Heather M. Ross

Progress toward the prevention and treatment of atrial fibrillation: A summary of the Heart Rhythm Society Research Forum on the Treatment and Prevention of Atrial Fibrillation, Washington, DC, December 9-10, 2013

The Heart Rhythm Society convened a research symposium on December 9–10, 2013, in Washington, DC, that focused on the prevention of atrial fibrillation (AF) as well as AF-related stroke and morbidity. Attendees sought to summarize advances in understanding AF since a 2008 National Institutes of Health (NIH) conference on this topic1 and to identify continued knowledge gaps and current research priorities. The research symposium also sought to identify key deficiencies and opportunities in research infrastructure, operations, and methodologies. The committee sought to identify both basic research targets and how clinical AF research could be improved in the current health care environment. This whitepaper summarizes our deliberations in an effort to accelerate progress toward preventing AF and its consequences. Although largely focused on primary prevention of AF, the paper also addresses some aspects of secondary prevention of recurrent AF due to the continuum of risk factors that contribute to arrhythmogenesis, permissive left atrial (LA) substrates, and the emergence of AF.

Elevations in ventricular pacing threshold with the use of the Y adaptor: implications for biventricular pacing.

RHO, R.W., et al.: Elevations in Ventricular Pacing Threshold with the Use of the Y Adaptor: Implications for Biventricular Pacing. Cardiac resynchronization therapy (CRT) is a new and promising therapeutic option for patients with severe heart failure and intraventricular conduction delay. Patients who are candidates for CRT and have a previously implanted device may utilize a “Y” IS 1 connector to accommodate the coronary sinus lead. This modification has the potential to alter biventricular pacing thresholds. During an 18 month period, successful biventricular pacemaker implantation was performed in 72 patients (age: 67 ± 11 years, left ventricular ejection fraction: 20.5 ± 5.6% ). All of these patients had severe symptomatic congestive heart failure (NYHA Class III and IV). In 20 patients a special “Y” adaptor that bifurcates the ventricular IS 1 bipolar output to two bipolar outputs or one unipolar and one bipolar output was utilized. During initial implantation, LV thresholds obtained in a unipolar configuration prior to connecting to the “Y” adaptor were significantly lower than thresholds obtained after connecting to the “Y” adaptor ( 1.7 ± 1.11 V at 0.5 ms pulse width versus 2.8 ± 1.5 V at 0.5 ms pulse width [P = 0.01] ). Two patients (10%) required left ventricular lead revisions due to unacceptably high left ventricular thresholds during device follow‐up. The difference in measured left ventricular thresholds between the two configurations is best explained by a resistive element that is added to the circuit when performing threshold measurement of the LV lead through the “Y” adaptor (combined tip to RV ring configuration) versus measurement of the LV lead in a unipolar configuration. This resistive element represents multiple factors including anode surface area, resistive polarization at the tissue‐electrode interface, and transmyocardial resistance. LV thresholds should be measured in an LV tip to RV ring configuration or ideally in a combined tip (LV and RV) to shared ring configuration in order to accurately assess LV thresholds. This observation has significant clinical implications as loss of capture may occur as a result of improper measurement of left ventricular thresholds at the time of implantation. (PACE 2003; 26:747–751)

Alcohol septal ablation complicated by complete heart block and permanent pacemaker failure

Alcohol septal ablation is a novel catheter‐based technique for the treatment of obstructive hypertrophic cardiomyopathy. Complete heart block complicates the procedure in 7%–30% of cases and necessitates the prophylactic insertion of a temporary pacing wire in all patients who do not have a permanent pacemaker. We describe a case of alcohol septal ablation complicated by complete heart block and failure to capture by both a permanent pacemaker and an implantable cardioverter defibrillator (ICFD) with pacing capabilities. Cathet Cardiovasc Intervent 2003;58:189–193.

Better Teaming Through Visual Cues: How Projecting Imagery in a Workspace Can Improve Human-Robot Collaboration

In this article, we present a communication paradigm using a context-aware mixed-reality approach for instructing human workers when collaborating with robots. The main objective is to utilize the physical work environment as a canvas to communicate task-related instructions and robot intentions in the form of visual cues. A vision-based object-tracking algorithm is used to precisely determine the pose and state of physical objects in and around the workspace. A projection-mapping technique is employed to overlay visual cues on the tracked objects and the workspace. Simultaneous tracking and projection onto objects enable the system to provide just-in-time instructions for carrying out a procedural task.

Human factors engineering for mobile health applications

Childhood asthma has effectively doubled since 1980 and currently affects about 8% of the U.S. childhood population. Efficiently analyzing quality of air data, which would ultimately improve the information available to parents with children suffering from asthma, is crucial to reduce the likelihood of a serious attack. In order to accomplish this task, the use of low-cost, wearable, environmental sensors contribute to construct a live “air-care” pollution map. Creating an alpha prototype application to gauge how well participants interact with and interpret healthcare information utilizing a “Wizard of Oz” paradigm becomes an important component in the research.