Real world clinical experience of using Brainomix e-CTA software in a medium size acute NHS trust.

Objectives: Artificial intelligence (AI) software including Brainomix "e-CTA" which detect large vessel occlusions (LVO) have clinical potential. We hypothesised that in real world use where prevalence is low, its clinical utility may be overstated.

Methods: In this single centre retrospective service evaluation project, data sent to Brainomix from a medium size acute National Health Service (NHS) Trust hospital between 1/3/2022-1/3/2023 was reviewed.

IMPACT: In-Memory ComPuting Architecture based on Y-FlAsh Technology for Coalesced Tsetlin machine inference.

The increasing demand for processing large volumes of data for machine learning (ML) models has pushed data bandwidth requirements beyond the capability of traditional von Neumann architecture. In-memory computing (IMC) has recently emerged as a promising solution to address this gap by enabling distributed data storage and processing at the micro-architectural level, significantly reducing both latency and energy. In this article, we present In-Memory comPuting architecture based on Y-FlAsh technology for Coalesced Tsetlin machine inference (IMPACT), underpinned on a cutting-edge memory device, Y-Flash, fabricated on a 180 nm complementary metal oxide semiconductor (CMOS) process.

Neural in-memory checksums: an error detection and correction technique for safe in-memory inference.

The advent of in-memory computing has introduced a new paradigm of computation, which offers significant improvements in terms of latency and power consumption for emerging embedded AI accelerators. Nevertheless, the effect of the hardware variations and non-idealities of the emerging memory technologies may significantly compromise the accuracy of inferred neural networks and result in malfunctions in safety-critical applications. This article addresses the issue from three different perspectives.

Clinical effectiveness and safety of transvenous lead extraction of very old leads.

Background: Transvenous lead extraction (TLE) success and safety are heavily influenced by lead dwell time.

Objective: In this study, we aim to compare the clinical effectiveness and safety of TLE between young and old leads.

Methods: We retrospectively identified all TLE procedures at Emory Healthcare from 2007 to 2023.

Costs, efficiency, and patient-reported outcomes associated with suture-mediated percutaneous closure for atrial fibrillation ablation: Secondary analysis of a randomized clinical trial.

Introduction: To evaluate the cost and efficiency of suture-mediated percutaneous closure (SMC) compared to manual compression (MC) after atrial fibrillation (AF) ablation. SMC has been demonstrated to be efficacious in reducing hemostasis and bedrest times after AF ablation. To date, randomized data comparing the direct and indirect cost between the two techniques have not been described.

Spontaneous fluctuation in atrial fibrillation burden and duration in patients with implantable loop monitors.

Background: Most studies of device-detected atrial fibrillation (AF) have recommended indefinite anticoagulation once a patient crosses a particular threshold for AF duration or burden. However, durations and burdens are known to fluctuate over time, but little is known about the magnitude of spontaneous fluctuations and the potential impact on anticoagulation decisions.

Objective: To quantify spontaneous fluctuations in AF duration and burden in patients with implantable loop recorders (ILRs) METHODS: We reviewed all ILR interrogations for patients with non-permanent AF at our institution from 2018 to 2023.

Procedural and long-term outcomes of tunneled transvenous leads.

Background: Lead-related venous stenosis and occlusion can complicate the insertion or replacement of transvenous leads in patients with cardiac implantable electronic devices (CIEDs). A possible solution is to tunnel the lead from the contralateral vasculature to the ipsilateral generator. Procedural complications and long-term outcomes remain unclear with this technique.

Medicare-mandated shared decision making for left atrial appendage closure in clinical practice.

Introduction: The Centers for Medicare & Medicaid Services (CMS) required a shared decision-making (SDM) interaction, with an "independent" physician, before left atrial appendage closure (LAAC). The purpose of this study is to better understand how this requirement is implemented in clinical practice.

Methods: We surveyed LAAC-performing centers.

Managing superior vena cava syndrome in patients with cardiac implantable electronic device leads: Strategies and considerations.

Background: Data on transvenous (TV) lead-associated superior vena cava (SVC) syndrome are limited. The management of this problem might require a multidisciplinary approach, often involving transvenous lead extraction (TLE) followed by angioplasty and stenting.

Objective: The purpose of this study was to describe the management and outcome of TV lead-associated SVC syndrome.

A Modular Communicative Leadless Pacing-Defibrillator System.

Background: The subcutaneous implantable cardioverter-defibrillator (ICD) is associated with fewer lead-related complications than a transvenous ICD; however, the subcutaneous ICD cannot provide bradycardia and antitachycardia pacing. Whether a modular pacing-defibrillator system comprising a leadless pacemaker in wireless communication with a subcutaneous ICD to provide antitachycardia and bradycardia pacing is safe remains unknown.

Methods: We conducted a multinational, single-group study that enrolled patients at risk for sudden death from ventricular arrhythmias and followed them for 6 months after implantation of a modular pacemaker-defibrillator system.

Sex-based outcomes of subcutaneous implantable cardioverter-defibrillator and impact of surgical technique.

Background: Because of differences in chest wall anatomy, female patients may have higher rates of subcutaneous implantable cardioverter-defibrillator (S-ICD) pocket-related complications.

Objective: We sought to evaluate sex-based outcomes after S-ICD implantation.

Methods: Patients implanted with an S-ICD at Emory Healthcare between 2010 and 2023 were included in the analysis.

Impact of omitting the intravenous heparin bolus on outcomes of leadless pacemaker implantation.

Background: Early guidance recommended a bolus of intravenous heparin at the beginning of leadless pacemaker (LP) implantation procedures. However, due to concern about bleeding complications, more recent practice has tended toward omitting the bolus and only running a continuous heparin infusion through the introducer sheath. The impact of omitting the heparin bolus on procedural outcomes is not clear.

Outcomes of tricuspid regurgitation after lead extraction.

Introduction: Transvenous leads have been implicated in tricuspid valve (TV) dysfunction, but limited data are available regarding the effect of extracting leads across the TV on valve regurgitation. The aim of this study is to quantify tricuspid regurgitation (TR) before and after lead extraction and identify predictors of worsening TR.

Methods: We studied 321 patients who had echocardiographic data before and after lead extraction.

Complex repolarization dynamics in ex vivo human ventricles are independent of the restitution properties.

Aims: The mechanisms of transition from regular rhythms to ventricular fibrillation (VF) are poorly understood. The concordant to discordant repolarization alternans pathway is extensively studied; however, despite its theoretical centrality, cannot guide ablation. We hypothesize that complex repolarization dynamics, i.