Localization of ventricular activation origin using patient‐specific geometry: Preliminary results

Abstract

The novel pace-mapping approach to localizing the origin of ventricular activation offers an easily implementable supplement and/or alternative to the preprocedure inverse solution; its simplicity makes it suitable for real-time applications during clinical catheter-ablation procedures.

Statistical guidance of VT ablation

“…Zhou et al 6 should be congratulated for providing proof-of-concept that critical targets for VT ablation may be identified rapidly from the 12-lead ECG by combining novel statistical analyses with multisite pacing, potentially with greater accuracy than the 120-lead inverse solution. Studies in larger populations are needed to confirm this approach, and more generally to establish the relative merits of noninvasive versus invasive mapping or when they should be combined, the optimal use of multisite pacing, and establish those features ideally extracted from structural imaging.…”

“…Ideally, ECGI or reduced ECG-based approaches such as that presented by Zhou et al 6 would identify not just potentially critical sites, but ranges of voltages, potential (and not just realized) isthmuses, scar areas, 17 and other functional measures of arrhythmic vulnerability. 18,19 …”

“…MRI or CT clearly identify ventricular infarct scar and fibrosis, 9 but this may not provide sufficient functional information to identify critical VT sites. Ideally, ECGI or reduced ECG-based approaches such as that presented by Zhou et al 6 would identify not just potentially critical sites, but ranges of voltages, potential (and not just realized) isthmuses, scar areas, 17 and other functional measures of arrhythmic vulnerability. 18,19 However, the optimal set of structural data needed to reconstruct cardiac electrical activation in this way is undefined.…”

“…In this issue of the Journal, Zhou et al 6 report a novel ECG signal processing method to rapidly and noninvasively localize VT exit sites during a procedure. In patients undergoing epicardial (n = 4) or endocardial (n = 3) VT mapping, the authors applied a statistical technique (multiple linear regression, MLR) to 12-lead ECG during multisite pacing, compared with the simultaneous inverse solution from 120 body surface electrodes.…”

The Importance of ECG Offset Correction for Premature Ventricular Contraction Origin Localization from Clinical Data

“…Such complex multiple-leads ECG measurement allows the mathematical expression of the relations between the cardiac generator and the body surface potentials used for the so-called inverse solutions of electrocardiography or electrocardiographic imaging (ECGI). The main goal of the solution of the inverse problem of electrocardiography is to examine the heart function noninvasively [1] and help in preoperation planning of the invasive interventions, especially for an elimination of the origins of ventricular or atrial arrhythmias [2], [3], [4]. Besides the multiple-leads ECG measurement, the inverse solution requires a patient-specific torso model with a known heart geometry and positions of electrodes on the chest.…”