We consider the inverse electrocardiographic problem of computing epicardial potentials from a body-surface potential map. We study how to improve numerical approximation of the inverse problem when the finite-element method is used. Being ill-posed, the inverse problem requires different discretization strategies from its corresponding forward problem. We propose refinement guidelines that specifically address the ill-posedness of the problem. The resulting guidelines necessitate the use of hybrid finite elements composed of tetrahedra and prism elements. Also, in order to maintain consistent numerical quality when the inverse problem is discretized into different scales, we propose a new family of regularizers using the variational principle underlying finiteelement methods. These variational-formed regularizers serve as an alternative to the traditional Tikhonov regularizers, but preserves the L₂ norm and thereby achieves consistent regularization in multiscale simulations. The variational formulation also enables a simple construction of the discrete gradient operator over irregularmeshes, which is difficult to define in traditional discretization schemes.We validated our hybrid element technique and the variational regularizers by simulations on a realistic 3-D torso/heart model with empirical heart data. Results show that discretization based on our proposed strategies mitigates the ill-conditioning and improves the inverse solution, and that the variational formulation may benefit a broader range of potential-based bioelectric problems.

BACKGROUND
Magnetic resonance imaging (MRI) allows visualization of location and extent of radiofrequency (RF) ablation lesion, myocardial scar formation, and real-time (RT) assessment of lesion formation. In this study, we report a novel 3-Tesla RT -RI based porcine RF ablation model and visualization of lesion formation in the atrium during RF energy delivery.

OBJECTIVE
The purpose of this study was to develop a 3-Tesla RT MRI-based catheter ablation and lesion visualization system.

METHODS
RF energy was delivered to six pigs under RT MRI guidance. A novel MRI-compatible mapping and ablation catheter was used. Under RT MRI, this catheter was safely guided and positioned within either the left or right atrium. Unipolar and bipolar electrograms were recorded. The catheter tip–tissue interface was visualized with a T1-weighted gradient echo sequence. RF energy was then delivered in a power-controlled fashion. Myocardial changes and lesion formation were visualized with a T2-weighted (T2W) half Fourier acquisition with single-shot turbo spin echo (HASTE) sequence during ablation.

RESULTS
RT visualization of lesion formation was achieved in 30% of the ablations performed. In the other cases, either the lesion was formed outside the imaged region (25%) or the lesion was not created (45%) presumably due to poor tissue– catheter tip contact. The presence of lesions was confirmed by late gadolinium enhancement MRI and macroscopic tissue examination.

CONCLUSION
MRI-compatible catheters can be navigated and RF energy safely delivered under 3-Tesla RT MRI guidance. Recording electrograms during RT imaging also is feasible. RT visualization of lesion as it forms during RF energy delivery is possible and was demonstrated using T2W HASTE imaging.

The Implicit Continuous-fluid Eulerian (ICE) method is a successful and widely used semi-implicit finitevolume method that applies to flows that range from supersonic to subsonic regimes. The classical ICE method has been expanded to problems in multiphase flow which span a wide area of science and engineering. The ICE method is utilized by the C-SAFE code Uintah written at the University of Utah to simulate explosions, fires and other fluid and fluid-structure interaction phenomena. The ICE method used in Uintah (referred to here as Production ICE) is described in many papers by Kashiwa at Los Alamos and Harman at Utah. However, Production ICE does not perform as well as many current methods for compressible flow problems governed by the Euler equations.We show, via examples, that changing the nonconservation form of the solver in Production ICE to a conservation form improves the numerical solutions. In addition, the use of slope limiters makes it possible to suppress the nonphysical oscillations generated by the ICE method in conservation form. This new form of ICE is referred to as IMPICE, the IMproved Production ICE method. The accuracy of IMPICE for one dimensional Euler equations is investigated by using a number of test cases.

The electrocardiogram (ECG) is ubiquitously employed as a diagnostic and monitoring tool for patients experiencing cardiac distress and/or disease. It is widely known that changes in heart position resulting from, for example, posture of the patient (sitting, standing, lying) and respiration significantly affect the body-surface potentials; however, few studies have quantitatively and systematically evaluated the effects of heart displacement on the ECG. The goal of this study was to evaluate the impact of positional changes of the heart on the ECG in the specific clinical setting of myocardial ischemia. To carry out the necessary comprehensive sensitivity analysis, we applied a relatively novel and highly efficient statistical approach, the generalized polynomial chaos-stochastic collocation method, to a boundary element formulation of the electrocardiographic forward problem, and we drove these simulations with measured epicardial potentials from whole-heart experiments. Results of the analysis identified regions on the body-surface where the potentials were especially sensitive to realistic heart motion. The standard deviation (STD) of ST-segment voltage changes caused by the apex of a normal heart, swinging forward and backward or side-to-side was approximately 0.2 mV. Variations were even larger, 0.3 mV, for a heart exhibiting elevated ischemic potentials. These variations could be large enough to mask or to mimic signs of ischemia in the ECG. Our results suggest possible modifications to ECG protocols that could reduce the diagnostic error related to postural changes in patients possibly suffering from myocardial ischemia.

Cardiac experimental electrophysiology is in need of a well-defined Minimum Information Standard for recording, annotating, and reporting experimental data. As a step towards establishing this, we present a draft standard, called Minimum Information about a Cardiac Electrophysiology Experiment (MICEE). The ultimate goal is to develop a useful tool for cardiac electrophysiologists which facilitates and improves dissemination of the minimum information necessary for reproduction of cardiac electrophysiology research, allowing for easier comparison and utilisation of findings by others. It is hoped that this will enhance the integration of individual results into experimental, computational, and conceptual models. In its present form, this draft is intended for assessment and development by the research community. We invite the reader to join this effort, and, if deemed productive, implement the Minimum Information about a Cardiac Electrophysiology Experiment standard in their own work.

The Uintah Software framework was developed to provide an environment for solving fluid-structure interaction problems on structured adaptive grids on large-scale, long-running, data-intensive problems. Uintah uses a combination of fluid-flow solvers and particle-based methods for solids together with a novel asynchronous task-based approach with fully automated load balancing. Uintah’s memory use associated with ghost cells and global meta-data has become a barrier to scalability beyond O(100K) cores. A hybrid memory approach that addresses this issue is described and evaluated. The new approach based on a combination of Pthreads and MPI is shown to greatly reduce memory usage as predicted by a simple theoretical model, with comparable CPU performance.

Block-structured adaptive mesh renement (BSAMR) is widely used within simulation software because it improves the utilization of computing resources by rening the mesh only where necessary. For BSAMR to scale onto existing petascale and eventually exascale computers all portions of the simulation need to weak scale ideally. Any portions of the simulation that do not will become a bottleneck at larger numbers of cores. The challenge is to design algorithms that will make it possible to avoid these bottlenecks on exascale computers.

One step of existing BSAMR algorithms involves determining where to create new patches of renement. The Berger-Rigoutsos algorithm is commonly used to perform this task. This paper provides detailed analysis of the performance of two existing parallel implementations of the Berger-Rigoutsos algorithm and develops a new parallel implementation of the Berger-Rigoutsos algorithm and a Tiled algorithm that exhibits ideal scalability. The analysis and computational results up to 98,304 cores are used to design performance models which are then used to predict how these algorithms will perform on 100M cores.

The IDX data format provides efficient, cache oblivious, and progressive access to large-scale scientific datasets by storing the data in a hierarchical Z (HZ) order. Data stored in IDX format can be visualized in an interactive environment allowing for meaningful explorations with minimal resources. This technology enables real-time, interactive visualization and analysis of large datasets on a variety of systems ranging from desktops and laptop computers to portable devices such as iPhones/iPads and over the web. While the existing ViSUS API for writing IDX data is serial, there are obvious advantages of applying the IDX format to the output of large scale scientific simulations. We have therefore developed PIDX - a parallel API for writing data in an IDX format. With PIDX it is now possible to generate IDX datasets directly from large scale scientific simulations with the added advantage of real-time monitoring and visualization of the generated data.

In this paper, we provide an overview of the IDX file format and how it is generated using PIDX. We then present a data model description and a novel aggregation strategy to enhance the scalability of the PIDX library. The S3D combustion application is used as an example to demonstrate the efficacy of PIDX for a real-world scientific simulation. S3D is used for fundamental studies of turbulent combustion requiring exceptionally high fidelity simulations. PIDX achieves up to 18 GiB/s I/O throughput at 8,192 processes for S3D to write data out in the IDX format. This allows for interactive analysis and visualization of S3D data, thus, enabling in situ analysis of S3D simulation.

Objectives
This study tried to determine the association between left atrial (LA) fibrosis, detected using delayed-enhanced magnetic resonance imaging (DE-MRI), and the CHADS score (point system based on individual clinical risk factors including congestive heart failure, hypertension, age, diabetes, and prior stroke) variables, specifically stroke.

Background
In patients with atrial fibrillation (AF), conventional markers for the risk of stroke base their higher predictive effect on clinical features, particularly previous stroke history, and not individual LA pathophysiological properties. We aimed to determine the association between LA fibrosis, detected using DE-MRI, and the CHADS score variables, specifically stroke.

Methods
Patients with AF who presented to the AF clinic and received a DE-MRI of the LA were evaluated. Their risk factor profiles, including a CHADS score, were catalogued. The degree of LA fibrosis was determined as a percentage of the LA area. Any history of previous strokes, warfarin use, or cerebrovascular disease was recorded.

Results
A total of 387 patients, having a mean age of 65 ± 12 years, 36.8% female, were included in this study. A history of previous stroke was present in 36 (9.3%) patients. Those patients with previous strokes had a significantly higher percentage of LA fibrosis (24.4 ± 12.4% vs. 16.2 ± 9.9%, p < 0.01). A larger amount of LA fibrosis was also seen in those patients with a higher CHADS score (≥2: 18.7 ± 11.4 vs. <2: 14.7 ± 9.2, p < 0.01). A logistic regression analysis of all variables except strokes (CHAD score) demonstrated that LA fibrosis independently predicted cerebrovascular events (p = 0.002) and significantly increased the predictive performance of the score (area under the curve = 0.77).

Conclusions
Our preliminary, multicenter results suggest DE-MRI–based detection of LA fibrosis is independently associated with prior history of strokes. We propose that the amount of DE-MRI–determined LA fibrosis could represent a marker for stroke and a possible therapeutic target with potential applicability for clinical treatment for patients with AF. (J Am Coll Cardiol 2011;57:831–8) © 2011 by the American College of Cardiology Foundation

A spectral/hp element discretisation permits both geometric flexibility and beneficial convergence properties to be attained simultaneously. The choice of elemental polynomial order has a profound effect on the efficiency of different implementation strategies with their performance varying substantially for low and high order spectral/hp discretisations. We examine how careful selection of the strategy minimises computational cost across a range of polynomial orders in three dimensions and compare how different operators, and the choice of element shape, lead to different break-even points between the implementations. In three dimensions, higher expansion orders quickly lead to a large increase in the number of element-interior modes, particularly in hexahedral elements. For a typical boundary–interior modal decomposition, this can rapidly lead to a poor performance from a global approach, while a sum-factorisation technique, exploiting the tensor-product structure of elemental expansions, leads to better performance. Furthermore, increased memory requirements may cause an implementation to show poor runtime performance on a given system, even if the strict operation count is minimal, due to detrimental caching effects and other machine-dependent factors.

Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in adult cardiology.1,2 Several studies have demonstrated that AF is associated with electrical, contractile, and structural remodeling (SRM) in the left atrium (LA) that contributes to the persistence and sustainability of the arrhythmia.3-7 It has also been shown that the end result of this remodeling process is loss of atrial myocytes and increased collagen content and hence fibrosis of the LA wall.5 Delayed enhancement MRI (DE-MRI) using gadolinium contrast has been demonstrated to localize and quantify the degree of SRM or fibrosis associated with AF in the LA.

DE-MRI has also been shown to be useful in localizing and quantifying scar formation in the LA following radiofrequency ablation (RFA).9,10 The pulmonary vein (PV) antral region can be visualized to assess circumferential PV scarring that results from RFA lesions/ablation. In addition, the amount of scarring to the LA after catheter ablation can be quantified as a proportion of the total left atrial volume.

Rhythm control of AF using catheter ablation has yielded varying results in different patient populations.11 Identifying the ideal candidate for catheter ablation remains a significant challenge. In addition, a number of different approaches to catheter ablation have been reported and most experts agree that 1 ablation strategy does not fit allAF patients.11-15 Therefore, selecting the proper strategy for a particular patient is also an important determinant of procedure success.

We used DE-MRI to quantify both the degree of SRM/fibrosis pre-ablation and scar formation post ablation. Our aim was to identify predictors of successful ablation in a group of patients stratified according to pre-ablation fibrosis. This would help select the most appropriate ablation strategy for the individual AF ablation candidate.