Activation Wavefront Research Articles

High-fidelity metasurface holography illuminated by ultra-uniform flat-top beam generated through active wavefront shaping

High-fidelity metasurface holography illuminated by ultra-uniform flat-top beam generated through active wavefront shaping

Wavefront curvature analysis derived from preprocedural imaging can identify the critical isthmus in patients with postinfarcted ventricular tachycardia

BackgroundWhere activation wavefront curvature is convexly shaped, functional conduction block can occur. ObjectiveThe purpose of this study was to determine whether left ventricular (LV) wall thickness determined from contrast-enhanced computed tomography (CT) is useful in localizing such areas in clinical postinfarction reentrant ventricular tachycardia (VT). MethodsWe evaluated data from 6 patients who underwent catheter ablation for postinfarction VT. CT imaging with inHEART processing was conducted 1–3 days before electrophysiological (EP) study to determine LV wall thickness (T). Activation wavefront curvature was approximated as ΔT/T, where ΔT represents wall thickness change. During EP study, bipolar LV VT electrograms were acquired using a high-density mapping catheter, and activation times were determined. Maps of T, ΔT/T, and VT activation were subsequently compared using statistical analyses. ResultsTwo of 6 cases exhibited dual circuit morphologies, resulting in a total of 8 VT morphologies analyzed. The LV wall near the VT isthmus location tended to be thin, on the order of a few hundred micrometers. Regions of largest ΔT/T partially coincided with the lateral isthmus boundaries where electrical conduction block occurred during VT. ΔT/T at the boundaries, measured from imaging, was significantly larger compared to values at the isthmus midline and to the global LV mean value (P <.001). ConclusionWavefront curvature measured by ΔT/T and caused by source–sink mismatch is dependent on ventricular wall thickness. Areas of high wavefront curvature partly coincide with and may be helpful in locating the VT isthmus in infarct border zones using preprocedural imaging analysis.

Duration of left and right atrial activation wavefront assessed non-invasively is significantly higher in patients with atrial fibrillation than in controls

Abstract Introduction Ablation strategies in atrial fibrillation (AF) are currently a "one-size- fits- all" type of approach. Pulmonary vein isolation as the standard of care is not perfect, especially in the persistent forms, but none of the alternatives has shown better results. The dichotomic paroxysmal versus persistent AF classification in no longer acceptable. Characterization of the atrial substrate before ablation is needed. Electrocardiographic imaging (ECGI) is capable of non-invasively assess atrial activation in a single beat and in a panoramic fashion. The aim of this study was to evaluate the feasibility and accuracy of ECGI to assess the activation speed and identify possible targets for ablation. Methods We studied 18 consecutive patients, 9 referred for ablation of paroxysmal AF and 9 without AF, referred for ablation of premature ventricular contractions (PVCs), that had an ECGI performed before ablation. No patient had structural heart disease and all patients had normal electrocardiographic evaluation in sinus rhythm (SR). The ECGI was performed in SR with the AMYCARD 01 system, based on body surface electrocardiograms of a maximum of 224 electrodes and computed tomography imaging data. Total duration of atrial activation, left atrial (LA), and right atrial (RA) activation duration, and presence of lines of conduction block (LOB) defined as the presence of a jump in the local activation time of 50 ms or more between contiguous points, were assessed. The results were compared in patients with and without AF. Results The results are depicted in the Table. Patients with AF were older. Total atrial activation duration, LA, and RA activation duration were longer in patients with AF and there was a trend towards a higher prevalence of LOB in the LA in patients with AF (Figure). Discussion &amp; Conclusion Total atrial activation duration as well as LA and RA activation duration assessed with the ECGI were significantly prolonged in patients with AF. Presence of LOB in the LA showed a trend towards a higher prevalence in AF patients. These pilot study has proved that this technology is accurate in identifying a pathological substrate in AF patients. We intend to use ECGI in a subsequent study that will include patients with AF both in paroxysmal and persistent forms, in order to identify markers of disease as well as possible targets to perform a customized AF ablation.Comparison between AF and control groupsECGI showing local activation times

Lower contact force predicts right pulmonary vein carina breakthrough after ablation index-guided pulmonary vein isolation using high-power short-duration.

Carina breakthrough (CB) at the right pulmonary vein (RPV) can occur after circumferential pulmonary vein isolation (PVI) due to epicardial bridging or transient tissue edema. High-power short-duration (HPSD) ablation may increase the incidence of RPV CB. Currently, the surrogate of ablation parameters to predict RPV CB is not well established. This study investigated predictors of RPV CB in patients undergoing ablation index (AI)-guided PVI with HPSD. The study included 62 patients with symptomatic atrial fibrillation (AF) who underwent AI-guided PVI using HPSD. Patients were categorized into two groups based on the presence or absence of RPV CB. Lesions adjacent to the RPV carina were assessed, and CB was confirmed through residual voltage, low voltage along the ablation lesions, and activation wavefront propagation. Out of the 62 patients, 21 (33.87%) experienced RPV CB (Group 1), while 41 (66.13%) achieved first-pass RPV isolation (Group 2). Despite similar AI and HPSD, patients with RPV CB had lower contact force (CF) at lesions adjacent to the RPV carina. Receiver operating characteristic (ROC) curve analysis identified CF < 10.5 g as a predictor of RPV CB, with 75.7% sensitivity and 56.2% specificity (area under the curve: 0.714). In patients undergoing AI-guided PVI with HPSD, lower CF adjacent to the carina was associated with a higher risk of RPV CB. These findings suggest that maintaining higher CF during ablation in this region may reduce the occurrence of RPV CB.

Improved active-tracking performance through Hadamard speckle contrast reduction.

We report wave-optics simulation results and benchtop experimental findings that demonstrate reduced centroiding error through a Hadamard speckle contrast reduction (HSCR). The method involves projecting multiple orthogonal phase patterns onto an actively imaged object within a single camera resolution cell and integration time. Ideally, performance improves in proportion to the square root of the number of such phase realizations applied. Using 16 subpixels per camera pixel, our simulated track performance consistently meets this expectation with a decent experimental agreement, particularly at smaller object sizes. This outcome has promising implications for active tracking and wavefront sensing, extending the utility of HSCR beyond its known benefits to coherent image quality.

Coherent Manipulation of Extreme-Ultraviolet Bessel Vortex Beams from Solids by Active Wavefront Shaping of Driving Fundamental Beams

Coherent Manipulation of Extreme-Ultraviolet Bessel Vortex Beams from Solids by Active Wavefront Shaping of Driving Fundamental Beams

Nonreciprocal terahertz wavefront manipulation based on a magneto-optical metasurface with an orthogonal meta-atom pair

Active wavefront manipulation and nonreciprocal transmission give key performances in beam steering, unidirectional isolation, and multichannel multiplexing. In this work, we propose a magneto-optical (MO) Pancharatnam–Berry (PB) metasurface, which consists of a pair of orthogonal anisotropic Si and InSb columns. This orthogonal meta-atom pair (OMP) structure leads to destructive interference in the geometric phase so that the wavefront manipulation is in the OFF state without a biased magnetic field (BMF). When the BMF is applied, the nonreciprocal transmission effect for different spin states in InSb breaks the original destructive interference, so the devices provide different geometric phase distribution for different magnetic field directions and spin states, achieving the ON state of the nonreciprocal wavefront manipulation, where cross-polarization circular dichroism is higher than 0.98 and the polarization conversion rate is over 97%. Furthermore, based on this mechanism, a beam deflector and a vortex beam generator are designed by arranging the OMP with different azimuthal angles. Compared with ordinary reciprocal wavefront manipulation, this work shows that this MO PB metasurface with OMP structure has irreplaceable functions in the isolation, selection, and conversion of the two conjugate spin beams, providing a unique path for active THz wavefront manipulation.

Association of Sinus Wavefront Activation and Ventricular Extrastimuli Mapping With Ventricular Tachycardia Re-Entrant Circuits

BackgroundSubstrate-based ablation targets areas of delayed and fractionated electrograms during sinus rhythm, which are sensitive for identifying the ventricular tachycardia (VT) isthmus but is influenced by the activation wavefront direction and decremental pacing. ObjectivesThe aim of this study was to correlate the areas of latest activation during varying wavefront activation mapping and decremental pacing mapping with sites critical to the VT isthmus. MethodsThree high-density electroanatomical substrate maps were created in patients presenting for ablation of monomorphic VT: 1) native sinus rhythm; 2) right ventricular (RV) apical pacing; and 3) an RV apical S2 map following the S1 drive train at 20 ms above the ventricular effective refractory period. Areas corresponding to the latest activation were compared with the VT isthmus identified by conventional mapping. ResultsTwenty patients with structural heart disease with a mean age of 55.6 ± 16.9 years were included. The majority of the cohort consisted of patients with ischemic heart disease (50%) and arrhythmogenic RV cardiomyopathy (35%). Epicardial ablation was performed in 45% of patients. The concordance of the site of latest activation in sinus rhythm with the VT isthmus was 75%. The location of the latest activation during RV apical pacing corresponded with the VT isthmus in 85% of cases. However, in 95% of cases, the site of the latest activation following the S2 stimulus colocalized to the VT isthmus. ConclusionsIn a mix of underlying myocardial substrates, regions of conduction slowing during decremental pacing colocalize with the VT isthmus more frequently than sinus rhythm activation mapping and may have a role in substrate-based ablation where VT induction is undesirable.

BICs-enhanced active terahertz wavefront modulator enabled by laser-cut graphene ribbons

Graphene-based terahertz (THz) metasurfaces combined with metallic antennas have the advantages of ultra-small thickness, electrical tunability, and fast tuning speed. However, their tuning ability is limited by non-independently tunable pixels and low modulation depth due to the ultra-small thickness of graphene. Here, we demonstrate a reconfigurable THz phase modulator with 5×5 independently tunable units enabled by switching the voltages applied on 10 graphene ribbons prepared by laser cutting. In addition, by introducing quasi-bound states in the continuum resonance through a designed double C-shaped antenna, the efficiency of the device is enhanced by 2.7–3.6 times under different graphene chemical potentials. Experimental results demonstrate that a focus can be formed, and the focal length is changed from 14.3 mm to 22.6 mm. This work provides potential for compact THz spatial light modulators that may be applied in THz communication, detection, and imaging.

Photo-Excited Metasurface for Tunable Terahertz Reflective Circular Polarization Conversion and Anomalous Beam Deflection at Two Frequencies Independently.

In this paper, a photo-excited metasurface (MS) based on hybrid patterned photoconductive silicon (Si) structures was proposed in the terahertz (THz) region, which can realize the tunable reflective circular polarization (CP) conversion and beam deflection effect at two frequencies independently. The unit cell of the proposed MS consists of a metal circular-ring (CR), Si ellipse-shaped-patch (ESP) and circular-double-split-ring (CDSR) structure, a middle dielectric substrate, and a bottom metal ground plane. By altering the external infrared-beam pumping power, it is possible to modify the electric conductivity of both the Si ESP and CDSR components. By varying the conductivity of the Si array in this manner, the proposed MS can achieve a reflective CP conversion efficiency that ranges from 0% to 96.6% at a lower frequency of 0.65 THz, and from 0% to 89.3% at a higher frequency of 1.37 THz. Furthermore, the corresponding modulation depth of this MS is as high as 96.6% and 89.3% at two distinct and independent frequencies, respectively. Moreover, at the lower and higher frequencies, the 2π phase shift can also be achieved by respectively rotating the oriented angle (αi) of the Si ESP and CDSR structures. Finally, an MS supercell is constructed for the reflective CP beam deflection, and the efficiency is dynamically tuned from 0% to 99% at the two independent frequencies. Due to its excellent photo-excited response, the proposed MS may find potential applications in active functional THz wavefront devices, such as modulators, switches, and deflectors.

Lipomatous Metaplasia Facilitates Slow Conduction in Critical Ventricular Tachycardia Corridors Within Postinfarct Myocardium

BackgroundMyocardial lipomatous metaplasia (LM) has been reported to be associated with post-infarct ventricular tachycardia (VT) circuitry. ObjectivesThis study examined the association of scar versus LM composition with impulse conduction velocity (CV) in putative VT corridors that traverse the infarct zone in post-infarct patients. MethodsThe cohort included 31 post-infarct patients from the prospective INFINITY (Intra-Myocardial Fat Deposition and Ventricular Tachycardia in Cardiomyopathy) study. Myocardial scar, border zone, and potential viable corridors were defined by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR), and LM was defined by computed tomography. Images were registered to electroanatomic maps, and the CV at each electroanatomic map point was calculated as the mean CV between that point and 5 adjacent points along the activation wave front. ResultsRegions with LM exhibited lower CV than scar (median = 11.9 vs 13.5 cm/s; P < 0.001). Of 94 corridors computed from LGE-CMR and electrophysiologically confirmed to participate in VT circuitry, 93 traversed through or near LM. These critical corridors displayed slower CV (median 8.8 [IQR: 5.9-15.7] cm/s vs 39.2 [IQR: 28.1-58.5]) cm/s; P < 0.001) than 115 noncritical corridors distant from LM. Additionally, critical corridors demonstrated low-peripheral, high-center (mountain shaped, 23.3%) or mean low-level (46.7%) CV patterns compared with 115 noncritical corridors distant from LM that displayed high-peripheral, low-center (valley shaped, 19.1%) or mean high-level (60.9%) CV patterns. ConclusionsThe association of myocardial LM with VT circuitry is at least partially mediated by slowing nearby corridor CV thus facilitating an excitable gap that enables circuit re-entry.

The effect of scar imaging quality on in-silico pace-mapping of post-infarction ventricular tachycardia

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Wellcome Trust and British Heart Foundation. Background In-silico pacing mapping is a technique which involves using an anatomically-personalised image-based computational model to generate a ‘virtual’ clinical pace map for enhanced pre-procedural ablation planning of post-infarction ventricular tachycardia (VT). Utilising, as it does, a direct clinical ECG (or implanted device) recording of the clinical VT in order to construct the map, it has a number of advantages over other computational methods which attempt to simulate patient-specific VTs to identify ablation targets. However, accurate model construction relies on adequate scar imaging data, which may not be available with current clinical cardiac MR (CMR) sequences. Purpose To investigate the impact of scar imaging quality on the ability of in-silico pace-mapping to determine the VT origin. Methods VTs were simulated in three post-infarction porcine heart models reconstructed from high resolution (1mm isotropic) contrast-enhanced CMR data. Visual analysis of the VT circuits was performed to identify the VT site of origin (exit site) in each case (as the gold standard). The ECG of each simulated VT was computed and used as input for the construction of the in-silico virtual pace-mapping approach. Prior to pace map construction, the scar anatomy was modified to represent three different levels of imaging resolution: high resolution scar mapping (default); low resolution scar (representing standing clinical CMR sequences), obtained by performing dilation and erosion in the scar to close all inner pathways; and, finally, no scar (cardiac anatomy only, representing CT-based reconstructions). In-silico pace-mapping was performed by pacing the heart in N = 1000 sites from randomly chosen locations, on both surfaces and intramurally, within close proximity (&amp;lt;5mm) from the infarct. ECG signals computed following each paced activation wavefront were compared to the VT ECG through correlation analysis to construct the virtual pace map. The distance d between the VT exit site and the pacing location with the strongest correlation was also computed. Results As can be seen in Figure 1, correlation between VT and paced ECGs was found to be strongest at pacing locations near the VT exit site in all models. Correlation coefficients were similar in value and distribution in models with high- (min: -0.49±0.27 and max: 0.92±0.05) and low-resolution scars (min: -0.46±0.29 and max: 0.93±0.05). While the correlation map in the absence of scar had smaller values when compared to the other two models (min: -0.50±0.24 and max: 0.71±0.09), the VT exit was still located near the pacing location with the strongest correlation: d = 9.47±2.83 (high-res), d = 6.63±6.35mm (low-res) and d = 18.60±7.10mm (no scar). Conclusion In-silico pace-mapping successfully detected the VT exit sites regardless the resolution of the scar. This finding suggest that the level of infarct anatomical detail has a minor effect on simulated paced activation to localize VT ablation.

Conduction Velocity Dispersion Predicts Postinfarct Ventricular Tachycardia Circuit Sites and Associates With Lipomatous Metaplasia

BackgroundRegional myocardial conduction velocity (CV) dispersion has not been studied in postinfarct patients with ventricular tachycardia (VT). ObjectivesThis study sought to compare the following: 1) the association of CV dispersion vs repolarization dispersion with VT circuit sites; and 2) myocardial lipomatous metaplasia (LM) vs fibrosis as the anatomic substrate for CV dispersion. MethodsAmong 33 postinfarct patients with VT, we characterized dense and border zone infarct tissue by late gadolinium enhancement cardiac magnetic resonance, and LM by computed tomography, with both images registered with electroanatomic maps. Activation recovery interval (ARI) was the time interval from the minimum derivative within the QRS complex to the maximum derivative within the T-wave on unipolar electrograms. CV at each EAM point was the mean CV between that point and 5 adjacent points along the activation wave front. CV and ARI dispersion were the coefficient of variation (CoV) of CV and ARI per American Heart Association (AHA) segment, respectively. ResultsRegional CV dispersion exhibited a much larger range than ARI dispersion, with median 0.65 vs 0.24; P < 0.001. CV dispersion was a more robust predictor of the number of critical VT sites per AHA segment than ARI dispersion. Regional LM area was more strongly associated with CV dispersion than fibrosis area. LM area was larger (median 0.44 vs 0.20 cm2; P < 0.001) in AHA segments with mean CV <36 cm/s and CoV_CV >0.65 than those with mean CV <36 cm/s and CoV_CV <0.65. ConclusionsRegional CV dispersion more strongly predicts VT circuit sites than repolarization dispersion, and LM is a critical substrate for CV dispersion.

P102 DIFFERENCES IN HIGH–DENSITY MAPPING OF KOCH‘S TRIANGLE DURING TYPICAL AV NODAL REENTRANT TACHYCARDIA INTEGRATED AND NOT INTEGRATED WITH DIRECT RECORDING OF ATRIOVENTRICULAR NODE STRUCTURES POTENTIAL: A MULTICENTER NON–RANDOMIZED STUDY

Abstract Background Despite the sustained efforts and advances in the fields of anatomy, histology, immunohistochemistry and cardiac mapping, the definition of the AVNRT circuit in humans is still incomplete. This discouraging result can be explained by many reasons, but the most important one has been the impossibility to map the AVNRT circuit without recording the electrical activity of the AVN and its extensions, which represent the diastolic interval in the tachycardia cycle. The aim of this study was to compare high density activation mapping integrated and not integrated with AV node potential recordings to establish the importance of annotation of AV nodal structure electrical activity in defining Koch’s triangle activation during AVNRT. Methods Electroanatomic 3–D reconstruction and propagation automated mapping of atrial activation during both sinus rhythm and tachycardia was performed using a basket catheter (64 electrodes of 0.4–mm2 area; 2.5–mm spacing, Orion, Boston Scientific, Natick, MA) and the Rhythmia electroanatomic mapping system in group 1 patients (X). In group 2 patients (45) the AV node potential (a very low frequency signal distinct from atrial, His bundle or ventricular activations, recorded from electrodes overlying the region of the compact AV node and its extensions by using a non–conventional bipolar electrogram filtering of [0.05/1 – 250] Hz) were also recorded both during slow fast AVNRT. Results The integrated map showed that during AVNRT, the activation wavefront descends from the Tendon of Todaro region (fast pathway area) and rises along the septal leaflet of the tricuspid valve through the RINE and reaches the AV bundle probably via the LNB bypassing the compact AV node almost completely. This kind of activation of the Koch’s triangle was not reconstructed by the non–integrated map. Moreover, the recording of the potentials of the AV node structures makes it possible to obtain a 100% coverage of the tachycardia cycle which was only 32% in the non–integrated maps (p &amp;lt; 0.0001). Conclusion The recording of the electrical activity of AV nodal structures allows a better definition of the circuit of typical slow–fast AVNRT which, in the majority of the cases, is completely localised in the right atrium.

Investigation into the importance of using natural PVCs and pathological models for potential-based ECGI validation.

Introduction: Premature ventricular contractions (PVCs) are one of the most commonly targeted pathologies for ECGI validation, often through ventricular stimulation to mimic the ectopic beat. However, it remains unclear if such stimulated beats faithfully reproduce spontaneously occurring PVCs, particularly in the case of the R-on-T phenomenon. The objective of this study was to determine the differences in ECGI accuracy when reconstructing spontaneous PVCs as compared to ventricular-stimulated beats and to explore the impact of pathophysiological perturbation on this reconstruction accuracy. Methods: Langendorff-perfused pig hearts (n = 3) were suspended in a human torso-shaped tank, and local hyperkalemia was induced through perfusion of a high-K+ solution (8mM) into the LAD. Recordings were taken simultaneously from the heart and tank surfaces during ventricular pacing and during spontaneous PVCs (including R-on-T), both at baseline and high K+. Epicardial potentials were reconstructed from torso potentials using ECGI. Results: Spontaneously occurring PVCs were better reconstructed than stimulated beats at baseline in terms of electrogram morphology [correlation coefficient (CC) = 0.74 ± 0.05 vs. CC = 0.60 ± 0.10], potential maps (CC = 0.61 ± 0.06 vs. CC = 0.51 ± 0.12), and activation time maps (CC = 0.86 ± 0.07 vs. 0.76 ± 0.10), though there was no difference in the localization error (LE) of epicardial origin (LE = 14 ± 6 vs. 15 ± 11mm). High K+ perfusion reduced the accuracy of ECGI reconstructions in terms of electrogram morphology (CC = 0.68 ± 0.10) and AT maps (CC = 0.70 ± 0.12 and 0.59 ± 0.23) for isolated PVCs and paced beats, respectively. LE trended worse, but the change was not significant (LE = 17 ± 9 and 20 ± 12mm). Spontaneous PVCs were less well when the R-on-T phenomenon occurred and the activation wavefronts encountered a line of block. Conclusion: This study demonstrates the differences in ECGI accuracy between spontaneous PVCs and ventricular-paced beats. We also observed a reduction in this accuracy near regions of electrically inactive tissue. These results highlight the need for more physiologically realistic experimental models when evaluating the accuracy of ECGI methods. In particular, reconstruction accuracy needs to be further evaluated in the presence of R-on-T or isolated PVCs, particularly when encountering obstacles (functional or anatomical) which cause line of block and re-entry.

PO-04-134 STAR MAPPING METHOD TO IDENTIFY ENDO-EPICARDIAL DISSOCIATION AND DRIVING SITES IN PERSISTENT ATRIAL FIBRILLATION

Recurrence rates following ablation for persistent AF (psAF) remain high with the underlying mechanisms complex and poorly understood. Asynchronous activation of the endocardial and epicardial surfaces during AF, defined as endo-epicardial dissociation (EED) may be a driver for AF. We aim to investigate whether using the novel vector mapping approach, Stochastic Trajectory Analysis of Ranked (STAR) signals, endo- epicardial dissociation and early sites of activation (ESA) can be identified. Six (6) patients underwent endo-epicardial AF ablation utilizing the pericardial percutaneous CO2 insufflation technique. Two AdvisorTM HD Grid mapping catheters were placed in corresponding endocardial and epicardial positions in the left atrium. During AF, 30 second segments were recorded at the base of the left atrial appendage, anterior, inferior, left lateral and posterior LA wall. Fifteen (15) corresponding endo-epicardial segments were analysed using STAR maps and assessed for ESA and variation in direction of activation wavefront between the endocardium and epicardium. Activation wavefront direction was defined as dissociated if there was >40-degree difference between activation direction of simultaneous endo-epicardial wavefronts on STAR mapping. For each 30 second recording if there was more than 1 dominant wavefront direction, the 2 most common were used and an average taken. The overall mean difference in angulation of wavefront between the endocardium and epicardium was 71 ± 55 degrees. Nine (9) of 15 STAR maps (53%) showed activation angulation difference of >40 degrees between the endocardial and epicardial wavefront activation. Of these 9, 3 were on the posterior wall, 3 were at the base of the appendage, 2 were on the left lateral wall and 1 was on the anterior wall. ESA was identified in 6 STAR mapped endo and epicardial segments of AF, with 4 of these 6 (67%) ESAs in the epicardium. STAR mapping identifies activation wavefront discrepancy showing EED in multiple sites of the atrium with the majority of ESAs in the epicardial atrial surface.

PO-01-084 HIDING IN PLAIN SIGHT

Substrate based scar modification requires accurate detection and characterization of myocardial scar in sinus rhythm or using different wavefronts of activation. Mapping during ventricular tachycardia can be performed only in about 30% to 40% cases. We describe a challenging case of scar VT with discrepancy in the delineation of scar between voltage mapping and cardiac MRI and the role of Decremental Evoked Potential Mapping as a guide to a more focussed ablation in such circumstances. N/A N/A 56 year diabetic female status post Coronary artery bypass grafting in 2016 and moderate left ventricular dysfunction with recurrent episodes of hemodynamically unstable ventricular tachycardia and patient's refusal for ICD was evaluated and cardiac MRI revealed subendocardial scar in the anterior wall and patent grafts on coronary angiogram. Patient was taken up for 3D mapping and ablation using 3.5 mm tip non force sensing unidirectional irrigation ablation catheter.In view of hemodynamically unstable VT, activation mapping was not possible, hence substrate mapping was planned. Endocardial bipolar voltage mapping didnot delineate any scar in sinus rhythm and after changing the wavefront of activation to right ventricular paced rhythm. Unipolar voltage map didnot show any scar. While mapping the anterior wall , abnormal local electrograms were seen superimposed into the far field electrograms. To do a foccussed ablation we applied the concept of Decremental Evoked Potential Mapping and identified the slow conduction zone - the most critical component of the scar for initiation and maintainence of re-entry. We identified and ablated only the points with abnormal local electrograms with absolute value of decrement more than 10 ms as part of slow conduction zone. Post ablation, VT was not inducible despite induction protocol using triple extrastimuli from two different sites. Activation mapping is not possible in hemodynamically unstable VT. Substrate based mapping needs accurate delineation of myocardial scar. As the 3D mapping system is an automated system and annotates only the largest amplitude signals for color coded voltage mapping, in cases without dense scar, voltage mapping doesnot reliably identify and delineate the scar when compared to cardiac MRI, particularly with a larger tip diameter ablation catheter. Novel mapping techniques like Decremental Evoked Potential Mapping enable limited ablation in such cases.

Inverse ECG imaging as a novel solution for acute coronary syndrome classification from standard 12-lead ECG in the emergency department

Spiral wave reentry is a potential mechanism of atrial fibrillation (AF), but is difficult to differentiate clinically from multiple wavelet breakup using standard bipolar recordings. We developed a new methodology using bipolar recordings to estimate the direction of local activation wavefronts during AF by calculating the electrogram conformation (Egm-C). We subsequently used recurrence quantification analysis (RQA) of Egm-C to differentiate regions of spiral wave reentry from wavelet breakup.A 2D computer simulation was created with regions containing a stable spiral wave and also regions of wavebreak. A grid of 40 × 40 unipolar electrodes was superimposed. At each site, the actual wavefront direction (WD) was determined by comparing relative activation timings of the local intracellular recordings, and the estimated wavefront direction (Egm-C) was determined from the morphology of the local bipolar electrogram. RQA of Egm-C was compared to RQA of actual WD in order to differentiate AF mechanisms.RQA of actual WD and Egm-C both distinguished regions of spiral wave reentry from wavelet breakup with high correlation between the two methods (recurrence rate, r = 0.96; determinism, r = 0.61; line max, r = 0.95; entropy, r = 0.84; p < 0.001 for all). In areas of stable spiral wave reentry, the recurrence plots of both Egm-C and actual WD demonstrated stable, periodic dynamics, while regions of wavelet breakup demonstrated chaotic behavior largely devoid of repetitive activation patterns.Calculation of Egm-C allows RQA to be performed on bipolar electrograms during AF and differentiates regions of spiral wave reentry from multiple wavelet breakup.

Universal Active Metasurfaces for Ultimate Wavefront Molding by Manipulating the Reflection Singularities

AbstractOptical metasurfaces are becoming ubiquitous optical components to control light properties. However, most of these devices are passive and cannot be arbitrarily reconfigured according to the change in the surrounding environment. Here the authors propose an innovative design strategy relying on the position of topological singularities to address full phase modulation of light with almost unity efficiency. The active metasurface unit cells consist of asymmetric Gires–Tournois resonators filled with either silicon or hetero‐structured materials to leverage on the thermo‐optical or electro‐optical effects, respectively. In both cases, a full phase modulation associated with 100% reflection amplitude is observed even when dealing with extremely low refractive index change, on the order of 0.01. Improving the deflection efficiencies for each deflection angle is performed by optimizing the refractive index modulation profile in the extended unit cell using an advanced statistical learning optimization methodology. Consequently, active beam steering designs for active thermo‐optical effect with ultimate performance exceeding 90% have been optimized. Furthermore, active wavefront splitting using electro‐optics materials is optimized to reach ultimate modulation performances with nearly 92% efficiency. The realization of highly efficient active beam‐forming operating at high frequencies would open important applications in imaging microscopy, and 3D light detection and ranging (LiDAR).

Tunable Polarization-Multiplexed Achromatic Dielectric Metalens.

Tunable metasurfaces provide a compact and efficient strategy for optical active wavefront shaping. Varifocal metalens is one of the most important applications. However, the existing tunable metalens rarely serves broadband wavelengths restricting their applications in broadband imaging and color display due to chromatic aberration. Herein, an electrically tunable polarization-multiplexed achromatic metalens integrated with twisted nematic liquid crystals (TNLCs) in the visible region is demonstrated. The phase profiles at different wavelengths under two orthogonal polarization channels are customized by the particle swarm optimization algorithm and matched with the dielectric metaunits database to achieve polarization-multiplexed achromatic performance. By combining the broadband linear polarization conversion ability of TNLC, the tunability of varifocal achromatic metalens is realized by applying different voltages. Further, the electrically tunable customized dispersion-manipulated metalens and switchable color metaholograms are demonstrated. The proposed devices will accelerate the application of metasurfaces in broadband zoom imaging, AR/VR displays and spectral detection.