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102. Model Driven Mutation Applied to Adaptative Systems Testing

Author

Bartel, Alexandre, Baudry, Benoit, Munoz, Freddy, Klein, Jacques, Mouelhi, Tejeddine, Le Traon, Yves, Bartel, Alexandre, Baudry, Benoit, Munoz, Freddy, Klein, Jacques, Mouelhi, Tejeddine, and Le Traon, Yves

Abstract

Dynamically Adaptive Systems modify their behavior and structure in response to changes in their surrounding environment and according to an adaptation logic. Critical systems increasingly incorporate dynamic adaptation capabilities, examples include disaster relief and space exploration systems. In this paper, we focus on mutation testing of the adaptation logic. We propose a fault model for adaptation logics that classifies faults into environmental completeness and adaptation correctness. Since there are several adaptation logic languages relying on the same underlying concepts, the fault model is expressed independently from specific adaptation languages. Taking benefit from model-driven engineering technology, we express these common concepts in a metamodel and define the operational semantics of mutation operators at this level. Mutation is applied on model elements and model transformations are used to propagate these changes to a given adaptation policy in the chosen formalism. Preliminary results on an adaptive web server highlight the difficulty of killing mutants for adaptive systems, and thus the difficulty of generating efficient tests.

Published
2011
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113. Anticoagulant selection in relation to the SAMe-TT2R2score in patients with atrial fibrillation: The GLORIA-AF registry

Author

Ntaios, George, Huisman, Menno V., Diener, Hans-Christoph, Halperin, Jonathan L., Teutsch, Christine, Marler, Sabrina, Gurusamy, Venkatesh K., Thompson, Milla, Lip, Gregory Y.H., Olshansky, Brian, Abban, Dzifa Wosornu, Abdul, Nasser, Abud, Atilio Marcelo, Adams, Fran, Addala, Srinivas, Adragão, Pedro, Ageno, Walter, Aggarwal, Rajesh, Agosti, Sergio, Agostoni, Piergiuseppe, Aguilar, Francisco, Linares, Julio Aguilar, Aguinaga, Luis, Ahmed, Jameel, Aiello, Allessandro, Ainsworth, Paul, Aiub, Jorge Roberto, Al-Dallow, Raed, Alderson, Lisa, Aldrete Velasco, Jorge Antonio, Alexopoulos, Dimitrios, Manterola, Fernando Alfonso, Aliyar, Pareed, Alonso, David, Alves da Costa, Fernando Augusto, Amado, José, Amara, Walid, Amelot, Mathieu, Amjadi, Nima, Ammirati, Fabrizio, Andrade, Marianna, Andrawis, Nabil, Annoni, Giorgio, Ansalone, Gerardo, Ariani, M.Kevin, Arias, Juan Carlos, Armero, Sébastien, Arora, Chander, Aslam, Muhammad Shakil, Asselman, M., Audouin, Philippe, Augenbraun, Charles, Aydin, S., Ayryanova, Ivaneta, Aziz, Emad, Backes, Luciano Marcelo, Badings, E., Bagni, Ermentina, Baker, Seth H., Bala, Richard, Baldi, Antonio, Bando, Shigenobu, Banerjee, Subhash, Bank, Alan, Esquivias, Gonzalo Barón, Barr, Craig, Bartlett, Maria, Kes, Vanja Basic, Baula, Giovanni, Behrens, Steffen, Bell, Alan, Benedetti, Raffaella, Mazuecos, Juan Benezet, Benhalima, Bouziane, Bergler-Klein, Jutta, Berneau, Jean-Baptiste, Bernstein, Richard A., Berrospi, Percy, Berti, Sergio, Berz, Andrea, Best, Elizabeth, Bettencourt, Paulo, Betzu, Robert, Bhagwat, Ravi, Bhatta, Luna, Biscione, Francesco, BISIGNANI, Giovanni, Black, Toby, Bloch, Michael J., Bloom, Stephen, Blumberg, Edwin, Bo, Mario, Bøhmer, Ellen, Bollmann, Andreas, Bongiorni, Maria Grazia, Boriani, Giuseppe, Boswijk, D.J., Bott, Jochen, Bottacchi, Edo, Kalan, Marica Bracic, Bradman, Drew, Brautigam, Donald, Breton, Nicolas, Brouwers, P.J.A.M., Browne, Kevin, Cortada, Jordi Bruguera, Bruni, A., Brunschwig, Claude, Buathier, Hervé, Buhl, Aurélie, Bullinga, John, Cabrera, Jose Walter, Caccavo, Alberto, Cai, Shanglang, Caine, Sarah, Calò, Leonardo, Calvi, Valeria, Sánchez, Mauricio Camarillo, Candeias, Rui, Capuano, Vincenzo, Capucci, Alessandro, Caputo, Ronald, Rizo, Tatiana Cárdenas, Cardona, Francisco, Carlos da Costa Darrieux, Francisco, Duarte Vera, Yan Carlos, Carolei, Antonio, Carreño, Susana, Carvalho, Paula, Cary, Susanna, Casu, Gavino, Cavallini, Claudio, Cayla, Guillaume, Celentano, Aldo, Cha, Tae-Joon, Cha, Kwang Soo, Chae, Jei Keon, Chalamidas, Kathrine, Challappa, Krishnan, Chand, Sunil Prakash, Chandrashekar, Harinath, Chartier, Ludovic, Chatterjee, Kausik, Chavez Ayala, Carlos Antero, Cheema, Aamir, Cheema, Amjad, Chen, Lin, Chen, Shih-Ann, Chen, Jyh Hong, Chiang, Fu-Tien, Chiarella, Francesco, Chih-Chan, Lin, Cho, Yong Keun, Choi, Jong-Il, Choi, Dong Ju, Chouinard, Guy, Hoi-Fan Chow, Danny, Chrysos, Dimitrios, Chumakova, Galina, José Roberto Chuquiure Valenzuela, Eduardo Julián, Nica, Nicoleta Cindea, Cislowski, David J., Clay, Anthony, Clifford, Piers, Cohen, Andrew, Cohen, Michael, Cohen, Serge, Colivicchi, Furio, Collins, Ronan, Colonna, Paolo, Compton, Steve, Connolly, Derek, Conti, Alberto, Buenostro, Gabriel Contreras, Coodley, Gregg, Cooper, Martin, Coronel, Julian, Corso, Giovanni, Sales, Juan Cosín, Cottin, Yves, Covalesky, John, Cracan, Aurel, Crea, Filippo, Crean, Peter, Crenshaw, James, Cullen, Tina, Darius, Harald, Dary, Patrick, Dascotte, Olivier, Dauber, Ira, Davalos, Vicente, Davies, Ruth, Davis, Gershan, Davy, Jean-Marc, Dayer, Mark, De Biasio, Marzia, De Bonis, Silvana, De Caterina, Raffaele, De Franceschi, Teresiano, de Groot, J.R., De Horta, José, De La Briolle, Axel, Topete, Gilberto de la Pena, Vicenzo de Paola, Angelo Amato, de Souza, Weimar, de Veer, A., De Wolf, Luc, Decoulx, Eric, Deepak, Sasalu, Defaye, Pascal, Del-Carpio Munoz, Freddy, Brkljacic, Diana Delic, Deumite, N. Joseph, Di Legge, Silvia, Diemberger, Igor, Dietz, Denise, Dionísio, Pedro, Dong, Qiang, Rossi dos Santos, Fabio, Dotcheva, Elena, Doukky, Rami, D'Souza, Anthony, Dubrey, Simon, Ducrocq, Xavier, Dupljakov, Dmitry, Duque, Mauricio, Dutta, Dipankar, Duvilla, Nathalie, Duygun, A., Dziewas, Rainer, Eaton, Charles B., Eaves, William, Ebels-Tuinbeek, L.A., Ehrlich, Clifford, Eichinger-Hasenauer, Sabine, Eisenberg, Steven J., El Jabali, Adnan, El Shahawy, Mahfouz, Hernandes, Mauro Esteves, Izal, Ana Etxeberria, Evonich, Rudolph, Evseeva, Oksana, Ezhov, Andrey, Fahmy, Raed, Fang, Quan, Farsad, Ramin, Fauchier, Laurent, Favale, Stefano, Fayard, Maxime, Fedele, Jose Luis, Fedele, Francesco, Fedorishina, Olga, Fera, Steven R., Gomes Ferreira, Luis Gustavo, Ferreira, Jorge, Ferri, Claudio, Ferrier, Anna, Ferro, Hugo, Finsen, Alexandra, First, Brian, Fischer, Stuart, Fonseca, Catarina, Almeida, Luísa Fonseca, Forman, Steven, Frandsen, Brad, French, William, Friedman, Keith, Friese, Athena, Fruntelata, Ana Gabriela, Fujii, Shigeru, Fumagalli, Stefano, Fundamenski, Marta, Furukawa, Yutaka, Gabelmann, Matthias, Gabra, Nashwa, Gadsbøll, Niels, Galinier, Michel, Gammelgaard, Anders, Ganeshkumar, Priya, Gans, Christopher, Quintana, Antonio Garcia, Gartenlaub, Olivier, Gaspardone, Achille, Genz, Conrad, Georger, Frédéric, Georges, Jean-Louis, Georgeson, Steven, Giedrimas, Evaldas, Gierba, Mariusz, Ortega, Ignacio Gil, Gillespie, Eve, Giniger, Alberto, Giudici, Michael C., Gkotsis, Alexandros, Glotzer, Taya V., Gmehling, Joachim, Gniot, Jacek, Goethals, Peter, Goldbarg, Seth, Goldberg, Ronald, Goldmann, Britta, Golitsyn, Sergey, Gómez, Silvia, Mesa, Juan Gomez, Gonzalez, Vicente Bertomeu, Gonzalez Hermosillo, Jesus Antonio, González López, Víctor Manuel, Gorka, Hervé, Gornick, Charles, Gorog, Diana, Gottipaty, Venkat, Goube, Pascal, Goudevenos, Ioannis, Graham, Brett, Greer, G. Stephen, Gremmler, Uwe, Grena, Paul G., Grond, Martin, Gronda, Edoardo, Grönefeld, Gerian, Gu, Xiang, Torres Torres, Ivett Guadalupe, Guardigli, Gabriele, Guevara, Carolina, Guignier, Alexandre, Gulizia, Michele, Gumbley, Michael, Günther, Albrecht, Ha, Andrew, Hahalis, Georgios, Hakas, Joseph, Hall, Christian, Han, Bing, Han, Seongwook, Hargrove, Joe, Hargroves, David, Harris, Kenneth B., Haruna, Tetsuya, Hayek, Emil, Healey, Jeff, Hearne, Steven, Heffernan, Michael, Heggelund, Geir, Heijmeriks, J.A., Hemels, Maarten, Hendriks, I., Henein, Sam, Her, Sung-Ho, Hermany, Paul, Hernández Del Río, Jorge Eduardo, Higashino, Yorihiko, Hill, Michael, Hisadome, Tetsuo, Hishida, Eiji, Hoffer, Etienne, Hoghton, Matthew, Hong, Kui, Hong, Suk keun, Horbach, Stevie, Horiuchi, Masataka, Hou, Yinglong, Hsing, Jeff, Huang, Chi-Hung, Huckins, David, Hughes, kathy, Huizinga, A., Hulsman, E.L., Hung, Kuo-Chun, Hwang, Gyo-Seung, Ikpoh, Margaret, Imberti, Davide, Ince, Hüseyin, Indolfi, Ciro, Inoue, Shujiro, Irles, Didier, Iseki, Harukazu, Israel, C. Noah, Iteld, Bruce, Iyer, Venkat, Jackson-Voyzey, Ewart, Jaffrani, Naseem, Jäger, Frank, James, Martin, Jang, Sung-Won, Jaramillo, Nicolas, Jarmukli, Nabil, Jeanfreau, Robert J., Jenkins, Ronald D., Sánchez, Carlos Jerjes, Jimenez, Javier, Jobe, Robert, Joen-Jakobsen, Tomas, Jones, Nicholas, Moura Jorge, Jose Carlos, Jouve, Bernard, Jung, Byung Chun, Jung, Kyung Tae, Jung, Werner, Kachkovskiy, Mikhail, Kafkala, Krystallenia, Kalinina, Larisa, Kallmünzer, Bernd, Kamali, Farzan, Kamo, Takehiro, Kampus, Priit, Kashou, Hisham, Kastrup, Andreas, Katsivas, Apostolos, Kaufman, Elizabeth, Kawai, Kazuya, Kawajiri, Kenji, Kazmierski, John F., Keeling, P., Kerr Saraiva, José Francisco, Ketova, Galina, Khaira, AJIT Singh, Khripun, Aleksey, Kim, Doo-Il, Kim, Young Hoon, Kim, Nam Ho, Kim, Dae Kyeong, Kim, Jeong Su, Kim, June Soo, Kim, Ki Seok, Kim, Jin bae, Kinova, Elena, Klein, Alexander, Kmetzo, James J., Kneller, G. Larsen, Knezevic, Aleksandar, Angela Koh, Su Mei, Koide, Shunichi, Kollias, Athanasios, Kooistra, J.A., Koons, Jay, Koschutnik, Martin, Kostis, William J., Kovacic, Dragan, Kowalczyk, Jacek, Koziolova, Natalya, Kraft, Peter, Kragten, Johannes A., Krantz, Mori, Krause, Lars, Krenning, B.J., Krikke, F., Kromhout, Z., Krysiak, Waldemar, Kumar, Priya, Kümler, Thomas, Kuniss, Malte, Kuo, Jen-Yuan, Küppers, Achim, Kurrelmeyer, Karla, Kwak, Choong Hwan, Laboulle, Bénédicte, Labovitz, Arthur, Lai, Wen Ter, Lam, Andy, Lam, Yat Yin, Zanetti, Fernando Lanas, Landau, Charles, Landini, Giancarlo, Figueiredo, Estêvão Lanna, Larsen, Torben, Lavandier, Karine, LeBlanc, Jessica, Lee, Moon Hyoung, Lee, Chang-Hoon, Lehman, John, Leitão, Ana, Lellouche, Nicolas, Lelonek, Malgorzata, Lenarczyk, Radoslaw, Lenderink, T., González, Salvador León, Leong-Sit, Peter, Leschke, Matthias, Ley, Nicolas, Li, Zhanquan, Li, Xiaodong, Li, Weihua, Li, Xiaoming, Lichy, Christhoh, Lieber, Ira, Limon Rodriguez, Ramon Horacio, Lin, Hailong, Lip, Gregory Y.H., Liu, Feng, Liu, Hengliang, Esperon, Guillermo Llamas, Navarro, Nassip Llerena, Lo, Eric, Lokshyn, Sergiy, López, Amador, López-Sendón, José Luís, Lorga Filho, Adalberto Menezes, Lorraine, Richard S., Luengas, Carlos Alberto, Luke, Robert, Luo, Ming, Lupovitch, Steven, Lyrer, Philippe, Ma, Changsheng, Ma, Genshan, Madariaga, Irene, Maeno, Koji, Magnin, Dominique, Maid, Gustavo, Mainigi, Sumeet K., Makaritsis, Konstantinos, Malhotra, Rohit, Manning, Rickey, Manolis, Athanasios, Manrique Hurtado, Helard Andres, Mantas, Ioannis, Jattin, Fernando Manzur, Maqueda, Vicky, Marchionni, Niccolo, Ortuno, Francisco Marin, Santana, Antonio Martín, Martinez, Jorge, Maskova, Petra, Hernandez, Norberto Matadamas, Matsuda, Katsuhiro, Maurer, Tillmann, Mauro, Ciro, May, Erik, Mayer, Nolan, McClure, John, McCormack, Terry, McGarity, William, McIntyre, Hugh, McLaurin, Brent, Medina Palomino, Feliz Alvaro, Melandri, Francesco, Meno, Hiroshi, Menzies, Dhananjai, Mercader, Marco, Meyer, Christian, Meyer, Beat j., Miarka, Jacek, Mibach, Frank, Michalski, Dominik, Michel, Patrik, Chreih, Rami Mihail, Mikdadi, Ghiath, Mikus, Milan, Milicic, Davor, Militaru, Constantin, Minaie, Sedi, Minescu, Bogdan, Mintale, Iveta, Mirault, Tristan, Mirro, Michael J., Mistry, Dinesh, Miu, Nicoleta Violeta, Miyamoto, Naomasa, Moccetti, Tiziano, Mohammed, Akber, Nor, Azlisham Mohd, Mollerus, Michael, Molon, Giulio, Mondillo, Sergio, Moniz, Patrícia, Mont, Lluis, Montagud, Vicente, Montaña, Oscar, Monti, Cristina, Moretti, Luciano, Mori, Kiyoo, Moriarty, Andrew, Morka, Jacek, Moschini, Luigi, Moschos, Nikitas, Mügge, Andreas, Mulhearn, Thomas J., Muresan, Carmen, Muriago, Michela, Musial, Wlodzimierz, Musser, Carl W., Musumeci, Francesco, Nageh, Thuraia, Nakagawa, Hidemitsu, Nakamura, Yuichiro, Nakayama, Toru, Nam, Gi-Byoung, Nanna, Michele, Natarajan, Indira, Nayak, Hemal M., Naydenov, Stefan, Nazli, Jurica, Nechita, Alexandru Cristian, Nechvatal, Libor, Negron, Sandra Adela, Neiman, James, Neuenschwander, Fernando Carvalho, Neves, David, Neykova, Anna, Miguel, Ricardo Nicolás, Nijmeh, George, Nizov, Alexey, Campos, Rodrigo Noronha, Nossan, Janko, Novikova, Tatiana, Nowalany-Kozielska, Ewa, Nsah, Emmanuel, Nunez Fragoso, Juan Carlos, Nurgalieva, Svetlana, Nuyens, Dieter, Nyvad, Ole, Odin de Los Rios Ibarra, Manuel, O'Donnell, Philip, O'Donnell, Martin, Oh, Seil, Oh, Yong Seog, Oh, Dongjin, O'Hara, Gilles, Oikonomou, Kostas, Olivares, Claudia, Oliver, Richard, Ruiz, Rafael Olvera, Olympios, Christoforos, omaszuk-Kazberuk, Anna, Asensi, Joaquín Osca, jose, eena Padayattil, Padilla Padilla, Francisco Gerardo, Rios, Victoria Padilla, Pajes, Giuseppe, Pandey, A. Shekhar, Paparella, Gaetano, Paris, F., Park, Hyung Wook, Park, Jong Sung, Parthenakis, Fragkiskos, Passamonti, Enrico, Patel, Rajesh J., Patel, Jaydutt, Patel, Mehool, Patrick, Janice, Jimenez, Ricardo Pavón, Paz, Analía, Pengo, Vittorio, Pentz, William, Pérez, Beatriz, Pérez Ríos, Alma Minerva, Pérez-Cabezas, Alejandro, Perlman, Richard, Persic, Viktor, Perticone, Francesco, Peters, Terri K., Petkar, Sanjiv, Pezo, Luis Felipe, Pflücke, Christian, Pham, David N., Phillips, Roland T., Phlaum, Stephen, Pieters, Denis, Pineau, Julien, Pinter, Arnold, Pinto, Fausto, Pisters, R., Pivac, Nediljko, Pocanic, Darko, Podoleanu, Cristian, Politano, Alessandro, Poljakovic, Zdravka, Pollock, Stewart, Garcéa, Jose Polo, Poppert, Holger, Porcu, Maurizio, Reino, Antonio Pose, Prasad, Neeraj, Précoma, Dalton Bertolim, Prelle, Alessandro, Prodafikas, John, Protasov, Konstantin, Pye, Maurice, Qiu, Zhaohui, Quedillac, Jean-Michel, Raev, Dimitar, Raffo Grado, Carlos Antonio, Rahimi, Sidiqullah, Raisaro, Arturo, Rama, Bhola, Ramos, Ricardo, Ranieri, Maria, Raposo, Nuno, Rashba, Eric, Rauch-Kroehnert, Ursula, Reddy, Ramakota, Renda, Giulia, Reza, Shabbir, Ria, Luigi, Richter, Dimitrios, Rickli, Hans, Rieker, Werner, Vera, Tomas Ripolil, Ritt, Luiz Eduardo, Roberts, Douglas, Briones, Ignacio Rodriguez, Rodriguez Escudero, Aldo Edwin, Pascual, Carlos Rodríguez, Roman, Mark, Romeo, Francesco, Ronner, E., Roux, Jean-Francois, Rozkova, Nadezda, Rubacek, Miroslav, Rubalcava, Frank, Russo, Andrea M., Rutgers, Matthieu Pierre, Rybak, Karin, Said, Samir, Sakamoto, Tamotsu, Salacata, Abraham, Salem, Adrien, Bodes, Rafael Salguero, Saltzman, Marco A., Salvioni, Alessandro, Vallejo, Gregorio Sanchez, Fernández, Marcelo Sanmartín, Saporito, Wladmir Faustino, Sarikonda, Kesari, Sasaoka, Taishi, Sati, Hamdi, Savelieva, Irina, Scala, Pierre-Jean, Schellinger, Peter, Scherr, Carlos, Schmitz, Lisa, Schmitz, Karl-Heinz, Schmitz, Bettina, Schnabel, Teresa, Schnupp, Steffen, Schoeniger, Peter, Schön, Norbert, Schwimmbeck, Peter, Seamark, Clare, Searles, Greg, Seidl, Karl-Heinz, Seidman, Barry, Sek, Jaroslaw, Sekaran, Lakshmanan, SERRATI, Carlo, Shah, Neerav, Shah, Vinay, Shah, Anil, Shah, Shujahat, Sharma, Vijay Kumar, Shaw, Louise, Sheikh, Khalid H., Shimizu, Naruhito, Shimomura, Hideki, Shin, Dong-Gu, Shin, Eun-Seok, Shite, Junya, Sibilio, Gerolamo, Silver, Frank, Sime, Iveta, Simmers, Tim A., Singh, Narendra, Siostrzonek, Peter, Smadja, Didier, Smith, David W., Snitman, Marcelo, Filho, Dario Sobral, Soda, Hassan, Sofley, Carl, Sokal, Adam, Oi Yan, Yannie Soo, Sotolongo, Rodolfo, Ferreira de Souza, Olga, Sparby, Jon Arne, Spinar, Jindrich, Sprigings, David, Spyropoulos, Alex C., Stakos, Dimitrios, Steinwender, Clemens, Stergiou, Georgios, Stiell, Ian, Stoddard, Marcus, Stoikov, Anastas, Streb, Witold, Styliadis, Ioannis, Su, Guohai, Su, Xi, Sudnik, Wanda, Sukles, Kai, Sun, Xiaofei, Swart, H., Szavits-Nossan, Janko, Taggeselle, Jens, Takagi, Yuichiro, Singh Takhar, Amrit Pal, Tamm, Angelika, Tanaka, Katsumi, Tanawuttiwat, Tanyanan, Tang, Sherman, Tang, Aylmer, Tarsi, Giovanni, Tassinari, Tiziana, Tayal, Ashis, Tayebjee, Muzahir, Berg, J.M. ten, Tesloianu, Dan, The, Salem H.K., Thomas, Dierk, Timsit, Serge, Tobaru, Tetsuya, Tomasik, Andrzej R., Torosoff, Mikhail, Touze, Emmanuel, Trendafilova, Elina, Tsai, W. Kevin, Tse, Hung Fat, Tsutsui, Hiroshi, Tu, Tian Ming, Tuininga, Ype, Turakhia, Minang, Turk, Samir, Tcurner, Wayne, Tveit, Arnljot, Tytus, Richard, Valadão, C., van Bergen, P.F.M.M., van de Borne, Philippe, van den Berg, B.J., van der Zwaan, C., Van Eck, M., Vanacker, Peter, Vasilev, Dimo, Vasilikos, Vasileios, Vasilyev, Maxim, Veerareddy, Srikar, Miño, Mario Vega, Venkataraman, Asok, Verdecchia, Paolo, Versaci, Francesco, Vester, Ernst Günter, Vial, Hubert, Victory, Jason, Villamil, Alejandro, Vincent, Marc, Vlastaris, Anthony, Dahl, Jürgen vom, Vora, Kishor, Vranian, Robert B., Wakefield, Paul, Wang, Ningfu, Wang, Mingsheng, Wang, Xinhua, Wang, Feng, Wang, Tian, Warner, Alberta L., Watanabe, Kouki, Wei, Jeanne, Weimar, Christian, Weiner, Stanislav, Weinrich, Renate, Wen, Ming-Shien, Wiemer, Marcus, Wiggers, Preben, Wilke, Andreas, Williams, David, Williams, Marcus L., Witzenbichler, Bernhard, Wong, Brian, Lawrence Wong, Ka Sing, Wozakowska-Kaplon, Beata, Wu, Shulin, Wu, Richard C., Wunderlich, Silke, Wyatt, Nell, Wylie, John (Jack), Xu, Yong, Xu, Xiangdong, Yamanoue, Hiroki, Yamashita, Takeshi, Bryan Yan, Ping Yen, Yang, Tianlun, Yao, Jing, Yeh, Kuo-Ho, Yin, Wei Hsian, Yotov, Yoto, Zahn, Ralf, Zarich, Stuart, Zenin, Sergei, Zeuthen, Elisabeth Louise, Zhang, Huanyi, Zhang, Donghui, Zhang, Xingwei, Zhang, Ping, Zhang, Jun, Zhao, Shui Ping, Zhao, Yujie, Zhao, Zhichen, Zheng, Yang, Zhou, Jing, Zimmermann, Sergio, Zini, Andrea, Zizzo, Steven, Zong, Wenxia, and Zukerman, L Steven

Abstract

The SAMe-TT2R2score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2scores >2 than to patients with lower scores.

Published
2021
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114. ST-Segment Elevation Myocardial Infarction and Normal Coronary Arteries after Consuming Energy Drinks

Author

Michael Gharacholou, S., Ijioma, Nkechinyere, Banwart, Emma, and Del Carpio Munoz, Freddy

Abstract

The use of energy drinks, which often contain stimulants, is common among young persons, yet there have been few reports of adverse cardiac events. We report the case of a 27-year-old man who was admitted to our facility with an acute ST-segment elevation myocardial infarction in the setting of using energy drinks. Angiography revealed no obstructive coronary disease. The patient had elevation of cardiac troponin. Noninvasive testing with echocardiography and cardiac magnetic resonance imaging demonstrated both abnormalities in resting wall motion at the anterior apex along with late gadolinium enhancement of the anterior wall, respectively. The patient also underwent formal invasive evaluation with an intracoronary Doppler study demonstrating normal coronary flow reserve and acetylcholine provocation that excluded endothelial dysfunction and microvascular disease. The patient recovered and has abstained from consuming additional energy drinks with no reoccurrence of symptoms. A review of some of the potential cardiac risks associated with consuming energy drinks is presented.

Published
2017
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115. Outcomes of atrial fibrillation ablation in community hospitals with and without onsite cardiothoracic surgery availability.

Author

Ola O, Gharacholou SM, Deshmukh AJ, Valverde AM, Scott CG, Lee AT, and Del-Carpio Munoz F

Abstract

Background: Limited data exist on outcomes of atrial fibrillation (AF) catheter ablation based on hospital setting and, specifically, the availability of onsite cardiothoracic surgery (CTS). We aimed to describe the characteristics and outcomes of catheter ablation for AF performed at a facility with and without CTS., Methods: This was a retrospective study of consecutive patients who underwent catheter ablation for AF at hospital with (CTS) and without cardiothoracic surgery (N-CTS) from January 2011 through December 2019. Clinical and procedural characteristics, complications, and 1-year outcomes, including clinical events and AF recurrence, were collected., Results: There were 326 unique patients who underwent an index AF ablation procedure: 206 CTS patients and 120 N-CTS patients. There were no differences in overall cardiac complications (2.5% vs. 5.8%), including mapping catheter entrapment requiring open-heart surgery (0% vs. 0.5%), pericardial effusion requiring pericardiocentesis (0.8% vs. 0.5%), hemopericardium (1.7% vs. 0.5%), acute myocardial infarction (0% vs. 1.0%), and sinus node injury (0% versus 0.5%) (all P values > .05) between N-CTS and CTS patients. Likewise, overall noncardiac complications (20.7% vs. 19.8%, P = .85), including bleeding, cerebrovascular accident, and phrenic or vagus nerve injury, were similar between N-CTS and CTS hospitals. Also, 1-year cumulative Kaplan-Meier estimates of overall AF recurrence (11.6% vs. 16.4%; log-rank P = 0.21; HR 1.47; 95% CI, 0.79-2.74) were not statistically significant between N-CTS and CTS hospitals., Conclusion: Catheter ablation procedure is safe and effective regardless of onsite CTS presence, and there were no significant differences between the two hospital settings., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Published
2024
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116. Left bundle branch pacing vs ventricular septal pacing for cardiac resynchronization therapy.

Author

Chen J, Ezzeddine FM, Liu X, Vaidya V, McLeod CJ, Valverde AM, Del-Carpio Munoz F, Deshmukh AJ, Madhavan M, Killu AM, Mulpuru SK, Friedman PA, and Cha YM

Abstract

Background: The outcomes of left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) in patients with heart failure remain to be learned., Objective: The objective of this study was to assess the echocardiographic and clinical outcomes of LBBP, LVSP, and deep septal pacing (DSP)., Methods: This retrospective study included patients who met the criteria for cardiac resynchronization therapy (CRT) and underwent attempted LBBP in 5 Mayo centers. Clinical, electrocardiographic, and echocardiographic data were collected at baseline and follow-up., Results: A total of 91 consecutive patients were included in the study. A total of 52 patients had LBBP, 25 had LVSP, and 14 had DSP. The median follow-up duration was 307 (interquartile range 208, 508) days. There was significant left ventricular ejection fraction (LVEF) improvement in the LBBP and LVSP groups (from 35.9 ± 8.5% to 46.9 ± 10.0%, P < .001 in the LBBP group; from 33.1 ± 7.5% to 41.8 ± 10.8%, P < .001 in the LVSP group) but not in the DSP group. A unipolar paced right bundle branch block morphology during the procedure in lead V1 was associated with higher odds of CRT response. There was no significant difference in heart failure hospitalization and all-cause deaths between the LBBP and LVSP groups. The rate of heart failure hospitalization and all-cause deaths were increased in the DSP group compared with the LBBP group (hazard ratio 5.10, 95% confidence interval 1.14-22.78, P = .033; and hazard ratio 7.83, 95% confidence interval 1.38-44.32, P = .020, respectively)., Conclusion: In patients undergoing CRT, LVSP had comparable CRT outcomes compared with LBBP., (© 2024 Heart Rhythm Society. Published by Elsevier Inc.)

Published
2024
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117. Using artificial intelligence-enabled electrocardiogram to predict cardiac resynchronization therapy outcomes of left bundle branch area pacing.

Author

Chen J, Ezzeddine FM, Liu X, Del-Carpio Munoz F, Friedman P, and Cha YM

Subjects
Humans, Artificial Intelligence, Heart Conduction System, Bundle of His, Electrocardiography, Treatment Outcome, Cardiac Pacing, Artificial, Ventricular Function, Left, Cardiac Resynchronization Therapy, Heart Failure diagnosis, Heart Failure therapy
Abstract

Competing Interests: Conflict of interest: none declared.

Published
2023
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122. Characterization of ventricular arrhythmias and sudden cardiac death in subjects with mitral valve prolapse and mitral annular disjunction.

Author

Raina A, Gersh BJ, Asirvatham SJ, and Del-Carpio Munoz F

Subjects
Humans, Mitral Valve, Arrhythmias, Cardiac, Death, Sudden, Cardiac epidemiology, Death, Sudden, Cardiac etiology, Death, Sudden, Cardiac prevention & control, Mitral Valve Prolapse complications, Mitral Valve Prolapse diagnosis, Heart Valve Diseases complications
Abstract

Sudden cardiac death is reported as the leading cause of mortality in developed nations. Arrhythmic mitral valve disease, encompassing mitral valve prolapse and/or mitral annular disjunction, is thought to be responsible in a sizable portion of these deaths. Despite this evidence, there are no reliable methods or clinically useful risk stratification schemes to determine which group of patients are at higher risk or may benefit from interventions such as catheter ablation or prophylactic implantation of a defibrillator. The reasons for this lack of guidance include our incomplete understanding of the mechanisms of ventricular arrhythmias and the fact that mitral valve prolapse and disjunction are frequently diagnosed, yet carry an overall low risk of sudden cardiac death. This heterogeneity makes the development of a reliable prediction model based on the presence of common risk factors very difficult. In this review, we summarize the relevant literature regarding the epidemiology, diagnosis, pathophysiology, and management of mitral valve prolapse and mitral annular disjunction and elucidate their role in sudden cardiac death., (Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Published
2023
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123. Cardiac ablation with pulsed electric fields: principles and biophysics.

Author

Sugrue A, Maor E, Del-Carpio Munoz F, Killu AM, and Asirvatham SJ

Subjects
Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac surgery, Biophysics, Humans, Catheter Ablation adverse effects, Catheter Ablation methods
Abstract

Pulsed electric fields (PEFs) have emerged as an ideal cardiac ablation modality. At present numerous clinical trials in humans are exploring PEF as an ablation strategy for both atrial and ventricular arrhythmias, with early data showing significant promise. As this is a relatively new technology there is limited understanding of its principles and biophysics. Importantly, PEF biophysics and principles are starkly different to current energy modalities (radiofrequency and cryoballoon). Given the relatively novel nature of PEFs, this review aims to provide an understanding of the principles and biophysics of PEF ablation. The goal is to enhance academic research and ultimately enable optimization of ablation parameters to maximize procedure success and minimize risk., Competing Interests: Conflict of interest: none declared., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: journals.permissions@oup.com.)

Published
2022
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124. Novel insights into the substrate involved in maintenance of ventricular fibrillation: results from continuous multipolar mapping in a canine model.

Author

Ezzeddine FM, Ward RC, Jiang Z, Tri JA, Agboola K, Hu T, Lodhi F, Tan NY, Ladas TP, Christopoulos G, Sugrue AM, Tolkacheva EG, Munoz FD, McLeod CJ, Asirvatham SJ, and DeSimone CV

Abstract

Background: While the triggers for ventricular fibrillation (VF) are well-known, the substrate required for its maintenance remains elusive. We have previously demonstrated dynamic spatiotemporal changes across VF from electrical induction of VF to asystole. Those data suggested that VF drivers seemed to reside in the distal RV and LV. However, signals from these areas were not recorded continuously. The aim of this study was to map these regions of significance with stationary basket electrodes from induction to asystole to provide further insights into the critical substrate for VF rhythm sustenance in canines., Methods: In six healthy canines, three multipolar basket catheters were positioned in the distal right ventricle (RV), RV outflow tract, and distal left ventricle (LV), and remained in place throughout the study. VF was induced via direct current application from an electrophysiologic catheter. Surface and intracardiac electrograms were recorded simultaneously and continuously from baseline, throughout VF, and until asystole, in order to get a complete electrophysiologic analysis of VF. Focused data analysis was also performed via two defined stages of VF: early VF (immediately after induction of VF to 10 min) and late VF (after 10 min up to VF termination and asystole)., Results: VF was continuously mapped for a mean duration of 54 ± 9 min (range 42-70 min). Immediately after initiation of VF in the early phase, the distal LV region appeared to drive the maintenance of VF. Towards the terminal stage of VF, the distal RV region appeared to be responsible for VF persistence. In all canines, we noted local termination of VF in the LV, while VF on surface ECG continued; conversely, subsequent spontaneous termination of VF in the RV was associated with termination of VF on surface ECG into a ventricular escape rhythm. Continuous mapping of VF showed trends towards an increase in peak-to-peak ventricular electrogram cycle length (p = 0.06) and a decrease in the ventricular electrogram amplitude (p = 0.06) after 40 min. Once we could no longer discern surface QRS activity, we demonstrated local ventricular myocardial capture in both the RV and LV but could not reinitiate sustained VF despite aggressive ventricular burst pacing., Conclusions: This study describes the evolution of VF from electrical initiation to spontaneous VF termination without hemodynamic support in healthy canines. These data are hypothesis-generating and suggest that critical substrate for VF maintenance may reside in both the distal RV and LV depending on stage of VF. Further studies are needed to replicate these findings with hemodynamic support and to translate such findings into clinical practice. Ventricular fibrillation maintenance may be dependent on critical structures in the distal RV. ECG: electrocardiogram; LV: left ventricle; RV: right ventricle; RVOT: right ventricular outflow tract; VF: ventricular fibrillation., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Published
2022
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125. Ventricular nanosecond pulsed electric field delivery using active fixation leads: a proof-of-concept preclinical study.

Author

Tan NY, Ladas TP, Christopoulos G, Sugrue AM, van Zyl M, Ladejobi AO, Lodhi FK, Hu TY, Ezzeddine FM, Agboola K, Uecker D, Maor E, Tri JA, Jiang Z, Yasin OZ, DeSimone CV, Killu AM, Asirvatham SJ, and Del-Carpio Munoz F

Abstract

Background: Mid-myocardial ventricular arrhythmias are challenging to treat. Cardiac electroporation via pulsed electric fields (PEFs) offers significant promise. We therefore tested PEF delivery using screw-in pacemaker leads as proof-of-concept., Methods: In 5 canine models, we applied nanosecond PEF (pulse width 300 ns) across the right ventricular (RV) septum using a single lead bipolar configuration (n = 2) and between two leads (n = 3). We recorded electrograms (EGMs) prior to, immediately post, and 5 min after PEF. Cardiac magnetic resonance imaging (cMRI) and histopathology were performed at 2 weeks and 1 month., Results: Nanosecond PEF induced minimal extracardiac stimulation and frequent ventricular ectopy that terminated post-treatment; no canines died with PEF delivery. With 1 lead, energy delivery ranged from 0.64 to 7.28 J. Transient ST elevations were seen post-PEF. No myocardial delayed enhancement (MDE) was seen on cMRI. No lesions were noted on the RV septum at autopsy. With 2 leads, energy delivery ranged from 56.3 to 144.9 J. Persistent ST elevations and marked EGM amplitude decreases developed post-PEF. MDE was seen along the septum 2 weeks and 1 month post-PEF. There were discrete fibrotic lesions along the septum; pathology revealed dense connective tissue with < 5% residual cardiomyocytes., Conclusions: Ventricular electroporation is feasible and safe with an active fixation device. Reversible changes were seen with lower energy PEF delivery, whereas durable lesions were created at higher energies. Central illustration: pulsed electric field delivery into ventricular myocardium with active fixation leads., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Published
2022
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