scholarly journals In-vivo endocardial and epicardial quantitative comparison of multi-wave based non-invasive inverse electrocardiography

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
MJ Boonstra ◽  
RW Roudijk ◽  
PM Van Dam ◽  
JF Van Der Heijden ◽  
FW Asselbergs ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Quantitative Comparison ◽  
Anatomical Models ◽  
Anatomical Structures ◽  
Non Invasive ◽  
Purkinje System ◽  
Epicardial Surface ◽  
Inverse Electrocardiography ◽  
Ventricular Activation ◽  
Endocardial Surface

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Dutch Heart Foundation Introduction Non-invasive mapping of ventricular activation using inverse electrocardiography (iECG) in patients with cardiomyopathy during sinus rhythm, may improve risk stratification for sudden cardiac death. However, iECG is complicated by multiple simultaneous endocardial activation waves (multi-wave) mediated by the His-Purkinje system, especially when the QRS complex is narrow. The activation estimation should be based on a realistic physiological model of the His-Purkinje system combining multiple waves initiated at His-Purkinje associated endocardial locations. Equivalent double layer based iECG provides an estimation of both the endocardial and epicardial surface. To improve accuracy, equivalent double layer based iECG was supplemented with electro-anatomical structures associated with the His-Purkinje system to test initial ventricular activation (Figure, Panel C). Multi-wave iECG local activation timing (LAT) maps and invasive LAT maps during sinus rhythm were quantitatively compared. Purpose Quantitative comparison of multi-wave iECG in His-Purkinje mediated cardiac activation using invasive activation maps in patients. Methods Thirteen patients referred for invasive electro-anatomical mapping (EAM) of the endocardial and epicardial surface were included. Prior to EAM, each subject underwent 64 electrode body surface potential mapping, cardiac computed tomography (CT) imaging, and 3D imaging of electrode positions. Anatomical models of the ventricles, lungs and thorax were created using CT images and supplemented with electrode positions (Figure, Panel A-B). Electro-anatomical structures associated with the His-Purkinje system were incorporated in ventricular anatomical models (Figure, Panel C) and multiple simultaneous activation waves were simulated. Invasive endocardial and epicardial LAT maps were quantitatively compared to iECG LAT maps. Invasive EAM LAT maps were quantitatively compared to estimated iECG LAT maps (Figure, Panel D) using inter-map correlation coefficients (CC, Pearson’s) and absolute differences (AD). Results Mean inter-map CC and AD were 0.54 ± 0.19 and 18 ± 7 ms respectively for the epicardial surface (n = 13). Similar to the RV endocardial surface (n = 10, CC = 0.50 ± 0.29, AD = 20 ± 8 ms) and the LV endocardial surface (n = 4, CC = 0.44 ± 0.26, AD = 25 ± 7 ms). Conclusion(s): Quantitative comparison of the multi-wave iECG method showed overall moderate performance. This novel iECG method provides a physiologically more realistic and more robust estimation of sinus rhythm and may serve as a tool for detection of electro-anatomical substrates and risk stratification. Compared to other available non-invasive ECG methods, multi-wave iECG captures His-Purkinje mediated ventricular activation better. This method might also be useful for the accurate detection and localization of structural conduction disorders. Abstract Figure. Multi-Wave inverse electrocardiography

scholarly journals Comparing Non-invasive Inverse Electrocardiography With Invasive Endocardial and Epicardial Electroanatomical Mapping During Sinus Rhythm

2021 ◽  
Vol 12 ◽  
Author(s):  
Robert W. Roudijk ◽  
Machteld J. Boonstra ◽  
Rolf Brummel ◽  
Wil Kassenberg ◽  
Lennart J. Blom ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Right Ventricular ◽  
Correlation Coefficient ◽  
Left Ventricular ◽  
Absolute Difference ◽  
Non Invasive ◽  
Inverse Electrocardiography ◽  
Ventricular Activation ◽  
The Absolute ◽  
Endocardial Activation

This study presents a novel non-invasive equivalent dipole layer (EDL) based inverse electrocardiography (iECG) technique which estimates both endocardial and epicardial ventricular activation sequences. We aimed to quantitatively compare our iECG approach with invasive electro-anatomical mapping (EAM) during sinus rhythm with the objective of enabling functional substrate imaging and sudden cardiac death risk stratification in patients with cardiomyopathy. Thirteen patients (77% males, 48 ± 20 years old) referred for endocardial and epicardial EAM underwent 67-electrode body surface potential mapping and CT imaging. The EDL-based iECG approach was improved by mimicking the effects of the His-Purkinje system on ventricular activation. EAM local activation timing (LAT) maps were compared with iECG-LAT maps using absolute differences and Pearson’s correlation coefficient, reported as mean ± standard deviation [95% confidence interval]. The correlation coefficient between iECG-LAT maps and EAM was 0.54 ± 0.19 [0.49–0.59] for epicardial activation, 0.50 ± 0.27 [0.41–0.58] for right ventricular endocardial activation and 0.44 ± 0.29 [0.32–0.56] for left ventricular endocardial activation. The absolute difference in timing between iECG maps and EAM was 17.4 ± 7.2 ms for epicardial maps, 19.5 ± 7.7 ms for right ventricular endocardial maps, 27.9 ± 8.7 ms for left ventricular endocardial maps. The absolute distance between right ventricular endocardial breakthrough sites was 30 ± 16 mm and 31 ± 17 mm for the left ventricle. The absolute distance for latest epicardial activation was median 12.8 [IQR: 2.9–29.3] mm. This first in-human quantitative comparison of iECG and invasive LAT-maps on both the endocardial and epicardial surface during sinus rhythm showed improved agreement, although with considerable absolute difference and moderate correlation coefficient. Non-invasive iECG requires further refinements to facilitate clinical implementation and risk stratification.

scholarly journals Inference of ventricular activation properties from non-invasive electrocardiography

2021 ◽  
pp. 102143
Author(s):  
Julia Camps ◽  
Brodie Lawson ◽  
Christopher Drovandi ◽  
Ana Minchole ◽  
Zhinuo Jenny Wang ◽  
...  
Keyword(s):  
Non Invasive ◽  
Ventricular Activation

scholarly journals Echocardiographic diagnosis of atrial cardiomyopathy allows outcome prediction following pulmonary vein isolation

2021 ◽  
Author(s):  
Martin Eichenlaub ◽  
Bjoern Mueller-Edenborn ◽  
Jan Minners ◽  
Martin Allgeier ◽  
Heiko Lehrmann ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Validation Cohort ◽  
Low Voltage ◽  
Predictive Values ◽  
Contact Mapping ◽  
Non Invasive ◽  
Increased Risk ◽  
Echocardiographic Parameters

Abstract Background Relevant atrial cardiomyopathy (ACM), defined as a left atrial (LA) low-voltage area ≥ 2 cm2 at 0.5 mV threshold on endocardial contact mapping, is associated with new-onset atrial fibrillation (AF), higher arrhythmia recurrence rates after pulmonary vein isolation (PVI), and an increased risk of stroke. The current study aimed to assess two non-invasive echocardiographic parameters, LA emptying fraction (EF) and LA longitudinal strain (LAS, during reservoir (LASr), conduit (LAScd) and contraction phase (LASct)) for the diagnosis of ACM and prediction of arrhythmia outcome after PVI. Methods We prospectively enrolled 60 consecutive, ablation-naive patients (age 66 ± 9 years, 80% males) with persistent AF. In 30 patients (derivation cohort), LA-EF and LAS cut-off values for the presence of relevant ACM (high-density endocardial contact mapping in sinus rhythm prior to PVI at 3000 ± 1249 sites) were established in sinus rhythm and tested in a validation cohort (n = 30). Arrhythmia recurrence within 12 months was documented using 72-h Holter electrocardiograms. Results An LA-EF of < 34% predicted ACM with an area under the curve (AUC) of 0.846 (sensitivity 69.2%, specificity 76.5%) similar to a LASr < 23.5% (AUC 0.878, sensitivity 92.3%, specificity 82.4%). In the validation cohort, these cut-offs established the correct diagnosis of ACM in 76% of patients (positive predictive values 87%/93% and negative predictive values 73%/75%, respectively). Arrhythmia recurrence in the entire cohort was significantly more frequent in patients with LA-EF < 34% and LASr < 23.5% (56% vs. 29% and 55% vs. 26%, both p < 0.05). Conclusion The echocardiographic parameters LA-EF and LAS allow accurate, non-invasive diagnosis of ACM and prediction of arrhythmia recurrence after PVI. Graphic abstract

scholarly journals Automated Framework for the Inclusion of a His–Purkinje System in Cardiac Digital Twins of Ventricular Electrophysiology

2021 ◽  
Author(s):  
Karli Gillette ◽  
Matthias A. F. Gsell ◽  
Julien Bouyssier ◽  
Anton J. Prassl ◽  
Aurel Neic ◽  
...  
Keyword(s):  
Cardiac Electrophysiology ◽  
Ventricular Myocardium ◽  
Activation Patterns ◽  
Purkinje System ◽  
Digital Twins ◽  
Emergent Features ◽  
Ventricular Activation ◽  
Endocardial Layer ◽  
Right Ventricular Apical Pacing ◽  
Electrocardiogram Ecg

AbstractPersonalized models of cardiac electrophysiology (EP) that match clinical observation with high fidelity, referred to as cardiac digital twins (CDTs), show promise as a tool for tailoring cardiac precision therapies. Building CDTs of cardiac EP relies on the ability of models to replicate the ventricular activation sequence under a broad range of conditions. Of pivotal importance is the His–Purkinje system (HPS) within the ventricles. Workflows for the generation and incorporation of HPS models are needed for use in cardiac digital twinning pipelines that aim to minimize the misfit between model predictions and clinical data such as the 12 lead electrocardiogram (ECG). We thus develop an automated two stage approach for HPS personalization. A fascicular-based model is first introduced that modulates the endocardial Purkinje network. Only emergent features of sites of earliest activation within the ventricular myocardium and a fast-conducting sub-endocardial layer are accounted for. It is then replaced by a topologically realistic Purkinje-based representation of the HPS. Feasibility of the approach is demonstrated. Equivalence between both HPS model representations is investigated by comparing activation patterns and 12 lead ECGs under both sinus rhythm and right-ventricular apical pacing. Predominant ECG morphology is preserved by both HPS models under sinus conditions, but elucidates differences during pacing.

Abstract 15430: Comparison of Ventricular Activation Time in Sinus and His Bundle Paced Beats

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shakeel Jamal ◽  
Beth Bailey ◽  
Rehan Mahmud
Keyword(s):  
Comparative Analysis ◽  
Left Ventricular ◽  
Conduction Time ◽  
Activation Time ◽  
Excitation Wave ◽  
His Bundle ◽  
Purkinje System ◽  
Ventricular Activation ◽  
The Relationship ◽  
Lower Voltage

Introduction: The relationship between conduction time of a sinus impulse and a paced impulse from His bundle to peak of left ventricular activation (HVAT) has not been systematically studied. Hypothesis: To perform a comparative analysis of HVAT of sinus and paced impulse in non-selective (NS) His bundle pacing (HBP) and selective (S)-HBP. Furthermore, to determine if pacing voltage and presence of His Purkinje system (HPS) disease affects HVAT. Methods: In 102 consecutive patients a comparative analysis of native HVAT and paced HVAT at higher (5-volt) and lower voltage (1-volt) was done in all patients and in groups subdivided into NS-HBP, S-HBP, with and without HPS disease. Results: Compared to sinus HVAT (105.9 ± 24.0 ms), paced HVAT was shorter at 5-volt (97.2 ± 17.9 ms) ( p<0.01 ) and longer at 1-volt ( p<0.01 ). This voltage effect was significant only in NS-HBP (-15.8 ± 15.7 ms, p<0.01 ) but not in selective-HBP (-6.2± 13.6 ms p=0.16 ). In NS-HBP, decrease in HVAT caused by 5-volt was the same in normal vs diseased HPS (-14.5 ± 12.8 vs-13.2 ±16.3 ms). Conclusions: 1) Compared to sinus HVAT, NS-HBP HVAT is significantly shorter at 5-volt, however, tends to prolong at 1-volt.2) The 1-volt to 5-volt HVAT decrease appears to be similar both normal and diseased NS-HBP thus not related to correction of HPS delay. 3) The voltage related decrease in HVAT is significant in presence of pre-excitation wave seen in NS-HBP and is not significant in S-HBP.

P2567First experience of non-invasive and invasive activation maps merge in carto system for topical diagnosis of focal arrhythmias

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Budanova ◽  
M Chmelevsky ◽  
S Zubarev ◽  
D Potyagaylo ◽  
L Parreira ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Operation Time ◽  
Lateral Wall ◽  
Posterior Wall ◽  
Late Enhancement ◽  
Ablation Procedure ◽  
Electrocardiographic Imaging ◽  
Non Invasive ◽  
Topical Diagnosis ◽  
Endocardial Surface

Abstract Background Correct preoperative topical diagnostics of atrial and ventricular arrhythmias allows for operation time reduction by facilitating the ablation target localization, especially in case of several ectopic sources. Purpose To implement a non-invasive electrocardiographic imaging (ECGI) technique in CARTO system for aiming at topical diagnostics of focal arrhythmias improving. Methods Twelve patients (m/f – 10/2, age (min–max) – 50,5 (32–71)) with focal arrhythmias underwent ECGI in combination with CT or MR imaging. Two subjects had atrial premature contractions (PAC), while ten patients suffered from ventricular premature contractions (PVC) with indications for ablation. Before the ablation procedure Carto LAT mapping was performed in all patients. Using ECGI epi-/endocardial polygonal models of the heart were created, isopotential and activation maps were calculated, uploaded into the Carto system and merged with the CARTO FAM models (Figure 1). Results For six patients with PVC and two patients with PAC, earliest activation zones (EAZs) anatomical locations obtained by invasive and non-invasive methods were the same (RVOT septum, RVOT lateral-anterior and RV lateral-basal walls, right aortic cusp, LVOT, coronary sinus (CS), CS ostium, RA posterior wall), and arrhythmias ablation was successful. Two patients featured coherent EAZs (RV lateral-basal wall and RVOT septum) but a negative ablation outcome. In one patient, EAZs were situated in different anatomical regions: CARTO showed the PVC EAZ in RV septum, whereas Amycard system identified endocardial surface of lateral-basal RV wall. In this patient, PVC was ablated partially. For another patient with MRI late enhancement area in LV lateral wall the EAZs were in the same LV segment but with mismatch in epi/endocardial surface. Conclusion Non-invasive and invasive activation maps merge can improve localization of ablation targets in focal arrhythmias, potentially increasing effectiveness of the EP procedure and reducing operation time.

scholarly journals Non-invasive topical diagnostics of heart arrhythmias

2015 ◽  
Vol 18 (4) ◽  
pp. 96 ◽  
Author(s):  
M. S. Khlynin ◽  
S. V. Popov ◽  
S. N. Krivolapov ◽  
R. Ye. Batalov
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Radiofrequency Catheter Ablation ◽  
Atrial Arrhythmias ◽  
Epicardial Mapping ◽  
Non Invasive ◽  
Ventricular Activation ◽  
Noninvasive Mapping ◽  
Electrophysiological Examination ◽  
Heart Arrhythmias

The aim of this study was to measure the accuracy of noninvasively obtained ventricular activation (isolated epicardial vs combined endo-epicardial mapping) as compared with that of standard invasive mapping in patients with ventricular arrhythmias. 94 patients (35 males and 59 females) aged 20 to 67 years (mean age 42.6 years) with ventricular arrhythmias of different localization and etiology and 8 patients (4 males and 4 females) aged 21 to 65 years (mean age 48.8 years) with atrial arrhythmias were examined. All patients underwent noninvasive electrophysiological examination, which was performed with Amycard System, subsequent intracardiac mapping and radiofrequency catheter ablation. The arrythmogenic focus localizations coincided in 83 cases, in 11 patients with ventricular arrhythmias some variances were observed and in patients with atrial arrhythmias no such variances were found. Thus, the accuracy of noninvasive mapping turned out to be 89.2%.

scholarly journals NON-INVASIVE ELECTROCARDIOGRAPHIC IMAGING IN DIFFERENTIAL AND TOPICAL DIAGNOSIS OF VENTRICULAR TACHYCARDIA WITH VENTRICULOATRIAL RETROGRADE CONDUCTION

2020 ◽  
Vol 26 (3) ◽  
pp. 65-70
Author(s):  
M. P. Chmelevsky ◽  
S. V. Zubarev ◽  
M. A. Budanova ◽  
T. V. Treshkur ◽  
D. S. Lebedev
Keyword(s):  
Ventricular Tachycardia ◽  
Conflicts Of Interest ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Electrocardiographic Imaging ◽  
Clinical Specialist ◽  
Non Invasive ◽  
Topical Diagnosis ◽  
Endocardial Surface ◽  
Retrograde Conduction

A case report of differential and topical diagnosis of ventricular tachycardia from right ventricular outflow tract endocardial surface with ventriculoatrial retrograde conduction using non-invasive electrocardiographic imaging is presented.Conflicts of Interest: M.Chmelevsky - clinical specialist EP Solutions SA, S.Zubarev and M.Budanova - consultants EP Solutions SA.

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