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PubMed2001

Radiofrequency catheter ablation with the split-tip electrode in the temperature-controlled mode.

The 7 Fr "split-tip electrode" (2.5-mm tip electrode divided longitudinally into four electrodes with an adjacent 2-mm ring electrode) improves mapping resolution due to its small recording electrodes and narrow interelectrode distances (0.1 mm). The purpose of this study was to examine the temperature-controlled ablation properties of this electrode. In seven anesthetized dogs, the thigh muscles were exposed and superfused with canine blood. A split-tip catheter electrode (with a thermocouple in each of the five electrodes) and a conventional 4-mm catheter electrode were positioned at constant pressure perpendicular or parallel to the surface of the thigh muscle. Impedance measured between each split electrode and a skin patch correlated with the degree of contact with blood and tissue. In the parallel catheter to tissue orientation, split electrodes not in contact with tissue had a low impedance (mean 210-224 ohms), and the split electrode almost entirely in contact with tissue had the highest impedance (380 +/- 56 ohms). In the perpendicular catheter to tissue orientation all split electrodes had a similar impedance (mean 279-286 ohms). A total of 75 radiofrequency (RF) lesions were produced in the temperature-controlled mode with the 4-mm electrode (target 60 degrees C) or the split-tip electrode (power limited by the hottest electrode reaching 70 degrees C) with current delivered to all five electrodes simultaneously, or only to electrodes in contact with tissue. Lesion depth was not significantly different between electrodes in the parallel orientation (5.2 +/- 0.9 vs 5.1 +/- 1.4 vs 5.3 +/- 1.1 mm), but significantly deeper with the conventional 4-mm tip electrode in the perpendicular orientation (6.7 +/- 1.2 vs 5.3 +/- 1.3 vs 5.6 +/- 0.9 mm, P < 0.05). This was due to higher power delivered to the conventional 4-mm electrode (27 +/- 9 vs 17 +/- 7 vs 15 +/- 7 W, P < 0.05) because convective cooling by the blood flow was less effective for the split-tip electrode due to a reduced heat conduction across the interelectrode space from the hottest electrode to cooler areas of the group of five electrodes (mean temperature difference between the hottest split electrodes and the ring electrode: 24 degrees C). Electrode cooling or heat conduction was not effected by the elimination of current delivery to non-contact electrodes. Steam pops occurred in 36% of applications with the conventional 4-mm electrode in the perpendicular orientation but never with the split-tip electrode in spite of the higher target temperature. Measurement of impedance from the split electrodes allow the determination of electrode tissue contact and RF lesions produced with the split-tip electrode in the temperature-controlled mode using a target of 70 degrees C were of reasonable size and not associated with steam pops.

Animals↗
PubMed1999

Effects of electrode location and spacing on phoneme recognition with the Nucleus-22 cochlear implant.

OBJECTIVE: The objective of this paper was to determine how phoneme identification was affected by the cochlear location and spacing of the electrodes in cochlear implant listeners. DESIGN: Subjects were initially programmed with the full complement of 20 active electrodes, in which each electrode was assigned to represent the output of one filter in the normal SPEAK processor. In the present study several four-electrode processors were constructed by assigning the output of more than one filter to a single electrode. In all conditions speech sounds were still analyzed into 20 frequency bands and processed according to the usual SPEAK processing strategy, but the location and spacing of the four stimulated electrode pairs were varied systematically. In Experiment I, the spacing between stimulated electrodes was fixed at 3.75 mm and the cochlear location of the four electrode pairs was shifted from the most-apical position up to 3.0 mm toward the base in 0.75 mm steps. In Experiment II, the spatial separation between the four electrode pairs (each bipolar-plus-one) was systematically changed from 1.5 mm to 4.5 mm while holding the most apical active electrode fixed. In Experiment III, the spacing of active electrodes was varied to represent equal tonotopic spacing to equal linear frequency intervals between pairs. Recognition of medial vowels and consonants was measured in three subjects with these custom four-electrode speech processors. RESULTS: In Experiment I, results showed that both vowel and consonant recognition were best when the electrodes were in the most apical locations. In Experiment II, best speech recognition occurred when electrode pairs were separated by 3 to 3.75 mm. In Experiment III, both vowel and consonant recognition scores decreased when the spacing of electrode pairs was changed from equal tonotopic spacing to equal linear frequency intervals. Overall, vowel and consonant recognition were best at the most apical electrode locations and when the spacing of electrodes matched the frequency intervals of the analysis filters. Consonant recognition was relatively robust to alterations in electrode location and spacing. The best vowel scores with four-electrode speech processors were about 10 percentage lower than scores obtained with the full 20-electrode speech processors. However, the best consonant scores with four-electrode speech processors were similar to those obtained with the full 20-electrode speech processors. Information transmission analysis revealed that temporal envelope cues (voicing and manner) were not strongly affected by changes in electrode location and spacing, whereas spectral cues, as represented by vowel recognition and consonantal place of articulation, were strongly affected. Both spectral and temporal phoneme cues were strongly affected by the degree of tonotopic warping, created by altering both the location and spacing of the activated electrodes. CONCLUSION: The cochlear location and spacing of the activated electrodes had a clear effect on phoneme recognition. Temporal cues were less affected by tonotopic shifts or linear tonotopic stretching or shrinking, but were susceptible to nonlinear tonotopic warping. Spectral cues were sensitive to all tonotopic manipulations: shifting, linear stretching, and nonlinear warping. However, the present experiments could not differentiate whether the optimal mapping between analysis frequency bands and stimulation electrodes was determined by the normal acoustic tonotopic pattern or by the pattern learned from experience with the 20-electrode implant.

Adult↗
PubMed2001

Comparison of irrigated electrode designs for radiofrequency ablation of myocardium.

BACKGROUND: Previous reports have demonstrated that radiofrequency energy delivered to myocardium via an irrigated electrode results in a more voluminous ablation lesion than a non-irrigated electrode. Different irrigated electrode designs have been utilized; no direct comparisons have been reported. PURPOSE: To compare different irrigated electrode designs. METHODS: Three irrigation electrode designs were compared to a control (non-irrigated electrode) group: 1. internal; 2. showerhead; 3. sheath. For each electrode, prior to ablation Doppler echocardiographic assessment of the irrigant flow along the electrode outer surface was performed. Ablation was performed in vitro utilizing a whole blood-superfused system. Electrode, electrode-endocardial interface, and intramyocardial temperatures were assessed, as were ablation circuit impedance, total delivered energy, and lesion and electrode morphology. Room temperature normal saline was utilized as the irrigating fluid, delivered at 20 cc/min. Electrode-endocardial interfacial blood flow was assessed at rates of 0 and 0.26 m/s. RESULTS: Irrigant was contained within the internal electrode design and therefore the electrode outer surface manifested no significant flow during irrigation. Irrigant spread primarily radially away from the showerhead electrode design, yielding relatively high electrode outer surface flow at the irrigation holes, but low elsewhere. Irrigant traveled in parallel to and enveloped the electrode outer surface of the sheath electrode design, yielding relatively moderate but uniform flow. Ablation via each of the irrigated electrodes yielded greater ablation energy deposition and larger lesion dimensions than the non-irrigated electrode. Irrigation did not necessarily prevent interfacial boiling, which could occur during uninterrupted radiofrequency energy deposition and lesion growth. The results for the 3 irrigation designs were incongruent. The duration of radiofrequency energy application via the internal electrode design was significantly shorter than the other designs, curtailed by impedance rise. This yielded the smallest total radiofrequency energy deposition and smallest ablation lesion volume. Relative to this, duration using the showerhead design was significantly longer, associated with greater total energy deposition and larger lesion volume. The sheath design permitted the longest duration, associated with the largest total energy deposition and lesion volume. CONCLUSIONS: Although each of the irrigated electrode designs yielded larger lesions than the non-irrigated electrode, they were not comparable. Ablation duration and lesion size were directly correlated with flow along the electrode outer surface.

Animals↗
PubMed2001

Chronic electrical stimulation of the auditory nerve using high surface area (HiQ) platinum electrodes.

High surface area cochlear implant electrodes with much smaller geometric surface areas than current designs might be used in the future to increase the number of stimulating electrodes along the carrier. Potential problems with an increase in charge density for a common stimulus resulting from decreasing the geometric surface area would be reduced by the enlarged real surface area of such electrodes. Electrochemically modified (HiQ) platinum (Pt) electrodes, with a real surface area approximately 75 times greater than the current standard Pt electrodes of the same geometric size, had shown in vitro a low polarization (Z(pol)) and electrode impedance (Z(e)), as well as a low residual direct current (DC). In this study we examined the chronic performance of HiQ electrodes in cats, which were bilaterally implanted with a two-channel HiQ or standard Pt scala tympani electrode array and unilaterally stimulated for periods of up to 2390 h. Stimuli consisted of 50 micros/phase charge-balanced biphasic current pulses presented at 2000 pulses/s/channel with a 50% duty cycle. Electrode impedance (Z(e)), access resistance (R(a)) and polarization impedance (Z(pol)) were calculated from current and voltage measurements obtained periodically throughout the implantation period. Immediately following implantation HiQ electrodes showed a significantly smaller Z(pol), resulting in a reduced Z(e) (P<0.0001) compared to standard electrodes, while there was no significant difference between R(a) of both electrode designs (P=0.91). Subsequently, Z(e) generally increased mainly due to a rise in R(a), which dominated Z(e) and obliterated the effect of a lower Z(pol) on Z(e) in HiQ electrodes. Peak R(a) levels correlated closely (r=0.85) with the amount of intracochlear fibrous tissue found adjacent to the array. Following explantation of the array, voltage waveforms for both electrode designs recorded in saline were again very similar to those recorded immediately after implantation. Mean DC levels were consistently lower for HiQ electrodes compared with standard electrodes (22.45 nA vs 134.7 nA). Histopathological examination of corresponding cochlear sections comparing the stimulated test side with the unstimulated control side showed no significant difference (P>0.05) for either animals implanted with HiQ electrodes (n=6) or standard electrodes (n=2). Nor were there any significant differences between the spiral ganglion cell density of the basal turn implanted with HiQ or standard electrodes for both the stimulated test (P=0.31) and the unstimulated control side (P=0.84). Although these findings are based on a small group of animals implanted with standard electrodes (n=2), and those negative statistical results could potentially be due to the small sample size, similar spiral ganglion cell survival was found in a previous study of a larger group of animals using standard electrodes stimulated with the same stimulus paradigm as in the present study [Xu et al. (1997) Hear. Res. 105, 1-29]. Our data indicate that while some initial advantages of HiQ electrodes are lost during chronic implantation due to intracochlear fibrous tissue growth, low DC levels and the high surface area appear to be maintained, suggesting that HiQ electrodes may have important clinical applications.

Animals↗
PubMed2000

Are electrocardiogram electrodes acceptable for electroencephalogram bispectral index monitoring?

BACKGROUND: The monitoring of electroencephalogram bispectral index (EEG-BIS) during anaesthesia reduces anaesthetic use and improves recovery. However, it also increases the direct costs of anaesthesia due to the need for special EEG electrodes. In the present study we tested the feasibility of less expensive electrocardiogram (ECG) electrodes for EEG-BIS monitoring. METHODS: In the first part of the study we compared skin-electrode impedances when EEG electrodes were used after alcohol swab pretreatment of skin to impedances when ECG electrodes were used after alcohol swab pretreatment with or without skin abrasion paste. In the second part of the study we evaluated the difference in parallel BIS values collected with two BIS monitors, using either ECG electrodes or EEG electrodes. In the third part of the study we compared parallel BIS values collected with two sets of EEG electrodes. RESULTS: Skin pretreatment with abrasion paste led to lower impedances with ECG electrodes than did alcohol swab pretreatment of skin with EEG electrodes. When the skin was pretreated with alcohol swab, higher impedances were measured with ECG electrodes than with EEG electrodes. In most patients, BIS values collected with ECG electrodes were also higher than those collected with adhesive EEG electrodes. The difference between parallel BIS values collected with two sets of adhesive EEG electrodes was smaller than the difference between BIS values collected with ECG and EEG electrode sets. CONCLUSION: Low skin-electrode impedances indicating reliable skin-electrode contact can be ensured with inexpensive pregelled ECG electrodes only if the skin is carefully prepared with both abrasion paste and alcohol. When only alcohol pretreatment of skin is used, the BIS values collected with EEG electrodes and ECG electrodes are not equal. EEG-BIS monitoring with pregelled ECG electrodes is recommended only if skin is prepared with abrasion paste before attaching the electrodes.

Adult↗
PubMed2006

Optimum design of electrode structure and parameters in electrical impedance tomography.

In electrical impedance tomography (EIT) the electrode structure and parameters significantly influence measurement sensitivity and image quality, so how to optimize the electrode structure and parameters is one of the key problems in research today. This paper presents a method to optimize the EIT electrode structure and parameters based on coercive equipotential node models. The coercive equipotential mode of the compound electrode has been established based on that of the line electrode. A simulation study for the line electrode and the compound electrode of EIT has been made on a simulation software platform. The influences of different electrode structures and parameters on measurement sensitivity and the image reconstruction quality are studied. For line electrode simulation studies, two important conclusions are drawn. First, a narrower electrode is helpful in improving the imaging quality. Second, although it is known that a wider electrode is beneficial in decreasing the contact impedance, using a too wide electrode causes the measurement sensitivity to decrease. Furthermore the electrode width that leads to the best measurement sensitivity is different for different measurement depths. The compound electrode has four parameters: the excitation electrode width, the measurement electrode width, the space between the excitation electrode and the measurement electrode, and the distance between two adjacent compound electrodes. These parameters have mutual restrictions and complex influences on each other. It is unwise to optimize the design of a compound electrode by only using the overlay rate of electrodes. A simulation study of EIT electrode structure and parameter influences can be carried out according to this paper to determine the optimum design of the electrode structure and its parameters.

Computer Simulation↗
PubMed2001

Lateralization of temporal lobe foci: depth versus subdural electrodes.

OBJECTIVES: Definitive localization of an epileptic focus correlates with a favorable outcome following epilepsy surgery. This study was undertaken to determine the incremental value of data yielded for surgical decision making when using subdural electrodes alone and in addition to depth electrodes for temporal lobe epilepsy. METHODS: Standardized placement for intracranial electrodes included: (1) longitudinal placement of bilateral temporal lobe depth electrodes; (2) bilateral subtemporal subdural strips; and (3) bilateral orbitofrontal subdural strips. Sixty-three events were randomly reviewed for: (1) subdural electrodes alone; and (2) depth electrodes in conjunction with subdural electrodes. RESULTS: Of the 63 seizures, 54 (85.7%) demonstrated congruent lateralization to ipsilateral subtemporal subdural strip electrodes (based on depth electrode localization) when subdural strip electrodes were utilized alone. In 3 of 22 patients, 7 seizures demonstrated 'false localization' on subdural electrode analysis alone when compared with depth recording and post-surgical outcome. For these 3 patients, retrospective review of neuroimaging demonstrated suboptimal ipsilateral placement of subtemporal subdural electrodes with the most mesial electrode lateral to the collateral sulcus. Four additional patients had suboptimal placement of subtemporal subdural electrodes. Two of these 4 patients had congruent localization with subdural electrodes to ipsilateral depth electrodes despite suboptimal placement. Subtemporal subdural electrodes accurately localized for all seizures from the mesial temporal lobe when the mesial electrodes of the subtemporal subdural strip recorded mesial to the collateral sulcus from the parahippocampal region. CONCLUSION: We conclude that although there are high concordance rates between subdural and depth electrodes, localization of seizure onset based on subdural strip electrodes alone may result in inaccurate focus identification with potential for possible suboptimal treatment of temporal lobe epilepsy. When subtemporal subdural electrodes provide recording from the parahippocampal region, there is accurate localization of the seizure focus. If suboptimal placement occurs lateral to the collateral sulcus, the electroencephalographer cannot make a definitive identification of the seizure focus.

Brain Mapping↗
PubMedDate not supplied

Performance of an intramuscular electrode during functional neuromuscular stimulation for gait training post stroke.

The goal of rehabilitation for stroke patients in this research was to improve the volitional coordination of the swing phase and stance phases of gait. Functional neuromuscular stimulation (FNS) is a promising rehabilitation tool for restoring motor control. For our gait training protocols, FNS systems with surface electrodes were impractical. For the rehabilitation protocols that we defined, available implantable electrode designs did not meet desired criteria regarding fracture rate, invasiveness of placement procedures, and maintenance of position at the motor point. The criteria for the new intramuscular (IM) electrode design included minimally invasive electrode placement technique, accurate placement of electrodes, good muscle selectivity, consistency of muscle activation, good position maintenance of the electrode at the motor point, comfortable stimulus, and practical donning time for the system. A percutaneous electrode was designed for placement beneath the skin at the motor point of seven paralyzed or paretic muscles in the lower limb. A single-helical coil lead, a double-helical coil electrode, and fine wire barbs were design features that enhanced the anchoring capability of the electrode. A polypropylene core enhanced electrode durability. Implantation tools were custom-designed to enable accurate electrode placement without incision. We studied 17 subjects with a total of 124 electrodes. With the use of IM electrodes, FNS was provided for 1,413.8 electrode months. During this time, no instances of infection occurred. The measure of electrode integrity showed a 99% electrode survival rate. Throughout the treatment protocols, 93% of the electrodes delivered a good muscle response; 7% (nine electrodes) moved from the motor point and delivered a poor muscle response during the treatment protocol. Anchoring performance was higher for electrodes implanted in muscles that moved the hip (96.0%) and ankle joints (97.45%) compared with electrodes implanted in muscles that moved the knee joint (88.5%). Ninety-seven percent of the electrodes delivered a comfortable stimulus. Three percent delivered a stimulus that was uncomfortable at therapeutic levels and therefore were not used. We achieved gains in subject impairment and disability measures. The system proved to be practical for use in both clinical and home environments.

Aged↗
PubMed2001

Control of electrochemical reactions at the capillary electrophoresis outlet/electrospray emitter electrode under CE/ESI-MS through the application of redox buffers.

It was found that combining capillary electrophoresis (CE) and electrospray ionization mass spectrometry (ESI-MS) overlays two controlled current techniques to form a three-electrode system (CE inlet, CE outlet/ES emitter, and MS inlet electrodes) in which the CE outlet electrode and the ES emitter electrode were shared between the CE and the ESI-MS circuits. Depending on the polarities and magnitudes of the voltages at the CE inlet, CE outlet/ES emitter, and MS inlet electrodes, the nature of the two redox reactions at the shared electrode was the same or different (both reduction, both oxidation, or one oxidation and the other reduction). Several redox buffers were introduced for controlling electrochemical reactions at the shared electrode. By reacting at this electrode, redox buffers were able to maintain electrode potentials below the onset of water electrolysis, thereby eliminating gas bubble formation and/or pH drift. The volume of the gas generated due to water electrolysis was used to quantitate water oxidation or reduction at this electrode. Two types of redox buffers were used. A reactive electrode with an oxidation potential below that of water was used as the electrode under anodic conditions. Also, a reactive compound with a redox potential below that of water was added to the CE and/or ESI running buffer. When the shared electrode was the anode of both CE and ESI-MS circuits, the use of iron or etched and sanded stainless steel (ss) wire, instead of platinum wire, suppressed bubble formation at the shared electrode. Under these conditions, corrosion of the Fe wire and formation of Fe2+ replaced oxidation of water, eliminating O2 gas bubble and H+ formation. When mixtures of peptides were analyzed, iron adducts of peptides were observed. For a fresh wire, however, the intensities of adduct ions were less than 3% of the protonated molecules. After a few days of operation, the intensities of the adduct ions increased to approximately 50%, due to rust formation on the Fe wire. On-column rinsing with a 40% solution of citric acid rejuvenated the Fe wire and reduced the adduct peak intensities to less than 3%. Unmodified ss wire did not quench bubble formation, which was attributed to its passivated surface. When Fe, ss, and Pt wires were used as the shared electrode under forward polarity CE and positive ESI mode, where the shared electrode acted as a cathode with respect to CE inlet and as an anode with respect to MS inlet, reduction of water at the cathodic end of the electrode and, in the case of ss and Pt wires, oxidation of water at the anodic end of the shared electrode produced a significant amount of bubbles. Under these conditions, however, a buffer containing 50 mM p-benzoquinone completely suppressed both cathodic reduction and anodic oxidation of water for CE currents up to 4 microA. Reduction of p-benzoquinone at the cathodic end of the shared electrode to hydroquinone, and oxidation of this hydroquinone at the anodic end of the electrode, replaced reduction and oxidation of water, eliminating bubble formation. A 0.1% acetic acid solution saturated with I2 was also found to suppress bubble formation at the cathode for CE currents up to 3 microA; however, strong iodine adduct ions were observed under CE/ESI-MS when a mixture of peptides was analyzed. The application of iron as an in-capillary electrode for the analysis of a peptide mixture and a protein digest demonstrated a high separation efficiency similar to when hydroquinone was used as a redox buffer.

Journal Article↗
PubMed1991

Comparative efficacy of subcutaneous mesh and plate electrodes for nonthoracotomy canine defibrillation.

To determine the optimal configuration for the subcutaneous placement of electrodes for the performance of ventricular defibrillation without thoracotomy, internal defibrillation using four different subcutaneous electrodes was performed in 13 anesthetized dogs (7-12 Kg, mean +/- SD: 9.2 +/- 1.5 Kg). An electrode (7 cm2) was positioned transvenously in the superior vena cava with the following electrodes randomly implanted subcutaneously on the left chest: small mesh electrode (14 cm2), large mesh electrode (28 cm2), small titanium plate electrode (14 cm2), and large plate electrode (28 cm2). Ventricular fibrillation was induced by applying alternating current; a monophasic defibrillation wave was administered between the superior vena cava and the subcutaneous electrodes 10 seconds later. The energy level associated with a 50% successful defibrillation, as predicted by logistic regression analysis, was defined as the ED50. After the completion of the defibrillation protocol using the four subcutaneous electrodes, the small mesh electrode was sutured to the epicardium and the ED50 measurements were repeated. Energy ED50s were lower when the superior vena cava electrode was used as the cathode rather than as the anode. Of the subcutaneous electrodes, the large plate electrode showed the lowest energy ED50 (3.3 +/- 0.9 joules). The plate electrodes had lower energy ED50s than the mesh electrodes, and the large electrode had a lower energy ED50 than the small electrodes. Using the epicardium electrode, transient arrhythmias and ST elevation were observed following successful defibrillation; however, no arrhythmias or ST-T changes were observed following defibrillation using the subcutaneous electrodes.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1978

The choice of the pacemaker-electrode combination.

The advantages of the endocardial electrode over the transthoracic electrode are illustrated by the fact that the Vth International Symposium on Cardiac Pacing in March 1976 in Tokyo a world wide survey of 15000 electrodes implanted in 1975 showed that 93.4% were of the tarnsvenous type. These advantages will be discussed. An important electrode choice that has to be made next is the selection between the monopolar and the bipolar electrode. Mechanical (electro), physiological and clinical aspects have pushed this choice towards the monopolar electrodes. The monopolar transvenous electrode is known in various types. The selection of the electrode can be determined by the incidence of electrode dislocation that has resulted in electrode tips with fixation principles like hooks, barbs and balloon or screw mechanism. For the longevity of a pacemaker system the efficiency of the electrode system is important, that means the energy needed for cardiac stimulation. This stimulation threshold is determined by the myocardial tissue, the stimulation impulse and the electrode, especially the electrode surface. Decrease of the surface area from 50 mm2 about 8-10 years ago to 5-10 mm2 raises the question if there exists an optimal surface area and optimal electrode shape. The electrode area can also influence the R-wave amplitude as detected by the pacemaker and therefore the electrode-pacemaker interface has to be discussed. The solution of some of the electrode problems, that has resulted in more sophisticated electrodes and improved electrode pacemaker systems, will be illustrated.

Cardiac Pacing, Artificial↗