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 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 Intraventricular flow patterns during right ventricular apical pacing

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001057 ◽  
Author(s):  
Francesco Bianco ◽  
Vincenzo Cicchitti ◽  
Valentina Bucciarelli ◽  
Alvin Chandra ◽  
Enrico Di Girolamo ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Right Ventricular ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Right Ventricular Apical Pacing

ObjectivesTo assess differences in blood flow momentum (BFM) and kinetic energy (KE) dissipation in a model of cardiac dyssynchrony induced by electrical right ventricular apical (RVA) stimulation compared with spontaneous sinus rhythm.MethodsWe cross-sectionally enrolled 12 consecutive patients (mean age 74±8 years, 60% male, mean left ventricular ejection fraction 58%±6 %), within 48 hours from pacemaker (PMK) implantation. Inclusion criteria were: age>18 years, no PMK-dependency, sinus rhythm with a spontaneous narrow QRS at the ECG, preserved ejection fraction (>50%) and a low percentage of PMK-stimulation (<20%). All the participants underwent a complete echocardiographic evaluation, including left ventricular strain analysis and particle image velocimetry.ResultsCompared with sinus rhythm, BFM shifted from 27±3.3 to 34±7.6° (p=0.016), while RVA-pacing was characterised by a 35% of increment in KE dissipation, during diastole (p=0.043) and 32% during systole (p=0.016). In the same conditions, left ventricle global longitudinal strain (LV GLS) significantly decreased from 17±3.3 to 11%±2.8% (p=0.004) during RVA-stimulation. At the multivariable analysis, BFM and diastolic KE dissipation were significantly associated with LV GLS deterioration (Beta Coeff.=0.54, 95% CI 0.07 to 1.00, p=0.034 and Beta Coeff.=0.29, 95% CI 0.02 to 0.57, p=0.049, respectively).ConclusionsIn RVA-stimulation, BFM impairment and KE dissipation were found to be significantly associated with LV GLS deterioration, when controlling for potential confounders. Such changes may favour the onset of cardiac remodelling and sustain heart failure.

scholarly journals Influence of the Inter-Trial Interval, Movement Observation, and Hand Dominance on the Previous Trial Effect

2021 ◽  
Vol 15 ◽  
Author(s):  
Hitoshi Oda ◽  
Yasushi Sawaguchi ◽  
Taku Kawasaki ◽  
Shiho Fukuda ◽  
Koichi Hiraoka
Keyword(s):  
Correlation Coefficient ◽  
Absolute Difference ◽  
Hand Dominance ◽  
Previous Trial ◽  
Motor Execution ◽  
Trial Effect ◽  
Movement Observation ◽  
Inter Trial Interval ◽  
The Absolute ◽  
Over Time

Previous studies have shown that current movement is influenced by the previous movement, which is known as the previous trial effect. In this study, we investigated the influence of the inter-trial interval, movement observation, and hand dominance on the previous trial effect of the non-target discrete movement. Right-handed healthy humans abducted the index finger in response to a start cue, and this task was repeated with constant inter-trial intervals. The absolute difference in the reaction time (RT) between the previous and current trials increased as the inter-trial interval increased. The absolute difference in RT reflects the reproducibility of the time taken for the motor execution between two consecutive trials. Thus, the finding supported the view that there is a carryover of movement information from one trial to the next, and that the underlying reproducibility of the RT between the two consecutive trials decays over time. This carryover of movement information is presumably conveyed by implicit short-term memory, which also decays within a short period of time. The correlation coefficient of the RT between the previous and current trials decreased with an increase in the inter-trial interval, indicating that the common responsiveness of two consecutive trials weakens over time. The absolute difference was smaller when the response was performed while observing finger movement, indicating that a carryover of the visual information to the next trial enhances the reproducibility of the motor execution process between consecutive trials. Hand dominance did not influence the absolute difference or correlation coefficient, indicating that the central process mediating previous trial effect of hand movement is not greatly lateralized.

Time-order of ventricular activation for premature beats in sheep and dogs

1960 ◽  
Vol 198 (2) ◽  
pp. 315-321 ◽  
Author(s):  
Robert L. Hamlin ◽  
C. Roger Smith ◽  
Richard W. Redding
Keyword(s):  
Right Ventricular ◽  
Muscle Fiber ◽  
Sagittal Plane ◽  
Left Ventricular ◽  
Qrs Complex ◽  
Purkinje Fibers ◽  
Purkinje System ◽  
Ventricular Activation ◽  
The Mean ◽  
Premature Beats

Average durations for the sinus QRS complex were 0.035 seconds for the sheep and 0.041 seconds for the dog. The average prolongation of premature beats was 145% in the sheep and 210% in the dog. Spatially, the mean QRS vector for both species was directed coplaner to the median sagittal plane—the sheep being minus 120 degrees at a magnitude of 0.8 mv, and the dog being at 88 degrees and a magnitude of 1.4 mv. In both species, premature beats from left ventricular focuses were directed cephalically; and from right ventricular focuses, caudally. It is difficult to explain why premature beats from identical focuses in sheep and dog hearts have nearly identical mean spatial QRS vectors, yet the prolongation and magnitude is so much greater in the dog whose heart is less than one-half the size of the sheep's. Of the possible explanations for the data: ( a) that the activation for premature beats is all muscle fiber to muscle fiber; ( b) that the impulse quickly re-enters into the Purkinje system; or ( c) that a combination of the two exists, the last is most tenable based upon anatomic studies describing the more complete penetration of the Purkinje fibers into the epicardium of sheep.

Variation in non-invasive measurements of vascular function in healthy volunteers during daytime

2005 ◽  
Vol 108 (5) ◽  
pp. 425-431 ◽  
Author(s):  
Ewoud ter AVEST ◽  
Suzanne HOLEWIJN ◽  
Anton F. H. STALENHOEF ◽  
Jacqueline de GRAAF
Keyword(s):  
Healthy Volunteers ◽  
Vascular Function ◽  
Augmentation Index ◽  
Intima Media Thickness ◽  
Time Of Day ◽  
Repeated Measurements ◽  
Absolute Difference ◽  
Non Invasive ◽  
Significant Difference ◽  
The Absolute

Although it is often recommended to standardize the time of day when performing non-invasive measurements of vascular function, the exact influence of the time of day on the outcome of IMT (intima-media thickness), PWV (pulse wave velocity), AIX (augmentation index) and FMD (flow-mediated dilatation) measurements has not been reported before. Nineteen healthy volunteers visited our department on two different occasions: the first visit was at 09:00 hours after an overnight fast, and the second visit was at 14:00 hours after a standardized breakfast. Non-invasive measurements of atherosclerosis were performed twice at 09:00 hours and once on the second visit at 14:00 hours. Measurement of IMT, PWV, AIX and FMD was reproducible according to the method of Bland and Altman. The absolute difference between repeated measurements at 09:00 hours showed no significant difference compared with the absolute difference between 09:00 and 14:00 hours for IMT (0.029±0.014 compared with 0.021±0.014 mm; P=0.27), PWV (0.63±0.50 compared with 0.75±0.74 m/s; P=0.52), AIX (4.0±4.0 compared with 5.5±5.2%; P=0.35) and FMD (3.8±3.7 compared with 4.2±2.9%; P=0.70). In conclusion, our results show that, in healthy volunteers during the daytime, IMT, PWV, AIX and FMD outcomes are not confounded by variation in the exact time of the examination as long as other (exogenous) conditions, including food intake, smoking and intake of alcohol, are carefully controlled for.

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