Dorin Panescu

CUNY Graduate Center, New York City, New York, United States

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Publications (42)38.43 Total impact

  • Dorin Panescu, Max Nerheim, Mark Kroll
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    ABSTRACT: Introduction: TASER(®) conducted electrical weapons (CEW) deliver electrical pulses that can inhibit a person's neuromuscular control or temporarily incapacitate. TASER X26, X26P, and X2 are among CEW models most frequently deployed by law enforcement agencies. The X2 CEW uses two cartridge bays while the X26 and X26P CEWs have only one. The TASER X26P CEW electronic output circuit design is equivalent to that of any one of the two TASER X2 outputs. The goal of this paper was to analyze the nominal electrical outputs of TASER X26, X26P, and X2 CEWs in reference to provisions of several international standards that specify safety requirements for electrical medical devices and electrical fences. Although these standards do not specifically mention CEWs, they are the closest electrical safety standards and hence give very relevant guidance.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 07/2013; 2013:5342-5347.
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    ABSTRACT: Accidental electrocutions kill about 1000 individuals annually in the USA alone. There has not been a systematic review or modeling of elapsed time duration defibrillation success rates following electrically-induced VF. With such a model, there may be an opportunity to improve the outcomes for industrial electrocutions and further understand arrest-related-deaths where a TASER(®) electrical weapon was involved. We searched for MedLine indexed papers dealing with defibrillation success following electrically-induced VF with time durations of 1 minute or greater post VF induction. We found 10 studies covering a total of 191 experiments for defibrillation of electrically-induced VF for post-induction durations out to 16 minutes including 0-9 minutes of pre-shock chest compressions. The results were fitted to a logistic regression model. Total minutes of VF and use of pre-shock chest compressions were significant predictors of success (p < .00005 and p= .003 respectively). The number of minutes of chest compressions was not a predictor of success. With no compressions, the 90% confidence of successful defibrillation is reached at 6 minutes and the median time limit for success is 9.5 minutes. However, with pre-shock chest compressions, the modeled data suggest a 90% success rate at 10 minutes and a 50% rate at 14 minutes.1.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2012; 2012:689-93.
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    ABSTRACT: Acute Myocardial Infarction (AMI) remains a leading cause of mortality in the United States. Finding accurate and cost effective solutions for AMI diagnosis in Emergency Departments (ED) is vital. Consecutive, or serial, ECGs, taken minutes apart, have the potential to improve detection of AMI in patients presented to ED with symptoms of chest pain. By transforming the ECG into 3 dimensions (3D), computing 3D ECG markers, and processing marker variations, as extracted from serial ECG, more information can be gleaned about cardiac electrical activity. We aimed at improving AMI diagnostic accuracy relative to that of expert cardiologists. We utilized support vector machines in a multilayer network, optimized via a genetic algorithm search. We report a mean sensitivity of 86.82%±4.23% and specificity of 91.05%±2.10% on randomized subsets from a master set of 201 patients. Serial ECG processing using the proposed algorithm shows promise in improving AMI diagnosis in Emergency Department settings.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2012; 2012:2704-7.
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    ABSTRACT: Even though electrocution has been recognized - and studied - for over a century, there remain several common misconceptions among medical professional as well as lay persons. This review focuses on "low-power" electrocutions rather than on the "high-power" electrocutions such as from lightning and power lines. Low-power electrocution induces ventricular fibrillation (VF). We review the 3 established mechanisms for electrocution: (1) shock on cardiac T-wave, (2) direct induction of VF, and (3) long-term high-rate cardiac capture reducing the VF threshold until VF is induced. There are several electrocution myths addressed, including the concept - often taught in medical school - that direct current causes asystole instead of VF and that electrical exposure can lead to a delayed cardiac arrest by inducing a subclinical ventricular tachycardia (VT). Other misunderstandings are also discussed.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2012; 2012:5734-40.
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    ABSTRACT: The first recorded heart rhythm for cardiac arrest patients can either be ventricular fibrillation (VF) which is treatable with a defibrillator, or asystole or pulseless electrical activity (PEA) which are not. The time course for the deterioration of VF to either asystole or PEA is not well understood. Knowing the time course of this deterioration may allow for improvements in emergency service delivery. In addition, this may improve the diagnosis of possible electrocutions from various electrical sources including utility power, electric fences, or electronic control devices (ECDs) such as a TASER(®) ECD.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2012; 2012:6377-81.
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    MW Kroll, D Panescu
    01/2012;
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    ABSTRACT: Atrial fibrillation (AF) surveillance using a wireless handheld monitor capable of 12-lead electrocardiogram reconstruction was performed, and arrhythmia detection rate was compared with serial Holter monitoring. Twenty-five patients were monitored after an AF ablation procedure using the hand-held monitor for 2 months immediately after and then for 1 month approximately 6 months postablation. All patients underwent 12-lead 24-hour Holter monitoring at 1, 2, and 6 months postablation. During months 1-2, 425 of 2942 hand-held monitor transmissions from 21 of 25 patients showed AF/atrial flutter (Afl). The frequency of detected arrhythmias decreased by month 6 to 85/1128 (P < .01) in 15 of 23 patients. Holter monitoring diagnosed AF/Afl in 8 of 25 and 7 of 23 patients at months 1-2 and month 6, respectively (P < .01 compared with wireless hand-held monitor). Af/Afl diagnosis by wireless monitoring preceded Holter detection by an average of 24 days. Wireless monitoring with 12-lead electrocardiogram reconstruction demonstrated reliable AF/Afl detection that was more sensitive than serial 12-lead 24-hour Holter monitoring.
    Journal of electrocardiology 11/2011; 45(2):129-35. · 1.08 Impact Factor
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    ABSTRACT: Acute myocardial infarction (AMI) diagnosis in type II diabetes (DM2) patients is difficult and ECG findings are often non-diagnostic or inconclusive. We developed computer algorithms to process standard 12-lead ECG input data for quantitative 3-dimensional (3D) analysis (my3KGTM), and hypothesized that use of the my3KGTM's array of over 100 3D-based AMI diagnostic markers may improve diagnostic accuracy for AMI in DM2 patients. Methods: We identified 155 consecutive DM2 patients age >25 yrs with chest discomfort or shortness of breath who were evaluated at an urban emergency department (130 patients (pts)) or the cardiac catheterization laboratory (25 pts) for possible AMI. The first digital 12-lead ECG for each patient, obtained within 30 min of presentation, was evaluated by (1) 2 blinded expert cardiologists, and (2) my3KGTM. In each case, the ECG was classified as either likely AMI or likely non-AMI. "Gold standard" was the final clinical diagnosis. Statistical analysis was McNemar's test with continuity correction. Results: The 155 DM2 patients were 50% male, mean age 56.8 ± 12.0 yrs; 44 pts had a final clinical diagnosis of AMI (17 ST Elevation Myocardial Infarctions (STEMI), 27 Non-ST Elevation Myocardial Infarctions (NSTEMI)) and 111 had no AMI. Conclusions: Relative to standard 12L ECG read by cardiologists, quantitative 3D ECG analysis showed significant and substantial gains in sensitivity for AMI diagnosis in DM2 patients, without loss in specificity. Sensitivity gains were particularly high in patients exhibiting NSTEMI, the most common form of AMI in DM2.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2011; 2011:965-8.
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    ABSTRACT: Differential diagnosis of symptomatic events in post-ablation atrial fibrillation (AF) patients (pts) is important; in particular, accurate, reliable detection of AF or atrial flutter (AFL) is essential. However, existing remote monitoring devices usually require attached leads and are not suitable for prolonged monitoring; moreover, most do not provide sufficient information to assess atrial activity, since they generally monitor only 1-3 ECG leads and rely on RR interval variability for AF diagnosis. A new hand-held, wireless, symptom-activated event monitor (CardioBip; CB) does not require attached leads and hence can be conveniently used for extended periods. Moreover, CB provides data that enables remote reconstruction of full 12-lead ECG data including atrial signal information. We hypothesized that these CB features would enable accurate remote differential diagnosis of symptomatic arrhythmias in post-ablation AF pts. 21 pts who underwent catheter ablation for AF were instructed to make a CB transmission (TX) whenever palpitations, lightheadedness, or similar symptoms occurred, and at multiple times daily when asymptomatic, during a 60 day post-ablation time period. CB transmissions (TXs) were analyzed blindly by 2 expert readers, with differences adjudicated by consensus. 7 pts had no symptomatic episodes during the monitoring period. 14 of 21 pts had symptomatic events and made a total of 1699 TX, 164 of which were during symptoms. TX quality was acceptable for rhythm diagnosis and atrial activity in 96%. 118 TX from 10 symptomatic pts showed AF (96 TX from 10 pts) or AFL (22 TX from 3 pts), and 46 TX from 9 pts showed frequent PACs or PVCs. No other arrhythmias were detected. Five pts made symptomatic TX during AF/AFL and also during PACs/PVCs. Use of CB during symptomatic episodes enabled detection and differential diagnosis of symptomatic arrhythmias. The ability of CB to provide accurate reconstruction of 12 L ECGs including atrial activity, combined with its ease of use, makes it suitable for long-term surveillance for recurrent AF in post-ablation patients.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2011; 2011:4741-4.
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    ABSTRACT: The TASER® Conducted Electrical Weapon (CEW) is used by law enforcement agencies about 900 times per day worldwide and has been shown to reduce suspect and officer injuries by about 65%. However, since a CEW delivers rapid electrical pulses through injected probes, the risk of inducing ventricular fibrillation (VF) has been considered. Animal studies have shown that the tip of the probe must come within a few millimeters of the surface of the heart for the CEW to induce VF in a typical animal application. Early calculations of the CEW VF risk in humans used sophisticated 3-D chest models to determine the size of the probe landing areas that had cardiac tissue within a given distance of the inner surface of the ribs. This produced a distribution of area (cm(2)) vs. mm of depth. Echocardiography was then used to determine the shortest distance from the skin surface to the cardiac surface. This produced a population distribution of skin-to-heart (STH) distances. These 2 distributions were then convolved to arrive at a probability of inducing VF for a typical human CEW application. With 900, 000 probe-mode field uses to date, epidemiological results have shown that these initial VF risk estimates were significant overestimates. We present model refinements that take into account the gender and body-mass-index (BMI) of the target demographics and produce VF risk estimates concordant with the epidemiological results. The risk of VF is estimated at 0.4 per million uses with males.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2011; 2011:271-7.
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    ABSTRACT: This paper presents image-guided therapies development and advantages using real time imaging modalities such as computed tomography, ultrasound imaging, and magnetic resonance imaging. The following are also highlighted: image-guided cancer interventions and image-guided cardiovascular interventions.
    IEEE Pulse. 01/2011; 2(5):25-27.
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    ABSTRACT: This article presents an overview of the workshop "Lessons Learned from Medical Systems Development" at the 32nd Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBS) on 31 August 2010. The workshop was designed to highlight the unique aspects of medical systems development in commercial settings.
    Pulse, IEEE. 01/2011; 2(1):34-38.
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    ABSTRACT: A workshop titled "Lessons Learned from Medical Systems Development" was well attended during the 32nd Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBS) on 31 August 2010. Fifty-six participants attended the workshop organized by Dr. Nick Chbat (Philips Research North America) and Dr. Dorin Panescu (NewCardio, Inc.). Additional invited speakers included Dr. Xuan Kong (Neurometrix Inc.), Dr. Mark Kroll (University of Minnesota), and Dr. Dieter Haemmerich (Medical University of South Carolina). The workshop was initiated by the EMBS Industrial Relations Committee and was a part of the IEEE Engineering in Medicine and Biology Conference (EMBC) 2010's theme 11 (industrial applications, com-mercialization, education, and society).
    IEEE pulse. 01/2011; 2(1):34-8.
  • Dirar S. Khoury, Liyun Rao, Dorin Panescu
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    ABSTRACT: The contraction of the heart is carefully orchestrated spatially and temporally by a specialized network of electrical pathways along which the electrical activity spreads. Abnormalities in these conduction pathways or localized aberrations of electrical activity of cardiac cells (myocytes) can result in irregular heart beats (cardiac arrhythmia). Usually, cardiac arrhythmia is associated with a particular chamber of the heart, e.g., ventricular tachycardia describes an arrhythmia with rapid contraction of the ventricles. Traditionally, drugs have been the treatment of choice for the vast majority of cardiac arrhythmias. In the last couple of decades, an image-guided form of localized treatment named cardiac catheter ablation has found wide clinical acceptance. During this treatment, a catheter is introduced through the vascular system into the heart and placed in contact with the cardiac tissue to be treated. Typically, fluoroscopy (i.e., X-ray imaging combined with intermittent infusion of contrast agent to visualize heart and vascular structures) is used as imaging modality to guide the procedure. Local electrical activity is recorded by several catheters placed in various locations of the heart to identify the location where the arrhythmia originates (so-called electrophysiological mapping). After the target site has been identified, a small tissue volume at the target site is destroyed by either heating or freezing (
    IEEE Pulse. 01/2011; 2(5):56-64.
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    ABSTRACT: CardioBip (CB) is a hand-held patient-activated device for recording and wireless transmission of reconstructed 12-lead ECG (12CB) based on patient specific matrices. It has 5 contact points: 3 precordial and 2 on the device top serving as limb leads when touched by index fingers. To determine whether CB could be used to monitor coronary disease (CAD) patients, we compared 12CB to simultaneous 12-lead ECGs (12L) in patients with CAD, pre-and post-exercise treadmill testing (ETT). The study goals were to assess: (1) whether 12CB can accurately reconstruct and wirelessly transmit 12-lead ECGs in CAD patients during ETT recovery; (2) whether 12CB can be used to evaluate ST segment changes in patients with exercise-induced ischemia.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 01/2010; 2010:2215-20.
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    ABSTRACT: It has been long recognized that there are 2 methods for inducing VF (ventricular fibrillation) with electrical currents‥ These are: (1) delivering a high-charge shock into the cardiac T-wave, and (2) delivering lower level currents for 1-5 seconds. Present electrical safety standards are based on this understanding. We present new data showing a 3(rd) mechanism of inducing VF which involves the steps of delivering sufficient current to cause high-rate cardiac capture, causing cardiac output collapse, leading to ischemia, for sufficiently long duration, which then lowers the VFT (VF threshold) to the level of the current, which finally results in VF. This requires about 40% of the normal VF-induction current but requires a duration of minutes instead of seconds for the VF to be induced. Anesthetized and ventilated swine (n=6) had current delivered from a probe tip 10 mm from the epicardium sufficient to cause hypotensive capture but not directly induce VF within 5 s. After a median time of 90 s, VF was induced. This 3(rd) mechanism of VF induction should be studied further and considered for electrical safety standards and is relevant to long-duration TASER Electronic Control Device applications.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 01/2010; 2010:1990-6.
  • Article: Reply.
    Journal of the American College of Cardiology 01/2010; 55(3):259. · 14.09 Impact Factor
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    ABSTRACT: Since the introduction of the Conducted Electrical Weapons (CEW) several studies have been conducted and multiple reports have been published on safety of these devices from a medical point of view. Use of these devices in different situations and reported deaths attracts media attention and causes general anxiety around these devices. These devices have several limitations- such as rate of fire or maximum effective range in comparison to fire arms. Here we wish to review medical publications regarding the safety of these devices based on different systems.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 01/2010; 2010:1266-70.
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    ABSTRACT: Remote surveillance is important for patients with atrial fibrillation (AF). Atrial signal recognition with conventional monitoring devices is difficult; remote AF detection is predominantly accomplished by R-R interval analysis. Twelve lead ECG (12L) displays atrial activity and remains the gold standard for AF diagnosis. CardioBip is a portable wireless patient-activated event monitor providing signal reconstruction of a 12L waveform (12CB) using 5 leads and patient-specific transformation matrices. We hypothesized that atrial signal analysis with 12CB can detect atrial activity and improve AF detection. 18 patients with AF undergoing DC cardioversion (CV) were studied. Separate 12-lead P and QRS patient-specific transformation matrices were created at baseline AF. Multiple wireless 12CB transmissions were performed 3-7 days before and up to 2 weeks after CV. Rhythm was confirmed with 12-lead ECGs (12L). In SR the number of leads with visible P waves (atrial signal > 0.05 mV), and P wave polarity were analyzed. In AF, the number of leads with AF signal were compared (fibrillatory [f] waves >0.025 mV). Fourteen of 18 patients successfully cardioverted to SR and 4 failed; thus, 14 SR and 22 AF transmissions were analyzed. SR P wave was visible on 141/168 leads on 12L and 137/168 on 12CB (126 true pos [TP] and 11 false pos [FP] relative to 12L; p=0.26). In 126 leads with P waves in both 12L and 12CB, the methods agreed on P wave polarity in 125. In AF, F waves were visible in 178/264 leads on 12L and 189/264 leads on 12CB (144 TP, 45 FP; p=0.27). All 5 AF relapses were successfully detected by 12CB based on atrial activity. 12CB is not inferior to 12L in detecting atrial signal in SR and AF, and shows excellent potential for remote wireless monitoring of AF patients.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 01/2010; 2010:1113-8.
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    ABSTRACT: This study was designed to investigate the properties of multiple bioelectric impedance signals recorded during congestive heart failure (CHF) by utilizing various electrode configurations of an implanted cardiac resynchronization therapy system. The monitoring of CHF has relied mainly on right-side heart sensors. Fifteen normal dogs underwent implantation of cardiac resynchronization therapy systems using standard leads. An additional left atrial (LA) pressure lead sensor was implanted in 5 dogs. Continuous rapid right ventricular (RV) pacing was applied over several weeks. Left ventricular (LV) catheterization and echocardiography were performed biweekly. Six steady-state impedance signals, utilizing intrathoracic and intracardiac vectors, were measured through ring (r), coil (c), and device Can electrodes. Congestive heart failure developed in all animals after 2 to 4 weeks of pacing. Impedance diminished gradually during CHF induction, but at varying rates for different vectors. Impedance during CHF decreased significantly in all measured vectors: LV(r)-Can, -17%; LV(r)-RV(r), -15%; LV(r)-RA(r), -11%; RV(r)-Can, -12%; RV(c)-Can, -7%; and RA(r)-Can, -5%. The LV(r)-Can vector reflected both the fastest and largest change in impedance in comparison with vectors employing only right-side heart electrodes, and was highly reflective of changes in LV end-diastolic volume and LA pressure. Impedance, acquired by different lead electrodes, has variable responses to CHF. Impedance vectors employing an LV lead are highly responsive to physiologic changes during CHF. Measuring multiple impedance signals could be useful for optimizing ambulatory monitoring in heart failure patients.
    Journal of the American College of Cardiology 04/2009; 53(12):1075-81. · 14.09 Impact Factor

Publication Stats

96 Citations
38.43 Total Impact Points

Institutions

  • 2012
    • CUNY Graduate Center
      New York City, New York, United States
  • 2011
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 2010–2011
    • Dedinje Cardiovascular Institute
      Beograd, Central Serbia, Serbia
  • 2009
    • Houston Methodist Hospital
      Houston, Texas, United States
  • 2006–2008
    • St. Jude Medical
      Little Canada, Minnesota, United States
    • Baylor College of Medicine
      • Section of Cardiology
      Houston, TX, United States