Advantages and pitfalls of noninvasive electrocardiographic imaging

Bear, Laura; Bouhamama, Oumayma; Cluitmans, Matthijs; Duchâteau, Josselin; Walton, Richard D.; Abell, Emma; Belterman, Charly; Haı̈ssaguerre, Michel; Bernus, Olivier; Coronel, Ruben; Dubois, Rémi

doi:10.1016/j.jelectrocard.2019.08.007

Cited by 29 publications

(23 citation statements)

References 17 publications

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“…as visible in figure 2 of ref. [4]. More advanced analysis methods for RT determination should be developed for these areas, possibly considering the amplitude or area of the T-wave, which can also be accurate measures of local RT [5].…”

Section: Discussionmentioning

confidence: 99%

Variability of Electrocardiographic Imaging Within and Between Leadsets

Stoks¹,

Rees²,

Groeneveld³

et al. 2020

2020 Computing in Cardiology Conference (CinC)

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The variability of the inverse solution provided by electrocardiographic imaging (ECGI) is largely unknown when comparing different leadsets or (similar) beats. In four patients, we compared activation times (ATs), recovery times (RTs), and correlation coefficients during QRS complex and STT segment between: 1) consecutive sinus beats within one leadset, and 2) multiple beats for two leadsets. Furthermore, reasons behind differences in RT were investigated. Zero-th order Tikhonov regularization was used to reconstruct ventricular epicardial potentials. A spatiotemporal estimation method was then used to determine the ATs and RTs from the reconstructed epicardial electrograms. Inter-leadset differences were generally low for ATs, but exceeded intraleadset beat-to-beat variations. RTs, however, showed larger variation independent of leadset. Differences in RTs between beats or leadsets could partially be explained by low T-wave amplitudes and high levels of noise, which suggests that RT determination may require more advanced methods in these cases. These findings increase our understanding of the consequences of electrode placement for the inverse solution, as well as our understanding of the complexities of recovery time estimation in ECGI.

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Section: Discussionmentioning

confidence: 99%

Variability of Electrocardiographic Imaging Within and Between Leadsets

Stoks¹,

Rees²,

Groeneveld³

et al. 2020

2020 Computing in Cardiology Conference (CinC)

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“…The experimental protocol was approved by Directive 2010/63/EU of the European Parliament on the protection of animals used for scientific purposes and the local ethical committee. Hearts were excised from pigs ( N = 7, 30–40 kg) and perfused in Langendorff setup as previously reported ( Bear et al, 2019a , c ). The left anterior descending (LAD) artery was cannulated on a separate perfusion.…”

Section: Methodsmentioning

confidence: 99%

Body Surface Mapping of Ventricular Repolarization Heterogeneity: An Ex-vivo Multiparameter Study

et al. 2020

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Background Increased heterogeneity of ventricular repolarization is associated with life-threatening arrhythmia and sudden cardiac death (SCD). T-wave analysis through body surface potential mapping (BSPM) is a promising tool for risk stratification, but the clinical effectiveness of current electrocardiographic indices is still unclear, with limited experimental validation. This study aims to investigate performance of non-invasive state-of-the-art and novel T-wave markers for repolarization dispersion in an ex vivo model. Methods Langendorff-perfused pig hearts ( N = 7) were suspended in a human-shaped 256-electrode torso tank. Tank potentials were recorded during sinus rhythm before and after introducing repolarization inhomogeneities through local perfusion with dofetilide and/or pinacidil. Drug-induced repolarization gradients were investigated from BSPMs at different experiment phases. Dispersion of electrical recovery was quantified by duration parameters, i.e., the time interval between the peak and the offset of T-wave (T PEAK -T END ) and QT interval, and variability over time and electrodes was also assessed. The degree of T-wave symmetry to the peak was quantified by the ratio between the terminal and initial portions of T-wave area ( Asy ). Morphological variability between left and right BSPM electrodes was measured by dynamic time warping (DTW). Finally, T-wave organization was assessed by the complexity of repolarization index (CR), i.e., the amount of energy non-preserved by the dominant eigenvector computed by principal component analysis (PCA), and the error between each multilead T-wave and its 3D PCA approximation (NMSE). Body surface indices were compared with global measures of epicardial dispersion of repolarization, and with local gradients between adjacent ventricular sites. Results After drug intervention, both regional and global repolarization heterogeneity were significantly enhanced. On the body surface, T PEAK -T END was significantly prolonged and less stable in time in all experiments, while QT interval showed higher variability across the interventions in terms of duration and spatial dispersion. The rising slope of the repolarization profile was steeper, and T-waves were more asymmetric than at baseline. Interventricular shape dissimilarity was enhanced by repolarization gradients according to DTW. Organized T-wave patterns were associated with abnormal repolarization, and they were properly described by the first principal components. Conclusion Repolarization heterogeneity significantly affects T-wave properties, and can be non-invasively captured by BSPM-based metrics.

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“…The experimental protocol was approved by Directive 2010/63/EU of the European Parliament on the protection of animals used for scientific purposes and the local ethical committee. As in [6,7], N H =7 Langendorff-perfused pig hearts were suspended in a human-shaped torso tank filled with Tyrode's solution. Repolarization gradients were created by separate infusion of pinacidil (30 µM, shortening repolarization duration) and/or dofetilide (250 nM, prolonging repolarization duration) through the left anterior descending (LAD) and non-LAD coronaries, respectively.…”

Section: Experimental Setup and Datasetmentioning

confidence: 99%

Relation of surface T-wave to vulnerability to ventricular fibrillation in explanted structurally normal hearts

Meo

Bonizzi

Bear

et al. 2020

2020 Computing in Cardiology Conference (CinC)

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Introduction: Body surface characterization of repolarization gradient substrates for ventricular fibrillation (VF) is still poor. We investigated if VF propensity can be assessed from surface T-wave in an ex-vivo model of purely electrical repolarization dispersion. Methods: To create repolarization gradients, dofetilide and/or pinacidil were separately infused in N=7 isolated pig hearts in a humanshaped torso tank. At each drug state, VF inducibility was quantified by the vulnerability window (VW), i.e. the interval during which VF was triggered by S1 (atrium) S2 (ventricle) stimulation. T-wave duration (the peak-to-end interval, T PEAK-T END), and shape, i.e., symmetry (the ratio of the areas under the peak-to-end and onset-to-peak frames, Asy), and flatness (kurtosis, Kurt) were computed from 256 tank potentials. We fitted a linear mixed-effect (LMM) model to link T-wave markers (fixed effects) with VW (response), with random effects on drug states and hearts. Results: VF was induced in 14/23 drug states from at least one ventricle. In vulnerable substrates (higher VW), Twaves were longer (T PEAK-T END , p=0.0004), less symmetric (Asy, p<0.0001) and moderately flat (Kurt, p=0.1). In a combined LMM model, significant effects were only explained by Asy (p<0.0001) and Kurt (p=0.04). Conclusions: Vulnerability to VF can be assessed from surface T-wave in heterogeneous repolarization substrates.

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Advantages and pitfalls of noninvasive electrocardiographic imaging

Cited by 29 publications

References 17 publications

Variability of Electrocardiographic Imaging Within and Between Leadsets

Variability of Electrocardiographic Imaging Within and Between Leadsets

Body Surface Mapping of Ventricular Repolarization Heterogeneity: An Ex-vivo Multiparameter Study

Relation of surface T-wave to vulnerability to ventricular fibrillation in explanted structurally normal hearts

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