The repolarization pattern of ARVC patients, healthy gene carriers and controls as analyzed with a 252-leads Body Surface Mapping Vest

Abstract Background Repolarization abnormalities have a central role on the diagnosis of ARVC according to recent HRS consensus document from 2019 stating that T wave inversion in the right precordial leads is a major criteria if it appears in V1-V3 or a minor criteria if it appears in only V1-V2. Purpose The aim of our study was to investigate whether repolarization patterns as recorded by a Body Surface Mapping (BSM) system consisting of a vest with 252 ECG leads, could differentiate ARVC patients and even gene carriers from normal individuals. Our hypothesis is that the method can potentially identify repolarization disturbances earlier or better than conventional 12-lead ECG. Method 12 definite ARVC patients, 20 healthy gene carriers and 8 family members who tested negative for the family mutation (controls) were included. All patients underwent 12-lead ECG, including right precordial leads (V4R) and BSM recordings. Repolarization (T-wave polarity and concordance with QRS complex vector) was analyzed qualitatively in all BSM recordings, the results of which were displayed on a color code map (fig.1). Results The mean age was 49.6, 43.6 and 38.8 years in ARVC patients, healthy gene carriers and controls, respectively. The number of males in the three groups were 8/12, 8/20 and 5/8, respectively. All 8 controls had similar repolarization patterns with negative and concordant T waves on the right back panel, and T waves that successively changed from negative concordant (green) to positive disconcordant (red) and finally positive concordant (blue) on the left front panel (pattern 1). All 12 ARVC patients had different repolarization patterns as compared to the controls. Two of these patients had no apparent repolarization changes on conventional 12 lead ECG. The pattern type 2 repolarization, as defined by same pattern as the controls at the right back panel but different pattern at the front left panel was seen in 3/12 ARVC patients. The remaining 9 ARVC patients had different repolarization patterns both on the front and on the back panel (pattern 3). Among gene carriers, 15 had a normal repolarization pattern (pattern 1) and 5 demonstrated an abnormal repolarization pattern (4 had pattern type 2 and one pattern 3) despite normal surface ECG. Conclusions Using BSM recordings, abnormal repolarization patterns can be detected in all ARVC patients, even in those without repolarization changes on conventional surface ECG. The observation that 25% of gene carriers had divergent repolarization patterns, may indicate an early stage of the disease, and be used as an early diagnostic marker of the disease. Further and larger studies are warranted to confirm these observations. Repolarisation patterns recorded by BSM Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Selanders Stiftelse

Download Full-text

QRS dispersion using 252-leads Body Surface Mapping (BSM) – an explorative study of a novel diagnostic tool for Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)

European Heart Journal ◽

10.1093/ehjci/ehaa946.0336 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V Kommata ◽

M.I Elshafie ◽

M Perez ◽

R Augustine ◽

C Blomstrom-Lundquist

Keyword(s):

Body Surface ◽

Diagnostic Tool ◽

Funding Source ◽

Late Potentials ◽

Body Surface Mapping ◽

Surface Mapping ◽

Surface Ecg ◽

Qrs Duration ◽

The Mean ◽

Group 1

Abstract Background The diagnosis of ARVC is complex and challenging requiring multiple investigational tools, most of which include the demonstration of depolarization/conduction abnormalities, described in recent HRS consensus documents 2019. A simple and user friendly diagnostic tool is warranted. Purpose The purpose of our study was therefore to explore whether the analysis of QRS dispersion obtained from 252-leads recorded by a Body Surface Mapping (BSM) system can be used to identify ARVC patients as compared to the traditional ECG criteria including QRS dispersion measured by conventional 12 lead surface ECG. Methods 12 definite ARVC patients (10/12 with known pathogenic mutation) (Group 1) and 8 healthy family members tested negative for the family mutation served as controls (Group 0), were included. All patients underwent 12-lead ECG (50mm/sec), Signal-averaged ECG for late potentials and 252 lead BSM recordings. The QRS duration was measured in each of the 12 ECG leads manually with digital caliper. The QRS duration from the BSM leads were manually analyzed in Matlab by two observers unaware of the diagnosis. For each lead, the mean value of three randomly chosen beats was calculated. The QRS dispersion was calculated as the difference between the minimum and maximum value for both the 12 lead ECG and the BSM recordings. Results The mean age was 49,6 and 38,8 years in ARVC patients and controls, respectively. The number of males in the two groups were 8/12 and 5/8, respectively. Epsilon waves and Terminal Activation Duration (TAD) >55msec were detected in 6/12 and 8/12 ARVC patients, respectively, but in no controls. Late potentials were detected in 11/12 ARVC patients and in 2 controls. The QRS duration and QTc duration was not statistically different in the two Groups. The ECG-QRS dispersion was significantly more pronounced in Group 1 (42 ms ± 15, range 20–70 ms) than in Group 0 (26 ms ± 8, range 16–36 ms) (p=0.013). The BSM-QRS dispersion was significantly longer in Group 1 (68 ms ± 17, range 29–90ms) than in Group 0 (30 ms ± 7, range 22–41ms) (p=0.001). Only one ARVC patient had a BSM-QRS dispersion <50 msec, whereas none of the controls had a QRS dispersion over 50 msec (Fig. 1). Conclusion BSM-QRS dispersion, specifically using the cut off <50 ms, can potentially be a more sensitive and specific method than other ECG related techniques for diagnosing ARVC patients versus non-ARVC patients. Larger patient cohorts and further studies are required to confirm our findings. Figure 1. ECG and BSM-QRS dispersion Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Selanders Stiftelse

Download Full-text

Activation pattern during his pacing: how close are we to normal physiology?

European Heart Journal ◽

10.1093/ehjci/ehaa946.0804 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

O Yasin ◽

V Vaidya ◽

J Tri ◽

M Van Zyl ◽

A Ladejobi ◽

...

Keyword(s):

Sinus Rhythm ◽

Left Ventricular ◽

Conduction System ◽

Funding Source ◽

Activation Pattern ◽

His Bundle ◽

His Bundle Pacing ◽

Surface Ecg ◽

Qrs Duration ◽

The Right

Abstract Background His bundle pacing aims to mimic the activation pattern of normal conduction to maintain ventricular synchrony. However, selective His capture can be challenging, and the activation sequence during His pacing may not replicate normal conduction. Purpose Compare the right ventricular (RV) and left ventricular (LV) activation pattern in sinus rhythm and His bundle pacing. Methods Baseline LV and RV map was created in sinus rhythm using Rhythmia mapping system (Boston Scientific Corporation) in canine animal model. Medtronic 3830 lead was placed near the bundle of His under fluoroscopic, intracardiac echocardiogram, and electroanatomic guidance. Conduction system capture was confirmed by observing a QRS duration <120ms and an isoelectric segment between pacing artifact and QRS on surface ECG. Repeat LV and RV activation map was obtained during His pacing. Average QRS, HV and pacing to V intervals were calculated with standard deviation. Results Mapping was performed successfully in four animals. At baseline, the average QRS duration was 44±2.6ms and HV interval was 32±4.2ms. Earliest site of myocardial activation was in the mid-septal LV region. The earliest RV myocardial activation was also at the septum closer to the apex, but later than the LV (Figure1A). With His pacing, the average QRS duration was 70±17.0ms and the average stim to V interval was 31±8.7ms. During His pacing, the earliest site of activation was in the RV septum, with an activation pattern from base to apex in both the RV and LV. Conclusion Unlike normal physiology, the activation pattern during conduction system pacing is from base to apex with earliest site in the RV. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Mayo Clinic

Download Full-text

25First evidence that differences in the t-wave upslope of the body surface ECG reflect right to left dispersion of repolarization in the intact human heart

EP Europace ◽

10.1093/europace/eux283.034 ◽

2017 ◽

Vol 19 (suppl_1) ◽

pp. i11-i11

Author(s):

NT Srinivasan ◽

M Orini ◽

R Providencia ◽

RB Simon ◽

MD Lowe ◽

...

Keyword(s):

Body Surface ◽

Human Heart ◽

The Body ◽

T Wave ◽

Dispersion Of Repolarization ◽

Surface Ecg

Download Full-text

Electrodynamic Heart Model Construction and ECG Simulation

Methods of Information in Medicine ◽

10.1055/s-0038-1634119 ◽

2006 ◽

Vol 45 (05) ◽

pp. 564-573 ◽

Cited By ~ 15

Author(s):

M. Huo ◽

Q. Wei ◽

F. Liu ◽

S. Crozier ◽

L. Xia

Keyword(s):

Myocardial Ischemia ◽

Body Surface ◽

The Body ◽

Heart Model ◽

Surface Potentials ◽

T Wave ◽

Torso Model ◽

St Segment ◽

Surface Ecg ◽

Cardiac Excitation

Summary Objectives: In this paper, we present a unified electrodynamic heart model that permits simulations of the body surface potentials generated by the heart in motion. The inclusion of motion in the heart model significantly improves the accuracy of the simulated body surface potentials and therefore also the 12-lead ECG. Methods: The key step is to construct an electromechanical heart model. The cardiac excitation propagation is simulated by an electrical heart model, and the resulting cardiac active forces are used to calculate the ventricular wall motion based on a mechanical model. The source-field point relative position changes during heart systole and diastole. These can be obtained, and then used to calculate body surface ECG based on the electrical heart-torso model. Results: An electromechanical biventricular heart model is constructed and a standard 12-lead ECG is simulated. Compared with a simulated ECG based on the static electrical heart model, the simulated ECG based on the dynamic heart model is more accordant with a clinically recorded ECG, especially for the ST segment and T wave of a V1-V6 lead ECG. For slight-degree myocardial ischemia ECG simulation, the ST segment and T wave changes can be observed from the simulated ECG based on a dynamic heart model, while the ST segment and T wave of simulated ECG based on a static heart model is almost unchanged when compared with a normal ECG. Conclusions: This study confirms the importance of the mechanical factor in the ECG simulation. The dynamic heart model could provide more accurate ECG simulation, especially for myocardial ischemia or infarction simulation, since the main ECG changes occur at the ST segment and T wave, which correspond with cardiac systole and diastole phases.

Download Full-text

Measurement of T wave variability in body surface ECG

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2016.07.014 ◽

2016 ◽

Vol 49 (6) ◽

pp. 883-886 ◽

Cited By ~ 2

Author(s):

Mathias Baumert

Keyword(s):

Body Surface ◽

T Wave ◽

Surface Ecg

Download Full-text

Differences in the upslope of the precordial body surface ECG T wave reflect right to left dispersion of repolarization in the intact human heart

Heart Rhythm ◽

10.1016/j.hrthm.2018.12.006 ◽

2019 ◽

Vol 16 (6) ◽

pp. 943-951 ◽

Cited By ~ 14

Author(s):

Neil T. Srinivasan ◽

Michele Orini ◽

Rui Providencia ◽

Ron Simon ◽

Martin Lowe ◽

...

Keyword(s):

Body Surface ◽

Human Heart ◽

T Wave ◽

Dispersion Of Repolarization ◽

Surface Ecg

Download Full-text

Abstract 15668: Noninvasive Mapping Can Predict Success of Ablation for Atrial Fibrillation

Circulation ◽

10.1161/circ.142.suppl_3.15668 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Namita Ravi ◽

Kian Waddell ◽

Wouter-Jan Rappel ◽

Miguel Rodrigo ◽

Sanjiv M Narayan

Keyword(s):

Atrial Fibrillation ◽

Body Surface ◽

Signal Amplitude ◽

Dominant Frequency ◽

The Body ◽

Body Surface Mapping ◽

Surface Mapping ◽

Surface Ecg ◽

Acute Success ◽

Noninvasive Mapping

Introduction: It is currently not possible to non-invasively identify patients with atrial fibrillation (AF) who may respond acutely to ablation. We hypothesized that high resolution body surface mapping can identify specific distributions of AF in individuals that predict acute success from ablation. Objective: To correlate 64 lead body surface ECG in AF to acute ablation response and non-invasively identify patients in whom ablation does and does not terminate AF. Method: Fig A shows 64 body surface electrodes in N=17 consecutive AF patients (14 persistent AF, 67 ± 9.06 years). Spectral dominant frequency (DF) from 4096-point FFT, cycle length, AF electrogram amplitude were measured in 200-300 time slices of duration 60s between patches on the body surface representing each atrium (Fig A). Results: Ablation terminated AF in N=7/17 patients (41.2%, Fig. B). Patients with AF termination had more organized AF than those without termination, indicated by lower DF on body surface mapping of the regions corresponding to left (5.00 ± 1.33 vs 5.47 ± 1.30, p < 0.001) and right atrium (5.16 ± 1.50 vs 5.50 ± 1.01, p < 0.003) (Fig C shows composite). DF was stable without statistically significant variations across 20s slices spanning the full minute, supporting interpretability of mechanisms from this analysis (p = NS). Further, AF signal amplitude averaged across left and right atria was lower in patients with AF termination (65.47 ± 36.9 vs 120.13 ± 99.9, p < 0.001) (Fig D). Conclusion: Body surface analysis of AF can non-invasively identify patients in whom ablation may acutely terminate AF. Future studies should determine if this approach can predict who may ultimately achieve long term freedom from AF, and whether body surface signatures are representative enough to be analyzed days prior to the procedure.

Download Full-text