruptions in therapy, drug discontinuation, management of bleeding events, drug interactions, and management of patients requiring cardioversion/ablation were reviewed. Results: Rivaroxaban is efficacious in high-risk populations, including elderly patients, patients with diabetes, heart failure, history of stroke, prior myocardial infarction, or peripheral arterial disease (PAD). Patients with PAD have a higher risk of bleeding with rivaroxaban compared with warfarin. East Asian populations do not require a dose adjustment for rivaroxaban, while a reduced dose of 15 mg daily is required for patients with moderate renal impairment. Rivaroxaban remains effective with temporary interruptions in therapy and in patients requiring cardioversion/ablation. Rates of major bleeding and subsequent outcomes were similar in patients on warfarin and rivaroxaban, although rates of gastrointestinal bleeding were higher with rivaroxaban. Concurrent use of antiarrhythmic therapy was not associated with adverse outcomes. Conclusions: Rivaroxaban represents an efficacious alternative to warfarin in high-risk patients with AF. Dose adjustment is required for patients with moderate renal impairment. Rivaroxaban can be used safely in a number of challenging clinical management scenarios although the concurrent use of amiodarone requires more study. PMID:27555569

Sacral neuromodulation and cardiac pacemakers.

PubMed

Roth, Ted M

2010-08-01

Potential for cross-talk between cardiac pacemakers and sacral neuromodulation remains speculative. We present a case series of patients with cardiac pacemakers who underwent staged Interstim (Medtronic, Minneapolis, MN) implantation and patients who had pulse generator implantation who later required cardiac pacemakers. No cross-talk was demonstrated in either group. Sacral neuromodulation appears to be safe in the setting of cardiac pacemakers without cardioversion/defibrillation technology.

[Cardioversion for paroxysmal supraventricular tachycardia during lung surgery in a patient with concealed Wolff-Parkinson-White syndrome].

PubMed

Sato, Yoshiharu; Nagata, Hirofumi; Inoda, Ayako; Miura, Hiroko; Watanabe, Yoko; Suzuki, Kenji

2014-10-01

We report a case of paroxysmal supraventricular tachycardia (PSVT) that occurred during video-assisted thoracoscopic (VATS) lobectomy in a patient with concealed Wolff-Parkinson-White (WPW) syndrome. A 59-year-old man with lung cancer was scheduled for VATS lobectomy under general anesthesia. After inserting a thoracic epidural catheter, general anesthesia was induced with intravenous administration of propofol. Anesthesia was maintained with inhalation of desfurane in an air/oxygen mixture and intravenous infusion of remifentanil. Recurrent PSVT occurred three times, and the last episode of PSVT continued for 50 minutes regardless of administration of antiarrhythmic drugs. Synchronized electric shock via adhesive electrode pads on the patient's chest successfully converted PSVT back to normal sinus rhythm. The remaining course and postoperative period were uneventful. An electrophysiological study performed after hospital discharge detected concealed WPW syndrome, which had contributed to the development of atrioventricular reciprocating tachycardia. Concealed WPW syndrome is a rare, but critical complication that could possibly cause lethal atrial tachyarrhythmias during the perioperative period. In the present case, cardioversion using adhesive electrode pads briefly terminated PSVT in a patient with concealed WPW syndrome.

Successful electrical cardioversion of supraventricular tachycardia in a pregnant patient

PubMed Central

Yılmaz, Fevzi; Beydilli, Inan; Kavalcı, Cemil; Yılmaz, Serkan

2012-01-01

Summary Background: Pregnancy can precipitate cardiac arrhythmias not previously present in seemingly well individuals. Atrial and ventricular premature beats are frequently present during pregnancy and are usually benign. Supraventricular tachycardia and malignant ventricular tachyarrhythmias occur less frequently. Maternal and fetal arrhythmias occurring during pregnancy may jeopardize the life of the mother and the fetus. Case Report: A 32-year-old pregnant women at 26 weeks gestation presented to the emergency department with palpitation. She had mild chest discomfort after a supraventricular tachycardia (SVT) episode but did not have syncope. After monitoring and access of an IV line, vagal manoeuvres were applied but the rhythm was resistant. Then she was treated with 5 mg metoprolol IV, but the SVT persisted. Then after IV infusion of adenosine triphosphate 6 to 12 mg, the rhythm was resistant. Synchronized cardioversion with 100 joules was performed. Patients’ rhythm was normalized to a sinus rhythm. She was discharged from hospital without any adverse effects following 24-hour monitoring. Conclusions: All pregnant patients with SVT require careful maternal and fetal monitoring during treatment, and close collaboration between the managing obstetrician and the cardiologist is essential. PMID:23569481

[Automated external defibrillators, life vest defibrillator, or both?].

PubMed

Conti, C Richard

2012-03-01

As most understand, survival of cardiac arrest victims falls significantly if cardioversion is not performed promptly. The standard of practice for out-of-hospital defibrillation is the implantable cardiac defibrillator; however, much has been written and discussed about the use of automated external defibrillators. Not as much has been written about life vest wearable defibrillators. How to use these devices will be reviewed in this article.

Left Atrial 4D Blood Flow Dynamics and Hemostasis following Electrical Cardioversion of Atrial Fibrillation.

PubMed

Cibis, Merih; Lindahl, Tomas L; Ebbers, Tino; Karlsson, Lars O; Carlhäll, Carl-Johan

2017-01-01

Background: Electrical cardioversion in patients with atrial fibrillation is followed by a transiently impaired atrial mechanical function, termed atrial stunning. During atrial stunning, a retained risk of left atrial thrombus formation exists, which may be attributed to abnormal left atrial blood flow patterns. 4D Flow cardiovascular magnetic resonance (CMR) enables blood flow assessment from the entire three-dimensional atrial volume throughout the cardiac cycle. We sought to investigate left atrial 4D blood flow patterns and hemostasis during left atrial stunning and after left atrial mechanical function was restored. Methods: 4D Flow and morphological CMR data as well as blood samples were collected in fourteen patients at two time-points: 2-3 h (Time-1) and 4 weeks (Time-2) following cardioversion. The volume of blood stasis and duration of blood stasis were calculated. In addition, hemostasis markers were analyzed. Results: From Time-1 to Time-2: Heart rate decreased (61 ± 7 vs. 56 ± 8 bpm, p = 0.01); Maximum change in left atrial volume increased (8 ± 4 vs. 22 ± 15%, p = 0.009); The duration of stasis (68 ± 11 vs. 57 ± 8%, p = 0.002) and the volume of stasis (14 ± 9 vs. 9 ± 7%, p = 0.04) decreased; Thrombin-antithrombin complex (TAT) decreased (5.2 ± 3.3 vs. 3.3 ± 2.2 μg/L, p = 0.008). A significant correlation was found between TAT and the volume of stasis ( r 2 = 0.69, p < 0.001) at Time-1 and between TAT and the duration of stasis ( r 2 = 0.34, p = 0.04) at Time-2. Conclusion: In this longitudinal study, left atrial multidimensional blood flow was altered and blood stasis was elevated during left atrial stunning compared to the restored left atrial mechanical function. The coagulability of blood was also elevated during atrial stunning. The association between blood stasis and hypercoagulability proposes that assessment of left atrial 4D flow can add to the pathophysiological understanding of thrombus formation during atrial fibrillation related atrial stunning.

Thyroid Storm Caused by a Chinese Herb Contaminated with Thyroid Hormones

PubMed Central

St-Onge, Maude; Vandenberghe, Hilde; Thompson, Margaret

2015-01-01

Patient: Male, 70 Final Diagnosis: Thyroid storm Symptoms: Atrial fibrillation • confusion • hyperthermia • tachycardia Medication: — Clinical Procedure: Intubation • cardioversion Specialty: Critical Care Medicine Objective: Adverse events of drug therapy Background: We report a case of thyroid storm caused by consuming a Chinese herb contaminated with thyroid hormones. Case Report: A 70-year-old man presented to an emergency department after 2 days of nausea, vomiting, and weakness. Three days previously, he had started taking Cordyceps powder and “Flower Man Sang Hung” as recommended by his Chinese physician. Following admission, the patient deteriorated and was eventually diagnosed with thyroid storm complicated by rapid atrial fibrillation requiring cardioversion, intubation, and intensive care admission. The analysis of the Chinese herb “Flower Man Sang Hung” was positive for levothyroxine. The patient was extubated 11 days after admission and discharged to a rehabilitation centre after 17 days of hospitalization. The Chinese medicine physician was informed of the events. Conclusions: Herbal products can be the source of illness, medication interactions, and contamination. Awareness should be raised among Chinese medicine physicians, allopathic physicians, and their patients. Clinicians should also have a low threshold of suspicion to seek laboratory analysis of suspect substances when the cause of the clinical presentation is unclear. PMID:25644333

[Clinical aspects of reperfusion arrhythmia following intravenous thrombolysis in acute myocardial infarct].

PubMed

Kettner, W; Klein, E; Schulz, W; Götze, C

1987-05-15

In accordance with the majority of the reports in the literature reperfusion arrhythmias were observed in more than 30% of the patients with acute myocardial infarction (n = 25) under or immediately after a highly dosed short-term infusion with streptokinase. With reference to indirect signs the recanalisation rate was assumed with 75%. Only one third of the reperfusion arrhythmias had haemodynamically significant characteristics and required an influence. Though in literature from animal experimental findings directive conclusions for the therapy are to be derived, the procedure in practice is still vastly empirical. In the ventricular tachycardia lidocaine, procainamide and ajmalin may be recommended. In ineffectiveness or particularly threatening situations the electrotherapy (cardioversion, DC-shock) is to be preferred. The concept inaugurated by Corr and Witkowski apply alpha-adrenoreceptor blockers has not yet entered the clinical practice. Possible problems in the treatment of reperfusion arrhythmias in the prehospital phase should at present still be a reason not to antedate the thrombolytic therapy into this phase.

[Wearable Automatic External Defibrillators].

PubMed

Luo, Huajie; Luo, Zhangyuan; Jin, Xun; Zhang, Leilei; Wang, Changjin; Zhang, Wenzan; Tu, Quan

2015-11-01

Defibrillation is the most effective method of treating ventricular fibrillation(VF), this paper introduces wearable automatic external defibrillators based on embedded system which includes EGG measurements, bioelectrical impedance measurement, discharge defibrillation module, which can automatic identify VF signal, biphasic exponential waveform defibrillation discharge. After verified by animal tests, the device can realize EGG acquisition and automatic identification. After identifying the ventricular fibrillation signal, it can automatic defibrillate to abort ventricular fibrillation and to realize the cardiac electrical cardioversion.

Current status of the surgical treatment of atrial fibrillation.

PubMed

Geha, Alexander S; Abdelhady, Khaled

2008-03-01

Atrial fibrillation (AF) affects several million patients worldwide and is associated with a number of heart conditions, particularly coronary artery disease, rheumatic heart disease, hypertension, and congestive heart failure. The treatment of AF and its complications is quite costly. Atrial fibrillation usually results from multiple macro-re-entrant circuits in the left atrium. Very frequently, particularly in association with mitral valve disease, these circuits arise from the area of the junction of the pulmonary venous endothelium and the left atrial endocardium. Pharmacological therapy is at best 50% effective. Therapeutic options for AF include antiarrhythmic drugs, cardioversion, atrioventricular (A-V) node block, pacemaker insertion, and ablative surgery. In 1987, Cox developed an effective surgical procedure to achieve ablation. Current ablative procedures include the classic cut-and-sew Maze operation or a modification of it, namely through catheter ablation, namely, cryoablation, radiofrequency ablation (dry or irrigated), and other forms of ablation (e.g., laser, microwave). These procedures will be described, along with the indications, advantages and disadvantages of each. Special emphasis on the alternative means to cutting and sewing to achieve appropriate effective atrial scars will be stressed, and our experience with these approaches in 50 patients with AF and associated cardiac lesions and their outcomes is presented.

Pharmacologic conversion of atrial fibrillation: a systematic review of available evidence.

PubMed

Slavik, R S; Tisdale, J E; Borzak, S

2001-01-01

This report reviews the efficacy of currently available antiarrhythmic agents for conversion of atrial fibrilation (AF) to normal sinus rhythm (NSR). A systematic search of literature in the English language was done on computerized databases, such as MEDLINE, EMBASE, and Current Contents, in reference lists, by manual searching, and in contact with expert informants. Published studies involving humans that described the use of antiarrhythmic therapy for conversion of AF to NSR were considered and only studies that examined the use of agents currently available in the United States were included. Studies exclusively describing antiarrhythmic therapy for conversion of postsurgical AF were excluded. The methodology and results of each trial were assessed and attempts were made to acquire additional information from investigators when needed. Assessment of methodological quality was incorporated into a levels-of-evidence scheme. Eighty-eight trials were included, of which 34 (39%) included a placebo group (level I data). We found in recent-onset AF of less than 7 days, intravenous (i.v.) procainamide, high-dose i.v. or high-dose combination i.v. and oral amiodarone, oral quinidine, oral flecainide, oral propafenone, and high-dose oral amiodarone are more effective than placebo for converting AF to NSR. In recent-onset AF of less than 90 days, i.v. ibutilide is more effective than placebo and i.v. procainamide. In chronic AF, oral dofetilide converts AF to NSR within 72 hours, and oral propafenone and amiodarone are effective after 30 days of therapy. We conclude than for conversion of recent-onset AF of less than 7 days, procainamide may be considered a preferred i.v. agent and propafenone a preferred oral agent. For conversion of recent-onset AF of longer duration (less than 90 days), i.v. ibutilide may be considered a preferred agent. For patients with chronic AF and left ventricular dysfunction, direct current cardioversion is the preferred conversion method. Larger, well-designed randomized controlled trials with clinically important endpoints in specific populations of AF patients are needed. Copyright 2001 by W.B. Saunders Company

Low-energy cardioversion of spontaneous atrial fibrillation. Immediate and long-term results.

PubMed

Lévy, S; Ricard, P; Gueunoun, M; Yapo, F; Trigano, J; Mansouri, C; Paganelli, F

1997-07-01

Recent studies have suggested that induced atrial fibrillation (AF) could be successfully terminated by using a two-catheter electrode system and low energy (< 400 V). This study evaluated the efficacy and safety of low-energy cardioversion in spontaneous chronic and paroxysmal AF. Forty-two consecutive patients with spontaneous AF underwent low-energy electrical cardioversion. AF was chronic (> or = 1 month) with a mean duration of 9 +/- 19 months in 28 patients (group I) or paroxysmal with a history of recurrent attacks and a mean duration of the present episode of 7 +/- 16 days in 14 patients (group II). An underlying heart disease was present in 28 patients. A 3/3-ms biphasic shock was delivered between catheters positioned in the right atrium and the coronary sinus in 32 patients. In 10 patients, the left pulmonary artery branch was used. The catheters were connected to a custom external defibrillator. The shocks were synchronized to the R wave. Following a test shock of 60 V, the energy was increased in 40-V steps until a maximum of 400 V or restoration of sinus rhythm. Sinus rhythm was restored in 22 of the 28 patients (78%) of group I by using a mean leading-edge voltage of 297 +/- 57 V (mean energy 3.3 +/- 1.3 J) and in 11 of 14 patients (78%) of group II by using a mean leading-edge voltage of 223 +/- 41 V (mean energy, 1.8 +/- 0.7 J). The energy required for terminating chronic AF was significantly (P < .001) higher than that required for terminating paroxysmal AF. Among the other variables studied, the duration of AF significantly affected the successful voltage. Ventricular proarrhythmia occurred in 1 patient with atrial flutter due to an unsynchronized shock. Of the 22 patients of group I in whom sinus rhythm was restored, 14 (63%) remained in sinus rhythm with a mean follow-up of 9 +/- 3 months. Pain level showed a good correlation with increasing voltage. However, a marked inter-individual variation was noted. Atrial defibrillation using low energy between two intracardiac catheters with an electrical field between the right and left atria and the protocol used is feasible in patients with persistent spontaneous AF. The technique is safe provided synchronization to the R wave is achieved. A low recurrence rate of AF was seen in patients in whom sinus rhythm was restored.

Long-term left ventricular assist device use before transplantation.

PubMed

Sapirstein, J S; Pae, W E; Aufiero, T X; Boehmer, J P; Pierce, W S

1995-01-01

Between September 1992 and April 1995, 19 patients at the authors' institution received pneumatic, pulsatile left ventricular assist devices (LVADs) for bridging to cardiac transplantation. The mean (+/- SD) age of the patients was 51 +/- 14 years (range, 19-64 years). Nine (47%) patients had end-stage idiopathic cardiomyopathy, five (26%) had ischemic cardiomyopathy, and five (26%) other recipients were in cardiogenic shock caused by acute myocardial infarction (AMI). Fifteen (79%) patients were supported with an intraaortic balloon pump or centrifugal LVAD at the time of LVAD insertion (duration, 5.5 +/- 4.1 days). Aprotinin was given to limit bleeding; heparin, followed by warfarin sodium, was used for anticoagulation. A vigorous exercise and nutrition protocol was followed. Cardiac index averaged 2.94 +/- 0.87 L/min/m2 immediately after the implantation procedure. No patient required placement of a right VAD. Average duration of LVAD support was 45 +/- 39 days (range, 3-153 days). Major complications included bleeding requiring reoperation (three patients); cerebrovascular accident (three patients); and severe dysrhythmias requiring direct current cardioversion (four patients). Fourteen (74%) patients underwent transplantation, with one patient still being mechanically supported. All of the patients receiving transplants were discharged from the hospital. Of the individuals who died while supported with the LVAD, 75% were patients with AMI. Timely application of LVADs as part of the interdisciplinary management of end-stage heart disease has generated excellent results for transplant candidates. Right ventricular dysfunction has not necessitated right VAD placement in the authors' experience. Patients with AMI have a higher risk of death while being supported with the device than do more chronically ill recipients.

Prediction of atrial fibrillation recurrence after cardioversion-interaction analysis of cardiac autonomic regulation.

PubMed

Seeck, A; Rademacher, W; Fischer, C; Haueisen, J; Surber, R; Voss, A

2013-03-01

Today atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice accounting for approximately one third of hospitalizations and accompanied with a 5 fold increased risk for ischemic stroke and a 1.5 fold increased mortality risk. The role of the cardiac regulation system in AF recurrence after electrical cardioversion (CV) is still unclear. The aim of this study was to investigate the autonomic regulation by analyzing the interaction between heart rate and blood pressure using novel methods of nonlinear interaction dynamics, namely joint symbolic dynamics (JSD) and segmented Poincaré plot analysis (SPPA). For the first time, we applied SPPA to analyze the interaction between two time series. Introducing a parameter set of two indices, one derived from JSD and one from SPPA, the linear discriminant function analysis revealed an overall accuracy of 89% (sensitivity 91.7%, specificity 86.7%) for the classification between patients with stable sinus rhythm (group SR, n = 15) and with AF recurrence (group REZ, n = 12). This study proves that the assessment of the autonomic regulation by analyzing the coupling of heart rate and systolic blood pressure provides a potential tool for the prediction of AF recurrence after CV and could aid in the adjustment of therapeutic options for patients with AF. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

Temporo-mandibular joint dislocation: an unusual complication of transoesophageal echocardiography.

PubMed

Anantharam, Brijesh; Chahal, Navtej; Stephens, Nigel; Senior, Roxy

2010-03-01

Temporo-mandibular joint (TMJ) dislocation is an unusual complication of transoesophageal echocardiography (TEE). We report a rare case of bilateral TMJ dislocation in an 84-year-old man prior to DC cardioversion (DCCV) for atrial flutter. Shortly after TEE and DCCV, the patient complained of bilateral facial pain. An orthopantomogram revealed bilateral TMJ dislocation. A closed reduction was performed by maxillo-facial surgeons under intravenous anaesthesia. Although very uncommon, the physician should be aware of the complication and its management.

[Current international recommendations for pediatric cardiopulmonary resuscitation: the European guidelines].

PubMed

López-Herce, Jesús; Rodríguez Núñez, Antonio; Maconochie, Ian; Van de Voorde, Patric; Biarent, Dominique; Eich, Christof; Bingham, Robert; Rajka, Thomas; Zideman, David; Carrillo, Ángel; de Lucas, Nieves; Calvo, Custodio; Manrique, Ignacio

2017-07-01

This summary of the European guidelines for pediatric cardiopulmonary resuscitation (CPR) emphasizes the main changes and encourages health care professionals to keep their pediatric CPR knowledge and skills up to date. Basic and advanced pediatric CPR follow the same algorithm in the 2015 guidelines. The main changes affect the prevention of cardiac arrest and the use of fluids. Fluid expansion should not be used routinely in children with fever in the abuse of signs of shock because too high a volume can worsen prognosis. Rescue breaths should last around 1 second in basic CPR, making pediatric recommendations consistent with those for adults. Chest compressions should be at least as deep as one-third the anteroposterior diameter of the thorax. Most children in cardiac arrest lack a shockable rhythm, and in such cases a coordinated sequence of breaths, chest compressions, and administration of adrenalin is essential. An intraosseous canula may be the first choice for introducing fluids and medications, especially in young infants. In treating supraventricular tachycardia with cardioversion, an initial dose of 1 J/kg is currently recommended (vs the dose of 0.5 J/kg previously recommended). After spontaneous circulation is recovered, measures to control fever should be taken. The goal is to reach a normal temperature even before arrival to the hospital.

Short-term prevention of thromboembolic complications in patients with atrial fibrillation with aspirin plus clopidogrel: the Clopidogrel-Aspirin Atrial Fibrillation (CLAAF) pilot study.

PubMed

Lorenzoni, Roberto; Lazzerini, Guido; Cocci, Franca; De Caterina, Raffaele

2004-07-01

We evaluated the short-term safety and efficacy of aspirin-plus-clopidogrel as antithrombotic therapy in nonvalvular atrial fibrillation (AF). Thirty patients (11 women, 45 to 75 years of age) with non-high-risk permanent (n = 12) or persistent AF awaiting cardioversion (n = 18) underwent transesophageal echocardiography to exclude left heart thrombi and were then randomly assigned to receive warfarin (international normalized ratio, 2 to 3 for 3 weeks) or aspirin (100 mg/d alone for 1 week)-plus-clopidogrel (75 mg/d added to aspirin for 3 weeks). Bleeding time and serum thromboxane B2 were measured at entry and at 3 weeks. Bleeding time, not affected by warfarin, was prolonged by 71% by aspirin (P <.05) and further, by 144%, by adding clopidogrel (P <.01 vs aspirin alone; +319%, P <.01, vs baseline). Thromboxane B2, not affected by warfarin, was reduced by aspirin (-98%, P <.01) but not further by clopidogrel. No thrombi or dense spontaneous echo-contrast were found at the 3-week transesophageal echocardiography. Seven of 9 patients receiving warfarin and 7 of 9 patients receiving aspirin-plus-clopidogrel, undergoing electrical cardioversion, achieved sinus rhythm. No thromboembolic or hemorrhagic events occurred in both arms throughout the 3-week treatment and a further 3-month follow-up. Aspirin-plus-clopidogrel and warfarin were equally safe and effective in preventing thromboembolism in this small group of patients with non-high-risk AF.

Long-term use and tolerability of irbesartan for control of hypertension

PubMed Central

Forni, Valentina; Wuerzner, Grégoire; Pruijm, Menno; Burnier, Michel

2011-01-01

In this review, we discuss the pharmacological and clinical properties of irbesartan, a noncompetitive angiotensin II receptor type 1 antagonist, successfully used for more than a decade in the treatment of essential hypertension. Irbesartan exerts its antihypertensive effect through an inhibitory effect on the pressure response to angiotensin II. Irbesartan 150–300 mg once daily confers a lasting effect over 24 hours, and its antihypertensive efficacy is further enhanced by the coadministration of hydrochlorothiazide. Additionally and partially beyond its blood pressure-lowering effect, irbesartan reduces left ventricular hypertrophy, favors right atrial remodeling in atrial fibrillation, and increases the likelihood of maintenance of sinus rhythm after cardioversion in atrial fibrillation. In addition, the renoprotective effects of irbesartan are well documented in the early and later stages of renal disease in type 2 diabetics. Furthermore, both the therapeutic effectiveness and the placebo-like side effect profile contribute to a high adherence rate to the drug. Currently, irbesartan in monotherapy or combination therapy with hydrochlorothiazide represent a rationale pharmacologic approach for arterial hypertension and early-stage and late-stage diabetic nephropathy in hypertensive type II diabetics. PMID:21949635

[Plasma cardiac natriuretic peptide as a biological marker of recurrence of atrial fibrillation in elderly people].

PubMed

Mabuchi, N; Tsutamoto, T; Maeda, K; Masahiko, K

2000-07-01

We designed this study to evaluate the relationship between plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels and recurrence of atrial fibrillation (AF) after direct current cardioversion (DC) and the differences with aging. Fifty patients with mild congestive heart failure (CHF) undergoing elective DC of AF were included in this study (New York Heart Association (NYHA) functional class II: n = 42, III = 8). Patients who failed to show restoration of sinus rhythm or those with mitral valve stenosis were excluded. Before successful DC, we measured plasma levels of ANP and BNP and evaluated left atrial dimension (LAD), left ventricular end-diastolic dimension (LVDd), and left ventricular ejection fraction (EF) by echocardiography. Twenty-one patients had recurrence of AF within 2 months after DC (average 9.05 days). We followed up the other 29 patients for 580.5 days. By Cox stepwise multivariate analysis, history of AF (p = 0.007), low plasma levels of ANP (p = 0.003), and high plasma levels of BNP (p = 0.0003) were found to be independent predictors of recurrent AF. High plasma BNP levels indicating ventricular dysfunction and low plasma ANP levels may be due to atrial histological change such as fibrosis. In these patients, plasma ratios of ANP and BNP (ANP/BNP) less than 0.43 were predictive factors for AF recurrence (sensitivity 70%, specificity 62%), especially in patients who were older than 70 years (sensitivity 100%, specificity 80%). Relatively low plasma ANP level compared to BNP is an independent risk factor of AF recurrence in patients with CHF, especially in elderly patients, suggesting that plasma cardiac natriuretic peptides are important biochemical markers of AF recurrence in elderly patients with CHF.

Sleep-Disordered Breathing and Excessive Daytime Sleepiness in Patients With Atrial Fibrillation

PubMed Central

Albuquerque, Felipe N.; Calvin, Andrew D.; Sert Kuniyoshi, Fatima H.; Konecny, Tomas; Lopez-Jimenez, Francisco; Pressman, Gregg S.; Kara, Thomas; Friedman, Paul; Ammash, Naser; Somers, Virend K.

2012-01-01

Background: An important consequence of sleep-disordered breathing (SDB) is excessive daytime sleepiness (EDS). EDS often predicts a favorable response to treatment of SDB, although in the setting of cardiovascular disease, particularly heart failure, SDB and EDS do not reliably correlate. Atrial fibrillation (AF) is another highly prevalent condition strongly associated with SDB. We sought to assess the relationship between EDS and SDB in patients with AF. Methods: We conducted a prospective study of 151 patients referred for direct current cardioversion for AF who also underwent sleep evaluation and nocturnal polysomnography. The Epworth Sleepiness Scale (ESS) was administered prior to polysomnography and considered positive if the score was ≥ 11. The apnea-hypopnea index (AHI) was tested for correlation with the ESS, with a cutoff of ≥ 5 events/h for the diagnosis of SDB. Results: Among the study participants, mean age was 69.1 ± 11.7 years, mean BMI was 34.1 ± 8.4 kg/m2, and 76% were men. The prevalence of SDB in this population was 81.4%, and 35% had EDS. The association between ESS score and AHI was low (R2 = 0.014, P = .64). The sensitivity and specificity of the ESS for the detection of SDB in patients with AF were 32.2% and 54.5%, respectively. Conclusions: Despite a high prevalence of SDB in this population with AF, most patients do not report EDS. Furthermore, EDS does not appear to correlate with severity of SDB or to accurately predict the presence of SDB. Further research is needed to determine whether EDS affects the natural history of AF or modifies the response to SDB treatment. PMID:21903736

[Surgical cryoablation and left ventriculoplasty for electrical storm after acute myocardial infarction].

PubMed

Tobe, Satoshi; Yoshida, K; Adachi, K; Fukase, K; Tanimura, N; Yamaguchi, M

2008-03-01

A 65-year-old man was referred to our hospital to treat recent anterior myocardial infarction. Coronary artery angiography showed acute occlusion of left anterior descending coronary artery (LAD) and chronic occlusion of right coronary artery. After emergent percutaneous coronary intervention for LAD, drug-refractory electrical storm necessitating frequent electrical defibrillating cardioversion occurred. This patient successfully underwent surgical cryoablation, left ventriculoplasty and coronary revascularization. At 2 years and 10th month after the operation, he is well without limitation of daily activities and any evidence of myocardial ischemia and ventricular tachycardia.

Human Factors Approach to Comparative Usability of Hospital Manual Defibrillators.

PubMed

Fidler, Richard; Johnson, Meshell

2016-04-01

Equipment-related issues have recently been cited as a significant contributor to the suboptimal outcomes of resuscitation management. A systematic evaluation of the human-device interface was undertaken to evaluate the intuitive nature of three different defibrillators. Devices tested were the Physio-Control LifePak 15, the Zoll R Series Plus, and the Philips MRx. A convenience sample of 73 multidisciplinary health care providers from 5 different hospitals participated in this study. All subjects' performances were evaluated without any training on the devices being studied to assess the intuitiveness of the user interface to perform the functions of delivering an Automated External Defibrillator (AED) shock, a manual defibrillation, pacing to achieve 100% capture, and synchronized cardioversion on a rhythm simulator. Times to deliver an AED shock were fastest with the Zoll, whereas the Philips had the fastest times to deliver a manual defibrillation. Subjects took the least time to attain 100% capture for pacing with the Physio-Control device. No differences in performance times were seen with synchronized cardioversion among the devices. Human factors issues uncovered during this study included a preference for knobs over soft keys and a desire for clarity in control panel design. This study demonstrated no clearly superior defibrillator, as each of the models exhibited strengths in different areas. When asked their defibrillator preference, 67% of subjects chose the Philips. This comparison of user interfaces of defibrillators in simulated situations allows the assessment of usability that can provide manufacturers and educators with feedback about defibrillator implementation for these critical care devices. Published by Elsevier Ireland Ltd.

Effects of Persistent Atrial Fibrillation-Induced Electrical Remodeling on Atrial Electro-Mechanics - Insights from a 3D Model of the Human Atria.

PubMed

Adeniran, Ismail; MacIver, David H; Garratt, Clifford J; Ye, Jianqiao; Hancox, Jules C; Zhang, Henggui

2015-01-01

Atrial stunning, a loss of atrial mechanical contraction, can occur following a successful cardioversion. It is hypothesized that persistent atrial fibrillation-induced electrical remodeling (AFER) on atrial electrophysiology may be responsible for such impaired atrial mechanics. This simulation study aimed to investigate the effects of AFER on atrial electro-mechanics. A 3D electromechanical model of the human atria was developed to investigate the effects of AFER on atrial electro-mechanics. Simulations were carried out in 3 conditions for 4 states: (i) the control condition, representing the normal tissue (state 1) and the tissue 2-3 months after cardioversion (state 2) when the atrial tissue recovers its electrophysiological properties after completion of reverse electrophysiological remodelling; (ii) AFER-SR condition for AF-remodeled tissue with normal sinus rhythm (SR) (state 3); and (iii) AFER-AF condition for AF-remodeled tissue with re-entrant excitation waves (state 4). Our results indicate that at the cellular level, AFER (states 3 & 4) abbreviated action potentials and reduced the Ca2+ content in the sarcoplasmic reticulum, resulting in a reduced amplitude of the intracellular Ca2+ transient leading to decreased cell active force and cell shortening as compared to the control condition (states 1 & 2). Consequently at the whole organ level, atrial contraction in AFER-SR condition (state 3) was dramatically reduced. In the AFER-AF condition (state 4) atrial contraction was almost abolished. This study provides novel insights into understanding atrial electro-mechanics illustrating that AFER impairs atrial contraction due to reduced intracellular Ca2+ transients.

The Indian consensus guidance on stroke prevention in atrial fibrillation: An emphasis on practical use of nonvitamin K oral anticoagulants.

PubMed

Dalal, Jamshed; Bhave, Abhay; Oomman, Abraham; Vora, Amit; Saxena, Anil; Kahali, Dhiman; Poncha, Fali; Gambhir, D S; Chaudhuri, Jaydip Ray; Sinha, Nakul; Ray, Saumitra; Iyengar, S S; Banerjee, Suvro; Kaul, Upendra

2015-12-01

The last ten years have seen rapid strides in the evolution of nonvitamin K oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation (AF). For the preparation of this consensus, a comprehensive literature search was performed and data on available trials, subpopulation analyses, and case reports were analyzed. This Indian consensus document intends to provide guidance on selecting the right NOAC for the right patients by formulating expert opinions based on the available trials and Asian/Indian subpopulation analyses of these trials. A section has been dedicated to the current evidence of NOACs in the Asian population. Practical suggestions have been formulated in the following clinical situations: (i) Dose recommendations of the NOACs in different clinical scenarios; (ii) NOACs in patients with rheumatic heart disease (RHD); (iii) Monitoring anticoagulant effect of the NOACs; (iv) Overdose of NOACs; (v) Antidotes to NOACs; (vi) Treatment of hypertrophic cardiomyopathy (HCM) with AF using NOACs; (vii) NOACs dose in elderly, (viii) Switching between NOACs and vitamin K antagonists (VKA); (ix) Cardioversion or ablation in NOAC-treated patients; (x) Planned/emergency surgical interventions in patients currently on NOACs; (xi) Management of bleeding complications of NOACs; (xii) Management of acute coronary syndrome (ACS) in AF with NOACs; (xiii) Management of acute ischemic stroke while on NOACs. Copyright © 2015. Published by Elsevier B.V.

Defibrillator synchronization tester.

PubMed

Demirbilek, Fatma N; Krajnak, Mike; Stolarczyk, George

2009-01-01

A defibrillator sync output signal connector provides an ECG synchronization signal that can be used by some defibrillators for the purpose of performing synchronized cardioversion [1]. This process is used to stop an abnormally fast heart rate or cardiac arrhythmia by the delivery of a therapeutic dose of electric current to the heart during the R-wave of the cardiac cycle. Timing the shock to the R-wave prevents the delivery of the shock during the vulnerable period of the cardiac cycle, which could induce ventricular fibrillation [2]. GE patient monitors include a selectable analog output feature, which provides an analog ECG or arterial blood pressure signal. The blood pressure signal can be used to synchronize balloon pumps to provide cardiac assist to post-MI patients with poor injection fraction. Proper operation requires the defibrillator sync and analog output function to be checked. Checkouts are typically done during planned maintenance and after major part replacements such as patient monitor's main CPU board. Checking out defibrillator sync signals could be done using a GE defibrillator sync tester. The defibrillator sync tester provides a loop back path for the defibrillator sync signals to be displayed on the patient monitor screen and eliminates the need for an external oscilloscope.

HALT & REVERSE: Hsf1 activators lower cardiomyocyt damage; towards a novel approach to REVERSE atrial fibrillation.

PubMed

Lanters, Eva A H; van Marion, Denise M S; Kik, Charles; Steen, Herman; Bogers, Ad J J C; Allessie, Maurits A; Brundel, Bianca J J M; de Groot, Natasja M S

2015-11-05

Atrial fibrillation is a progressive arrhythmia, the exact mechanism underlying the progressive nature of recurrent AF episodes is still unknown. Recently, it was found that key players of the protein quality control system of the cardiomyocyte, i.e. Heat Shock Proteins, protect against atrial fibrillation progression by attenuating atrial electrical and structural remodeling (electropathology). HALT & REVERSE aims to investigate the correlation between electropathology, as defined by endo- or epicardial mapping, Heat Shock Protein levels and development or recurrence of atrial fibrillation following pulmonary vein isolation, or electrical cardioversion or cardiothoracic surgery. This study is a prospective observational study. Three separate study groups are defined: (1) cardiothoracic surgery, (2) pulmonary vein isolation and (3) electrical cardioversion. An intra-operative high-resolution epicardial (group 1) or endocardial (group 2) mapping procedure of the atria is performed to study atrial electropathology. Blood samples for Heat Shock Protein determination are obtained at baseline and during the follow-up period at 3 months (group 2), 6 months (groups 1 and 2) and 1 year (group 1 and 2). Tissue samples of the right and left atrial appendages in patients in group 1 are analysed for Heat Shock Protein levels and for tissue characteristics. Early post procedural atrial fibrillation is detected by continuous rhythm monitoring, whereas late post procedural atrial fibrillation is documented by either electrocardiogram or 24-h Holter registration. HALT & REVERSE aims to identify the correlation between Heat Shock Protein levels and degree of electropathology. The study outcome will contribute to novel diagnostic tools for the early recognition of clinical atrial fibrillation. Rotterdam Medical Ethical Committee MEC-2014-393, Dutch Trial Registration NTR4658.

Atrial tachyarrhythmia in adult congenital heart disease

PubMed Central

Karbassi, Arsha; Nair, Krishnakumar; Harris, Louise; Wald, Rachel M; Roche, S Lucy

2017-01-01

The adult congenital heart disease (ACHD) population continues to grow and most cardiologists, emergency room physicians and family doctors will intermittently come into contact with these patients. Oftentimes this may be in the setting of a presentation with atrial tachyarrhythmia; one of the commonest late complications of ACHD and problem with potentially serious implications. Providing appropriate initial care and ongoing management of atrial tachyarrhythmia in ACHD patients requires a degree of specialist knowledge and an awareness of certain key issues. In ACHD, atrial tachyarrhythmia is usually related to the abnormal anatomy of the underlying heart defect and often occurs as a result of surgical scar or a consequence of residual hemodynamic or electrical disturbances. Arrhythmias significantly increase mortality and morbidity in ACHD and are the most frequent reason for ACHD hospitalization. Intra-atrial reentrant tachycardia and atrial fibrillation are the most prevalent type of arrhythmia in this patient group. In hemodynamically unstable patients, urgent cardioversion is required. Acute management of the stable patient includes anticoagulation, rate control, and electrical or pharmacological cardioversion. In ACHD, rhythm control is the preferred management strategy and can often be achieved. However, in the long-term, medication side-effects can prove problematic. Electrophysiology studies and catheter ablation are important treatments modalities and in certain cases, surgical or percutaneous treatment of the underlying cardiac defect has a role. ACHD patients, especially those with complex CHD, are at increased risk of thromboembolic events and anticoagulation is usually required. Female ACHD patients of child bearing age may wish to pursue pregnancies. The risk of atrial arrhythmias is increased during pregnancy and management of atrial tachyarrhythmia during pregnancy needs specific consideration. PMID:28706585

Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion.

PubMed

Degiovanni, Anna; Boggio, Enrico; Prenna, Eleonora; Sartori, Chiara; De Vecchi, Federica; Marino, Paolo N

2018-04-01

Diastolic dysfunction promotes atrial fibrillation (AF) inducing left atrial (LA) remodeling, with chamber dilation and fibrosis. Predominance of LA phasic conduit (LAC) function should reflect not only chamber alterations but also underlying left ventricular (LV) filling impairment. Thus, LAC was tested as possible predictor of early AF relapse after electrical cardioversion (EC). 96 consecutive patients, who underwent EC for persistent non-valvular AF, were prospectively enrolled. Immediately after successful EC (3 h ± 15 min), an echocardiographic apical four-chamber view was acquired with transmitral velocities, annular tissue Doppler and simultaneous LV and LA three-dimensional full-volume datasets. Then, from LA-LV volumetric curves we computed LAC as: [(LV maximum - LV minimum) - (LA maximum - LA minimum) volume], expressed as % LV stroke volume. LA pump, immediately post-EC, was assumed and verified as being negligible. Sinus rhythm persistence at 1 month was checked with ECG-Holter monitoring. At 1 month 62 patients were in sinus rhythm and 34 in AF. AF patients presented pre-EC higher E/é values (p = 0.012), no major LA volume differences (p = NS), but a stiffer LV cavity (p = 0.012) for a comparable LV capacitance (p = 0.461). Conduit contributed more (p < 0.001) to LV stroke volume in AF subpopulation. Multiple regression revealed LAC as the most significant AF predictor (p = 0.013), even after correction for biometric characteristics and pharmacotherapy (p = 0.008). Our data suggest that LAC larger contribution to LV filling soon after EC reflects LA-LV stiffening, which skews atrioventricular interaction leading to AF perpetuation and makes conduit dominance a powerful predictor of early AF recurrence.

Trends in U.S. Hospitalizations Rates and Rhythm Control Therapies Following Publication of the AFFIRM and RACE Trials

PubMed Central

Martin-Doyle, William; Essebag, Vidal; Zimetbaum, Peter; Reynolds, Matthew R.

2010-01-01

Introduction The impact of trials comparing rate vs. rhythm control for AF on subsequent use of rhythm control therapies and hospitalizations at a national level has not been described. Methods and Results We queried the Healthcare Cost & Utilization Project on the frequency of hospital admissions and performance of specific rhythm control procedures from 1998–2006. We analyzed trends in hospitalization for AF as principal diagnosis before and after the publication of key rate vs. rhythm trials in 2002. We also reviewed the use of electrical cardioversion and catheter ablation as principal procedures during hospital admissions for any cause and for AF as principal diagnosis. We additionally appraised the overall outpatient utilization of antiarrhythmic drugs during this same time frame using IMS Health’s National Prescription Audit.™ Admissions for AF as a principal diagnosis increased at 5%/year from 1998–2002. Following publication of the AFFIRM and RACE trials in 2002, admissions declined by 2%/year from 2002–2004, before rising again from 2004–06. In-hospital electrical cardioversion followed a similar pattern. National prescription volumes for antiarrhythmic drugs grew at <1%/yr from 2002–06, with a marked decline in the use of Class I-A agents, while catheter ablations during admissions for AF as the principal diagnosis increased at 30%/year. Conclusion The use of rhythm control therapies in the U.S. declined significantly in the first few years after publication of AFFIRM and RACE. This trend reversed by 2005, at which time rapid growth in the use of catheter ablation for AF was observed. PMID:21087329

Association between transthoracic impedance and electrical cardioversion success with biphasic defibrillators: An analysis of 1055 shocks for atrial fibrillation and flutter.

PubMed

Sadek, Mouhannad M; Chaugai, Varsha; Cleland, Mark J; Zakutney, Timothy J; Birnie, David H; Ramirez, F Daniel

2018-03-13

The relevance of transthoracic impedance (TTI) to electrical cardioversion (ECV) success for atrial tachyarrhythmias when using biphasic waveform defibrillators is unknown. TTI is predictive of ECV success with contemporary defibrillators. De-identified data stored in biphasic defibrillator memory cards from ECV attempts for atrial fibrillation (AF) or atrial flutter (AFL) over a 2-year period at our center were evaluated. ECV success, defined as arrhythmia termination and ≥ 1 sinus beat, was adjudicated by 2 blinded cardiac electrophysiologists. The association between TTI and ECV success was assessed via Cochrane-Armitage trend and Spearman rank correlation tests, as well as simple and multivariable logistic regression. The influence of TTI on the number of shocks and on cumulative energy delivered per patient was also examined. 703 patients (593 with AF, 110 with AFL) receiving 1055 shocks were included. Last shock success was achieved in 88.0% and 98.2% of patients with AF and AFL, respectively. In patients with AF, TTI was positively associated with last shock failure (P trend  =0.019), the need for multiple shocks (P trend  <0.001), and cumulative energy delivered (ρ = 0.348; P < 0.001). After adjusting for first shock energy, 10-Ω increments in TTI were associated with odds ratios of 1.36 (95% CI: 1.24-1.49) and 1.22 (95% CI: 1.09-1.37) for first and last shock failure, respectively (P < 0.001 for both). Although contemporary defibrillators are designed to compensate for TTI, this variable continues to be associated with ECV failure in patients with AF. Strategies to lower TTI during ECV for AF may improve procedural success. © 2018 Wiley Periodicals, Inc.

Effects of Persistent Atrial Fibrillation-Induced Electrical Remodeling on Atrial Electro-Mechanics – Insights from a 3D Model of the Human Atria

PubMed Central

Adeniran, Ismail; MacIver, David H.; Garratt, Clifford J.; Ye, Jianqiao; Hancox, Jules C.; Zhang, Henggui

2015-01-01

Aims Atrial stunning, a loss of atrial mechanical contraction, can occur following a successful cardioversion. It is hypothesized that persistent atrial fibrillation-induced electrical remodeling (AFER) on atrial electrophysiology may be responsible for such impaired atrial mechanics. This simulation study aimed to investigate the effects of AFER on atrial electro-mechanics. Methods and Results A 3D electromechanical model of the human atria was developed to investigate the effects of AFER on atrial electro-mechanics. Simulations were carried out in 3 conditions for 4 states: (i) the control condition, representing the normal tissue (state 1) and the tissue 2–3 months after cardioversion (state 2) when the atrial tissue recovers its electrophysiological properties after completion of reverse electrophysiological remodelling; (ii) AFER-SR condition for AF-remodeled tissue with normal sinus rhythm (SR) (state 3); and (iii) AFER-AF condition for AF-remodeled tissue with re-entrant excitation waves (state 4). Our results indicate that at the cellular level, AFER (states 3 & 4) abbreviated action potentials and reduced the Ca2+ content in the sarcoplasmic reticulum, resulting in a reduced amplitude of the intracellular Ca2+ transient leading to decreased cell active force and cell shortening as compared to the control condition (states 1 & 2). Consequently at the whole organ level, atrial contraction in AFER-SR condition (state 3) was dramatically reduced. In the AFER-AF condition (state 4) atrial contraction was almost abolished. Conclusions This study provides novel insights into understanding atrial electro-mechanics illustrating that AFER impairs atrial contraction due to reduced intracellular Ca2+ transients. PMID:26606047

Loss of atrial contractility is primary cause of atrial dilatation during first days of atrial fibrillation.

PubMed

Schotten, Ulrich; de Haan, Sunniva; Neuberger, Hans-Ruprecht; Eijsbouts, Sabine; Blaauw, Yuri; Tieleman, Robert; Allessie, Maurits

2004-11-01

Atrial fibrillation (AF) induces a progressive dilatation of the atria which in turn might promote the arrhythmia. The mechanism of atrial dilatation during AF is not known. To test the hypothesis that loss of atrial contractile function is a primary cause of atrial dilatation during the first days of AF, eight goats were chronically instrumented with epicardial electrodes, a pressure transducer in the right atrium, and piezoelectric crystals to measure right atrial diameter. AF was induced with the use of repetitive burst pacing. Atrial contractility was assessed during sinus rhythm, atrial pacing (160-, 300-, and 400-ms cycle length), and electrically induced AF. The compliance of the fibrillating right atrium was measured during unloading the atria with diuretics and loading with 1 liter of saline. All measurements were repeated after 6, 12, and 24 h of AF and then once a day during the first 5 days of AF. Recovery of the observed changes after spontaneous cardioversion was also studied. After 5 days of AF, atrial contractility during sinus rhythm or slow atrial pacing was greatly reduced. During rapid pacing (160 ms) or AF, the amplitude of the atrial pressure waves had declined to 20% of control. The compliance of the fibrillating atria increased twofold, whereas the right atrial pressure was unchanged. As a result, the mean right atrial diameter increased by approximately 12%. All changes were reversible within 3 days of sinus rhythm. We conclude that atrial dilatation during the first days of AF is due to an increase in atrial compliance caused by loss of atrial contractility during AF. Atrial compliance and size are restored when atrial contractility recovers after cardioversion of AF.

A Novel Application for the Detection of an Irregular Pulse using an iPhone 4S in Patients with Atrial Fibrillation

PubMed Central

McManus, David D.; Lee, Jinseok; Maitas, Oscar; Esa, Nada; Pidikiti, Rahul; Carlucci, Alex; Harrington, Josephine; Mick, Eric; Chon, Ki H.

2012-01-01

Background Atrial fibrillation (AF) is common and associated with adverse health outcomes. Timely detection of AF can be challenging using traditional diagnostic tools. Smartphone use is increasing and may provide an inexpensive and user-friendly means to diagnose AF. Objective To test the hypothesis that a smartphone-based application could detect an irregular pulse from AF. Methods 76 adults with persistent AF were consented for participation in our study. We obtained pulsatile time series recordings before and after cardioversion using an iPhone 4S camera. A novel smartphone application conducted real-time pulse analysis using 2 statistical methods [Root Mean Square of Successive RR Differences (RMSSD/mean); Shannon Entropy (ShE)]. We examined the sensitivity, specificity, and predictive accuracy of both algorithms using the 12-lead electrocardiogram as the gold standard. Results RMSDD/mean and ShE were higher in participants in AF compared with sinus rhythm. The 2 methods were inversely related to AF in regression models adjusting for key factors including heart rate and blood pressure (β coefficients per SD-increment in RMSDD/mean and ShE were −0.20 and −0.35; p<0.001). An algorithm combining the 2 statistical methods demonstrated excellent sensitivity (0.962), specificity (0.975), and accuracy (0.968) for beat-to-beat discrimination of an irregular pulse during AF from sinus rhythm. Conclusions In a prospectively recruited cohort of 76 participants undergoing cardioversion for AF, we found that a novel algorithm analyzing signals recorded using an iPhone 4S accurately distinguished pulse recordings during AF from sinus rhythm. Data are needed to explore the performance and acceptability of smartphone-based applications for AF detection. PMID:23220686

A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation.

PubMed

McManus, David D; Lee, Jinseok; Maitas, Oscar; Esa, Nada; Pidikiti, Rahul; Carlucci, Alex; Harrington, Josephine; Mick, Eric; Chon, Ki H

2013-03-01

Atrial fibrillation (AF) is common and associated with adverse health outcomes. Timely detection of AF can be challenging using traditional diagnostic tools. Smartphone use is increasing and may provide an inexpensive and user-friendly means to diagnoseAF. To test the hypothesis that a smartphone-based application could detect an irregular pulse fromAF. Seventy-six adults with persistent AF were consented for participation in our study. We obtained pulsatile time series recordings before and after cardioversion using an iPhone 4S camera. A novel smartphone application conducted real-time pulse analysis using 2 statistical methods: root mean square of successive RR difference (RMSSD/mean) and Shannon entropy (ShE). We examined the sensitivity, specificity, and predictive accuracy of both algorithms using the 12-lead electrocardiogram as the gold standard. RMSDD/mean and ShE were higher in participants in AF than in those with sinus rhythm. The 2 methods were inversely related to AF in regression models adjusting for key factors including heart rate and blood pressure (beta coefficients per SD increment in RMSDD/mean and ShE were-0.20 and-0.35; P<.001). An algorithm combining the 2 statistical methods demonstrated excellent sensitivity (0.962), specificity (0.975), and accuracy (0.968) for beat-to-beat discrimination of an irregular pulse during AF from sinus rhythm. In a prospectively recruited cohort of 76 participants undergoing cardioversion for AF, we found that a novel algorithm analyzing signals recorded using an iPhone 4S accurately distinguished pulse recordings during AF from sinus rhythm. Data are needed to explore the performance and acceptability of smartphone-based applications for AF detection. Copyright © 2013 Heart Rhythm Society. All rights reserved.

Systematic analysis of ECG predictors of sinus rhythm maintenance after electrical cardioversion for persistent atrial fibrillation.

PubMed

Lankveld, Theo; de Vos, Cees B; Limantoro, Ione; Zeemering, Stef; Dudink, Elton; Crijns, Harry J; Schotten, Ulrich

2016-05-01

Electrical cardioversion (ECV) is one of the rhythm control strategies in patients with persistent atrial fibrillation (AF). Unfortunately, recurrences of AF are common after ECV, which significantly limits the practical benefit of this treatment in patients with AF. The objectives of this study were to identify noninvasive complexity or frequency parameters obtained from the surface electrocardiogram (ECG) to predict sinus rhythm (SR) maintenance after ECV and to compare these ECG parameters with clinical predictors. We studied a wide variety of ECG-derived time- and frequency-domain AF complexity parameters in a prospective cohort of 502 patients with persistent AF referred for ECV. During 1-year follow-up, 161 patients (32%) maintained SR. The best clinical predictor of SR maintenance was antiarrhythmic drug (AAD) treatment. A model including clinical parameters predicted SR maintenance with a mean cross-validated area under the receiver operating characteristic curve (AUC) of 0.62 ± 0.05. The best single ECG parameter was the dominant frequency (DF) on lead V6. Combining several ECG parameters predicted SR maintenance with a mean AUC of 0.64 ± 0.06. Combining clinical and ECG parameters improved prediction to a mean AUC of 0.67 ± 0.05. Although the DF was affected by AAD treatment, excluding patients taking AADs did not significantly lower the predictive performance captured by the ECG. ECG-derived parameters predict SR maintenance during 1-year follow-up after ECV at least as good as known clinical predictors of rhythm outcome. The DF proved to be the most powerful ECG-derived predictor. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Conversion of atrial fibrillation after levothyroxine in a dog with hypothyroidism and arterial thromboembolism.

PubMed

Chow, B; French, A

2014-05-01

A six-year-old female spayed mixed-breed dog was referred following a 3-week history of lameness and progressive neurological deficits in both hindlimbs, and a 1-week history of a cardiac arrhythmia. The dog was diagnosed with hypothyroidism, atrial fibrillation, myocardial dysfunction and arterial thromboembolism. Cardioversion occurred after 2 weeks of levothyroxine supplementation, with improved systolic function over time. To the authors' knowledge, this is the first case reported in the veterinary or human literature documenting hypothyroidism with persistent atrial fibrillation being converted to sinus rhythm with levothyroxine as sole therapy. © 2014 British Small Animal Veterinary Association.

Failure of communication and capture: The perils of temporary unipolar pacing system.

PubMed

Sahinoglu, Efe; Wool, Thomas J; Wool, Kenneth J

2015-06-01

We present a case of a patient with pacemaker dependence secondary to complete heart block who developed loss of capture of her temporary pacemaker. Patient developed torsades de pointes then ventricular fibrillation, requiring CPR and external cardioversion. After patient was stabilized, it was noticed that loss of capture of pacemaker corresponded with nursing care, when the pulse generator was lifted off patient׳s chest wall, and that patient׳s temporary pacing system had been programmed to unipolar mode without knowledge of attending cardiologist. This case highlights the importance of communication ensuring all caregivers are aware of mode of the temporary pacing system.

The Current Role of Omega-3 Fatty Acids in the Management of Atrial Fibrillation.

PubMed

Christou, Georgios A; Christou, Konstantinos A; Korantzopoulos, Panagiotis; Rizos, Evangelos C; Nikas, Dimitrios N; Goudevenos, John A

2015-09-22

The main dietary source of omega-3 polyunsaturated fatty acids (n-3 PUFA) is fish, which contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). In the present manuscript, we aimed to review the current evidence regarding the clinical role of n-3 PUFA in the prevention of atrial fibrillation (AF) and the possible underlying mechanisms. A literature search based on PubMed listings was performed using "Omega-3 fatty acids" and "atrial fibrilation" as key search terms. n-3 PUFA have been shown to attenuate structural atrial remodeling, prolong atrial effective refractory period through the prevention of reentry and suppress ectopic firing from pulmonary veins. Dietary fish intake has been found to have no effect on the incidence of AF in the majority of studies. Circulating DHA has been consistently reported to be inversely associated with AF risk, whereas EPA has no such effect. The majority of studies investigating the impact of n-3 PUFA supplementation on the incidence of AF following cardiac surgery reported no benefit, though most of them did not use n-3 PUFA pretreatment for adequate duration. Studies using adequate four-week pretreatment with n-3 PUFA before cardioversion of AF showed a reduction of the AF incidence. Although n-3 PUFA have antiarrhythmogenic properties, their clinical efficacy on the prevention of AF is not consistently supported. Further well-designed studies are needed to overcome the limitations of the existing studies and provide robust conclusions.

The Current Role of Omega-3 Fatty Acids in the Management of Atrial Fibrillation

PubMed Central

Christou, Georgios A.; Christou, Konstantinos A.; Korantzopoulos, Panagiotis; Rizos, Evangelos C.; Nikas, Dimitrios N.; Goudevenos, John A.

2015-01-01

Background: The main dietary source of omega-3 polyunsaturated fatty acids (n-3 PUFA) is fish, which contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). In the present manuscript, we aimed to review the current evidence regarding the clinical role of n-3 PUFA in the prevention of atrial fibrillation (AF) and the possible underlying mechanisms. Methods: A literature search based on PubMed listings was performed using “Omega-3 fatty acids” and “atrial fibrilation” as key search terms. Results: n-3 PUFA have been shown to attenuate structural atrial remodeling, prolong atrial effective refractory period through the prevention of reentry and suppress ectopic firing from pulmonary veins. Dietary fish intake has been found to have no effect on the incidence of AF in the majority of studies. Circulating DHA has been consistently reported to be inversely associated with AF risk, whereas EPA has no such effect. The majority of studies investigating the impact of n-3 PUFA supplementation on the incidence of AF following cardiac surgery reported no benefit, though most of them did not use n-3 PUFA pretreatment for adequate duration. Studies using adequate four-week pretreatment with n-3 PUFA before cardioversion of AF showed a reduction of the AF incidence. Conclusions: Although n-3 PUFA have antiarrhythmogenic properties, their clinical efficacy on the prevention of AF is not consistently supported. Further well-designed studies are needed to overcome the limitations of the existing studies and provide robust conclusions. PMID:26402674

Constitutively Active Acetylcholine-Dependent Potassium Current Increases Atrial Defibrillation Threshold by Favoring Post-Shock Re-Initiation

PubMed Central

Bingen, Brian O.; Askar, Saïd F. A.; Neshati, Zeinab; Feola, Iolanda; Panfilov, Alexander V.; de Vries, Antoine A. F.; Pijnappels, Daniël A.

2015-01-01

Electrical cardioversion (ECV), a mainstay in atrial fibrillation (AF) treatment, is unsuccessful in up to 10–20% of patients. An important aspect of the remodeling process caused by AF is the constitutive activition of the atrium-specific acetylcholine-dependent potassium current (IK,ACh → IK,ACh-c), which is associated with ECV failure. This study investigated the role of IK,ACh-c in ECV failure and setting the atrial defibrillation threshold (aDFT) in optically mapped neonatal rat cardiomyocyte monolayers. AF was induced by burst pacing followed by application of biphasic shocks of 25–100 V to determine aDFT. Blocking IK,ACh-c by tertiapin significantly decreased DFT, which correlated with a significant increase in wavelength during reentry. Genetic knockdown experiments, using lentiviral vectors encoding a Kcnj5-specific shRNA to modulate IK,ACh-c, yielded similar results. Mechanistically, failed ECV was attributed to incomplete phase singularity (PS) removal or reemergence of PSs (i.e. re-initiation) through unidirectional propagation of shock-induced action potentials. Re-initiation occurred at significantly higher voltages than incomplete PS-removal and was inhibited by IK,ACh-c blockade. Whole-heart mapping confirmed our findings showing a 60% increase in ECV success rate after IK,ACh-c blockade. This study provides new mechanistic insight into failing ECV of AF and identifies IK,ACh-c as possible atrium-specific target to increase ECV effectiveness, while decreasing its harmfulness. PMID:26487066

The implantable cardioverter defibrillator: technology, indications, and impact on cardiovascular survival.

PubMed

Bhatia, Atul; Cooley, Ryan; Berger, Marcie; Blanck, Zalmen; Dhala, Anwer; Sra, Jasbir; Axtell-Mcbride, Kathleen; Vandervort, Cheryl; Akhtar, Masood

2004-06-01

Since the introduction of the implantable cardioverter defibrillator (ICD) for the management of patients with high risk of arrhythmic SCD, there has been increasing use of this device. Its basic promise to effectively terminate ventricular tachycardia (VT)-ventricular fibrillation (VF) has been repeatedly met. In several randomized trials, the ICD has been shown to be superior to conventional anti-arrhythmic therapy, both in patients with documented VT-VF (secondary prevention) and those with high risk such as left ventricular ejection fraction and no prior sustained VT-VF (primary prevention). In both groups, the ICD showed overall and cardiac mortality reduction. The device now can more accurately detect VT-VF and differentiate these from other arrhythmias through a series of algorithms and direct-chamber sensing. Therapy options include painless antitachycardia pacing, low-energy cardioversion, and high-energy defibrillation. The technique implant is now simple as a pacemaker with one lead attached to an active (hot) can functioning as the other electrode. Among other improvements is its weight, volume, multiprogrammability, and storage of information,dual-chamber pacing and sensing, dual-chamber defibrillation, and addition of biventricular pacing for cardiac synchronization. It is anticipated that further improvement in ICD technology will take place and the list of indications will grow.

Detection of atrial fibrillation and flutter by a dual-chamber implantable cardioverter-defibrillator. For the Worldwide Jewel AF Investigators.

PubMed

Swerdlow, C D; Schsls, W; Dijkman, B; Jung, W; Sheth, N V; Olson, W H; Gunderson, B D

2000-02-29

To distinguish prolonged episodes of atrial fibrillation (AF) that require cardioversion from self-terminating episodes that do not, an atrial implantable cardioverter-defibrillator (ICD) must be able to detect AF continuously for extended periods. The ICD should discriminate between atrial tachycardia/flutter (AT), which may be terminated by antitachycardia pacing, and AF, which requires cardioversion. We studied 80 patients with AT/AF and ventricular arrhythmias who were treated with a new atrial/dual-chamber ICD. During a follow-up period lasting 6+/-2 months, we validated spontaneous, device-defined AT/AF episodes by stored electrograms in all patients. In 58 patients, we performed 80 Holter recordings with telemetered atrial electrograms, both to validate the continuous detection of AT/AF and to determine the sensitivity of the detection of AT/AF. Detection was appropriate in 98% of 132 AF episodes and 88% of 190 AT episodes (98% of 128 AT episodes with an atrial cycle length <300 ms). Intermittent sensing of far-field R waves during sinus tachycardia caused 27 inappropriate AT/AF detections; these detections lasted 2.6+/-2.0 minutes. AT/AF was detected continuously in 27 of 28 patients who had spontaneous episodes of AT/AF (96%). The device memory recorded 90 appropriate AT/AF episodes lasting >1 hour, for a total of 2697 hours of continuous detection of AT/AF. During Holter monitoring, the sensitivity of the detection of AT/AF (116 hours) was 100%; the specificity of the detection of non-AT/AF rhythms (1290 hours) was 99.99%. Of 166 appropriate episodes detected as AT, 45% were terminated by antitachycardia pacing. A new ICD detects AT/AF accurately and continuously. Therapy may be programmed for long-duration AT/AF, with a low risk of underdetection. Discrimination of AT from AF permits successful pacing therapy for a significant fraction of AT.

Magnitude of increase in QTc interval after initiation of dofetilide in patients with persistent atrial fibrillation is associated with increased rates of pharmacological cardioversion and long-term freedom from recurrent atrial fibrillation.

PubMed

Huang, Henry D; Waks, Jonathan W; Steinhaus, Daniel A; Zimetbaum, Peter

2016-07-01

Dofetilide is a class III antiarrhythmic drug approved for the treatment of atrial fibrillation (AF). Dofetilide-induced corrected QT (QTc) interval prolongation is a surrogate for the degree of drug effect, but the relationships between drug-induced QTc interval prolongation, pharmacological cardioversion (PCV), and freedom from recurrent AF are unclear. The purpose of this study was to assess associations between QTc interval change during dofetilide initiation and PCV and long-term AF recurrence. We performed retrospective analyses of a prospective cohort of patients with AF admitted for dofetilide initiation between 2001 and 2014. Clinical characteristics and electrocardiographic variables were assessed. We evaluated outcomes of successful PCV in patients with persistent AF and time to recurrence of AF in patients with paroxysmal and persistent AF. During the study, 243 patients with persistent AF and 176 patients with paroxysmal AF initiated dofetilide. PCV occurred in 93/243 (41.7%) patients with persistent AF. After multivariable adjustment, QTc interval change was associated with PCV (adjusted odds ratio 1.21; P = .003 per 10-ms QTc increase). Inhospital QTc interval change was associated with long-term freedom from AF in patients with persistent AF (adjusted hazard ratio 0.92; P = .011 at 4 years per 10-ms QTc increase), but not in patients with paroxysmal AF. In patients with persistent AF, PCV was also associated with long-term freedom from recurrent AF (adjusted hazard ratio 0.62; P = .009 at 4 years). The magnitude of QTc interval prolongation during dofetilide initiation is an independent predictor of successful PCV and long-term freedom from arrhythmia in patients with persistent AF. QTc interval change had no association with AF recurrence in patients with paroxysmal AF, suggesting that different mechanisms of arrhythmogenesis may be operant in different AF types. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Gender differences in clinical presentation and 1-year outcomes in atrial fibrillation

PubMed Central

Schnabel, Renate B; Pecen, Ladislav; Ojeda, Francisco M; Lucerna, Markus; Rzayeva, Nargiz; Blankenberg, Stefan; Darius, Harald; Kotecha, Dipak; Caterina, Raffaele De; Kirchhof, Paulus

2017-01-01

Objectives Our objective was to examine gender differences in clinical presentation, management and prognosis of atrial fibrillation (AF) in a contemporary cohort. Methods In 6412 patients, 39.7% women, of the PREvention oF thromboembolic events – European Registry in Atrial Fibrillation, we examined gender differences in symptoms, risk factors, therapies and 1-year incidence of adverse outcomes. Results Men with AF were on average younger than women (mean±SD: 70.1±10.7 vs 74.1±9.7 years, p<0.0001). Women more frequently had at least one AF-related symptom at least occasionally compared with men (95.4% in women, 89.8% in men, p<0.0001). Prescription of oral anticoagulation was similar, with an increase of non-vitamin K antagonist oral anticoagulants from 5.9% to 12.6% in women and from 6.2% to 12.6% in men, p<0.0001 for both. Men were more frequently treated with electrical cardioversion and ablation (20.6% and 6.3%, respectively) than women (14.9% and 3.3%, respectively), p<0.0001. Women had 65% (OR: 0.35; 95% CI (0.22 to 0.56)) lower age-adjusted and country-adjusted odds of coronary revascularisation, 40% (OR: 0.60; (0.38 to 0.93)) lower odds of acute coronary syndrome and 20% (OR: 0.80; (0.68 to 0.96)) lower odds of heart failure at 1 year. There were no statistically significant gender differences in 1-year stroke/transient ischaemic attack/arterial thromboembolism and major bleeding events. Conclusion In a ‘real-world’ European AF registry, women were more symptomatic but less likely to receive invasive rhythm control therapy such as electrical cardioversion or ablation. Further study is needed to confirm that these differences do not disadvantage women with AF. PMID:28228467

Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events--European Registry in Atrial Fibrillation (PREFER in AF).

PubMed

Kirchhof, Paulus; Ammentorp, Bettina; Darius, Harald; De Caterina, Raffaele; Le Heuzey, Jean-Yves; Schilling, Richard John; Schmitt, Josef; Zamorano, Jose Luis

2014-01-01

We sought to describe the management of patients with atrial fibrillation (AF) in Europe after the release of the 2010 AF Guidelines of the European Society of Cardiology. The PREFER in AF registry enrolled consecutive patients with AF from January 2012 to January 2013 in 461 centres in seven European countries. Seven thousand two hundred and forty-three evaluable patients were enrolled, aged 71.5 ± 11 years, 60.1% male, CHA2DS2VASc score 3.4 ± 1.8 (mean ± standard deviation). Thirty per cent patients had paroxysmal, 24.0% had persistent, 7.2% had long-standing persistent, and 38.8% had permanent AF. Oral anticoagulation was used in the majority of patients: 4799 patients (66.3%) received a vitamin K antagonist (VKA) as mono-therapy, 720 patients a combination of VKA and antiplatelet agents (9.9%), 442 patients (6.1%) a new oral anticoagulant drugs (NOAC). Antiplatelet agents alone were given to 808 patients (11.2%), no antithrombotic therapy to 474 patients (6.5%). Of 7034 evaluable patients, 5530 (78.6%) patients were adequately rate controlled (mean heart rate 60-100 bpm). Half of the patients (50.7%) received rhythm control therapy by electrical cardioversion (18.1%), pharmacological cardioversion (19.5%), antiarrhythmic drugs (amiodarone 24.1%, flecainide or propafenone 13.5%, sotalol 5.5%, dronedarone 4.0%), and catheter ablation (5.0%). The management of AF patients in 2012 has adapted to recent evidence and guideline recommendations. Oral anticoagulant therapy with VKA (majority) or NOACs is given to over 80% of eligible patients, including those at risk for bleeding. Rate is often adequately controlled, and rhythm control therapy is widely used.

Efficacy and safety in pharmacological cardioversion of recent-onset atrial fibrillation: a propensity score matching to compare amiodarone vs class IC antiarrhythmic drugs.

PubMed

Bonora, Antonio; Turcato, Gianni; Franchi, Elena; Taioli, Gabriele; Dilda, Alice; Zerman, Germana; Maccagnani, Antonio; Pistorelli, Claudio; Olivieri, Oliviero

2017-09-01

The acute management of recent-onset (<48 h) atrial fibrillation (AF) is still debated. Aim of our study was to compare efficacy and safety of intravenously administered class IC antidysrhythmic agents vs amiodarone in a propensity score matched series of patients acutely treated for AF in the emergency department. During a 3-year period, we retrospectively evaluated all episodes of recent-onset (<48 h) AF pharmacologically treated for sinus rhythm restoration in the emergency department. By means of a propensity score matching considering the main statistically different covariates, we selected two accurately matched treatment groups. We analysed the differences between amiodarone and class IC group in terms of efficacy and safety that is conversion to sinus rhythm rates within 12 and 48 h after starting treatment, time to conversion, and adverse drug effects. An overall number of 817 episodes of recent-onset AF were collected (amiodarone group = 406, class IC group = 411). After matching, we obtained 358 episodes equally divided (amiodarone group = 179 and class IC group = 179). Conversion rates within 12 h were 139 (53.1 %) in amiodarone group and 95 (72.6 %) in class IC group (p < 0.05). Median time for cardioversion was 420 min (331.6-508.3 CI 95 %) in amiodarone and 55 min (44.9-65.1 CI 95 %) in class IC group (p < 0.05). The incidence of adverse events in both groups was very low and equally distributed (p = ns). Intravenously administration of class IC agents, when compared with amiodarone, proved to be more rapid and effective, and equally safe in the acute management of recent-onset AF.

Instantly Converting Atrial Fibrillation into Sinus Rhythm by a Digital Rectal Exam on a 29-year-Old Male

PubMed Central

Ruan, Cheng-Huai

2010-01-01

Vagal maneuvers cause increase in vagal tone, which has been shown to slow many types supraventricular tachycardia, such as atrial fibrillation (AF). However, the conversion of AF to sinus rhythm is usually not associated with vagal manuvers. Thus, AF is classically treated with medication and electrical cardioversion. Here, we present a 29-year-old male with no cardiovascular history and a low atherosclerotic risk profile who developed AF which converted into sinus rhythm immediately after a digital rectal exam. The patient remained asymptomatic after a 3-month follow-up. This implies that the digital rectal exam can be considered as an additional attempt to convert AF to sinus rhythm in AF patients. PMID:21769254

Healthcare Resource Utilization and Costs Associated with Recurrent Episodes of Atrial Fibrillation: The FRACTAL Registry

PubMed Central

REYNOLDS, MATTHEW R.; ESSEBAG, VIDAL; ZIMETBAUM, PETER; COHEN, DAVID J.

2007-01-01

Cost of Recurrent AF Introduction Drivers of cost in the atrial fibrillation (AF) population are not fully understood. We sought to characterize the resource utilization and costs of treating new-onset AF, with emphasis on the incremental costs associated with recurrent episodes of AF over time. Methods and Results An inception cohort of 973 AF patients was followed at 3–6 month intervals in an observational registry over a mean of 24 ± 9 months. AF therapies, clinical outcomes, and both inpatient and outpatient medical resource utilization were tracked at each follow-up interval. Registry patients were managed primarily with cardioversion and pharmacological therapy. Direct healthcare costs were calculated from a U.S. perspective by multiplying measures of resource utilization by representative price weights. Costs were compared among patients in whom the initial episode of AF became permanent and patients who initially achieved sinus rhythm and had either 0, 1–2, or ≥3 documented recurrences during follow-up. Mean annual costs for these four groups were $2,372, $3,385, $6,331, and $10,312 per patient per year, respectively (P < 0.001 for trend), with the largest variation related to hospital costs. In multivariable analysis controlling for demographic characteristics and baseline cardiac and comorbid conditions, each documented recurrence of AF was found to increase annual healthcare costs by ∼$1,600. Conclusion Following initial diagnosis, patients with AF treated with traditional therapies incur $4,000–$5,000 in annual direct healthcare costs. Costs are markedly higher in patients with multiple AF recurrences. These data may be helpful in evaluating the economic impact of new technologies for treating AF. PMID:17451468

[Coronary artery spasm immediately after the long-standing operation for cancer of the tongue].

PubMed

Hayashida, M; Matsushita, F; Suzuki, S; Misawa, K

1992-12-01

A 72-year-old male underwent radical operation for cancer of the tongue. Anesthesia was maintained with the combination of enflurane-N2O-vecuronium and cervical epidural block. Five minutes after the cessation of the longstanding operation, VT and circulatory collapse occurred. After administration of lidocaine and ephedrine, VPC and ST elevation were noted, followed by VT and Vf. Cardioversion successfully restored sinus rhythm with no ST change, suggesting an episode of coronary artery spasm. The possible inducing factors in this case were hypotension and acute imbalance in autonomic nervous systems caused by hypovolemia, hypothermia, insufficient anesthetic depth, loss of surgical stress, neostigmine and epidural block. The authors reviewed case reports on coronary spasm, especially looking for possible inducing factors of coronary artery spasm during anesthesia.

Single coronary artery originating from the right sinus Valsalva and ability to work.

PubMed

De Rosa, Roberto; Ratti, Gennaro; Gerardi, Donato; Tedeschi, Carlo; Lamberti, Monica

2015-01-01

We present a case of a 56-year-old male electrician who was admitted to the hospital with atrial fibrillation, atypical chest pain and dyspnea. He gave a history that on the morning he had working for almost 4 hours carrying out various activities with considerable physical effort. After cardioversion, conventional coronary angiography revealed a suspect of single coronary vessel (SCA) arising from the right sinus of Valsalva. The patient underwent multislice computed tomography that showed a SCA arising from the right sinus Valsalva and dividing in Right Coronary Artery (RCA) and Left Main coronary artery (LM). The finding of posterior course of the LM without atherosclerotic has proved crucial for the expression of an opinion of working capacity even with limitation.

Rescue pulmonary vein isolation for hemodynamically unstable atrial fibrillation storm in a patient with an acute extensive myocardial infarction.

PubMed

Morishima, Itsuro; Sone, Takahito; Tsuboi, Hideyuki; Mukawa, Hiroaki

2012-11-26

New-onset atrial fibrillation in patients hospitalized for an acute myocardial infarction often leads to hemodynamic deterioration and has serious adverse prognostic implications; mortality is particularly high in patients with congestive heart failure and/or a reduced left ventricular ejection fraction. The mechanism of atrial fibrillation in the context of an acute myocardial infarction has not been well characterized and an effective treatment other than optimal medical therapy and mechanical hemodynamic support are expected. A 71 year-old male with an acute myocardial infarction due to an occlusion of the left main coronary artery was treated with percutaneous coronary intervention. He had developed severe congestive heart failure with a left ventricular ejection fraction of 34%. The systemic circulation was maintained with an intraaortic balloon pump, continuous hemodiafiltration, and mechanical ventilation until atrial fibrillation occurred on day 3 which immediately led to cardiogenic shock. Because atrial fibrillation was refractory to intravenous amiodarone, beta-blockers, and a total of 15 electrical cardioversions, the patient underwent emergent radiofrequency catheter ablation on day 4. Soon after electrical cardioversion, ectopies from the right superior pulmonary vein triggered the initiation of atrial fibrillation. The right pulmonary veins were isolated during atrial fibrillation. Again, atrial fibrillation was electrically cardioverted, then, sinus rhythm was restored. Subsequently, the left pulmonary veins were isolated. The stabilization of the hemodynamics was successfully achieved with an increase in the blood pressure and urine volume. Hemodiafiltration and amiodarone were discontinued. The patient had been free from atrial fibrillation recurrence until he suddenly died due to ventricular fibrillation on day 9. To the best of our knowledge, this is the first report of pulmonary vein isolation for a rescue purpose applied in a patient with hemodymically unstable atrial fibrillation complicated with an acute myocardial infarction. This case demonstrates that ectopic activity in the pulmonary veins may be responsible for triggering atrial fibrillation in the critical setting of an acute myocardial infarction and thus pulmonary vein isolation could be an effective therapeutic option.

The impact of cardiac rhythm on the mitral valve area and gradient in patients with mitral stenosis.

PubMed

Arı, Hasan; Arı, Selma; Karakuş, Alper; Camcı, Sencer; Doğanay, Kübra; Tütüncü, Ahmet; Melek, Mehmet; Bozat, Tahsin

2017-08-01

The aim of this study was to evaluate the effect of cardiac rhythm on the echocardiographic mitral valve area (MVA) and transmitral gradient calculation in relation to net atrioventricular compliance (Cn). Patients (n=22) with mild or moderate pure rheumatic mitral stenosis (MS) (MVA <2 cm2 and MVA >1 cm2) and atrial fibrillation (AF) were evaluated. All patients underwent transthoracic electrical DC cardioversion under amiodarone treatment. Nineteen of the 22 patients were successfully converted to sinus rhythm (SR). The patients were evaluated with transthoracic echocardiography before and two to three days after DC cardioversion. In order to deal with variable R-R intervals, the measurements were averaged on five to eight consecutive beats in AF. Cn was calculated with a previously validated equation [Cn (mL/mm Hg)=1.270 x MVA/E-wave downslope]. The Cn difference between AF and SR was calculated as follows: [(AF Cn-SR Cn)/AF Cn] x 100. The percentage gradient (mean or maximal) difference between AF and SR was calculated as follows: [AF gradient (mean or maximal) - SR gradient (mean or maximal)]/[AF gradient (mean or maximal)] x 100. The MVA was lower (MVA planimetric; 1.62±0.29 vs. 1.54±0.27; p=.003, MVA PHT; 1.66±0.30 vs. 1.59±0.26; p=0.01) but transmitral gradient (mean gradient; 6.49±2.51 vs. 8.89±3.52; p=0.001, maximal gradient: 16.94±5.11 vs. 18.57±4.54; p=0.01) and Cn values (5.37±0.77 vs. 6.26±0.64; p<0.001) were higher in the AF than SR. There was a significant correlation between Cn difference and transmitral gradient difference (mean and maximal) (Cn difference-mean gradient difference; r=0.46; p=0.05; Cn difference-maximal gradient difference; r=0.72; p=0.001). Cardiac rhythm has a significant impact on echocardiographic evaluation of MVA, transmitral gradient, and Cn in patients with MS.

Admissions with atrial fibrillation in a multiracial population in Kuala Lumpur, Malaysia.

PubMed

Freestone, B; Rajaratnam, R; Hussain, N; Lip, G Y H

2003-10-01

There are established differences in cardiovascular disease in different racial groups. Worldwide, the literature regarding the clinical epidemiology of atrial fibrillation in non-white populations is scarce. To document the prevalence of atrial fibrillation (AF) in the multiracial population of Malaysia, and to describe the clinical features and management of these patients. Busy city centre general hospital in Kuala Lumpur, Malaysia, over a 1-month period. One-thousand four hundred and thirty-five acute medical admissions, of whom 40 patients (2.8%) had AF. Of 1435 acute medical admissions to Kuala Lumpur General Hospital over the 4-week study period, 40 had AF (21 male, 19 female; mean age 65 years). Of these, 18 were Malay, 16 Chinese and six Indian. Nineteen patients had previously known AF (seven with paroxysmal AF) and 21 were newly diagnosed cases. The principal associated medical conditions were ischaemic heart disease (42.5%), hypertension (40%) and heart failure (40%). Dyspnoea was the commonest presentation, whilst stroke was the cause of presentation in only two patients. Investigations were under-utilised, with chest X-ray and echocardiography in only 62.5% of patients and thyroid function checked in 15%. Only 16% of those with previously diagnosed AF were on warfarin, with a further three on aspirin. Anticoagulant therapy was started in 13.5% of patients previously not on warfarin, and aspirin in 8%. Records of contraindications to warfarin were unreliable, being identified in only 25%. For those with known AF, 58% were on digoxin. For new onset AF, digoxin was again the most common rate-limiting treatment, initiated in 38%, whilst five patients with new onset AF were commenced on amiodarone. DC cardioversion was not used in any of the patients with new onset AF. Amongst acute medical admissions to a single centre in Malaysia the prevalence of AF was 2.8%. Consistent with previous similar surveys in mainly western (caucasian) populations, standard investigations in this Malaysian cohort were also inadequate and there was underuse of anticoagulation, medication for ventricular rate control and cardioversion to sinus rhythm.

Une tachycardie à QRS large mal tolérée chez un nourrisson

PubMed Central

Affangla, Désiré Alain; Leye, Mohamed; Simo, Angèle Wabo; D’Almeida, Franck; Sarr, Thérèse Yandé; Phiri, Adamson; Kane, Adama

2017-01-01

Les tachycardies à QRS large mal tolérées du nourrisson posent le problème de leur diagnostic et de la prise en charge en urgence. Nous rapportons un cas de tachycardie à QRS large chez un nourrisson de 35 jours reçu pour détresse cardio-circulatoire. Le cœur était morphologiquement normal à l’échographie cardiaque Doppler. Un traitement par une dose charge d’Amiodarone n’a pas permis de réduire cette tachycardie. Un retour en rythme sinusal a été obtenu après cardioversion par un défibrillateur externe semi-automatique type Lifeline. Un traitement d’entretien par Amiodarone per os est institué et le patient est en rythme sinusal à 03 mois. PMID:28904685

Obstructive Sleep Apnoea and Atrial Fibrillation

PubMed Central

Zhang, Ling; Hou, Yuemei; Po, Sunny S

2015-01-01

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and is associated with significant morbidity and mortality. Obstructive sleep apnoea (OSA) is common among patients with AF. Growing evidence suggests that OSA is associated with the initiation and maintenance of AF. This association is independent of obesity, body mass index and hypertension. OSA not only promotes initiation of AF but also has a significant negative impact on the treatment of AF. Patients with untreated OSA have a higher AF recurrence rate with drug therapy, electrical cardioversion and catheter ablation. Treatment with continuous positive airway pressure (CPAP) has been shown to improve AF control in patients with OSA. In this article, we will review and discuss the pathophysiological mechanisms of OSA that may predispose OSA patients to AF as well as the standard and emerging therapies for patients with both OSA and AF. PMID:26835094

Rare case of left-dominant arrhythmogenic right ventricular cardiomyopathy with dramatic reverse remodeling after cardiac resynchronization as an adjunct to pharmacological therapy.

PubMed

Hsiao, Chih-Chung; Kuo, Jen-Yuan; Yun, Chun-Ho; Hung, Chung-Lieh; Tsai, Cheng-Ho; Yeh, Hung-I

2012-01-01

A 57-year-old man presented with near syncope and hemodynamic compromise after exercise. A sustained ventricular tachycardia (VT) of right bundle-branch block morphology was evident upon examination at our emergency department. Baseline 12-lead electrocardiography revealed a sinus rhythm with a complete left bundle-branch block after successful cardioversion of the VT. Coronary angiography revealed patent coronary arteries, whereas left ventriculography demonstrated impaired systolic function, accompanied by a peculiar basal lateral aneurysm. Both echocardiography and magnetic resonance imaging were consistent with a diagnosis of left-dominant arrhythmogenic right ventricular cardiomyopathy. Four months later, substantial ventricular reverse remodeling and clinical improvements were observed after cardiac resynchronization therapy with a defibrillator, as an adjunct to conventional pharmacological therapy. Copyright © 2012 Elsevier Inc. All rights reserved.

[Management of glycemia: an audit in 66 ICUs].

PubMed

Orban, J-C; Scarlatti, A; Lefrant, J-Y; Molinari, N; Leone, M; Jaber, S; Constantin, J-M; Allaouchiche, B; Ichai, C

2013-02-01

The interest of tight glucose control in ICU is still debated. In France, no data are available regarding this therapy and the implementation of its guidelines. Sub-study of a one-day audit performed between January and May 2009. During a one-day audit performed in 66 ICUs, trained residents collected data regarding the presence of a formal glucose control protocol and its practical application. A formalized glucose control protocol was found in 88% of patients. During the day before the audit, 3645 glycemia measurements were performed accounting for six measurements [4-9] per patient with a median higher value of 1.6 [1.4-2.1]. Hypoglycemia (<0.8 g/L) and hyperglycemia (>1.4 g/L in non-diabetic and >1.8 g/L in diabetic patients) were found in 81 (15%) and 326 (58%) patients respectively. Two episodes (0.36%) of severe hypoglycemia (<0.4 g/L) were reported. Factors associated with glucose control protocol application were: a high SOFA score, cardioversion, mechanical ventilation, intracranial pressure monitoring, steroid use and nurse to patient ratio less than 1/2.5. Hepatic failure was the only factor associated with hypoglycemia. Glucose control protocols are available in more than 80% ICUs but their implementation is still imperfect. However, the median glycemia meets international current recommendations. Severe hypoglycemia is a very rare event in ICU. Copyright © 2012 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

Clinical Trials Update: CAPRICORN, COPERNICUS, MIRACLE, STAF, RITZ-2, RECOVER and RENAISSANCE and cachexia and cholesterol in heart failure. Highlights of the Scientific Sessions of the American College of Cardiology, 2001.

PubMed

Louis, A; Cleland, J G; Crabbe, S; Ford, S; Thackray, S; Houghton, T; Clark, A

2001-06-01

This is a synopsis of presentations made at the American College of Cardiology (ACC) in 2001 summarising recent research developments relating to heart failure. Clinical studies of particular interest to physicians with an interest in heart failure and its prevention are reviewed. The COPERNICUS trial lends further support to the use of the beta-blocker, carvedilol, in severe heart failure and the CAPRICORN trial to its use in patients with post-infarction left ventricular systolic dysfunction. The MIRACLE study reinforces the evidence from three smaller trials that cardiac resynchronisation therapy is an effective treatment for the relief of symptoms in patients with severe heart failure and cardiac dyssynchrony. The STAF trial casts further doubt on the wisdom of cardioversion as a routine strategy for the management of chronic atrial fibrillation. The RITZ-2 trial suggests that an intravenous, non-selective endothelin antagonist is effective in improving haemodynamics and symptoms and possibly in reducing morbidity in severe heart failure. Observational studies in heart failure suggest that a moderate excess of body fat and elevated blood cholesterol may be desirable in patients with heart failure, challenging the current non-evidenced-based vogue for cholesterol lowering therapy in heart failure. The RENAISSANCE and RECOVER outcome studies of etanercept, a tumour necrosis factor (TNF) receptor analogue that blocks the effect of TNF, were stopped because of lack of evidence of benefit shortly after the ACC.

Alteration in transthoracic impedance following cardiac surgery.

PubMed

Khan, Nouman U; Strang, Tim; Bonsheck, Claire; Krishnamurty, Bhuvana; Hooper, Timothy L

2008-06-01

Haemodynamically significant ventricular tachyarrhythmias are a frequent complication in the immediate post-operative period after cardiac surgery. Successful cardioversion depends on delivery of sufficient current, which in turn is dependent on transthoracic impedance (TTI). However, it is uncertain if there is a change in TTI immediately following cardiac surgery using cardiopulmonary bypass (CPB). TTI was measured on 40 patients undergoing first time isolated cardiac surgery using CPB. TTI was recorded at 30 kHz using Bodystat Multiscan 5000 equipment before operation (with and without a positive end-expiratory pressure (PEEP) of 5 cm of H(2)O) and then at 1, 4 and 24 h after the operation. Data was analyzed to determine the relationship between pre- and post-operative variables and TTI values. Mean pre-operative TTI was 54.5+/-10.55 ohms without PEEP and 61.8+/-15.4 ohms on a PEEP of 5 cm of H(2)O. TTI dropped significantly (p<0.001) after the operation to 47.2+/-10.6 ohms at 1 h, 42.6+/-10.2 ohms at 4 h and 41.8+/-10.4 ohms at 24 h. A positive correlation was noted between duration of operation and TTI change at 1 h (r=0.38; p=0.016). There was no significant correlation between the duration of bypass and change in TTI. TTI decreases by more than 30% in the immediate post-operative period following cardiac surgery. This state may favour defibrillation at lower energy levels.

Statins as antiarrhythmics: a systematic review part I: effects on risk of atrial fibrillation.

PubMed

Abuissa, Hussam; O'Keefe, James H; Bybee, Kevin A

2009-10-01

Recent studies have demonstrated that statins may possess antiarrhythmic properties in addition to their lipid-lowering effects. Studies which reported the association of statins with the incidence of atrial arrhythmias were identified through a systematic review of published literature. One randomized, placebo-controlled trial of 200 patients undergoing cardiac surgery showed that atorvastatin decreased the incidence of postoperative atrial fibrillation by 61%. Observational studies in patients with stable coronary disease, left ventricular dysfunction, or those undergoing cardiac or noncardiac surgery show that statin therapy is associated with an approximately 50% lower rate of atrial fibrillation. Two small randomized trials reported conflicting results: one showing that atorvastatin reduced the recurrence of AF after electrical cardioversion and the other finding that pravastatin did not. Published data suggests that statins may possess antiarrhythmic properties that reduce the propensity for atrial fibrillation. Most of this data is observational; more randomized, placebo-controlled trials are needed.

Myotonic Dystrophy Initially Presenting as Tachycardiomyopathy Successful Catheter Ablation of Atrial Flutter

PubMed Central

Asbach, S.; Gutleben, K. J.; Dahlem, P.; Brachmann, J.; Nölker, G.

2010-01-01

Myotonic dystrophy is a genetic muscular disease that is frequently associated with cardiac arrhythmias. Bradyarrhythmias, such as sinus bradycardia and atrioventricular block, are more common than tachyarrhythmias. Rarely, previously undiagnosed patients with myotonic dystrophy initially present with a tachyarrhythmia. We describe the case of a 14-year-old boy, who was admitted to the hospital with clinical signs and symptoms of decompensated heart failure and severely reduced left ventricular function. Electrocardiography showed common-type atrial flutter with 2 : 1 conduction resulting in a heart rate of 160 bpm. Initiation of medical therapy for heart failure as well as electrical cardioversion led to a marked clinical improvement. Catheter ablation of atrial flutter was performed to prevent future cardiac decompensations and to prevent development of tachymyopathy. Left ventricular function normalized during followup. Genetic analysis confirmed the clinical suspicion of myotonic dystrophy as known in other family members in this case. PMID:20871860

Neonatal thyrotoxicosis with severe supraventricular tachycardia: case report and review of the literature.

PubMed

Abbasoğlu, Aslıhan; Ecevit, Ayşe; Tuğcu, Ali Ulaş; Erdoğan, Lkay; Kınık, Sibel Tulgar; Tarcan, Aylin

2015-03-01

Neonatal thyrotoxicosis is a rare condition caused by the transplacental passage of thyroid stimulating immunoglobulins from mothers with Graves' disease. We report a case of neonatal thyrotoxicosis with concurrent supraventricular tachycardia (SVT). The female infant, who was born by section due to breech delivery and meconium in the amniotic fluid at 36 weeks of gestation, presented with tachycardia on day 7. Her heart rate was between 260 and 300 beats/min, and an electrocardiogram revealed ongoing SVT. Sotalol was effective after two cardioversions in maintaining sinus rhythm. Thyroid function studies revealed hyperthyroidism in the infant, and her mother was found to have Graves' disease. Since symptoms and signs can vary, especially in preterm infants with neonatal hyperthyroidism, we want to emphasize the importance of prenatal care and follow-ups of Graves' disease associated pregnancies and management of newborns after birth.

Low-Energy Defibrillation Failure Correction is Possible Through Nonlinear Analysis of Spatiotemporal Arrhythmia Data

NASA Astrophysics Data System (ADS)

Simonotto, Jennifer; Furman, Michael; Beaver, Thomas; Spano, Mark; Kavanagh, Katherine; Iden, Jason; Hu, Gang; Ditto, William

2004-03-01

Explanted Porcine hearts were Langendorff-perfused, administered a voltage-sensitive fluorescent dye (Di-4-ANEPPS) and illuminated with a ND:Yag laser (532 nm); the change in fluorescence resulting from electrical activity on the heart surface was recorded with an 80 x 80 pixel CCD camera at 1000 frames per second. The heart was put into fibrillation with rapid ventricular pacing and shocks were administered close to the defibrillation threshold. Defibrillation failure data was analyzed using synchronization, space-time volume plots and recurrence quantification. Preliminary spatiotemporal synchronization results reveal a short window of time ( 1 second) after defibrillation failure in which the disordered electrical activity becomes ordered; this ordered period occurs 4-5 seconds after the defibrillation shock. Recurrence analysis of a single time series confirmed these results, thus opening the avenue for dynamic defibrillators that can detect an optimal window for cardioversion.

Management of cardiac arrest caused by coronary artery spasm: epinephrine/adrenaline versus nitrates.

PubMed

Kiss, Gabor; Corre, Olivier; Gueret, Gildas; Nguyen Ba, Vinh; Gilard, Martine; Boschat, Jaques; Arvieux, Charles Chistian

2009-01-01

Cardiopulmonary resuscitation guidelines imply the use of epinephrine/adrenaline during cardiopulmonary arrest. However, in cardiac arrest situations resulting from coronary artery spasm (CAS), the use of epinephrine/adrenaline could be deleterious. A 49-year-old patient underwent an emergency coronarography with an attempt to stent the coronary arteries. Radiologic imaging revealed a positive methylergonovine maleate (Methergine, Novartis Pharmaceuticals, East Hanover, NJ) test, with subocclusive CAS in several coronary vessels leading to electromechanical dissociation. Cardiopulmonary resuscitation was performed, and intracoronary boluses of isosorbide dinitrate were given to treat CAS. Epinephrine/adrenaline was not administered during resuscitation. Spontaneous circulation was obtained after cardioversion for ventricular fibrillation, and the patient progressively regained consciousness. Resuscitation guidelines do not specify the use of trinitrate derivatives in cardiac arrest situations caused by CAS. The pros and cons of the use of nitrates and epinephrine/adrenaline during cardiac arrest caused by CAS are analyzed in this case report.

Canadian Cardiovascular Society atrial fibrillation guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter.

PubMed

Cairns, John A; Connolly, Stuart; McMurtry, Sean; Stephenson, Michael; Talajic, Mario

2011-01-01

The stroke rate in atrial fibrillation is 4.5% per year, with death or permanent disability in over half. The risk of stroke varies from under 1% to over 20% per year, related to the risk factors of congestive heart failure, hypertension, age, diabetes, and prior stroke or transient ischemic attack (TIA). Major bleeding with vitamin K antagonists varies from about 1% to over 12% per year and is related to a number of risk factors. The CHADS(2) index and the HAS-BLED score are useful schemata for the prediction of stroke and bleeding risks. Vitamin K antagonists reduce the risk of stroke by 64%, aspirin reduces it by 19%, and vitamin K antagonists reduce the risk of stroke by 39% when directly compared with aspirin. Dabigatran is superior to warfarin for stroke prevention and causes no increase in major bleeding. We recommend that all patients with atrial fibrillation or atrial flutter, whether paroxysmal, persistent, or permanent, should be stratified for the risk of stroke and for the risk of bleeding and that most should receive antithrombotic therapy. We make detailed recommendations as to the preferred agents in various types of patients and for the management of antithrombotic therapies in the common clinical settings of cardioversion, concomitant coronary artery disease, surgical or diagnostic procedures with a risk of major bleeding, and the occurrence of stroke or major bleeding. Alternatives to antithrombotic therapies are briefly discussed. Copyright © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

The frequency of anesthesia-related cardiac arrests in patients with congenital heart disease undergoing cardiac surgery.

PubMed

Odegard, Kirsten C; DiNardo, James A; Kussman, Barry D; Shukla, Avinash; Harrington, James; Casta, Al; McGowan, Francis X; Hickey, Paul R; Bacha, Emile A; Thiagarajan, Ravi R; Laussen, Peter C

2007-08-01

The frequency of anesthesia-related cardiac arrests during pediatric anesthesia has been reported between 1.4 and 4.6 per 10,000 anesthetics. ASA physical status >III and younger age are risk factors. Patients with congenital cardiac disease may also be at increased risk. Therefore, in this study, we evaluated the frequency of cardiac arrest in patients with congenital heart disease undergoing cardiac surgery at a large pediatric tertiary referral center. Using an established data registry, all cardiac arrests from January 2000 through December 2005 occurring in the cardiac operating rooms were reviewed. A cardiac arrest was defined as any event requiring external or internal chest compressions, with or without direct cardioversion. Events determined to be anesthesia-related were classified as likely related or possibly related. There were 41 cardiac arrests in 40 patients (median age, 2.9 mo; range, 2 days to 23 yr) during 5213 anesthetics over the time period, for an overall frequency of 0.79%; 78% were open procedures requiring cardiopulmonary bypass and 22% closed procedures not requiring cardiopulmonary bypass. Eleven cardiac arrests (26.8%) were classified as either likely (n = 6) or possibly related (n = 5) to anesthesia, (21.1 per 10,000 anesthetics) but with no mortality; 30 were categorized as procedure-related. The incidence of anesthesia-related and procedure-related cardiac arrests was highest in neonates (P < 0.001). There was no association with year of event or experience of the anesthesiologist. The frequency of anesthesia-related cardiac arrest in patients undergoing cardiac surgery is increased, but is not associated with an increase in mortality. Neonates and infants are at higher risk. Careful preparation and anticipation is important to ensure timely and effective resuscitation.

The Role of Pharmacogenetics in Atrial Fibrillation Therapeutics: Is Personalized Therapy in Sight?

PubMed

Darbar, Dawood

2016-01-01

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide requiring therapy. Despite recent advances in catheter-based and surgical therapy, antiarrhythmic drugs (AADs) remain the mainstay of treatment for symptomatic AF. However, response in individual patients is highly variable with over half the patients treated with rhythm control therapy experiencing recurrence of AF within a year. Contemporary AADs used to suppress AF are incompletely and unpredictably effective and associated with significant risks of proarrhythmia and noncardiac toxicities. Furthermore, this "one-size" fits all strategy for selecting antiarrhythmics is based largely on minimizing risk of adverse effects rather than on the likelihood of suppressing AF. The limited success of rhythm control therapy is in part due to heterogeneity of the underlying substrate, interindividual differences in disease mechanisms, and our inability to predict response to AADs in individual patients. Genetic studies of AF over the past decade have revealed that susceptibility to and response to therapy for AF is modulated by the underlying genetic substrate. However, the bedside application of these new discoveries to the management of AF patients has thus far been disappointing. This may in part be related to our limited understanding about genetic predictors of drug response in general, the challenges associated with determining efficacy of response to AADs, and lack of randomized genotype-directed clinical trials. Nonetheless, recent studies have shown that common AF susceptibility risk alleles at the chromosome 4q25 locus modulated response to AADs, electrical cardioversion, and ablation therapy. This monograph discusses how genetic approaches to AF have not only provided important insights into underlying mechanisms but also identified AF subtypes that can be better targeted with more mechanism-based "personalized" therapy.

The Role of Pharmacogenetics in Atrial Fibrillation Therapeutics – Is Personalized Therapy in Sight?

PubMed Central

Darbar, Dawood

2015-01-01

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide requiring therapy. Despite recent advances in catheter-based and surgical therapy, antiarrhythmic drugs (AAD) remain the mainstay of treatment for symptomatic AF. However, response in individual patients is highly variable with over half the patients treated with rhythm control therapy experiencing recurrence of AF within a year. Contemporary AADs used to suppress AF are incompletely and unpredictably effective and associated with significant risks of proarrhythmia and non-cardiac toxicities. Furthermore, this ‘one-size’ fits all strategy for selecting antiarrhythmics is based largely on minimizing risk of adverse effects rather than on the likelihood of suppressing AF. The limited success of rhythm-control therapy is in part due to heterogeneity of the underlying substrate, interindividual differences in disease mechanisms, and our inability to predict response to AADs in individual patients. Genetic studies of AF over the last decade have revealed that susceptibility to and response to therapy for AF is modulated by the underlying genetic substrate. However, the bedside application of these new discoveries to the management of AF patients has thus far been disappointing. This may in part be related to our limited understanding about genetic predictors of drug response in general, the challenges associated with determining efficacy of response to AADs and lack of randomized genotype-directed clinical trials. Nonetheless, recent studies have shown that common AF susceptibility risk alleles at the chromosome 4q25 locus modulated response to AADs, electrical cardioversion and ablation therapy. This monograph discusses how genetic approaches to AF have not only provided important insights into underlying mechanisms but also identified AF sub-types that can be better targeted with more mechanism-based ‘personalized’ therapy. PMID:25970841

Acute epigastric and low back pain during amiodarone infusion; is it the drug or the vehicle to blame?

PubMed

Petrou, Emmanouil; Iakovou, Ioannis; Boutsikou, Maria; Girasis, Chrysafios; Mavrogeni, Sophie; Pavlides, Gregory

2014-01-01

Amiodarone is a Class III antiarrhythmic agent used for cardioversion and prevention of recurrences of atrial fibrillation. However, its use is limited due to its side-effects resulting from the drug's long-term administration. We have described acute epigastric pain following treatment with intravenous amiodarone for atrial fibrillation in a previous report. Hereby, we describe a second patient who suffered acute epigastric pain, as well as one who suffered acute low back pain. Intravenous amiodarone has been related to a series of minor and major adverse reactions, indicating other constituents of the intravenous solution as the possible cause, possibly polysorbate-80. A possible correlation between acute epigastric and low back pain after intravenous amiodarone loading is unproven; however it is of crucial importance for clinicians to be aware of this phenomenon, and especially since an acute epigastric pain is implicated in the differential diagnosis of cardiac ischemia. Copyright © 2014 Elsevier Inc. All rights reserved.

Procedural and interpretive skills of medical students: experiences and attitudes of fourth-year students.

PubMed

Wu, Edward H; Elnicki, D Michael; Alper, Eric J; Bost, James E; Corbett, Eugene C; Fagan, Mark J; Mechaber, Alex J; Ogden, Paul E; Sebastian, James L; Torre, Dario M

2008-10-01

Recent data do not exist regarding fourth-year medical students' performance of and attitudes toward procedural and interpretive skills, and how these differ from third-year students'. Cross-sectional survey conducted in February 2006 of 122 fourth-year students from seven U.S. medical schools, compared with their responses in summer 2005. Students estimated their cumulative performance of 22 skills and reported self-confidence and perceived importance using a five-point Likert-type scale. The response rate was 79% (96/122). A majority reported never having performed cardioversion, thoracentesis, cardiopulmonary resuscitation, blood culture, purified protein derivative placement, or paracentesis. One fifth of students had never performed peripheral intravenous catheter insertion, phlebotomy, or arterial blood sampling. Students reported increased cumulative performance of 17 skills, increased self-confidence in five skills, and decreased perceived importance in three skills (two-sided P < .05). A majority of fourth-year medical students still have never performed important procedures, and a substantial minority have not performed basic procedures.

Atrial fibrillation and hyperthyroidism: A literature review.

PubMed

Reddy, Vivek; Taha, Wael; Kundumadam, Shanker; Khan, Mazhar

Atrial fibrillation is the most common arrhythmia worldwide with increasing frequency noted with age. Hyperthyroidism is a well-known cause of atrial fibrillation with a 16%-60% prevalence of atrial fibrillation in patients with known hyperthyroidism Ross et al. (2016). While hyperthyroidism as a causative factor of atrial fibrillation is well established, this literature review aims to answer several questions on this topic including: 1. The relationship of atrial fibrillation to hyperthyroidism 2. Atrial fibrillation as a predictor of hyperthyroidism 3. The pathophysiology of thyrotoxic atrial fibrillation 4. Subclinical hyperthyroidism and the relationship with atrial fibrillation 5. Cardioversion and Catheter ablation of hyperthyroid patients with atrial fibrillation 6. Thrombotic risk of hyperthyroid patients with atrial fibrillation 7. Management of Thyrotoxic Atrial fibrillation 8. Pharmacological rhythm control in patients with hyperthyroidism and atrial fibrillation 9. Treatment of Hyperthyroidism to prevent atrial fibrillation 10. Clinical Implications of Hyperthyroidism and Atrial Fibrillation. Copyright © 2017 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Atrial fibrillation with wide QRS tachycardia and undiagnosed Wolff-Parkinson-White syndrome: diagnostic and therapeutic dilemmas in a pediatric patient.

PubMed

Panduranga, Prashanth; Al-Farqani, Abdullah; Al-Rawahi, Najib

2012-11-01

A 10-year-old girl presented to the emergency department of a regional hospital with 1 episode of generalized tonic-clonic seizures. Postictal monitoring followed by a 12-lead electrocardiogram showed fast atrial fibrillation with intermittent wide QRS regular tachycardia. Immediately following this, her rhythm changed to wide QRS irregular tachycardia without hemodynamic compromise. She was suspected to have ventricular tachycardia and was treated with intravenous amiodarone with cardioversion to sinus rhythm. Subsequent electrocardiogram in sinus rhythm showed typical features of manifest Wolff-Parkinson-White (WPW) accessory pathway. This case illustrates the diagnostic and therapeutic dilemmas in patients with atrial fibrillation, wide QRS tachycardia, and undiagnosed WPW syndrome with antidromic conduction of atrial arrhythmias through the accessory pathway. Furthermore, this case demonstrates that undiagnosed wide QRS tachycardias need to be treated with drugs acting on the accessory pathway, thus keeping in mind underlying WPW syndrome as a possibility to avoid potentially catastrophic events.

Efficacy and safety of ablation for people with non-paroxysmal atrial fibrillation.

PubMed

Nyong, Jonathan; Amit, Guy; Adler, Alma J; Owolabi, Onikepe O; Perel, Pablo; Prieto-Merino, David; Lambiase, Pier; Casas, Juan Pablo; Morillo, Carlos A

2016-11-22

The optimal rhythm management strategy for people with non-paroxysmal (persistent or long-standing persistent) atrial fibrilation is currently not well defined. Antiarrhythmic drugs have been the mainstay of therapy. But recently, in people who have not responded to antiarrhythmic drugs, the use of ablation (catheter and surgical) has emerged as an alternative to maintain sinus rhythm to avoid long-term atrial fibrillation complications. However, evidence from randomised trials about the efficacy and safety of ablation in non-paroxysmal atrial fibrillation is limited. To determine the efficacy and safety of ablation (catheter and surgical) in people with non-paroxysmal (persistent or long-standing persistent) atrial fibrillation compared to antiarrhythmic drugs. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, conference abstracts, clinical trial registries, and Health Technology Assessment Database. We searched these databases from their inception to 1 April 2016. We used no language restrictions. We included randomised trials evaluating the effect of radiofrequency catheter ablation (RFCA) or surgical ablation compared with antiarrhythmic drugs in adults with non-paroxysmal atrial fibrillation, regardless of any concomitant underlying heart disease, with at least 12 months of follow-up. Two review authors independently selected studies and extracted data. We evaluated risk of bias using the Cochrane 'Risk of bias' tool. We calculated risk ratios (RRs) for dichotomous data with 95% confidence intervals (CIs) a using fixed-effect model when heterogeneity was low (I² <= 40%) and a random-effects model when heterogeneity was moderate or substantial (I² > 40%). Using the GRADE approach, we evaluated the quality of the evidence and used the GRADE profiler (GRADEpro) to import data from Review Manager 5 to create 'Summary of findings' tables. We included three randomised trials with 261 participants (mean age: 60 years) comparing RFCA (159 participants) to antiarrhythmic drugs (102) for non-paroxysmal atrial fibrillation. We generally assessed the included studies as having low or unclear risk of bias across multiple domains, with reported outcomes generally lacking precision due to low event rates. Evidence showed that RFCA was superior to antiarrhythmic drugs in achieving freedom from atrial arrhythmias (RR 1.84, 95% CI 1.17 to 2.88; 3 studies, 261 participants; low-quality evidence), reducing the need for cardioversion (RR 0.62, 95% CI 0.47 to 0.82; 3 studies, 261 participants; moderate-quality evidence), and reducing cardiac-related hospitalisation (RR 0.27, 95% CI 0.10 to 0.72; 2 studies, 216 participants; low-quality evidence) at 12 months follow-up. There was substantial uncertainty surrounding the effect of RFCA regarding significant bradycardia (or need for a pacemaker) (RR 0.20, 95% CI 0.02 to 1.63; 3 studies, 261 participants; low-quality evidence), periprocedural complications, and other safety outcomes (RR 0.94, 95% CI 0.16 to 5.68; 3 studies, 261 participants; very low-quality evidence). In people with non-paroxysmal atrial fibrillation, evidence suggests a superiority of RFCA to antiarrhythmic drugs in achieving freedom from atrial arrhythmias, reducing the need for cardioversion, and reducing cardiac-related hospitalisations. There was uncertainty surrounding the effect of RFCA with significant bradycardia (or need for a pacemaker), periprocedural complications, and other safety outcomes. Evidence should be interpreted with caution, as event rates were low and quality of evidence ranged from moderate to very low.

Effects of a digital clinical pathway for elective electrocardioversion for atrial fibrillation on quality of care.

PubMed

Valente, Mattia; Zwaan, Esther; Wit, Mirjam; Kimman, Geert P; Umans, Victor

2010-12-01

Clinical pathways attempt to increase efficiency by organizing the care-delivery process into individual analyzable steps. However, full advantage may only be taken if the process is governed by a "process care taker." Currently, new opportunities are emerging for nurses to become involved as health care experts and may become an intermediate between patient and clinical team. We evaluate a digital clinical pathway for electrocardioversion in atrial fibrillation with a nurse-coordinator in the ongoing consecutive experience in clinical practice. The introduction of a digital pathway into the hospital information system allows continuous surveillance of clinical outcome indicators as well as variance indicators. This article describes a service evaluation and the implementation and effects of introducing a clinical pathway. However, when comparing the 2 eras, the primary goals were improved guideline-adherence and reduced walk-through times in the 600 consecutive pathway patients versus 100 consecutive control patients. The pathway was launched in January 2008. Up to January 2009, 600 all-comer, elective patients were treated using this integrated digital clinical pathway, without exception. Treatment and outpatient check-up appointments are made immediately for all patients. The pathway enabled the cardiologist to complete the risk calculator and drug therapy recommendations significantly better when compared with control patients and also reduced walk-through times significantly. Patient satisfaction rose from 8.7 to 9.1 (P < 0.01) using the pathway. A nurse-led clinical pathway for cardioversion patients is safely and efficaciously introduced in a teaching hospital. The pathway improved guideline-adherence. These results emphasize the importance of a nurse-coordinator who is an intermediary between atrial fibrillation patients and the clinical care team.

Advances in Clinical Cardiology 2016: A Summary of the Key Clinical Trials.

PubMed

Gray, Alastair; McQuillan, Conor; Menown, Ian B A

2017-07-01

The findings of many new cardiology clinical trials over the last year have been published or presented at major international meetings. This paper aims to describe and place in context a summary of the key clinical trials in cardiology presented between January and December 2016. The authors reviewed clinical trials presented at major cardiology conferences during 2016 including the American College of Cardiology (ACC), European Association for Percutaneous Cardiovascular Interventions (EuroPCR), European Society of Cardiology (ESC), European Association for the Study of Diabetes (EASD), Transcatheter Cardiovascular Therapeutics (TCT), and the American Heart Association (AHA). Selection criteria were trials with a broad relevance to the cardiology community and those with potential to change current practice. A total of 57 key cardiology clinical trials were identified for inclusion. Here we describe and place in clinical context the key findings of new data relating to interventional and structural cardiology including delayed stenting following primary angioplasty, contrast-induced nephropathy, management of jailed wires, optimal duration of dual antiplatelet therapy (DAPT), stenting vs bypass for left main disease, new generation stents (BioFreedom, Orsiro, Absorb), transcatheter aortic valve implantation (Edwards Sapien XT, transcatheter embolic protection), and closure devices (Watchman, Amplatzer). New preventative cardiology data include trials of bariatric surgery, empagliflozin, liraglutide, semaglutide, PCSK9 inhibitors (evolocumab and alirocumab), and inclisiran. Antiplatelet therapy trials include platelet function monitoring and ticagrelor vs clopidogrel for peripheral vascular disease. New data are also presented in fields of heart failure (sacubitril/valsartan, aliskiren, spironolactone), atrial fibrillation (rivaroxaban in patients undergoing coronary intervention, edoxaban in DC cardioversion), cardiac devices (implantable cardioverter defibrillator in non-ischemic cardiomyopathy), and electrophysiology (cryoballoon vs radiofrequency ablation). This paper presents a summary of key clinical cardiology trials during the past year and should be of practical value to both clinicians and cardiology researchers.

Tachydysrhythmia treatment and adverse events in patients with wolff-Parkinson-white syndrome.

PubMed

Siegelman, Jeffrey N; Marill, Keith A; Adler, Jonathan N

2014-09-01

Current guidelines recommend avoiding atrioventricular-nodal blocking agents (AVNB) when treating tachydysrhythmias in Wolff-Parkinson-White syndrome (WPW) patients. We investigated medications selected and resulting outcomes for patients with tachydysrhythmias and WPW. In this single-center retrospective cohort study, we searched a hospital-wide database for the following inclusion criteria: WPW, tachycardia, and intravenous antidysrhythmics. The composite outcome of adverse events was acceleration of tachycardia, new hypotension, new malignant dysrhythmia, and cardioversion. The difference in binomial proportions of patients meeting the composite outcome after AVNB or non-AVNB (NAVNB) treatment was calculated after dividing the groups by QRS duration. A random-effects mixed linear analysis was performed to analyze the vital sign response. The initial database search yielded 1158 patient visits, with 60 meeting inclusion criteria. Patients' median age was 52.5 years; 53% were male, 43% presented in wide complex tachycardia (WCT), with 75% in atrial fibrillation (AF) or flutter. AVNBs were administered in 42 (70%) patient visits. For those patients with WCT in AF, the difference in proportions of patients meeting the composite outcome after AVNBs vs. NAVNBs treatment was an increase of 3% (95% confidence interval [CI] -39%-49%), and for those with narrow complex AF it was a decrease of 13% (95% CI -37%-81%). No instances of malignant dysrhythmia occurred. Mixed linear analysis showed no statistically significant effects on heart rate, though suggested a trend toward increasing heart rate after AVNB in wide complex AF. In this sample of WPW-associated tachydysrhythmia patients, many were treated with AVNBs. The composite outcome was similarly met after use of either AVNB or NAVNB, and no malignant dysrhythmias were observed. Copyright © 2014 Elsevier Inc. All rights reserved.

Treatment of out-of-hospital supraventricular tachycardia: adenosine vs verapamil.

PubMed

Brady, W J; DeBehnke, D J; Wickman, L L; Lindbeck, G

1996-06-01

To compare the use of adenosine and the use of verapamil as out-of-hospital therapy for supraventricular tachycardia (SVT). A period of prospective adenosine use (March 1993 to February 1994) was compared with a historical control period of verapamil use (March 1990 to February 1991) for SVT. Data were obtained for SVT patients treated in a metropolitan, fire-department-based paramedic system serving a population of approximately 1 million persons. Standard drug protocols were used and patient outcomes (i.e., conversion rates, complications, and recurrences) were monitored. During the adenosine treatment period, 105 patients had SVT; 87 (83%) received adenosine, of whom 60 (69%) converted to a sinus rhythm (SR). Vagal maneuvers (VM) resulted in restoration of SR in 8 patients (7.6%). Some patients received adenosine for non-SVT rhythms: 7 sinus tachycardia, 18 atrial fibrilation, 7 wide-complex tachycardia (WCT), and 2 ventricular tachycardia; no non-SVT rhythm converted to SR and none of these patients experienced an adverse effect. Twenty-five patients were hemodynamically unstable (systolic blood pressure < 90 mm Hg), with 20 receiving drug and 13 converting to SR; 8 patients required electrical cardioversion. Four patients experienced adverse effects related to adenosine (chest pain dyspnea, prolonged bradycardia, and ventricular tachycardia). In the verapamil period, 106 patients had SVT: 52 (49%) received verapamil (p < 0.001, compared with the adenosine period), of whom 43 (88%) converted to SR (p = 0.11). Two patients received verapamil for WCT; neither converted to SR and both experienced cardiovascular collapse. VM resulted in restoration of SR in 12 patients (11.0%) (p = 0.52). Sixteen patients were hemodynamically unstable, with 5 receiving drug (p = 0.005) and 5 converting to SR; 9 patients required electrical cardioversion (p = 0.48). Four patients experienced adverse effects related to verapamil (hypotension ventricular tachycardia, ventricular fibrillation). Recurrence of SVT was noted in 2 adenosine patients and 2 verapamil patients in the out-of-hospital setting and in 23 adenosine patients and 15 verapamil patients after ED arrival, necessitating additional therapy (p = 0.48 and 0.88, for recurrence rates and types of additional therapies, respectively). Hospital diagnoses, outcomes, and ED dispositions were similar for the 2 groups. Adenosine and verapamil were equally successful in converting out-of-hospital SVT in patients with similar etiologies responsible for the SVT. Recurrence of SVT occurred at similar rates for the 2 medications. Rhythm misidentification remains a common issue in out-of-hospital cardiac care in this emergency medical services system.

The management of ventricular dysrhythmia in aconite poisoning.

PubMed

Coulson, James M; Caparrotta, Thomas M; Thompson, John P

2017-06-01

Aconite poisoning is relatively rare but is frequently complicated by ventricular dysrhythmias, which may be fatal. Molecular basis of aconite alkaloid ventricular arrhythmogenicity: Aconite exerts its toxic effects due to the presence of an admixture of alkaloids present in all parts of the plant. The major target of these aconite alkaloids is the fast voltage-gates sodium channel, where they cause persistent activation. This blockade of the channel in the activated state promotes automaticity within the ventricular myocardium and the generation of ventricular arrhythmias. Aconitine-induced arrhythmias: Aconite alkaloids are known to cause many different types of disturbance of heart rhythm. However, this focused review specifically looks at ventricular rhythm disturbances, namely ventricular ectopy, ventricular tachycardia, torsades des pointes and ventricular fibrillation. The objective of this review was to identify the outcome of anti-dysrhythmic strategies from animal studies and case reports in humans in order to guide the management of ventricular dysrhythmias in aconite poisoning in humans. A review of the literature in English was conducted in PubMed and Google Scholar from 1966 to July 2016 using the search terms "aconite/aconitine"; "aconite/aconitine + poisoning" and "aconite/aconitine + dysrhythmia". 168 human case-reports and case-series were identified by these searches, of which 103 were rejected if exposure to aconite did not result in ventricular dysrhythmias, if it was uncertain as to whether aconite had been ingested, if other agents were co-ingested, if there was insufficient information to determine the type of treatments administered or if there was insufficient information to determine outcome. Thus, 65 case reports of probable aconite poisoning that resulted in ventricular dysrhythmias were identified. Toxicokinetic data in aconite poisoning: Data were only available in three papers; the presence of ventricular rhythm disturbances directly correlated with the concentration of aconite alkaloids in the plasma. 54 of 65 cases developed ventricular tachycardia, six developed torsades des pointes, 15 patients developed ventricular fibrillation, 10 developed ventricular ectopics and one developed a broad complex tachycardia not otherwise specified; each dysrhythmia was regarded as separate and patients may have had more than one dysrhythmia. 10 patients died, giving a mortality of 15%. In total, 147 treatments were administered to 65 patients. 46 of the interventions were assessed by the authors as having been associated with successful restoration of sinus rhythm. Flecainide administration was accompanied by dysrhythmia termination in six of seven cases. Mexiletine was connected with correcting dysrhythmias in 3 of 3 cases. Procainamide administration was associated with return to sinus rhythm in 2 of 2 cases. Prolonged cardio-pulmonary resuscitation was administered to 15 patients where it was associated with a return to sinus rhythm in nine of these. Amiodarone was linked to success in correcting dysrhythmias in 11 of 20 cases. Cardiopulmonary bypass use was associated with a return to sinus rhythm in four out of six cases. Epinephrine was documented as being employed on four occasions, and was associated with a restoration of sinus rhythm on two of these. Magnesium sulphate administration was accompanied by dysrhythmia termination in two of nine cases. Direct cardioversion was associated with a return of sinus rhythm in 5 of 30 cases. However, it is not certain whether the drug treatment influenced the course of the dysrhythmia. Based on the evidence available from human case reports, flecainaide or amiodarone appear to be more associated with a return to sinus rhythm than lidocaine and/or cardioversion, although it is not established whether the administration of treatment caused reversion to normal sinus rhythm. The potential beneficial effects of amiodarone were not observed in animal studies. This may be due to intra-species differences between ion channels or relate to the wider cardiovascular toxicity of aconite that extends beyond arrhythmias. Prolonged cardiopulmonary resuscitation and cardiopulmonary bypass should be considered as an integral part of good clinical care as "time-buying" strategies to allow the body to excrete the toxic alkaloids. There may also be a role for mexiletine, procainamide and magnesium sulphate.

[Typical atrial flutter: Diagnosis and therapy].

PubMed

Thomas, Dierk; Eckardt, Lars; Estner, Heidi L; Kuniss, Malte; Meyer, Christian; Neuberger, Hans-Ruprecht; Sommer, Philipp; Steven, Daniel; Voss, Frederik; Bonnemeier, Hendrik

2016-03-01

Typical, cavotricuspid-dependent atrial flutter is the most common atrial macroreentry tachycardia. The incidence of atrial flutter (typical and atypical forms) is age-dependent with 5/100,000 in patients less than 50 years and approximately 600/100,000 in subjects > 80 years of age. Concomitant heart failure or pulmonary disease further increases the risk of typical atrial flutter.Patients with atrial flutter may present with symptoms of palpitations, reduced exercise capacity, chest pain, or dyspnea. The risk of thromboembolism is probably similar to atrial fibrillation; therefore, the same antithrombotic prophylaxis is required in atrial flutter patients. Acutely symptomatic cases may be subjected to cardioversion or pharmacologic rate control to relieve symptoms. Catheter ablation of the cavotricuspid isthmus represents the primary choice in long-term therapy, associated with high procedural success (> 97 %) and low complication rates (0.5 %).This article represents the third part of a manuscript series designed to improve professional education in the field of cardiac electrophysiology. Mechanistic and clinical characteristics as well as management of isthmus-dependent atrial flutter are described in detail. Electrophysiological findings and catheter ablation of the arrhythmia are highlighted.

Systolic MOLLI T1 mapping with heart-rate-dependent pulse sequence sampling scheme is feasible in patients with atrial fibrillation.

PubMed

Zhao, Lei; Li, Songnan; Ma, Xiaohai; Greiser, Andreas; Zhang, Tianjing; An, Jing; Bai, Rong; Dong, Jianzeng; Fan, Zhanming

2016-03-15

T1 mapping enables assessment of myocardial characteristics. As the most common type of arrhythmia, atrial fibrillation (AF) is often accompanied by a variety of cardiac pathologies, whereby the irregular and usually rapid ventricle rate of AF may cause inaccurate T1 estimation due to mis-triggering and inadequate magnetization recovery. We hypothesized that systolic T1 mapping with a heart-rate-dependent (HRD) pulse sequence scheme may overcome this issue. 30 patients with AF and 13 healthy volunteers were enrolled and underwent cardiovascular magnetic resonance (CMR) at 3 T. CMR was repeated for 3 patients after electric cardioversion and for 2 volunteers after lowering heart rate (HR). A Modified Look-Locker Inversion Recovery (MOLLI) sequence was acquired before and 15 min after administration of 0.1 mmol/kg gadopentetate dimeglumine. For AF patients, both the fixed 5(3)3/4(1)3(1)2 and the HRD sampling scheme were performed at diastole and systole, respectively. The HRD pulse sequence sampling scheme was 5(n)3/4(n)3(n)2, where n was determined by the heart rate to ensure adequate magnetization recovery. Image quality of T1 maps was assessed. T1 times were measured in myocardium and blood. Extracellular volume fraction (ECV) was calculated. In volunteers with repeated T1 mapping, the myocardial native T1 and ECV generated from the 1st fixed sampling scheme were smaller than from the 1st HRD and 2nd fixed sampling scheme. In healthy volunteers, the overall native T1 times and ECV of the left ventricle (LV) in diastolic T1 maps were greater than in systolic T1 maps (P < 0.01, P < 0.05). In the 3 AF patients that had received electrical cardioversion therapy, the myocardial native T1 times and ECV generated from the fixed sampling scheme were smaller than in the 1st and 2nd HRD sampling scheme (all P < 0.05). In patients with AF (HR: 88 ± 20 bpm, HR fluctuation: 12 ± 9 bpm), more T1 maps with artifact were found in diastole than in systole (P < 0.01). The overall native T1 times and ECV of the left ventricle (LV) in diastolic T1 maps were greater than systolic T1 maps, either with fixed or HRD sampling scheme (all P < 0.05). Systolic MOLLI T1 mapping with heart-rate-dependent pulse sequence scheme can improve image quality and avoid T1 underestimation. It is feasible and with further validation may extend clinical applicability of T1 mapping to patients with atrial fibrillation.

The Impact of Cryoballoon Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation on Healthcare Utilization and Costs: An Economic Analysis From the FIRE AND ICE Trial.

PubMed

Chun, K R Julian; Brugada, Josep; Elvan, Arif; Gellér, Laszlo; Busch, Matthias; Barrera, Alberto; Schilling, Richard J; Reynolds, Matthew R; Hokanson, Robert B; Holbrook, Reece; Brown, Benedict; Schlüter, Michael; Kuck, Karl-Heinz

2017-07-27

This study sought to assess payer costs following cryoballoon or radiofrequency current (RFC) catheter ablation of paroxysmal atrial fibrillation in the randomized FIRE AND ICE trial. A trial period analysis of healthcare costs evaluated the impact of ablation modality (cryoballoon versus RFC) on differences in resource use and associated payer costs. Analyses were based on repeat interventions, rehospitalizations, and cardioversions during the trial, with unit costs based on 3 national healthcare systems (Germany [€], the United Kingdom [£], and the United States [$]). Total payer costs were calculated by applying standard unit costs to hospital stays, using International Classification of Diseases, 10th Revision diagnoses and procedure codes that were mapped to country-specific diagnosis-related groups. Patients (N=750) randomized 1:1 to cryoballoon (n=374) or RFC (n=376) ablation were followed for a mean of 1.5 years. Resource use was lower in the cryoballoon than the RFC group (205 hospitalizations and/or interventions in 122 patients versus 268 events in 154 patients). The cost differences per patient in mean total payer costs during follow-up were €640, £364, and $925 in favor of cryoballoon ablation ( P =0.012, 0.013, and 0.016, respectively). This resulted in trial period total cost savings of €245 000, £140 000, and $355 000. When compared with RFC ablation, cryoballoon ablation was associated with a reduction in resource use and payer costs. In all 3 national healthcare systems analyzed, this reduction resulted in substantial trial period cost savings, primarily attributable to fewer repeat ablations and a reduction in cardiovascular rehospitalizations with cryoballoon ablation. URL: http://www.clinicaltrials.gov. Identifier: NCT01490814. © 2017 The Authors and Medtronic. Published on behalf of the American Heart Association, Inc., by Wiley.

Catheter ablation versus medical therapy for patients with persistent atrial fibrillation: a systematic review and meta-analysis of evidence from randomized controlled trials.

PubMed

Chen, Chen; Zhou, Xinbin; Zhu, Min; Chen, Shenjie; Chen, Jie; Cai, Hongwen; Dai, Jin; Xu, Xiaoming; Mao, Wei

2018-06-01

The superiority of catheter ablation (CA) for persistent (and long-standing persistent) atrial fibrillation (AF) is currently not well defined. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the clinical outcomes of CA compared with medical therapy in persistent AF patients. We systematically searched PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov for RCTs comparing CA with medical therapy in patients with persistent AF. For CA vs medical rhythm control, the primary outcome was freedom from atrial arrhythmia. For CA vs medical rate control, the primary outcome was the change in the left ventricular ejection fraction (LVEF). Eight studies with a total of 809 patients were included in the final analysis. Compared with medical rhythm control, CA was superior in achieving freedom from atrial arrhythmia (RR 2.08, 95% CI [1.67, 2.58]; P < 0.00001). Similar result was found in CA arm without antiarrhythmic drug use after operation (RR 1.82, 95%CI [1.33, 2.49]; P = 0.0002). CA was also superior in reducing the probability of cardioversion (RR 0.59, 95%CI [0.46, 0.76]; P < 0.0001) and hospitalization (RR 0.54, 95%CI [0.39, 0.74]; P = 0.0002). Compared with the medical rate control in persistent AF patients with heart failure (HF), CA significantly improved the LVEF (MD 7.72, 95%CI [4.78, 10.67]; P < 0.00001) and reduced Minnesota Living with Heart Failure Questionnaire scores (MD 11.1395% CI [2.52-19.75]; P = 0.01). CA appeared to be superior to medical therapy in persistent AF patients and might be considered as a first-line therapy for some persistent AF patients especially for those with HF.

Training Course for Power Operating Personnel. Lesson No. 6: Alternating-Current Generator Excitation.

ERIC Educational Resources Information Center

Department of the Interior, Denver, CO. Engineering and Research Center.

Subjects covered in this text are controlling the hydroelectric generator, generator excitation, basic principles of direct current generation, direction of current flow, basic alternating current generator, alternating and direct current voltage outputs, converting alternating current to direct current, review of the basic generator and…

Onsite-effects of dual-hemisphere versus conventional single-hemisphere transcranial direct current stimulation: A functional MRI study.

PubMed

Kwon, Yong Hyun; Jang, Sung Ho

2012-08-25

We performed functional MRI examinations in six right-handed healthy subjects. During functional MRI scanning, transcranial direct current stimulation was delivered with the anode over the right primary sensorimotor cortex and the cathode over the left primary sensorimotor cortex using dual-hemispheric transcranial direct current stimulation. This was compared to a cathode over the left supraorbital area using conventional single-hemispheric transcranial direct current stimulation. Voxel counts and blood oxygenation level-dependent signal intensities in the right primary sensorimotor cortex regions were estimated and compared between the two transcranial direct current stimulation conditions. Our results showed that dual-hemispheric transcranial direct current stimulation induced greater cortical activities than single-hemispheric transcranial direct current stimulation. These findings suggest that dual-hemispheric transcranial direct current stimulation may provide more effective cortical stimulation than single-hemispheric transcranial direct current stimulation.

Onsite-effects of dual-hemisphere versus conventional single-hemisphere transcranial direct current stimulation

PubMed Central

Kwon, Yong Hyun; Jang, Sung Ho

2012-01-01

We performed functional MRI examinations in six right-handed healthy subjects. During functional MRI scanning, transcranial direct current stimulation was delivered with the anode over the right primary sensorimotor cortex and the cathode over the left primary sensorimotor cortex using dual-hemispheric transcranial direct current stimulation. This was compared to a cathode over the left supraorbital area using conventional single-hemispheric transcranial direct current stimulation. Voxel counts and blood oxygenation level-dependent signal intensities in the right primary sensorimotor cortex regions were estimated and compared between the two transcranial direct current stimulation conditions. Our results showed that dual-hemispheric transcranial direct current stimulation induced greater cortical activities than single-hemispheric transcranial direct current stimulation. These findings suggest that dual-hemispheric transcranial direct current stimulation may provide more effective cortical stimulation than single-hemispheric transcranial direct current stimulation. PMID:25624815

Is transcranial direct current stimulation a potential method for improving response inhibition?☆

PubMed Central

Kwon, Yong Hyun; Kwon, Jung Won

2013-01-01

Inhibitory control of movement in motor learning requires the ability to suppress an inappropriate action, a skill needed to stop a planned or ongoing motor response in response to changes in a variety of environments. This study used a stop-signal task to determine whether transcranial direct-current stimulation over the pre-supplementary motor area alters the reaction time in motor inhibition. Forty healthy subjects were recruited for this study and were randomly assigned to either the transcranial direct-current stimulation condition or a sham-transcranial direct-current stimulation condition. All subjects consecutively performed the stop-signal task before, during, and after the delivery of anodal transcranial direct-current stimulation over the pre-supplementary motor area (pre-transcranial direct-current stimulation phase, transcranial direct-current stimulation phase, and post-transcranial direct-current stimulation phase). Compared to the sham condition, there were significant reductions in the stop-signal processing times during and after transcranial direct-current stimulation, and change times were significantly greater in the transcranial direct-current stimulation condition. There was no significant change in go processing-times during or after transcranial direct-current stimulation in either condition. Anodal transcranial direct-current stimulation was feasibly coupled to an interactive improvement in inhibitory control. This coupling led to a decrease in the stop-signal process time required for the appropriate responses between motor execution and inhibition. However, there was no transcranial direct-current stimulation effect on the no-signal reaction time during the stop-signal task. Transcranial direct-current stimulation can adjust certain behaviors, and it could be a useful clinical intervention for patients who have difficulties with response inhibition. PMID:25206399

Is transcranial direct current stimulation a potential method for improving response inhibition?

PubMed

Kwon, Yong Hyun; Kwon, Jung Won

2013-04-15

Inhibitory control of movement in motor learning requires the ability to suppress an inappropriate action, a skill needed to stop a planned or ongoing motor response in response to changes in a variety of environments. This study used a stop-signal task to determine whether transcranial direct-current stimulation over the pre-supplementary motor area alters the reaction time in motor inhibition. Forty healthy subjects were recruited for this study and were randomly assigned to either the transcranial direct-current stimulation condition or a sham-transcranial direct-current stimulation condition. All subjects consecutively performed the stop-signal task before, during, and after the delivery of anodal transcranial direct-current stimulation over the pre-supplementary motor area (pre-transcranial direct-current stimulation phase, transcranial direct-current stimulation phase, and post-transcranial direct-current stimulation phase). Compared to the sham condition, there were significant reductions in the stop-signal processing times during and after transcranial direct-current stimulation, and change times were significantly greater in the transcranial direct-current stimulation condition. There was no significant change in go processing-times during or after transcranial direct-current stimulation in either condition. Anodal transcranial direct-current stimulation was feasibly coupled to an interactive improvement in inhibitory control. This coupling led to a decrease in the stop-signal process time required for the appropriate responses between motor execution and inhibition. However, there was no transcranial direct-current stimulation effect on the no-signal reaction time during the stop-signal task. Transcranial direct-current stimulation can adjust certain behaviors, and it could be a useful clinical intervention for patients who have difficulties with response inhibition.

Post-parathyroidectomy thyrotoxicosis and atrial flutter: a case for caution

PubMed Central

Asmar, Abdo

2011-01-01

Despite transient hyperthyroidism reportedly occurring in ∼30% of post-parathyroidectomy (PTX) patients with primary hyperparathyroidism, it has rarely been described in the internal medicine literature. It occurs within days of surgery, is usually clinically mild or silent, and typically spontaneously resolves within weeks. Patients can, however, unusually present with symptoms and signs of thyrotoxicosis, including arrhythmias. We report a case of a hemodialysis patient who developed self-limited hyperthyroidism after intra-operative thyroid manipulation and excision during PTX surgery for secondary hyperparathyroidism that failed medical management. The patient was symptomatic with agitation, restlessness and new-onset atrial flutter, which required electrical cardioversion and temporary beta blockade. It is important that clinicians be aware of this potential surgical complication, so as to not attribute manifestations to post-PTX divalent cation disorders (i.e. hungry bone syndrome), thereby allowing prompt diagnosis and treatment. Post-operative monitoring of thyroid function is warranted for at least some subsets of patients: individuals who undergo thyroid exploration and palpation as part of their surgery to localize the parathyroid glands, as well as those with underlying cardiac disease or who are otherwise at high risk from even mild states of hyperthyroidism. PMID:25984129

Neonatal atrial flutter after insertion of an intracardiac umbilical venous catheter

PubMed Central

de Almeida, Marcos Moura; Tavares, Wládia Gislaynne de Sousa; Furtado, Maria Mônica Alencar Araripe; Fontenele, Maria Marcia Farias Trajano

2016-01-01

Abstract Objective: To describe a case of neonatal atrial flutter after the insertion of an intracardiac umbilical venous catheter, reporting the clinical presentation and reviewing the literature on this subject. Case description: A late-preterm newborn, born at 35 weeks of gestational age to a diabetic mother and large for gestational age, with respiratory distress and rule-out sepsis, required an umbilical venous access. After the insertion of the umbilical venous catheter, the patient presented with tachycardia. Chest radiography showed that the catheter was placed in the position that corresponds to the left atrium, and traction was applied. The patient persisted with tachycardia, and an electrocardiogram showed atrial flutter. As the patient was hemodynamically unstable, electric cardioversion was successfully applied. Comments: The association between atrial arrhythmias and misplaced umbilical catheters has been described in the literature, but in this case, it is noteworthy that the patient was an infant born to a diabetic mother, which consists in another risk factor for heart arrhythmias. Isolated atrial flutter is a rare tachyarrhythmia in the neonatal period and its identification is essential to establish early treatment and prevent systemic complications and even death. PMID:26525686

Lacosamide-Induced Recurrent Ventricular Tachycardia in the Acute Care Setting.

PubMed

Berei, Theodore J; Lillyblad, Matthew P; Almquist, Adrian K

2018-04-01

Lacosamide is a new-generation antiepileptic drug (AED) most commonly used adjunctively in the setting of partial-onset seizures refractory to traditional therapy. We describe the first case report, to our knowledge, of a patient who developed recurrent, sustained ventricular tachycardia with multiple administrations of lacosamide in an acute setting. A 70-year-old woman with a history significant for valvular heart disease was admitted to the inpatient cardiology service for worsening heart failure. On hospital day 7, she received a bioprosthetic aortic valve. Prior to surgery and immediately after, the patient's electrocardiogram (ECG) was normal. After developing multiple generalized tonic-clonic seizures refractory to levetiracetam, fosphenytoin, and valproic acid, the decision was made to initiate lacosamide. Two hours following the second lacosamide dose, the patient developed a wide complex QRS that transitioned into sustained ventricular tachycardia requiring electrical cardioversion. Sustained ventricular tachycardia occurred again, just hours after the third dose of lacosamide was given. Following cessation of lacosamide, the patient's QRS interval normalized and has since had no documented episodes of ventricular tachycardia. Clinicians should be aware of the potential for life-threatening rhythmic disturbances in patients initiated on lacosamide and the need for vigilant ECG, electrolyte, and drug-drug monitoring.

Dofetilide in Overdose: A Case Series from Poison Center Data.

PubMed

Hieger, M A; Maskell, K F; Moss, M J; Powell, S W; Cumpston, K L

2017-07-01

Dofetilide is a class III antiarrhythmic used for treating atrial dysrhythmias. Though its adverse effects are well described in routine use, very little is known about dofetilide toxicity in overdose. This is a retrospective case series of consecutive patients reported to our poison center after dofetilide overdose. Twenty-seven cases were included. Seventeen patients were treated at a healthcare facility, and of these, eight were admitted. Twenty-one patients took one extra capsule, four took someone else's medication, one took three extra capsules, and one had a large intentional overdose. Ten patients had co-ingestants reported, including three QT-prolonging agents. No one required cardioversion, defibrillation, CPR, or overdrive pacing. The patient who reported taking 90 times his usual dose in suicide attempt was the only patient to have significant clinical effects. He experienced an 8-beat run of non-sustained ventricular tachycardia, frequent multifocal PVCs, and ventricular bigeminy. He received magnesium sulfate and potassium chloride supplementation. In this series, unintentional small overdoses did not result in significant clinical effects and were often managed successfully at home, despite the fact that information showing a single capsule can cause torsades. This study is limited by its small sample size, retrospective design, and reliance on incomplete information.

Neuroversion: using electroconvulsive therapy as a bridge to deep brain stimulation implantation.

PubMed

Williams, Nolan R; Sahlem, Greg; Pannu, Jaspreet; Takacs, Istvan; Short, Baron; Revuelta, Gonzalo; George, Mark S

2017-02-01

Parkinson's disease (PD) is a movement disorder with significant neuropsychiatric comorbidities. Electroconvulsive therapy (ECT) is effective in treating these neuropsychiatric symptoms; however, clinicians are reluctant to use ECT in patients with deep brain stimulation (DBS) implantations for fear of damaging the device, as well as potential cognitive side effects. Right unilateral ultra-brief pulse (RUL UBP) ECT has a more favorable cognitive side-effect profile yet has never been reported in PD patients with DBS implants. We present a case series of three patients with a history of PD that all presented with psychiatric decompensation immediately prior to planned DBS surgery. All three patients had DBS electrode(s) in place at the time and an acute course of ECT was utilized in a novel method to "bridge" these individuals to neurosurgery. The patients all experienced symptom resolution (psychosis and/or depression and/or anxiety) without apparent cognitive side effects. This case series not only illustrates that right unilateral ultra-brief pulse can be utilized in patients with DBS electrodes but also illustrates that this intervention can be utilized as a neuromodulatory "bridge", where nonoperative surgical candidates with unstable psychiatric symptoms can be converted to operative candidates in a manner similar to electrical cardioversion.

Recent advances in rhythm control for atrial fibrillation

PubMed Central

Bond, Richard; Olshansky, Brian; Kirchhof, Paulus

2017-01-01

Atrial fibrillation (AF) remains a difficult management problem. The restoration and maintenance of sinus rhythm—rhythm control therapy—can markedly improve symptoms and haemodynamics for patients who have paroxysmal or persistent AF, but some patients fare well with rate control alone. Sinus rhythm can be achieved with anti-arrhythmic drugs or electrical cardioversion, but the maintenance of sinus rhythm without recurrence is more challenging. Catheter ablation of the AF triggers is more effective than anti-arrhythmic drugs at maintaining sinus rhythm. Whilst pulmonary vein isolation is an effective strategy, other ablation targets are being evaluated to improve sinus rhythm maintenance, especially in patients with chronic forms of AF. Previously extensive ablation strategies have been used for patients with persistent AF, but a recent trial has shown that pulmonary vein isolation without additional ablation lesions is associated with outcomes similar to those of more extensive ablation. This has led to an increase in catheter-based technology to achieve durable pulmonary vein isolation. Furthermore, a combination of anti-arrhythmic drugs and catheter ablation seems useful to improve the effectiveness of rhythm control therapy. Two large ongoing trials evaluate whether a modern rhythm control therapy can improve prognosis in patients with AF. PMID:29043080

Emotional stress as a cause of syncope and torsade de pointes in patients with long QT syndrome.

PubMed

Vukmirović, Mihailo; Vukmirović, Irena Tomašević; Angelkov, Lazar; Vukmirović, Filip

2015-02-01

Long QT syndrome (LQTS) is a disorder of myocardial repolarization characterized by the prolongation of QT interval and high risk propensity of torsade de pointes (TdP) that can lead to syncope, cardiac arrest and sudden death. Episodes may be provoked by various stimuli depending on the type of the condition. A 25-year-old famele patient was hospitalized due to syncope that occurred immediately after her solo concert, first time in her life. The patient studied solo singing and after intensive preparations the first solo concert was organized. Electrocardiography (ECG) on admission registered frequent ventricular premature beats (VES), followed by polymorphic ventricular tachycardia--TdP that degenerated into ventricular fibrilation (VF). After immediate cardioversion magnesium and beta-blockers were administered. TdP was registered again several times preceded by VES. The corrected QT interval (QTc) was 516 msec. For secondary prevention of sudden cardiac death, a cardioverter defibrillator was implanted, and beta-blockers continued. After a 1-year follow-up there were no recurrent episodes of TdP, and measured QTc was reduced to 484 msec. Patients with syncope following intensive emotional stress should be evaluated for malignant arrhythmias in the context of LQTS.

Hybrid Therapy in the Management of Atrial Fibrillation

PubMed Central

Stárek, Zdeněk; Lehar, František; Jež, Jiří; Wolf, Jiří; Novák, Miroslav

2015-01-01

Atrial fibrillation is the most common sustained arrhythmia. Because of the sub-optimal outcomes and associated risks of medical therapy as well as the recent advances in non-pharmacologic strategies, a multitude of combined (hybrid) algorithms have been introduced that improve efficacy of standalone therapies while maintaining a high safety profile. Antiarrhythmic administration enhances success rate of electrical cardioversion. Catheter ablation of antiarrhythmic drug-induced typical atrial flutter may prevent recurrent atrial fibrillation. Through simple ablation in the right atrium, suppression of atrial fibrillation may be achieved in patients with previously ineffective antiarrhythmic therapy. Efficacy of complex catheter ablation in the left atrium is improved with antiarrhythmic drugs. Catheter ablation followed by permanent pacemaker implantation is an effective and safe treatment option for selected patients. Additional strategies include pacing therapies such as atrial pacing with permanent pacemakers, preventive pacing algorithms, and/or implantable dual-chamber defibrillators are available. Modern hybrid strategies combining both epicardial and endocardial approaches in order to create a complex set of radiofrequency lesions in the left atrium have demonstrated a high rate of success and warrant further research. Hybrid therapy for atrial fibrillation reviews history of development of non-pharmacological treatment strategies and outlines avenues of ongoing research in this field. PMID:25028165

Roles of Transesophageal Echocardiography and Cardiac Computed Tomography for Evaluation of Left Atrial Thrombus and Associated Pathology: A Review and Critical Analysis.

PubMed

Pathan, Faraz; Hecht, Harvey; Narula, Jagat; Marwick, Thomas H

2018-04-01

Evaluation of the left atrium and left atrial appendage for the presence of thrombus prior to cardioversion and pulmonary vein isolation, and of the entire heart for embolic sources in the setting of cryptogenic stroke, has long been standard medical care. Guidelines have uniformly recommended transesophageal echocardiography (TEE) to accomplish these goals. In recent years, computed tomographic angiography has demonstrated diagnostic accuracy similar to that of TEE for the detection of thrombus. Analysis of the pertinent data and relative merits of the 2 technologies leads to the conclusions that: 1) both modalities have some unique, nonoverlapping capabilities that may dictate their use in specific situations; 2) computed tomographic angiography is a reasonable alternative to TEE when the primary aim is to exclude left atrial and left atrial appendage thrombus and in patients in whom the risks associated with TEE outweigh the benefits; and 3) both options should be discussed with the patient in the setting of shared decision making. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

The preoperative cardiology consultation: indications and risk modification.

PubMed

Groot, M W; Spronk, A; Hoeks, S E; Stolker, R J; van Lier, F

2017-11-01

The cardiologist is regularly consulted preoperatively by anaesthesiologists. However, insights into the efficiency and usefulness of these consultations are unclear. This is a retrospective study of 24,174 preoperatively screened patients ≥18 years scheduled for elective non-cardiac surgery, which resulted in 273 (1%) referrals to the cardiologist for further preoperative evaluation. Medical charts were reviewed for patient characteristics, main reason for referring, requested diagnostic tests, interventions, adjustment in medical therapy, 30-day mortality and major adverse cardiac events. The most common reason for consultation was the evaluation of a cardiac murmur (95 patients, 35%). In 167 (61%) patients, no change in therapy was initiated by the cardiologist. Six consultations (2%) led to invasive interventions (electrical cardioversion, percutaneous coronary intervention or coronary artery bypass surgery). On average, consultation delayed clearance for surgery by two weeks. In most patients referred to the cardiologist after being screened at an outpatient anaesthesiology clinic, echocardiography is performed for ruling out specific conditions and to be sure that no further improvement can be made in the patient's health. In the majority, no change in therapy was initiated by the cardiologist. A more careful consideration about the potential benefits of consulting must be made for every patient.

Dronedarone: a novel antiarrhythmic agent for the treatment of atrial fibrillation.

PubMed

Duray, Gabor Z; Ehrlich, Joachim R; Hohnloser, Stefan H

2010-01-01

To describe the electrophysiological profile and the clinical portfolio of dronedarone, a new multichannel-blocking antiarrhythmic drug developed for the treatment of atrial fibrillation. Dronedarone is a derivative of amiodarone that is free of iodine and less lipophilic. The drug has - as its predecessor - multichannel-blocking efficacy and in addition vasodilating effects. It reduces the incidence of ventricular fibrillation in several experimental models. Dronedarone has undergone thorough clinical evaluation in various patient populations. In two large trials, the drug was shown to postpone the recurrence of atrial fibrillation after cardioversion relative to placebo. In a trial in unstable heart failure patients, there was excess mortality in the dronedarone arm. This trial was stopped prematurely and prompted the conduct of a large outcome study. The ATHENA trial demonstrated a significant reduction in cardiovascular hospitalizations and death in atrial fibrillation patients randomly assigned to receive dronedarone or placebo. This large trial in more than 4600 patients revealed no signs of excess mortality or morbidity in patients receiving dronedarone. On the basis of the results of five international, multicenter, randomized clinical trials involving nearly 6300 patients, dronedarone was approved by the FDA for treatment of nonpermanent atrial fibrillation to reduce the risk of cardiovascular hospitalization.

A Case of Multiple Cardiovascular and Tracheal Anomalies Presented with Wolff-Parkinson-White Syndrome in a Middle-aged Adult.

PubMed

Shi, Hyejin; Sohn, Sungmin; Wang, SungHo; Park, Sungrock; Lee, SangKi; Kim, Song Yi; Jeong, Sun Young; Kim, Changhwan

2017-12-01

Congenital cardiovascular anomalies, such as dextrocardia, persistent left superior vena cava (SVC), and pulmonary artery (PA) sling, are rare disorders. These congenital anomalies can occur alone, or coincide with other congenital malformations. In the majority of cases, congenital anomalies are detected early in life by certain signs and symptoms. A 56-year-old man with no previous medical history was admitted due to recurrent wide QRS complex tachycardia with hemodynamic collapse. A chest radiograph showed dextrocardia. After synchronized cardioversion, an electrocardiogram revealed Wolff-Parkinson-White (WPW) syndrome. Persistent left SVC, PA sling, and right tracheal bronchus were also detected by a chest computed tomography (CT) scan. He was diagnosed with paroxysmal supraventricular tachycardia (PSVT) associated with WPW syndrome, and underwent radiofrequency ablation. We reported the first case of situs solitus dextrocardia coexisting with persistent left SVC, PA sling and right tracheal bronchus presented with WPW and PSVT in a middle-aged adult. In patients with a cardiovascular anomaly, clinicians should consider thorough evaluation of possibly combined cardiovascular and airway malformations and cardiac dysrhythmia. © 2017 The Korean Academy of Medical Sciences.

46 CFR 111.05-29 - Dual voltage direct current systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Dual voltage direct current systems. Each dual voltage direct current system must have a suitably sensitive ground detection system which indicates current in the ground connection, has a range of at least... 46 Shipping 4 2010-10-01 2010-10-01 false Dual voltage direct current systems. 111.05-29 Section...

46 CFR 111.05-29 - Dual voltage direct current systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Dual voltage direct current systems. Each dual voltage direct current system must have a suitably sensitive ground detection system which indicates current in the ground connection, has a range of at least... 46 Shipping 4 2011-10-01 2011-10-01 false Dual voltage direct current systems. 111.05-29 Section...

Aternating current photovoltaic building block

DOEpatents

Bower, Ward Issac; Thomas, Michael G.; Ruby, Douglas S.

2004-06-15

A modular apparatus for and method of alternating current photovoltaic power generation comprising via a photovoltaic module, generating power in the form of direct current; and converting direct current to alternating current and exporting power via one or more power conversion and transfer units attached to the module, each unit comprising a unitary housing extending a length or width of the module, which housing comprises: contact means for receiving direct current from the module; one or more direct current-to-alternating current inverters; an alternating current bus; and contact means for receiving alternating current from the one or more inverters.

Multiday Transcranial Direct Current Stimulation Causes Clinically Insignificant Changes in Childhood Dystonia: A Pilot Study.

PubMed

Bhanpuri, Nasir H; Bertucco, Matteo; Young, Scott J; Lee, Annie A; Sanger, Terence D

2015-10-01

Abnormal motor cortex activity is common in dystonia. Cathodal transcranial direct current stimulation may alter cortical activity by decreasing excitability while anodal stimulation may increase motor learning. Previous results showed that a single session of cathodal transcranial direct current stimulation can improve symptoms in childhood dystonia. Here we performed a 5-day, sham-controlled, double-blind, crossover study, where we measured tracking and muscle overflow in a myocontrol-based task. We applied cathodal and anodal transcranial direct current stimulation (2 mA, 9 minutes per day). For cathodal transcranial direct current stimulation (7 participants), 3 subjects showed improvements whereas 2 showed worsening in overflow or tracking error. The effect size was small (about 1% of maximum voluntary contraction) and not clinically meaningful. For anodal transcranial direct current stimulation (6 participants), none showed improvement, whereas 5 showed worsening. Thus, multiday cathodal transcranial direct current stimulation reduced symptoms in some children but not to a clinically meaningful extent, whereas anodal transcranial direct current stimulation worsened symptoms. Our results do not support transcranial direct current stimulation as clinically viable for treating childhood dystonia. © The Author(s) 2015.

46 CFR 111.30-27 - Direct current ship's service switchboards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Direct current ship's service switchboards. 111.30-27... ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-27 Direct current ship's service switchboards. (a) Each direct current ship's service switchboard must have the equipment required by paragraphs (b...

46 CFR 111.30-27 - Direct current ship's service switchboards.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Direct current ship's service switchboards. 111.30-27... ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-27 Direct current ship's service switchboards. (a) Each direct current ship's service switchboard must have the equipment required by paragraphs (b...

30 CFR 75.703 - Grounding offtrack direct-current machines and the enclosures of related detached components.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Grounding offtrack direct-current machines and...-UNDERGROUND COAL MINES Grounding § 75.703 Grounding offtrack direct-current machines and the enclosures of related detached components. [Statutory Provisions] The frames of all offtrack direct-current machines and...

30 CFR 75.703 - Grounding offtrack direct-current machines and the enclosures of related detached components.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Grounding offtrack direct-current machines and...-UNDERGROUND COAL MINES Grounding § 75.703 Grounding offtrack direct-current machines and the enclosures of related detached components. [Statutory Provisions] The frames of all offtrack direct-current machines and...

Combined effects of cerebellar transcranial direct current stimulation and transcutaneous spinal direct current stimulation on robot-assisted gait training in patients with chronic brain stroke: A pilot, single blind, randomized controlled trial.

PubMed

Picelli, Alessandro; Chemello, Elena; Castellazzi, Paola; Filippetti, Mirko; Brugnera, Annalisa; Gandolfi, Marialuisa; Waldner, Andreas; Saltuari, Leopold; Smania, Nicola

2018-01-01

Preliminary evidence showed additional effects of anodal transcranial direct current stimulation over the damaged cerebral hemisphere combined with cathodal transcutaneous spinal direct current stimulation during robot-assisted gait training in chronic stroke patients. This is consistent with the neural organization of locomotion involving cortical and spinal control. The cerebellum is crucial for locomotor control, in particular for avoidance of obstacles, and adaptation to novel conditions during walking. Despite its key role in gait control, to date the effects of transcranial direct current stimulation of the cerebellum have not been investigated on brain stroke patients treated with robot-assisted gait training. To evaluate the effects of cerebellar transcranial direct current stimulation combined with transcutaneous spinal direct current stimulation on robot-assisted gait training in patients with chronic brain stroke. After balanced randomization, 20 chronic stroke patients received ten, 20-minute robot-assisted gait training sessions (five days a week, for two consecutive weeks) combined with central nervous system stimulation. Group 1 underwent on-line cathodal transcranial direct current stimulation over the contralesional cerebellar hemisphere + cathodal transcutaneous spinal direct current stimulation. Group 2 received on-line anodal transcranial direct current stimulation over the damaged cerebral hemisphere + cathodal transcutaneous spinal direct current stimulation. The primary outcome was the 6-minute walk test performed before, after, and at follow-up at 2 and 4 weeks post-treatment. The significant differences in the 6-minute walk test noted between groups at the first post-treatment evaluation (p = 0.041) were not maintained at either the 2-week (P = 0.650) or the 4-week (P = 0.545) follow-up evaluations. Our preliminary findings support the hypothesis that cathodal transcranial direct current stimulation over the contralesional cerebellar hemisphere in combination with cathodal transcutaneous spinal direct current stimulation might be useful to boost the effects of robot-assisted gait training in chronic brain stroke patients with walking impairment.

Adaptive PI control strategy for flat permanent magnet linear synchronous motor vibration suppression

NASA Astrophysics Data System (ADS)

Meng, Fanwei; Liu, Chengying; Li, Zhijun; Wang, Liping

2013-01-01

Due to low damping ratio, flat permanent magnet linear synchronous motor's vibration is difficult to be damped and the accuracy is limited. The vibration suppressing results are not good enough in the existing research because only the longitudinal direction vibration is considered while the normal direction vibration is neglected. The parameters of the direct-axis current controller are set to be the same as those of the quadrature-axis current controller commonly. This causes contradiction between signal noise and response. To suppress the vibration, the electromagnetic force model of the flat permanent magnet synchronous linear motor is formulated first. Through the analysis of the effect that direct-axis current noise and quadrature-axis current noise have on both direction vibration, it can be declared that the conclusion that longitudinal direction vibration is only related to the quadrature-axis current noise while the normal direction vibration is related to both the quadrature-axis current noise and direct-axis current noise. Then, the simulation test on current loop with a low-pass filter is conducted and the results show that the low-pass filter can not suppress the vibration but makes the vibration more severe. So a vibration suppressing strategy that the proportional gain of direct-axis current controller adapted according to quadrature-axis reference current is proposed. This control strategy can suppress motor vibration by suppressing direct-axis current noise. The experiments results about the effect of K p and T i on normal direction vibration, longitudinal vibration and the position step response show that this strategy suppresses vibration effectively while the motor's motion performance is not affected. The maximum reduction of vibration can be up to 40%. In addition, current test under rated load condition is also conducted and the results show that the control strategy can avoid the conflict between the direct-axis current and the quadrature-axis current under typical load. Adaptive PI control strategy can effectively suppress the flat permanent magnet linear synchronous motor's vibration without affecting the motor's performance.

Human Induced Pluripotent Stem Cell-Derived Cardiac Cell Sheets Expressing Genetically Encoded Voltage Indicator for Pharmacological and Arrhythmia Studies.

PubMed

Shaheen, Naim; Shiti, Assad; Huber, Irit; Shinnawi, Rami; Arbel, Gil; Gepstein, Amira; Setter, Noga; Goldfracht, Idit; Gruber, Amit; Chorna, Snizhanna V; Gepstein, Lior

2018-06-05

Fulfilling the potential of human induced pluripotent stem cell (hiPSC)-derived cardiomyocytes for studying conduction and arrhythmogenesis requires development of multicellular models and methods for long-term repeated tissue phenotyping. We generated confluent hiPSC-derived cardiac cell sheets (hiPSC-CCSs), expressing the genetically encoded voltage indicator ArcLight. ArcLight-based optical mapping allowed generation of activation and action-potential duration (APD) maps, which were validated by mapping the same hiPSC-CCSs with the voltage-sensitive dye, Di-4-ANBDQBS. ArcLight mapping allowed long-term assessment of electrical remodeling in the hiPSC-CCSs and evaluation of drug-induced conduction slowing (carbenoxolone, lidocaine, and quinidine) and APD prolongation (quinidine and dofetilide). The latter studies also enabled step-by-step depiction of drug-induced arrhythmogenesis ("torsades de pointes in the culture dish") and its prevention by MgSO 4 and rapid pacing. Phase-mapping analysis allowed biophysical characterization of spiral waves induced in the hiPSC-CCSs and their termination by electrical cardioversion and overdrive pacing. In conclusion, ArcLight mapping of hiPSC-CCSs provides a powerful tool for drug testing and arrhythmia investigation. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Review of the management of sudden cardiac arrest on the football field.

PubMed

Kramer, Efraim; Dvorak, Jiri; Kloeck, Walter

2010-06-01

Football is the most popular sport on earth. When a young, fit popular player suddenly collapses and dies during play, the tragic event is frequently screened and publicised worldwide. The reported incidence of sudden cardiac arrest (SCA) varies from 1:65,000 to 1:200,000 athletes. A broad spectrum of cardiac and non-cardiac causes have been implicated, and regular precompetition medical assessments are recommended as a preventive measure. Immediate cardiopulmonary resuscitation and early defibrillation is the treatment for SCA. High success rates can be achieved if this is initiated promptly, preferably within seconds of the arrest. Trained medical responders must be allowed to respond, ideally with a defibrillator (manual or automated) in hand, to a player who suddenly and unexpectedly collapses and remains unresponsive on the field. Immediate defibrillation of a pulseless ventricular tachycardia or ventricular fibrillation, within 1 to 2 min of onset, has a successful cardioversion rate exceeding 90%. Medical responders should be well trained and rehearsed in the recognition of SCA, including distractors such as seizures, myoclonic jerks and agonal (gasping) breathing. Prompt initiation of chest compressions on the field, together with early defibrillation, will result in many athletes' lives being saved by immediate implementation of these simple recommendations.

[Influence of sinus rhythm restoration and maintenance on left ventricle diameter and function in patients with persistent atrial fibrillation--one year follow-up].

PubMed

Kosior, Dariusz A; Szulc, Marcin; Stawicki, Sławomir; Roik, Marek; Rabczenko, Daniel; Opolski, Grzegorz

2005-01-01

Aim of our study was to determine the dynamics of selected echocardiographic parameters after sinus rhythm (SR) restoration and maintenance in pts with persistent nonvalvular atrial fibrillation (AF) during one year follow-up period. Our study population comprised 104 pts (F/M 33/71; mean age 60.4 +/- 7.4) assigned to SR restoration and maintenance with serial antiarrhythmic drug usage, for whom transthoracic echocardiographic (TTE) variables were recorded prior to, 2 and 12 months after cardioversion (CD). Left ventricle diastolic diameter and fractional shortening were variables of interest. SR was presented in 66 (63.5%) pts at one year. There was no significant differences in left ventricle diastolic diameter during the follow up. A significant increase in left ventricular fractional shortening (29.9 +/- 6.9% vs 34.5 +/- 8.9%; p < 0.001) was found in pts assigned to the sinus rhythm restoration according to intention-to-treat analysis. Such trend was noted only in pts who maintained SR during the follow up (29.9 +/- 7.6% vs 35.6 +/- 9.3%; p < 0.001). Among all considered variables only value of left ventricular fractional shortening increased after successful CV of persistent AF in one year follow-up.

Atrial Fibrillation in Eight New World Camelids.

PubMed

Bozorgmanesh, R; Magdesian, K G; Estell, K E; Stern, J A; Swain, E A; Griffiths, L G

2016-01-01

There is limited information on the incidence of clinical signs, concurrent illness and treatment options for atrial fibrillation (AF) in New World Camelids (NWC). Describe clinical signs and outcome of AF in NWC. Eight New World Camelids admitted with AF. A retrospective observational study of camelids diagnosed with AF based on characteristic findings on electrocardiogram (ECG). All animals had an irregularly irregular heart rhythm detected on physical examination and 4 cases had obtunded mentation on admission. Three camelids were diagnosed with AF secondary to oleander intoxication, 3 animals had underlying cardiovascular disease, 1 was diagnosed with lone AF and 1 had AF diagnosed on examination for a urethral obstruction. Five of eight animals survived to discharge and nonsurvivors consisted of animals which died or were euthanized as a result of cardiovascular disease (2/8) or extra-cardiac disease unrelated to the AF (1/8). Atrial fibrillation occurs in NWC in association with cardiovascular disease, extra-cardiac disease or as lone AF. Amiodarone and transthoracic cardioversion were attempted in one llama with lone AF, but were unsuccessful. Atrial fibrillation was recorded in 0.1% of admissions. Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Enhanced distributed energy resource system

DOEpatents

Atcitty, Stanley [Albuquerque, NM; Clark, Nancy H [Corrales, NM; Boyes, John D [Albuquerque, NM; Ranade, Satishkumar J [Las Cruces, NM

2007-07-03

A power transmission system including a direct current power source electrically connected to a conversion device for converting direct current into alternating current, a conversion device connected to a power distribution system through a junction, an energy storage device capable of producing direct current connected to a converter, where the converter, such as an insulated gate bipolar transistor, converts direct current from an energy storage device into alternating current and supplies the current to the junction and subsequently to the power distribution system. A microprocessor controller, connected to a sampling and feedback module and the converter, determines when the current load is higher than a set threshold value, requiring triggering of the converter to supply supplemental current to the power transmission system.

Effiectiveness and safety of transcranial direct current stimulation in fibromyalgia: A systematic review and meta-analysis.

PubMed

Zhu, Chang-E; Yu, Bo; Zhang, Wen; Chen, Wen-Hua; Qi, Qi; Miao, Yun

2017-01-19

To evaluate the effectiveness and safety of transcranial direct current stimulation for fibro-myalgia. Databases, conference records and registered trials were searched for articles published from the date of establishment of the database through to October 2015. Six randomized controlled trials (n=192) of transcranial direct current stimulation for fibromyalgia were included in the current study. Two researchers independently screened the literature, assessed methodological quality using the Cochrane Collaboration's tool, and extracted data. Studies were divided into 3 groups for meta-analysis according to stimulation site and polarity. Significant improvement in pain and general fibromyalgia-related function was seen with anodal transcranial direct current stimulation over the primary motor cortex (p<0.05). However, the pressure pain threshold did not improve (p>0.05). Anodal transcranial direct current stimulation over the left dorsolateral prefrontal cortex did not significantly reduce pain or improve general fibromyalgia-related function compared with sham stimulation (p>0.05). Cathodal transcranial direct current stimulation over the primary motor cortex did not improve the pressure pain threshold compared with sham stimulation (p>0.05). No significant adverse effects were seen. Anodal transcranial direct current stimulation over the primary motor cortex is more likely than sham transcranial direct current stimulation to relieve pain and improve general fibromyalgia-related function.

Current-direction dependence of the transport properties in single-crystalline face-centered-cubic cobalt films

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xiao, X.; Liang, J. H.; Chen, B. L.

2015-07-28

Face-centered-cubic cobalt films are epitaxially grown on insulating LaAlO{sub 3}(001) substrates by molecular beam epitaxy. Transport measurements are conducted in different current directions relative to the crystal axes. We find that the temperature dependent anisotropic magnetoresistance ratio strongly depends on the current direction. However, the anomalous Hall effect shows isotropic behavior independent of the current direction. Our results demonstrate the interplay between the current direction and the crystalline lattice in single-crystalline ferromagnetic films. A phenomenological analysis is presented to interpret the experimental data.

Stimulating thought: a functional MRI study of transcranial direct current stimulation in schizophrenia.

PubMed

Orlov, Natasza D; O'Daly, Owen; Tracy, Derek K; Daniju, Yusuf; Hodsoll, John; Valdearenas, Lorena; Rothwell, John; Shergill, Sukhi S

2017-09-01

Individuals with schizophrenia typically suffer a range of cognitive deficits, including prominent deficits in working memory and executive function. These difficulties are strongly predictive of functional outcomes, but there is a paucity of effective therapeutic interventions targeting these deficits. Transcranial direct current stimulation is a novel neuromodulatory technique with emerging evidence of potential pro-cognitive effects; however, there is limited understanding of its mechanism. This was a double-blind randomized sham controlled pilot study of transcranial direct current stimulation on a working memory (n-back) and executive function (Stroop) task in 28 individuals with schizophrenia using functional magnetic resonance imaging. Study participants received 30 min of real or sham transcranial direct current stimulation applied to the left frontal cortex. The 'real' and 'sham' groups did not differ in online working memory task performance, but the transcranial direct current stimulation group demonstrated significant improvement in performance at 24 h post-transcranial direct current stimulation. Transcranial direct current stimulation was associated with increased activation in the medial frontal cortex beneath the anode; showing a positive correlation with consolidated working memory performance 24 h post-stimulation. There was reduced activation in the left cerebellum in the transcranial direct current stimulation group, with no change in the middle frontal gyrus or parietal cortices. Improved performance on the executive function task was associated with reduced activity in the anterior cingulate cortex. Transcranial direct current stimulation modulated functional activation in local task-related regions, and in more distal nodes in the network. Transcranial direct current stimulation offers a potential novel approach to altering frontal cortical activity and exerting pro-cognitive effects in schizophrenia. © The Author (2017). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

RF lockout circuit for electronic locking system

NASA Astrophysics Data System (ADS)

Becker, Earl M., Jr.; Miller, Allen

1991-02-01

An electronics lockout circuit was invented that includes an antenna adapted to receive radio frequency signals from a transmitter, and a radio frequency detector circuit which converts the radio frequency signals into a first direct current voltage indicative of the relative strength of the field resulting from the radio frequency signals. The first direct current voltage is supplied to a trigger circuit which compares this direct current voltage to an adjustable direct current reference voltage. This provides a second direct current voltage at the output whenever the amplitude of the first direct current voltage exceeds the amplitude of the reference voltage provided by the comparator circuit. This is supplied to a disconnect relay circuit which, upon receiving a signal from the electronic control unit of an electronic combination lock during the time period at which the second direct current voltage is present, isolates the door strike coil of a security door from the electronic control unit. This prevents signals falsely generated by the electronic control unit because of radio frequency signals in the vicinity of the electronic control unit energizing the door strike coil and accidentally opening a security door.

Tests of the relative roles of calcium channels and calcium pumps in controlling gravity-directed development in single spore cells of the fern Ceratopteris richardii

NASA Astrophysics Data System (ADS)

Roux, Stanley; Porterfield, D. Marshall; Haque, Aeraj Ul; Bushart, Thomas

The vector of gravity sets the direction of polarized development of single spore cells of the fern Ceratopteris richardii after light initiates their germination. Gravity also sets the direction of a trans-cell calcium current, which enters the cell along its bottom and exits it from its top. The direction of this current predicts the subsequent direction of spore development, and blocking this current with calcium channel blockers randomizes the direction of subsequent development. Recently the laboratory of D. Marshall Porterfield (Purdue University) developed a microchip device that can measure the direction and magnitude of the trans-spore calcium current in real time. Our laboratory in collaboration with Porterfield's recently found that this current inverts rapidly when the cells are turned upside down and that the magnitude of the current rises and falls with the magnitude of the g-force when these cells are tested in parabolic flight on the DC-9 aircraft. We assume that the gravity-directed entry of calcium into these cells is through calcium channels and its exit is through calcium pumps. Here we report our studies of a calcium pump that is highly expressed in the spores during the period when gravity is setting the direction of the calcium current, and we describe pharmacological tests of the relative importance of calcium pumps in maintaining the calcium current and in controlling the direction of subsequent spore development. We found that inhibitors that block the activity of calcium pumps also greatly depress the trans-cell current, but, surprisingly, have little effect on the ability of gravity to set the direction of spore development. These results, in combination with earlier findings, indicate that the gravity-directed opening of calcium channels along the bottom of spore cells plays a more important role in directing subsequent spore development than the activity of calcium pumps, despite the importance of these pumps in maintaining the trans-cell calcium current. Supported by NASA grants NAG2-1586 and NAG10-295 to S. J. R.

Combining physical training with transcranial direct current stimulation to improve gait in Parkinson's disease: a pilot randomized controlled study.

PubMed

Kaski, D; Dominguez, R O; Allum, J H; Islam, A F; Bronstein, A M

2014-11-01

To improve gait and balance in patients with Parkinson's disease by combining anodal transcranial direct current stimulation with physical training. In a double-blind design, one group (physical training; n = 8) underwent gait and balance training during transcranial direct current stimulation (tDCS; real/sham). Real stimulation consisted of 15 minutes of 2 mA transcranial direct current stimulation over primary motor and premotor cortex. For sham, the current was switched off after 30 seconds. Patients received the opposite stimulation (sham/real) with physical training one week later; the second group (No physical training; n = 8) received stimulation (real/sham) but no training, and also repeated a sequential transcranial direct current stimulation session one week later (sham/real). Hospital Srio Libanes, Buenos Aires, Argentina. Sixteen community-dwelling patients with Parkinson's disease. Transcranial direct current stimulation with and without concomitant physical training. Gait velocity (primary gait outcome), stride length, timed 6-minute walk test, Timed Up and Go Test (secondary outcomes), and performance on the pull test (primary balance outcome). Transcranial direct current stimulation with physical training increased gait velocity (mean = 29.5%, SD = 13; p < 0.01) and improved balance (pull test: mean = 50.9%, SD = 37; p = 0.01) compared with transcranial direct current stimulation alone. There was no isolated benefit of transcranial direct current stimulation alone. Although physical training improved gait velocity (mean = 15.5%, SD = 12.3; p = 0.03), these effects were comparatively less than with combined tDCS + physical therapy (p < 0.025). Greater stimulation-related improvements were seen in patients with more advanced disease. Anodal transcranial direct current stimulation during physical training improves gait and balance in patients with Parkinson's disease. Power calculations revealed that 14 patients per treatment arm (α = 0.05; power = 0.8) are required for a definitive trial. © The Author(s) 2014.

Current strategy for treatment of patients with Wolff-Parkinson-White syndrome and asymptomatic preexcitation in Europe: European Heart Rhythm Association survey.

PubMed

Svendsen, Jesper Hastrup; Dagres, Nikolaos; Dobreanu, Dan; Bongiorni, Maria Grazia; Marinskis, Germanas; Blomström-Lundqvist, Carina

2013-05-01

The aims of this survey was to provide insight into treatment activity, the strategy of treatment, and risk stratification of patients with asymptomatic and symptomatic ventricular pre-excitation across Europe. Fifty-eight centres, members of the European Heart Rhythm Association EP research network, covering 20 countries answered the survey questions. All centres were high-volume ablation centres. A younger person with asymptomatic Wolff-Parkinson-White (WPW) pattern has a higher likelihood of being risk-stratified or receiving ablation therapy compared with an older subject. Two-thirds of centres report that they have observed a decline in the number of patients ablated for an accessory pathway during the last 10 years. Pre-excited atrial fibrillation is rarely seen. Discontinuation of a scheduled WPW ablation due to close vicinity of the accessory pathway to the AV node happens very rarely. Patients with a first episode of pre-excited atrial fibrillation would immediately be referred for catheter ablation to be performed within weeks by 80.4% of the centres. A significant proportion of responders (50.9%) would use electrical cardioversion to restore sinus rhythm in a patient with pre-excited atrial fibrillation. With respect to the choice of antiarrhythmic medication for a patient with pre-excited AF, the majority (80.0%) would choose class 1C antiarrhytmic drugs while waiting for a catheter ablation. A patient seen in the emergency room with a second episode of orthodromic atrioventricular reentry tachycardia would be referred for immediate ablation by 79.2-90.6% of centres depending on the presence of pre-excitation. The volume of paediatric ablations performed on children younger than 12 years was low (46.4%: 0 patients per year; 46.4%: 1-9 patients per year). The majority of responding centres (61-69%) report that their country lack national guidelines dealing with clinical strategies related to WPW. There is a need for national guidelines dealing with clinical strategy in patients with WPW syndrome. Older individuals with asymptomatic WPW pattern have a higher risk of not receiving risk stratification or curative therapy with ablation compared with younger patients, despite the higher risk of developing atrial fibrillation.

Direct current transformer

NASA Technical Reports Server (NTRS)

Khanna, S. M.; Urban, E. W. (Inventor)

1979-01-01

A direct current transformer in which the primary consists of an elongated strip of superconductive material, across the ends of which is direct current potential is described. Parallel and closely spaced to the primary is positioned a transformer secondary consisting of a thin strip of magnetoresistive material.

Digital High-Current Monitor

NASA Technical Reports Server (NTRS)

Cash, B.

1985-01-01

Simple technique developed for monitoring direct currents up to several hundred amperes and digitally displaying values directly in current units. Used to monitor current magnitudes beyond range of standard laboratory ammeters, which typically measure 10 to 20 amperes maximum. Technique applicable to any current-monitoring situation.

An Annotated Bibliography of High-Voltage Direct-Current Transmission and Flexible AC Transmission (FACTS) Devices, 1991-1993.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Litzenberger, Wayne; Lava, Val

1994-08-01

References are contained for HVDC systems, converter stations and components, overhead transmission lines, cable transmission, system design and operations, simulation of high voltage direct current systems, high-voltage direct current installations, and flexible AC transmission system (FACTS).

Propagation direction reversal of ionization zones in the transition between high and low current magnetron sputtering

DOE Office of Scientific and Technical Information (OSTI.GOV)

School of Materials Science and Engineering, State Key Lab for Materials Processing and Die & Mold Technology, Huazhong University of Science and Technology, Wuhan 430074, China; Department of Physics, University of California Berkeley, Berkeley, California 94720, USA; Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720, USA

2014-12-11

Past research has revealed the propagation of dense, asymmetric ionization zones in both high and low current magnetron discharges. Here we report about the direction reversal of ionization zone propagation as observed with fast cameras. At high currents, zones move in the E B direction with velocities of 103 to 104 m/s. However at lower currents, ionization zones are observed to move in the opposite, the -E B direction, with velocities ~;; 103 m/s. It is proposed that the direction reversal is associated with the local balance of ionization and supply of neutrals in the ionization zone.

Transcranial direct current stimulation for motor recovery of upper limb function after stroke.

PubMed

Lüdemann-Podubecká, Jitka; Bösl, Kathrin; Rothhardt, Sandra; Verheyden, Geert; Nowak, Dennis Alexander

2014-11-01

Changes in neural processing after stroke have been postulated to impede recovery from stroke. Transcranial direct current stimulation has the potential to alter cortico-spinal excitability and thereby might be beneficial in stroke recovery. We review the pertinent literature prior to 30/09/2013 on transcranial direct current stimulation in promoting motor recovery of the affected upper limb after stroke. We found overall 23 trials (they included 523 participants). All stimulation protocols pride on interhemispheric imbalance model. In a comparative approach, methodology and effectiveness of (a) facilitation of the affected hemisphere, (b) inhibition of the unaffected hemisphere and (c) combined application of transcranial direct current stimulation over the affected and unaffected hemispheres to treat impaired hand function after stroke are presented. Transcranial direct current stimulation is associated with improvement of the affected upper limb after stroke, but current evidence does not support its routine use. Copyright © 2014 Elsevier Ltd. All rights reserved.

46 CFR 111.30-27 - Direct current ship's service switchboards.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 4 2013-10-01 2013-10-01 false Direct current ship's service switchboards. 111.30-27 Section 111.30-27 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-27 Direct current ship's service switchboards...

46 CFR 111.30-27 - Direct current ship's service switchboards.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Direct current ship's service switchboards. 111.30-27 Section 111.30-27 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-27 Direct current ship's service switchboards...

46 CFR 111.30-27 - Direct current ship's service switchboards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Direct current ship's service switchboards. 111.30-27 Section 111.30-27 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Switchboards § 111.30-27 Direct current ship's service switchboards...

30 CFR 75.703-3 - Approved methods of grounding offtrack mobile, portable and stationary direct-current machines.

Code of Federal Regulations, 2011 CFR

2011-07-01

... separate grounding conductor located within the trailing cable of mobile and portable equipment and... conductor located within the direct-current power cable feeding stationary equipment and connected between... ground conductor connected between stationary equipment and the direct-current grounding medium; or, (d...

30 CFR 75.703-3 - Approved methods of grounding offtrack mobile, portable and stationary direct-current machines.

Code of Federal Regulations, 2012 CFR

2012-07-01

... separate grounding conductor located within the trailing cable of mobile and portable equipment and... conductor located within the direct-current power cable feeding stationary equipment and connected between... ground conductor connected between stationary equipment and the direct-current grounding medium; or, (d...

30 CFR 75.703-3 - Approved methods of grounding offtrack mobile, portable and stationary direct-current machines.

Code of Federal Regulations, 2013 CFR

2013-07-01

... separate grounding conductor located within the trailing cable of mobile and portable equipment and... conductor located within the direct-current power cable feeding stationary equipment and connected between... ground conductor connected between stationary equipment and the direct-current grounding medium; or, (d...

30 CFR 75.703-3 - Approved methods of grounding offtrack mobile, portable and stationary direct-current machines.

Code of Federal Regulations, 2010 CFR

2010-07-01

... separate grounding conductor located within the trailing cable of mobile and portable equipment and... conductor located within the direct-current power cable feeding stationary equipment and connected between... ground conductor connected between stationary equipment and the direct-current grounding medium; or, (d...

30 CFR 75.703-3 - Approved methods of grounding offtrack mobile, portable and stationary direct-current machines.

Code of Federal Regulations, 2014 CFR

2014-07-01

... separate grounding conductor located within the trailing cable of mobile and portable equipment and... conductor located within the direct-current power cable feeding stationary equipment and connected between... ground conductor connected between stationary equipment and the direct-current grounding medium; or, (d...

Interhemispheric currents in the ring current region as seen by the Cluster spacecraft

NASA Astrophysics Data System (ADS)

Tenfjord, P.; Ostgaard, N.; Haaland, S.; Laundal, K.; Reistad, J. P.

2013-12-01

The existence of interhemispheric currents has been predicted by several authors, but their extent in the ring current has to our knowledge never been studied systematically by using in-situ measurements. These currents have been suggested to be associated with observed asymmetries of the aurora. We perform a statistical study of current density and direction during ring current crossings using the Cluster spacecraft. We analyse the extent of the interhemispheric field aligned currents for a wide range of solar wind conditions. Direct estimations of equatorial current direction and density are achieved through the curlometer technique. The curlometer technique is based on Ampere's law and requires magnetic field measurements from all four spacecrafts. The use of this method requires careful study of factors that limit the accuracy, such as tetrahedron shape and configuration. This significantly limits our dataset, but is a necessity for accurate current calculations. Our goal is to statistically investigate the occurrence of interhemispheric currents, and determine if there are parameters or magnetospheric states on which the current magnitude and directions depend upon.

Heartbeat Cycle Length Detection by a Ballistocardiographic Sensor in Atrial Fibrillation and Sinus Rhythm

PubMed Central

Zink, Matthias Daniel; Brüser, Christoph; Winnersbach, Patrick; Napp, Andreas; Leonhardt, Steffen; Marx, Nikolaus; Schauerte, Patrick; Mischke, Karl

2015-01-01

Background. Heart rate monitoring is especially interesting in patients with atrial fibrillation (AF) and is routinely performed by ECG. A ballistocardiography (BCG) foil is an unobtrusive sensor for mechanical vibrations. We tested the correlation of heartbeat cycle length detection by a novel algorithm for a BCG foil to an ECG in AF and sinus rhythm (SR). Methods. In 22 patients we obtained BCG and synchronized ECG recordings before and after cardioversion and examined the correlation between heartbeat characteristics. Results. We analyzed a total of 4317 heartbeats during AF and 2445 during SR with a correlation between ECG and BCG during AF of r = 0.70 (95% CI 0.68–0.71, P < 0.0001) and r = 0.75 (95% CI 0.73–0.77, P < 0.0001) during SR. By adding a quality index, artifacts could be reduced and the correlation increased for AF to 0.76 (95% CI 0.74–0.77, P < 0.0001, n = 3468) and for SR to 0.85 (95% CI 0.83–0.86, P < 0.0001, n = 2176). Conclusion. Heartbeat cycle length measurement by our novel algorithm for BCG foil is feasible during SR and AF, offering new possibilities of unobtrusive heart rate monitoring. This trial is registered with IRB registration number EK205/11. This trial is registered with clinical trials registration number NCT01779674. PMID:26229965

Interplay between Clinical Guidelines and Organizational Workflow Systems. Experience from the MobiGuide Project.

PubMed

Shabo, Amnon; Peleg, Mor; Parimbelli, Enea; Quaglini, Silvana; Napolitano, Carlo

2016-12-07

Implementing a decision-support system within a healthcare organization requires integration of clinical domain knowledge with resource constraints. Computer-interpretable guidelines (CIG) are excellent instruments for addressing clinical aspects while business process management (BPM) languages and Workflow (Wf) engines manage the logistic organizational constraints. Our objective is the orchestration of all the relevant factors needed for a successful execution of patient's care pathways, especially when spanning the continuum of care, from acute to community or home care. We considered three strategies for integrating CIGs with organizational workflows: extending the CIG or BPM languages and their engines, or creating an interplay between them. We used the interplay approach to implement a set of use cases arising from a CIG implementation in the domain of Atrial Fibrillation. To provide a more scalable and standards-based solution, we explored the use of Cross-Enterprise Document Workflow Integration Profile. We describe our proof-of-concept implementation of five use cases. We utilized the Personal Health Record of the MobiGuide project to implement a loosely-coupled approach between the Activiti BPM engine and the Picard CIG engine. Changes in the PHR were detected by polling. IHE profiles were used to develop workflow documents that orchestrate cross-enterprise execution of cardioversion. Interplay between CIG and BPM engines can support orchestration of care flows within organizational settings.

Routine versus aggressive upstream rhythm control for prevention of early atrial fibrillation in heart failure: background, aims and design of the RACE 3 study.

PubMed

Alings, M; Smit, M D; Moes, M L; Crijns, H J G M; Tijssen, J G P; Brügemann, J; Hillege, H L; Lane, D A; Lip, G Y H; Smeets, J R L M; Tieleman, R G; Tukkie, R; Willems, F F; Vermond, R A; Van Veldhuisen, D J; Van Gelder, I C

2013-07-01

Rhythm control for atrial fibrillation (AF) is cumbersome because of its progressive nature caused by structural remodelling. Upstream therapy refers to therapeutic interventions aiming to modify the atrial substrate, leading to prevention of AF. The Routine versus Aggressive upstream rhythm Control for prevention of Early AF in heart failure (RACE 3) study hypothesises that aggressive upstream rhythm control increases persistence of sinus rhythm compared with conventional rhythm control in patients with early AF and mild-to-moderate early systolic or diastolic heart failure undergoing electrical cardioversion. RACE 3 is a prospective, randomised, open, multinational, multicenter trial. Upstream rhythm control consists of angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers, mineralocorticoid receptor antagonists, statins, cardiac rehabilitation therapy, and intensive counselling on dietary restrictions, exercise maintenance, and drug adherence. Conventional rhythm control consists of routine rhythm control therapy without cardiac rehabilitation therapy and intensive counselling. In both arms, every effort is made to keep patients in the rhythm control strategy, and ion channel antiarrhythmic drugs or pulmonary vein ablation may be instituted if AF relapses. Total inclusion will be 250 patients. If upstream therapy proves to be effective in improving maintenance of sinus rhythm, it could become a new approach to rhythm control supporting conventional pharmacological and non-pharmacological rhythm control.

Effects of ECT in treatment of depression: study protocol for a prospective neuroradiological study of acute and longitudinal effects on brain structure and function.

PubMed

Oltedal, Leif; Kessler, Ute; Ersland, Lars; Grüner, Renate; Andreassen, Ole A; Haavik, Jan; Hoff, Per Ivar; Hammar, Åsa; Dale, Anders M; Hugdahl, Kenneth; Oedegaard, Ketil J

2015-05-01

Major depression can be a serious and debilitating condition. For some patients in a treatment resistant depressive episode, electroconvulsive treatment (ECT) is the only treatment that is effective. Although ECT has shown efficacy in randomized controlled trials, the treatment is still controversial and stigmatized. This can in part be attributed to our lack of knowledge of the mechanisms of action. Some reports also suggest potential harmful effects of ECT treatment and memory related side effects have been documented. The present study will apply state of the art radiology through advanced magnetic resonance imaging (MRI) techniques to investigate structural and functional brain effects of ECT. As a multi-disciplinary collaboration, imaging findings will be correlated to psychiatric response parameters, neuropsychological functioning as well as neurochemical and genetic biomarkers that can elucidate the underlying mechanisms. The aim is to document both treatment effects and potential harmful effects of ECT. n = 40 patients in a major depressive episode (bipolar and major depressive disorder). Two control groups with n = 15 in each group: age and gender matched healthy volunteers not receiving ECT and patients undergoing electrical cardioversion (ECV) for atrial fibrillation (AF). Observation time: six months. The study will contribute to our understanding of the pathophysiology of major depression as well as mechanisms of action for the most effective treatment for the disorder; ECT.

Mild cognitive impairment in Parkinson's disease is improved by transcranial direct current stimulation combined with physical therapy.

PubMed

Manenti, Rosa; Brambilla, Michela; Benussi, Alberto; Rosini, Sandra; Cobelli, Chiara; Ferrari, Clarissa; Petesi, Michela; Orizio, Italo; Padovani, Alessandro; Borroni, Barbara; Cotelli, Maria

2016-05-01

Parkinson's disease (PD) is characterized by both motor and cognitive deficits. In PD, physical exercise has been found to improve physical functioning. Recent studies demonstrated that repeated sessions of transcranial direct current stimulation led to an increased performance in cognitive and motor tasks in patients with PD. The present study investigated the effects of anodal transcranial direct current stimulation applied over the dorsolateral prefrontal cortex and combined with physical therapy in PD patients. A total of 20 patients with PD were assigned to 1 of 2 study groups: group 1, anodal transcranial direct current stimulation plus physical therapy (n = 10) or group 2, placebo transcranial direct current stimulation plus physical therapy (n = 10). The 2 weeks of treatment consisted of daily direct current stimulation application for 25 minutes during physical therapy. Long-term effects of treatment were evaluated on clinical, neuropsychological, and motor task performance at 3-month follow-up. An improvement in motor abilities and a reduction of depressive symptoms were observed in both groups after the end of treatment and at 3-month follow-up. The Parkinson's Disease Cognitive Rating Scale and verbal fluency test performances increased only in the anodal direct current stimulation group with a stable effect at follow-up. The application of anodal transcranial direct current stimulation may be a relevant tool to improve cognitive abilities in PD and might be a novel therapeutic strategy for PD patients with mild cognitive impairment. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

The influence of winding direction of two-layer HTS DC cable on the critical current

NASA Astrophysics Data System (ADS)

Vyatkin, V. S.; Kashiwagi, K.; Ivanov, Y. V.; Otabe, E. S.; Yamaguchi, S.

2017-09-01

The design of twist pitch and direction of winding in multilayer HTS coaxial cable is important. For HTS AC transmitting cables, the main condition of twist pitch is the balance of inductances of each layer for providing the current balance between layers. In this work, the finite element method analysis for the coaxial cables with both same and opposite directions winding is used to calculate magnetic field distribution, and critical current of the cable is estimated. It was found that the critical current of the cable with same direction winding is about 10 percent higher than that in the case of the cable with the opposite direction winding.

Feasibility of transcranial direct current stimulation use in children aged 5 to 12 years.

PubMed

Andrade, Agnes Carvalho; Magnavita, Guilherme Moreira; Allegro, Juleilda Valéria Brasil Nunes; Neto, Carlos Eduardo Borges Passos; Lucena, Rita de Cássia Saldanha; Fregni, Felipe

2014-10-01

Transcranial direct current stimulation is a noninvasive brain stimulation technique that has been studied for the treatment of neuropsychiatric disorders in adults, with minimal side effects. The objective of this study is to report the feasibility, tolerability, and the short-term adverse effects of transcranial direct current stimulation in children from 5 to 12 years of age. It is a naturalistic study of 14 children who underwent 10 sessions of transcranial direct current stimulation as an alternative, off-label, and open-label treatment for various languages disorders. Frequency, intensity, adverse effects, and perception of improvement reported by parents were collected. The main side effects detected were tingling (28.6%) and itching (28.6%), acute mood changes (42.9%), and irritability (35.7%). Transcranial direct current stimulation is a feasible and tolerable technique in children, although studies regarding plastic and cognitive changes in children are needed to confirm its safety. In conclusion, this is a naturalistic report in which we considered transcranial direct current stimulation as feasible in children. © The Author(s) 2013.

Preliminary Experiment of Non-Inductive Plasma Current Startup in SUNIST Spherical Tokamak

NASA Astrophysics Data System (ADS)

He, Yexi; Zhang, Liang; Xie, Lifeng; Tang, Yi; Yang, Xuanzong; Feng, Chunhua; Fu, Hongjun

2006-01-01

The non-inductive plasma current startup is an important motivation in SUNIST spherical tokamak. In the recent experiment, the magnetron microwave system of 100 kW and 2.45 GHz has been used to the ECR plasma current startup. Besides the toroidal field, a vertical field was applied to generate preliminary toroidal plasma current without the action of the central solenoid. As the evidence of plasma current startup with the effect of vertical field drift, the direction of plasma current is changed when the direction of vertical field changes during the ECR plasma current startup discharge. We also observed a maximum plasma current by scanning vertical field in both directions. Additionally, we used electrode discharge to assist the ECR plasma current startup.

Adjustable direct current and pulsed circuit fault current limiter

DOEpatents

Boenig, Heinrich J.; Schillig, Josef B.

2003-09-23

A fault current limiting system for direct current circuits and for pulsed power circuit. In the circuits, a current source biases a diode that is in series with the circuits' transmission line. If fault current in a circuit exceeds current from the current source biasing the diode open, the diode will cease conducting and route the fault current through the current source and an inductor. This limits the rate of rise and the peak value of the fault current.

The immediate effects of lidocaine iontophoresis using interferential current on pressure sense threshold and tactile sensation.

PubMed

Yoosefinejad, Amin Kordi; Motealleh, Alireza; Abbasnia, Keramatollah

2016-01-01

Iontophoresis is the noninvasive delivery of ions using direct current. The direct current has some disadvantages such as skin burning. Interferential current is a kind of alternating current without limitations of direct current; so the purpose of this study is to investigate and compare the effects of lidocaine, interferential current and lidocaine iontophoresis using interferential current. 30 healthy women aged 20-24 years participated in this randomized clinical trial study. Pressure, tactile and pain thresholds were evaluated before and after the application of treatment methods. Pressure, tactile and pain sensitivity increased significantly after the application of lidocaine alone (p < 0.005) and lidocaine iontophoresis using interferential current (p < 0.0001). Lidocaine iontophoresis using interferential current can increase perception threshold of pain, tactile stimulus and pressure sense more significantly than lidocaine and interferential current alone.

Direct Electric Current Treatment under Physiologic Saline Conditions Kills Staphylococcus epidermidis Biofilms via Electrolytic Generation of Hypochlorous Acid

PubMed Central

Sandvik, Elizabeth L.; McLeod, Bruce R.; Parker, Albert E.; Stewart, Philip S.

2013-01-01

The purpose of this study was to investigate the mechanism by which a direct electrical current reduced the viability of Staphylococcus epidermidis biofilms in conjunction with ciprofloxacin at physiologic saline conditions meant to approximate those in an infected artificial joint. Biofilms grown in CDC biofilm reactors were exposed to current for 24 hours in 1/10th strength tryptic soy broth containing 9 g/L total NaCl. Dose-dependent log reductions up to 6.7 log10 CFU/cm2 were observed with the application of direct current at all four levels (0.7 to 1.8 mA/cm2) both in the presence and absence of ciprofloxacin. There were no significant differences in log reductions for wells with ciprofloxacin compared to those without at the same current levels. When current exposures were repeated without biofilm or organics in the medium, significant generation of free chlorine was measured. Free chlorine doses equivalent to the 24 hour endpoint concentration for each current level were shown to mimic killing achieved by current application. Current exposure (1.8 mA/cm2) in medium lacking chloride and amended with sulfate, nitrate, or phosphate as alternative electrolytes produced diminished kills of 3, 2, and 0 log reduction, respectively. Direct current also killed Pseudomonas aeruginosa biofilms when NaCl was present. Together these results indicate that electrolysis reactions generating hypochlorous acid from chloride are likely a main contributor to the efficacy of direct current application. A physiologically relevant NaCl concentration is thus a critical parameter in experimental design if direct current is to be investigated for in vivo medical applications. PMID:23390518

Direct electric current treatment under physiologic saline conditions kills Staphylococcus epidermidis biofilms via electrolytic generation of hypochlorous acid.

PubMed

Sandvik, Elizabeth L; McLeod, Bruce R; Parker, Albert E; Stewart, Philip S

2013-01-01

The purpose of this study was to investigate the mechanism by which a direct electrical current reduced the viability of Staphylococcus epidermidis biofilms in conjunction with ciprofloxacin at physiologic saline conditions meant to approximate those in an infected artificial joint. Biofilms grown in CDC biofilm reactors were exposed to current for 24 hours in 1/10(th) strength tryptic soy broth containing 9 g/L total NaCl. Dose-dependent log reductions up to 6.7 log(10) CFU/cm(2) were observed with the application of direct current at all four levels (0.7 to 1.8 mA/cm(2)) both in the presence and absence of ciprofloxacin. There were no significant differences in log reductions for wells with ciprofloxacin compared to those without at the same current levels. When current exposures were repeated without biofilm or organics in the medium, significant generation of free chlorine was measured. Free chlorine doses equivalent to the 24 hour endpoint concentration for each current level were shown to mimic killing achieved by current application. Current exposure (1.8 mA/cm(2)) in medium lacking chloride and amended with sulfate, nitrate, or phosphate as alternative electrolytes produced diminished kills of 3, 2, and 0 log reduction, respectively. Direct current also killed Pseudomonas aeruginosa biofilms when NaCl was present. Together these results indicate that electrolysis reactions generating hypochlorous acid from chloride are likely a main contributor to the efficacy of direct current application. A physiologically relevant NaCl concentration is thus a critical parameter in experimental design if direct current is to be investigated for in vivo medical applications.

30 CFR 77.701-2 - Approved methods of grounding metallic frames, casings, and other enclosures of electric...

Code of Federal Regulations, 2010 CFR

2010-07-01

... from a direct-current power system with one polarity grounded will be approved: (1) A solid connection..., casings, and other enclosures of electric equipment receiving power from a direct-current power system. 77... enclosures of electric equipment receiving power from a direct-current power system. (a) The following...

30 CFR 75.701-3 - Approved methods of grounding metallic frames, casings and other enclosures of electric equipment...

Code of Federal Regulations, 2011 CFR

2011-07-01

..., casings and other enclosures of electric equipment receiving power from direct current power systems with... equipment receiving power from direct current power systems with one polarity grounded. For the purpose of... direct-current power system with one polarity grounded, the following methods of grounding will be...

30 CFR 75.701-3 - Approved methods of grounding metallic frames, casings and other enclosures of electric equipment...

Code of Federal Regulations, 2010 CFR

2010-07-01

..., casings and other enclosures of electric equipment receiving power from direct current power systems with... equipment receiving power from direct current power systems with one polarity grounded. For the purpose of... direct-current power system with one polarity grounded, the following methods of grounding will be...

30 CFR 77.701-2 - Approved methods of grounding metallic frames, casings, and other enclosures of electric...

Code of Federal Regulations, 2011 CFR

2011-07-01

... from a direct-current power system with one polarity grounded will be approved: (1) A solid connection..., casings, and other enclosures of electric equipment receiving power from a direct-current power system. 77... enclosures of electric equipment receiving power from a direct-current power system. (a) The following...

30 CFR 75.701-3 - Approved methods of grounding metallic frames, casings and other enclosures of electric equipment...

Code of Federal Regulations, 2013 CFR

2013-07-01

..., casings and other enclosures of electric equipment receiving power from direct current power systems with... equipment receiving power from direct current power systems with one polarity grounded. For the purpose of... direct-current power system with one polarity grounded, the following methods of grounding will be...

30 CFR 75.701-3 - Approved methods of grounding metallic frames, casings and other enclosures of electric equipment...

Code of Federal Regulations, 2014 CFR

2014-07-01

..., casings and other enclosures of electric equipment receiving power from direct current power systems with... equipment receiving power from direct current power systems with one polarity grounded. For the purpose of... direct-current power system with one polarity grounded, the following methods of grounding will be...

30 CFR 75.701-3 - Approved methods of grounding metallic frames, casings and other enclosures of electric equipment...

Code of Federal Regulations, 2012 CFR

2012-07-01

..., casings and other enclosures of electric equipment receiving power from direct current power systems with... equipment receiving power from direct current power systems with one polarity grounded. For the purpose of... direct-current power system with one polarity grounded, the following methods of grounding will be...

Efficacy of transcranial direct-current stimulation in women with provoked vestibulodynia.

PubMed

Morin, Annie; Léonard, Guillaume; Gougeon, Véronique; Cyr, Marie-Pierre; Waddell, Guy; Bureau, Yves-André; Girard, Isabelle; Morin, Mélanie

2017-06-01

Provoked vestibulodynia is a highly prevalent condition characterized by acute recurrent pain located at the vaginal entrance in response to pressure application or attempted vaginal penetration. Despite a wide variety of treatments offered to women with provoked vestibulodynia, a high proportion of women are refractory to conventional treatment. Transcranial direct-current stimulation is a noninvasive brain stimulation technique that has been shown effective for improving various chronic pain conditions. Growing evidence suggests that the central nervous system could play a key role in provoked vestibulodynia. Targeting the central nervous system could therefore be a promising treatment for women with provoked vestibulodynia. The purpose of this study was to evaluate and compare the efficacy of active and sham transcranial direct-current stimulation in reducing pain intensity during intercourse in patients with provoked vestibulodynia. We conducted a triple-blind, parallel-group, randomized controlled trial. Women aged 17-45 years diagnosed with provoked vestibulodynia by a gynecologist using a validated protocol were randomized to 10 sessions of either active transcranial direct-current stimulation (intensity = 2 mA) or 10 sessions of sham transcranial direct-current stimulation, over a 2-week period. Both active and sham transcranial direct-current stimulation were applied for 20 minutes, with the anode positioned over the primary motor cortex, and the cathode over the contralateral supraorbital area. Outcome measures were collected at baseline, 2 weeks after treatment, and at 3-month follow-up by an evaluator blinded to group assignment. The primary objective was to assess pain intensity during intercourse, using a numerical rating scale. Secondary outcomes focused on sexual function and distress, vestibular sensitivity, psychological distress, treatment satisfaction, and patient impression of change. Statistical analyses were conducted on the intention-to-treat basis, and treatment effects were evaluated using a mixed linear model for repeated measures. A total of 40 patients were randomly assigned to receive either active (n = 20) or sham (n = 20) transcranial direct-current stimulation treatments from November 2014 through February 2016. Baseline characteristics were similar between the active and sham transcranial direct-current stimulation groups. In full compliance with the study protocol, every participant followed all courses of the study treatment, including assessments at 2-week and 3-month follow-up. Pain during sexual intercourse was not significantly different between active and sham treatment groups 2 weeks after treatment (P = .84) and at follow-up (P = .09). Mean baseline and 2-week assessment pain intensity were, respectively, 6.8 (95% confidence interval, 5.9-7.7) and 5.6 (95% confidence interval, 4.7-6.5) for active transcranial direct-current stimulation (P = .03) vs 7.5 (95% confidence interval, 6.6-8.4) and 5.7 (95% confidence interval, 4.8-6.6) for sham transcranial direct-current stimulation (P = .001). Nonsignificant differences between the 2 groups were also found in their sexual function and distress after treatment (P > .20) and at follow-up (P > .10). Overall, at 2-week assessment 68% assigned to active transcranial direct-current stimulation reported being very much, much, or slightly improved compared to 65% assigned to sham transcranial direct-current stimulation (P = .82), and still comparable at follow-up: 42% vs 65%, respectively (P = .15). Findings suggest that active transcranial direct-current stimulation is not more effective than sham transcranial direct-current stimulation for reducing pain in women with provoked vestibulodynia. Likewise, no significant effects were found on sexual function, vestibular sensitivity, or psychological distress. Copyright © 2017 Elsevier Inc. All rights reserved.

Electrical stimulation of the motor cortex enhances treatment outcome in post-stroke aphasia.

PubMed

Meinzer, Marcus; Darkow, Robert; Lindenberg, Robert; Flöel, Agnes

2016-04-01

Transcranial direct current stimulation has shown promise to improve recovery in patients with post-stroke aphasia, but previous studies have only assessed stimulation effects on impairment parameters, and evidence for long-term maintenance of transcranial direct current stimulation effects from randomized, controlled trials is lacking. Moreover, due to the variability of lesions and functional language network reorganization after stroke, recent studies have used advanced functional imaging or current modelling to determine optimal stimulation sites in individual patients. However, such approaches are expensive, time consuming and may not be feasible outside of specialized research centres, which complicates incorporation of transcranial direct current stimulation in day-to-day clinical practice. Stimulation of an ancillary system that is functionally connected to the residual language network, namely the primary motor system, would be more easily applicable, but effectiveness of such an approach has not been explored systematically. We conducted a randomized, parallel group, sham-controlled, double-blind clinical trial and 26 patients with chronic aphasia received a highly intensive naming therapy over 2 weeks (8 days, 2 × 1.5 h/day). Concurrently, anodal-transcranial direct current stimulation was administered to the left primary motor cortex twice daily at the beginning of each training session. Naming ability for trained items (n = 60 pictures that could not be named during repeated baseline assessments), transfer to untrained items (n = 284 pictures) and generalization to everyday communication were assessed immediately post-intervention and 6 months later. Naming ability for trained items was significantly improved immediately after the end of the intervention in both the anodal (Cohen's d = 3.67) and sham-transcranial direct current stimulation groups (d = 2.10), with a trend for larger gains in the anodal-transcranial direct current stimulation group (d = 0.71). Treatment effects for trained items were significantly better maintained in the anodal-transcranial direct current stimulation group 6 months later (d = 1.19). Transfer to untrained items was significantly larger in the anodal-transcranial direct current stimulation group after the training (d = 1.49) and during the 6 month follow-up assessment (d = 3.12). Transfer effects were only maintained in the anodal-transcranial direct current stimulation group. Functional communication was significantly more improved in the anodal-transcranial direct current stimulation group at both time points compared to patients treated with sham-transcranial direct current stimulation (d = 0.75-0.99). Our results provide the first evidence from a randomized, controlled trial that transcranial direct current stimulation can improve both function and activity-related outcomes in chronic aphasia, with medium to large effect sizes, and that these effects are maintained over extended periods of time. These effects were achieved with an easy-to-implement and thus clinically feasible motor-cortex montage that may represent a promising 'backdoor' approach to improve language recovery after stroke. © The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effectiveness of transcranial direct current stimulation and visual illusion on neuropathic pain in spinal cord injury

PubMed Central

Kumru, Hatice; Pelayo, Raul; Vidal, Joan; Tormos, Josep Maria; Fregni, Felipe; Navarro, Xavier; Pascual-Leone, Alvaro

2010-01-01

The aim of this study was to evaluate the analgesic effect of transcranial direct current stimulation of the motor cortex and techniques of visual illusion, applied isolated or combined, in patients with neuropathic pain following spinal cord injury. In a sham controlled, double-blind, parallel group design, 39 patients were randomized into four groups receiving transcranial direct current stimulation with walking visual illusion or with control illusion and sham stimulation with visual illusion or with control illusion. For transcranial direct current stimulation, the anode was placed over the primary motor cortex. Each patient received ten treatment sessions during two consecutive weeks. Clinical assessment was performed before, after the last day of treatment, after 2 and 4 weeks follow-up and after 12 weeks. Clinical assessment included overall pain intensity perception, Neuropathic Pain Symptom Inventory and Brief Pain Inventory. The combination of transcranial direct current stimulation and visual illusion reduced the intensity of neuropathic pain significantly more than any of the single interventions. Patients receiving transcranial direct current stimulation and visual illusion experienced a significant improvement in all pain subtypes, while patients in the transcranial direct current stimulation group showed improvement in continuous and paroxysmal pain, and those in the visual illusion group improved only in continuous pain and dysaesthesias. At 12 weeks after treatment, the combined treatment group still presented significant improvement on the overall pain intensity perception, whereas no improvements were reported in the other three groups. Our results demonstrate that transcranial direct current stimulation and visual illusion can be effective in the management of neuropathic pain following spinal cord injury, with minimal side effects and with good tolerability. PMID:20685806

Multitarget transcranial direct current stimulation for freezing of gait in Parkinson's disease.

PubMed

Dagan, Moria; Herman, Talia; Harrison, Rachel; Zhou, Junhong; Giladi, Nir; Ruffini, Giulio; Manor, Brad; Hausdorff, Jeffrey M

2018-04-01

Recent findings suggest that transcranial direct current stimulation of the primary motor cortex may ameliorate freezing of gait. However, the effects of multitarget simultaneous stimulation of motor and cognitive networks are mostly unknown. The objective of this study was to evaluate the effects of multitarget transcranial direct current stimulation of the primary motor cortex and left dorsolateral prefrontal cortex on freezing of gait and related outcomes. Twenty patients with Parkinson's disease and freezing of gait received 20 minutes of transcranial direct current stimulation on 3 separate visits. Transcranial direct current stimulation targeted the primary motor cortex and left dorsolateral prefrontal cortex simultaneously, primary motor cortex only, or sham stimulation (order randomized and double-blinded assessments). Participants completed a freezing of gait-provoking test, the Timed Up and Go, and the Stroop test before and after each transcranial direct current stimulation session. Performance on the freezing of gait-provoking test (P = 0.010), Timed Up and Go (P = 0.006), and the Stroop test (P = 0.016) improved after simultaneous stimulation of the primary motor cortex and left dorsolateral prefrontal cortex, but not after primary motor cortex only or sham stimulation. Transcranial direct current stimulation designed to simultaneously target motor and cognitive regions apparently induces immediate aftereffects in the brain that translate into reduced freezing of gait and improvements in executive function and mobility. © 2018 International Parkinson and Movement Disorder Society. © 2018 International Parkinson and Movement Disorder Society.

Transcranial direct current stimulation for depression in Alzheimer's disease: study protocol for a randomized controlled trial.

PubMed

Narita, Zui; Yokoi, Yuma

2017-06-19

Patients with Alzheimer's disease frequently elicit neuropsychiatric symptoms as well as cognitive deficits. Above all, depression is one of the most common neuropsychiatric symptoms in Alzheimer's disease but antidepressant drugs have not shown significant beneficial effects on it. Moreover, electroconvulsive therapy has not ensured its safety for potential severe adverse events although it does show beneficial clinical effect. Transcranial direct current stimulation can be the safe alternative of neuromodulation, which applies weak direct electrical current to the brain. Although transcranial direct current stimulation has plausible evidence for its effect on depression in young adult patients, no study has explored it in older subjects with depression in Alzheimer's disease. Therefore, we present a study protocol designed to evaluate the safety and clinical effect of transcranial direct current stimulation on depression in Alzheimer's disease in subjects aged over 65 years. This is a two-arm, parallel-design, randomized controlled trial, in which patients and assessors will be blinded. Subjects will be randomized to either an active or a sham transcranial direct current stimulation group. Participants in both groups will be evaluated at baseline, immediately, and 2 weeks after the intervention. This study investigates the safety and effect of transcranial direct current stimulation that may bring a significant impact on both depression and cognition in patients with Alzheimer's disease, and may be useful to enhance their quality of life. ClinicalTrials.gov, NCT02351388 . Registered on 27 January 2015. Last updated on 30 May 2016.

Advanced electric propulsion research - 1990

NASA Technical Reports Server (NTRS)

Monheiser, Jeffery M.; Wilbur, Paul J.

1991-01-01

An experimental study of impingement current collection on the accelerator grid of an ion thruster is presented. The equipment, instruments, and procedures being used to conduct the study are discussed. The contribution to this current due to charge-exchange ions produced close to the grid is determined using a volume-integration procedure and measured ion beam current design, computed neutral atom density and measured beam plasma potential data. This current, which is expected to be almost equal to that measured directly, is found to be an order of magnitude less. The impingement current determined by integrating the current density of ambient ions in the beam plasma close to the grid is found to agree with the directly measured impingement current. Possible reasons for the disagreement between the directly measured and volume integrated impingement currents are discussed.

Voltage-ampere characteristics of YBCO coated conductor under inhomogeneous oscillating magnetic field

NASA Astrophysics Data System (ADS)

Geng, J.; Shen, B.; Li, C.; Zhang, H.; Matsuda, K.; Li, J.; Zhang, X.; Coombs, T. A.

2016-06-01

Direct current carrying type II superconductors present a dynamic resistance when subjected to an oscillating magnetic field perpendicular to the current direction. If a superconductor is under a homogeneous field with high magnitude, the dynamic resistance value is nearly independent of transport current. Hoffmann and coworkers [Hoffmann et al., IEEE Trans. Appl. Supercond. 21, 1628 (2011)] discovered, however, flux pumping effect when a superconducting tape is under an inhomogeneous field orthogonal to the tape surface generated by rotating magnets. Following their work, we report the whole Voltage-Ampere (V-I) curves of an YBCO coated conductor under permanent magnets rotating with different frequencies and directions. We discovered that the two curves under opposite rotating directions differ from each other constantly when the transport current is less than the critical current, whereas the difference gradually reduces after the transport current exceeds the critical value. We also find that for different field frequencies, the difference between the two curves decreases faster with lower field frequency. The result indicates that the transport loss is dependent on the relative direction of the transport current and field travelling, which is distinct from traditional dynamic resistance model. The work may be instructive for the design of superconducting motors.

Current direction-dependent modulation of human hand motor function by intermittent theta burst stimulation (iTBS).

PubMed

Shirota, Yuichiro; Dhaka, Suman; Paulus, Walter; Sommer, Martin

2017-05-22

Transcranial magnetic stimulation (TMS) with different current directions can activate different sets of neurons. Current direction can also affect the results of repetitive TMS. To test the influence of uni-directional intermittent theta burst stimulation (iTBS) using different current directions, namely posteroanterior (PA) and anteroposterior (AP), on motor behaviour. In a cross-over design, PA- and AP-iTBS was applied over the left primary motor cortex in 19 healthy, right-handed volunteers. Performance of a finger-tapping task was recorded before and 0, 10, 20, and 30min after the iTBS. The task was conducted with the right and left hands separately at each time point. As a control, AP-iTBS with reduced intensity was applied to 14 participants in a separate session (AP weak condition). The finger-tapping count with the left hand was decreased after PA-iTBS. Neither AP- nor AP weak -iTBS altered the performance. Current direction had a significant impact on the after-effects of iTBS. Copyright © 2017 Elsevier B.V. All rights reserved.

Design of an intelligent instrument for large direct-current measurement

NASA Astrophysics Data System (ADS)

Zhang, Rong; Zhang, Gang; Zhang, Zhipeng

2000-05-01

The principle and structure of an intelligent large direct current measurement is presented in this paper. It is of reflective type and detects signal by employing the high direct current sensor. The single-chip microcomputer of this system provides a powerful function of control and processing and greatly improves the extent of intelligence. The value can be displayed and printed automatically or manually.

In-vivo Imaging of Magnetic Fields Induced by Transcranial Direct Current Stimulation (tDCS) in Human Brain using MRI

NASA Astrophysics Data System (ADS)

Jog, Mayank V.; Smith, Robert X.; Jann, Kay; Dunn, Walter; Lafon, Belen; Truong, Dennis; Wu, Allan; Parra, Lucas; Bikson, Marom; Wang, Danny J. J.

2016-10-01

Transcranial direct current stimulation (tDCS) is an emerging non-invasive neuromodulation technique that applies mA currents at the scalp to modulate cortical excitability. Here, we present a novel magnetic resonance imaging (MRI) technique, which detects magnetic fields induced by tDCS currents. This technique is based on Ampere’s law and exploits the linear relationship between direct current and induced magnetic fields. Following validation on a phantom with a known path of electric current and induced magnetic field, the proposed MRI technique was applied to a human limb (to demonstrate in-vivo feasibility using simple biological tissue) and human heads (to demonstrate feasibility in standard tDCS applications). The results show that the proposed technique detects tDCS induced magnetic fields as small as a nanotesla at millimeter spatial resolution. Through measurements of magnetic fields linearly proportional to the applied tDCS current, our approach opens a new avenue for direct in-vivo visualization of tDCS target engagement.

Cerebellar transcranial direct current stimulation in patients with ataxia: A double-blind, randomized, sham-controlled study.

PubMed

Benussi, Alberto; Koch, Giacomo; Cotelli, Maria; Padovani, Alessandro; Borroni, Barbara

2015-10-01

Numerous studies have highlighted the possibility of modulating the excitability of cerebellar circuits using transcranial direct current stimulation. The present study investigated whether a single session of cerebellar anodal transcranial direct current stimulation could improve symptoms in patients with ataxia. Nineteen patients with ataxia underwent a clinical and functional evaluation pre- and post-double-blind, randomized, sham, or anodal transcranial direct current stimulation. There was a significant interaction between treatment and time on the Scale for the Assessment and Rating of Ataxia, on the International Cooperative Ataxia Rating Scale, on the 9-Hole Peg Test, and on the 8-Meter Walking Time (P < 0.001). At the end of the sessions, all performance scores were significantly different in the sham trial, compared to the intervention trial. A single session of anodal cerebellar transcranial direct current stimulation can transiently improve symptoms in patients with ataxia and might represent a promising tool for future rehabilitative approaches. © 2015 International Parkinson and Movement Disorder Society.

Transcranial Direct Current Stimulation Potentiates Improvements in Functional Ability in Patients With Chronic Stroke Receiving Constraint-Induced Movement Therapy.

PubMed

Figlewski, Krystian; Blicher, Jakob Udby; Mortensen, Jesper; Severinsen, Kåre Eg; Nielsen, Jørgen Feldbæk; Andersen, Henning

2017-01-01

Transcranial direct current stimulation may enhance effect of rehabilitation in patients with chronic stroke. The objective was to evaluate the efficacy of anodal transcranial direct current stimulation combined with constraint-induced movement therapy of the paretic upper limb. A total of 44 patients with stroke were randomly allocated to receive 2 weeks of constraint-induced movement therapy with either anodal or sham transcranial direct current stimulation. The primary outcome measure, Wolf Motor Function Test, was assessed at baseline and after the intervention by blinded investigators. Both groups improved significantly on all Wolf Motor Function Test scores. Group comparison showed improvement on Wolf Motor Function Test in the anodal group compared with the sham group. Anodal transcranial direct current stimulation combined with constraint-induced movement therapy resulted in improvement of functional ability of the paretic upper limb compared with constraint-induced movement therapy alone. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01983319. © 2016 American Heart Association, Inc.

Short-term anomia training and electrical brain stimulation.

PubMed

Flöel, Agnes; Meinzer, Marcus; Kirstein, Robert; Nijhof, Sarah; Deppe, Michael; Knecht, Stefan; Breitenstein, Caterina

2011-07-01

Language training success in chronic aphasia remains only moderate. Electric brain stimulation may be a viable way to enhance treatment efficacy. In a randomized, double-blind, sham-controlled crossover trial, we assessed if anodal transcranial direct current stimulation compared to cathodal transcranial direct current stimulation and sham stimulation over the right temporo-parietal cortex would improve the success of short-term high-frequency anomia training. Twelve chronic poststroke aphasia patients were studied. Naming outcome was assessed after training and 2 weeks later. All training conditions led to a significant increase in naming ability, which was retained for at least 2 weeks after the end of the training. Application of anodal transcranial direct current stimulation significantly enhanced the overall training effect compared to sham stimulation. Baseline naming ability significantly predicted anodal transcranial direct current stimulation effects. Anodal transcranial direct current stimulation applied over the nonlanguage dominant hemisphere can enhance language training outcome in chronic aphasia. Clinical Trial Registration- URL: www.clinicaltrials.gov/. Unique identifier: NCT00822068.

78 FR 67015 - Airworthiness Directives; Agusta S.p.A. (Type Certificate Currently Held by Agusta Westland...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-08

... Airworthiness Directives; Agusta S.p.A. (Type Certificate Currently Held by Agusta Westland) Helicopters AGENCY... Sec. 39.13 by adding the following new airworthiness directive (AD): 2013-22-16 Agusta S.P.A. (Type... new airworthiness directive (AD) for certain Agusta S.p.A. (Agusta) Model AW139 helicopters. This AD...

EFFECTS OF ELECTRICAL CURRENTS ON THE ABSORPTION OF WATER BY EGGS OF NEREIS LIMBATA

PubMed Central

Osterhout, W. J. V.

1950-01-01

Unfertilized eggs of the marine worm Nereis limbata subjected to electrical currents (direct or alternating) undergo remarkable changes. Certain minute granules just inside the surface of the egg absorb water and swell to more than 300 times their original size and thereby produce a mass of jelly which surrounds the egg with a zone about as wide as the original diameter of the egg. The amount of direct current is too small to produce any change of color in eggs stained with neutral red. In direct current the jelly appears first on the side toward the anode and moves toward the anode. In alternating current it appears on opposite sides facing the electrodes. It might be thought that the current changes the chemical character of the granules so that they are able to absorb very large quantities of water but this seems unlikely. If the current is shut off after 1 minute the swelling continues. This might be explained on the ground that each jelly precursor granule is covered with a waterproof film which is removed by the current. It does not seem probable that the effect is due to heat produced by the current since the exposure is so short. It seems possible that the current may strip off micelles from the waterproof covering of the granules and allow water to penetrate. The fact that alternating current is more effective than direct current might be explained on the ground that the egg may be represented as a capacity in parallel with a resistance so constituted that relatively little direct current can enter. The non-aqueous film which covers the surface of the protoplasm appears to be liquid rather than solid. PMID:15406375

Transcranial Direct Current Stimulation in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder (ADHD): A Pilot Study.

PubMed

Bandeira, Igor Dórea; Guimarães, Rachel Silvany Quadros; Jagersbacher, João Gabriel; Barretto, Thiago Lima; de Jesus-Silva, Jéssica Regina; Santos, Samantha Nunes; Argollo, Nayara; Lucena, Rita

2016-06-01

Studies investigating the possible benefits of transcranial direct current stimulation on left dorsolateral prefrontal cortex in children and adolescents with attention-deficit hyperactivity disorder (ADHD) have not been performed. This study assesses the effect of transcranial direct current stimulation in children and adolescents with ADHD on neuropsychological tests of visual attention, visual and verbal working memory, and inhibitory control. An auto-matched clinical trial was performed involving transcranial direct current stimulation in children and adolescents with ADHD, using SNAP-IV and subtests Vocabulary and Cubes of the Wechsler Intelligence Scale for Children III (WISC-III). Subjects were assessed before and after transcranial direct current stimulation sessions with the Digit Span subtest of the WISC-III, inhibitory control subtest of the NEPSY-II, Corsi cubes, and the Visual Attention Test (TAVIS-3). There were 9 individuals with ADHD according to Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria. There was statistically significant difference in some aspects of TAVIS-3 tests and the inhibitory control subtest of NEPSY-II. Transcranial direct current stimulation can be related to a more efficient processing speed, improved detection of stimuli, and improved ability to switch between an ongoing activity and a new one. © The Author(s) 2016.

Theory of Direct Optical Measurement of Pure Spin Currents in Direct-gap Semiconductors

NASA Astrophysics Data System (ADS)

Wang, Jing; Liu, Ren-Bao; Zhu, Bang-Fen

2010-01-01

We predict that a pure spin current in a semiconductor may lead to the optical circular birefingence effect without invoking magnetization. This effect may be exploited for a direct, non-destructive measurement of the pure spin current. We derive the effective coupling between a pure spin current and a polarized light beam, and point out that it originates from the inherent spin-orbit coupling in the valence bands, rather than the Rashba or Dresselhaus effects due to inversion asymmetries. The Faraday rotation angle in GaAs is estimated, which indicates that this spin current optical birefringence is experimentally observable.

Measuring bi-directional current through a field-effect transistor by virtue of drain-to-source voltage measurement

DOEpatents

Turner, Steven Richard

2006-12-26

A method and apparatus for measuring current, and particularly bi-directional current, in a field-effect transistor (FET) using drain-to-source voltage measurements. The drain-to-source voltage of the FET is measured and amplified. This signal is then compensated for variations in the temperature of the FET, which affects the impedance of the FET when it is switched on. The output is a signal representative of the direction of the flow of current through the field-effect transistor and the level of the current through the field-effect transistor. Preferably, the measurement only occurs when the FET is switched on.

Effects of direct current electric-field using ITO plate on breast cancer cell migration.

PubMed

Kim, Min Sung; Lee, Mi Hee; Kwon, Byeong-Ju; Seo, Hyok Jin; Koo, Min-Ah; You, Kyung Eun; Kim, Dohyun; Park, Jong-Chul

2014-01-01

Cell migration is an essential activity of the cells in various biological phenomena. The evidence that electrotaxis plays important roles in many physiological phenomena is accumulating. In electrotaxis, cells move with a directional tendency toward the anode or cathode under direct-current electric fields. Indium tin oxide, commonly referred to as ITO has high luminous transmittance, high infrared reflectance, good electrical conductivity, excellent substrate adherence, hardness and chemical inertness and hence, have been widely and intensively studied for many years. Because of these properties of ITO films, the electrotaxis using ITO plate was evaluated. Under the 0 V/cm condition, MDA-MB-231 migrated randomly in all directions. When 1 V/cm of dc EF was applied, cells moved toward anode. The y forward migration index was -0.046 ± 0.357 under the 0 V/cm and was 0.273 ± 0.231 under direct-current electric field of 1 V/cm. However, the migration speed of breast cancer cell was not affected by direct-current electric field using ITO plate. In this study, we designed a new electrotaxis system using an ITO coated glass and observed the migration of MDA-MB-231 on direct current electric-field of the ITO glass.

Observations and Simulations of the Impact of Wave-Current Interaction on Wave Direction in the Surf Zone

NASA Astrophysics Data System (ADS)

Hopkins, Julia; Elgar, Steve; Raubenheimer, Britt

2017-04-01

Accurately characterizing the interaction of waves and currents can improve predictions of wave propagation and subsequent sediment transport in the nearshore. Along the southern shoreline of Martha's Vineyard, MA, waves propagate across strong tidal currents as they shoal, providing an ideal environment for investigating wave-current interaction. Wave directions and mean currents observed for two 1-month-long periods in 7- and 2-m water depths along 11 km of the Martha's Vineyard shoreline have strong tidal modulations. Wave directions shift by as much as 70 degrees over a tidal cycle in 7 m depth, and by as much as 25 degrees in 2 m depth. The magnitude of the tidal modulations in the wave field decreases alongshore to the west, consistent with the observed decrease in tidal currents from 2.1 to 0.2 m/s. The observations are reproduced accurately by a numerical model (SWAN and Deflt3D-FLOW) that simulates waves and currents over the observed bathymetry. Model simulations with and without wave-current interaction and tidal depth changes demonstrate that the observed tidal modulations of the wave field primarily are caused by wave-current interaction and not by tidal changes to water depths over the nearby complex shoals. Sediment transport estimates from simulated wave conditions using a range of tidal currents and offshore wave fields indicate that the modulation of the wave field at Martha's Vineyard can impact the direction of wave-induced alongshore sediment transport, sometimes driving transport opposing the direction of the offshore incident wave field. As such, the observations and model simulations suggest the importance of wave-current interaction to tidally averaged transport in mixed-energy wave-and-current nearshore environments. Supported by ASD(R&E), NSF, NOAA (Sea Grant), and ONR.

Digital control of a direct current converter for a hybrid vehicle

NASA Astrophysics Data System (ADS)

Hernandez, Juan Manuel

The nonlinear feedback loops permitting the large signal control of pulse width modulators in direct current converters are discussed. A digital feedback loop on a converter controlling the coupling of a direct current machine is described. It is used in the propulsion of a hybrid vehicle (thermal-electric) with regenerative braking. The protection of the power switches is also studied. An active protection of the MOST bipolar transistor association is proposed.

Augmenting Visual Search Performance with Transcranial Direct Current Stimulation (tDCS)

DTIC Science & Technology

2015-03-01

AFRL-RH-WP-TR-2015-0013 Augmenting Visual Search Performance with transcranial Direct Current Stimulation ( tDCS ) Justin Nelson...Stimulation ( tDCS ) 5a. CONTRACT NUMBER In-House 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Justin Nelson‡, Dr. R. Andy McKinley...evaluate a form of non-invasive brain stimulation known as transcranial direct current stimulation ( tDCS ) over the left frontal eye field (LFEF) region

Field free, directly heated lanthanum boride cathode

DOEpatents

Leung, Ka-Ngo; Moussa, D.; Wilde, S.B.

1987-02-02

A directly heated cylindrical lanthanum boride cathode assembly is disclosed which minimizes generation of magnetic field which would interfere with electron emission from the cathode. The cathode assembly comprises a lanthanum boride cylinder in electrical contact at one end with a central support shaft which functions as one electrode to carry current to the lanthanum boride cylinder and in electrical contact, at its opposite end with a second electrode which is coaxially position around the central support shaft so that magnetic fields generated by heater current flowing in one direction through the central support shaft are cancelled by an opposite magnetic field generated by current flowing through the lanthanum boride cylinder and the coaxial electrode in a direction opposite to the current flow in the central shaft.

Zener diode controls switching of large direct currents

NASA Technical Reports Server (NTRS)

1965-01-01

High-current zener diode is connected in series with the positive input terminal of a dc supply to block the flow of direct current until a high-frequency control signal is applied across the zener diode. This circuit controls the switching of large dc signals.

Current observations offshore Punta Tuna, Puerto Rico, 21 June-7 December 1980. Part A

DOE Office of Scientific and Technical Information (OSTI.GOV)

Frye, D.; Leavitt, K.; Whitney, A.

1981-08-01

An oceanographic measurement program was conducted in the vicinity of a proposed ocean thermal energy conversion (OTEC) site about 20 km offshore of Punta Tuna, Puerto Rico. As part of the program, a mooring consisting of five current meters was maintained between 21 June and 7 December, 1980. The current data collected are summarized according to frequency of occurrence within 5 cm/sec speed and 15/sup 0/ direction intervals. Sums and percentages of total occurrence are given for each speed and direction class, along with mean speed, extreme speeds, mean component speeds, and standard deviations. Hourly averages of current speed, truemore » direction, current vector, temperature, and pressure are plotted as a function of time. On 13 December, 1980, a current meter array was deployed at the Punta Tuna site and recovered on May 16, 1981. The processed current data from this current meter array are described. (LEW)« less

Fiber optic current monitor for high-voltage applications

DOEpatents

Renda, G.F.

1992-04-21

A current monitor which derives its power from the conductor being measured for bidirectionally measuring the magnitude of current (from DC to above 50 khz) flowing through a conductor across which a relatively high level DC voltage is applied, includes a pair of identical transmitter modules connected in opposite polarity to one another in series with the conductor being monitored, for producing from one module a first light signal having an intensity directly proportional to the magnitude of current flowing in one direction through the conductor during one period of time, and from the other module a second light signal having an intensity directly proportional to the magnitude of current flowing in the opposite direction through the conductor during another period of time, and a receiver located in a safe area remote from the high voltage area for receiving the first and second light signals, and converting the same to first and second voltage signals having levels indicative of the magnitude of current being measured at a given time. 6 figs.

Fiber optic current monitor for high-voltage applications

DOEpatents

Renda, George F.

1992-01-01

A current monitor which derives its power from the conductor being measured for bidirectionally measuring the magnitude of current (from DC to above 50 khz) flowing through a conductor across which a relatively high level DC voltage is applied, includes a pair of identical transmitter modules connected in opposite polarity to one another in series with the conductor being monitored, for producing from one module a first light signal having an intensity directly proportional to the magnitude of current flowing in one direction through the conductor during one period of time, and from the other module a second light signal having an intensity directly proportional to the magnitude of current flowing in the opposite direction through the conductor during another period of time, and a receiver located in a safe area remote from the high voltage area for receiving the first and second light signals, and converting the same to first and second voltage signals having levels indicative of the magnitude of current being measured at a given time.

Considering the influence of stimulation parameters on the effect of conventional and high-definition transcranial direct current stimulation.

PubMed

To, Wing Ting; Hart, John; De Ridder, Dirk; Vanneste, Sven

2016-01-01

Recently, techniques to non-invasively modulate specific brain areas gained popularity in the form of transcranial direct current stimulation (tDCS) and high-definition transcranial direct current stimulation. These non-invasive techniques have already shown promising outcomes in various studies with healthy subjects as well as patient populations. Despite widespread dissemination of tDCS, there remain significant unknowns about the influence of a diverse number of tDCS parameters (e.g. polarity, size, position of electrodes & duration of stimulation) in inducing neurophysiological and behavioral effects. This article explores both techniques starting with the history of tDCS, to the differences between conventional tDCS and high-definition transcranial direct current stimulation, the underlying physiological mechanism, the (in)direct effects, the applications of tDCS with varying parameters, the efficacy, the safety issues and the opportunities for future research.

Enhanced motor learning with bilateral transcranial direct current stimulation: Impact of polarity or current flow direction?

PubMed

Naros, Georgios; Geyer, Marc; Koch, Susanne; Mayr, Lena; Ellinger, Tabea; Grimm, Florian; Gharabaghi, Alireza

2016-04-01

Bilateral transcranial direct current stimulation (TDCS) is superior to unilateral TDCS when targeting motor learning. This effect could be related to either the current flow direction or additive polarity-specific effects on each hemisphere. This sham-controlled randomized study included fifty right-handed healthy subjects in a parallel-group design who performed an exoskeleton-based motor task of the proximal left arm on three consecutive days. Prior to training, we applied either sham, right anodal (a-TDCS), left cathodal (c-TDCS), concurrent a-TDCS and c-TDCS with two independent current sources and return electrodes (double source (ds)-TDCS) or classical bilateral stimulation (bi-TDCS). Motor performance improved over time for both unilateral (a-TDCS, c-TDCS) and bilateral (bi-TDCS, ds-TDCS) TDCS montages. However, only the two bilateral paradigms led to an improvement of the final motor performance at the end of the training period as compared to the sham condition. There was no difference between the two bilateral stimulation conditions (bi-TDCS, ds-TDCS). Bilateral TDCS is more effective than unilateral stimulation due to its polarity-specific effects on each hemisphere rather than due to its current flow direction. This study is the first systematic evaluation of stimulation polarity and current flow direction of bi-hemispheric motor cortex TDCS on motor learning of proximal upper limb muscles. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

77 FR 36950 - Airworthiness Directives; Dassault Aviation Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-20

... time between overhauls, and required an initial overhaul, of the direct current (DC) generator... overhauls, and required an initial overhaul, of the DC generator (bearings). That NPRM resulted from... condition as: Time between overhaul (TBO) of DC [direct current] generator bearings is set at 1,000 flight...

Positive predictive value of cardiac examination, procedure and surgery codes in the Danish National Patient Registry: a population-based validation study

PubMed Central

Adelborg, Kasper; Sundbøll, Jens; Munch, Troels; Frøslev, Trine; Sørensen, Henrik Toft; Bøtker, Hans Erik; Schmidt, Morten

2016-01-01

Objective Danish medical registries are widely used for cardiovascular research, but little is known about the data quality of cardiac interventions. We computed positive predictive values (PPVs) of codes for cardiac examinations, procedures and surgeries registered in the Danish National Patient Registry during 2010–2012. Design Population-based validation study. Setting We randomly sampled patients from 1 university hospital and 2 regional hospitals in the Central Denmark Region. Participants 1239 patients undergoing different cardiac interventions. Main outcome measure PPVs with medical record review as reference standard. Results A total of 1233 medical records (99% of the total sample) were available for review. PPVs ranged from 83% to 100%. For examinations, the PPV was overall 98%, reflecting PPVs of 97% for echocardiography, 97% for right heart catheterisation and 100% for coronary angiogram. For procedures, the PPV was 98% overall, with PPVs of 98% for thrombolysis, 92% for cardioversion, 100% for radiofrequency ablation, 98% for percutaneous coronary intervention, and 100% for both cardiac pacemakers and implantable cardiac defibrillators. For cardiac surgery, the overall PPVs was 99%, encompassing PPVs of 100% for mitral valve surgery, 99% for aortic valve surgery, 98% for coronary artery bypass graft surgery, and 100% for heart transplantation. The accuracy of coding was consistent within age, sex, and calendar year categories, and the agreement between independent reviewers was high (99%). Conclusions Cardiac examinations, procedures and surgeries have high PPVs in the Danish National Patient Registry. PMID:27940630

Defibrillation and external pacing in flight: incidence and implications.

PubMed

Daly, Stuart; Milne, Helen J; Holmes, Dan P; Corfield, Alasdair R

2014-01-01

Emergency electrical intervention for patients in the form of defibrillation, cardioversion and external cardiac pacing can be life saving. Advances in medical technology have enabled electrical intervention to be delivered from small, portable devices. With the rising use of air transport for patients, electrical intervention during aeromedical transfer has an increasing incidence. Our aim was to describe the incidence of electrical intervention in a cohort of critically ill patients undergoing aeromedical transfer and review the risks associated with electrical intervention. All secondary retrievals undertaken by a national aeromedical critical care retrieval service were reviewed over a 48-month period. In a mixed medical and trauma critical care population, 11 of 967 (1.1%) secondary retrievals required electrical intervention during aeromedical critical care retrieval. The median age of these patients was 77 years (range 32-86) and the median transport time was 70 min (range 40-100 min). All of these patients had an underlying primary cardiac condition and had been identified as high risk for developing an arrhythmia. Electrical intervention in a transport environment brings unique challenges, particularly during aeromedical transport. Our study in a European model shows that there is a small but significant incidence of electrical intervention required during aeromedical flight for critically ill patients. There are potential safety issues with electrical intervention in aeromedical flight; therefore, any service involved in the transport of critically ill patients needs to have a robust procedure in place to deliver this safely.

A porcine model for acute ischaemic right ventricular dysfunction.

PubMed

Haraldsen, Pernille; Lindstedt, Sandra; Metzsch, Carsten; Algotsson, Lars; Ingemansson, Richard

2014-01-01

To establish an experimental model for acute ischaemic isolated right ventricular dysfunction and the subsequent haemodynamic changes. An open-chest porcine model with ischaemic dysfunction of the right ventricle induced by ligation of the three main branches supporting the right ventricular free wall. Invasive monitoring of mean arterial blood pressure (MAP), central venous pressure (CVP), left atrial pressure (LAP) and right ventricular pressure (RVP); ultrasonic measurement of cardiac output (CO) and calculation of haemodynamic parameters such as stroke volume (SV), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR) and right ventricular stroke work (RVSW) using standard formulae. The ischaemic challenge to the right ventricle resulted in a significant (≥30%) reduction in RVSW associated with an increase (6-25%) in CVP and reduction (8-18%) in pulmonary artery pressure (PAP) despite unchanged PVR, all reflecting the failing right ventricle. There was also a significant drop in CO (14-22%) despite unchanged LAP indicating lessened transpulmonary delivery of left ventricular preload due to the failing right ventricle causing the haemodynamic compromise rather than left ventricular failure. Supraventricular and ventricular arrhythmias occurred in three and two out of seven pigs, respectively-all of which except one were successfully resuscitated with cardioversion and/or defibrillation. This novel open-chest porcine model of induced ischaemia of the right ventricular free wall resulted in significant haemodynamic compromise confirmed using standard haemodynamic measurements making it useful for further research on acute, ischaemic isolated right ventricular failure.

Direct-Current Monitor With Flux-Reset Transformer Coupling

NASA Technical Reports Server (NTRS)

Canter, Stanley

1993-01-01

Circuit measures constant or slowly-varying unidirectional electrical current using flux-reset transformer coupling. Measurement nonintrusive in sense that no need for direct contact with wire that carries load current to be measured, and no need to install series resistive element in load-current path. Toroidal magnetic core wrapped with coil of wire placed around load-current-carrying wire, acts as transformer core, load-current-carrying wire acts as primary winding of transformer, and coil wrapped on core acts as secondary winding.

The control of the upstream movement of fish with pulsated direct current

USGS Publications Warehouse

McLain, Alberton L.

1957-01-01

In the Silver River, 78,648 fish comprising 21 species were taken from the trap of the direct-current diversion device. The total kill of fish moving upstream, including 289 sea lampreys, was 1,016, or 1.3 percent. This river had presented a serious problem in the operation of an alternating-current control device during previous seasons. In 1955, 85.5 percent of three important species of fish were killed at the control structure. During 1956, this mortality was reduced to 8.1 percent by the operation of the direct-current equipment.

An Incubatable Direct Current Stimulation System for In Vitro Studies of Mammalian Cells

PubMed Central

Panitch, Alyssa; Caplan, Michael; Sweeney, James D.

2012-01-01

Abstract The purpose of this study was to provide a simplified alternative technology and format for direct current stimulation of mammalian cells. An incubatable reusable stimulator was developed that effectively delivers a regulated current and does not require constant monitoring. PMID:23514694

Omega-3 Fatty acids: anti-arrhythmic, pro-arrhythmic, or both?

PubMed

von Schacky, C

2012-01-01

This review focuses on developments after 2008, when the topic was last reviewed by the author. Pertinent publications were found by medline searches and in the author's personal data base. Prevention of atrial fibrillation (AF) was investigated in a number of trials, sparked by one positive report on the effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), considerations of upstream therapy, data from electrophysiologic laboratories and animal experiments. If EPA + DHA prevent postoperative AF, the effect is probably smaller than initially expected. The same is probably true for maintenance of sinus rhythm after cardioversion and for new-onset AF. Larger trials are currently ongoing. Prevention of ventricular arrhythmias was studied in carriers of an implanted cardioverter-defibrillator, with no clear results. This might have been due to a broad definition of the primary endpoint, including any ventricular arrhythmia and any action of the device. Epidemiologic studies support the contention that high levels of EPA + DHA prevent sudden cardiac death (SCD). However, since SCD is a rare occurrence, it is difficult to conduct an adequately powered trial. In patients with congestive heart failure, EPA + DHA reduced total mortality and rehospitalizations, but not SCD or presumed arrhythmic death. Of three trials in patients after a myocardial infarction, two were inadequately powered, and in one, the dose might have been too low. Taken together, while epidemiologic studies support an inverse relation between EPA + DHA and occurrence of SCD or arrhythmic death, demonstrating this effect in intervention trials remained elusive so far. A pro-arrhythmic effect of EPA + DHA has not been seen in intervention studies, and results of epidemiologic and animal studies also rather argue against such an effect. A different, and probably more productive, perspective is provided by a standardized analytical assessment of a person's status in EPA + DHA by use of the omega-3 index, EPA + DHA in red cell fatty acids. In populations with a high omega-3 index, SCD is rare. Intervention trials can become more effective by including a low omega-3 index into the inclusion criteria, thus creating a study population more likely to demonstrate an effect of EPA + DHA. This is especially relevant in case of rare endpoints, like new-onset AF or SCD.

Interprofessional and interdisciplinary simulation-based training leads to safe sedation procedures in the emergency department.

PubMed

Sauter, Thomas C; Hautz, Wolf E; Hostettler, Simone; Brodmann-Maeder, Monika; Martinolli, Luca; Lehmann, Beat; Exadaktylos, Aristomenis K; Haider, Dominik G

2016-08-02

Sedation is a procedure required for many interventions in the Emergency department (ED) such as reductions, surgical procedures or cardioversions. However, especially under emergency conditions with high risk patients and rapidly changing interdisciplinary and interprofessional teams, the procedure caries important risks. It is thus vital but difficult to implement a standard operating procedure for sedation procedures in any ED. Reports on both, implementation strategies as well as their success are currently lacking. This study describes the development, implementation and clinical evaluation of an interprofessional and interdisciplinary simulation-based sedation training concept. All physicians and nurses with specialised training in emergency medicine at the Berne University Department of Emergency Medicine participated in a mandatory interdisciplinary and interprofessional simulation-based sedation training. The curriculum consisted of an individual self-learning module, an airway skill training course, three simulation-based team training cases, and a final practical learning course in the operating theatre. Before and after each training session, self-efficacy, awareness of emergency procedures, knowledge of sedation medication and crisis resource management were assessed with a questionnaire. Changes in these measures were compared via paired tests, separately for groups formed based on experience and profession. To assess the clinical effect of training, we collected patient and team satisfaction as well as duration and complications for all sedations in the ED within the year after implementation. We further compared time to beginning of procedure, time for duration of procedure and time until discharge after implementation with the one year period before the implementation. Cohen's d was calculated as effect size for all statistically significant tests. Fifty staff members (26 nurses and 24 physicians) participated in the training. In all subgroups, there is a significant increase in self-efficacy and knowledge with high effect size (d z  = 1.8). The learning is independent of profession and experience level. In the clinical evaluation after implementation, we found no major complications among the sedations performed. Time to procedure significantly improved after the introduction of the training (d = 0.88). Learning is independent of previous working experience and equally effective in raising the self-efficacy and knowledge in all professional groups. Clinical outcome evaluation confirms the concepts safety and feasibility. An interprofessional and interdisciplinary simulation-based sedation training is an efficient way to implement a conscious sedation concept in an ED.

Hemodynamic instability after pulmonary veins isolation in a patient with dual chamber pacemaker

PubMed Central

Kiuchi, Márcio Galindo; Lobato, Guilherme Miglioli; Chen, Shaojie

2017-01-01

Abstract Introduction: The standard treatment of sinus node dysfunction (SND) is the pacemaker implantation, and the ideal methodology for the management of atrial fibrillation (AF) is rhythm control, but this is sometimes very hard to accomplish. For such actions, complete isolation of all pulmonary veins (PVI) is currently widely accepted as the best endpoint. Case Presentation: In this case, we report a female patient, 81 years old, with controlled hypertension, without coronary artery disease, bearer of bilateral knee replacement, and dual chamber pacemaker implanted 1.5 years ago owing to sinus node disease, presenting the following symptoms: presyncope episodes associated with sustained irregular palpitation tachycardia. The evaluation of the pacemaker-recorded episodes of atrial fibrillation, the echocardiogram-presented normal systolic function and measurements, as well as the resting myocardial scintigraphy and with drug use did not demonstrate ischemia and/or fibrosis. The patient was in use of valsartan 320 mg daily, amlodipine 10 mg daily, sotalol hydrochloride 120 mg 2 times daily, and dabigatran 110 mg 2 times daily. At the end of the PVI, the patient presented hemodynamic instability, with a decrease in heart rate to 30 bpm and invasive arterial blood pressure to 60/30 mmHg. The pericardial puncture was quickly carried out with the possibility of cardiac tamponade as the first hypothesis, but no pericardial effusion was found. Next, we detected acute capture loss from the ventricular pacemaker lead, unvarying with high voltage and pulse width, even with stable impedance, sense and keeping the same position visualized by fluoroscopy. And there was soon afterwards induction of sustained ventricular tachycardia degenerating to spontaneous ventricular fibrillation. Electrical cardioversion-defibrillation was performed with 200J, and the sinus rhythm was reestablished, but there was a dead short, and the pacemaker generator was burned and disabled. Conclusions: So, we can speculate that application of atrial radiofrequency for PVI diffused through the tissues, affecting in some way the tip of the ventricular electrode, causing a microlesion in this structure and making it impossible to capture the right ventricle by the pacemaker. As we cannot see it, we can call it of phantom injury of the ventricular lead. PMID:28562571

Hemodynamic instability after pulmonary veins isolation in a patient with dual chamber pacemaker: The phantom injury of the ventricular lead.

PubMed

Kiuchi, Márcio Galindo; Lobato, Guilherme Miglioli; Chen, Shaojie

2017-06-01

The standard treatment of sinus node dysfunction (SND) is the pacemaker implantation, and the ideal methodology for the management of atrial fibrillation (AF) is rhythm control, but this is sometimes very hard to accomplish. For such actions, complete isolation of all pulmonary veins (PVI) is currently widely accepted as the best endpoint. In this case, we report a female patient, 81 years old, with controlled hypertension, without coronary artery disease, bearer of bilateral knee replacement, and dual chamber pacemaker implanted 1.5 years ago owing to sinus node disease, presenting the following symptoms: presyncope episodes associated with sustained irregular palpitation tachycardia. The evaluation of the pacemaker-recorded episodes of atrial fibrillation, the echocardiogram-presented normal systolic function and measurements, as well as the resting myocardial scintigraphy and with drug use did not demonstrate ischemia and/or fibrosis. The patient was in use of valsartan 320 mg daily, amlodipine 10 mg daily, sotalol hydrochloride 120 mg 2 times daily, and dabigatran 110 mg 2 times daily. At the end of the PVI, the patient presented hemodynamic instability, with a decrease in heart rate to 30 bpm and invasive arterial blood pressure to 60/30 mmHg. The pericardial puncture was quickly carried out with the possibility of cardiac tamponade as the first hypothesis, but no pericardial effusion was found. Next, we detected acute capture loss from the ventricular pacemaker lead, unvarying with high voltage and pulse width, even with stable impedance, sense and keeping the same position visualized by fluoroscopy. And there was soon afterwards induction of sustained ventricular tachycardia degenerating to spontaneous ventricular fibrillation. Electrical cardioversion-defibrillation was performed with 200J, and the sinus rhythm was reestablished, but there was a dead short, and the pacemaker generator was burned and disabled. So, we can speculate that application of atrial radiofrequency for PVI diffused through the tissues, affecting in some way the tip of the ventricular electrode, causing a microlesion in this structure and making it impossible to capture the right ventricle by the pacemaker. As we cannot see it, we can call it of phantom injury of the ventricular lead.

Omega-3 Fatty Acids: Anti-Arrhythmic, Pro-Arrhythmic, or Both?

PubMed Central

von Schacky, C.

2012-01-01

This review focuses on developments after 2008, when the topic was last reviewed by the author. Pertinent publications were found by medline searches and in the author’s personal data base. Prevention of atrial fibrillation (AF) was investigated in a number of trials, sparked by one positive report on the effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), considerations of upstream therapy, data from electrophysiologic laboratories and animal experiments. If EPA + DHA prevent postoperative AF, the effect is probably smaller than initially expected. The same is probably true for maintenance of sinus rhythm after cardioversion and for new-onset AF. Larger trials are currently ongoing. Prevention of ventricular arrhythmias was studied in carriers of an implanted cardioverter-defibrillator, with no clear results. This might have been due to a broad definition of the primary endpoint, including any ventricular arrhythmia and any action of the device. Epidemiologic studies support the contention that high levels of EPA + DHA prevent sudden cardiac death (SCD). However, since SCD is a rare occurrence, it is difficult to conduct an adequately powered trial. In patients with congestive heart failure, EPA + DHA reduced total mortality and rehospitalizations, but not SCD or presumed arrhythmic death. Of three trials in patients after a myocardial infarction, two were inadequately powered, and in one, the dose might have been too low. Taken together, while epidemiologic studies support an inverse relation between EPA + DHA and occurrence of SCD or arrhythmic death, demonstrating this effect in intervention trials remained elusive so far. A pro-arrhythmic effect of EPA + DHA has not been seen in intervention studies, and results of epidemiologic and animal studies also rather argue against such an effect. A different, and probably more productive, perspective is provided by a standardized analytical assessment of a person’s status in EPA + DHA by use of the omega-3 index, EPA + DHA in red cell fatty acids. In populations with a high omega-3 index, SCD is rare. Intervention trials can become more effective by including a low omega-3 index into the inclusion criteria, thus creating a study population more likely to demonstrate an effect of EPA + DHA. This is especially relevant in case of rare endpoints, like new-onset AF or SCD. PMID:22529815

Efficacy of transcranial direct current stimulation (tDCS) in reducing consumption in patients with alcohol use disorders: study protocol for a randomized controlled trial.

PubMed

Trojak, Benoit; Soudry-Faure, Agnès; Abello, Nicolas; Carpentier, Maud; Jonval, Lysiane; Allard, Coralie; Sabsevari, Foroogh; Blaise, Emilie; Ponavoy, Eddy; Bonin, Bernard; Meille, Vincent; Chauvet-Gelinier, Jean-Christophe

2016-05-17

Approximately 15 million persons in the European Union and 10 million persons in the USA are alcohol-dependent. The global burden of disease and injury attributable to alcohol is considerable: worldwide, approximately one in 25 deaths in 2004 was caused by alcohol. At the same time, alcohol use disorders remain seriously undertreated. In this context, alternative or adjunctive therapies such as brain stimulation may play a prominent role. The early results of studies using transcranial direct current stimulation found that stimulations delivered to the dorsolateral prefrontal cortex result in a significant reduction of craving and an improvement of the decision-making processes in various additive disorders. We, therefore, hypothesize that transcranial direct current stimulation can lead to a decrease in alcohol consumption in patients suffering from alcohol use disorders. We report the protocol of a randomized, double-blind, placebo-controlled, parallel-group trial, to evaluate the efficacy of transcranial direct current stimulation on alcohol reduction in patients with an alcohol use disorder. The study will be conducted in 14 centers in France and Monaco. Altogether, 340 subjects over 18 years of age and diagnosed with an alcohol use disorder will be randomized to receive five consecutive twice-daily sessions of either active or placebo transcranial direct current stimulation. One session consists in delivering a current flow continuously (anode F4; cathode F3) twice for 13 minutes, with treatments separated by a rest interval of 20 min. Efficacy will be evaluated using the change from baseline (alcohol consumption during the 4 weeks before randomization) to 24 weeks in the total alcohol consumption and number of heavy drinking days. Secondary outcome measures will include alcohol craving, clinical and biological improvements, and the effects on mood and quality of life, as well as cognitive and safety assessments, and, for smokers, an assessment of the effects of transcranial direct current stimulation on tobacco consumption. Several studies have reported a beneficial effect of transcranial direct current stimulation on substance use disorders by reducing craving, impulsivity, and risk-taking behavior, and suggest that transcranial direct current stimulation may be a promising treatment in addiction. However, to date, no studies have included sufficiently large samples and sufficient follow-up to confirm the hypothesis. Results from this large randomized controlled trial will give a better overview of the therapeutic potential of transcranial direct current stimulation in alcohol use disorders. Clinical Trials Gov, NCT02505126 (registration date: July 15 2015).

30 CFR 75.703-2 - Approved grounding mediums.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Approved grounding mediums. 75.703-2 Section 75... mediums. For purposes of grounding offtrack direct-current machines, the following grounding mediums are... alternating current grounding medium where such machines are fed by an ungrounded direct-current power system...

30 CFR 75.703-2 - Approved grounding mediums.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Approved grounding mediums. 75.703-2 Section 75... mediums. For purposes of grounding offtrack direct-current machines, the following grounding mediums are... alternating current grounding medium where such machines are fed by an ungrounded direct-current power system...

30 CFR 75.703-2 - Approved grounding mediums.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Approved grounding mediums. 75.703-2 Section 75... mediums. For purposes of grounding offtrack direct-current machines, the following grounding mediums are... alternating current grounding medium where such machines are fed by an ungrounded direct-current power system...

30 CFR 75.703-2 - Approved grounding mediums.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Approved grounding mediums. 75.703-2 Section 75... mediums. For purposes of grounding offtrack direct-current machines, the following grounding mediums are... alternating current grounding medium where such machines are fed by an ungrounded direct-current power system...

30 CFR 75.703-2 - Approved grounding mediums.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Approved grounding mediums. 75.703-2 Section 75... mediums. For purposes of grounding offtrack direct-current machines, the following grounding mediums are... alternating current grounding medium where such machines are fed by an ungrounded direct-current power system...

Opposite optimal current flow directions for induction of neuroplasticity and excitation threshold in the human motor cortex.

PubMed

Sommer, Martin; Norden, Christoph; Schmack, Lars; Rothkegel, Holger; Lang, Nicolas; Paulus, Walter

2013-05-01

Directional sensitivity is relevant for the excitability threshold of the human primary motor cortex, but its importance for externally induced plasticity is unknown. To study the influence of current direction on two paradigms inducing neuroplasticity by repetitive transcranial magnetic stimulation (rTMS). We studied short-lasting after-effects induced in the human primary motor cortex of 8 healthy subjects, using 5 Hz rTMS applied in six blocks of 200 pulses each, at 90% active motor threshold. We controlled for intensity, frequency, waveform and spinal effects. Only biphasic pulses with the effective component delivered in an anterioposterior direction (henceforth posteriorly directed) in the brain yielded an increase of motor-evoked potential (MEP) amplitudes outlasting rTMS. MEP latencies and F-wave amplitudes remained unchanged. Biphasic pulses directed posteroanterior (i.e. anteriorly) were ineffective, as were monophasic pulses from either direction. A 1 Hz study in a group of 12 healthy subjects confirmed facilitation after posteriorly directed biphasic pulses only. The anisotropy of the human primary motor cortex is relevant for induction of plasticity by subtreshold rTMS, with a current flow opposite to that providing lowest excitability thresholds. This is consistent with the idea of TMS primarily targeting cortical columns of the phylogenetically new M1 in the anterior bank of the central sulcus. For these, anteriorly directed currents are soma-depolarizing, therefore optimal for low thresholds, whereas posteriorly directed currents are soma-hyperpolarizing, likely dendrite-depolarizing and bested suited for induction of plasticity. Our findings should help focus and enhance rTMS effects in experimental and clinical settings. Copyright © 2013 Elsevier Inc. All rights reserved.

Cathodal transcranial direct current stimulation in children with dystonia: a sham-controlled study.

PubMed

Young, Scott J; Bertucco, Matteo; Sanger, Terence D

2014-02-01

Increased motor cortex excitability is a common finding in dystonia, and transcranial direct current stimulation can reduce motor cortex excitability. In an earlier study, we found that cathodal direct-current stimulation decreased motor overflow for some children with dystonia. To investigate this observation further, we performed a sham-controlled, double-blind, crossover study of 14 children with dystonia. We found a significant reduction in overflow following real stimulation, when participants performed the experimental task with the hand contralateral to the cathode. While these results suggest that cathodal stimulation may help some children to reduce involuntary overflow, the size of the effect is small. Further research will need to investigate ways to increase the magnitude of the effect of cathodal transcranial direct current stimulation.

Mechanism of orientation of stimulating currents in magnetic brain stimulation (abstract)

NASA Astrophysics Data System (ADS)

Ueno, S.; Matsuda, T.

1991-04-01

We made a functional map of the human motor cortex related to the hand and foot areas by stimulating the human brain with a focused magnetic pulse. We observed that each functional area in the cortex has an optimum direction for which stimulating currents can produce neural excitation. The present report focuses on the mechanism which is responsible for producing this anisotropic response to brain stimulation. We first obtained a functional map of the brain related to the left ADM (abductor digiti minimi muscles). When the stimulating currents were aligned in the direction from the left to the right hemisphere, clear EMG (electromyographic) responses were obtained only from the left ADM to magnetic stimulation of both hemisphere. When the stimulating currents were aligned in the direction from the right to the left hemisphere, clear EMG signals were obtained only from the right ADM to magnetic stimulation of both hemisphere. The functional maps of the brain were sensitive to changes in the direction of the stimulating currents. To explain the phenomena obtained in the experiments, we developed a model of neural excitation elicited by magnetic stimulation. When eddy currents which are induced by pulsed magnetic fields flow in the direction from soma to the distal part of neural fiber, depolarized area in the distal part are excited, and the membrane excitation propagates along the nerve fiber. In contrast, when the induced currents flow in the direction from the distal part to soma, hyperpolarized parts block or inhibit neural excitation even if the depolarized parts near the soma can be excited. The model explains our observation that the orientation of the induced current vectors reflect both the functional and anatomical organization of the neural fibers in the brain.

Efficacy of transcranial direct-current stimulation (tDCS) in women with provoked vestibulodynia: study protocol for a randomized controlled trial.

PubMed

Morin, Annie; Léonard, Guillaume; Gougeon, Véronique; Waddell, Guy; Bureau, Yves-André; Girard, Isabelle; Morin, Mélanie

2016-05-14

Provoked vestibulodynia is the most common form of vulvodynia. Despite its high prevalence and deleterious sexual, conjugal, and psychological repercussions, effective evidence-based interventions for provoked vestibulodynia remain limited. For a high proportion of women, significant pain persists despite the currently available treatments. Growing evidence suggests that the central nervous system (CNS) could play a key role in provoked vestibulodynia; thus, treatment targeting the CNS, rather than localized dysfunctions, may be beneficial for women suffering from provoked vestibulodynia. In this study, we aim to build on the promising results of a previous case report and evaluate whether transcranial direct-current stimulation, a non-invasive brain stimulation technique targeting the CNS, could be an effective treatment option for women with provoked vestibulodynia. This single-center, triple-blind, parallel group, randomized, controlled trial aims to compare the efficacy of transcranial direct-current stimulation with sham transcranial direct-current stimulation in women with provoked vestibulodynia. Forty women diagnosed with provoked vestibulodynia by a gynecologist, following a standardized treatment protocol, are randomized to either active transcranial direct-current stimulation treatment for ten sessions of 20 minutes at an intensity of 2 mA or sham transcranial direct-current stimulation over a 2-week period. Outcome measures are collected at baseline, 2 weeks after treatment and at 3-month follow-up. The primary outcome is pain during intercourse, assessed with a numerical rating scale. Secondary measurements focus on the sexual function, vestibular pain sensitivity, psychological distress, treatment satisfaction, and the patient's global impression of change. To our knowledge, this study is the first randomized controlled trial to examine the efficacy of transcranial direct-current stimulation in women with provoked vestibulodynia. Findings from this trial are expected to provide significant information about a promising intervention targeting the centralization of pain in women with provoked vestibulodynia. Clinicaltrials.gov, NCT02543593 . Registered on September 4, 2015.

Update Direct-Strike Lightning Environment for Stockpile-to-Target Sequence (Second Revision)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Uman, Martin A.; Rakov, V. A.; Elisme, J. O.

2010-10-05

The University of Florida has surveyed all relevant publications reporting lightning characteristics and presents here an up-to-date version of the direct-strike lightning environment specifications for nuclear weapons published in 1989 by R. J. Fisher and M. A. Uman. Further, we present functional expressions for current vs. time, current derivative vs. time, second current derivative vs. time, charge transfer vs. time, and action integral (specific energy) vs. time for positive and negative first return strokes, for negative subsequent return strokes, and for positive and negative continuing currents; and we give sets of constants for these functional expressions so that the resultantmore » waveforms exhibit approximately the median and extreme lightning parameters presented in the updated direct strike environment. Fourier transforms of the return stroke current waveforms are presented. The results of our literature survey are included in three Appendices entitled Return Stroke Current, Continuing Current, and Positive Lightning.« less

Direct-current resistivity data from 94 sites in northeastern Palm Beach County, Florida

USGS Publications Warehouse

Peterson, Cathleen J.

1988-01-01

Direct-current resistivity data were collected from 94 vertical electric sounding profiles in northeastern Palm Beach County, Florida. Direct-current resistivity data, which may be used to determine the location and thicknesses of shallow, semipermeable marls or locate zones of high chloride concentration, are presented in this report. The resistivity data consist of field data, smoothed data, layer resistivity from smoothed data, and Cartesian graphs of resistivity in relation to depth for 94 sites located in northeastern Palm Beach County. (USGS)

Effect of Modulated Alternating and Direct Current Iontophoresis on Transdermal Delivery of Lidocaine Hydrochloride

PubMed Central

Banga, Ajay K.

2014-01-01

The objective of this study was to investigate the iontophoretic delivery of lidocaine hydrochloride through porcine skin and to compare the effects of modulated alternating and direct current iontophoresis. Continuous and modulated iontophoresis was applied for one hour and two hours (0-1 h and 4-5th h) using a 1% w/v solution of lidocaine hydrochloride. Tape stripping was done to quantify the amount of drug permeated into stratum corneum and skin extraction studies were performed to determine the amount of drug in stripped skin. Receptor was sampled and analyzed over predefined time periods. The amount of lidocaine delivered across porcine skin after modulated direct current iontophoresis for 2 h was 1069.87 ± 120.03 μg/sq·cm compared to 744.81 ± 125.41 μg/sq·cm after modulated alternating current iontophoresis for 2 h. Modulated direct current iontophoresis also enhanced lidocaine delivery by twelvefold compared to passive delivery as 91.27 ± 18.71 μg/sq·cm of lidocaine was delivered after passive delivery. Modulated iontophoresis enhanced the delivery of lidocaine hydrochloride across porcine skin compared to the passive delivery. Modulated alternating current iontophoresis for duration of 2 h at frequency of 1 kHz was found to be comparable to the continuous direct current iontophoresis for 1 h. PMID:24959580

Effect of modulated alternating and direct current iontophoresis on transdermal delivery of lidocaine hydrochloride.

PubMed

Bhatia, Gaurav; Banga, Ajay K

2014-01-01

The objective of this study was to investigate the iontophoretic delivery of lidocaine hydrochloride through porcine skin and to compare the effects of modulated alternating and direct current iontophoresis. Continuous and modulated iontophoresis was applied for one hour and two hours (0-1 h and 4-5th h) using a 1% w/v solution of lidocaine hydrochloride. Tape stripping was done to quantify the amount of drug permeated into stratum corneum and skin extraction studies were performed to determine the amount of drug in stripped skin. Receptor was sampled and analyzed over predefined time periods. The amount of lidocaine delivered across porcine skin after modulated direct current iontophoresis for 2 h was 1069.87 ± 120.03 μ g/sq · cm compared to 744.81 ± 125.41 μ g/sq · cm after modulated alternating current iontophoresis for 2 h. Modulated direct current iontophoresis also enhanced lidocaine delivery by twelvefold compared to passive delivery as 91.27 ± 18.71 μ g/sq · cm of lidocaine was delivered after passive delivery. Modulated iontophoresis enhanced the delivery of lidocaine hydrochloride across porcine skin compared to the passive delivery. Modulated alternating current iontophoresis for duration of 2 h at frequency of 1 kHz was found to be comparable to the continuous direct current iontophoresis for 1 h.

Method for exciting inductive-resistive loads with high and controllable direct current

DOEpatents

Hill, Jr., Homer M.

1976-01-01

Apparatus and method for transmitting dc power to a load circuit by applying a dc voltage from a standard waveform synthesizer to duration modulate a bipolar rectangular wave generator. As the amplitude of the dc voltage increases, the widths of the rectangular wave generator output pulses increase, and as the amplitude of the dc voltage decreases, the widths of the rectangular wave generator output pulses decrease. Thus, the waveform synthesizer selectively changes the durations of the rectangular wave generator bipolar output pulses so as to produce a rectangular wave ac carrier that is duration modulated in accordance with and in direct proportion to the voltage amplitude from the synthesizer. Thereupon, by transferring the carrier to the load circuit through an amplifier and a rectifier, the load current also corresponds directly to the voltage amplitude from the synthesizer. To this end, the rectified wave at less than 100% duty factor, amounts to a doubled frequency direct voltage pulse train for applying a direct current to the load, while the current ripple is minimized by a high L/R in the load circuit. In one embodiment, a power transmitting power amplifier means having a dc power supply is matched to the load circuit through a transformer for current magnification without sacrificing load current duration capability, while negative voltage and current feedback are provided in order to insure good output fidelity.

Helicity-Driven Ratchet Effect Enhanced by Plasmons

NASA Astrophysics Data System (ADS)

Rozhansky, I. V.; Kachorovskii, V. Yu.; Shur, M. S.

2015-06-01

We demonstrate that the ratchet effect—a radiation-induced direct current in periodically modulated structures with built-in asymmetry—is dramatically enhanced in the vicinity of the plasmonic resonances and has a nontrivial polarization dependence. For a circular polarization, the current component, perpendicular to the modulation direction, changes sign with the inversion of the radiation helicity. In the high-mobility structures, this component might increase by several orders of magnitude due to the plasmonic effects and exceed the current component in the modulation direction. Our theory also predicts that in the dirty systems, where the plasma resonances are suppressed, the ratchet current is controlled by the Maxwell relaxation.

Transcranial direct-current stimulation induced in stroke patients with aphasia: a prospective experimental cohort study.

PubMed

Santos, Michele Devido; Gagliardi, Rubens José; Mac-Kay, Ana Paula Machado Goyano; Boggio, Paulo Sergio; Lianza, Roberta; Fregni, Felipe

2013-01-01

Previous animal and human studies have shown that transcranial direct current stimulation can induce significant and lasting neuroplasticity and may improve language recovery in patients with aphasia. The objective of the study was to describe a cohort of patients with aphasia after stroke who were treated with transcranial direct current stimulation. Prospective cohort study developed in a public university hospital. Nineteen patients with chronic aphasia received 10 transcranial direct current stimulation sessions lasting 20 minutes each on consecutive days, using a current of 2 mA. The anode was positioned over the supraorbital area and the cathode over the contralateral motor cortex. The following variables were analyzed before and after the 10 neuromodulation sessions: oral language comprehension, copying, dictation, reading, writing, naming and verbal fluency. There were no adverse effects in the study. We found statistically significant differences from before to after stimulation in relation to simple sentence comprehension (P = 0.034), naming (P = 0.041) and verbal fluency for names of animals (P = 0.038). Improved scores for performing these three tasks were seen after stimulation. We observed that excitability of the primary motor cortex through transcranial direct current stimulation was associated with effects on different aspects of language. This can contribute towards future testing in randomized controlled trials.

Spontaneous Polariton Currents in Periodic Lateral Chains.

PubMed

Nalitov, A V; Liew, T C H; Kavokin, A V; Altshuler, B L; Rubo, Y G

2017-08-11

We predict spontaneous generation of superfluid polariton currents in planar microcavities with lateral periodic modulation of both the potential and decay rate. A spontaneous breaking of spatial inversion symmetry of a polariton condensate emerges at a critical pumping, and the current direction is stochastically chosen. We analyze the stability of the current with respect to the fluctuations of the condensate. A peculiar spatial current domain structure emerges, where the current direction is switched at the domain walls, and the characteristic domain size and lifetime scale with the pumping power.

Surface-Charge-Based Micro-Models--A Solid Foundation for Learning about Direct Current Circuits

ERIC Educational Resources Information Center

Hirvonen, P. E.

2007-01-01

This study explores how the use of a surface-charge-based instructional approach affects introductory university level students' understanding of direct current (dc) circuits. The introduced teaching intervention includes electrostatics, surface-charge-based micro-models that explain the existence of an electric field inside the current-carrying…

78 FR 44042 - Airworthiness Directives; Agusta S.p.A. Helicopters (Type Certificate Currently Held By...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-23

...-0643; Directorate Identifier 2012-SW-096-AD] RIN 2120-AA64 Airworthiness Directives; Agusta S.p.A. Helicopters (Type Certificate Currently Held By AgustaWestland S.P.A) (AgustaWestland) AGENCY: Federal... (Type Certificate Currently Held By Agustawestland S.p.A) (AgustaWestland): Docket No. FAA-2013-0643...

Direction selectivity in the larval zebrafish tectum is mediated by asymmetric inhibition.

PubMed

Grama, Abhinav; Engert, Florian

2012-01-01

The extraction of the direction of motion is an important computation performed by many sensory systems and in particular, the mechanism by which direction-selective retinal ganglion cells (DS-RGCs) in the retina acquire their selective properties, has been studied extensively. However, whether DS-RGCs simply relay this information to downstream areas or whether additional and potentially de novo processing occurs in these recipient structures is a matter of great interest. Neurons in the larval zebrafish tectum, the largest retino-recipent area in this animal, show direction-selective (DS) responses to moving visual stimuli but how these properties are acquired is still unknown. In order to study this, we first used two-photon calcium imaging to classify the population responses of tectal cells to bars moving at different speeds and in different directions. Subsequently, we performed in vivo whole cell electrophysiology on these DS tectal neurons and we found that their inhibitory inputs were strongly biased toward the null direction of motion, whereas the excitatory inputs showed little selectivity. In addition, we found that excitatory currents evoked by a stimulus moving in the preferred direction occurred before the inhibitory currents whereas a stimulus moving in the null direction evoked currents in the reverse temporal order. The membrane potential modulations resulting from these currents were enhanced by the spike generation mechanism to generate amplified direction selectivity in the spike output. Thus, our results implicate a local inhibitory circuit in generating direction selectivity in tectal neurons.

Direction selectivity in the larval zebrafish tectum is mediated by asymmetric inhibition

PubMed Central

Grama, Abhinav; Engert, Florian

2012-01-01

The extraction of the direction of motion is an important computation performed by many sensory systems and in particular, the mechanism by which direction-selective retinal ganglion cells (DS-RGCs) in the retina acquire their selective properties, has been studied extensively. However, whether DS-RGCs simply relay this information to downstream areas or whether additional and potentially de novo processing occurs in these recipient structures is a matter of great interest. Neurons in the larval zebrafish tectum, the largest retino-recipent area in this animal, show direction-selective (DS) responses to moving visual stimuli but how these properties are acquired is still unknown. In order to study this, we first used two-photon calcium imaging to classify the population responses of tectal cells to bars moving at different speeds and in different directions. Subsequently, we performed in vivo whole cell electrophysiology on these DS tectal neurons and we found that their inhibitory inputs were strongly biased toward the null direction of motion, whereas the excitatory inputs showed little selectivity. In addition, we found that excitatory currents evoked by a stimulus moving in the preferred direction occurred before the inhibitory currents whereas a stimulus moving in the null direction evoked currents in the reverse temporal order. The membrane potential modulations resulting from these currents were enhanced by the spike generation mechanism to generate amplified direction selectivity in the spike output. Thus, our results implicate a local inhibitory circuit in generating direction selectivity in tectal neurons. PMID:22969706

Hybrid high direct current circuit interrupter

DOEpatents

Rockot, Joseph H.; Mikesell, Harvey E.; Jha, Kamal N.

1998-01-01

A device and a method for interrupting very high direct currents (greater than 100,000 amperes) and simultaneously blocking high voltages (greater than 600 volts). The device utilizes a mechanical switch to carry very high currents continuously with low loss and a silicon controlled rectifier (SCR) to bypass the current around the mechanical switch while its contacts are separating. A commutation circuit, connected in parallel with the SCR, turns off the SCR by utilizing a resonant circuit to divert the SCR current after the switch opens.

Drug-induced GABA transporter currents enhance GABA release to induce opioid withdrawal behaviors.

PubMed

Bagley, Elena E; Hacker, Jennifer; Chefer, Vladimir I; Mallet, Christophe; McNally, Gavan P; Chieng, Billy C H; Perroud, Julie; Shippenberg, Toni S; Christie, MacDonald J

2011-10-30

Neurotransmitter transporters can affect neuronal excitability indirectly via modulation of neurotransmitter concentrations or directly via transporter currents. A physiological or pathophysiological role for transporter currents has not been described. We found that GABA transporter 1 (GAT-1) cation currents directly increased GABAergic neuronal excitability and synaptic GABA release in the periaqueductal gray (PAG) during opioid withdrawal in rodents. In contrast, GAT-1 did not indirectly alter GABA receptor responses via modulation of extracellular GABA concentrations. Notably, we found that GAT-1-induced increases in GABAergic activity contributed to many PAG-mediated signs of opioid withdrawal. Together, these data support the hypothesis that GAT-1 activity directly produces opioid withdrawal signs through direct hyperexcitation of GABAergic PAG neurons and nerve terminals, which presumably enhances GABAergic inhibition of PAG output neurons. These data provide, to the best of our knowledge, the first evidence that dysregulation of a neurotransmitter transporter current is important for the maladaptive plasticity that underlies opiate withdrawal.

Asymmetry of magnetic motor evoked potentials recorded in calf muscles of the dominant and non-dominant lower extremity.

PubMed

Olex-Zarychta, Dorota; Koprowski, Robert; Sobota, Grzegorz; Wróbel, Zygmunt

2009-08-07

The aim of the study was to determine the applicability of magnetic stimulation and magnetic motor evoked potentials (MEPs) in motor asymmetry studies by obtaining quantitative and qualitative measures of efferent activity during low intensity magnetic stimulation of the dominant and non-dominant lower extremities. Magnetic stimulation of the tibial nerve in the popliteal fossa was performed in 10 healthy male right-handed and right-footed young adults. Responses were recorded from the lateral head of the gastrocnemius muscles of the right and left lower extremities. Response characteristics (duration, onset latency, amplitude) were analyzed in relation to the functional dominance of the limbs and in relation to the direction of the current in the magnetic coil by use of the Wilcoxon pair sequence test. The CCW direction of coil current was related to reduced amplitudes of recorded MEPs. Greater amplitudes of evoked potentials were recorded in the non-dominant extremity, both in the CW and CCW coil current directions, with the statistical significance of this effect (p=0.005). No differences in duration of response were found in the CW current direction, while in CCW the time of the left-side response was prolonged (p=0.01). In the non-dominant extremity longer onset latencies were recorded in both current directions, but only for the CW direction the side asymmetries showed a statistical significance of p=0.005. In the dominant extremity the stimulation correlated with stronger paresthesias, especially using the CCW direction of coil current. The results indicate that low intensity magnetic stimulation may be useful in quantitative and qualitative research into the motor asymmetry.

Pure spin polarized current through a full magnetic silicene junction

NASA Astrophysics Data System (ADS)

Lorestaniweiss, Zeinab; Rashidian, Zeinab

2018-06-01

Using the Landauer-Buttiker formula, we investigate electronic transport in silicene junction composed of ferromagnetic silicene. The direction of magnetization in the middle region may change in a plane perpendicular to the junction, whereas the magnetization direction keep fixed upward in silicene electrodes. We investigate how the various magnetization directions in the middle region affect the electronic transport. We demonstrate that conductance depends on the orientation of magnetizations in the middle region. It is found that by changing the direction of the magnetization in the middle region, a pure spin up current can be achieved. This achievement makes this full magnetic junction a good design for a full spin-up current polarizer.

InP electroluminescence as a tool to directly monitor carrier leakage in InGaAsP/InP buried heterostructure lasers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stern, M.B.; Brody, E.; Sowell, B.

1987-12-15

Direct measurements of homojunction and heterojunction carrier leakage currents in InGaAsP/InP buried heterostructure lasers have been made by monitoring the electroluminescence (EL) at 0.96 ..mu..m in the InP confinement layers. These EL measurements show directly, for the first time, a correlation between homojunction leakage currents and the sublinearity in the 1.3-..mu..m light output-current characteristic. The observed decrease in the 0.96-..mu..m intensity with increasing p-dopant concentration is a direct confirmation that heterojunction leakage is reduced when the doping level in the p-InP confinement layer is increased.

30 CFR 75.524 - Electric face equipment; electric equipment used in return air outby the last open crosscut...

Code of Federal Regulations, 2010 CFR

2010-07-01

... current between frames of equipment. 75.524 Section 75.524 Mineral Resources MINE SAFETY AND HEALTH... the last open crosscut; maximum level of alternating or direct electric current between frames of equipment. The maximum level of alternating or direct electric current that exists between the frames of any...

Influence of waveform and current direction on short-interval intracortical facilitation: a paired-pulse TMS study.

PubMed

Delvendahl, Igor; Lindemann, Hannes; Jung, Nikolai H; Pechmann, Astrid; Siebner, Hartwig R; Mall, Volker

2014-01-01

Transcranial magnetic stimulation (TMS) of the human primary motor hand area (M1-HAND) can produce multiple descending volleys in fast-conducting corticospinal neurons, especially so-called indirect waves (I-waves) resulting from trans-synaptic excitation. Facilitatory interaction between these I-waves can be studied non-invasively using a paired-pulse paradigm referred to as short-interval intracortical facilitation (SICF). We examined whether SICF depends on waveform and current direction of the TMS pulses. In young healthy volunteers, we applied single- and paired-pulse TMS to M1-HAND. We probed SICF by pairs of monophasic or half-sine pulses at suprathreshold stimulation intensity and inter-stimulus intervals (ISIs) between 1.0 and 5.0 ms. For monophasic paired-pulse stimulation, both pulses had either a posterior-anterior (PA) or anterior-posterior (AP) current direction (AP-AP or PA-PA), whereas current direction was reversed between first and second pulse for half-sine paired-pulse stimulation (PA-AP and AP-PA). Monophasic AP-AP stimulation resulted in stronger early SICF at 1.4 ms relative to late SICF at 2.8 and 4.4 ms, whereas monophasic PA-PA stimulation produced SICF of comparable size at all three peaks. With half-sine stimulation the third SICF peak was reduced for PA-AP current orientation compared with AP-PA. SICF elicited using monophasic as well as half-sine pulses is affected by current direction at clearly suprathreshold intensities. The impact of current orientation is stronger for monophasic compared with half-sine pulses. The direction-specific effect of paired-pulse TMS on the strength of early versus late SICF shows that different cortical circuits mediate early and late SICF. Copyright © 2014 Elsevier Inc. All rights reserved.

Analysis of critical thinking ability in direct current electrical problems solving

NASA Astrophysics Data System (ADS)

Hartono; Sunarno, Widha; Sarwanto; Arya Nugraha, Dewanta

2017-11-01

This study concern on analyzing the ability of students in critical thinking skills on the subject matter of direct current electricity. Samples were taken using purposive random sampling consisted of 32 students of grade XI, Multimedia 1, SMK Negeri 3 Surakarta in academic year 2016/2017. This study used descriptive quantitative method. The data were collected using tests and interviews regarding the subject matter of direct current electricity. Based on the results, students are getting some difficulties in solving problem in indicator 4. The average of students’ correct answer is 62.8%.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ramaswamy, B.; Algarin, J. M.; Waks, E., E-mail: edowaks@umd.edu

We demonstrate that spin transfer torque nano-oscillators (STNO) can act as wireless sensors for local current. The STNO acts as a transducer that converts weak direct currents into microwave field oscillations that we detect using an inductive coil. We detect direct currents in the range of 300–700 μA and report them wirelessly to a receiving induction coil at distances exceeding 6.5 mm. This current sensor could find application in chemical and biological sensing and industrial inspection.

On wind-wave-current interactions during the Shoaling Waves Experiment

NASA Astrophysics Data System (ADS)

Zhang, Fei W.; Drennan, William M.; Haus, Brian K.; Graber, Hans C.

2009-01-01

This paper presents a case study of wind-wave-current interaction during the Shoaling Waves Experiment (SHOWEX). Surface current fields off Duck, North Carolina, were measured by a high-frequency Ocean Surface Current Radar (OSCR). Wind, wind stress, and directional wave data were obtained from several Air Sea Interaction Spar (ASIS) buoys moored in the OSCR scanning domain. At several times during the experiment, significant coastal currents entered the experimental area. High horizontal shears at the current edge resulted in the waves at the peak of wind-sea spectra (but not those in the higher-frequency equilibrium range) being shifted away from the mean wind direction. This led to a significant turning of the wind stress vector away from the mean wind direction. The interactions presented here have important applications in radar remote sensing and are discussed in the context of recent radar imaging models of the ocean surface.

Thermodynamics analysis of diffusion in spark plasma sintering welding Cr3C2 and Ni

NASA Astrophysics Data System (ADS)

Zhang, Fan; Zhang, Jinyong; Leng, Xiaoxuan; Lei, Liwen; Fu, Zhengyi

2017-03-01

Spark plasma sintering (SPS) welding of chromium carbide (Cr3C2) and nickel (Ni) was used to investigate the atomic diffusion caused by bypassing current. It was found that the diffusion coefficient with bypassing current was enhanced by almost 3.57 times over that without bypassing current. Different from the previous researches, the thermodynamics analysis conducted herein showed that the enhancement included a current direction-independent part besides the known current direction-dependent part. A local temperature gradient (LTG) model was proposed to explain the current direction-independent effect. Assuming that the LTG was mainly due to the interfacial electric resistance causing heterogeneous Joule heating, the theoretical results were in good agreement with the experimental results both in the present and previous studies. This new LTG model provides a reasonable physical meaning for the low-temperature advantage of SPS welding and should be useful in a wide range of applications.

Updating the landscape of direct-to-consumer pharmacogenomic testing.

PubMed

Filipski, Kelly K; Murphy, John D; Helzlsouer, Kathy J

2017-01-01

Pharmacogenomics has identified important drug-gene interactions that affect the safety and efficacy of medications. Direct-to-consumer genetic testing, when first introduced, included some pharmacogenomic-related genes. The current landscape of pharmacogenomic direct-to-consumer testing is reviewed. Prior published reviews of the literature were updated through February 2017 and a scan of the current availability of direct-to-consumer genomic testing by companies was conducted. Results of the review demonstrate a shift toward physician-approved ordering.

Ohm's law for a current sheet

NASA Technical Reports Server (NTRS)

Lyons, L. R.; Speiser, T. W.

1985-01-01

The paper derives an Ohm's law for single-particle motion in a current sheet, where the magnetic field reverses in direction across the sheet. The result is considerably different from the resistive Ohm's law often used in MHD studies of the geomagnetic tail. Single-particle analysis is extended to obtain a self-consistency relation for a current sheet which agrees with previous results. The results are applicable to the concept of reconnection in that the electric field parallel to the current is obtained for a one-dimensional current sheet with constant normal magnetic field. Dissipated energy goes directly into accelerating particles within the current sheet.

Mutagenic and genotoxic potential of direct electric current in Escherichia coli and Salmonella thyphimurium strains.

PubMed

Gomes, Marina das Neves; Cardoso, Janine Simas; Leitão, Alvaro Costa; Quaresma, Carla Holandino

2016-05-01

Direct electric current has several therapeutic uses such as antibacterial and antiprotozoal action, tissues scarring and regeneration, as well as tumor treatment. This method has shown promising results in vivo and in vitro, with significant efficacy and almost no side effects. Considering lack of studies regarding direct electric current mutagenic and/or genotoxic effects, the present work evaluated both aspects by using five different bacterial experimental assays: survival of repair-deficient mutants, Salmonella-histidine reversion mutagenesis (Ames test), forward mutations to rifampicin resistance, phage reactivation, and lysogenic induction. In these experimental conditions, cells were submitted to an approach that allows evaluation of anodic, cathodic, and electro-ionic effects generated by 2 mA of direct electric current, with doses ranging from 0.36 to 3.60 Coulombs. Our results showed these doses did not induce mutagenic or genotoxic effects. © 2016 Wiley Periodicals, Inc.

Frontal transcranial direct current stimulation (tDCS) abolishes list-method directed forgetting.

PubMed

Silas, Jonathan; Brandt, Karen R

2016-03-11

It is a point of controversy as to whether directed forgetting effects are a result of active inhibition or a change of context initiated by the instruction to forget. In this study we test the causal role of active inhibition in directed forgetting. By applying cathodal transcranial direct current stimulation (tDCS) over the right prefrontal cortex we suppressed cortical activity commonly associated with inhibitory control. Participants who underwent real brain stimulation before completing the directed forgetting paradigm showed no directed forgetting effects. Conversely, those who underwent sham brain stimulation demonstrated classical directed forgetting effects. We argue that these findings suggest that inhibition is the primary mechanism that results in directed forgetting costs and benefits. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Hybrid high direct current circuit interrupter

DOEpatents

Rockot, J.H.; Mikesell, H.E.; Jha, K.N.

1998-08-11

A device and a method are disclosed for interrupting very high direct currents (greater than 100,000 amperes) and simultaneously blocking high voltages (greater than 600 volts). The device utilizes a mechanical switch to carry very high currents continuously with low loss and a silicon controlled rectifier (SCR) to bypass the current around the mechanical switch while its contacts are separating. A commutation circuit, connected in parallel with the SCR, turns off the SCR by utilizing a resonant circuit to divert the SCR current after the switch opens. 7 figs.

A self-sensing active magnetic bearing based on a direct current measurement approach.

PubMed

Niemann, Andries C; van Schoor, George; du Rand, Carel P

2013-09-11

Active magnetic bearings (AMBs) have become a key technology in various industrial applications. Self-sensing AMBs provide an integrated sensorless solution for position estimation, consolidating the sensing and actuating functions into a single electromagnetic transducer. The approach aims to reduce possible hardware failure points, production costs, and system complexity. Despite these advantages, self-sensing methods must address various technical challenges to maximize the performance thereof. This paper presents the direct current measurement (DCM) approach for self-sensing AMBs, denoting the direct measurement of the current ripple component. In AMB systems, switching power amplifiers (PAs) modulate the rotor position information onto the current waveform. Demodulation self-sensing techniques then use bandpass and lowpass filters to estimate the rotor position from the voltage and current signals. However, the additional phase-shift introduced by these filters results in lower stability margins. The DCM approach utilizes a novel PA switching method that directly measures the current ripple to obtain duty-cycle invariant position estimates. Demodulation filters are largely excluded to minimize additional phase-shift in the position estimates. Basic functionality and performance of the proposed self-sensing approach are demonstrated via a transient simulation model as well as a high current (10 A) experimental system. A digital implementation of amplitude modulation self-sensing serves as a comparative estimator.

Direct model-based predictive control scheme without cost function for voltage source inverters with reduced common-mode voltage

NASA Astrophysics Data System (ADS)

Kim, Jae-Chang; Moon, Sung-Ki; Kwak, Sangshin

2018-04-01

This paper presents a direct model-based predictive control scheme for voltage source inverters (VSIs) with reduced common-mode voltages (CMVs). The developed method directly finds optimal vectors without using repetitive calculation of a cost function. To adjust output currents with the CMVs in the range of -Vdc/6 to +Vdc/6, the developed method uses voltage vectors, as finite control resources, excluding zero voltage vectors which produce the CMVs in the VSI within ±Vdc/2. In a model-based predictive control (MPC), not using zero voltage vectors increases the output current ripples and the current errors. To alleviate these problems, the developed method uses two non-zero voltage vectors in one sampling step. In addition, the voltage vectors scheduled to be used are directly selected at every sampling step once the developed method calculates the future reference voltage vector, saving the efforts of repeatedly calculating the cost function. And the two non-zero voltage vectors are optimally allocated to make the output current approach the reference current as close as possible. Thus, low CMV, rapid current-following capability and sufficient output current ripple performance are attained by the developed method. The results of a simulation and an experiment verify the effectiveness of the developed method.

Transcranial direct current stimulation over left inferior frontal cortex improves speech fluency in adults who stutter.

PubMed

Chesters, Jennifer; Möttönen, Riikka; Watkins, Kate E

2018-04-01

See Crinion (doi:10.1093/brain/awy075) for a scientific commentary on this article.Stuttering is a neurodevelopmental condition affecting 5% of children, and persisting in 1% of adults. Promoting lasting fluency improvement in adults who stutter is a particular challenge. Novel interventions to improve outcomes are of value, therefore. Previous work in patients with acquired motor and language disorders reported enhanced benefits of behavioural therapies when paired with transcranial direct current stimulation. Here, we report the results of the first trial investigating whether transcranial direct current stimulation can improve speech fluency in adults who stutter. We predicted that applying anodal stimulation to the left inferior frontal cortex during speech production with temporary fluency inducers would result in longer-lasting fluency improvements. Thirty male adults who stutter completed a randomized, double-blind, controlled trial of anodal transcranial direct current stimulation over left inferior frontal cortex. Fifteen participants received 20 min of 1-mA stimulation on five consecutive days while speech fluency was temporarily induced using choral and metronome-timed speech. The other 15 participants received the same speech fluency intervention with sham stimulation. Speech fluency during reading and conversation was assessed at baseline, before and after the stimulation on each day of the 5-day intervention, and at 1 and 6 weeks after the end of the intervention. Anodal stimulation combined with speech fluency training significantly reduced the percentage of disfluent speech measured 1 week after the intervention compared with fluency intervention alone. At 6 weeks after the intervention, this improvement was maintained during reading but not during conversation. Outcome scores at both post-intervention time points on a clinical assessment tool (the Stuttering Severity Instrument, version 4) also showed significant improvement in the group receiving transcranial direct current stimulation compared with the sham group, in whom fluency was unchanged from baseline. We conclude that transcranial direct current stimulation combined with behavioural fluency intervention can improve fluency in adults who stutter. Transcranial direct current stimulation thereby offers a potentially useful adjunct to future speech therapy interventions for this population, for whom fluency therapy outcomes are currently limited.

Transspinal direct current stimulation modulates migration and proliferation of adult newly born spinal cells in mice.

PubMed

Samaddar, Sreyashi; Vazquez, Kizzy; Ponkia, Dipen; Toruno, Pedro; Sahbani, Karim; Begum, Sultana; Abouelela, Ahmed; Mekhael, Wagdy; Ahmed, Zaghloul

2017-02-01

Direct current electrical fields have been shown to be a major factor in the regulation of cell proliferation, differentiation, migration, and survival, as well as in the maturation of dividing cells during development. During adulthood, spinal cord cells are continuously produced in both animals and humans, and they hold great potential for neural restoration following spinal cord injury. While the effects of direct current electrical fields on adult-born spinal cells cultured ex vivo have recently been reported, the effects of direct current electrical fields on adult-born spinal cells in vivo have not been characterized. Here, we provide convincing findings that a therapeutic form of transspinal direct current stimulation (tsDCS) affects the migration and proliferation of adult-born spinal cells in mice. Specifically, cathodal tsDCS attracted the adult-born spinal cells, while anodal tsDCS repulsed them. In addition, both tsDCS polarities caused a significant increase in cell number. Regarding the potential mechanisms involved, both cathodal and anodal tsDCS caused significant increases in expression of brain-derived neurotrophic factor, while expression of nerve growth factor increased and decreased, respectively. In the spinal cord, both anodal and cathodal tsDCS increased blood flow. Since blood flow and angiogenesis are associated with the proliferation of neural stem cells, increased blood flow may represent a major factor in the modulation of newly born spinal cells by tsDCS. Consequently, we propose that the method and novel findings presented in the current study have the potential to facilitate cellular, molecular, and/or bioengineering strategies to repair injured spinal cords. NEW & NOTEWORTHY Our results indicate that transspinal direct current stimulation (tsDCS) affects the migratory pattern and proliferation of adult newly born spinal cells, a cell population which has been implicated in learning and memory. In addition, our results suggest a potential mechanism of action regarding the functional effects of applying direct current. Thus tsDCS may represent a novel method by which to manipulate the migration and cell number of adult newly born cells and restore functions following brain or spinal cord injury. Copyright © 2017 the American Physiological Society.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moore, S. A.; Plummer, G.; Fedor, J.

Mapping the distribution of currents inside a superconductor is usually performed indirectly through imaging of the stray magnetic fields above the surface. Here, we show that by direct imaging of the Doppler shift contribution to the quasiparticle excitation spectrum in the superconductor using low temperature scanning tunneling microscopy, we obtain directly the distribution of supercurrents inside the superconductor. We demonstrate the technique at the example of superconductor/ferromagnet hybrid structure that produces intricate current pattern consisting of combination Meissner shielding currents and Abrikosov vortex currents.

Helicopter Rotor Noise Prediction: Background, Current Status, and Future Direction

NASA Technical Reports Server (NTRS)

Brentner, Kenneth S.

1997-01-01

Helicopter noise prediction is increasingly important. The purpose of this viewgraph presentation is to: 1) Put into perspective the recent progress; 2) Outline current prediction capabilities; 3) Forecast direction of future prediction research; 4) Identify rotorcraft noise prediction needs. The presentation includes an historical perspective, a description of governing equations, and the current status of source noise prediction.

Symmetric voltage-controlled variable resistance

NASA Technical Reports Server (NTRS)

Vanelli, J. C.

1978-01-01

Feedback network makes resistance of field-effect transistor (FET) same for current flowing in either direction. It combines control voltage with source and load voltages to give symmetric current/voltage characteristics. Since circuit produces same magnitude output voltage for current flowing in either direction, it introduces no offset in presense of altering polarity signals. It is therefore ideal for sensor and effector circuits in servocontrol systems.

Microinverters for employment in connection with photovoltaic modules

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lentine, Anthony L.; Nielson, Gregory N.; Okandan, Murat

2015-09-22

Microinverters useable in association with photovoltaic modules are described. A three phase-microinverter receives direct current output generated by a microsystems-enabled photovoltaic cell and converts such direct current output into three-phase alternating current out. The three-phase microinverter is interleaved with other three-phase-microinverters, wherein such microinverters are integrated in a photovoltaic module with the microsystems-enabled photovoltaic cell.

Mental Models of Elementary and Middle School Students in Analyzing Simple Battery and Bulb Circuits

ERIC Educational Resources Information Center

Jabot, Michael; Henry, David

2007-01-01

Written assessment items were developed to probe students' understanding of a variety of direct current (DC) resistive electric circuit concepts. The items were used to explore the mental models that grade 3-8 students use in explaining the direction of electric current and how electric current is affected by different configurations of simple…

78 FR 37162 - Airworthiness Directives; Agusta S.p.A. (Type Certificate Currently Held by AgustaWestland S.p.A...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-20

...-0518; Directorate Identifier 2009-SW-021-AD] RIN 2120-AA64 Airworthiness Directives; Agusta S.p.A. (Type Certificate Currently Held by AgustaWestland S.p.A) (Agusta) Helicopters AGENCY: Federal Aviation....p.A. (Type Certificate Currently Held By Agustawestland S.p.A.) (Agusta): Docket No. FAA-2013-0518...

77 FR 73273 - Airworthiness Directives; Agusta S.p.A. (Type Certificate Currently Held by AgustaWestland S.p.A...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-10

... Airworthiness Directives; Agusta S.p.A. (Type Certificate Currently Held by AgustaWestland S.p.A.) (Agusta.... Helicopters (Type Certificate Currently Held By AgustaWestland S.P.A.) (Agusta): Amendment 39-17281; Docket No... ``Mail'' address between 9 a.m. and 5 p.m., Monday through Friday, except Federal holidays. Examining the...

Geometrical control of pure spin current induced domain wall depinning.

PubMed

Pfeiffer, A; Reeve, R M; Voto, M; Savero-Torres, W; Richter, N; Vila, L; Attané, J P; Lopez-Diaz, L; Kläui, Mathias

2017-03-01

We investigate the pure spin-current assisted depinning of magnetic domain walls in half ring based Py/Al lateral spin valve structures. Our optimized geometry incorporating a patterned notch in the detector electrode, directly below the Al spin conduit, provides a tailored pinning potential for a transverse domain wall and allows for a precise control over the magnetization configuration and as a result the domain wall pinning. Due to the patterned notch, we are able to study the depinning field as a function of the applied external field for certain applied current densities and observe a clear asymmetry for the two opposite field directions. Micromagnetic simulations show that this can be explained by the asymmetry of the pinning potential. By direct comparison of the calculated efficiencies for different external field and spin current directions, we are able to disentangle the different contributions from the spin transfer torque, Joule heating and the Oersted field. The observed high efficiency of the pure spin current induced spin transfer torque allows for a complete depinning of the domain wall at zero external field for a charge current density of [Formula: see text] A m -2 , which is attributed to the optimal control of the position of the domain wall.

Effect of asymmetrical eddy currents on magnetic diagnosis signals for equilibrium reconstruction in the Sino-UNIted Spherical Tokamak.

PubMed

Jiang, Y Z; Tan, Y; Gao, Z; Wang, L

2014-11-01

The vacuum vessel of Sino-UNIted Spherical Tokamak was split into two insulated hemispheres, both of which were insulated from the central cylinder. The eddy currents flowing in the vacuum vessel would become asymmetrical due to discontinuity. A 3D finite elements model was applied in order to study the eddy currents. The modeling results indicated that when the Poloidal Field (PF) was applied, the induced eddy currents would flow in the toroidal direction in the center of the hemispheres and would be forced to turn to the poloidal and radial directions due to the insulated slit. Since the eddy currents converged on the top and bottom of the vessel, the current densities there tended to be much higher than those in the equatorial plane were. Moreover, the eddy currents on the top and bottom of vacuum vessel had the same direction when the current flowed in the PF coils. These features resulted in the leading phases of signals on the top and bottom flux loops when compared with the PF waveforms.

Direct current ballast circuit for metal halide lamp

NASA Technical Reports Server (NTRS)

Lutus, P. (Inventor)

1981-01-01

A direct current ballast circuit for a two electrode metal halide lamp is described. Said direct current ballast circuit includes a low voltage DC input and a high frequency power amplifier and power transformer for developing a high voltage output. The output voltage is rectified by diodes and filtered by inductor and capacitor to provide a regulated DC output through commutating diodes to one terminal of the lamp at the output terminal. A feedback path from the output of the filter capacitor through the bias resistor to power the high frequency circuit which includes the power amplifier and the power transformer for sustaining circuit operations during low voltage transients on the input DC supply is described. A current sensor connected to the output of the lamp through terminal for stabilizing lamp current following breakdown of the lamp is described.

Transcranial cerebellar direct current stimulation and transcutaneous spinal cord direct current stimulation as innovative tools for neuroscientists

PubMed Central

Priori, Alberto; Ciocca, Matteo; Parazzini, Marta; Vergari, Maurizio; Ferrucci, Roberta

2014-01-01

Two neuromodulatory techniques based on applying direct current (DC) non-invasively through the skin, transcranial cerebellar direct current stimulation (tDCS) and transcutaneous spinal DCS, can induce prolonged functional changes consistent with a direct influence on the human cerebellum and spinal cord. In this article we review the major experimental works on cerebellar tDCS and on spinal tDCS, and their preliminary clinical applications. Cerebellar tDCS modulates cerebellar motor cortical inhibition, gait adaptation, motor behaviour, and cognition (learning, language, memory, attention). Spinal tDCS influences the ascending and descending spinal pathways, and spinal reflex excitability. In the anaesthetised mouse, DC stimulation applied under the skin along the entire spinal cord may affect GABAergic and glutamatergic systems. Preliminary clinical studies in patients with cerebellar disorders, and in animals and patients with spinal cord injuries, have reported beneficial effects. Overall the available data show that cerebellar tDCS and spinal tDCS are two novel approaches for inducing prolonged functional changes and neuroplasticity in the human cerebellum and spinal cord, and both are new tools for experimental and clinical neuroscientists. PMID:24907311

Document for 270 Voltage Direct Current (270 V dc) System

NASA Astrophysics Data System (ADS)

1992-09-01

The paper presents the technical design and application information established by the SAE Aerospace Recommended Practice concerning the generation, distribution, control, and utilization of aircraft 270 V dc electrical power systems and support equipment. Also presented are references and definitions making it possible to compare various electrical systems and components. A diagram of the generic 270 V Direct Current High-Voltage Direct System is included.

Cascaded resonant bridge converters

NASA Technical Reports Server (NTRS)

Stuart, Thomas A. (Inventor)

1989-01-01

A converter for converting a low voltage direct current power source to a higher voltage, high frequency alternating current output for use in an electrical system where it is desired to use low weight cables and other circuit elements. The converter has a first stage series resonant (Schwarz) converter which converts the direct current power source to an alternating current by means of switching elements that are operated by a variable frequency voltage regulator, a transformer to step up the voltage of the alternating current, and a rectifier bridge to convert the alternating current to a direct current first stage output. The converter further has a second stage series resonant (Schwarz) converter which is connected in series to the first stage converter to receive its direct current output and convert it to a second stage high frequency alternating current output by means of switching elements that are operated by a fixed frequency oscillator. The voltage of the second stage output is controlled at a relatively constant value by controlling the first stage output voltage, which is accomplished by controlling the frequency of the first stage variable frequency voltage controller in response to second stage voltage. Fault tolerance in the event of a load short circuit is provided by making the operation of the first stage variable frequency voltage controller responsive to first and second stage current limiting devices. The second stage output is connected to a rectifier bridge whose output is connected to the input of the second stage to provide good regulation of output voltage wave form at low system loads.

The current state, main problems and directions in improving water chemistry at NPSs

NASA Astrophysics Data System (ADS)

Tyapkov, V. F.; Sharafutdinov, R. B.

2007-05-01

An analysis of the current state of managing water-chemistry (WC) at Russian nuclear power plants with type-VVER and-RBMK reactors presently in operation is presented. The main directions for improvement of WC are shown.

Pump-Probe Noise Spectroscopy of Molecular Junctions.

PubMed

Ochoa, Maicol A; Selzer, Yoram; Peskin, Uri; Galperin, Michael

2015-02-05

The slow response of electronic components in junctions limits the direct applicability of pump-probe type spectroscopy in assessing the intramolecular dynamics. Recently the possibility of getting information on a sub-picosecond time scale from dc current measurements was proposed. We revisit the idea of picosecond resolution by pump-probe spectroscopy from dc measurements and show that any intramolecular dynamics not directly related to charge transfer in the current direction is missed by current measurements. We propose a pump-probe dc shot noise spectroscopy as a suitable alternative. Numerical examples of time-dependent and average responses of junctions are presented for generic models.

Helicopter noise prediction - The current status and future direction

NASA Technical Reports Server (NTRS)

Brentner, Kenneth S.; Farassat, F.

1992-01-01

The paper takes stock of the progress, assesses the current prediction capabilities, and forecasts the direction of future helicopter noise prediction research. The acoustic analogy approach, specifically, theories based on the Ffowcs Williams-Hawkings equations, are the most widely used for deterministic noise sources. Thickness and loading noise can be routinely predicted given good plane motion and blade loading inputs. Blade-vortex interaction noise can also be predicted well with measured input data, but prediction of airloads with the high spatial and temporal resolution required for BVI is still difficult. Current semiempirical broadband noise predictions are useful and reasonably accurate. New prediction methods based on a Kirchhoff formula and direct computation appear to be very promising, but are currently very demanding computationally.

Morphology and Orientation Selection of Non-metallic Inclusions in Electrified Molten Metal

NASA Astrophysics Data System (ADS)

Zhao, Z. C.; Qin, R. S.

2017-10-01

The effect of electric current on morphology and orientation selection of non-metallic inclusions in molten metal has been investigated using theoretical modeling and numerical calculation. Two geometric factors, namely the circularity ( fc ) and alignment ratio ( fe ) were introduced to describe the inclusions shape and configuration. Electric current free energy was calculated and the values were used to determine the thermodynamic preference between different microstructures. Electric current promotes the development of inclusion along the current direction by either expatiating directional growth or enhancing directional agglomeration. Reconfiguration of the inclusions to reduce the system electric resistance drives the phenomena. The morphology and orientation selection follow the routine to reduce electric free energy. The numerical results are in agreement with our experimental observations.

Direct current power delivery system and method

DOEpatents

Zhang, Di; Garces, Luis Jose; Dai, Jian; Lai, Rixin

2016-09-06

A power transmission system includes a first unit for carrying out the steps of receiving high voltage direct current (HVDC) power from an HVDC power line, generating an alternating current (AC) component indicative of a status of the first unit, and adding the AC component to the HVDC power line. Further, the power transmission system includes a second unit for carrying out the steps of generating a direct current (DC) voltage to transfer the HVDC power on the HVDC power line, wherein the HVDC power line is coupled between the first unit and the second unit, detecting a presence or an absence of the added AC component in the HVDC power line, and determining the status of the first unit based on the added AC component.

Transformer coupling for transmitting direct current through a barrier

DOEpatents

Brown, Ralph L.; Guilford, Richard P.; Stichman, John H.

1988-01-01

The transmission system for transmitting direct current from an energy source on one side of an electrical and mechanical barrier to a load on the other side of the barrier utilizes a transformer comprising a primary core on one side of the transformer and a secondary core on the other side of the transformer. The cores are magnetically coupled selectively by moving a magnetic ferrite coupler in and out of alignment with the poles of the cores. The direct current from the energy source is converted to a time varying current by an oscillating circuit, which oscillating circuit is optically coupled to a secondary winding on the secondary core to interrupt oscillations upon the voltage in the secondary winding exceeding a preselected level.

Transformer coupling for transmitting direct current through a barrier

DOEpatents

Brown, R.L.; Guilford, R.P.; Stichman, J.H.

1987-06-29

The transmission system for transmitting direct current from an energy source on one side of an electrical and mechanical barrier to a load on the other side of the barrier utilizes a transformer comprising a primary core on one side of the transformer and a secondary core on the other side of the transformer. The cores are magnetically coupled selectively by moving a magnetic ferrite coupler in and out of alignment with the poles of the cores. The direct current from the energy source is converted to a time varying current by an oscillating circuit, which oscillating circuit is optically coupled to a secondary winding on the secondary core to interrupt oscillations upon the voltage in the secondary winding exceeding a preselected level. 4 figs.

Transcranial direct current stimulation enhances recovery of stereopsis in adults with amblyopia.

PubMed

Spiegel, Daniel P; Li, Jinrong; Hess, Robert F; Byblow, Winston D; Deng, Daming; Yu, Minbin; Thompson, Benjamin

2013-10-01

Amblyopia is a neurodevelopmental disorder of vision caused by abnormal visual experience during early childhood that is often considered to be untreatable in adulthood. Recently, it has been shown that a novel dichoptic videogame-based treatment for amblyopia can improve visual function in adult patients, at least in part, by reducing inhibition of inputs from the amblyopic eye to the visual cortex. Non-invasive anodal transcranial direct current stimulation has been shown to reduce the activity of inhibitory cortical interneurons when applied to the primary motor or visual cortex. In this double-blind, sham-controlled cross-over study we tested the hypothesis that anodal transcranial direct current stimulation of the visual cortex would enhance the therapeutic effects of dichoptic videogame-based treatment. A homogeneous group of 16 young adults (mean age 22.1 ± 1.1 years) with amblyopia were studied to compare the effect of dichoptic treatment alone and dichoptic treatment combined with visual cortex direct current stimulation on measures of binocular (stereopsis) and monocular (visual acuity) visual function. The combined treatment led to greater improvements in stereoacuity than dichoptic treatment alone, indicating that direct current stimulation of the visual cortex boosts the efficacy of dichoptic videogame-based treatment. This intervention warrants further evaluation as a novel therapeutic approach for adults with amblyopia.

Transcranial Direct Current Stimulation Improves Audioverbal Memory in Stroke Patients

PubMed Central

Kazuta, Toshinari; Takeda, Kotaro; Osu, Rieko; Tanaka, Satoshi; Oishi, Ayako; Kondo, Kunitsugu; Liu, Meigen

2017-01-01

Objective The aim of this study was to investigate whether anodal transcranial direct current stimulation over the left temporoparietal area improved audioverbal memory performance in stroke patients. Design Twelve stroke patients with audioverbal memory impairment participated in a single-masked, crossover, and sham-controlled experiment. The anodal or sham transcranial direct current stimulation was applied during the Rey Auditory Verbal Learning Test, which evaluates the ability to recall a list of 15 heard words over five trials. The number of correctly recalled words was compared between the anodal and sham conditions and the influence of transcranial direct current stimulation on serial position effect of the 15 words was also examined. Results The increase in the number of correctly recalled words from the first to the fifth trial was significantly greater in the anodal condition than in the sham condition (P < 0.01). There was a significant difference (P < 0.01) between the anodal and sham conditions in the number of correctly recalled words within the first five words (primacy region) over the second to fifth trial trials, but not in the middle (next five words) or recency (last five words) regions. Conclusions Anodal transcranial direct current stimulation over the left temporoparietal area improved audioverbal memory performance and induced the primacy effect in stroke patients. PMID:28085735

Transcranial Direct Current Stimulation Does Not Improve Language Outcome in Subacute Poststroke Aphasia.

PubMed

Spielmann, Kerstin; van de Sandt-Koenderman, W Mieke E; Heijenbrok-Kal, Majanka H; Ribbers, Gerard M

2018-04-01

The aim of the present study is to investigate the effect of transcranial direct current stimulation on word-finding treatment outcome in subacute poststroke aphasia. In this multi-center, double-blind, randomized controlled trial with 6-month follow-up, we included 58 patients with subacute aphasia (<3 months poststroke), who were enrolled in a stroke rehabilitation program. Patients participated in 2 separate intervention weeks. Each intervention week included 5 daily sessions of 45-minute word-finding therapy combined with either anodal transcranial direct current stimulation (1 mA, 20 minutes; experimental group) or sham transcranial direct current stimulation (control group) over the left inferior frontal gyrus. The primary outcome measure was the Boston Naming Test. Secondary outcome measures included naming performance for trained/untrained picture items and verbal communication. Both the experimental (n=26) and the control group (n=32) improved on the Boston Naming Test over the intervention period and 6-month follow-up; however, there were no significant differences between groups. Also for the secondary outcome measures, no significant differences were found. The results of the present study do not support an effect of transcranial direct current stimulation as an adjuvant treatment in subacute poststroke aphasia. URL: http://www.trialregister.nl/trialreg/admin/rctview.asp. Unique identifier: NTR4364. © 2018 American Heart Association, Inc.

Transcranial Direct Current Stimulation Improves Audioverbal Memory in Stroke Patients.

PubMed

Kazuta, Toshinari; Takeda, Kotaro; Osu, Rieko; Tanaka, Satoshi; Oishi, Ayako; Kondo, Kunitsugu; Liu, Meigen

2017-08-01

The aim of this study was to investigate whether anodal transcranial direct current stimulation over the left temporoparietal area improved audioverbal memory performance in stroke patients. Twelve stroke patients with audioverbal memory impairment participated in a single-masked, crossover, and sham-controlled experiment. The anodal or sham transcranial direct current stimulation was applied during the Rey Auditory Verbal Learning Test, which evaluates the ability to recall a list of 15 heard words over five trials. The number of correctly recalled words was compared between the anodal and sham conditions and the influence of transcranial direct current stimulation on serial position effect of the 15 words was also examined. The increase in the number of correctly recalled words from the first to the fifth trial was significantly greater in the anodal condition than in the sham condition (P < 0.01). There was a significant difference (P < 0.01) between the anodal and sham conditions in the number of correctly recalled words within the first five words (primacy region) over the second to fifth trial trials, but not in the middle (next five words) or recency (last five words) regions. Anodal transcranial direct current stimulation over the left temporoparietal area improved audioverbal memory performance and induced the primacy effect in stroke patients.

Currents' spatial structure in the Western, Central and South-Eastern Baltic on the base of numerical model and ADCP data analysis

NASA Astrophysics Data System (ADS)

Golenko, Mariya; Golenko, Nikolay

2014-05-01

Numerical modeling of the currents' spatial structure in some regions of the Baltic Sea is performed on the base of POM (Princeton Ocean Model). The calculations were performed under the westerly (most frequent in the Baltic) and north-easterly wind forcings. In the regions adjacent to the Kaliningrad Region's, Polish and Lithuanian coasts these winds generate oppositely directed geostrophic, drift and others types of currents. On the whole these processes can be considered as downwelling and upwelling. Apart from the regions mentioned above the Slupsk Furrow region, which determines the mass and momentum exchange between the Western and Central Baltic, is also considered. During the analysis of currents not only the whole model velocity but also components directed along and across the barotropic geostrophic current velocity are considered. The along geostrophic component for one's turn is separated into the geostrophic current itself and an ageostrophic part. The across geostrophic component is totally ageostrophic. The velocity components directed along and across the geostrophic current approximately describe the velocity components directed along the coast (along isobathes) and from the coast towards the open sea. The suggested approach allowed to present the currents' spatial structures typical for different wind forcings as two maps with the components directed along and across the barotropic geostrophic current velocity. On these maps the areas of the intensive alongshore currents are clearly depicted (for ex. near the base of the Hel Spit, in the region of the Slupsk Sill). The combined analysis of the vectors of the whole and geostrophic velocities allows to reveal the areas where the geostrophic component is significantly strengthened or weakened by the ageostrophic component. Under the westerly wind such currents' features are clearly observed near the end of the Hel Spit and at the southern boarder of the Slupsk Sill, under the north-easterly wind - near the base of the Hel Spit, at the southern boarder of the Slupsk Furrow, near the Curonian Spit (where the relief is bent). On the maps presenting the spatial distributions of the across shore velocities the areas where the mass and momentum transport from the shore to the open sea in the surface layer and vice versa takes place are discriminated. There are also revealed the areas where sharp changes of different velocity components under the wind changes are expected as well as the areas where such changes are expected to be minimal. The model is validated using the field surveys of current velocities by ADCP in the area adjacent to the Kaliningrad region. The comparison of current velocities has shown a close correspondence. In rather wide area the directions and amplitudes of the model and ADCP surface velocities are close, that is additionally confirmed by the comparison of the local vorticity distributions. On the vertical transects of the ADCP current velocity directed across the shoreline the geostrophic jet is clearly pronounced. Its horizontal and vertical scales are in close correspondence with ones of the model jet. At that the more detail calculations which are allowed during the modeling have shown that the geostrophic currents amount to 40-60% (in average) of the whole velocity; two components of the ageostrophic velocity directed along and across the geostrophic velocity are highly variable (from 10 to 60% of the whole velocity). The ageostrophic component directed along the geostrophic current generally strengthens it (up to 20-40% in average and up to 60-70% near the end of the Hel Spit). But in some regions, for example, in the Slupsk Furrow the ageostrophic component slows down the geostrophic current (to 30-40%). In some narrow local areas immediately adjacent to the coast currents directed oppositely to the general quasi geostrophic jet were registered on both field and model data. Before the comparison with the field data these local jets revealed on the model data were considered as improbable. As a result, the comparative analysis of the field and model data led to more detail understanding of dynamic processes in some coastal parts of the Baltic Sea.

Direct Current Amplifier. Report No. 92; AMPLIFICADOR DE CORRIENTE CONTINUA. Informe No. 92

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marazzi, C.

1963-01-01

A direct-current amplifier with low zero current and solid-state chopper for input is described. This amplifier can be used in control circuits and for general applications such as temperature measurement in thermocouples, amplifier for a photo-sensitive element, or zero amplifier in control systems. The input impedance is relatively low, serving principally as current amplifier. It is possible to obtain a symmetry characteristic for positive and negative values of the output voltage with respect to the input. (tr-auth)

Circulation on the Inner-Shelf of Long Bay, South Carolina: Vertical Current Variability and Evidence for Cross-Shelf Variation in Near-Bed Currents

NASA Astrophysics Data System (ADS)

Gutierrez, B. T.; Voulgaris, G.; Work, P. A.; Seim, H.; Warner, J. C.

2004-12-01

Cross-shelf variations of near-bed currents and variations in vertical flow were investigated on the inner shelf of Long Bay, South Carolina during the spring and fall of 2001. Current meters sampled near-bed currents at six locations as well as vertical current profiles at three of the sites. The observations showed that the tides accounted for approximately 45-66% of the flow variability. The dominant tidal component, the semi-diurnal constituent M2, exhibited tidal ellipse orientations that are increasingly aligned with the coast closer to the shore. The largest M2 current magnitudes were identified closest to shore and over the top of a sand shoal located 5.5 km offshore of Myrtle Beach. The remaining flow variability was associated with sub-tidal flows which respond to the passage of low-pressure systems across the region. These weather systems were characterized by periods of southwesterly winds in advance of low-pressure centers followed by northeasterly winds as the systems passed over the study area. When strong southwesterly winds persisted, surface flow was oriented approximately in the direction of the wind. At the same time near-bottom flows were also directed to the northeast in the direction of the wind except during periods of stratification when vertical current profiles suggest near-bed onshore flow. The stratified flows were observed mainly during the spring deployment. For periods of strong northeasterly winds, currents were directed alongshore to the southwest and exhibited little variation throughout the water column. These observations are consistent with recent field and modeling studies for the inner-shelf. Comparison of the near-bed flow measurements during the fall deployment revealed a cross-shore gradient in alongshore flow during periods of strong northeasterly winds. During these episodes flows at the offshore measurement stations were oriented in the direction of the wind, while flows closest to shore occurred in the opposite direction. These observations reveal 1) conditions which contribute to cross-shore transport and 2) the presence of an alongshore flow gradient which may affect sediment transport patterns during certain meteorological conditions.

Crystal alignments in the Fast ice of arctic Alaska

NASA Astrophysics Data System (ADS)

Weeks, W. F.; Gow, A. J.

1980-02-01

Field observations at 60 sites located in the fast or near-fast ice along a 1200-km stretch of the north coast of Alaska between the Bering Strait and Barter Island have shown that the great majority of the ice samples (95%) exhibit striking c axis alignments within the horizontal plane. In all cases the degree of preferred orientation increased with depth in the ice. Representative standard deviations around a mean direction in the horizontal plane are commonly less than ±10° for samples collected near the bottom of the ice. At a given site the mean c axis direction ?0 may vary as much as 20° with vertical location in the ice sheet. The c axis allignments in the nearshore region generally parallel the coast, with strong alignments occurring in the lagoon systems between the barrier islands and the coast and seaward of the barrier islands. In passes between islands and in entrances such as the opening to Kotzebue Sound the alignment is parallel to the channel. Only limited observations are available farther seaward over the inner (10- to 50-m isobaths) and outer (50-m isobath to shelf break) shelf regions. These indicate NE-SW and E-W alignments, respectively, in the Beaufort Sea north of Prudhoe Bay. The general patterns of the alignments support the correlation between the preferred c axis direction and the current direction at the ice/water interface suggested by Weeks and Gow (1978). A comparison between c axis alignments and instantaneous current measurements made at 42 locations shows that the most frequent current direction coincides with ?0. At the one site where we were able to determine the current direction (52°T) over a longer period (7 hours), the agreement with ?0. (48°T) was excellent. Similarly, if only ?0. values determined in the nearshore region are considered, the most frequent deviation is 10° or less between ?0. and the trend of the adjacent shoreline, which is presumably parallel to the prevailing longshore currents. The c axis alignments are believed to be the result of geometric selection, with the most favored orientation being that in which the current flows normal to the (0001) plates of ice that comprise the dendritic sea ice/seawater interface. The instantaneous current observations suggest SW nearshore currents along the Chukchi coast between SW of Point Lay and SW of the Rogers-Post Monument. In the vicinity of Barrow all currents measured along the Chukchi coast were toward the NE. Current directions along the Beaufort coast in the nearshore region were generally parallel to the coast, with 45% of the observations indicating currents toward the E and 55% currents toward the W.

Golgi polarization plays a role in the directional migration of neonatal dermal fibroblasts induced by the direct current electric fields.

PubMed

Kim, Min Sung; Lee, Mi Hee; Kwon, Byeong-Ju; Koo, Min-Ah; Seon, Gyeung Mi; Park, Jong-Chul

2015-05-01

Directional cell migration requires cell polarization. The reorganization of the Golgi apparatus is an important phenomenon in the polarization and migration of many types of cells. Direct current electric fields (dc (EF) induced directional cell migration in a wide variety of cells. Here nHDFs migrated toward cathode under 1 V/cm dc EF, however 1 μM of brefeldin A (BFA) inhibited the dc EF induced directional migration. BFA (1 μM) did not cause the complete Golgi dispersal for 2 h. When the Golgi polarization maintained their direction of polarity, the direction of cell migration also kept toward the same direction of the Golgi polarization even though the dc EF was reversed. In this study, the importance of the Golgi polarization in the directional migration of nHDf under dc EF was identified. Copyright © 2015 Elsevier Inc. All rights reserved.

Start-up of a Cardiology Day Hospital: Activity, Quality Care and Cost-effectiveness Analysis of the First Year of Operation.

PubMed

Gallego-Delgado, María; Villacorta, Eduardo; Valenzuela-Vicente, M Carmen; Walias-Sánchez, Ángela; Ávila, Carmen; Velasco-Cañedo, M Jesús; Cano-Mozo, M Teresa; Martín-García, Agustín; García-Sánchez, María Jesús; Sánchez, Argelina; Cascón, Manuel; Sánchez, Pedro L

2018-05-21

The cardiology day hospital (CDH) is an alternative to hospitalization for scheduled cardiological procedures. The aims of this study were to analyze the activity, quality of care and the cost-effectiveness of a CDH. An observational descriptive study was conducted of the health care activity during the first year of operation of DHHA. The quality of care was analyzed through the substitution rate (outpatient procedures), cancellation rates, complications, and a satisfaction survey. For cost-effectiveness, we calculated the economic savings of avoided hospital stays. A total of 1646 patients were attended (mean age 69 ± 15 years, 60% men); 2550 procedures were scheduled with a cancellation rate of 4%. The most frequently cancelled procedure was electrical cardioversion. The substitution rate for scheduled invasive procedures was 66%. Only 1 patient required readmission after discharge from the CDH due to heart failure. Most surveyed patients (95%) considered the care received in the CDH to be good or very good. The saving due to outpatient-converted procedures made possible by the CDH was € 219 199.55, higher than the cost of the first year of operation. In our center, the CDH allowed more than two thirds of the invasive procedures to be performed on an outpatient basis, while maintaining the quality of care. In the first year of operation, the expenses due to its implementation were offset by a significant reduction in hospital admissions. Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Attitudes toward Catheter Ablation for Atrial Fibrillation: A Nationwide Survey among Danish Cardiologists.

PubMed

Vadmann, Henrik; Pedersen, Susanne S; Nielsen, Jens Cosedis; Rodrigo-Domingo, Maria; Pehrson, Steen; Johannessen, Arne; Hansen, Peter Steen; Johansen, Jens Brock; Riahi, Sam

2015-10-01

Catheter ablation for atrial fibrillation (AF) is an important but expensive procedure that is the subject of some debate. Physicians' attitudes toward catheter ablation may influence promotion and patient acceptance. This is the first study to examine the attitudes of Danish cardiologists toward catheter ablation for AF, using a nationwide survey. We developed a purpose-designed questionnaire to evaluate attitudes toward catheter ablation for AF that was sent to all Danish cardiologists (n = 401; response n = 272 (67.8%)). There was no association between attitudes toward ablation and the experience or age of the cardiologist with respect to patients with recurrent AF episodes with a duration of <48 hours or >7 days and/or need for cardioversion. The majority (69%) expected a recurrence of AF after catheter ablation in more than 30% of the cases. For patients with persistent longstanding AF with a duration of >1 year, the attitude toward ablation for longstanding AF was more likely to be positive with increasing age (P < 0.01) and years of experience of the cardiologist (P = 0.002). Danish cardiologists generally have a positive attitude toward catheter ablation for AF, maintain up-to-date knowledge of the procedure, and are aware what information on ablation treatment should be given to patients with AF. The cardiologists had a positive attitude toward ablation for AF in patients with AF episodes <48 hours and patients with episodes >7 days, or those who needed medical/electrical conversion, but a more negative attitude toward treating longstanding AF patients. © 2015 Wiley Periodicals, Inc.

PULSESMART: Pulse-based Arrhythmia Discrimination Using a Novel Smartphone Application

PubMed Central

McManus, David D.; Chong, Jo Woon; Soni, Apurv; Saczynski, Jane S.; Esa, Nada; Napolitano, Craig; Darling, Chad E.; Boyer, Edward; Rosen, Rochelle K.; Floyd, Kevin C.; Chon, Ki H.

2015-01-01

Background Atrial fibrillation (AF) is a common and dangerous paroxysmal rhythm abnormality. Smartphones are increasingly used for mobile health applications by older patients at risk for AF and may be useful for AF screening. Objectives To test whether an enhanced smartphone app for AF detection can discriminate between sinus rhythm (SR), AF, premature atrial contractions (PACs) and premature ventricular contractions (PVCs). Methods We analyzed 219 2-minute pulse recordings from 121 participants with AF (n=98), PACs (n=15), or PVCs (n=15) using an iPhone 4S. We obtained pulsatile time series recordings in 91 participants after successful cardioversion to sinus rhythm from pre-existing AF. The PULSESMART app conducted pulse analysis using 3 methods [Root Mean Square of Successive RR Differences; Shannon Entropy; Poincare plot]. We examined the sensitivity, specificity, and predictive accuracy of the app for AF, PAC, and PVC discrimination from sinus rhythm using the 12-lead EKG or 3-lead telemetry as the gold standard. We also administered a brief usability questionnaire to a subgroup (n=65) of app users. Results The smartphone-based app demonstrated excellent sensitivity (0.970), specificity (0.935), and accuracy (0.951) for real-time identification of an irregular pulse during AF. The app also showed good accuracy for PAC (0.955) and PVC discrimination (0.960). The vast majority of surveyed app users (83%) reported that it was “useful” and “not complex” to use. Conclusions A smartphone app can accurately discriminate pulse recordings during AF from sinus rhythm, PACs, and PVCs. PMID:26391728

Mechanical dispersion and global longitudinal strain by speckle tracking echocardiography: Predictors of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy.

PubMed

Candan, Ozkan; Gecmen, Cetin; Bayam, Emrah; Guner, Ahmet; Celik, Mehmet; Doğan, Cem

2017-06-01

In this study, we investigated whether mechanical dispersion which reflects electrical abnormality and other echocardiographic and clinic parameters predict appropriate ICD shock in patients undergone ICD implantation for hypertrophic cardiomyopathy. Sixty-three patients who received ICD implantation for primary or secondary prevention were included in the study. Patients' clinical, electrocardiographic, 2D classic, and speckle tracking echocardiographic data were collected. Mechanical dispersion was defined as the standard deviation of time to peak negative strain in 18 left ventricular segments. Appropriate ICD therapy was defined as cardioversion or defibrillation due to ventricular tachycardia or fibrillation. Patients were divided into two groups as occurrence or the absence of appropriate ICD therapy. A total of 17 (26.9%) patients were observed to have an appropriate ICD therapy during follow-up periods. In patients who performed appropriate ICD therapy, a larger left atrial volume index, higher sudden cardiac death (SCD)-Risk Score, longer mechanical dispersion, and decreased global longitudinal peak strain (GLPS) were observed. In multivariate logistic regression analysis, including (GLPS, mechanical dispersion, LAVi, and SCD-Risk Score) was used to determine independent predictors of occurrence of appropriate ICD therapy during the follow-up. Mechanical dispersion, GLPS, and SCD-Risk Score were found to be independent predictors of occurrence of appropriate ICD therapy. Mechanical dispersion, GLPS, and SCD-Risk Score were found to be predictive for appropriate ICD therapy in patients receiving ICD implantation. Readily measurable mechanical dispersion and GLPS could be helpful to distinguish patients at high risk who could optimally benefit from ICD therapy. © 2017, Wiley Periodicals, Inc.

[A prompt diagnosis of Steinert's dystrophy in emergency unit].

PubMed

Suppa, M; Migliozzi, E; Magnanelli, E; Negri, S; Cavicchi, F; Colzi, M; Coppola, A

2012-11-01

Atrial fibrillation is frequently observed in Fist Aid. A rare cause is myotonic dystrophy There are two forms: Steinert's dystrophy caused by a defect of a gene myotoninaprotein kinase and Promm secondary to a defect of a Zinc Finger Protein Gene Clinical manifestations are localized in skeletal and face muscles, vitreous body, sexual glands, endocrine system, smooth muscle, central nervous system and myocardium. Sometimes, in mild and unrecognized forms of this rare disease there are arrhythmias as atrial fibrillation. We report the clinical case of a 52 year-old man, with a suspect diagnosis of Steinert's dystrophy, admitted to the emergency room for a persistent atrial fibrillation. The patient begins oral anticoagulation therapy. The patient perform a transesophageal echocardiogram before the electrical cardioversion with reset to sinus rhythm. In conclusion, with improving the screening methods of patients with primary and secondary myopathies, it has been seen an increase of cases in which a cardiac involvement occurred before or after the onset of the neuromuscular disorders. One of the most frequent alterations is represented by atrial fibrillation, responsible for an increased risk of cerebral embolism, with absolute indication for oral anticoagulation therapy. The myopathy more frequently associated with atrial fibrillation, is myotonic dystrophy, although the risk of cerebral embolism in these patients does not appear to be higher than the general population. The present case report is a spur to perform the diagnosis of Steinert disease in cases admitted to an Emergency Room because of arrhytmias, because of the possibility to perform fast and reliable specific genetic tests. A similar praxis confers to these Units an even more diagnostic clinical role.

[Scope of the latest RE-LY substudies: clinical implications].

PubMed

Ruiz-Giménez Arrieta, N

2012-03-01

The approval of the use of dabiatran in stroke prevention in patients with nonvalvular atrial fibrilation (NVAF) is based on the results of the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial, one of the largest studies to date in this entity. In this trial, dabigatran showed similar safety and efficacy to warfarin in primary and secondary prevention of stroke in patients with AF. At a dose of 150 mg twice daily, dabigatran was superior to warfarin in the prevention of stroke or systemic embolism and the 110 mg dose twice daily showed similar efficacy and greater safety, given the lower incidence of hemorrhage. These results were consistently found in the various subanalyses, with some slight differences of interest for clinical practice. The ideal candidates for dabiatran are patients with NVAF suitable for cardioversion, who require short periods of anticoagulation, patients in remote geographical areas with difficulty in achieving good anticoagulation control or good control with anti-vitamin K treatment due to IRN fluctuations, and patients with a low risk of hemorrhage and a CHADS score ≥ 3 and/or with prior stroke, whenever there are no contraindications. The choice of dabigatran dose should be evaluated according to the patient's individual characteristics (caution must be exercised when prescribing this drug in the elderly and in renal insufficiency) and embolic and/or hemorrhagic risk. Studies of the long-term safety of this drug, pharmacoeconomic analyses in Spain and post-commercialization pharmacovigilance data are required before the definitive uses of this drug can be established. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Long-term influence of body mass index on cardiovascular events after atrial fibrillation ablation.

PubMed

Bunch, T Jared; May, Heidi T; Bair, Tami L; Crandall, Brian G; Cutler, Michael J; Jacobs, Victoria; Mallender, Charles; Muhlestein, Joseph B; Osborn, Jeffrey S; Weiss, J Peter; Day, John D

2016-09-01

Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach in symptomatic patients. Obesity is a dominant driver of AF recurrence after ablation. However, being both overweight and underweight drives long-term cardiac and general health risks. Long-term data are needed to understand the influence of body mass index (BMI) on outcomes after ablation in regard to arrhythmia recurrence and cardiovascular outcomes. All patients who underwent an index ablation with a BMI recorded and at least 3 years of follow-up were included (n = 1558). The group was separated and compared by index ablation BMI status (≤20, 21-25, 26-30, >30 kg/m(2)). Long-term outcomes included AF recurrence, stroke/TIA, heart failure (HF) hospitalization, and death. Patients with advancing BMI status were more likely to be male and have hypertension, a smoking history, diabetes, HF, and a prior cardioversion. Patients with a BMI ≤20 were more likely to have a moderate-high congestive heart failure, hypertension, age >75, diabetes, stroke (CHADS2) score. At 3 years, recurrence rates of AF increased significantly with increasing BMI status (p = 0.02); paradoxically, there was a trend for increased stroke risk with decreasing BMI (p = 0.06). Long-term death rates tended to increase inversely with BMI status, and HF rates were greatest in the highest and lowest BMI groups. Lower weight at AF ablation lowers arrhythmia recurrence risk. However, AF ablation patients who are normal or underweight remain at high risk of other cardiovascular outcomes including increased stroke risk with less AF burden.

Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 1

PubMed Central

Diener, Hans-Christoph; Aisenberg, James; Ansell, Jack; Atar, Dan; Breithardt, Günter; Eikelboom, John; Ezekowitz, Michael D.; Granger, Christopher B.; Halperin, Jonathan L.; Hohnloser, Stefan H.; Hylek, Elaine M.; Kirchhof, Paulus; Lane, Deirdre A.; Verheugt, Freek W.A.; Veltkamp, Roland; Lip, Gregory Y.H.

2017-01-01

Patients with atrial fibrillation (AF) have a high risk of stroke and mortality, which can be considerably reduced by oral anticoagulants (OAC). Recently, four non-vitamin-K oral anticoagulants (NOACs) were compared with warfarin in large randomized trials for the prevention of stroke and systemic embolism. Today's clinician is faced with the difficult task of selecting a suitable OAC for a patient with a particular clinical profile or a particular pattern of risk factors and concomitant diseases. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. NOACs for stroke prevention in AF with the aim to identify patient groups who might benefit from a particular OAC more than from another. In the first of a two-part review, we discuss the choice of NOAC for stroke prevention in the following subgroups of patients with AF: (i) stable coronary artery disease or peripheral artery disease, including percutaneous coronary intervention with stenting and triple therapy; (ii) cardioversion, ablation and anti-arrhythmic drug therapy; (iii) mechanical valves and rheumatic valve disease, (iv) patients with time in therapeutic range of >70% on warfarin; (v) patients with a single stroke risk factor (CHA2DS2VASc score of 1 in males, 2 in females); and (vi) patients with a single first episode of paroxysmal AF. Although there are no major differences in terms of efficacy and safety between the NOACs for some clinical scenarios, in others we are able to suggest that particular drugs and/or doses be prioritized for anticoagulation. PMID:26848149

Computational modeling of the effect of external electron injection into a direct-current microdischarge

DOE Office of Scientific and Technical Information (OSTI.GOV)

Panneer Chelvam, Prem Kumar; Raja, Laxminarayan L.

2015-12-28

Electron emission from the electrode surface plays an important role in determining the structure of a direct-current microdischarge. Here we have developed a computational model of a direct-current microdischarge to study the effect of external electron injection from the cathode surface into the discharge to manipulate its properties. The model provides a self-consistent, multi-species, multi-temperature fluid representation of the plasma. A microdischarge with a metal-insulator-metal configuration is chosen for this study. The effect of external electron injection on the structure and properties of the microdischarge is described. The transient behavior of the microdischarge during the electron injection is examined. Themore » nonlinearities in the dynamics of the plasma result in a large increase of conduction current after active electron injection. For the conditions simulated a switching time of ∼100 ns from a low-current to high-current discharge state is realized.« less

Directed current in the Holstein system.

PubMed

Hennig, D; Burbanks, A D; Osbaldestin, A H

2011-03-01

We propose a mechanism to rectify charge transport in the semiclassical Holstein model. It is shown that localized initial conditions associated with a polaron solution, in conjunction with static electron on-site potential not having inversion symmetry, constitute minimal prerequisites for the emergence of a directed current in the underlying periodic lattice system. In particular, we demonstrate that for unbiased spatially localized initial conditions (constituted by kicked static polaron states), violation of parity prevents the existence of pairs of counterpropagating trajectories, thus allowing for a directed current despite the time reversibility of the equations of motion. Nevertheless, propagating polaron solutions associated with sets of unbiased localized initial conditions which eventually leave the region of localized initial conditions do not exhibit time reversibility. Since the initial conditions belonging to the corresponding counterpropagating, current-compensating polaron solutions are not contained in the set, this gives rise to the emergence of a current. Occurrence of long-range coherent charge transport is demonstrated.

Effects of transcranial direct current stimulation on craving, heart-rate variability and prefrontal hemodynamics during smoking cue exposure.

PubMed

Kroczek, A M; Häußinger, F B; Rohe, T; Schneider, S; Plewnia, C; Batra, A; Fallgatter, A J; Ehlis, A-C

2016-11-01

Drug-related cue exposure elicits craving and risk for relapse during recovery. Transcranial direct current stimulation is a promising research tool and possible treatment for relapse prevention. Enhanced functional neuroconnectivity is discussed as a treatment target. The goal of this research was to examine whether transcranial direct current stimulation affected cortical hemodynamic indicators of functional connectivity, craving, and heart rate variability during smoking-related cue exposure in non-treatment-seeking smokers. In vivo smoking cue exposure supported by a 2mA transcranial direct current stimulation (anode: dorsolateral prefrontal cortex, cathode: orbitofrontal cortex; placebo-controlled, randomized, double-blind) in 29 (age: M=25, SD=5) German university students (smoking at least once a week). Cue reactivity was assessed on an autonomous (heart rate variability) and a subjective level (craving ratings). Functional near-infrared spectroscopy measured changes in the concentration of deoxygenated hemoglobin, and seed-based correlation analysis was used to quantify prefrontal connectivity of brain regions involved in cue reactivity. Cue exposure elicited increased subjective craving and heart rate variability changes in smokers. Connectivity between the orbitofrontal and dorsolateral prefrontal cortex was increased in subjects receiving verum compared to placebo stimulation (d=0.66). Hemodynamics in the left dorsolateral prefrontal cortex, however, increased in the group receiving sham stimulation (η 2 =0.140). Transcranial direct current stimulation did not significantly alter craving or heart rate variability during cue exposure. Prefrontal connectivity - between regions involved in the processing of reinforcement value and cognitive control - was increased by anodal transcranial direct current stimulation during smoking cue exposure. Possible clinical implications should be considered in future studies. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Aconite poisoning.

PubMed

Chan, Thomas Y K

2009-04-01

Aconitine and related alkaloids found in the Aconitum species are highly toxic cardiotoxins and neurotoxins. The wild plant (especially the roots and root tubers) is extremely toxic. Severe aconite poisoning can occur after accidental ingestion of the wild plant or consumption of an herbal decoction made from aconite roots. In traditional Chinese medicine, aconite roots are used only after processing to reduce the toxic alkaloid content. Soaking and boiling during processing or decoction preparation will hydrolyze aconite alkaloids into less toxic and non-toxic derivatives. However, the use of a larger than recommended dose and inadequate processing increases the risk of poisoning. A Medline search (1963-February 2009) was conducted. Key articles with information on the use of aconite roots in traditional medicine, active (toxic) ingredients, mechanisms of toxicity, toxicokinetics of Aconitum alkaloids, and clinical features and management of aconite poisoning were reviewed. The cardiotoxicity and neurotoxicity of aconitine and related alkaloids are due to their actions on the voltage-sensitive sodium channels of the cell membranes of excitable tissues, including the myocardium, nerves, and muscles. Aconitine and mesaconitine bind with high affinity to the open state of the voltage-sensitive sodium channels at site 2, thereby causing a persistent activation of the sodium channels, which become refractory to excitation. The electrophysiological mechanism of arrhythmia induction is triggered activity due to delayed after-depolarization and early after-depolarization. The arrhythmogenic properties of aconitine are in part due to its cholinolytic (anticholinergic) effects mediated by the vagus nerve. Aconitine has a positive inotropic effect by prolonging sodium influx during the action potential. It has hypotensive and bradycardic actions due to activation of the ventromedial nucleus of the hypothalamus. Through its action on voltage-sensitive sodium channels in the axons, aconitine blocks neuromuscular transmission by decreasing the evoked quantal release of acetylcholine. Aconitine, mesaconitine, and hypaconitine can induce strong contractions of the ileum through acetylcholine release from the postganglionic cholinergic nerves. Patients present predominantly with a combination of neurological, cardiovascular, and gastrointestinal features. The neurological features can be sensory (paresthesia and numbness of face, perioral area, and the four limbs), motor (muscle weakness in the four limbs), or both. The cardiovascular features include hypotension, chest pain, palpitations, bradycardia, sinus tachycardia, ventricular ectopics, ventricular tachycardia, and ventricular fibrillation. The gastrointestinal features include nausea, vomiting, abdominal pain, and diarrhea. The main causes of death are refractory ventricular arrhythmias and asystole and the overall in-hospital mortality is 5.5%. Management of aconite poisoning is supportive, including immediate attention to the vital functions and close monitoring of blood pressure and cardiac rhythm. Inotropic therapy is required if hypotension persists and atropine should be used to treat bradycardia. Aconite-induced ventricular arrhythmias are often refractory to direct current cardioversion and antiarrhythmic drugs. Available clinical evidence suggests that amiodarone and flecainide are reasonable first-line treatment. In refractory cases of ventricular arrhythmias and cardiogenic shock, it is most important to maintain systemic blood flow, blood pressure, and tissue oxygenation by the early use of cardiopulmonary bypass. The role of charcoal hemoperfusion to remove circulating aconitine alkaloids is not established. Aconite roots contain aconitine, mesaconitine, hypaconitine, and other Aconitum alkaloids, which are known cardiotoxins and neurotoxins. Patients present predominantly with neurological, cardiovascular, and gastrointestinal features. Management is supportive; the early use of cardiopulmonary bypass is recommended if ventricular arrhythmias and cardiogenic shock are refractory to first-line treatment.

30 CFR 28.4 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., assembles, or fabricates, or controls the design, manufacture, assembly, or fabrication of a fuse, and who... means a device, no less effective than an automatic circuit breaker, for use with direct current which... MINING PRODUCTS FUSES FOR USE WITH DIRECT CURRENT IN PROVIDING SHORT-CIRCUIT PROTECTION FOR TRAILING...

30 CFR 28.4 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., assembles, or fabricates, or controls the design, manufacture, assembly, or fabrication of a fuse, and who... means a device, no less effective than an automatic circuit breaker, for use with direct current which... MINING PRODUCTS FUSES FOR USE WITH DIRECT CURRENT IN PROVIDING SHORT-CIRCUIT PROTECTION FOR TRAILING...

30 CFR 28.4 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., assembles, or fabricates, or controls the design, manufacture, assembly, or fabrication of a fuse, and who... means a device, no less effective than an automatic circuit breaker, for use with direct current which... MINING PRODUCTS FUSES FOR USE WITH DIRECT CURRENT IN PROVIDING SHORT-CIRCUIT PROTECTION FOR TRAILING...

Effect of mass and charge transport speed and direction in porous anodes on microbial electrolysis cell performance.

PubMed

Sleutels, Tom H J A; Hamelers, Hubertus V M; Buisman, Cees J N

2011-01-01

The use of porous electrodes like graphite felt as anode material has the potential of achieving high volumetric current densities. High volumetric current densities, however, may also lead to mass transport limitations within these porous materials. Therefore, in this study we investigated the mass and charge transport limitations by increasing the speed of the forced flow and changing the flow direction through the porous anode. Increase of the flow speed led to a decrease in current density when the flow was directed towards the membrane caused by an increase in anode resistance. Current density increased at higher flow speed when the flow was directed away from the membrane. This was caused by a decrease in transport resistance of ions through the membrane which increased the buffering effect of the system. Furthermore, the increase in flow speed led to an increase of the coulombic efficiency by 306%. Copyright © 2010 Elsevier Ltd. All rights reserved.

Universal 'imaginary closed circuit method' and formula for determination of direction of induced emf/current

NASA Astrophysics Data System (ADS)

Balaram Atram, Dattatraya

2011-01-01

Fleming's right-hand rule and the right-flat-hand rule are generally applied for determining the direction of flow of induced emf/current in straight conductors. The right-hand-fingers rule is applied for coils only. The right-hand-thumb rule can be applied for either straight conductors or coils. Different rules have to be applied for different situations. Also, a formula for determining the direction of induced emf/current does not exist on the basis of these rules. In this article, based on Faraday's law of electromagnetic induction and Lenz's law, an 'imaginary closed circuit method' and a formula for determination of direction of induced emf/current has been proposed. The method is universal in the sense that it is applicable for conductors of any shape, for any kind of relative motion of the conductor with respect to the magnetic flux, and moreover it is applicable for the case of varying magnetic flux.

Cellular and Molecular Mechanisms of Action of Transcranial Direct Current Stimulation: Evidence from In Vitro and In Vivo Models

PubMed Central

Pelletier, Simon J.

2015-01-01

Transcranial direct current stimulation is a noninvasive technique that has been experimentally tested for a number of psychiatric and neurological conditions. Preliminary observations suggest that this approach can indeed influence a number of cellular and molecular pathways that may be disease relevant. However, the mechanisms of action underlying its beneficial effects are largely unknown and need to be better understood to allow this therapy to be used optimally. In this review, we summarize the physiological responses observed in vitro and in vivo, with a particular emphasis on cellular and molecular cascades associated with inflammation, angiogenesis, neurogenesis, and neuroplasticity recruited by direct current stimulation, a topic that has been largely neglected in the literature. A better understanding of the neural responses to transcranial direct current stimulation is critical if this therapy is to be used in large-scale clinical trials with a view of being routinely offered to patients suffering from various conditions affecting the central nervous system. PMID:25522391

Direct-current triboelectricity generation by a sliding Schottky nanocontact on MoS2 multilayers

NASA Astrophysics Data System (ADS)

Liu, Jun; Goswami, Ankur; Jiang, Keren; Khan, Faheem; Kim, Seokbeom; McGee, Ryan; Li, Zhi; Hu, Zhiyu; Lee, Jungchul; Thundat, Thomas

2018-02-01

The direct conversion of mechanical energy into electricity by nanomaterial-based devices offers potential for green energy harvesting1-3. A conventional triboelectric nanogenerator converts frictional energy into electricity by producing alternating current (a.c.) triboelectricity. However, this approach is limited by low current density and the need for rectification2. Here, we show that continuous direct-current (d.c.) with a maximum density of 106 A m-2 can be directly generated by a sliding Schottky nanocontact without the application of an external voltage. We demonstrate this by sliding a conductive-atomic force microscope tip on a thin film of molybdenum disulfide (MoS2). Finite element simulation reveals that the anomalously high current density can be attributed to the non-equilibrium carrier transport phenomenon enhanced by the strong local electrical field (105-106 V m-2) at the conductive nanoscale tip4. We hypothesize that the charge transport may be induced by electronic excitation under friction, and the nanoscale current-voltage spectra analysis indicates that the rectifying Schottky barrier at the tip-sample interface plays a critical role in efficient d.c. energy harvesting. This concept is scalable when combined with microfabricated or contact surface modified electrodes, which makes it promising for efficient d.c. triboelectricity generation.

Transcranial direct current stimulation (tDCS) for treatment of major depression during pregnancy: study protocol for a pilot randomized controlled trial.

PubMed

Vigod, Simone; Dennis, Cindy-Lee; Daskalakis, Zafiris; Murphy, Kellie; Ray, Joel; Oberlander, Tim; Somerton, Sarah; Hussain-Shamsy, Neesha; Blumberger, Daniel

2014-09-18

Women with depression in pregnancy are faced with difficult treatment decisions. Untreated, antenatal depression has serious negative implications for mothers and children. While antidepressant drug treatment is likely to improve depressive symptoms, it crosses the placenta and may pose risks to the unborn child. Transcranial direct current stimulation is a focal brain stimulation treatment that improves depressive symptoms within 3 weeks of treatment by inducing changes to brain areas involved in depression, without impacting any other brain areas, and without inducing changes to heart rate, blood pressure or core body temperature. The localized nature of transcranial direct current stimulation makes it an ideal therapeutic approach for treating depression during pregnancy, although it has never previously been evaluated in this population. We describe a pilot randomized controlled trial of transcranial direct current stimulation among women with depression in pregnancy to assess the feasibility of a larger, multicentre efficacy study. Women over 18 years of age and between 14 and 32 weeks gestation can be enrolled in the study provided they meet diagnostic criteria for a major depressive episode of at least moderate severity and have been offered but refused antidepressant medication. Participants are randomized to receive active transcranial direct current stimulation or a sham condition that is administered in 15 30-minute treatments over three weeks. Women sit upright during treatment and receive obstetrical monitoring prior to, during and after each treatment session. Depressive symptoms, treatment acceptability, and pregnancy outcomes are assessed at baseline (prior to randomization), at the end of each treatment week, every four weeks post-treatment until delivery, and at 4 and 12 weeks postpartum. Transcranial direct current stimulation is a novel therapeutic option for treating depression during pregnancy. This protocol allows for assessment of the feasibility of, acceptability of and adherence with a clinical trial protocol to administer this treatment to pregnant women with moderate to severe depression. Results from this pilot study will guide the development of a larger multicentre trial to definitively test the efficacy and safety of transcranial direct current stimulation for pregnant women with depression. Clinical Trials Gov NCT02116127.

Forward and reverse control system for induction motors

DOEpatents

Wright, J.T.

1987-09-15

A control system for controlling the direction of rotation of a rotor of an induction motor includes an array of five triacs with one of the triacs applying a current of fixed phase to the windings of the rotor and four of the triacs being switchable to apply either hot ac current or return ac current to the stator windings so as to reverse the phase of current in the stator relative to that of the rotor and thereby reverse the direction of rotation of the rotor. Switching current phase in the stator is accomplished by operating the gates of pairs of the triacs so as to connect either hot ac current or return ac current to the input winding of the stator. 1 fig.

System simulation of direct-current speed regulation based on Simulink

NASA Astrophysics Data System (ADS)

Yang, Meiying

2018-06-01

Many production machines require the smooth adjustment of speed in a certain range In the process of modern industrial production, and require good steady-state and dynamic performance. Direct-current speed regulation system with wide speed regulation range, small relative speed variation, good stability, large overload capacity, can bear the frequent impact load, can realize stepless rapid starting-braking and inversion of frequency and other good dynamic performances, can meet the different kinds of special operation requirements in production process of automation system. The direct-current power drive system is almost always used in the field of drive technology of high performance for a long time.

Anomalous - viscosity current drive

DOEpatents

Stix, Thomas H.; Ono, Masayuki

1988-01-01

An apparatus and method for maintaining a steady-state current in a toroidal magnetically confined plasma. An electric current is generated in an edge region at or near the outermost good magnetic surface of the toroidal plasma. The edge current is generated in a direction parallel to the flow of current in the main plasma and such that its current density is greater than the average density of the main plasma current. The current flow in the edge region is maintained in a direction parallel to the main current for a period of one or two of its characteristic decay times. Current from the edge region will penetrate radially into the plasma and augment the main plasma current through the mechanism of anomalous viscosity. In another aspect of the invention, current flow driven between a cathode and an anode is used to establish a start-up plasma current. The plasma-current channel is magnetically detached from the electrodes, leaving a plasma magnetically insulated from contact with any material obstructions including the cathode and anode.

Quantum Plasmonics: Quantum Information at the Nanoscale

DTIC Science & Technology

2016-11-06

journal. In total this project has thus far resulted in six journal articles. We are currently writing up an additional work, on direct quantum tomography...resulted in six journal articles. We are currently writing up an additional work, on direct quantum tomography on state entanglement in quantum

Deformations of the spin currents by topological screw dislocation and cosmic dispiration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Jianhua; Ma, Kai, E-mail: makainca@gmail.com; Li, Kang

2015-11-15

We study the spin currents induced by topological screw dislocation and cosmic dispiration. By using the extended Drude model, we find that the spin dependent forces are modified by the nontrivial geometry. For the topological screw dislocation, only the direction of spin current is bent by deforming the spin polarization vector. In contrast, the force induced by cosmic dispiration could affect both the direction and magnitude of the spin current. As a consequence, the spin-Hall conductivity does not receive corrections from screw dislocation.

Auroral electrojets and evening sector electron dropouts at synchronous orbit

NASA Technical Reports Server (NTRS)

Erickson, K. N.; Winckler, J. R.

1973-01-01

Evidence is presented in support of the concept that, during magnetospheric substorms, ionospheric auroral electrojet currents are directly coupled to the proton partial ring current in the outer magnetosphere. It has been found that for sufficiently isolated substorms the timing of the start of the electron dropout and of its maximum depression is in good agreement with the start and maximum of electrojet activity as indicated by the auroral electrojet index. This correlation suggests a direct coupling between the electrojet currents and the proton partial ring current.

Effect of a single session of transcranial direct-current stimulation combined with virtual reality training on the balance of children with cerebral palsy: a randomized, controlled, double-blind trial

PubMed Central

Lazzari, Roberta Delasta; Politti, Fabiano; Santos, Cibele Alimedia; Dumont, Arislander Jonathan Lopes; Rezende, Fernanda Lobo; Grecco, Luanda André Collange; Braun Ferreira, Luiz Alfredo; Oliveira, Claudia Santos

2015-01-01

[Purpose] The aim of the present study was to investigate the effects of a single session of transcranial direct current stimulation combined with virtual reality training on the balance of children with cerebral palsy. [Subjetcs and Methods] Children with cerebral palsy between four and 12 years of age were randomly allocated to two groups: an experimental group which performed a single session of mobility training with virtual reality combined with active transcranial direct current stimulation; and a control group which performed a single session of mobility training with virtual reality combined with placebo transcranial direct current stimulation. The children were evaluated before and after the training protocols. Static balance (sway area, displacement, velocity and frequency of oscillations of the center of pressure on the anteroposterior and mediolateral axes) was evaluated using a force plate under four conditions (30-second measurements for each condition): feet on the force plate with the eyes open, and with the eyes closed; feet on a foam mat with the eyes open, and with the eyes closed. [Results] An increase in sway velocity was the only significant difference found. [Conclusion] A single session of anodal transcranial direct current stimulation combined with mobility training elicited to lead to an increase in the body sway velocity of children with cerebral palsy. PMID:25931726

Electrolytic/fuel cell bundles and systems including a current collector in communication with an electrode thereof

DOEpatents

Hawkes, Grant L.; Herring, James S.; Stoots, Carl M.; O& #x27; Brien, James E.

2013-03-05

Electrolytic/fuel cell bundles and systems including such bundles include an electrically conductive current collector in communication with an anode or a cathode of each of a plurality of cells. A cross-sectional area of the current collector may vary in a direction generally parallel to a general direction of current flow through the current collector. The current collector may include a porous monolithic structure. At least one cell of the plurality of cells may include a current collector that surrounds an outer electrode of the cell and has at least six substantially planar exterior surfaces. The planar surfaces may extend along a length of the cell, and may abut against a substantially planar surface of a current collector of an adjacent cell. Methods for generating electricity and for performing electrolysis include flowing current through a conductive current collector having a varying cross-sectional area.

PSF mapping-based correction of eddy-current-induced distortions in diffusion-weighted echo-planar imaging.

PubMed

In, Myung-Ho; Posnansky, Oleg; Speck, Oliver

2016-05-01

To accurately correct diffusion-encoding direction-dependent eddy-current-induced geometric distortions in diffusion-weighted echo-planar imaging (DW-EPI) and to minimize the calibration time at 7 Tesla (T). A point spread function (PSF) mapping based eddy-current calibration method is newly presented to determine eddy-current-induced geometric distortions even including nonlinear eddy-current effects within the readout acquisition window. To evaluate the temporal stability of eddy-current maps, calibration was performed four times within 3 months. Furthermore, spatial variations of measured eddy-current maps versus their linear superposition were investigated to enable correction in DW-EPIs with arbitrary diffusion directions without direct calibration. For comparison, an image-based eddy-current correction method was additionally applied. Finally, this method was combined with a PSF-based susceptibility-induced distortion correction approach proposed previously to correct both susceptibility and eddy-current-induced distortions in DW-EPIs. Very fast eddy-current calibration in a three-dimensional volume is possible with the proposed method. The measured eddy-current maps are very stable over time and very similar maps can be obtained by linear superposition of principal-axes eddy-current maps. High resolution in vivo brain results demonstrate that the proposed method allows more efficient eddy-current correction than the image-based method. The combination of both PSF-based approaches allows distortion-free images, which permit reliable analysis in diffusion tensor imaging applications at 7T. © 2015 Wiley Periodicals, Inc.

Direct-to-consumer tobacco marketing and its association with tobacco use among adolescents and young adults.

PubMed

Soneji, Samir; Ambrose, Bridget K; Lee, Won; Sargent, James; Tanski, Susanne

2014-08-01

We assess exposure to direct-to-consumer tobacco marketing and its association with ever having tried smoking, smoking within past 30 days (current), and smoking ≥100 cigarettes in lifetime (established) among adolescents and young adults. We surveyed a U.S. telephone sample of 3,342 15- to 23-year-olds and 2,541 respondents subsequently completed a web-based survey. Among respondents completing both the telephone and web-based surveys (N = 2,541 [75%]), we assessed their exposure to direct-to-consumer tobacco marketing (receiving direct mail from tobacco companies and seeing tobacco company websites) and their associations with ever having tried smoking, current smoking, and established smoking. Overall, 12% of 15- to 17-year-olds and 26% of 18- to 23-year-olds were exposed to direct-to-consumer tobacco marketing. Racial/ethnic minority nonsmoking respondents were more likely to see tobacco websites than nonsmoking whites. Respondents exposed to either form of direct-to-consumer tobacco marketing were more likely to currently smoke (adjusted odds ratio 2.2, 95% confidence interval 1.3-3.8), while those exposed to both forms of marketing experienced even higher odds of currently smoking (adjusted odds ratio 2.7, 95% confidence interval 1.1-6.6). We observed similar relationships for ever having tried smoking and established smoking. Direct-to-consumer tobacco marketing reaches adolescent and young adult nonsmokers and is associated with smoking behavior. Copyright © 2014 Society for Adolescent Health and Medicine. All rights reserved.

Characterization, Processing, and Consolidation of Nanoscale Tungsten Powder

DTIC Science & Technology

2009-12-01

gas fusion, and all other elements were measured by direct current plasma emission spectroscopy. The analysis showed a relatively high amount of...measured by direct current plasma emission spectroscopy, and oxygen was detected by inert gas fusion. The results show that carbon and cobalt levels...of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB

Evidence for breathing modes in direct current, pulsed, and high power impulse magnetron sputtering plasmas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Yuchen; Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720; Zhou, Xue

2016-01-18

We present evidence for breathing modes in magnetron sputtering plasmas: periodic axial variations of plasma parameters with characteristic frequencies between 10 and 100 kHz. A set of azimuthally distributed probes shows synchronous oscillations of the floating potential. They appear most clearly when considering the intermediate current regime in which the direction of azimuthal spoke motion changes. Breathing oscillations were found to be superimposed on azimuthal spoke motion. Depending on pressure and current, one can also find a regime of chaotic fluctuations and one of stable discharges, the latter at high current. A pressure-current phase diagram for the different situations is proposed.

40 CFR 230.23 - Current patterns and water circulation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... or fill material can modify current patterns and water circulation by obstructing flow, changing the direction or velocity of water flow, changing the direction or velocity of water flow and circulation, or otherwise changing the dimensions of a water body. As a result, adverse changes can occur in: Location...

40 CFR 230.23 - Current patterns and water circulation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... or fill material can modify current patterns and water circulation by obstructing flow, changing the direction or velocity of water flow, changing the direction or velocity of water flow and circulation, or otherwise changing the dimensions of a water body. As a result, adverse changes can occur in: Location...

40 CFR 230.23 - Current patterns and water circulation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... or fill material can modify current patterns and water circulation by obstructing flow, changing the direction or velocity of water flow, changing the direction or velocity of water flow and circulation, or otherwise changing the dimensions of a water body. As a result, adverse changes can occur in: Location...

Promoting Conceptual Change through Active Learning Using Open Source Software for Physics Simulations

ERIC Educational Resources Information Center

Baser, Mustafa

2006-01-01

This paper reports upon an active learning approach that promotes conceptual change when studying direct current electricity circuits, using free open source software, "Qucs". The study involved a total of 102 prospective mathematics teacher students. Prior to instruction, students' understanding of direct current electricity was…

Direct Current Series Circuits: An Educational Module.

ERIC Educational Resources Information Center

Sturgess, Keith

This module was developed as remedial material for physics students who have difficulty understanding concepts of circuits and calculating resistances, and voltage drops and currents. Lists of prerequisite skills and instructional objectives are followed by a pretest (with answers). Students are directed to the subject matter in the module based…

Early Childhood Inclusion in the United States: Goals, Current Status, and Future Directions

ERIC Educational Resources Information Center

Guralnick, Michael J.; Bruder, Mary Beth

2016-01-01

The current status and future directions of early childhood inclusion in the United States are discussed from the perspective of 4 key goals: access, accommodations and feasibility, developmental progress, and social integration. Recommendations are put forward to promote inclusion goals emphasizing administrative structures, personnel…

Modelling the effect of electrode displacement on transcranial direct current stimulation (tDCS)

NASA Astrophysics Data System (ADS)

Ramaraju, Sriharsha; Roula, Mohammed A.; McCarthy, Peter W.

2018-02-01

Objective. Transcranial direct current stimulation (tDCS) is a neuromodulatory technique that delivers a low-intensity, direct current to cortical areas with the purpose of modulating underlying brain activity. Recent studies have reported inconsistencies in tDCS outcomes. The underlying assumption of many tDCS studies has been that replication of electrode montage equates to replicating stimulation conditions. It is possible however that anatomical difference between subjects, as well as inherent inaccuracies in montage placement, could affect current flow to targeted areas. The hypothesis that stimulation of a defined brain region will be stable under small displacements was tested. Approach. Initially, we compared the total simulated current flowing through ten specific brain areas for four commonly used tDCS montages: F3-Fp2, C3-Fp2, Fp1-F4, and P3-P4 using the software tool COMETS. The effect of a slight (~1 cm in each of four directions) anode displacement on the simulated regional current density for each of the four tDCS montages was then determined. Current flow was calculated and compared through ten segmented brain areas to determine the effect of montage type and displacement. The regional currents, as well as the localised current densities, were compared with the original electrode location, for each of these new positions. Main results. Recommendations for montages that maximise stimulation current for the ten brain regions are considered. We noted that the extent to which stimulation is affected by electrode displacement varies depending on both area and montage type. The F3-Fp2 montage was found to be the least stable with up to 38% change in average current density in the left frontal lobe while the Fp1-F4 montage was found to the most stable exhibiting only 1% change when electrodes were displaced. Significance. These results indicate that even relatively small changes in stimulation electrode placement appear to result in surprisingly large changes in current densities and distribution.

The Role of Direct Current Electric Field-Guided Stem Cell Migration in Neural Regeneration.

PubMed

Yao, Li; Li, Yongchao

2016-06-01

Effective directional axonal growth and neural cell migration are crucial in the neural regeneration of the central nervous system (CNS). Endogenous currents have been detected in many developing nervous systems. Experiments have demonstrated that applied direct current (DC) electric fields (EFs) can guide axonal growth in vitro, and attempts have been made to enhance the regrowth of damaged spinal cord axons using DC EFs in in vivo experiments. Recent work has revealed that the migration of stem cells and stem cell-derived neural cells can be guided by DC EFs. These studies have raised the possibility that endogenous and applied DC EFs can be used to direct neural tissue regeneration. Although the mechanism of EF-directed axonal growth and cell migration has not been fully understood, studies have shown that the polarization of cell membrane proteins and the activation of intracellular signaling molecules are involved in the process. The application of EFs is a promising biotechnology for regeneration of the CNS.

Electrical-assisted double side incremental forming and processes thereof

DOEpatents

Roth, John; Cao, Jian

2014-06-03

A process for forming a sheet metal component using an electric current passing through the component is provided. The process can include providing a double side incremental forming machine, the machine operable to perform a plurality of double side incremental deformations on the sheet metal component and also apply an electric direct current to the sheet metal component during at least part of the forming. The direct current can be applied before or after the forming has started and/or be terminated before or after the forming has stopped. The direct current can be applied to any portion of the sheet metal. The electrical assistance can reduce the magnitude of force required to produce a given amount of deformation, increase the amount of deformation exhibited before failure and/or reduce any springback typically exhibited by the sheet metal component.

Tides, and tidal and residual currents in Suisun and San Pablo bays, California; results of measurements, 1986

USGS Publications Warehouse

Gartner, J.W.; Yost, B.T.

1988-01-01

Current meter data collected at 11 stations and water level data collected at one station in Suisun and San Pablo Bays, California, in 1986 are compiled in this report. Current-meter measurements include current speed and direction, and water temperature and salinity (computed from temperature and conductivity). For each of the 19 current-meter records, data are presented in two forms. These are: (1) results of harmonic analysis; and (2) plots of tidal current speed and direction versus time and plots of temperature and salinity versus time. Spatial distribution of the properties of tidal currents are given in graphic form. In addition, Eulerian residual currents have been compiled by using a vector-averaging technique. Water level data are presented in the form of a time-series plot and the results of harmonic analysis. (USGS)

Investigations in the ionosphere on Kosmos 378. V. Anisotropy of electron fluxes of 0. 5-12 keV at high latitudes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Khokhlov, M.Z.

1975-01-01

Electron fluxes directed upward and earthward were compared by means of electrostatic analyzers oriented in opposite directions. The reflection coefficients reached 0.3-0.45 in the loss cone and were frequently less than 1 outside the cone. In some cases the fluxes of reflected electrons exceeded those of incident electrons. The direction of the current carried by such electrons was mostly opposite to the adopted direction of the system of field-aligned currents in the magnetosphere, which is determined by electrons of much lower energies. 17 references.

High-temperature performance of MoS2 thin-film transistors: Direct current and pulse current-voltage characteristics

NASA Astrophysics Data System (ADS)

Jiang, C.; Rumyantsev, S. L.; Samnakay, R.; Shur, M. S.; Balandin, A. A.

2015-02-01

We report on fabrication of MoS2 thin-film transistors (TFTs) and experimental investigations of their high-temperature current-voltage characteristics. The measurements show that MoS2 devices remain functional to temperatures of at least as high as 500 K. The temperature increase results in decreased threshold voltage and mobility. The comparison of the direct current (DC) and pulse measurements shows that the direct current sub-linear and super-linear output characteristics of MoS2 thin-films devices result from the Joule heating and the interplay of the threshold voltage and mobility temperature dependences. At temperatures above 450 K, a kink in the drain current occurs at zero gate voltage irrespective of the threshold voltage value. This intriguing phenomenon, referred to as a "memory step," was attributed to the slow relaxation processes in thin films similar to those in graphene and electron glasses. The fabricated MoS2 thin-film transistors demonstrated stable operation after two months of aging. The obtained results suggest new applications for MoS2 thin-film transistors in extreme-temperature electronics and sensors.

Conceptual Design of a 100kW Energy Integrated Type Bi-Directional Tidal Current Turbine

NASA Astrophysics Data System (ADS)

Kim, Ki Pyoung; Ahmed, M. Rafiuddin; Lee, Young Ho

2010-06-01

The development of a tidal current turbine that can extract maximum energy from the tidal current will be extremely beneficial for supplying continuous electric power. The present paper presents a conceptual design of a 100kW energy integrated type tidal current turbine for tidal power generation. The instantaneous power density of a flowing fluid incident on an underwater turbine is proportional to the cubic power of current velocity which is approximately 2.5m/s. A cross-flow turbine, provided with a nozzle and a diffuser, is designed and analyzed. The potential advantages of ducted and diffuser-augmented turbines were taken into consideration in order to achieve higher output at a relatively low speed. This study looks at a cross-flow turbine system which is placed in an augmentation channel to generate electricity bi-directionally. The compatibility of this turbine system is verified using a commercial CFD code, ANSYSCFX. This paper presents the results of the numerical analysis in terms of pressure, streaklines, velocity vectors and performance curves for energy integrated type bi-directional tidal current turbine (BDT) with augmentation.

Sliding mode control of direct coupled interleaved boost converter for fuel cell

NASA Astrophysics Data System (ADS)

Wang, W. Y.; Ding, Y. H.; Ke, X.; Ma, X.

2017-12-01

A three phase direct coupled interleaved boost converter (TP-DIBC) was recommended in this paper. This converter has a small unbalance current sharing among the branches of TP-DIBC. An adaptive control law sliding mode control (SMC) is designed for the TP-DIBC. The aim is to 1) reduce ripple output voltage, inductor current and regulate output voltage tightly 2) The total current carried by direct coupled interleaved boost converter (DIBC) must be equally shared between different parallel branches. The efficacy and robustness of the proposed TP-DIBC and adaptive SMC is confirmed via computer simulations using Matlab SimPower System Tools. The simulation result is in line with the expectation.

Detection of oppositely directed reconnection jets in a solar wind current sheet

NASA Astrophysics Data System (ADS)

Davis, M. S.; Phan, T. D.; Gosling, J. T.; Skoug, R. M.

2006-10-01

We report the first two-spacecraft (Wind and ACE) detection of oppositely directed plasma jets within a bifurcated current sheet in the solar wind. The event occurred on January 3, 2003 and provides further direct evidence that such jets result from reconnection. The magnetic shear across the bifurcated current sheet at both Wind and ACE was ~150°, indicating that the magnetic shear must have been the same at the reconnection site located between the two spacecraft. These observations thus provide strong evidence for component merging with a guide field ~ 30% of the antiparallel field. The dimensionless reconnection rate based on the measured inflow was 0.03, implying fast reconnection.

Detection of oppositely directed reconnection jets in a solar wind current sheet

NASA Astrophysics Data System (ADS)

Davis, M. S.; Phan, T. D.; Gosling, J. T.; Skoug, R. M.

2006-12-01

We report the first two-spacecraft (Wind and ACE) detection of oppositely directed plasma jets within a bifurcated current sheet in the solar wind. The event occurred on January 3, 2003 and provides further direct evidence that such jets result from reconnection. The magnetic shear across the bifurcated current sheet at both Wind and ACE was approximately 150 degrees, indicating that the magnetic shear must have been the same at the reconnection site located between the two spacecraft. These observations thus provide strong evidence for component merging with a guide field approximately 30% of the antiparallel field. The dimensionless reconnection rate based on the measured inflow was 0.03, implying fast reconnection.

Can the use of pulsed direct current induce oscillation in the applied pressure during spark plasma sintering?

PubMed Central

Salamon, David; Eriksson, Mirva; Nygren, Mats; Shen, Zhijian

2012-01-01

The spark plasma sintering (SPS) process is known for its rapid densification of metals and ceramics. The mechanism behind this rapid densification has been discussed during the last few decades and is yet uncertain. During our SPS experiments we noticed oscillations in the applied pressure, related to a change in electric current. In this study, we investigated the effect of pulsed electrical current on the applied mechanical pressure and related changes in temperature. We eliminated the effect of sample shrinkage in the SPS setup and used a transparent quartz die allowing direct observation of the sample. We found that the use of pulsed direct electric current in our apparatus induces pressure oscillations with the amplitude depending on the current density. While sintering Ti samples we observed temperature oscillations resulting from pressure oscillations, which we attribute to magnetic forces generated within the SPS apparatus. The described current–pressure–temperature relations might increase understanding of the SPS process. PMID:27877472

Magnetic thin-film split-domain current sensor-recorder

DOEpatents

Hsieh, Edmund J.

1979-01-01

A sensor-recorder for recording a representation of the direction and peak amplitude of a transient current. A magnetic thin film is coated on a glass substrate under the influence of a magnetic field so that the finished film is magnetically uniaxial and anisotropic. The film is split into two oppositely magnetized contiguous domains with a central boundary by subjecting adjacent portions of the film simultaneously to magnetic fields that are opposed 180.degree.. With the split-domain sensor-recorder placed with the film plane and domain boundary either perpendicular or parallel to the expected conductive path of a transient current, the occurrence of the transient causes switching of a portion of one domain to the direction of the other domain. The amount of the switched domain portion is indicative of the amplitude of the peak current of the transient, while the particular domain that is switched is indicative of the direction of the current. The resulting domain patterns may be read with a passive magnetic tape viewer.

Technology-based suicide prevention: current applications and future directions.

PubMed

Luxton, David D; June, Jennifer D; Kinn, Julie T

2011-01-01

This review reports on current and emerging technologies for suicide prevention. Technology-based programs discussed include interactive educational and social networking Web sites, e-mail outreach, and programs that use mobile devices and texting. We describe innovative applications such as virtual worlds, gaming, and text analysis that are currently being developed and applied to suicide prevention and outreach programs. We also discuss the benefits and limitations of technology-based applications and discuss future directions for their use.

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2014 CFR

2014-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

Sources, Developments and Directions of Task-Based Language Teaching

ERIC Educational Resources Information Center

Bygate, Martin

2016-01-01

This paper provides an outline of the origins, the current shape and the potential directions of task-based language teaching (TBLT) as an approach to language pedagogy. It first offers a brief description of TBLT and considers its origins within language teaching methodology and second language acquisition. It then summarises the current position…

Calculating Electrical Requirements for Direct Current Electric Actuators

DTIC Science & Technology

2017-11-29

These requirements lead to the determination of multiple design decisions such as: operating voltage, regenerative energy capture/dissipation, and...15. SUBJECT TERMS Electro-mechanical actuation Regenerative energy Electrical power Servo control Direct current (DC...Method 6 Power Supply Requirements 7 Approaches to Handling Regenerative Energy 8 Conductor Selection 10 Results and Discussions 10 Example

Teaching Direct Current Theory Using a Field Model

ERIC Educational Resources Information Center

Stocklmayer, Susan

2010-01-01

Principles of direct current have long been recognised in the literature as presenting difficulties for learners. Most of these difficulties have been reported in the context of the traditional electron flow model. In this paper, an alternative approach for high school students using a field model is explored. Findings from a range of short pilot…

Discrete symmetry breaking and baryon currents in U(N) and SU(N) gauge theories

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lucini, B.; Patella, A.

2009-06-15

In SU(N) gauge theories with fermions in the fundamental or in a two-index (either symmetric or antisymmetric) representation formulated on a manifold with at least one compact dimension with nontrivial holonomy the discrete symmetries C, P, and T are broken at small enough size of the compact direction(s) for certain values of N. We show that for those N in the broken phase a nonzero baryon current wrapping in the compact direction exists, which provides a measurable observable for the breaking of C, P, and T. We prove that in all cases where the current is absent there is nomore » breaking of those discrete symmetries. This includes the limit N{yields}{infinity} of the SU(N) gauge theory with symmetric or antisymmetric fermions and U(N) gauge theory at any value of N. We then argue that the component of the baryon current in the compact direction is the physical order parameter for C, P, and T breaking due to the breaking of Lorentz invariance.« less

On the Loop Current Penetration into the Gulf of Mexico

NASA Astrophysics Data System (ADS)

Weisberg, Robert H.; Liu, Yonggang

2017-12-01

The Gulf of Mexico Loop Current generally intrudes some distance into the Gulf of Mexico before shedding an anticyclonic eddy and retreating back to its more direct entry to exit pathway. The control of this aperiodic process remains only partially known. Here we describe the evolution of the Loop Current throughout the era of satellite altimetry, and offer a mechanistic hypothesis on Loop Current intrusion. As a complement to the known effects of Loop Current forcing on the west Florida shelf circulation, we argue that the west Florida shelf, in turn, impacts the Loop Current evolution. A Self-Organizing Map analysis shows that anomalous northward penetrations of the Loop Current into the Gulf of Mexico occur when the eastern side of Loop Current is positioned west from the southwest corner of the west Florida shelf, whereas the more direct inflow to outflow route occurs when the eastern side of the Loop Current comes in contact with the southwest corner of the west Florida shelf. In essence, we argue that the west Florida shelf anchors the Loop Current in its direct path configuration and that farther northward penetration into the Gulf of Mexico occurs when such anchoring is released. To test of this hypothesis heuristically, we estimate that the dissipation and buoyancy work due to known Loop Current forcing of the west Florida shelf circulation (when in contact with the southwest corner) may exceed the pressure work required for the Loop Current to advance against the ambient Gulf of Mexico fluid.