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BACKGROUND: Ice machines in healthcare facilities have been suspected and even linked to outbreaks and pseudo-outbreaks. Guidelines exist for maintenance of these devices but there is no clear independent infection control standard, and little is known about their microbial contamination. AIM: To evaluate the microbial contamination, amplification, and presence of opportunistic pathogens in ice-water machines in a healthcare facility. METHODS: Concentrations of general microbial indicators (heterotrophic plate counts (HPC), total and intact cells), faecal indicators (enterococci) and opportunistic pathogens (Pseudomonas aeruginosa, non-tuberculous mycobacteria (NTM), Candida spp.) were measured in 36 ice-water machines on patient wards of a 772-bed hospital. Profile sampling was performed on five ice-water machines and adjacent faucets to identify sites of microbial proliferation. FINDINGS: Candida spp. were found in half of ice-water samples while enterococci and P. aeruginosa were present in six and 11 drain inlets respectively. NTM were measured in all ice-water samples and 35 out of 36 biofilms. Pre-filters and ice machines are sites for additional amplification: NTM densities were on average 1.3 log10 higher in water of ice machine flushed 5 min compared to flushed adjacent tap water. CONCLUSION: Ice machine design needs to be adapted to reduce microbial proliferation. The absence of correlation between HPC densities (current microbial indicators) and NTM concentrations suggests a need for cleaning efficiency indicators better correlated with opportunistic pathogens. Cleaning and disinfection guidelines of ice machines in healthcare facilities need to be improved, especially when ice is given to the most vulnerable patients, and NTM may be an efficiency indicator.

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The emergence of carbapenemases in Enterobacteriaceae has raised global concern among the scientific, medical and public health communities. Both the CDC and the WHO consider carbapenem-resistant Enterobacteriaceae (CRE) to constitute a significant threat that necessitates immediate action. In this article, we review the challenges faced by laboratory workers, infection prevention specialists and clinicians who are confronted with this emerging infection control issue.

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AIMS: The aim of this work is to study the expression of stress genes and those involved in pediocin and nisin production in Pediococcus acidilactici UL5 and Lactococcus lactis ATCC11454 under simulated gastrointestinal (GI) physiological conditions. METHODS AND RESULTS: The two strains were fed to a dynamic GI model (TIM-1). Samples were taken from different compartments and analysed for strain survival as well as for the expression of pediocin PA-1 operon, nisin A production gene and stress genes using RT-qPCR. Ileal-delivered efflux showed a survival rate of 17 and 0·0007% for Ped. acidilactici and La. lactis, respectively. Pediocin operon genes from stressed cells were generally expressed at least at the same level as for unstressed cells. However, pedA is up-regulated in the effluent at 120 and 180 min. Nisin A genes were always up-regulated with particularly in the stomach after 70 min compared with control. CONCLUSIONS: Bacteriocin production of Ped. acidilactici UL5 and Lc. lactis ATCC 11454 are not affected by upper GI simulated conditions and thus could be considered as relevant probiotic candidates. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrates the capacity of lactic acid bacteria to survive and express their bacteriocins genes under simulated GI conditions.

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OBJECTIVE: A new technique called electroarthrography (EAG) measures electrical potentials on the surface of the knee during joint loading. The objective of this study was to evaluate the effectiveness of EAG to assess joint cartilage degeneration. DESIGN: EAG recordings were performed on 20 asymptomatic subjects (Control group) and on 20 patients with bilateral knee osteoarthritis (OA) who had had a unilateral total knee replacement (TKR), both the TKR knee and the remaining knee were analyzed. EAG signals were recorded at eight electrode sites over one knee as the subjects shifted their weight from one leg to the other to achieve joint loading. The EAG signals were filtered, baseline-corrected and time-averaged. RESULTS: EAG repeatability was assessed with a test-retest protocol which showed statistically significant high intraclass correlation coefficients (ICC) for four electrode sites near the joint line. These sites also showed the highest mean EAG values. The mean EAG potentials of the Control group were significantly higher compared with the OA group for three sites overlying the joint line. The potentials overlying the TKR were statistically nul. In the Control group, no statistically significant correlation was found between the EAG amplitude and age, weight, height or body mass index (BMI); no statistical difference was found in mean EAG potentials between women and men. CONCLUSIONS: This study indicates that EAG signals arise from the streaming potentials in compressed articular cartilage which are known sensitive indicators of joint cartilage health. EAG is a promising new technique for the non-invasive assessment of cartilage degeneration and arthritis.

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Partial meniscectomy is believed to change the biomechanics of the knee joint through alterations in the contact of articular cartilages and menisci. Although fluid pressure plays an important role in the load support mechanism of the knee, the fluid pressurization in the cartilages and menisci has been ignored in the finite element studies of the mechanics of meniscectomy. In the present study, a 3D fibril-reinforced poromechanical model of the knee joint was used to explore the fluid flow dependent changes in articular cartilage following partial medial and lateral meniscectomies. Six partial longitudinal meniscectomies were considered under relaxation, simple creep, and combined creep loading conditions. In comparison to the intact knee, partial meniscectomy not only caused a substantial increase in the maximum fluid pressure but also shifted the location of this pressure in the femoral cartilage. Furthermore, these changes were positively correlated to the size of meniscal resection. While in the intact joint, the location of the maximum fluid pressure was dependent on the loading conditions, in the meniscectomized joint the location was predominantly determined by the site of meniscal resection. The partial meniscectomy also reduced the rate of the pressure dissipation, resulting in even larger difference between creep and relaxation times as compared to the case of the intact knee. The knee joint became stiffer after meniscectomy because of higher fluid pressure at knee compression followed by slower pressure dissipation. The present study indicated the role of fluid pressurization in the altered mechanics of meniscectomized knees.

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The mechanical functions of the menisci may be partially performed through the fluid pressurization in articular cartilages and menisci. This creep behavior has not been investigated in whole knee joint modeling. A three-dimensional finite element knee model was employed in the present study to explore the fluid-flow dependent creep behaviors of normal and meniscectomy knees. The model included distal femur, tibia, fibula, articular cartilages, menisci and four major ligaments. Articular cartilage or meniscus was modeled as a fluid-saturated solid matrix reinforced by a nonlinear orthotropic and site-specific collagen network. A 300 N compressive force, equal to half of body weight, was applied to the knee in full extension followed by creep. The results showed that the fluid pressurization played a substantial role in joint contact mechanics. Menisci bore more loading as creep developed, leading to decreased stresses in cartilages. The removal of menisci not only changed the stresses in the cartilages, which was in agreement with published studies, but also altered the distribution and the rate of dissipation of fluid pressure in the cartilages. The high fluid pressures in the femoral cartilage moved from anterior to more central regions of the condyles after total meniscectomy. For both intact and meniscectomy joints, the fluid pressure level remained considerably high for thousands of seconds during creep, which lasted even longer after meniscectomy. For the femoral cartilage, the maximum principal stress was generally in agreement with the fiber direction, which indicated the essential role of fibers in load support of the tissue.

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A tetrapolar method to measure electrical conductivity of cartilage and bone, and to estimate the thickness of articular cartilage attached to bone, was developed. We determined the electrical conductivity of humeral head bovine articular cartilage and subchondral bone from a 1- to 2-year-old steer to be 1.14+/-0.11 S/m (mean+/-sd, n =11) and 0.306+/-0.034 S/m, (mean+/-sd, n =3), respectively. For a 4-year-old cow, articular cartilage and subchondral bone electrical conductivity were 0.88+/-0.08 S/m (mean+/-sd, n =9) and 0.179+/-0.046 S/m (mean+/-sd, n =3), respectively. Measurements on slices of cartilage taken from different distances from the articular surface of the steer did not reveal significant depth-dependence of electrical conductivity. We were able to estimate the thickness of articular cartilage with reasonable precision (<20% error) by injecting current from multiple electrode pairs with different inter-electrode distances. Requirements for the precision of this method to measure cartilage thickness include the presence of a distinct layer of calcified cartilage or bone with a much lower electrical conductivity than that of uncalcified articular cartilage, and the use of inter-electrode distances of the current injecting electrodes that are on the order of the cartilage thickness. These or similar methods present an attractive approach to the non-destructive determination of cartilage thickness, a parameter that is required in order to estimate functional properties of cartilage attached to bone, and evaluate the need for therapeutic interventions in arthritis.

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Severe disorders of the heart rhythm that can cause syncope or sudden cardiac death (SCD), can be treated by radio-frequency (RF) catheter ablation. The precise localization of the arrhythmogenic site and the positioning of the RF catheter over that site are problematic: they can impair the efficiency of the procedure and are time consuming (several hours). Our approach consists of integrating fluoroscopic and electrical data from the RF catheters into the same image so as to better guide RF ablation, shorten the duration of this procedure and increase its efficacy.

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Cartilage molecular changes in osteoarthritis are most commonly related to the degradation and loss of proteoglycan and collagen fibrils of the extracellular matrix, which directly influence tissue stiffness and compression-generated streaming potentials. In this study, we evaluated the potential of a new technique, spatially resolved mapping of streaming potentials, to non-destructively indicate cartilage health or degeneration. Matched pairs of bovine cartilage/bone explant disks were cultured for 11 days in a serum free medium with and without interleukin-lalpha (IL-1alpha). The electromechanical properties (static stiffness, dynamic stiffness and streaming potentials) of cartilage disks were measured during unconfined compression using a mechanical tester coupled with a linear array of eight 50 microm diameter platinum-iridium microelectrodes. After 11 days of culture, the proteoglycan content of IL-1alpha treated disks was significantly reduced and the denatured and cleaved collagen content was increased compared to control disks. These biochemical alterations were concomitant with the reductions in the amplitudes of the static stiffness, the dynamic stiffness and the streaming potential profile as well as changes in the shape of the streaming potential profile. We found that spatial mapping of streaming potentials presents several advantages for the development of a clinical instrument to evaluate the degeneration of articular cartilage.

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Streaming potential distributions were measured on the surface of articular cartilage in uniaxial unconfined compression using a linear array of microelectrodes. Potential profiles were obtained for sinusoidal and ramp/stress-relaxation displacements and exhibited dependencies on radial position, sinusoidal amplitude and frequency, time during stress relaxation, and on ionic strength. The measurements agreed with trends predicted by biphasic and related models. In particular, the absolute potential amplitude was maximal at the disk center, as was the predicted fluid pressure and the potential gradient (the electric field) was seen to be maximal at the disk periphery, as was the predicted fluid velocity. We also observed a similarity between non-linear behavior of streaming potential amplitude and load amplitude with respect to sinusoidal displacement amplitude. Taken together, these results support many of the phenomena concerning relative fluid-solid movement and fluid pressurization predicted by biphasic and related models, and they indicate the general utility of spatially resolved measurements of streaming potentials for the investigation of electromechanical phenomena in tissues. For example, these streaming potential maps could be used to non-destructively diagnose cartilage extracellular matrix composition and function, as well as to quantify spatially and temporally varying physical signals in cartilage that can induce cellular and extracellular biological responses to load.

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Transitin is an avian intermediate filament protein whose transient expression in the progenitor cells of the muscle and nerve tissues is similar to that of mammalian nestin. Both proteins contain an alpha-helical core domain flanked by a short N-terminal head and a long C-terminal extremity. However, the tail region of transitin is significantly different from that of nestin in that it harbors a unique motif containing more than 50 leucine zipper-like heptad repeats which is not found in any other intermediate filament protein. Despite the absence of introns in this region of the transitin gene, it was reported that different isoforms of the protein were produced by exclusion or inclusion of a number of repeats generated by an unusual splicing mechanism recognizing consensus 5' and 3' splice sites contained within the coding sequence of the heptad repeat domain [Napier et al. (1999) J Mol Neurosci 12:11-22]. Two monoclonal antibodies (mAbs) reacting with repeated epitopes of this motif were used to monitor transitin expression during in vitro myogenesis of the quail myogenic cell line QM7. Confocal microscopy revealed that the subcellular domains decorated with mAbs A2B11 and VAP-5 were mutually exclusive: the intermediate filament network visualized with mAb VAP-5 appeared to abut on a submembranous domain defined by mAb A2B11. When QM7 cells were induced to differentiate by switching to medium containing low serum components, an early effect was the local loss of A2B11 cortical staining at the points of cell-cell contacts. The A2B11 signal also disappeared before that of VAP-5 in newly formed myotubes. Unexpectedly, the mutually exclusive staining pattern of the mAbs could not be explained by alternative splicing since both epitopes mapped to a repeated element preceding the consensus 5' splice sites of the heptad repeat domain. An alternative explanation would be that the central repeat domain of transitin is a polymorphic structure from which different conformations exist depending on the local context. This hypothesis is strengthened by the observation that in cultured neural crest cells, the A2B11 antigen is preferentially expressed by freely migrating crest cells whose intracellular pH and calcium concentrations are different from those of non-migrating cells.

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The passive electrical properties of cardiac tissue, such as the intracellular and interstitial conductivities along the longitudinal and transverse axes, have not been often measured because intracellular electrodes are usually needed for these measurements. In this paper, we present a theoretical analysis of two myocardial models developed to estimate these properties by analyzing potentials recorded with a pair of extracellular electrodes while injecting alternating current between another pair of electrodes. First, the cardiac tissue is represented by a standard bidomain model which includes a membrane capacitance; second, this model is modified by adding an intracellular capacitance representing the intercalated disks. Numerical solutions are computed with a fast Fourier transform algorithm without constraining the anisotropy ratios of the interstitial and intracellular domains. We systematically investigate the effects of changes in the bidomain parameters on the voltage-to-current ratio curves. We also demonstrate how the bidomain parameters can be theoretically estimated by fitting, with a modified Shor's r algorithm, the simulated potentials along the longitudinal and transverse axes for different frequencies between 10 and 10,000 Hz. An important finding is that the interelectrode distance must be similar to the myocardial space constant so as to obtain frequency dependent measurements.

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Radio frequency (RF) current delivered through a thin catheter can be used to perforate the pulmonary valve or the atrial septum to treat pulmonary atresia in newborns. To understand better the mechanisms of RF perforation, a numerical model is developed, and experiments are performed in isolated canine cardiac tissue. The model consists of a cylindrical domain with a tissue layer between two blood layers. The finite-difference method is used to compute both the potential and temperature distributions. When the tissue temperature exceeds 100 degrees C in all points that are directly in front of the catheter, these points are considered to be instantly vaporised, and the catheter advances over these points. The computed temperature time course coincides with measured temperature at small voltages (< 16 V). Simulated perforation occurs when the voltage exceeds a threshold of 70-80 V for a catheter diameter of 0.30-0.44 mm, which coincides with experimental observations in the myocardium. A voltage exceeding this perforation threshold tends to decrease tissue damage. Shorter electrodes (0.7 mm as against 2.4 mm) with smaller diameters produce a more rapid perforation. In conclusion, numerical simulations provide insights into aspects of RF perforation, such as electrode size, current, speed of perforation and collateral damage.

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A putative hemoglobin (Hb) gene, related to those previously characterized in the green alga Chlamydomonas eugametos, the ciliated protozoan Paramecium caudatum, the cyanobacterium Nostoc commune and the bacterium Mycobacterium tuberculosis, was recently discovered in the complete genome sequence of the cyanobacterium Synechocystis PCC 6803. In this paper, we report the purification of Synechocystis Hb and describe some of its salient biochemical and spectroscopic properties. We show that the recombinant protein contains Fe-protoporphyrin IX and forms a very stable complex with oxygen. The oxygen dissociation rate measured, 0.011 s(-1), is among the smallest known and is four orders of magnitude smaller than the rate measured for N. commune Hb, which suggests functional differences between these Hbs. Optical and resonance Raman spectroscopic study of the structure of the heme pocket of Synechocystis Hb reveals that the heme is 6-coordinate and low-spin in both ferric and ferrous forms in the pH range 5.5-10.5. We present evidence that His46, predicted to occupy the helical position E10 based on amino-acid sequence comparison, is involved in the formation of the ferric and ferrous 6-coordinate low-spin structures. The analysis of the His46Ala mutant shows that the ferrous form is 5-coordinate and high-spin and the ferric form contains a 6-coordinate high-spin component in which the sixth ligand is most probably a water molecule. We conclude that the heme pocket of the wild type Synechocystis Hb has a unique structure that requires a histidine residue at the E10 position for the formation of its native structure.

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OBJECTIVES: To investigate a noninvasive technique to localize the atrial insertion site of concealed accessory pathways based on the analysis of body surface potential maps (BSPMs) of retrograde P waves in dogs with simulated retrograde pathways. ANIMALS AND METHODS: Orthodromic tachycardias were simulated by atrial stimulations at eight different sites around the atrioventricular ring with long (250 ms and 300 ms) and short (100 ms and 130 ms) coupling times in 14 anesthetized dogs to have P waves well separated from the T wave or occurring during the T wave, respectively. The distance between pacing sites was 15 to 40 mm in group 1 (eight dogs) and 2 mm (in the right atrial free wall region) in group 2 (six dogs). Beats were signal-averaged during 30 s and BSPMs were constructed from 63 unipolar leads. RESULTS: The P wave BSPM pattern for any specific stimulation site was stable and reproducible (correlation coefficient greater than 0.98), and similar in different dogs at long coupling interval stimulations. The thoracic distribution of negative potentials and position of the potential minimum clearly identified the stimulation site when long coupling time stimulations were used. The spatial resolution of the technique as determined by comparison of correlation coefficients in group 2 was 6 mm (P<0.05). When short coupling time stimulations were used (fast tachycardia simulation), the T wave masked the P wave potential distribution in four of eight dogs, but the retrograde P wave map could still be accurately extracted by subtracting a straight line joining the onset and offset of the P wave in 24 of 28 (86%) of the tachycardia simulation sites in these four dogs. CONCLUSIONS: The BSPM patterns of simulated retrograde P waves are specifically related to the site of atrial stimulation. Although the T wave altered these BSPM patterns, a subtraction technique recovered the pattern of the retrograde P wave in 93% of all simulated orthodromic tachycardias. The spatial resolution of the retrograde P wave BSPM method was 6 mm.

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BACKGROUND: Potential losses caused by stable non-Q-wave myocardial infarction (MI) are too small to diagnose with the use of standard ECG. The aim of the present study was to obtain accurate diagnostic criteria for this prognostically important disease with the help of body surface mapping. METHODS AND RESULTS: Body surface potentials were recorded with the use of 63 unipolar leads in 45 patients with a non-Q-wave MI (41 to 75 years old); 24 healthy adults, 42 patients with unstable angina, and 70 patients with Q-wave MI served as reference groups. Qualitative pathological features of the isopotential maps, such as onset time and site and magnitude of the first right-anterior/anterior minimum, as well as pathological negativities at that time, were defined in non-Q-wave MI cases. These features, which account for the activation sequence and the body surface projections of specific cardiac regions (Selvester classification), showed a 91% sensitivity and an 88% specificity for the detection of non-Q-wave MI. In comparison, the different departure maps (first third QRS, QRS, and QRST isoarea) resulted in less favorable specificities (50% to 58%). Concordance between the isopotential maps and the acute-phase ECG (90%), hypokinesis (64%), fixed perfusion defects (59%), and significant stenosis of the infarct-related coronary artery (87%) supported the concept that these isopotential map changes correspond to the supposed sites of MI. There were pathological features in 69% of patients with unstable angina, with similar concordances as in non-Q-wave MI. CONCLUSIONS: Isopotential maps revealed characteristic features that were suitable for the detection and localization of non-Q-wave MI in the clinical setting of unstable coronary artery disease.

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OBJECTIVE: To discriminate between monomorphic (MVT) and polymorphic (PVT) ventricular tachycardias in humans using cycle length variability (CLV), and to characterize the onset of MVT and PVT using power spectral analysis of the CLV during sinus rhythm and the number of ventricular extrasystoles before onset of arrhythmia. PATIENTS AND METHODS: Medtronic, Inc's Spontaneous Ventricular Tachy- arrhythmia Database was analyzed. This data base contains sets of 1000 RR intervals (n=135) that preceded spontaneous onset of ventricular tachycardia or fibrillation and sets of controls (n=135) without spontaneous ventricular tachycardia or fibrillation from 78 patients with the Medtronic Model 7218 implantable cardioverter defibrillator. CLV was measured as the standard deviation of RR intervals normalized by the mean RR value. Power spectral analysis based on the fast Fourier transform analysis was performed on 128 RR samples, and the normalized power spectrum of the low frequency band (0.04 to 0.15 Hz) and of the high (NHF) frequency band (0.15 to 0.4 Hz) were estimated. RESULTS: During PVT the CLV was much greater (0. 133+/-0.095) than during MVT (0.04+/-0.035) (P<0.0001). Also, 64% of patients who developed PVT had more than 27 extrasystoles compared with 40% of patients during control conditions (P=0.03). This parameter was not significantly different in patients with MVT. Due to the high incidence of extrasystoles in this population, only 36% of PVT and 43% of MVT recordings could be analyzed for CLV during sinus rhythm. NHF characterizing parasympathetic activity decreased from 50.6% (PVT control) to 34.4% (PVT onset) (P=0.06) and from 47. 4% (MVT control) to 43.7% (MVT onset) (P=0.18). CONCLUSIONS: Discrimination between MVT and PVT episodes was possible based on CLV analysis. The onset of PVT was characterized by a greater number of preceding extrasystoles compared with the control. During sinus rhythm, the NHF spectral power activity decreased at the onset of both types of arrhythmic episodes compared with control, although statistical significance was marginal.

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Angiogenesis is a complex process that involves the activation of endothelial cells through the triggering of several intracellular signaling pathways including those involving tyrosine phosphorylation. In the present study, we analyzed the angiogenic properties of two phosphotyrosyl phosphatase (PTP) inhibitors that are composed of a peroxovanadium core containing different ancillary ligands. In cell monolayer and 3D culture systems examined in this study, the administration of potassium bisperoxo(1,10-phenanthroline)oxovanadate(V) [bpV(phen)] or potassium bisperoxo(pyridine-2-carboxylato)oxovanadate(V) [bpV(pic)], but not oxovanadiums, interfered markedly with endothelial cell growth, organization, and terminal differentiation. This effect was dependent upon both the compound's dose and the nature of the ancillary ligand. Rat aortic ring assay showed a significant inhibition by low dose of bpV(phen) on cell migration. In addition, a chick embryo angiogenesis assay demonstrated that bpV(phen) is a potent inhibitor of angiogenesis. Among PTP inhibitors, bpV(phen) had powerful angiostatic properties at a low concentration.

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Transitin and IFAPa-400 are developmentally regulated high M(r) proteins expressed transiently in early chick embryogenesis. Both are associated with radially oriented fibers in the developing CNS and with various neural and myogenic tissues before their down-regulation at later stages. Previous studies have shown that IFAPa-400 colocalized and copurified with intermediate filament proteins and recent molecular cloning has indicated that transitin is a member of this family of cytoskeletal proteins. Here, we provide evidence that IFAPa-400 and transitin are the same protein. The sequence of a composite cDNA corresponding to more than 700 amino acids of IFAPa-400 carboxy-terminal extremity is identical to that of transitin. Both proteins exhibit identical apparent M(r) and isoelectric point. Immunopurified IFAPa-400 reacts with different antibodies to transitin and vice-versa. The patterns of expression of both proteins show a perfect coincidence at the tissue level. At the subcellular level, most antibodies to IFAPa-400/transitin decorate a typical intermediate filament network. However, monoclonal antibody A2B11, at the origin of transitin identification, exhibits a staining more typical of a cortical component, suggesting that different populations of transitin exist within the cell.

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The objective of this study was to assess the capability of wavelet transform (WT) analysis to differentiate between monomorphic (MVTs) and polymorphic ventricular tachycardias (PVTs) in a canine model and to relate these results to epicardial isochronal maps on a beat-by-beat basis. Unipolar electrograms were simultaneously recorded from the surface of both ventricles with a 127-lead sock electrode array in 24 open-chest anesthetized dogs. The sampling frequency was 500 Hz. Atrioventricular block was induced by formaldehyde injection into the atrioventricular node. The left anterior descending coronary artery was occluded for 60 minutes under ventricular pacing (140 stimuli/min) followed by reperfusion. Ventricular tachycardias were obtained during reperfusion and during left stellate ganglion stimulation. After visual selection, a total of 97 segments of 2,048 samples (4.096 seconds) were extracted and classified as 67 MVTs and 30 PVTs. A parameter based on the cycle length variability was defined in the second scale of the WT decomposition, normalized by its mean value. Similar assessment of cycle length variability was performed based on the detection of the point of most rapid change in potential with a negative slope in excess of -0.5 mV/ms in each individual electrogram to test the accuracy of the results obtained with the WT parameter. The WT parameter correctly identified 97% MVT and 83.3% PVT segments, for an overall accuracy of 92.8%. Beat-by-beat epicardial maps of MVT displayed a cluster of sites of initial activation close to the reperfusion area, while the sites of breakthrough from beats during PVT were much more dispersed over both ventricles. A strong and significant correlation was found between the number of electrodes with the earliest epicardial activation and the WT parameter (r = .78, P < .0001). To test the accuracy of the results obtained, a comparison was performed between the WT parameter (0.082 +/- 0.007) and the cycle length variability, estimated as the normalized standard deviation of the intervals between individual electrograms (0.076 +/- 0.006). No significant differences were shown (P = .0022), and a strong linear correlation was found between both measurements (Pearson correlation coefficient, .966). It is concluded that WT analysis discriminated accurately between MVT and PVT, and a quantitative relation was found with the spatial dispersion of sites of earliest epicardial activation. The WT results strongly correlated with those obtained by another method of estimating cycle length variability. Methodologically, the strength of the WT lies in the complementary information that could be extracted from the processing of electrograms to enhance the detection/discrimination of different types of arrhythmias.

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