1
|
Njeru DK, Athawale TM, France JJ, Johnson CR. Quantifying and Visualizing Uncertainty for Source Localization in Electrocardiographic Imaging. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING. IMAGING & VISUALIZATION 2022; 11:812-822. [PMID: 37284179 PMCID: PMC10241371 DOI: 10.1080/21681163.2022.2113824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/12/2022] [Indexed: 06/08/2023]
Abstract
Electrocardiographic imaging (ECGI) presents a clinical opportunity to noninvasively understand the sources of arrhythmias for individual patients. To help increase the effectiveness of ECGI, we provide new ways to visualize associated measurement and modeling errors. In this paper, we study source localization uncertainty in two steps: First, we perform Monte Carlo simulations of a simple inverse ECGI source localization model with error sampling to understand the variations in ECGI solutions. Second, we present multiple visualization techniques, including confidence maps, level-sets, and topology-based visualizations, to better understand uncertainty in source localization. Our approach offers a new way to study uncertainty in the ECGI pipeline.
Collapse
Affiliation(s)
- Dennis K Njeru
- Scientific Computing and Imaging (SCI) Institute, University of Utah, Salt Lake City, USA
| | - Tushar M Athawale
- Scientific Computing and Imaging (SCI) Institute, University of Utah, Salt Lake City, USA
| | - Jessie J France
- Scientific Computing and Imaging (SCI) Institute, University of Utah, Salt Lake City, USA
| | - Chris R Johnson
- Scientific Computing and Imaging (SCI) Institute, University of Utah, Salt Lake City, USA
| |
Collapse
|
2
|
Cheniti G, Puyo S, Martin CA, Frontera A, Vlachos K, Takigawa M, Bourier F, Kitamura T, Lam A, Dumas-Pommier C, Pillois X, Pambrun T, Duchateau J, Klotz N, Denis A, Derval N, Cochet H, Sacher F, Dubois R, Jais P, Hocini M, Haissaguerre M. Noninvasive Mapping and Electrocardiographic Imaging in Atrial and Ventricular Arrhythmias (CardioInsight). Card Electrophysiol Clin 2019; 11:459-471. [PMID: 31400870 DOI: 10.1016/j.ccep.2019.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Electrocardiographic imaging is a mapping technique aiming to noninvasively characterize cardiac electrical activity using signals collected from the torso to reconstruct epicardial potentials. Its efficacy has been demonstrated clinically, from mapping premature ventricular complexes and accessory pathways to of complex arrhythmias. Electrocardiographic imaging uses a standardized workflow. Signals should be checked manually to avoid automatic processing errors. Reentry is confirmed in the presence of local activation covering the arrhythmia cycle length. Focal breakthroughs demonstrate a QS pattern associated with centrifugal activation. Electrocardiographic imaging offers a unique opportunity to better understand the mechanism of cardiac arrhythmias and guide ablation.
Collapse
Affiliation(s)
- Ghassen Cheniti
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France.
| | - Stephane Puyo
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Claire A Martin
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Antonio Frontera
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Konstantinos Vlachos
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Masateru Takigawa
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Felix Bourier
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Takeshi Kitamura
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Anna Lam
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Carole Dumas-Pommier
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France
| | - Xavier Pillois
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France
| | - Thomas Pambrun
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Josselin Duchateau
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Nicolas Klotz
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Arnaud Denis
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Nicolas Derval
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Hubert Cochet
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France; Department of Cardiovascular Imaging, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France
| | - Frederic Sacher
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Remi Dubois
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Pierre Jais
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Meleze Hocini
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| | - Michel Haissaguerre
- Cardiac electrophysiology department, Hôpital Haut-Lévêque, 1 Magellan Avenue, Bordeaux, Pessac 33600, France; Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, avenue Haut Leveque, Pessac 33600, France
| |
Collapse
|
3
|
Kozlíková K, Trnka M. Varied onset of heart ventricular depolarization in different age groups of healthy volunteers. Physiol Res 2019; 68:S389-S397. [DOI: 10.33549/physiolres.934379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Group mean isopotential maps of initial parts of ventricular depolarization (QRS complex) in 4 age groups (10, 14, 19 and 22 years) of young healthy subjects, females and males, were analyzed using different increments between isopotential lines. It was found that the increment 0.1 mV masks some features of the maps, which are seen only by smaller increment (0.02 mV): the time of appearance of maximum and minimum on the anterior chest, smaller voltage values of the extrema as usually published, minimum dominating over maximum in the youngest groups. Therefore, the often applied criterion for the QRS onset – the increasing maximum on the anterior chest – should be reconsidered at least when it concerns the isopotential maps of children.
Collapse
Affiliation(s)
- K. Kozlíková
- Institute of Medical Physics, Biophysics, Informatics and Telemedicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic.
| | | |
Collapse
|
4
|
J Shah A, Hocini M, Pascale P, Roten L, Komatsu Y, Daly M, Ramoul K, Denis A, Derval N, Sacher F, Dubois R, Bokan R, Eliatou S, Strom M, Ramanathan C, Jais P, Ritter P, Haissaguerre M. Body Surface Electrocardiographic Mapping for Non-invasive Identification of Arrhythmic Sources. Arrhythm Electrophysiol Rev 2016; 2:16-22. [PMID: 26835035 DOI: 10.15420/aer.2013.2.1.16] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors describe a novel three-dimensional, 252-lead electrocardiography (ECG) and computed tomography (CT)-based non-invasive cardiac imaging and mapping modality. This technique images potentials, electrograms and activation sequences (isochrones) on the epicardial surface of the heart. This tool has been investigated in the normal cardiac electrophysiology and various tachyarrhythmic, conduction and anomalous depo-repolarisation disorders. The clinical application of this system includes a wide range of electrical disorders like atrial arrhythmias (premature atrial beat, atrial tachycardia, atrial fibrillation), ventricular arrhythmias (premature ventricular beat, ventricular tachycardia) and ventricular pre-excitation (Wolff-Parkinson-White syndrome). In addition, the system has been used in exploring abnormalities of the His-Purkinje conduction like the bundle branch block and intraventricular conduction disturbance and thereby useful in electrically treating the associated heart failure (cardiac resynchronisation). It has a potential role in furthering our understanding of abnormalities of ventricular action potential (depolarisation [Brugada syndrome and repolarisation], long QT and early repolarisation syndromes) and in evaluating the impact of drugs on His-Purkinje conduction and cardiac action potential.
Collapse
Affiliation(s)
- Ashok J Shah
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Meleze Hocini
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Patrizio Pascale
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Laurent Roten
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Yuki Komatsu
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Matthew Daly
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Khaled Ramoul
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Remi Dubois
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Ryan Bokan
- CardioInsight Technologies Inc, Cleveland, Ohio, US
| | | | - Maria Strom
- CardioInsight Technologies Inc, Cleveland, Ohio, US
| | | | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Philippe Ritter
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| |
Collapse
|
5
|
Dubois R, Shah AJ, Hocini M, Denis A, Derval N, Cochet H, Sacher F, Bear L, Duchateau J, Jais P, Haissaguerre M. Non-invasive cardiac mapping in clinical practice: Application to the ablation of cardiac arrhythmias. J Electrocardiol 2015; 48:966-74. [PMID: 26403066 DOI: 10.1016/j.jelectrocard.2015.08.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Indexed: 11/17/2022]
Abstract
Ten years ago, electrocardiographic imaging (ECGI) started to demonstrate its efficiency in clinical settings. The initial application to localize focal ventricular arrhythmias such as ventricular premature beats was probably the easiest to challenge and validates the concept. Our clinical experience in using this non-invasive mapping technique to identify the sources of electrical disorders and guide catheter ablation of atrial arrhythmias (premature atrial beat, atrial tachycardia, atrial fibrillation), ventricular arrhythmias (premature ventricular beats) and ventricular pre-excitation (Wolff-Parkinson-White syndrome) is described here.
Collapse
Affiliation(s)
- Rémi Dubois
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France; Hopital de Cardiologie du Haut Lévêque, CHU de Bordeaux, France; Université de Bordeaux, INSERM U1045, CRCTB, France.
| | - Ashok J Shah
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France; Hopital de Cardiologie du Haut Lévêque, CHU de Bordeaux, France; Université de Bordeaux, INSERM U1045, CRCTB, France
| | - Mélèze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France; Hopital de Cardiologie du Haut Lévêque, CHU de Bordeaux, France; Université de Bordeaux, INSERM U1045, CRCTB, France
| | - Arnaud Denis
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France; Hopital de Cardiologie du Haut Lévêque, CHU de Bordeaux, France; Université de Bordeaux, INSERM U1045, CRCTB, France
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France; Hopital de Cardiologie du Haut Lévêque, CHU de Bordeaux, France; Université de Bordeaux, INSERM U1045, CRCTB, France
| | - Hubert Cochet
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France; Hopital de Cardiologie du Haut Lévêque, CHU de Bordeaux, France; Université de Bordeaux, INSERM U1045, CRCTB, France
| | - Frédéric Sacher
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France; Hopital de Cardiologie du Haut Lévêque, CHU de Bordeaux, France; Université de Bordeaux, INSERM U1045, CRCTB, France
| | - Laura Bear
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France; Hopital de Cardiologie du Haut Lévêque, CHU de Bordeaux, France; Université de Bordeaux, INSERM U1045, CRCTB, France
| | - Josselin Duchateau
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France; Hopital de Cardiologie du Haut Lévêque, CHU de Bordeaux, France; Université de Bordeaux, INSERM U1045, CRCTB, France
| | - Pierre Jais
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France; Hopital de Cardiologie du Haut Lévêque, CHU de Bordeaux, France; Université de Bordeaux, INSERM U1045, CRCTB, France
| | - Michel Haissaguerre
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France; Hopital de Cardiologie du Haut Lévêque, CHU de Bordeaux, France; Université de Bordeaux, INSERM U1045, CRCTB, France
| |
Collapse
|
6
|
|
7
|
Monaco MA, Liberman L, Starc TJ, Silver ES. Defining the electrocardiogram in the neonate with hypoplastic left heart syndrome. Pediatr Cardiol 2015; 36:1014-8. [PMID: 25605039 DOI: 10.1007/s00246-015-1112-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
Abstract
Hypoplastic left heart syndrome (HLHS) is a severe form of congenital heart disease characterized by underdevelopment of the left heart. There has been no previously defined "classic" ECG pattern in a large homogenous population of patients with HLHS. We performed a retrospective review of ECGs from neonates with HLHS from 2001 to 2011 with electrocardiograms available prior to surgical intervention. Eighty-nine neonates met the inclusion criteria and were compared to a control population. HLHS patients had a longer PR interval 108 ± 18 versus 98 ± 11 ms (p < 0.05), a wider QRS complex 84 ± 17 versus 54 ± 5 ms (p < 0.05), lower voltage S waves in V1 2.0 ± 3.3 versus 5.8 ± 4.6 mm (p < 0.001) or absent S waves in V1 52 versus 4 % (p < 0.001) and lower voltage R waves in V6 7.8 ± 4.8 versus 9.3 ± 4.2 mm (p < 0.05). Patients with HLHS were more likely to have absent Q waves in the lateral precordial leads 78 versus 0 % (p < 0.001) and inferior leads 20 versus 1 % (p < 0.001) and an abnormal frontal plane QRS axis 26 versus 11 % (p < 0.05). HLHS patients were more likely to have a preexcited appearance 11 versus 0 % (p = 0.001). Despite these findings, 20 % of patients with HLHS had a normal ECG. Compared to age-matched controls, patients with HLHS were more likely to exhibit a longer PR interval, a wider QRS complex, decreased left-sided forces, an absence of septal Q waves in the inferior and lateral leads, an abnormal frontal plane QRS axis and a preexcited appearance.
Collapse
Affiliation(s)
- Michael A Monaco
- Division of Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, 3959 Broadway, CH-2 North, New York, NY, 10032-3784, USA
| | | | | | | |
Collapse
|
8
|
Noninvasive reconstruction of cardiac electrical activity: update on current methods, applications and challenges. Neth Heart J 2015; 23:301-11. [PMID: 25896779 PMCID: PMC4446282 DOI: 10.1007/s12471-015-0690-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Electrical activity at the level of the heart muscle can be noninvasively reconstructed from body-surface electrocardiograms (ECGs) and patient-specific torso-heart geometry. This modality, coined electrocardiographic imaging, could fill the gap between the noninvasive (low-resolution) 12-lead ECG and invasive (high-resolution) electrophysiology studies. Much progress has been made to establish electrocardiographic imaging, and clinical studies appear with increasing frequency. However, many assumptions and model choices are involved in its execution, and only limited validation has been performed. In this article, we will discuss the technical details, clinical applications and current limitations of commonly used methods in electrocardiographic imaging. It is important for clinicians to realise the influence of certain assumptions and model choices for correct and careful interpretation of the results. This, in combination with more extensive validation, will allow for exploitation of the full potential of noninvasive electrocardiographic imaging as a powerful clinical tool to expedite diagnosis, guide therapy and improve risk stratification.
Collapse
|
9
|
Shah AJ, Lim HS, Yamashita S, Zellerhoff S, Berte B, Mahida S, Hooks D, Aljefairi N, Derval N, Denis A, Sacher F, Jais P, Dubois R, Hocini M, Haissaguerre M. Non Invasive ECG Mapping To Guide Catheter Ablation. J Atr Fibrillation 2014; 7:1139. [PMID: 27957124 DOI: 10.4022/jafib.1139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 08/23/2014] [Accepted: 08/23/2014] [Indexed: 11/10/2022]
Abstract
Since more than 100 years, 12-lead electrocardiography (ECG) is the standard-of-care tool, which involves measuring electrical potentials from limited sites on the body surface to diagnose cardiac disorder, its possible mechanism and the likely site of origin. Several decades of research has led to the development of a 252-lead-ECG and CT-scan based, three dimensional, electro-imaging modality to non-invasively map abnormal cardiac rhythms including fibrillation. These maps provide guidance towards ablative therapy and thereby help advance the management of complex heart rhythm disorders. Here, we describe the clinical experience obtained using non-invasive technique in mapping the electrical disorder and guide the catheter ablation of atrial arrhythmias (premature atrial beat, atrial tachycardia, atrial fibrillation), ventricular arrhythmias (premature ventricular beats) and ventricular pre-excitation (Wolff-Parkinson-White syndrome).
Collapse
Affiliation(s)
- Ashok J Shah
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Han S Lim
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Seigo Yamashita
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Stephan Zellerhoff
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Benjamin Berte
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Saagar Mahida
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Darren Hooks
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Nora Aljefairi
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Remi Dubois
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Meleze Hocini
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut-Lévêque and the Université Bordeaux II, Bordeaux, France
| |
Collapse
|
10
|
van Dam PM, Tung R, Shivkumar K, Laks M. Quantitative localization of premature ventricular contractions using myocardial activation ECGI from the standard 12-lead electrocardiogram. J Electrocardiol 2013; 46:574-9. [PMID: 24028996 DOI: 10.1016/j.jelectrocard.2013.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The precise localization of the site of origin of a premature ventricular contractions (PVC) prior to ablation would facilitate the planning and execution of the electrophysiological procedure. Current electrocardiographic imaging (ECGI) techniques require body surface maps, a costly and complex procedure, that requires as many as 256 leads to localize the PVC origin. We developed and tested a novel myocardial activation based ECGI technique utilizing the readily available 12-lead ECG to localize the PVC origin. METHODS The major components of the 12-lead ECGI method are: the source model, proximity effect and spatial orientation, volume conductor, and patient specific model of the heart, lungs, and thorax as derived from magnetic resonance imaging (MRI). For the PVC origin localization, the fastest route algorithm is used on patient specific models created by newly developed morphing software. PVC localization by the 12-lead ECGI was correlated to the site of successful ablation. RESULTS Seven patients that underwent electrophysiological mapping and ablation of PVCs were studied. All patients (7/7) had accurate prediction of the PVC origin. However in two patients, no specific MRI was used for localization that resulted in an incorrect switch between the RV free wall and septum of the RVOT. With patient-specific models, these latter two cases would likely be localized correctly. CONCLUSIONS This feasibility study of a novel myocardial activation-based ECGI using only the standard 12-lead ECG shows promise to localize the origin of PVC. This ECGI method yields activation estimates of isochrones on both ventricles from which the PVC origin location is derived. This method has the capability to localize the PVC from any part of the ventricular endocardium, intra-myocardium or epicardium.
Collapse
Affiliation(s)
- Peter M van Dam
- University Medical Center Nijmegen, The Netherlands; UCLA Cardiac Arrhythmia Center, UCLA Heath System, David Geffen School of Medicine at UCLA, Los Angeles, USA.
| | | | | | | |
Collapse
|
11
|
Wang Y, Cuculich PS, Zhang J, Desouza KA, Vijayakumar R, Chen J, Faddis MN, Lindsay BD, Smith TW, Rudy Y. Noninvasive electroanatomic mapping of human ventricular arrhythmias with electrocardiographic imaging. Sci Transl Med 2012; 3:98ra84. [PMID: 21885406 DOI: 10.1126/scitranslmed.3002152] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The rapid heartbeat of ventricular tachycardia (VT) can lead to sudden cardiac death and is a major health issue worldwide. Efforts to identify patients at risk, determine mechanisms of VT, and effectively prevent and treat VT through a mechanism-based approach would all be facilitated by continuous, noninvasive imaging of the arrhythmia over the entire heart. Here, we present noninvasive real-time images of human ventricular arrhythmias using electrocardiographic imaging (ECGI). Our results reveal diverse activation patterns, mechanisms, and sites of initiation of human VT. The spatial resolution of ECGI is superior to that of the routinely used 12-lead electrocardiogram, which provides only global information, and ECGI has distinct advantages over the currently used method of mapping with invasive catheter-applied electrodes. The spatial resolution of this method and its ability to image electrical activation sequences over the entire ventricular surfaces in a single heartbeat allowed us to determine VT initiation sites and continuation pathways, as well as VT relationships to ventricular substrates, including anatomical scars and abnormal electrophysiological substrate. Thus, ECGI can map the VT activation sequence and identify the location and depth of VT origin in individual patients, allowing personalized treatment of patients with ventricular arrhythmias.
Collapse
Affiliation(s)
- Yong Wang
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO 63110, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Fishman GI, Chugh SS, Dimarco JP, Albert CM, Anderson ME, Bonow RO, Buxton AE, Chen PS, Estes M, Jouven X, Kwong R, Lathrop DA, Mascette AM, Nerbonne JM, O'Rourke B, Page RL, Roden DM, Rosenbaum DS, Sotoodehnia N, Trayanova NA, Zheng ZJ. Sudden cardiac death prediction and prevention: report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop. Circulation 2011; 122:2335-48. [PMID: 21147730 DOI: 10.1161/circulationaha.110.976092] [Citation(s) in RCA: 443] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Glenn I Fishman
- NYU School of Medicine, Division of Cardiology, 522 First Avenue, Smilow 801, New York, NY 10016, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Silva JNA, Ghosh S, Bowman TM, Rhee EK, Woodard PK, Rudy Y. Cardiac resynchronization therapy in pediatric congenital heart disease: insights from noninvasive electrocardiographic imaging. Heart Rhythm 2009; 6:1178-85. [PMID: 19632630 DOI: 10.1016/j.hrthm.2009.04.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Accepted: 04/10/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Electrocardiographic imaging (ECGI) is a novel electrophysiologic imaging modality that may help guide patient selection and lead placement for cardiac resynchronization therapy (CRT). OBJECTIVE The purpose of this study was to apply noninvasive ECGI to pediatric heart failure patients with congenital heart disease (CHD) undergoing evaluation for CRT. METHODS ECGI was applied in eight patients with CHD who were either being evaluated for CRT or undergoing CRT. An electrical dyssynchrony (ED) index was computed from the ECGI epicardial activation maps as the standard deviation of activation times at 500 epicardial sites of the systemic ventricle. A normal ED of 20 +/- 4 ms was calculated from a control group of normal pediatric patients. RESULTS Four patients had an ECGI assessment for ED but did not undergo CRT implant. Two other patients had ECGI assessment pre-CRT that demonstrated abnormal ED and went on to CRT implant. In both cases, the resynchronization lead was placed at the site of latest electrical activation (as determined by ECGI) in pre-CRT baseline rhythm. A total of four patients (two responders, two nonresponders) were studied with post-CRT in multiple rhythms. Responders had an average ED of 22 ms in optimal CRT conditions. The nonresponder had very elevated ED (37 ms) in all rhythms including optimal CRT settings. ED and ECG QRS duration showed weak correlation (r = 0.58). CONCLUSIONS ECGI can be used in pediatric heart failure patients to evaluate ventricular ED and identify suitable candidates for CRT. In addition, ECGI can guide resynchronization lead placement to the area of latest electrical activation. It could also be used in noninvasive follow-ups for assessing synchrony and the electrophysiological substrate over time.
Collapse
Affiliation(s)
- Jennifer N A Silva
- Division of Pediatric Cardiology, Washington University School of Medicine/St Louis Children's Hospital, Washington University, St Louis, Missouri 63130-4899, USA
| | | | | | | | | | | |
Collapse
|
14
|
Avari JN, Rhee EK. Cardiac resynchronization therapy for pediatric heart failure. Heart Rhythm 2008; 5:1476-8. [PMID: 18672406 DOI: 10.1016/j.hrthm.2008.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Indexed: 10/22/2022]
Affiliation(s)
- Jennifer N Avari
- Division of Pediatric Cardiology, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri 63110, USA.
| | | |
Collapse
|