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Locati ET, Van Dam PM, Ciconte G, Heilbron F, Boonstra M, Vicedomini G, Micaglio E, Ćalović Ž, Anastasia L, Santinelli V, Pappone C. Electrocardiographic temporo-spatial assessment of depolarization and repolarization changes after epicardial arrhythmogenic substrate ablation in Brugada syndrome. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:473-487. [PMID: 38045442 PMCID: PMC10689926 DOI: 10.1093/ehjdh/ztad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 12/05/2023]
Abstract
Aims In Brugada syndrome (BrS), with spontaneous or ajmaline-induced coved ST elevation, epicardial electro-anatomic potential duration maps (epi-PDMs) were detected on a right ventricle (RV) outflow tract (RVOT), an arrhythmogenic substrate area (AS area), abolished by epicardial-radiofrequency ablation (EPI-AS-RFA). Novel CineECG, projecting 12-lead electrocardiogram (ECG) waveforms on a 3D heart model, previously localized depolarization forces in RV/RVOT in BrS patients. We evaluate 12-lead ECG and CineECG depolarization/repolarization changes in spontaneous type-1 BrS patients before/after EPI-AS-RFA, compared with normal controls. Methods and results In 30 high-risk BrS patients (93% males, age 37 + 9 years), 12-lead ECGs and epi-PDMs were obtained at baseline, early after EPI-AS-RFA, and late follow-up (FU) (2.7-16.1 months). CineECG estimates temporo-spatial localization during depolarization (Early-QRS and Terminal-QRS) and repolarization (ST-Tpeak, Tpeak-Tend). Differences within BrS patients (baseline vs. early after EPI-AS-RFA vs. late FU) were analysed by Wilcoxon signed-rank test, while differences between BrS patients and 60 age-sex-matched normal controls were analysed by the Mann-Whitney test. In BrS patients, baseline QRS and QTc durations were longer and normalized after EPI-AS-ATC (151 ± 15 vs. 102 ± 13 ms, P < 0.001; 454 ± 40 vs. 421 ± 27 ms, P < 0.000). Baseline QRS amplitude was lower and increased at late FU (0.63 ± 0.26 vs. 0.84 ± 13 ms, P < 0.000), while Terminal-QRS amplitude decreased (0.24 ± 0.07 vs. 0.08 ± 0.03 ms, P < 0.000). At baseline, CineECG depolarization/repolarization wavefront prevalently localized in RV/RVOT (Terminal-QRS, 57%; ST-Tpeak, 100%; and Tpeak-Tend, 61%), congruent with the AS area on epi-PDM. Early after EPI-AS-RFA, RV/RVOT localization during depolarization disappeared, as Terminal-QRS prevalently localized in the left ventricle (LV, 76%), while repolarization still localized on RV/RVOT [ST-Tpeak (44%) and Tpeak-Tend (98%)]. At late FU, depolarization/repolarization forces prevalently localized in the LV (Terminal-QRS, 94%; ST-Tpeak, 63%; Tpeak-Tend, 86%), like normal controls. Conclusion CineECG and 12-lead ECG showed a complex temporo-spatial perturbation of both depolarization and repolarization in BrS patients, prevalently localized in RV/RVOT, progressively normalizing after epicardial ablation.
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Affiliation(s)
- Emanuela T Locati
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Peter M Van Dam
- Cardiology Department, Utrecht University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Kopernika 7e, 31-034 Kraków, Poland
| | - Giuseppe Ciconte
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Francesca Heilbron
- Milano Bicocca University, Istituto Auxologico, Via Thomas Mann 8, 20162 Milan, Italy
| | - Machteld Boonstra
- Cardiology Department, Utrecht University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - Gabriele Vicedomini
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Emanuele Micaglio
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Žarko Ćalović
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Luigi Anastasia
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Carlo Pappone
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
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Frosted R, Paludan-Müller C, Vad OB, Olesen MS, Bundgaard H, van Dam P, Christensen AH. CineECG analysis provides new insights into Familial ST-segment Depression Syndrome. Europace 2023; 25:euad116. [PMID: 37140072 PMCID: PMC10228618 DOI: 10.1093/europace/euad116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/04/2023] [Indexed: 05/05/2023] Open
Abstract
AIMS Familial ST-segment Depression Syndrome (Fam-STD) is a novel inherited cardiac disease associated with arrhythmias and sudden cardiac death. This study aimed at investigating the cardiac activation pathway in patients with Fam-STD, modelling the electrocardiogram (ECG) phenotype, and performing in-depth ST-segment analyses. METHODS AND RESULTS CineECG analysis of patients with Fam-STD and age- and sex-matched controls. The groups were compared using the CineECG software which included the trans-cardiac ratio and the electrical activation pathway. We simulated the Fam-STD ECG phenotype by adjusting action potential duration (APD) and action potential amplitude (APA) in specific cardiac regions. High-resolution ST-segment analyses were performed per lead by dividing the ST-segment into nine 10 ms subintervals. Twenty-seven Fam-STD patients (74% females, mean age 51.6 ± 6.2 years) and 83 matched controls were included. Among Fam-STD patients, electrical activation pathway analysis in the anterior-basal orientation showed significantly abnormal direction toward the basal areas of the heart starting from QRS 60-89 ms until Tpeak-Tend (all P < 0.001). Simulations with shortened APD and reduced APA in the left ventricle basal regions recapitulated the Fam-STD ECG phenotype. Detailed ST-segment analyses showed significant differences in all nine 10 ms subintervals (all P < 0.01), with the most prominent findings during the 70-79/80-89 ms intervals. CONCLUSION CineECG analyses indicated abnormal repolarization with basal directions, and the Fam-STD ECG phenotype was simulated by reducing APD and APA in the left ventricle basal regions. Detailed ST-analysis showed amplitudes consistent with the proposed diagnostic criteria for Fam-STD patients. Our findings provide new insight into the electrophysiological abnormalities of Fam-STD.
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Affiliation(s)
- Rasmus Frosted
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital—Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 11, 2730 Herlev, Denmark
| | - Christian Paludan-Müller
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Laboratory for Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Oliver Bundgaard Vad
- Laboratory for Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Morten Salling Olesen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Laboratory for Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Peter van Dam
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- ECG Excellence BV, Weijland 38, 2415 BC Nieuwerbrug, The Netherlands
| | - Alex Hørby Christensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital—Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 11, 2730 Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Robustness of imageless electrocardiographic imaging against uncertainty in atrial morphology and location. J Electrocardiol 2023; 77:58-61. [PMID: 36634462 DOI: 10.1016/j.jelectrocard.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/13/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Electrocardiographic Imaging is a non-invasive technique that requires cardiac Imaging for the reconstruction of cardiac electrical activity. In this study, we explored imageless ECGI by quantifying the errors of using heart meshes with either an inaccurate location inside the thorax or an inaccurate geometry. METHODS Multiple‑lead body surface recordings of 25 atrial fibrillation (AF) patients were recorded. Cardiac atrial meshes were obtained by segmentation of medical images obtained for each patient. ECGI was computed with each patient's segmented atrial mesh and compared with the ECGI obtained under errors in the atrial mesh used for ECGI estimation. We modeled both the uncertainty in the location of the atria inside the thorax by artificially translating the atria inside the thorax and the geometry of the atrial mesh by using an atrial mesh in a reference database. ECGI signals obtained with the actual meshes and the translated or estimated meshes were compared in terms of their correlation coefficients, relative difference measurement star, and errors in the dominant frequency (DF) estimation in epicardial nodes. RESULTS CC between ECGI signals obtained after translating the actual atrial meshes from the original position by 1 cm was above 0.97. CC between ECGIs obtained with patient specific atrial geometry and estimated atrial geometries was 0.93 ± 0.11. Mean errors in DF estimation using an estimated atrial mesh were 7.6 ± 5.9%. CONCLUSION Imageless ECGI can provide a robust estimation of cardiac electrophysiological parameters such as activation rates even during complex arrhythmias. Furthermore, it can allow more widespread use of ECGI in clinical practice.
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Yurasova ES, Blinova EV, Sakhnova TA. On the history of vectorcardiography: past, present, future. TERAPEVT ARKH 2022; 94:1122-1125. [DOI: 10.26442/00403660.2022.09.201841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Indexed: 11/05/2022]
Abstract
The vector concept in the analysis of the electrical signals of the heart began to be used at the dawn of the development of electrocardiology. For several decades, vectorcardiography has developed in parallel with electrocardiography; reached its peak in the 60s, and after a period of cooling experienced a resurgence since the early 90s, when it became possible to mathematically synthesize vectorcardiograms (VCG) from digital electrocardiograms in 12 leads. VCG reflects the same phenomena as electrocardiography, but allows you to calculate and visualize a number of three-dimensional characteristics of the electrical signals of the heart. The article describes the main milestones in the development of the VCG, the history of international cooperation in this area, the contribution of domestic scientists to this field of science. Modern promising areas of research related to the vector concept of the analysis of the electrical signals of the heart are briefly reflected.
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Locati ET, Pappone C, Heilbron F, van Dam PM. CineECG provides a novel anatomical view on the normal atrial P-wave. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:169-180. [PMID: 36713023 PMCID: PMC9708036 DOI: 10.1093/ehjdh/ztac007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/09/2022] [Accepted: 02/03/2022] [Indexed: 02/01/2023]
Abstract
Aims Novel CineECG computed from standard 12-lead electrocardiogram (ECG) correlated the ventricular electric activity to ventricular anatomy. CineECG was never applied to reconstruct the spatial distribution of normal atrial electric activity into an atrial anatomic model. Methods and results From 6409 normal ECGs from PTB-XL database, we computed a median beat with fiducial points for P-and Q-onset. To determine the temporo-spatial location of atrial activity during PQ-interval, CineECG was computed on a normal 58-year-old male atrial/torso model. CineECG was projected to three major cardiac axes: posterior-anterior, right-left, base-roof, and to the standard cardiac four-chamber, left anterior oblique, and right anterior oblique (RAO) views. In 6409 normal subjects, during P-wave, CineECG moved homogeneously from right atrial roof towards left atrial base (-54 ± 14° in four-chamber view, 95 ± 24° RAO view). During terminal PQ-interval, the CineECG direction was opposite, moving towards left atrial roof (62 ± 27° in four-chamber view, 78 ± 27° RAO view). We identified the deflection point, where the atrial CineECG changes in direction. The time from P-onset to deflection point was similar to P-wave duration. Conclusion CineECG provided a novel three-dimensional visualization of atrial electrical activity during the PQ-interval, relating atrial electrical activity to the atrial anatomy. CineECG location during P-wave and terminal PQ-interval were homogeneous within normal controls. CineECG and its deflection point may enable the early detection of atrial conduction disorders predisposing to atrial arrhythmias.
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Affiliation(s)
- Emanuela T Locati
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, Milano, Italy
| | - Carlo Pappone
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, Milano, Italy,University San Raffaele Vita & Salute, Milano, Italy
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Boonstra MJ, Brooks DH, Loh P, van Dam PM. CineECG: A novel method to image the average activation sequence in the heart from the 12-lead ECG. Comput Biol Med 2022; 141:105128. [PMID: 34973587 DOI: 10.1016/j.compbiomed.2021.105128] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/03/2022]
Abstract
The standard 12-lead electrocardiogram (ECG) is a diagnostic tool to asses cardiac electrical activity. The vectorcardiogram is a related tool that represents that activity as the direction of a vector. In this work we investigate CineECG, a new 12-lead ECG based analysis method designed to directly estimate the average cardiac anatomical location of activation over time. We describe CineECG calculation and a novel comparison parameter, the average isochrone position (AIP). In a model study, fourteen different activation sequences were simulated and corresponding 12-lead ECGs were computed. The CineECG was compared to AIP in terms of location and direction. In addition, 67-lead body surface potential maps from ten patients were used to study the sensitivity of CineECG to electrode mispositioning and anatomical model selection. Epicardial activation maps from four patients were used for further evaluation. The average distance between CineECG and AIP across the fourteen sequences was 23.7 ± 2.4 mm, with significantly better agreement in the terminal (27.3 ± 5.7 mm) versus the initial QRS segment (34.2 ± 6.1 mm). Up to four cm variation in electrode positioning produced an average distance of 6.5 ± 4.5 mm between CineECG trajectories, while substituting a generic heart/torso model for a patient-specific one produced an average difference of 6.1 ± 4.8 mm. Dominant epicardial activation map features were recovered. Qualitatively, CineECG captured significant features of activation sequences and was robust to electrode misplacement. CineECG provides a realistic representation of the average cardiac activation in normal and diseased hearts. In particular, the terminal segment of the CineECG might be useful to detect pathology.
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Affiliation(s)
- Machteld J Boonstra
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Dana H Brooks
- Electrical and Computer Engineering, Northeastern University, Boston, MA, 02115, USA
| | - Peter Loh
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter M van Dam
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; ECG Excellence BV, Nieuwerbrug aan den Rijn, the Netherlands.
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Boonstra MJ, Hilderink BN, Locati ET, Asselbergs FW, Loh P, van Dam PM. Novel CineECG enables anatomical 3D localization and classification of bundle branch blocks. Europace 2021; 23:i80-i87. [PMID: 33751077 DOI: 10.1093/europace/euaa396] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Ventricular conduction disorders can induce arrhythmias and impair cardiac function. Bundle branch blocks (BBBs) are diagnosed by 12-lead electrocardiogram (ECG), but discrimination between BBBs and normal tracings can be challenging. CineECG computes the temporo-spatial trajectory of activation waveforms in a 3D heart model from 12-lead ECGs. Recently, in Brugada patients, CineECG has localized the terminal components of ventricular depolarization to right ventricle outflow tract (RVOT), coincident with arrhythmogenic substrate localization detected by epicardial electro-anatomical maps. This abnormality was not found in normal or right BBB (RBBB) patients. This study aimed at exploring whether CineECG can improve the discrimination between left BBB (LBBB)/RBBB, and incomplete RBBB (iRBBB). METHODS AND RESULTS We utilized 500 12-lead ECGs from the online Physionet-XL-PTB-Diagnostic ECG Database with a certified ECG diagnosis. The mean temporo-spatial isochrone trajectory was calculated and projected into the anatomical 3D heart model. We established five CineECG classes: 'Normal', 'iRBBB', 'RBBB', 'LBBB', and 'Undetermined', to which each tracing was allocated. We determined the accuracy of CineECG classification with the gold standard diagnosis. A total of 391 ECGs were analysed (9 ECGs were excluded for noise) and 240/266 were correctly classified as 'normal', 14/17 as 'iRBBB', 55/55 as 'RBBB', 51/51 as 'LBBB', and 31 as 'undetermined'. The terminal mean temporal spatial isochrone contained most information about the BBB localization. CONCLUSION CineECG provided the anatomical localization of different BBBs and accurately differentiated between normal, LBBB and RBBB, and iRBBB. CineECG may aid clinical diagnostic work-up, potentially contributing to the difficult discrimination between normal, iRBBB, and Brugada patients.
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Affiliation(s)
- Machteld J Boonstra
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht 3508 GA, Heidelberglaan 100, Utrecht, The Netherlands
| | - Bashar N Hilderink
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht 3508 GA, Heidelberglaan 100, Utrecht, The Netherlands
| | - Emanuela T Locati
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, Milano, Italy
| | - Folkert W Asselbergs
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht 3508 GA, Heidelberglaan 100, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - Peter Loh
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht 3508 GA, Heidelberglaan 100, Utrecht, The Netherlands
| | - Peter M van Dam
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht 3508 GA, Heidelberglaan 100, Utrecht, The Netherlands.,ECG Excellence BV, Nieuwerbrug aan den Rijn, The Netherlands
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van Dam PM, Boonstra M, Locati ET, Loh P. The relation of 12 lead ECG to the cardiac anatomy: The normal CineECG. J Electrocardiol 2021; 69S:67-74. [PMID: 34325899 DOI: 10.1016/j.jelectrocard.2021.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/02/2021] [Accepted: 07/17/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The interpretation of the 12‑lead ECG is notoriously difficult and requires experts to distinguish normal from abnormal ECG waveforms. ECG waveforms depend on body build and electrode positions, both often different in males and females. To relate the ECG waveforms to cardiac anatomical structures is even more difficult. The novel CineECG algorithm enables a direct projection of the 12‑lead ECG to the cardiac anatomy by computing the mean location of cardiac activity over time. The aim of this study is to investigate the cardiac locations of the CineECG derived from standard 12‑lead ECGs of normal subjects. METHODS In this study we used 6525 12‑lead ECG tracings labelled as normal obtained from the certified Physionet PTB XL Diagnostic ECG Database to construct the CineECG. All 12 lead ECGs were analyzed, and then divided by age groups (18-29,30-39,40-49,50-59,60-69,70-100 years) and by gender (male/female). For each ECG, we computed the CineECG within a generic 3D heart/torso model. Based on these CineECG's, the average normal cardiac location and direction for QRS, STpeak, and TpeakTend segments were determined. RESULTS The CineECG direction for the QRS segment showed large variation towards the left free wall, whereas the STT segments were homogeneously directed towards the septal/apical region. The differences in the CineECG location for the QRS, STpeak, and TpeakTend between the age and gender groups were relatively small (maximally 10 mm at end T-wave), although between the gender groups minor differences were found in the 4 chamber direction angles (QRS 4°, STpeak 5°, and TpeakTend 8°) and LAO (QRS 1°, STpeak 13°, and TpeakTend 30°). CONCLUSION CineECG demonstrated to be a feasible and pragmatic solution for ECG waveform interpretation, relating the ECG directly to the cardiac anatomy. The variations in depolarization and repolarization CineECG were small within this group of normal healthy controls, both in cardiac location as well as in direction. CineECG may enable an easier discrimination between normal and abnormal QRS and T-wave morphologies, reducing the amount of expert training. Further studies are needed to prove whether novel CineECG can significantly contribute to the discrimination of normal versus abnormal ECG tracings.
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Affiliation(s)
- Peter M van Dam
- Department of Cardiology, University Medical Center Utrecht, the Netherlands; ECG Excellence BV, Nieuwerbrug aan den Rijn, Netherlands.
| | - Machteld Boonstra
- Department of Cardiology, University Medical Center Utrecht, the Netherlands
| | - Emanuela T Locati
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, Milano, Italy
| | - Peter Loh
- Department of Cardiology, University Medical Center Utrecht, the Netherlands
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9
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van Dam PM, Locati ET, Ciconte G, Borrelli V, Heilbron F, Santinelli V, Vicedomini G, Monasky MM, Micaglio E, Giannelli L, Mecarocci V, Ćalović Ž, Anastasia L, Pappone C. Novel CineECG Derived From Standard 12-Lead ECG Enables Right Ventricle Outflow Tract Localization of Electrical Substrate in Patients With Brugada Syndrome. Circ Arrhythm Electrophysiol 2020; 13:e008524. [DOI: 10.1161/circep.120.008524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
In Brugada syndrome (BrS), diagnosed in presence of a spontaneous or ajmaline-induced type-1 pattern, ventricular arrhythmias originate from the right ventricle outflow tract (RVOT). We developed a novel CineECG method, obtained by inverse electrocardiogram (ECG) from standard 12-lead ECG, to localize the electrical activity pathway in patients with BrS.
Methods:
The CineECG enabled the temporospatial localization of the ECG waveforms, deriving the mean temporospatial isochrone from standard 12-lead ECG. The study sample included (1) 15 patients with spontaneous type-1 Brugada pattern, and (2) 18 patients with ajmaline-induced BrS (at baseline and after ajmaline), in whom epicardial potential duration maps were available; (3) 17 type-3 BrS pattern patients not showing type-1 BrS pattern after ajmaline (ajmaline-negative); (4) 47 normal subjects; (5) 18 patients with right bundle branch block (RBBB). According to CineECG algorithm, each ECG was classified as Normal, Brugada, RBBB, or Undetermined.
Results:
In patients with spontaneous or ajmaline-induced BrS, CineECG localized the terminal mean temporospatial isochrone forces in the RVOT, congruent with the arrhythmogenic substrate location detected by epicardial potential duration maps. The RVOT location was never observed in normal, RBBB, or ajmaline-negative patients. In most patients with ajmaline-induced BrS (78%), the RVOT location was already evident at baseline. The CineECG classified all normal subjects and ajmaline-negative patients at baseline as Normal or Undetermined, all patients with RBBB as RBBB, whereas all patients with spontaneous and ajmaline-induced BrS as Brugada. Compared with standard 12-lead ECG, CineECG at baseline had a 100% positive predictive value and 81% negative predictive value in predicting ajmaline test results.
Conclusions:
In patients with spontaneous and ajmaline-induced BrS, the CineECG localized the late QRS activity in the RVOT, a phenomenon never observed in normal, RBBB, or ajmaline-negative patients. The possibility to identify the RVOT as the location of the arrhythmogenic substrate by the noninvasive CineECG, based on the standard 12-lead ECG, opens new prospective for diagnosing patients with BrS.
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Affiliation(s)
- Peter M. van Dam
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (P.M.v.D.)
- ECG Excellence BV, Nieuwerbrug aan den Rijn, the Netherlands (P.M.v.D.)
| | - Emanuela T. Locati
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Giuseppe Ciconte
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Valeria Borrelli
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Francesca Heilbron
- Milano Bicocca University, Istituto Auxologico Italiano San Luca, Milan, Italy (F.H.)
| | - Vincenzo Santinelli
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Gabriele Vicedomini
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Michelle M. Monasky
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Emanuele Micaglio
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Luigi Giannelli
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Valerio Mecarocci
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Žarko Ćalović
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
| | - Luigi Anastasia
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
- Vita-Salute San Raffaele University (L.A., C.P.)
| | - Carlo Pappone
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (E.T.L., G.C., V.B., V.S., G.V., M.M.M., E.M., L.G., V.M., Z.C., L.A, C.P.)
- Vita-Salute San Raffaele University (L.A., C.P.)
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10
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Asatryan B, Ebrahimi R, Strebel I, van Dam PM, Kühne M, Knecht S, Spies F, Abächerli R, Badertscher P, Kozhuharov N, Zeljkovic I, Schaer B, Osswald S, Sticherling C, Reichlin T. Man vs machine: Performance of manual vs automated electrocardiogram analysis for predicting the chamber of origin of idiopathic ventricular arrhythmia. J Cardiovasc Electrophysiol 2019; 31:410-416. [PMID: 31840899 DOI: 10.1111/jce.14320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/23/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation of idiopathic ventricular arrhythmias (VAs) is performed to eliminate symptoms and to prevent or reverse arrhythmia-induced cardiomyopathy. Preprocedural prediction of the chamber of VA origin is critical for patient counseling, procedure planning, and guidance of invasive mapping. OBJECTIVE We aimed to assess the performance of manual expert versus automated 12-lead electrocardiogram (ECG) analysis in the prediction of VA origin. METHODS Patients with ablation of idiopathic VA and sustained success were included. The VA origin was defined as the site where ablation caused arrhythmia suppression. Standard baseline 12-lead ECGs with documentation of the VA were analyzed manually in a blinded fashion by three electrophysiologists and three electrophysiology (EP) fellows. In addition, the same standard 12-lead ECG was analyzed by an automated computer algorithm using a vectorcardiographic approach. RESULTS Thirty-eight patients (median age, 47 [interquartile range, 37-58]; 68% female) were enrolled. The VA originated from the right ventricle in 24 (63%) and the left ventricle in 14 (37%) patients. The electrophysiologists and EP fellows identified the VA chamber of origin with a similar accuracy of 73% and 72% (P = .72). The automated algorithm showed a higher accuracy of 89% (P = .03 compared with electrophysiologists and EP fellows). This resulted in a sensitivity of 95% and specificity of 86%. CONCLUSION While the manual ECG analysis of the standard 12-lead ECG by both electrophysiologists and EP fellows correctly identified the chamber of VA origin in around 75% of cases, an automated vectorcardiographic computer algorithm achieved an accuracy of 89% with clinically acceptable diagnostic parameters.
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Affiliation(s)
- Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ramin Ebrahimi
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Ivo Strebel
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Peter M van Dam
- Department of Cardiology, UMC Utrecht, Utrecht, The Netherlands.,Peacs BV, Nieuwerbrug aan den Rijn, The Netherlands
| | - Michael Kühne
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Florian Spies
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Roger Abächerli
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,Institute of Medical Engineering (IMT), Lucerne University of Applied Sciences and Arts, Horw, Switzerland
| | - Patrick Badertscher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Ivan Zeljkovic
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Beat Schaer
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
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