Rubinlamm8871

Mutations in the cardiac ryanodine receptor 2 gene (RYR2) are noted in approximately 55% of the patients with catecholaminergic polymorphic ventricular tachycardia (CPVT). However, a high background rate of rare amino acid-altering variants in RYR2 [≈3% (whites) to 6% (nonwhites)] in combination with delayed onset and variable expressivity of the CPVT phenotype make attributing causality to rare RYR2 variants difficult. The proposed set of guidelines for characterization of variants include, among many different criteria, functional studies to classify variants as pathogenic versus non- pathogenic. However, in vitro data, especially for complex channelopathies like CPVT, does not always correlate well with the human phenotype; therefore, characterizing the phenotypic features of rare RYR2 variants in humans is of importance. We report a 13-year-old carrier of a rare maternally inherited variant in exon 3 of RYR2 (p.Thr85Ile, c.254C>T [rs772005577]) who was successfully resuscitated from exercise-associated sudden cardiac arrest and was subsequently found to have exercise-induced complex ventricular ectopy. His brother, who has been asymptomatic, was also found to carry the same variant and demonstrated complex ventricular ectopy on exercise stress testing. These findings suggest that this rare variant, which has previously not been reported in patients with RYR2 related conditions, is associated with pathogenicity.A 72-year-old woman with a dual-chamber implantable cardioverter-defibrillator (Biotronik Lumax 540 DR-T) at elective replacement indicator presented for generator replacement. A new MicroPort generator (Platinium DR) was attached to her existing leads. Eight days later, multiple red alert messages were received on the Biotronik remote monitoring system from the explanted generator. Investigations revealed alert transmission via a CardioMessenger Smart mobile device registered to another patient that came into proximity of the explanted generator. The Biotronik remote monitoring system is unique in that red alerts could be sent through any CardioMessenger Smart device regardless of whether they were paired.Fasciculoventricular pathway (FVP) is a rare form of preexcitation syndrome. A FVP connects the fascicle and the ventricle. It is indistinguishable to the common preexcitation pathways on the 12‑lead electrocardiography. We herein present a case of FVP, who was with the same His-ventricular interval and QRS morphology during sinus rhythm, junctional beats and rapid atrial pacing rhythm. Using a mapping catheter at the right ventricular anterior (RV) wall, we can clearly demonstrate the activation of RV with and without FVP conduction. With FVP conduction, the RV was activated from basal wall to apex. Without FVP conduction, the activation direction was reversed.

Some patients with ongoing heart failure symptoms after treatment with cardiac resynchronization therapy (CRT) demonstrate QRS prolongation during exercise. We investigated whether the optimal CRT pacing configuration changes during dobutamine stress.

Seven patients undergoing CRT implantation underwent invasive LV dP/dT

measurement during CRT pacing in 10 configurations to determine the optimal baseline pacing configuration (OPC). Measurements were repeated during dobutamine infusion. Differences in mean LV dP/dT

between pacing configurations were compared.

Baseline OPC differed from stress OPC in 6/7 patients. The mean (SD) LV dP/dT

obtained during dobutamine infusion was 1140 (377) mmHg/s in AAI pacing, 1458 (448) mmHg/s in the baseline OPC, and 1656 (435) mmHg/s in the dobutamine OPC (p<0.001 for differences). The mean increase in LV dP/dT

obtained by changing from baseline OPC to dobutamine OPC during dobutamine infusion was 197 (338) mmHg/s (13%). The QRS duration, QRS morphology, QLV and QRV intervals did not change significantly during dobutamine infusion (all P>0.05).

The optimal CRT pacing configuration changes during dobutamine infusion while LV and RV activation timing does not. Further studies investigating the usefulness of automated dynamic changes to CRT pacing configuration according to physiologic condition may be warranted.

The optimal CRT pacing configuration changes during dobutamine infusion while LV and RV activation timing does not. Further studies investigating the usefulness of automated dynamic changes to CRT pacing configuration according to physiologic condition may be warranted.

Electrode misplacement and interchange errors are known problems when recording the 12‑lead electrocardiogram (ECG). Automatic detection of these errors could play an important role for improving clinical decision making and outcomes in cardiac care. The objectives of this systematic review and meta-analysis is to 1) study the impact of electrode misplacement on ECG signals and ECG interpretation, 2) to determine the most challenging electrode misplacements to detect using machine learning (ML), 3) to analyse the ML performance of algorithms that detect electrode misplacement or interchange according to sensitivity and specificity and 4) to identify the most commonly used ML technique for detecting electrode misplacement/interchange. Propionyl-L-carnitine This review analysed the current literature regarding electrode misplacement/interchange recognition accuracy using machine learning techniques.

A search of three online databases including IEEE, PubMed and ScienceDirect identified 228 articles, while 3 articles were includedarning shows promise in detecting lead misplacement/interchange and highlights an opportunity for developing and operationalising deep learning algorithms such as convolutional neural network (CNN) to detect electrode misplacement/interchange.

To compare the mean apparent diffusion coefficient (ADCmean) and glandular density of Gleason score (GS) 3 + 3 transition zone prostate cancers (TZ-PCa) with those of the peripheral zone (PZ-PCa).

Seventy-nine men (mean age 65 ± 6 [SD] years; range 52-81 years) with 37 TZ-PCa (37/79; 53 %) and 42 PZ-PCa (42/79; 47 %) had prostate MRI before radical prostatectomy. Glandular cell density was semi-quantitatively evaluated in all tumors. ADCmean and glandular cell density of GS3 + 3 TZ-PCa were compared to those of PZ-PCa. ADCmean was correlated to GS in each zone.

ADCmean of GS 3 + 3 tumors was significantly lower in the TZ (728 × 10

±52 [SD] mm²/s; range 670-1060mm²/s) than in the PZ (865 × 10

±121 [SD] mm²/s; range 670-1120mm²/s) (p = 0.0007), related to a significantly higher glandular density involving more than 50 % of the tumor in 58 % (7/12) of patients in GS3 + 3 TZ-PCa versus 7.6 % (1/13) in PZ-PCa (p = 0.03). ADCmean of GS3 + 3 TZ-PCa was not significantly different from that of GS 3 + 4 (p = 0.