Kuniomi Ogata

Quantitative magnetic detection of finger movements in patients with Parkinson’s disease

To develop a new measurement tool for quantitatively detecting the finger movement of a patient with Parkinsons disease (PD), we designed a magnetic sensing system consisting of a magnetic induction coil, a sensing coil, and a circuit unit. The sensing coil detects the inducted magnetic field that varies with the distance between the two coils, and the detected signals are demodulated in the circuit unit in order to obtain the variation voltage from the oscillation frequency. To obtain a coefficient for converting voltage to distance, we measured the output voltages for seven fixed finger positions of 12 normal volunteers. The voltage differences corresponding to the finger movement in 20 PD patients, six age-matched controls, and 12 normal volunteers were then recorded for 30s. To investigate the velocity and acceleration of the finger movement, we calculated their waveforms from the measured displacement waveform. We also detected the main frequency of the tapping rhythm by using a fast Fourier transform (FFT). The averaged amplitude of each waveform decreased with the disorder in the Hoehn-Yahr (HY) stage, while the averaged tapping frequency of PD patients did not have any correlation with this stage. It can be concluded that this magnetic sensing system can assess finger movement quantitatively.

Identifying patterns of spatial current dispersion that characterise and separate the Brugada syndrome and complete right-bundle branch block.

The aim of the study was to detect patterns of spatial-current distribution in the late QRS and early ST-segments that distinguish Brugada-syndrome cases from complete right-bundle branch block (CRBBB). Magnetocardiograms (MCGs) were recorded from Brugada-syndrome patients (n=6), CRBBB patients (n=4) and the members of a control group (n=33). The current distributions at six time points from Q-onset were estimated by producing current-arrow maps (CAMs). The angle of the current arrow of maximum amplitude at each time point was calculated. In the Brugada cases, the characteristic ST elevation was seen above the upper right chest, and abnormal currents appeared to be present in the right-ventricular outflow tract (RVOT). The angles of the abnormal arrows were −78°±51° at 100ms and −50°±61° at 110ms. In the cases of CRBBB, wide S- and R-waves were recorded above the upper right and lower right chest, respectively. The angles of the abnormal arrows for CRBBB were 152°±19° at 100ms, 159°±20° at 110ms, and 157°±19° at 120ms. The findings suggest that an abnormal current from the RVOT to the upper left chest may be a feature of the Brugada syndrome, and that the direction of this current is completely different from that seen in CRBBB.

Classifying cases of fetal Wolff-Parkinson-White syndrome by estimating the accessory pathway from fetal magnetocardiograms.

The paper presents an evaluation of the possibility of using fetal magnetocardiogram (FMCG) signals to estimate and classify the accessory pathway in fetal Wolff-Parkinson-White (WPW) syndrome. The FMCG signals of two fetuses with WPW syndrome (type A) were detected using a 64-channel superconducting quantum-interference device system. An average across the cycles of these signals was taken to obtain clear WPW signals. To determine the direction and position of the accessory pathway in a fetal heart accurately, the accessory pathway and activated pathway at the peak of the QRS complex thus obtained were estimated for each fetus, using a single-dipole model. The phase angle (about 90o) between the equivalent current dipoles (ECDs) was the same for both fetuses. This angle suggested that the accessory pathway is in the left side of the heart, i.e. that the pathway exists in the position of the accessory pathway in a fetus with WPW syndrome from the angle between the ECD of the accessory pathway and the ECD of the peak in the QRS complex was thus demonstrated.

Detection of spatial repolarization abnormalities in patients with LQT1 and LQT2 forms of congenital long-QT syndrome

The aim of this study is to detect the spatial current dispersion that appears in the T-wave of patients with congenital long-QT syndrome (LQTS). To observe this dispersion, magnetocardiograms (MCGs)--which have a high spatial resolution--of LQT1 patients (n = 7), LQT2 patients (n = 9) and a control group (n = 33) were recorded. The dispersion was evaluated by plotting current-arrow maps (CAMs) calculated from the MCG signals. In the case of LQT1, abnormal current arrows in the CAMs appeared above the inferior part of the heart in two LQT1 patients with a long corrected QT interval (QTc) (>0.6), and the current direction was from the left (origin side) to the right ventricular muscle (110 degrees). In six out of nine LQT2 patients, abnormal current arrows with angles below 20 degrees were observed above the right inferior part or lower septum; the current direction was from the right (origin side) to the left ventricular muscle. However, in the case of the LQT2 patients, the QTc values did not correlate with the abnormal current. These findings suggest that the origin of abnormal repolarization in LQT1 is the left ventricular muscle and the origin of that in LQT2 is the right ventricular muscle or lower septum. The estimation of the origin in LQTS patients can provide important information such as the risk factor of sudden death.

Ability of magnetocardiography to detect regional dominant frequencies of atrial fibrillation

Lead V1 on electrocardiography (ECG) can detect the dominant frequency (DF) of atrial fibrillation (AF) in the right atrium (RA). Paroxysmal AF is characterized by a frequency gradient from the left atrium (LA) to the right atrium (RA). We examined the ability of magnetocardiography (MCG) to detect regional DFs in both the atria.

Electrical Space-Time Abnormalities of Ventricular Depolarization in Patients with Brugada Syndrome and Patients with Complete Right-Bundle Branch Blocks Studied by Magnetocardiography

Background: Both ventricular depolarization abnormalities (QRS complex) and repolarization ones (ST/T) are still controversial in literature. The objective of this study was to clarify the space‐time variations that occur in patients carriers of Brugada syndrome using Magnetocardiography and also compare them with cases of complete right‐bundle branch block (CRBBB) and individuals without any dromotropic disorder (control group).

Electrogram organization predicts left atrial reverse remodeling after the restoration of sinus rhythm by catheter ablation in patients with persistent atrial fibrillation

BACKGROUND Despite the informative nature of atrial fibrillation (AF) electrograms, electrophysiological aspects of predicting reversal of structural remodeling of the left atrium (LA) have not been evaluated. OBJECTIVES To identify predictors of reverse remodeling after restoration of sinus rhythm by catheter ablation in patients with persistent AF. METHODS This study included 90 patients with persistent AF and enlarged LA (left atrial volume indexed to body surface area [LAVi] ≥32 mL/m(2)). LAVi was measured by echocardiography before ablation and 12 months after sinus rhythm restoration. We divided 73 (81%) patients free from recurrences into 2 groups according to reduction in LAVi: responders, reduction ≥23% (n = 35); nonresponders, reduction <23% (n = 38). Serological testing and electrophysiological characteristics on electrocardiogram and magnetocardiogram were analyzed. RESULTS LAVi decreased from 43 ± 12 to 27 ± 7 mL/m(2) in responders and from 37 ± 8 to 33 ± 8 mL/m(2) in nonresponders. Higher LAVi at baseline (P = .01), lower age (59 ± 7 years vs 63 ± 7 years; P <.05), higher brain natriuretic peptide level (median = 92, interquartile range [IQR] = 98 pg/mL vs median = 60, IQR = 64 pg/mL; P = 0.01), higher atrial natriuretic peptide level (median = 73, IQR = 74 pg/mL vs median = 54, IQR = 70 pg/mL; P = .02), and higher organization index of AF signals (0.51 ± 0.11 vs 0.42 ± 0.09; P = .0001) were observed in responders. There was a linear correlation between organization index and % reduction in LAVi (R = 0.63; P <.0001). Multiple linear regression analysis showed relations between reverse remodeling and age (β = -0.28; P = .002), atrial natriuretic peptide level (β = 0.21; P = .03), and organization index (β = 0.53; P <.0001). CONCLUSIONS Electrogram organization was a robust predictor of reverse remodeling of the enlarged LA after sinus rhythm restoration by catheter ablation in patients with persistent AF.

Reconstruction of action potential of repolarization in patients with congenital long-QT syndrome

A method for reconstructing an action potential during the repolarization period was developed. This method uses a current distribution-plotted as a current-arrow map (CAM)--calculated using magnetocardiogram (MCG) signals. The current arrows are summarized during the QRS complex period and subtracted during the ST-T wave period in order to reconstruct the action-potential waveform. To ensure the similarity between a real action potential and the reconstructed action potential using CAM, a monophasic action potential (MAP) and an MCG of the same patient with type-I long-QT syndrome were measured. Although the MAP had one notch that was associated with early afterdepolarization (EAD), the reconstructed action potential had two large and small notches. The small notch timing agreed with the occurrence of the EAD in the MAP. On the other hand, the initiation time of an abnormal current distribution coincides with the appearance timing of the first large notch, and its end time coincides with that of the second small notch. These results suggest that a simple reconstruction method using a CAM based on MCG data can provide a similar action-potential waveform to a MAP waveform without having to introduce a catheter.

Open-type hybrid magnetic shield using high-TC superconducting wire and flexible magnetic sheets

An open-ended, cylindrical magnetic shield using high-TC superconducting rings and flexible magnetic sheets has been developed. The superconducting ring is made of Bi2Sr2Ca2Cu3Ox tape wire, and the flexible magnetic sheet is made of Fe–Cu–Nb–Si–B nanocrystalline alloy, which has superior soft magnetic properties. The superconducting rings are set near the open ends of a ferromagnetic cylinder. When a magnetic field is induced in the rings, a shielding current flows so as to keep the magnetic flux through the ring constant. It is concluded that the superconducting rings effectively increase the shielding factor of a magnetic shield.

Development of a magnetocardiography-based algorithm for discrimination between ventricular arrhythmias originating from the right ventricular outflow tract and those originating from the aortic sinus cusp: A pilot study

BACKGROUND Although several reports address characteristic 12-lead electrocardiographic findings of outflow tract ventricular arrhythmias (OT-VAs), the accuracy of electrocardiogram-based algorithms to predict the OT-VA origin is sometimes limited. OBJECTIVE This study aimed to develop a magnetocardiography (MCG)-based algorithm using a novel adaptive spatial filter to differentiate between VAs originating from the aortic sinus cusp (ASC-VAs) and those originating from the right ventricular outflow tract (RVOT-VAs). METHODS This study comprised 51 patients with an OT-VA as the target of catheter ablation. An algorithm was developed by correlating MCG findings with the successful ablation site. The arrhythmias were classified as RVOT-VAs or ASC-VAs. Three parameters were obtained from 3-dimensional MCG imaging: depth of the origin of the OT-VA in the anteroposterior direction; distance between the earliest atrial activation site, that is, sinus node, and the origin of the OT-VA; and orientation of the arrhythmia propagation at the QRS peak. The distance was indexed to the patients body surface area (in mm/m2). RESULTS Origins of ASC-VAs were significantly deeper (81 ± 6 mm/m(2) vs. 68 ± 8 mm/m(2); P < .01) and farther from the sinus node (55 ± 9 mm/m2 vs. 41 ± 9 mm/m(2); P < .01) than those of RVOT-VAs. ASC-VA propagation had a tendency toward rightward axis. Receiver operating characteristic analyses determined that the depth of the origin was the most powerful predictor, with a sensitivity of 90% and a specificity of 73% (area under the curve = 0.90; P < .01). Discriminant analysis combining all 3 parameters revealed the accuracy of the localization to be 94%. CONCLUSION This MCG-based algorithm appeared to precisely discriminate ASC-VAs from RVOT-VAs. Further investigation is required to validate the clinical value of this technique.