Dorin Panescu

Advanced Cardiac Therapeutics (ACT), Santa Clara, California, United States

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Publications (51)87.79 Total impact

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    dorin panescu · mark kroll · michael brave
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    ABSTRACT: Copyrighted paper cannot be posted: Panescu D, Kroll M and Brave M. Cardiac Fibrillation Risks with TASER Conducted Electrical Weap-ons. . IEEE EMBC Conference Proceedings. 2015;37:323-329. Introduction—The TASER® conducted electrical weapon (CEW) delivers electrical pulses that can temporarily incapacitate subjects. We analyzed the cardiac fibrillation risk with TASER CEWs. Our risk model accounted for realistic body mass index distributions, used a new model of effects of partial or oblique dart penetration and used recent epidemiological CEW statics. Methods and Results—Finite element modeling (FEM) was used to approximate the current density in tissues around CEW darts, including accounting for the effects of fat, anisotropic skeletal muscles, sternum, ribs, and lungs. IEC 60479-2 indicated that charge levels of at least 1 mC were necessary to induce VF. TASER® X26™ CEW deliver only 100 μC. To induce VF at such low electrical output levels, the closest heart surface would have to be located at less than 4.3 mm from the CEW dart tip, or 13.3 mm from the skin surface, assuming a perpendicularly-penetrated 9 mm dart. Recent epidemiological studies put the probability of CEW darts hitting anterior chest locations at 14.8%. Out of such anterior chest hits, at most 2.7% stood chances of landing at locations with shortest skin-to-heart distances (MinSTH). Imaging studies showed that the proportion of males with MinSTHs shorter than 13.3 mm was 1.1% in the general population and 0% in the typical population encountered by law enforcement. The probability that partially penetrated CEW darts with an oblique entry angle had an orientation favorable to VF induction was less than 0.78%. After accounting for all above probabilities, the overall theoretical VF risk was estimated not to exceed 0.0000003481, or less than 1 in 2,873,147 cases, consistent with epidemiological CEW statics. Conclusions—While not risk-free, the use of TASER X26 CEWs implies an extremely low cardiac risk profile.
    Full-text · Conference Paper · Aug 2015
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    dorin panescu · mark kroll · chris andrews · hugh pratt
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    ABSTRACT: Copyrighted paper is found at: Panescu D, Kroll M, Andrews C and Pratt H. Transthoracic Ventricular Fibrillation Charge Thresholds. IEEE EMBC Conference Proceedings. 2015;37:7208-7213. Introduction—Standards, including IEC 60479-1 and -2, provide current-based ventricular fibrillation thresholds (VFT) for stimuli durations between 0.1 ms and 10 s. It has been established that the amount of electrical charge, not the current calculated by root-mean-square, is most representative of the effects of cardiac stimulation. There are no unified models that present transthoracic charge VFTs for a wide range of stimuli durations. This work proposes a new unified charge model applicable to transthoracic stimuli durations ranging over 1 s – 300 s. Methods and Results—VFTs were compiled from our previous animal work and from other published reports, including from the studies that provided the raw data for IEC 60479-1 and -2. Our study goal was to cover a wide range of stimuli durations, for which reliable data exists. Consistent data were found for stimuli durations covering the range of 1 s – 300 s where VFTs were expressed as charge. The model predicted a transthoracic charge VFT of 1 mC at 1 s duration. The charge VFT increased with stimulus duration and reached 10 C at 300 s. Conclusions—Presenting the first charge-based transthoracic VFT model covering stimuli durations over 1 μs – 300 s, we found 3 behavioral regions of charge VFT vs. duration. For short stimuli durations, 1 s – 10 ms, VFTs followed a classic Weiss charge strength-duration curve. For long stimuli, longer than 5 s, charge VFTs can be approximated using a 38 mArms constant current model. From 10 ms to 5 s, charge VFTs tracked through a transition zone that could be approximated as a constant charge model Q  100 mC.
    Full-text · Conference Paper · Aug 2015
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    Mark W Kroll · Dorin Panescu · Peter E. Perkins
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    ABSTRACT: The ubiquitous electric fence is essential to modern agriculture and has saved lives by reducing the number of livestock automobile collisions. Modern safety standards such as IEC 60335-2-76 and UL 69 have played a role in this positive result. However, these standards are essentially based on energy and power (RMS current), which have limited direct relationship to cardiac effects. We compared these standards to bioelectrically more relevant units of charge and average current in view of recent work on VF (ventricular fibrillation) induction and to existing IEC AC current limits. METHODS and RESULTS There are 3 limits for normal (low) pulsing rate: IEC energy limit, IEC current limit, and UL current limit. We then calculated the delivered charge allowed for each pulse duration for these limits and then compared them to a charge-based safety model derived from published human ventricular-fibrillation induction data. Both the IEC and UL also allow for rapid pulsing for up to 3 minutes. We calculated maximum outputs for various pulse durations assuming pulsing at 10, 20, and 30 pulses per second. These were then compared to standard utility power safety (AC) limits via the conversion factor of 7.4 to convert average current to RMS current for VF risk. The outputs of TASER electrical weapons (typically < 100 µC and ~100 µs duration) were also compared. Conclusions The IEC and UL electric fence energizer normal rate standards are conservative in comparison with actual human laboratory experiments. The IEC and UL electric fence energizer rapid-pulsing standards are consistent with accepted IEC AC current limits for commercially used pulse durations. The copyrighted paper is found at: Kroll M, Perkins P and Panescu D. Electric Fence Standards Comport with Human Data and AC Limits. . IEEE EMBC Conference Proceedings. 2015;37:1343-1348.
    Full-text · Conference Paper · Aug 2015
  • Dorin Panescu · Mark Kroll · Michael Brave
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    ABSTRACT: The most common cause of death due to electric shock is ventricular fibrillation (VF). This work reviews applicable results from the literature and provides an estimation model for the risk of VF with short-duration pulses. Methods and Results - For 1 ms pulses, the predicted current and charge thresholds required for successful transthoracic cardiac stimulation were 1.12 A and 1.12 mC, respectively. For pulses of 0.1 ms durations, the transthoracic current and charge thresholds predicted by the model are 10.9 A and 1.09 mC, respectively. Conclusion - In humans, the charge required for single-response cardiac capture using transthoracic electrodes and 0.1 ms pulses is at least 0.5 mC. The transthoracic charge required to trigger repetitive ventricular responses in humans is at least several times higher than that for single responses. Hence, in adult humans, the transthoracic charge threshold required to induce repetitive ventricular responses, tachycardia, or fibrillation, with 0.1 ms pulses is expected to be significantly greater than 1 mC.
    No preview · Article · Aug 2014
  • Dorin Panescu · Mark Kroll · Michael Brave
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    ABSTRACT: Introduction - Human electrical safety standards are based almost exclusively on animal studies and there is an unjustified assumption that ventricular fibrillation (VF) thresholds in animals are the same as those in humans. Methods and Results - We analyzed differences between animals and humans in cardiac stimulation. A broad literature survey revealed that swine are a fragile electrophysiologic research species and have a dense intramural Purkinje fiber network, which is not found in some other species, including humans. Anesthesia agents have to be chosen carefully as swine are prone to malignant hyperthermia. Cardiac stimulation thresholds depend on weight and capture rates. Thus, the animal weight has to be representative of the weight of human subjects. Studies have shown significant ECG differences between humans and other species, including swine and canine. At least one study suggested that rabbit hearts tend to develop VF in a manner more similar to that seen in humans. Conclusion - Animal studies can play a role in conservatively evaluating cardiac safety. However, while still abiding by the precautionary principle, animal study design has to take into account the significant anatomical and electrophysiological differences between humans and other mammals. Data from multiple animal models may offer broader perspectives. If attempts are made to extrapolate animal results to humans then appropriate numerical correction factors should be applied, such as some of those discussed in this article.
    No preview · Article · Aug 2014
  • Dorin Panescu · Mark Kroll · Carlyn Iverson · Michael Brave
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    ABSTRACT: Introduction - The TASER(®) conducted electrical weapon (CEW) delivers electrical pulses that can temporarily incapacitate subjects. We analyzed the distribution of TASER CEW currents in tissues posterior to the sternum to understand the likelihood of triggering cardiac arrhythmias. We also assessed the electrical `shielding' effects of the sternum. Methods and Results - Finite element modeling (FEM) was used to approximate the current density and electric field strength in tissues around the sternum. We analyzed 2 CEW dart deployment scenarios: (a) both darts over the anterior aspect of the sternum; and (b) a CEW dart anterior to the sternum and the other over the abdomen. In both scenarios, the sternum provided significant attenuation of CEW currents. Particularly, both FEMs predicted that the residual electrical current or charge from CEWs would be insufficient to cause either cardiac capture or induction of ventricular fibrillation at locations where cardiac tissue would reside relative to the posterior aspect of the sternum. Conclusion - The sternum offers significant `shielding' effect and protects the tissues posterior to it against effects of electrical current flow from anteriorly-placed CEW electrodes.
    No preview · Article · Aug 2014
  • 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.
    No preview · Article · Jul 2013 · Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference
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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.
    Full-text · Article · Aug 2012 · Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference
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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.
    No preview · Article · Aug 2012 · Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference
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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.
    No preview · Article · Aug 2012 · Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference
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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.
    No preview · Article · Aug 2012 · Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference
  • Source
    MW Kroll · Dorin Panescu
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    ABSTRACT: Electrical injuries are common worldwide but poorly understood. Electricity is characterized by numerous parameters such as charge, current, voltage, power, resistance, resistivity, and energy. Electrical current must be itself divided into RMS current (for thermal injuries) and aggregate current (for stimulation and arrhythmia risk). The resistivity of body tissues ranges from blood (which is good conductor) to bone (which is almost an insulator). Muscle is a good conductor along the fibers but a poor conductor transverse to the fibers. These differences can result in surprising current flow paths. Common adages of electrical injury, such as “wet skin increases the risk” and “low resistance implies greater injury,” are misleading and often lead to false conclusions.
    Full-text · Chapter · Jan 2012
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    ABSTRACT: Introduction: For monitoring pulmonary edema secondary to Congestive Heart Failure (CHF), we investigated trends of impedance between implanted electrodes. Methods: ICDs were implanted in 16 dogs and 5 sheep. Right ventricles were paced (230–250 bpm) for several weeks. Impedance was measured every hour along 4 intrathoracic, 2 intracardiac and 4 cardiogenic vectors. Cardiac function was assessed biweekly by catheterization and echocardiography. Left Atrial Pressure (LAP) was measured daily by an implanted sensor. Results: All animals developed CHF after 2–4 weeks of pacing (EF, 52 vs. 34%; LVEDV, 65 vs. 97 ml; LVEDP, 7 vs. 16 mm Hg; LAV, 17 vs. 33 ml; LAP, 7 vs. 26 mm Hg). Impedance decreased during CHF: LV-Can, ; LV–RV, ; LV–RA, ; RV-Can, ; RV coil-Can, ; RA-Can, . The LV-Can decrease was greatest and correlated well with LAP ( ). All impedances were associated with circadian variability at the baseline, which diminished during CHF ( vs. ). In CHF, cardiogenic impedances displayed reduced peak-to-peak amplitude and increased fractionation. Conclusions: As impedance decreased during CHF, left-heart trends were better correlated with LAP. Left-heart vectors may improve the detection of CHF compared to sensing by right-heart leads alone. This approach has important clinical implications for managing HF patients in ambulatory settings.
    No preview · Article · Dec 2011 · Scientia Iranica
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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.
    No preview · Article · Nov 2011 · Journal of electrocardiology
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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.
    Full-text · Article · Sep 2011 · IEEE Pulse
  • 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 (
    No preview · Article · Sep 2011 · IEEE Pulse
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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.
    No preview · Article · Aug 2011 · Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference
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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.
    No preview · Article · Aug 2011 · Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference
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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.
    No preview · Article · Aug 2011 · Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference
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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).
    No preview · Article · Jan 2011 · IEEE Pulse

Publication Stats

206 Citations
87.79 Total Impact Points

Institutions

  • 2014
    • Advanced Cardiac Therapeutics (ACT)
      Santa Clara, California, United States
  • 2013
    • Intuitive Surgical
      Sunnyvale, California, United States
  • 2012
    • CUNY Graduate Center
      New York City, New York, United States
  • 2011
    • Mission College
      Santa Clara, California, United States
    • Houston Methodist Hospital
      Houston, Texas, United States
  • 2010
    • Kansas City University of Medicine and Biosciences
      • Department of Internal Medicine
      Kansas City, Missouri, United States
  • 2007-2009
    • St. Jude Medical
      Little Canada, Minnesota, United States