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Related Concept Videos

PD Controller: Design01:26

PD Controller: Design

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In automotive engineering, car suspension systems often employ Proportional Derivative (PD) controllers to enhance performance. PD controllers are utilized to adjust the damping force in response to road conditions. A controller, acting as an amplifier with a constant gain, demonstrates proportional control, with output directly mirroring input.
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Understanding the working function of different types of controllers can be illustrated with practical analogies, such as adjusting a stereo's volume equalizer. Cranking up the bass involves a phase-lead controller, which functions as a high-pass filter, while increasing the treble uses a phase-lag controller, which acts as a low-pass filter. PD controllers, similar to high-pass filters, enhance the system's response to high-frequency components. PI controllers, akin to low-pass...
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Cardiac action potentials are essential for proper heart function, enabling the rhythmic contractions needed for adequate blood circulation. Nodal cells and Purkinje fibers, specialized for electrical conduction, generate these action potentials.
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The normal cardiac rhythm is a synchronized electrical activity that facilitates the regular and coordinated contraction of the heart muscle. This process is essential for efficient blood circulation throughout the body. The fundamental elements involved in establishing and maintaining this rhythm include the unique electrical properties of cardiac muscle cells, the sinoatrial (SA) node's pacemaker function, the specialized conducting system, and the ionic mechanisms underlying each phase...
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A Modular Communicative Leadless Pacing-Defibrillator System.

Reinoud E Knops1, Michael S Lloyd1, Paul R Roberts1

  • 1From the Department of Cardiology, Amsterdam University Medical Center, Amsterdam (R.E.K., L.V.A.B.), and the Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein (L.V.A.B.) - both in the Netherlands; Emory University Section of Cardiac Electrophysiology, Atlanta (M.S.L., F.M.M.); University Hospital Southampton, Southampton (P.R.R.), the Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool (D.J.W.), and Leeds Teaching Hospitals NHS Trust, Leeds (C.P.), and Manchester Heart Centre, Manchester Royal Infirmary, Manchester (C.C.) - all in the United Kingdom; HonorHealth Cardiac Arrhythmia Group, HonorHealth Research Institute, Scottsdale, and the College of Medicine (R.D.) and Banner University Medical Center Phoenix (W.W.S.), University of Arizona, Phoenix - all in Arizona; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester (P.A.F., Y.-M.C.), and Boston Scientific, St. Paul (J. West, E.M., B.S., A.J.B., J. Weinstock, K.M.S.) - both in Minnesota; the Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic (P.N.); Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (C.B.-L.); Heart Rhythm Clinic, San Rossore Hospital, Pisa, Italy (M.G.B.); CorVita Science Foundation, Chicago (M.C.B.); Departement de Cardiologie, Hôpital Privé du Confluent, Nantes (D.G.), and the Arrhythmia Unit, Cardiology Department, Heart and Lung Institute, Lille (C.M.) - both in France; Cardiac Electrophysiology, Drexel University (S.P.K.), and the Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania (D.S.F.), Philadelphia, and the Department of Cardiology, Saint Mary Medical Center, Langhorne (S.P.K.) - all in Pennsylvania; OhioHealth Heart and Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, OhioHealth Riverside Methodist Hospital (A.K.A., E.Y.F.), and the Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Department of Internal Medicine, Ohio State University Wexner Medical Center (R.A.) Columbus, and the Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (T.D.C.); Northwell, Hyde Park (L.M.E.), the Cardiovascular Institute, Northwell Health Manhasset, Manhasset (L.M.E.), and Icahn School of Medicine, Mount Sinai, New York (M.A.M., V.Y.R.) - all in New York; Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, and Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid (J.M.T., L.M.); Baptist Health Lexington, Lexington, KY (J.D.A.); Erlanger Health System, University of Tennessee, Chattanooga (H.M.); the Department of Cardiac Electrophysiology and Research, St. Bernard's Heart and Vascular Center, Arrhythmia Research Group, Jonesboro, AR (D.G.N.); Institut de Cardiologie de Montréal, Montreal Heart Institute, Université de Montréal, Montréal (B.M.); Sentara Norfolk General Hospital, Norfolk, VA (J.G.); and the Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, Austria (K.S.).

The New England Journal of Medicine
|May 20, 2024
PubMed
Summary
This summary is machine-generated.

A new modular pacing-defibrillator system, combining a leadless pacemaker with a subcutaneous implantable cardioverter-defibrillator (ICD), demonstrated safety and efficacy in patients at risk for sudden cardiac death.

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Devices

Background:

  • Subcutaneous implantable cardioverter-defibrillators (ICDs) reduce lead complications but lack bradycardia and antitachycardia pacing.
  • The safety of a modular pacing-defibrillator system, integrating a leadless pacemaker with a subcutaneous ICD for comprehensive pacing, was previously unknown.

Purpose of the Study:

  • To evaluate the safety and performance of a novel modular pacing-defibrillator system.
  • To assess leadless pacemaker-related complications, wireless communication success, and pacing thresholds in patients receiving the system.

Main Methods:

  • A multinational, single-group study enrolled patients at risk for sudden cardiac death.
  • The system included a leadless pacemaker wirelessly communicating with a subcutaneous ICD.
  • Follow-up was conducted for 6 months, assessing safety and performance end points against prespecified goals.

Main Results:

  • 97.5% of patients were free from major leadless pacemaker complications, exceeding the 86% goal.
  • Wireless communication between devices was successful in 98.8% of tests (goal: 88%).
  • 97.4% of patients achieved pacing thresholds ≤2.0 V at 0.4 msec (goal: 80%), with 61.3% of arrhythmias successfully terminated by antitachycardia pacing.

Conclusions:

  • The modular pacing-defibrillator system met or exceeded all performance goals for safety and efficacy at 6 months.
  • This system offers a promising solution for bradycardia and antitachycardia pacing in patients with subcutaneous ICDs.
  • The study confirms the feasibility of wireless communication between leadless pacemakers and subcutaneous ICDs for enhanced cardiac rhythm management.