In this paper we describe the design of a Cartesian Controller for a generic robot manipulator. We address some of the challenges that are typically encountered in the field of humanoid robotics. The ...solution we propose deals with a large number of degrees of freedom, produce smooth, human-like motion and is able to compute the trajectory on-line. In this paper we support the idea that to produce significant advancements in the field of robotics it is important to compare different approaches not only at the theoretical level but also at the implementation level. For this reason we test our software on the iCub platform and compare its performance against other available solutions.
A novel fully-analog lock-in amplifier for the accurate measurements of low quantities of gas in sensor applications is here presented. When compared with commercial lock-in and other solutions ...available in the literature, the proposed system implements an automatic alignment of the relative phase between input and reference signals, both at power-on and for any variation of the input signal phase and amplitude during the working time, so allowing to detect, accurately and in a continuous way, the mean value of the input signal coming from sensors (typically buried into noise). The circuit has been optimized to operate at a specified reference frequency, in particular 77 Hz; this value is suitable for gas sensor applications, since it avoids also any kind of interferences at 50 Hz net frequency and its harmonics. Experimental results have confirmed the correct functionality of the system, also tested for both carbon monoxide (CO) and ethylene glycol detections. With respect to the simpler resistive gas sensor interface, implemented by a resistive voltage divider, the improvement experimentally given by the proposed automatic lock-in amplifier, in terms of resolution, has been of a factor of about 100 for the CO and 230 for the ethylene glycol measurements, so allowing a theoretical gas detection in the order of ppb.
Patients on hemodialysis suffer from high risk of premature death, which is largely attributed to cardiovascular disease, but interventions targeting traditional cardiovascular risk factors have made ...little or no difference. Long chain n-3 polyunsaturated fatty acids (n-3 PUFA) are putative candidates to reduce cardiovascular disease. Diets rich in n-3 PUFA are recommended in the general population, although their role in the hemodialysis setting is uncertain. We evaluated the association between the dietary intake of n-3 PUFA and mortality for hemodialysis patients.
The DIET-HD study is a prospective cohort study (January 2014–June 2017) in 9757 adults treated with hemodialysis in Europe and South America. Dietary n-3 PUFA intake was measured at baseline using the GA2LEN Food Frequency Questionnaire. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association of dietary n-3 PUFA intake with cardiovascular and all-cause mortality.
During a median follow up of 2.7 years (18,666 person-years), 2087 deaths were recorded, including 829 attributable to cardiovascular causes. One third of the study participants consumed sufficient (at least 1.75 g/week) n-3 PUFA recommended for primary cardiovascular prevention, and less than 10% recommended for secondary prevention (7–14 g/week). Compared to patients with the lowest tertile of dietary n-3 PUFA intake (<0.37 g/week), the adjusted hazard ratios (95% confidence interval) for cardiovascular mortality for patients in the middle (0.37 to <1.8 g/week) and highest (≥1.8 g/week) tertiles of n-3 PUFA were 0.82 (0.69–0.98) and 1.03 (0.84–1.26), respectively. Corresponding adjusted hazard ratios for all-cause mortality were 0.96 (0.86–1.08) and 1.00 (0.88–1.13), respectively.
Dietary n-3 PUFA intake was not associated with cardiovascular or all-cause mortality in patients on hemodialysis. As dietary n-3 PUFA intake was low, the possibility that n-3 PUFA supplementation might mitigate cardiovascular risk has not been excluded.
Transesophageal echocardiography (TEE) is recommended in patients undergoing atrial fibrillation (AF) ablation, but use of this strategy is variable.
To evaluate whether TEE is necessary before AF ...ablation in patients treated with novel oral anticoagulants (NOACs).
We performed a prospective multicenter registry of AF patients undergoing radiofrequency catheter ablation on uninterrupted NOACs (apixaban and rivaroxaban). All patients were on NOACs for at least 4 weeks before ablation. Heparin bolus was administered to all patients before transseptal catheterization to maintain a target activated clotting time above 300 seconds. A subset of 86 patients underwent brain diffuse magnetic resonance imaging (dMRI) to detect silent cerebral ischemia (SCI).
A total of 970 patients (514 53% apixaban patients and 456 47% rivaroxaban patients) were enrolled for this study. The mean age was 69.5 ± 9.0 years, with 824 patients (85%) having nonparoxysmal AF, and 636 patients (65.6%) were male. The average CHA2DS2-VASc score was 3.01 ± 1.3 and CHADS2 score was ≥2 in 609 patients (62.8%). Intracardiac echocardiogram ruled out left atrial appendage thrombus in all patients whose left atrial appendage was visualized (692, 71%), and detected "smoke" in 407 patients (42%). SCI at postprocedure dMRI was detected in 2.3% (2/86). One thromboembolic event (transient ischemic attack) (0.10%) with positive dMRI occurred in a patient on uninterrupted rivaroxaban with longstanding persistent AF.
Our study illustrates that performing AF ablation while on uninterrupted apixaban and rivaroxaban without TEE is feasible and safe. This finding has important clinical and economic relevance.
Abstract Background Rhythm control of non-paroxysmal atrial fibrillation (AF) is significantly more challenging, as a result of arrhythmia perpetuation promoting atrial substrate changes and AF ...maintenance. Purpose We describe a tailored ablation strategy targeting multiple left atrial (LA) sites via the multielectrode FarawaveTM pulsed field ablation (PFA) catheter in patients with persistent AF sustained beyond 6 months (PerAF>6m) and long-standing persistent AF (LSPAF). Methods The ablation protocol included the following stages: pulmonary vein antral and posterior wall isolation plus anterior roof line ablation (Stage 1); electrogram-guided substrate ablation (Stage 2); atrial tachyarrhythmia (AT) regionalization and ablation (Stage 3). Results Seventy-two age:68±10y, 61.1%males; AF history: 25 (18-45) months patients with PerAF>6m (52.8%) and LSPAF (47.2%) underwent their first PFA via the FarapulseTM system. LA substrate ablation (Stage 1 and 2) led to AF termination in 95.8% of patients. AF termination occurred while ablating the mitral edge of the postero-lateral ridge (40.3%), the inferior left atrium above the proximal coronary sinus (27.4%), the interatrial septum (22.6%), the superior aspect of the postero-lateral ridge (6.5%), the base of the appendage (3.2%). AF organized into a left-sided atrial flutter (AFlu) in 46 (74.2%) patients. The FarawaveTM catheter was used to identify LA sites showing diastolic, low-voltage electrograms and entrainment from its splines was performed to confirm the pacing site was inside the AFlu circuit (Figure 1). Left AFlu termination was achieved in all cases via PFA delivery. Total procedural and LA dwell times were 112±25min and 59±22 min, respectively. Major complications occurred in 2 (2.8%) patients with pre-existing left ventricular systolic dysfunction (EF<35%) who required inotropic therapy due to acute heart failure. Hemodynamics normalized within 24h and both patients were discharged after 2 and 3 additional hospital days. Transient ST-segment elevation was documented in 4 patients after peri-mitral PFA; timely nitrate administration led to ECG normalization within 10 minutes. Single-procedure success rate was 81.8% after 13.3±1.9 months of follow-up; AF-free survival was 93.1% (Figure 2). A subgroup of 36 patients completed a follow-up transthoracic echocardiography study to assess left atrial mechanical contraction changes after ablation. Median A-wave velocity was 30 (IQR: 20-35) cm/s post-ablation and 50 (IQR: 41-70) cm/s after a mean of 7.3±1.8 months post-ablation. Conclusions In our cohort, PFA-based AF substrate ablation led to AF termination in 95.8% of cases. Very favorable clinical outcomes were observed at one year of follow-up.Entrainment from the PFA Catheter.Kaplan-Meier Analysis.
Abstract Background Achieving durable posterior wall isolation (PWI) with thermal-based energies is challenging, as reconnection rates have been reported to be up to 60%. Additionally, PWI can ...significantly increase the risk of collateral thermal damage to the esophagus. Pulsed field ablation (PFA) is a non-thermal energy source with a remarkable safety profile due to its selectivity to cardiac tissue. Additionally, PWI durability was reported to be 100% in a recent phase-3 study enrolling persistent AF patients undergoing PFA via the FarapulseTM system. Purpose To report procedural details, acute lesion transmurality, and long-term success of PWI via the FarapulseTMsystem. Methods Consecutive persistent AF patients undergoing first-time ablation with the FarapulseTM system at four different centres were prospectively enrolled. All patients received first-time pulmonary vein isolation (PVI) and PWI. PFA was performed with either a 31mm or a 35mm device and an energy output of 2.0kV. At least 2 applications per position were delivered. Primary efficacy endpoint was freedom from any atrial tachyarrhythmia >30s after a 3month blanking period. PW lesion transmurality was assessed in a subpopulation of patients with an indication for hybrid AF ablation and left atrial appendage (LAA) clipping. The procedure was performed according to the following steps: 1) endocardial PVI plus PWI via the FarapulseTM system; 2) endocardial high-density mapping with RhythmiaTM plus Intellanav OrionTM; 3) thoracoscopy-assisted epicardial high-density mapping with Intellanav OrionTM 4) left atrial appendage clipping. Results 157 persistent AF patients (mean age: 62±11years; 75.5% males) were included. First-pass PVI was achieved in 100% of patients. On average, pulsed electric field applications for PWI were 16.3±2.4. Mean procedural time was 66±17min; left atrial dwelling and fluoroscopy times were 46±12min and 14±6min, respectively. SR restoration during PWI was observed in 8 (5.1%) cases. Minor and major periprocedural complications occurred in 2.5% (groin hematoma: 4pts) and 0.6% (diplopia with negative cerebral MRI) patients, respectively. During a mean follow-up of 353±58 days, arrhythmia-free survival was 78.3% (n=123). A redo ablation was performed in 23 patients, showing reconnection of 22.8% of PVs. Durable PWI was observed in 82.6% of patients. In the subpopulation of patients (n=3) undergoing hybrid ablation plus LAA clipping, thoracoscopy-guided epicardial mapping of the PW was performed between 57 and 72 minutes after the last endocardial PFA application. All patients showed transmural PWI (Figure1). Conclusions In a real-world multicenter registry, PWI by means of the FarapulseTM system was safe and feasible, contributing to approximately 80% success rate after 1 year. Endocardial PFA-based PWI led to 100% transmural lesions acutely, with a rate of reconnection <20% at redo procedures.
Abstract Background Atrial fibrillation (AF) patients receiving haemodialysis (HD) face increased bleeding risks, so the net benefit of stroke prophylaxis by oral anticoagulation (OAC) is ill ...defined. Left atrial appendage closure (LAAC) might serve as a suitable alternative to OAC for stroke prevention in this high-risk cohort. Objective To determine the safety and clinical efficacy of LAAC in HD patients with AF. Methods In an international multi-center (n=9) registry, the clinical details were compiled from all HD+AF patients who underwent LAAC. Results The cohort included 147 patients: age 72.6 ± 10.4 yrs, 73% male, CHA2DS2-VASc 4.5 ± 1.5, HAS-BLED 4.7 ± 1.2, prior stroke/TIA 22,5%, prior major bleed 57,8%. The pre-LAAC anticoagulation regimen was heterogeneous with a wide array of at least 12 different combinations of medications utilized. A total of 149 procedures were performed and LAAC was successful in 98% (146 of 149), with a median procedure time of 43 (30-66) minutes. The most common device was Watchman (61%), followed by Amulet (23,3%). The rate of major complications was 5,4% (8), same as the rate of minor complications (5,4%), leading to an overall complication rate of 10,7% (16/149) including one fatal bleed the day after implantation, 4 (2.7%) cardiac tamponades of which 3 were treated with pericardiocentesis and one surgery, and 2 device dislodgements requiring percutaneous retrieval followed by successful reimplantation. Most patients were discharged on DAPT (61,6%). At a median of 61 days follow-up, imaging was performed in 83% of patients, revealing: only 2 (1.7%) peri-device leaks ≥5 mm, and no DRT. Subsequently, anticoagulation was shifted to SAPT so that SAPT emerged as the predominant anticoagulation regimen representing 165,9 patient years (py) of usage followed by DAPT (41,8 py). Over the follow-up of 222,9 py, the incidence of ischemic stroke was 0,9% per year (2 strokes in total), reflecting an 88% relative risk reduction (p<0,001) compared with the calculated stroke rate of 7,4% for patients with a similar CHA2DS2VASc score and no anticoagulation. Similarly, the rate of major bleeding events (defined as BARC score ≥3) was 4,5% per year, signifying a 55% relative risk reduction (p=0,023) compared to the expected rate of patients on VKA therapy, based on a comparable HAS-BLED score. Event tough time on SAPT was nearly four times longer than on DAPT, the number of major bleeding events was similar (SAPT: 5; DAPT: 4). Conclusion In light of these findings LAAO emerges as a promising solution for this unique patient cohort. By mitigating the risks of both bleeding complications associated with anticoagulation and the threat of stroke in the absence of anticoagulation, LAAO represents a well-balanced and effective therapeutic strategy for these individuals. However, the procedural complication rate was elevated compared to that observed in other LAAC cohorts, and requires further study.
Abstract Background Catheter ablation (CA) with pulmonary vein isolation (PVI) is an optimal treatment option in patients with paroxysmal atrial fibrillation (AF). PVI alone in patients with ...persistent AF has proved to have suboptimal results. Ablation of additional atrial structures, such as posterior wall (PW) and left atrial appendage has been investigated as a tool to improve procedural efficacy. Recently very high-power short-duration (vHPSD) ablation was developed to allow rapid PVI, limiting complication through the maximization of resistive heating, and minimization of conductive heating. Objectives Compare PVI plus PWI using vHPSD versus standard-power (SP) ablation index-guided CA among consecutive patients with persistent AF Methods Forty consecutive patients underwent PVI plus PW isolation using vHPSD, compared to 40 controls underwent standard power (SP) PVI plus PW isolation. The primary efficacy endpoint outcome was recurrence of atrial tachyarrhythmias after a 3-month blanking period. The primary safety outcome was a composite of major complications within 30 days of CA. Results Treated patients have a median age of 62.8±9 years, 68 (85%) are male. Median left atrial volume is 42.4 (36-50) ml/m2. 61 (78.8%) patients had never undergone catheter ablation before. There are no statistically significant differences between groups. PW isolation was obtained more commonly in the vHPSD compared to the SP group (98% vs. 75%, p=0.007), despite shorter procedure and fluoroscopy times (p<0.001). Survival free from recurrent atrial tachyarrhythmias at 18 months was 68% in the vHPSD and 47% in SP groups, respectively (log-rank p=0.071), without major adverse events. The vHPSD approach was significantly associated with reduced risk of recurrent AF at multivariable analysis (HR, 0.39, p=0.030). Conclusions The results show feasibility and safety of posterior wall vHPSD ablation for persistent AF using this new temperature-controlled catheter without intraprocedural and periprocedural major complications at follow-up. vHPSD ablation for PW isolation may be more effective in term of atrial tachyarrhythmias recurrences with a trend for superior efficacy. However, this remains a single center experience in a small group of patients. Comparative trials involving greater number of patients with long-term follow-up are necessary to definitive results.
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