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PubMed2001

Response-time dynamics: evidence for linear and low-dimensional nonlinear structure in human choice sequences.

Response time (RT) is a commonly used measure of cognitive performance, which is usually characterized as stochastic. However, useful information may be hidden in the apparently random fluctuations of RT. Dynamical systems analysis techniques allow an exploration of the alternative hypothesis that RT fluctuations are deterministic, albeit in a complex manner. We applied careful task construction and noise-reduction and surrogate series tests to show that RT series from a forced-pace serial response-time task have low-dimensional chaotic characteristics. In Experiment 1, 80% of subjects' filtered RT series had low dimensionality, sensitive dependence on initial conditions, spectra close to 1/f, and stable attractor geometry across sessions. In Experiment 2, we showed that the size of the inter-stimulus interval (ISI) determined the number of subjects with low-dimensional chaotic series. A small ISI caused 100% of subjects to respond in the chaotic regime, whereas only 25% had a low-dimensional chaotic RT component when the ISI was large. We argue that demanding task requirements cause a reduction in the dimensionality of the dynamics, producing RT fluctuations that may reflect a response strategy for controlling RT.

Adult↗

PubMed1991

Combined thermodilution and two-dimensional echocardiographic evaluation of right ventricular function during respiratory support with PEEP.

In ten patients requiring respiratory support for an episode of acute respiratory failure (ARF), the best therapeutic level of PEEP was determined by measurement of changes in lung and chest wall compliance (CT) during a PEEP challenge from 0 to 20 cm H2O. During this challenge, hemodynamic monitoring combined with thermodilution measurement of right ventricular (RV) ejection fraction (EF) and two-dimensional echocardiographic measurement of RV size permitted assessment of the effects of increasing levels of PEEP on RV function. RV preload, as reflected by RV end-diastolic volume (EDV) and two-dimensional RV end-diastolic area (EDA), remained unchanged and RV diastolic compliance progressively decreased. On the other hand, RV systolic function, as assessed by RVEF and two-dimensional RV fractional area contraction (FAC), was progressively depressed. Substantial deleterious effects of PEEP were noted at high levels of PEEP including reduced CT and augmented pulmonary vascular resistance. Inadequate increase in RV preload to compensate for increased RV afterload resulted in depressed RV systolic function and contributed to the reduction in cardiac output. Finally, two-dimensional echocardiography proved to be more sensitive than fast-response thermodilution to evaluate change in RV function.

Echocardiography↗

PubMed1994

Neoadjuvant hormonal therapy improves the therapeutic ratio in patients with bulky prostatic cancer treated with three-dimensional conformal radiation therapy.

PURPOSE: To determine the extent of reduction of volume of normal tissue structures exposed to high doses of radiation therapy (RT) after administration of neoadjuvant hormonal therapy (NHT) in patients with bulky, geometrically unfavorable prostatic cancers. METHODS AND MATERIALS: Twenty-two patients with bulky prostatic cancers were treated with a 3 month course of neoadjuvant leuprolide acetate and eulexin prior to three-dimensional (3-D) conformal radiotherapy. Patients were included if 3-D treatment planning revealed that either > 30% of the rectal wall would receive 95% of the prescription dose (D95) (n = 13); > or = 50% of the bladder wall would receive D95 (n = 10); or that any volume of small bowel would receive > or = 65% of the prescription dose (n = 16). All patients underwent simulation and conformal treatment planning before and after NHT. Pre and posthormone cumulative dose volume histogram (DVH) calculations for all normal tissue structures were analyzed and compared for each patient. RESULTS: The median percentage of target volume reduction after NHT was 25% (range: 3-52%). Ten of 13 patients (78%) whose prehormone rectal DVH demonstrated > 30% of the rectal wall receiving D95 responded to NHT with a median 25% (range: 16-48%) reduction of rectal volume receiving the D95. A median reduction of 50% (range: 6-64%) of the bladder volume receiving D95 was observed in nine of ten patients (90%), while 13 of 16 (81%) showed a reduction of small bowel volume to a median percentage of 88% (range: 67-100%) of the prehormonal values. CONCLUSION: Neoadjuvant hormonal therapy is an effective method for decreasing the size of bulky prostatic tumors as well as for optimizing the geometry of the target volume in relation to the adjacent normal tissue structures prior to radiation therapy. Such an approach allows for reduction of the volume of normal tissues exposed to high doses in the majority of treated patients. Currently, studies are underway to determine whether NHT will lead to a decreased likelihood of long-term complications associated with radiotherapy of bulky, geometrically unfavorable prostatic tumors, and permit the safe delivery of escalated dose levels using conformal treatment techniques.

Aged↗

PubMed1980

Lack of genic variation in the abundant proteins of human kidney.

Abundant proteins of 25 human kidneys were surveyed for genic variation by means of two-dimensional electrophoresis. Eighty-three (83) proteins were scored, and no genic variation was detected. This reduction in genic heterozygosity corroborates results determined with two-dimensional electrophoresis in mice and flies. These results suggest that previous estimates of electrophoretic variation may have been in error because of biased selection of loci.

Electrophoresis, Polyacrylamide Gel↗

PubMed1984

An evaluation of the time-dependent dimensional stability of eleven elastomeric impression materials.

The dimensional stability of three polysulfides, one condensation-cured silicone, six addition-cured silicones, and one polyether, was evaluated when poured immediately and after storage for 1, 4, and 24 hours. Dimensional stability was determined by measuring the amount of gap width developed by a master coping when seated on the die that had been poured in the impression. The greatest accuracy occurred when the impressions were poured immediately. All the addition-cured silicone materials exhibited excellent dimensional stability for all storage times. Delayed pouring of artificial stone in the impressions made in these materials should result in very little change in die accuracy. The condensation-cured silicone material Polytrans has good accuracy if poured immediately. Delayed pouring results in a rapid loss of accuracy. The polysulfides have good accuracy only if poured immediately, with the exception of Omniflex, which can be stored up to 4 hours with only a minimum loss of accuracy. The polyether material Impregum expanded during storage. Since the dimensional change of the impression during storage is a characteristic of the material, a reduction in its bulk should lead to a desired amount of dimensional change. To achieve this desirable state, custom trays that will provide for the minimum recommended bulk of material should be fabricated. The complex geometry of the cavity preparation makes any prediction of the desirability of impression material expansion or contraction difficult, because a change in impression material dimensions may be beneficial to the fit in one portion of the casting but have an extremely adverse effect in another.(ABSTRACT TRUNCATED AT 250 WORDS)

Chemical Phenomena↗

PubMed2004

Postoperative imaging of zygomaticomaxillary complex fractures using digital volume tomography.

PURPOSE: Three-dimensional imaging using digital volume tomography after reduction of zygomaticomaxillary complex fractures was performed and evaluated. PATIENTS AND METHODS: Ten patients admitted for surgical treatment of zygomaticomaxillary complex fractures were included in the study. All patients were male, aged 17 to 81 years (average, 43.8 years). Preoperative diagnostics and surgical treatment involving open reduction under general anesthesia were performed as usual. One to 3 days (average, 1.6 days) postoperatively, a digital volume tomography data set was generated using the NewTom 9000 (NIM s.r.l., Verona, Italy). After DICOM-import in eFilm Workstation 1.8.3 (Merge Technologies Inc, Milwaukee, WI), axial, coronal, and sagittal reconstructions were evaluated by 6 examiners with the help of 5 defined criteria. RESULTS: One data set was sufficient to visualize all fracture sites of the midface in all patients. Postprocessing using eFilm was successfully performed in all cases. Best scoring results were found regarding bony anchorage of screws and fitting of plates. Remarkable was the low level of metal artifacts in primary and secondary reconstructions, even in close proximity of the material. Most difficulty was encountered during the identification of the medial orbital wall, especially next to poorly ventilated ethmoidal cells. Osseous structures of older patients with decreased bone density proved difficult to visualize. CONCLUSION: Digital volume tomography using the NewTom 9000 is suitable for assessment of postoperative results after zygomaticomaxillary complex reduction.

Adolescent↗

PubMed1990

Antibody organization on lipid films. Influence of pH and interchain disulphide reduction.

Two distinct lattice structures are observed for two-dimensional (2-D) antibody organization on phospholipid films. A low-order, small-unit-cell, square lattice is obtained at pH 7 and below for mouse IgE, mouse IgG2a and IgG2b and rabbit IgG. At pH 7.5 and above, the observed lattice structure switches to a large-unit-cell, hexagonal type for rabbit IgG and mouse IgE. Interchain disulphide reduction by exposure to 2 mM-dithiothreitol results in the formation of the compact 2-D lattice for all cases and for all pH conditions.

Animals↗

PubMed1998

Turbulent transport reduction by zonal flows: massively parallel simulations

Three-dimensional gyrokinetic simulations of microturbulence in magnetically confined toroidal plasmas with massively parallel computers showed that, with linear flow damping, an asymptotic residual flow develops in agreement with analytic calculations. Nonlinear global simulations of instabilities driven by temperature gradients in the ion component of the plasma support the view that turbulence-driven fluctuating zonal flows can substantially reduce turbulent transport. Finally, the outstanding differences in the flow dynamics observed in global and local simulations are found to be due to profile variations.

Journal Article↗

PubMed2003

Focal adhesion kinase is expressed in the angiogenic blood vessels of malignant astrocytic tumors in vivo and promotes capillary tube formation of brain microvascular endothelial cells.

PURPOSE: Focal adhesion kinase (FAK) is a cytoplasmic tyrosine kinase that has been shown to promote proliferation, migration, and invasion of several cell types in vitro, and we have shown recently that FAK promotes proliferation of malignant astrocytoma cells in vivo. To determine the role of FAK in angiogenesis in malignant astrocytic tumors, we investigated the expression and function of FAK in brain endothelial cells. EXPERIMENTAL DESIGN: We characterized the expression of FAK and activated FAK in endothelial cells by immunohistochemistry. We also determined the function of FAK in brain microvascular endothelial cells by transfecting these cells with a dominant interfering form of FAK [FAK-related nonkinase (FRNK)] or a mutant FRNK (Leu-1034 to Ser) and assessed the effect on capillary tube formation and cell migration. RESULTS: We found that FAK was expressed in the endothelial cells of grade III (4 of 9 samples) and IV (9 of 10 samples) astrocytoma biopsies but not in the endothelial cells of normal brain (0 of 9 samples) and not in grade I (0 of 5 samples) or II (0 of 4 samples) astrocytoma biopsies. Furthermore, we found that both FAK and activated FAK were expressed in the endothelial cells in malignant astrocytoma tumors propagated intracerebrally in the severe combined immunodeficient mouse brain. As expected, immunofluorescence analysis showed FRNK protein to localize to focal adhesions, whereas mutant FRNK protein did not. FRNK-transfected endothelial cells showed a 55% reduction in branched tube formation and a 40% reduction in tube length when propagated in three-dimensional collagen gels, compared with cells transfected with the mutant FRNK construct. Furthermore, FRNK-transfected cells showed a 35-50% reduction in haptotactic migration toward fibronectin and collagen, compared with mutant FRNK-transfected cells. CONCLUSIONS: These data suggest that FAK promotes angiogenesis and that this occurs, at least in part, through the promotion of endothelial cell migration.

Animals↗

PubMed1995

[Biomechanics of AF new 3-d pedical screw system and treatment of 31 patients with unstable thoracolumbar fracture].

For anatomic reduction of the spinal frectures, the 3 dimensional multiple correction forces were needed. Several pedical screw systems were designed for reducion and fixation of the spinal fractures as the AO universal joint system and the RF angle screw system. Because of the contradiction of the universal joint and the fixed angle, a new generation of RF was designed and named AF (atlas fixator) system. This is a new concept of 3-D reduction, without complex structure as universal joint, but has truly 3-D adjustment that allowed to reduce the intra-canal compromise. It also provided rigid fixation to maintain the reduction. Comparison with CD, AO, Steffee, and RF, the AF was truly 3-D reduction in XTZ axis. It provided strong symmetric transmitter orthotic force to correct the deformity. 31 patients with unstable thoracolumbar fractures were treated with the new AF system. 17 had partial (15) or complete (2) neurologic deficits. The AF system provided accurate angle to restore the normal thoracic-lumbar lordosis and to maintain it. All patients had a anatomic reduction by AF system. The spinal canal area increased over 33% by CT scan (P < 0.01). All cases were followed up over 8 months. No one deteriorated neurologically after AF fixation.

Adult↗

PubMed2004

Speckle reducing anisotropic diffusion for 3D ultrasound images.

This paper presents an approach for reducing speckle in three dimensional (3D) ultrasound images. A 2D speckle reduction technique, speckle reducing anisotropic diffusion (SRAD), is explored and extended to 3D. 3D SRAD is advantageous in that, like 2D SRAD, it keeps the advantages of the conventional anisotropic diffusion and the traditional speckle reducing filter, the Lee filter, by exploiting the instantaneous coefficient of variation (ICOV). Besides, 3D SRAD uses 3D information; thus it overcomes the shortcoming of the 2D technique that only uses 2D information. The algorithm of 3D SRAD is presented in the continuous domain as well as in the discrete domain. Experiments have been performed on both synthetic and real 3D ultrasound images and the experimental results were compared with those obtained by 3D anisotropic diffusion and the 3D Lee filter. The experimental results show that the quality of the 3D SRAD for speckle reduction in 3D ultrasound images improves upon that of 3D anisotropic diffusion and 3D Lee filter in terms of edge preservation and the smoothness of homogenous regions.

Algorithms↗

PubMed1989

Transient myocardial thickening in acute myocarditis--serial study by two-dimensional echocardiography.

A 13-year-old girl developed viral myocarditis complicated by pulmonary thromboembolism. Marked dilatation and reduction in the contractility of the left ventricle were noted in a two-dimensional echocardiogram on admission. The thicknesses of the left ventricle and the interventricular septum were both 8 mm at this time, but increased after the 9th day of the illness to reach 2 cm by the 15th day, with a concomitant reduction in the left ventricular cavity. The myocardial thickening gradually decreased and the ejection fraction improved on serial echocardiographic evaluations, and the wall thickness and ejection fraction returned to normal by the 32nd day. The myocarditis resolved without sequelae. The implications of this transient myocardial thickening are discussed.

Acute Disease↗

PubMed2004

[Reduction of reconstruction time and data volume of sinogram by angular compression for clinical three-dimensional whole body FDG-PET].

In positron emission tomography (PET), the large number of lines of responses in three-dimensional (3D) acquisition mode creates a high volume of sinogram data and increases reconstruction time in iterative reconstruction. We tried to decrease sinogram data volume by reducing the number of views using angular compression and then evaluated the accuracy of this mashed mode. Three methods were compared, conventional mode (CONV), X2 mashed mode (X2: two adjacent projection angles are added together), and X4 mashed mode (X4: four adjacent angles added). A point source of (18)F was used to measure spatial resolution. A hot spot phantom made of 6 hot spheres (10-38 mm in diameter) within water of 20 cm in diameter was scanned to evaluate the recovery coefficient (RC). A lung-heart-liver phantom made of homogeneous radioactive myocardium, a spherical hot mass in the lung (10 mm in diameter), and background activity in the liver was scanned to evaluate the homogeneity of the myocardial wall. The quality of the reconstructed images was evaluated in terms of the normalized mean square error (NMSE), Bull's eye map, profile curve, and peak value of the spherical hot mass. The reconstruction times of X2 and X4 were one-half and one-quarter, respectively, of that of CONV. In terms of spatial resolution, FWHM of CONV, X2, and X4 were, 4.26, 4.33, and 4.48 (mm) at the center, 4.81, 5.68, and 8.73 tangentially, and 8.01, 8.19, and 8.27 radially at R=200 mm, respectively. RC was similar for all methods. The NMSE values of X2 and X4 compared with CONV were 0.0003 and 0.0014, respectively. In the hot mass, these methods showed almost the same profile curves, although the peak value of X4 was only -1.95% less than that of CONV. Although the result of spatial resolution of X4 was slightly degraded, image quality and physical performance were good. Therefore, the X4 mashed mode used with angular compression was considered clinically useful.

Humans↗

PubMed1999

Three-dimensional treatment planning for postoperative radiotherapy in patients with node-positive cervical cancer. Comparison between a conventional and a conformal technique.

PURPOSE: Reduction of irradiated small bowel volume, using a conformal three-dimensional treatment planning technique in postoperative radiotherapy of cervical cancer patients. PATIENTS AND METHODS: Large gynecological treatment fields including the para-aortic nodes were analyzed in 15 patients. A conventional treatment plan with anterior and posterior (AP-PA) parallel opposed fields and a 3D 4-field conformal radiotherapy plan with a central blocking of small bowel were compared for each patient. Dose-volume histograms and dose parameters were established. Because of the tolerance constraints of the small bowel, the cumulative dose applied to the target was 48.6 Gy. RESULTS: The mean Tumor Control Probability (TCP) values for both the conventional and the conformal technique were 0.60 and 0.61, respectively, with ranges of 0.56 to 0.67 and 0.57 to 0.66, respectively. The mean volume receiving 95% or more of the prescribed dose (V95) of the small bowel was 47.6% (32.5 to 66.3%) in the AP-PA technique and 14.9% (7.0 to 22.5%) in the conformal technique (p < 0.001), indicating a significant reduction in irradiated volume of small bowel in the higher dose range. The mean Normal Tissue Complication Probability (NTCP) decreased from 0.11 to 0.03 with the conformal plan. In patients who received a pedicled omentoplasty during surgery, the mean V95 for small bowel could be reduced to 8.5% (7.0 to 9.9%). The mean median dose to the kidneys was only slightly elevated in the conformal treatment. Especially the mean dose to the right kidney in conventional vs conformal treatment was 3.3 vs 7.9 Gy. The mean near-minimum dose (D95) to the rectosigmoid decreased from 48.4 to 30.1 Gy in the conformal plan compared to the conventional plan. CONCLUSION: The small bowel dose can be significantly reduced with 3D treatment planning, particularly if a pedicled omentoplasty is performed. This allows dose escalation to the tumor region without unacceptable toxicity for the small bowel.

Adenocarcinoma↗

PubMedDate not supplied

Influence of structural pelvic disorders during standing and walking in adolescents with idiopathic scoliosis.

BACKGROUND CONTEXT: In adolescents with idiopathic scoliosis (AIS), several studies have shown that the pelvis is structurally changed by the spinal disorder. In fact, a significant correlation has been observed between the three-dimensional changes in the lumbar curve and the reduction in pelvic displacement in the three spatial planes during gait. However, the impact of this pelvic disorder on the walking mechanism has not been established. PURPOSE: To quantitatively evaluate the influence of scoliosis on the three-dimensional (3D) pelvic position during bipedal standing, on the 3D pelvic displacement during gait, and on the walking mechanics in adolescents with idiopathic lumbar and thoraco-lumbar scoliosis. STUDY DESIGN/SETTING: Paired sample matched for age and gender. PATIENT SAMPLE: Twenty-four subjects, 12 healthy adolescents matched for age and gender with 12 adolescents with lumbar or thoraco-lumbar idiopathic scoliosis. OUTCOME MEASURES: A test battery including clinical examination, radiological assessment, static 3D pelvic examination in bipedal position, and instrumented gait analysis. The statistical analysis was performed by a paired t test to evaluate the differences on nominally recorded data between control subjects and patients and a signed rank test for ordinal data. METHODS: The spine and pelvis were assessed by X-ray, clinical examination, and 3D analysis with the Elite system V5, in the standing position. The gait was assessed by instrumented analysis, including synchronous kinematic, dynamic, and electromyographic (EMG) recordings. RESULTS: Our results showed that radiological measurements of the pelvis were significantly different between patients and control subjects. However, 3D pelvic kinematics were not significantly different between AIS patients and normal subjects during standing and walking. We observed an increase in the muscular external work, a reduction in the efficiency of the locomotor mechanism, and a prolonged duration of activation of the lumbar muscles, ie, erector spinae and quadratum lumborum, in AIS patients. CONCLUSIONS: The scoliosis affected the structural bones of the pelvis with no effect on the 3D pelvis position during standing. During walking, normal 3D pelvic displacements could be explained by the prolonged duration of activation of the erector spinae and quadratum lumborum muscles bilaterally allowing the equilibrium of the pelvis to be maintained. This excessive muscular activity caused a failure of the locomotor mechanism as shown by an increase in the muscular external work.

Adolescent↗

PubMed1986

The human growth hormone receptor of cultured human lymphocytes. Structural characteristics and glycosylation properties.

The structural characteristics and glycoprotein nature of the human growth hormone (hGH) receptor in cultured lymphocytes (IM-9 cell line) were studied with the use of a bifunctional reagent (disuccinimidyl suberate) to couple 125I-hGH covalently to intact cells. After cross-linking, the hormone-receptor complexes were analysed by sodium dodecyl sulphate/polyacrylamide-gel electrophoresis. A single band of Mr 140,000 was identified under reducing conditions. The labelling of this band was blocked by unlabelled hGH but not by insulin, ovine prolactin, bovine or ovine growth hormones. The Mr 140,000 band was immunoprecipitated by either anti-hGH antibody or by a monoclonal antibody against rat liver growth hormone receptor. In the absence of reductant two major bands of Mr 270,000 and 140,000 were found. On two-dimensional gel electrophoresis, with the first dimension in the absence of reductant and the second in its presence, the Mr 270,000 complex generated the Mr 140,000 band. The nature of the oligosaccharide chains of the receptor was studied by treatment with different glycosidases. The electrophoretic mobility of the Mr 140,000 receptor complex was markedly increased after digestion with endoglycosidase F but showed no or little change after digestion with endoglycosidase H. The Mr 140,000 band was also sensitive to neuraminidase treatment. In addition the 125I-hGH-receptor complex was adsorbed by immobilized wheat germ agglutinin and to a smaller extent by immobilized concanavalin A, lentil lectin, ricin I and ricin II. In conclusion, taking into account that hGH is a Mr 22,000 polypeptide, the binding subunit of the GH receptor in human IM-9 lymphocytes has an Mr of approx. 120,000. The native receptor may exist as a homodimer of the binding subunit formed by disulphide bonds. Furthermore, the GH receptor subunit contains asparagine N-linked type of oligosaccharide chains. Most, if not all, of these chains are of the complex type and appear to be sialylated whereas no high-mannose type chains are detectable in the mature form of the receptor.

Acetylglucosaminidase↗

PubMed2005

Benefit of respiration-gated stereotactic radiotherapy for stage I lung cancer: an analysis of 4DCT datasets.

PURPOSE: High local control rates have been reported with stereotactic radiotherapy (SRT) for Stage I non-small-cell lung cancer. Because high-dose fractions are used, reduction in treatment portals will reduce the risk of toxicity to adjacent structures. Respiratory gating can allow reduced field sizes and planning four-dimensional computed tomography scans were retrospectively analyzed to study the benefits for gated SRT and identify patients who derive significant benefit from this approach. METHODS AND MATERIALS: A total of 31 consecutive patients underwent a four-dimensional computed tomography scan, in which three-dimensional computed tomography datasets for 10 phase bins of the respiratory cycle were acquired during free breathing. For a total of 34 tumors, the three planning target volumes (PTVs) were analyzed, namely (1) PTV(10bins), derived from an internal target volume (ITV) that incorporated all observed mobility (ITV(10bins)), with the addition of a 3-mm isotropic setup margin; (2) PTV(gating), derived from an ITV generated from mobility observed in three consecutive phases ("bins") during tidal-expiration, plus addition of a 3-mm isotropic margin; and (3) PTV(10 mm), derived from the addition of a 10-mm isotropic margin to the most central gross tumor volumes in the three bins selected for gating. RESULTS: The PTV(10bins) and PTV(gating) were, on average, 48.2% and 33.3% of the PTV(10 mm), and respective mean volumes of normal tissue (outside the PTV) receiving the prescribed doses were 57.1% and 39.1%, respectively, of that of PTV(10 mm). A significant correlation was seen between the extent of tumor mobility (i.e., a three-dimensional mobility vector of at least 1 cm) and reduction in normal tissue irradiation achieved with gating. The ratio of the intersecting and the encompassing volumes of GTVs at extreme phases of tidal respiration predicted for the benefits of gated respiration. CONCLUSION: The use of "standard population-based" margins for SRT leads to unnecessary normal tissue irradiation. The risk of toxicity is further reduced if respiration-gated radiotherapy is used to treat mobile tumors. These findings suggest that gated SRT will be of clinical relevance in selected patients with mobile tumors.

Carcinoma, Non-Small-Cell Lung↗

PubMed2003

Effects of septal pacing on P wave characteristics: the value of three-dimensional echocardiography.

Interatrial septum (IAS) pacing has been proposed for the prevention of paroxysmal atrial fibrillation. IAS pacing is usually guided by fluoroscopy and P wave analysis. The authors have developed a new approach for IAS pacing using intracardiac echocardiography (ICE), and examined its effects on P wave characteristics. Cross-sectional images are acquired during pullback of the ICE transducer from the superior vena cava into the inferior vena cava by an electrocardiogram- and respiration-gated technique. The right atrium and IAS are then three-dimensionally reconstructed, and the desired pacing site is selected. After lead placement and electrical testing, another three-dimensional reconstruction is performed to verify the final lead position. The study included 14 patients. IAS pacing was achieved at seven suprafossal (SF) and seven infrafossal (IF) lead locations, all confirmed by three-dimensional imaging. IAS pacing resulted in a significant reduction of P wave duration as compared to sinus rhythm (99.7 +/- 18.7 vs 140.4 +/- 8.8 ms; P < 0.01). SF pacing was associated with a greater reduction of P wave duration than IF pacing (56.1 +/- 9.9 vs 30.2 +/- 13.6 ms; P < 0.01). P wave dispersion remained unchanged during septal pacing as compared to sinus rhythm (21.4 +/- 16.1 vs 13.5 +/- 13.9 ms; NS). Three-dimensional intracardiac echocardiography can be used to guide IAS pacing. SF pacing was associated with a greater decrease in P wave duration, suggesting that it is a preferable location to decrease interatrial conduction delay.

Adult↗