Novel non-invasive ECG imaging method based on the 12-lead ECG for reconstruction of ventricular activation: A proof-of-concept study

Abstract

AimCurrent non-invasive electrocardiographic imaging (ECGi) methods are often based on complex body surface potential mapping, limiting the clinical applicability. The aim of this pilot study was to evaluate the ability of a novel non-invasive ECGi method, based on the standard 12-lead ECG, to localize initial site of ventricular activation in right ventricular (RV) paced patients. Validation of the method was performed by comparing the ECGi reconstructed earliest site of activation against the true RV pacing site determined from cardiac computed tomography (CT).MethodsThis was a retrospective study using data from 34 patients, previously implanted with a dual chamber pacemaker due to advanced atrioventricular block. True RV lead position was determined from analysis of a post-implant cardiac CT scan. The ECGi method was based on an inverse-ECG algorithm applying electrophysiological rules. The algorithm integrated information from an RV paced 12-lead ECG together with a CT-derived patient-specific heart-thorax geometric model to reconstruct a 3D electrical ventricular activation map.ResultsThe mean geodesic localization error (LE) between the ECGi reconstructed initial site of activation and the RV lead insertion site determined from CT was 13.9 ± 5.6 mm. The mean RV endocardial surface area was 146.0 ± 30.0 cm2 and the mean circular LE area was 7.0 ± 5.2 cm2 resulting in a relative LE of 5.0 ± 4.0%.ConclusionWe demonstrated a novel non-invasive ECGi method, based on the 12-lead ECG, that accurately localized the RV pacing site in relation to the ventricular anatomy.

Localization of the ventricular pacing site from BSPM and standard 12-lead ECG: a comparison study

“…To support patient selection for CRT and guide CRT implants, the system needs only to search the targeted implantation area, right ventricular endocardium, or left epicardium. Recently, we have developed a 12-lead inverse ECG method (iECG) to estimate the endocardial and epicardial ventricular activation 9 , 10 .…”

Chronic effects of right ventricular pacing: The impact of right ventricular lead position

“…The description of the ECGi method in this section is based the method description in paper III. 3 Reconstructing the electrical ventricular activation was done in a stepwise process starting with collection of input data, processing of input data, and finally application of the inverse ECG algorithm (Figure 5).…”

“…The figure is reused with permission from study III. 3 The ECGi method required input from a digitally recorded 12-lead ECG and a CTderived heart-thorax geometry with correctly positioned ECG electrodes on the thorax model. At the follow-up visit, a new RV-paced 12-lead ECG was digitally recorded using the Cardiovit AT-102 plus resting ECG machine (Schiller, Baar, Switzerland).…”

“…The algorithm is described in detail in paper III. 3 The algorithm combined several mathematical models describing electrophysiological rules. Through integration of information from the 12-lead ECG and the heart-thorax geometry, the biventricular electrical activation was reconstructed and visualised on the 3D heart model.…”

“…Descriptive statistics were the same in the three studies. [1][2][3] For continuous variables, the mean and SD or the median and interquartile range (IQR) were reported as appropriate based on the distribution. To compare differences, Student's t-test or Mann-Whitney test were used as appropriate.…”