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Objectives This study evaluated heart failure (HF) patients who underwent cardiac resynchronization therapy (CRT) and who had device-documented sleep-disordered breathing (SDB). We found gender differences in acute changes in SDB due to CRT impact. Background SDB typically occurs in HF patients. However, the role of SDB and its response to CRT in HF patients, as well as the relation with gender are currently not fully researched. Methods Among 63 consecutive patients who received CRT with an SDB algorithm, 23 patients documented SDB at one-month cardiac device interrogation and represented our population. We defined a Sleep apnoea Severity SCore(SSSC), and consequently, patients were categorized to have mild, moderate, and severe sleep apnoea syndrome divided into two groups: Group-1: 18 males (78%); Group-2: 5 females (22%). We evaluated the variation of apnoea burden and CRT response based on gender differences. Results A significantly higher proportion of patients in the male group were non-responders to CRT at 12-months follow-up (p = 0.076) while in the female population 5/5 patients (100%) were responders to CRT at the same follow-up time (p = 0.021). Among Group-2 subjects, we documented a significant linear decrease in SSSC(p > 0,01) while in Group-1 the CRT effect on SSSC was variable. At 12-months follow-up, the difference in SSSC between the two groups was statistically significant (p Conclusions Our study reports a correlation between CRT response and sleep apnoea burden considering gender differences. In particular, HF-women responders to CRT demonstrate a significant linear decrease in sleep apnoea burden determined through a device algorithm, when compared to a similar male population. Further research is needed to confirm these findings.

Background Fluoroscopic guidance is the standard tool used in device implantation. This means that both the patient and the operator are exposed to radiation, which may sometimes be high. The possibility of single-lead permanent pacemaker implantation without fluoroscopy has already been demonstrated. Objective The aim of our study was to investigate the feasibility and reliability of biventricular device implantation guided only by an electroanatomic navigation system. Methods Sixty-one patients with heart failure underwent implantation of a cardiac resynchronization therapy (CRT) device with or without defibrillator (CRT-D; CRT-P). The procedure was performed with or without fluoroscopy guidance (Rx+; Rx0). In the latter case, the EnSite Velocity system was used; this system is able to reconstruct the anatomy and activation of the cardiac chambers by simultaneously collecting a "cloud" of anatomical points from multiple electrodes. Results Lead positioning was achieved in 24 of 26 patients undergoing CRT implantation without fluoroscopy (92% success). No complications were observed during the procedure and no catheter dislodgment occurred the day after the implantation or during 1-month follow-up. Procedure time progressively decreased from 136 minutes in the first case to 59 minutes in the last one, suggesting that operators gradually gained confidence while using the new technique. Conclusion Our study demonstrates the feasibility, efficacy, and safety of lead positioning guided only by the nonfluoroscopic EnSite Velocity mapping system without the use of fluoroscopy in CRT-P or CRT-D implantation. The benefits in terms of significantly reduced fluoroscopy exposure are associated with technical and clinical advantages.

The Poietic Generator and Open Studio are examples of interactive art, a form of art intended for the viewer's direct participation. They are based on distributed applications for visual interaction enabling to collaborate on the creation of visual images and narratives. This paper reports the analysis of the visual activity generated by their users. Such an analysis is founded on the phenomenological hypothesis that the visual activity generated by the participants in the Poietic Generator and Open Studio allows the study of the interaction process in terms of a co-determining relationship between perception and action . The results of this analysis indicate five classes of mediators capable of tuning the development of the interaction process according to the context and emotional state of the participants. These classes are based on: (1) spatial relationships, (2) chromatic relationships, (3) figurative elements, (4) textual elements, and (5) temporal events. By sustaining the intersubjective processing of information among participants, mediators sustain their socially intelligent ability of constructing and sharing meaningful activities; that is, they sustain co-creation . For this reason, mediators are particularly important in the design of social interactive systems that have purposes but not explicit goals (as in the case of art and creative activities in general).

The power of the unaided individual mind is highly overrated. Although society often thinks of creative individuals as working in isolation, intelligence and creativity result in large part from interaction and collaboration with other individuals. Much human creativity is social, arising from activities that take place in a context in which interaction with other people and the artifacts that embody collective knowledge are essential contributors.This paper examines: (1) how individual and social creativity can be integrated by means of proper collaboration models and tools supporting distributed cognition; (2) how the creation of shareable externalizations ("boundary objects") and the adoption of evolutionary process models in the construction of meta-design environments can enhance creativity and support spontaneous design activities ("unselfconscious cultures of design"); and (3) how a new design competence is emerging one that requires passage from individual creative actions to synergetic activities, from the reflective practitioner to reflective communities and from given tasks to personally meaningful activities. The paper offers examples in the context of collaborative design and art practice, including urban planning, interactive art and open source. In the effort to draw a viable path "beyond binary choices", the paper points out some major challenges for the next generation of socio-technical environments to further increase the integration of individual and social creativity.

SESSION 50: DEVICES XVI: Cardiac Resynchronization Therapy and Biomarkers Saturday, May 7, 2005 8:45 a.m.–10:15 a.m.