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Stoks J, Patel KHK, van Rees B, Nguyen UC, Mihl C, Deissler PM, ter Bekke RMA, Peeters R, Vijgen J, Dendale P, Ng FS, Cluitmans MJM, Volders PGA. Variant patterns of electrical activation and recovery in normal human hearts revealed by noninvasive electrocardiographic imaging. Europace 2024; 26:euae172. [PMID: 38970395 PMCID: PMC11226755 DOI: 10.1093/europace/euae172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/13/2024] [Indexed: 07/08/2024] Open
Abstract
AIMS Although electrical activity of the normal human heart is well characterized by the electrocardiogram, detailed insights into within-subject and between-subject variations of ventricular activation and recovery by noninvasive electroanatomic mapping are lacking. We characterized human epicardial activation and recovery within and between normal subjects using non-invasive electrocardiographic imaging (ECGI) as a basis to better understand pathology. METHODS AND RESULTS Epicardial activation and recovery were assessed by ECGI in 22 normal subjects, 4 subjects with bundle branch block (BBB) and 4 with long-QT syndrome (LQTS). We compared characteristics between the ventricles [left ventricle (LV) and right ventricle (RV)], sexes, and age groups (<50/≥50years). Pearson's correlation coefficient (CC) was used for within-subject and between-subject comparisons. Age of normal subjects averaged 49 ± 14 years, 6/22 were male, and no structural/electrical heart disease was present. The average activation time was longer in LV than in RV, but not different by sex or age. Electrical recovery was similar for the ventricles, but started earlier and was on average shorter in males. Median CCs of between-subject comparisons of the ECG signals, activation, and recovery patterns were 0.61, 0.32, and 0.19, respectively. Within-subject beat-to-beat comparisons yielded higher CCs (0.98, 0.89, and 0.82, respectively). Activation and/or recovery patterns of patients with BBB or LQTS contrasted significantly with those found in the normal population. CONCLUSION Activation and recovery patterns vary profoundly between normal subjects, but are stable individually beat to beat, with a male preponderance to shorter recovery. Individual characterization by ECGI at baseline serves as reference to better understand the emergence, progression, and treatment of electrical heart disease.
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Affiliation(s)
- Job Stoks
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Advanced Computing Sciences, Maastricht University, Maastricht, The Netherlands
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
- Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium
| | | | - Bianca van Rees
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Uyen Chau Nguyen
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Casper Mihl
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Peter M Deissler
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rachel M A ter Bekke
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ralf Peeters
- Department of Advanced Computing Sciences, Maastricht University, Maastricht, The Netherlands
| | - Johan Vijgen
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
- Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium
| | - Paul Dendale
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
- Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium
| | - Fu Siong Ng
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Matthijs J M Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
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2
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Patel KHK, Bajaj N, Statton BK, Bishop MJ, Herath NS, Stoks J, Li X, Sau A, Nyamakope K, Davidson R, Savvidou S, Agha-Jaffar D, Coghlin JA, Brezitski M, Bergman H, Berry A, Ardissino M, de Marvao A, Cousins J, Ware JS, Purkayastha S, Volders P, Peters NS, O'Regan DP, Coronel R, Cluitmans M, Lambiase PD, Ng FS. Bariatric surgery partially reverses subclinical proarrhythmic structural, electrophysiological, and autonomic changes in obesity. Heart Rhythm 2024:S1547-5271(24)02665-1. [PMID: 38825299 DOI: 10.1016/j.hrthm.2024.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Obesity confers higher risks of cardiac arrhythmias. The extent to which weight loss reverses subclinical proarrhythmic adaptations in arrhythmia-free obese individuals is unknown. OBJECTIVE The purpose of this study was to study structural, electrophysiological, and autonomic remodeling in arrhythmia-free obese patients and their reversibility with bariatric surgery using electrocardiographic imaging (ECGi). METHODS Sixteen arrhythmia-free obese patients (mean age 43 ± 12 years; 13 (81%) female participants; BMI 46.7 ± 5.5 kg/m2) had ECGi pre-bariatric surgery, of whom 12 (75%) had ECGi postsurgery (BMI 36.8 ± 6.5 kg/m2). Sixteen age- and sex-matched lean healthy individuals (mean age 42 ± 11 years; BMI 22.8 ± 2.6 kg/m2) acted as controls and had ECGi only once. RESULTS Obesity was associated with structural (increased epicardial fat volumes and left ventricular mass), autonomic (blunted heart rate variability), and electrophysiological (slower atrial conduction and steeper ventricular repolarization time gradients) remodeling. After bariatric surgery, there was partial structural reverse remodeling, with a reduction in epicardial fat volumes (68.7 cm3 vs 64.5 cm3; P = .0010) and left ventricular mass (33 g/m2.7 vs 25 g/m2.7; P < .0005). There was also partial electrophysiological reverse remodeling with a reduction in mean spatial ventricular repolarization gradients (26 mm/ms vs 19 mm/ms; P = .0009), although atrial activation remained prolonged. Heart rate variability, quantified by standard deviation of successive differences in R-R intervals, was also partially improved after bariatric surgery (18.7 ms vs 25.9 ms; P = .017). Computational modeling showed that presurgical obese hearts had a larger window of vulnerability to unidirectional block and had an earlier spiral-wave breakup with more complex reentry patterns than did postsurgery counterparts. CONCLUSION Obesity is associated with adverse electrophysiological, structural, and autonomic remodeling that is partially reversed after bariatric surgery. These data have important implications for bariatric surgery weight thresholds and weight loss strategies.
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Affiliation(s)
| | - Nikesh Bajaj
- National Heart & Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | - Ben K Statton
- Medical Research Council London Laboratory of Medical Sciences, London, United Kingdom
| | | | - Nihara S Herath
- National Heart & Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | - Job Stoks
- Maastricht University, Maastricht, The Netherlands
| | - Xinyang Li
- National Heart & Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | - Arunashis Sau
- National Heart & Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | - Kimberley Nyamakope
- National Heart & Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | - Ross Davidson
- National Heart & Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | - Stelutsa Savvidou
- National Heart & Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | - Danya Agha-Jaffar
- National Heart & Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | - Joseph A Coghlin
- National Heart & Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | - Maria Brezitski
- Medical Research Council London Laboratory of Medical Sciences, London, United Kingdom
| | - Hannah Bergman
- Medical Research Council London Laboratory of Medical Sciences, London, United Kingdom
| | - Alaine Berry
- Medical Research Council London Laboratory of Medical Sciences, London, United Kingdom
| | - Maddalena Ardissino
- National Heart & Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | - Antonio de Marvao
- Medical Research Council London Laboratory of Medical Sciences, London, United Kingdom
| | | | - James S Ware
- National Heart & Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | | | - Paul Volders
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Nicholas S Peters
- National Heart & Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | - Declan P O'Regan
- Medical Research Council London Laboratory of Medical Sciences, London, United Kingdom
| | - Ruben Coronel
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | | | - Fu Siong Ng
- National Heart & Lung Institute (NHLI), Imperial College London, London, United Kingdom.
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van der Waal J, Meijborg V, Coronel R, Dubois R, Oostendorp T. Basis and applicability of noninvasive inverse electrocardiography: a comparison between cardiac source models. Front Physiol 2023; 14:1295103. [PMID: 38152249 PMCID: PMC10752226 DOI: 10.3389/fphys.2023.1295103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/30/2023] [Indexed: 12/29/2023] Open
Abstract
The body surface electrocardiogram (ECG) is a direct result of electrical activity generated by the myocardium. Using the body surface ECGs to reconstruct cardiac electrical activity is called the inverse problem of electrocardiography. The method to solve the inverse problem depends on the chosen cardiac source model to describe cardiac electrical activity. In this paper, we describe the theoretical basis of two inverse methods based on the most commonly used cardiac source models: the epicardial potential model and the equivalent dipole layer model. We discuss similarities and differences in applicability, strengths and weaknesses and sketch a road towards improved inverse solutions by targeted use, sequential application or a combination of the two methods.
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Affiliation(s)
- Jeanne van der Waal
- Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Veronique Meijborg
- Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Ruben Coronel
- Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Rémi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac, France
| | - Thom Oostendorp
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
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4
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Elliott MK, Strocchi M, Sieniewicz BJ, Mehta V, Wijesuriya N, deVere F, Howell S, Thorpe A, Martic D, Bishop MJ, Niederer S, Rinaldi CA. Left bundle branch area pacing reduces epicardial dispersion of repolarization compared with biventricular cardiac resynchronization therapy. Heart Rhythm 2023; 20:1629-1636. [PMID: 37516414 DOI: 10.1016/j.hrthm.2023.07.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Biventricular endocardial pacing (BiV-endo) and left bundle branch area pacing (LBBAP) are novel methods of delivering cardiac resynchronization therapy. These techniques are associated with improved activation times and acute hemodynamic response compared with conventional biventricular epicardial pacing (BiV-epi); however, the effects on repolarization and arrhythmic risk are unknown. OBJECTIVE The purpose of this study was to compare the effects of temporary BiV-epi, BiV-endo, and LBBAP on epicardial left ventricular (LV) repolarization using electrocardiographic imaging (ECGi). METHODS Eleven patients indicated for cardiac resynchronization therapy underwent a temporary pacing protocol with ECGi. BiV-endo was delivered via endocardial stimulation of the LV lateral wall. LBBAP was delivered by pacing the LV septum. Epicardial LV repolarization time (LVRT-95; time taken for 95% of the LV to repolarize), LV RT dispersion, mean LV activation recovery interval (ARI), LV ARI dispersion, and RT gradients were calculated. RESULTS The protocol was completed in 10 patients. During LBBAP, there were significant reductions in LVRT-95 (94.9 ± 17.4 ms vs 125.0 ± 29.4 ms; P = .03) and LV RT dispersion (29.4 ± 6.3 ms vs 40.8 ± 11.4 ms; P = .015) compared with BiV-epi. In contrast, there were no significant differences between baseline, BiV-epi, or BiV-endo. There was a nonsignificant reduction in mean RT gradients between LBBAP and baseline rhythm (0.74 ± 0.22 ms/mm vs 1.01 ± 0.31 ms/mm; P = .07). There were no significant differences in mean LV ARI or LV ARI dispersion between groups. CONCLUSION Temporary LBBAP reduces epicardial dispersion of repolarization compared with conventional BiV-epi. Further study is required to determine whether these repolarization changes on ECGi translate into a reduced risk of ventricular arrhythmia in clinical practice.
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Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Benjamin J Sieniewicz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Felicity deVere
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sandra Howell
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrew Thorpe
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Dejana Martic
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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5
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Manche M, El Houari K, Kachenoura A, Albera L, Rochette M, Hernández A, Moussaoui S. A reduced complexity ECG imaging model for regularized inversion optimization. Comput Biol Med 2023; 167:107698. [PMID: 37956624 DOI: 10.1016/j.compbiomed.2023.107698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023]
Abstract
The resolution of the inverse problem of electrocardiography represents a major interest in the diagnosis and catheter-based therapy of cardiac arrhythmia. In this context, the ability to simulate several cardiac electrical behaviors was crucial for evaluating and comparing the performance of inversion methods. For this application, existing models are either too complex or do not produce realistic cardiac patterns. In this work, a low-resolution heart-torso model generating realistic whole heart cardiac mappings and electrocardiograms in healthy and pathological cases is designed. This model was built upon a simplified heart-torso geometry and implements the monodomain formalism by using the finite element method. In addition, a model reduction step through a sensitivity analysis was proposed where parameters were identified using an evolutionary optimization approach. Finally, the study illustrates the usefulness of the proposed model by comparing the performance of different variants of Tikhonov-based inversion methods for the determination of the regularization parameter in healthy, ischemic and ventricular tachycardia scenarios. First, results of the sensitivity analysis show that among 58 parameters only 25 are influent. Note also that the level of influence of the parameters depends on the heart region. Besides, the synthesized electrocardiograms globally present the same characteristic shape compared to the reference once with a correlation value that reaches 88%. Regarding inverse problem, results highlight that only Robust Generalized Cross Validation and Discrepancy Principle provide best performance, with a quasi-perfect success rate for both, and a respective relative error, between the generated electrocardiograms to the reference one, of 0.75 and 0.62.
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Affiliation(s)
- Maureen Manche
- University of Rennes (LTSI), Inserm - UMR 1099, Rennes, 35000, France; Nantes Université, Ecole Centrale Nantes, LS2N UMR CNRS 6004, Nantes, 44000, France
| | | | - Amar Kachenoura
- University of Rennes (LTSI), Inserm - UMR 1099, Rennes, 35000, France.
| | - Laurent Albera
- University of Rennes (LTSI), Inserm - UMR 1099, Rennes, 35000, France
| | | | - Alfredo Hernández
- University of Rennes (LTSI), Inserm - UMR 1099, Rennes, 35000, France
| | - Saïd Moussaoui
- Nantes Université, Ecole Centrale Nantes, LS2N UMR CNRS 6004, Nantes, 44000, France
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6
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Bear LR, Bergquist JA, Abell E, Cochet H, MacLeod RS, Dubois R, Serinagaoglu Y. Investigation into the importance of using natural PVCs and pathological models for potential-based ECGI validation. Front Physiol 2023; 14:1198002. [PMID: 37275229 PMCID: PMC10232953 DOI: 10.3389/fphys.2023.1198002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction: Premature ventricular contractions (PVCs) are one of the most commonly targeted pathologies for ECGI validation, often through ventricular stimulation to mimic the ectopic beat. However, it remains unclear if such stimulated beats faithfully reproduce spontaneously occurring PVCs, particularly in the case of the R-on-T phenomenon. The objective of this study was to determine the differences in ECGI accuracy when reconstructing spontaneous PVCs as compared to ventricular-stimulated beats and to explore the impact of pathophysiological perturbation on this reconstruction accuracy. Methods: Langendorff-perfused pig hearts (n = 3) were suspended in a human torso-shaped tank, and local hyperkalemia was induced through perfusion of a high-K+ solution (8 mM) into the LAD. Recordings were taken simultaneously from the heart and tank surfaces during ventricular pacing and during spontaneous PVCs (including R-on-T), both at baseline and high K+. Epicardial potentials were reconstructed from torso potentials using ECGI. Results: Spontaneously occurring PVCs were better reconstructed than stimulated beats at baseline in terms of electrogram morphology [correlation coefficient (CC) = 0.74 ± 0.05 vs. CC = 0.60 ± 0.10], potential maps (CC = 0.61 ± 0.06 vs. CC = 0.51 ± 0.12), and activation time maps (CC = 0.86 ± 0.07 vs. 0.76 ± 0.10), though there was no difference in the localization error (LE) of epicardial origin (LE = 14 ± 6 vs. 15 ± 11 mm). High K+ perfusion reduced the accuracy of ECGI reconstructions in terms of electrogram morphology (CC = 0.68 ± 0.10) and AT maps (CC = 0.70 ± 0.12 and 0.59 ± 0.23) for isolated PVCs and paced beats, respectively. LE trended worse, but the change was not significant (LE = 17 ± 9 and 20 ± 12 mm). Spontaneous PVCs were less well when the R-on-T phenomenon occurred and the activation wavefronts encountered a line of block. Conclusion: This study demonstrates the differences in ECGI accuracy between spontaneous PVCs and ventricular-paced beats. We also observed a reduction in this accuracy near regions of electrically inactive tissue. These results highlight the need for more physiologically realistic experimental models when evaluating the accuracy of ECGI methods. In particular, reconstruction accuracy needs to be further evaluated in the presence of R-on-T or isolated PVCs, particularly when encountering obstacles (functional or anatomical) which cause line of block and re-entry.
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Affiliation(s)
- Laura R. Bear
- IHU-Liryc, Heart Rhythm Disease Institute, Foundation Bordeaux Université, Bordeaux, France
- University Bordeaux, CRCTB, Bordeaux, France
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Jake A. Bergquist
- Scientific Computing and Imaging Institute, University of Utah, Salt LakeCity, UT, United States
- Norra Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah, Salt LakeCity, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt LakeCity, UT, United States
| | - Emma Abell
- IHU-Liryc, Heart Rhythm Disease Institute, Foundation Bordeaux Université, Bordeaux, France
- University Bordeaux, CRCTB, Bordeaux, France
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Hubert Cochet
- IHU-Liryc, Heart Rhythm Disease Institute, Foundation Bordeaux Université, Bordeaux, France
- University Bordeaux, CRCTB, Bordeaux, France
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
- Bordeaux University Hospital (CHU), Pessac, France
| | - Rob S. MacLeod
- Scientific Computing and Imaging Institute, University of Utah, Salt LakeCity, UT, United States
- Norra Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah, Salt LakeCity, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt LakeCity, UT, United States
| | - Remi Dubois
- IHU-Liryc, Heart Rhythm Disease Institute, Foundation Bordeaux Université, Bordeaux, France
- University Bordeaux, CRCTB, Bordeaux, France
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Yesim Serinagaoglu
- Electrical-Electronics Engineering Department, Middle East Technical University, Ankara, Türkiye
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Surget E, Duchateau J, Marchant J, Maury P, Walton R, Lavergne T, Gandjbakhch E, Leenhardt A, Extramiana F, Haïssaguerre M. Idiopathic ventricular fibrillation associated with long-coupled Purkinje ectopy. J Cardiovasc Electrophysiol 2023; 34:615-623. [PMID: 36748854 DOI: 10.1111/jce.15833] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/07/2023] [Accepted: 01/14/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Idiopathic ventricular fibrillation (IVF) is mainly associated with and triggered by short-coupled (R-on-T) ventricular ectopics. However, little is known about the risk of VF associated with long-coupled premature ventricular complexes (LCPVCs). OBJECTIVE To examine the prevalence and characteristics of IVF patients presenting with LCPVCs. METHODS Consecutive patients with IVF and PVCs from five arrhythmia referral centers were reviewed. We included patients presenting LCPVCs, defined as PVCs falling after the end of the T wave, with a normal QTc interval. We evaluated demographics, medical history, and clinical circumstances associated with PVCs and VF episodes. The origin of PVCs was determined by invasive mapping. RESULTS Seventy-nine patients with IVF were reviewed. Among them, 12 (15.2%) met the inclusion criteria (8 women, age 36 ± 14 years). Eleven patients had documented LCPVCs initiating repetitive PVCs or sustained VF, whereas 1 had only documented isolated PVCs. In 10 of 12 patients, PVCs were recorded showing both long and short coupling intervals of 418 ± 46 and 304 ± 33 ms, respectively. Mapping showed that PVCs originated from the left Purkinje in 10 patients, from the right Purkinje in 1 patient, and both in 1 patient. Compared to other patients from the initial cohort, IVF with LCPVCs was associated with a left-sided origin of PVCs (92% in long-coupled IVF vs. 46% of left Purkinje PVCs in short-coupled IVF, p = .004). CONCLUSION Long-coupled fascicular PVCs, traditionally recognized as benign, can be associated with IVF in a subset of patients. They can induce IVF by themselves or in association with short-coupled PVCs.
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Affiliation(s)
- Elodie Surget
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - James Marchant
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Philippe Maury
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Richard Walton
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France
| | - Thomas Lavergne
- Cardiology Department, Rhythmology Unit, Hôpital Européen Georges Pompidou, Paris, France
| | - Estelle Gandjbakhch
- Institute of Cardiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Antoine Leenhardt
- Université de Paris Cité, CNMR, Maladies Cardiaques Héréditaires Rares, APHP Hôpital Bichat, Paris, France
| | - Fabrice Extramiana
- Université de Paris Cité, CNMR, Maladies Cardiaques Héréditaires Rares, APHP Hôpital Bichat, Paris, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Foundation Bordeaux Université, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
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8
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Zenger B, Bergquist JA, Busatto A, Good WW, Rupp LC, Sharma V, MacLeod RS. Tipping the scales of understanding: An engineering approach to design and implement whole-body cardiac electrophysiology experimental models. Front Physiol 2023; 14:1100471. [PMID: 36744034 PMCID: PMC9893785 DOI: 10.3389/fphys.2023.1100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/02/2023] [Indexed: 01/21/2023] Open
Abstract
The study of cardiac electrophysiology is built on experimental models that span all scales, from ion channels to whole-body preparations. Novel discoveries made at each scale have contributed to our fundamental understanding of human cardiac electrophysiology, which informs clinicians as they detect, diagnose, and treat complex cardiac pathologies. This expert review describes an engineering approach to developing experimental models that is applicable across scales. The review also outlines how we applied the approach to create a set of multiscale whole-body experimental models of cardiac electrophysiology, models that are driving new insights into the response of the myocardium to acute ischemia. Specifically, we propose that researchers must address three critical requirements to develop an effective experimental model: 1) how the experimental model replicates and maintains human physiological conditions, 2) how the interventions possible with the experimental model capture human pathophysiology, and 3) what signals need to be measured, at which levels of resolution and fidelity, and what are the resulting requirements of the measurement system and the access to the organs of interest. We will discuss these requirements in the context of two examples of whole-body experimental models, a closed chest in situ model of cardiac ischemia and an isolated-heart, torso-tank preparation, both of which we have developed over decades and used to gather valuable insights from hundreds of experiments.
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Affiliation(s)
- Brian Zenger
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States,Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States,Spencer Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States,*Correspondence: Brian Zenger,
| | - Jake A. Bergquist
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States,Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States,Department of Biomedical Engineering, College of Engineering, University of Utah, Salt Lake City, UT, United States
| | - Anna Busatto
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States,Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States,Department of Biomedical Engineering, College of Engineering, University of Utah, Salt Lake City, UT, United States
| | | | - Lindsay C. Rupp
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States,Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States,Department of Biomedical Engineering, College of Engineering, University of Utah, Salt Lake City, UT, United States
| | - Vikas Sharma
- Spencer Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Rob S. MacLeod
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States,Nora Eccles Harrison Cardiovascular Research and Training Institute, The University of Utah, Salt Lake City, UT, United States,Department of Biomedical Engineering, College of Engineering, University of Utah, Salt Lake City, UT, United States
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9
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Stoks J, Bear LR, Vijgen J, Dendale P, Peeters R, Volders PGA, Cluitmans MJM. Understanding repolarization in the intracardiac unipolar electrogram: A long-lasting controversy revisited. Front Physiol 2023; 14:1158003. [PMID: 37089414 PMCID: PMC10119409 DOI: 10.3389/fphys.2023.1158003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/24/2023] [Indexed: 04/25/2023] Open
Abstract
Background: The optimal way to determine repolarization time (RT) from the intracardiac unipolar electrogram (UEG) has been a topic of debate for decades. RT is typically determined by either the Wyatt method or the "alternative method," which both consider UEG T-wave slope, but differently. Objective: To determine the optimal method to measure RT on the UEG. Methods: Seven pig hearts surrounded by an epicardial sock with 100 electrodes were Langendorff-perfused with selective cannulation of the left anterior descending (LAD) coronary artery and submersed in a torso-shaped tank containing 256 electrodes on the torso surface. Repolarization was prolonged in the non-LAD-regions by infusing dofetilide and shortened in the LAD-region using pinacidil. RT was determined by the Wyatt (tWyatt) and alternative (tAlt) methods, in both invasive (recorded with epicardial electrodes) and in non-invasive UEGs (reconstructed with electrocardiographic imaging). tWyatt and tAlt were compared to local effective refractory period (ERP). Results: With contact mapping, mean absolute error (MAE) of tWyatt and tAlt vs. ERP were 21 ms and 71 ms, respectively. Positive T-waves typically had an earlier ERP than negative T-waves, in line with theory. tWyatt -but not tAlt-shortened by local infusion of pinacidil. Similar results were found for the non-invasive UEGs (MAE of tWyatt and tAlt vs. ERP were 30 ms and 92 ms, respectively). Conclusion: The Wyatt method is the most accurate to determine RT from (non) invasive UEGs, based on novel and historical analyses. Using it to determine RT could unify and facilitate repolarization assessment and amplify its role in cardiac electrophysiology.
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Affiliation(s)
- Job Stoks
- Department of Cardiology, CARIM, Maastricht University Medical Center+, Maastricht, Netherlands
- Department of Advanced Computing Sciences, Maastricht University, Maastricht, Netherlands
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Laura R. Bear
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Johan Vijgen
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Paul Dendale
- Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Ralf Peeters
- Department of Advanced Computing Sciences, Maastricht University, Maastricht, Netherlands
| | - Paul G. A. Volders
- Department of Cardiology, CARIM, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Matthijs J. M. Cluitmans
- Department of Cardiology, CARIM, Maastricht University Medical Center+, Maastricht, Netherlands
- *Correspondence: Matthijs J. M. Cluitmans,
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10
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van der Waal J, Bear L, Meijborg V, Dubois R, Cluitmans M, Coronel R. Steep repolarization time gradients in pig hearts cause distinct changes in composite electrocardiographic T‐wave parameters. Ann Noninvasive Electrocardiol 2022; 27:e12994. [DOI: 10.1111/anec.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jeanne van der Waal
- Department of Experimental and Clinical Cardiology Amsterdam UMC, Location AMC Amsterdam The Netherlands
| | - Laura Bear
- IHU Liryc, Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université Pessac France
- Université de Bordeaux Pessac France
- Inserm, Cardio‐Thoracix Research Centre of Bordeaux Pessac France
| | - Veronique Meijborg
- Department of Experimental and Clinical Cardiology Amsterdam UMC, Location AMC Amsterdam The Netherlands
| | - Rémi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université Pessac France
- Université de Bordeaux Pessac France
- Inserm, Cardio‐Thoracix Research Centre of Bordeaux Pessac France
| | - Matthijs Cluitmans
- CARIM School for Cardiovascular Diseases Maastricht University Medical Centre Maastricht The Netherlands
| | - Ruben Coronel
- Department of Experimental and Clinical Cardiology Amsterdam UMC, Location AMC Amsterdam The Netherlands
- Université de Bordeaux Pessac France
- Inserm, Cardio‐Thoracix Research Centre of Bordeaux Pessac France
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11
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State-of-the-Art Multimodality Imaging in Sudden Cardiac Arrest with Focus on Idiopathic Ventricular Fibrillation: A Review. J Clin Med 2022; 11:jcm11164680. [PMID: 36012918 PMCID: PMC9410297 DOI: 10.3390/jcm11164680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Idiopathic ventricular fibrillation is a rare cause of sudden cardiac arrest and a diagnosis by exclusion. Unraveling the mechanism of ventricular fibrillation is important for targeted management, and potentially for initiating family screening. Sudden cardiac arrest survivors undergo extensive clinical testing, with a growing role for multimodality imaging, before diagnosing “idiopathic” ventricular fibrillation. Multimodality imaging, considered as using multiple imaging modalities as diagnostics, is important for revealing structural myocardial abnormalities in patients with cardiac arrest. This review focuses on combining imaging modalities (echocardiography, cardiac magnetic resonance and computed tomography) and the electrocardiographic characterization of sudden cardiac arrest survivors and discusses the surplus value of multimodality imaging in the diagnostic routing of these patients. We focus on novel insights obtained through electrostructural and/or electromechanical imaging in apparently idiopathic ventricular fibrillation patients, with special attention to non-invasive electrocardiographic imaging.
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12
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Elliott MK, Strocchi M, Mehta VS, Wijesuriya N, Mannakkara NN, Jackson T, Pereira H, Behar JM, Bishop MJ, Niederer S, Rinaldi CA. Dispersion of repolarization increases with cardiac resynchronization therapy and is associated with left ventricular reverse remodeling. J Electrocardiol 2022; 72:120-127. [PMID: 35468456 PMCID: PMC10171825 DOI: 10.1016/j.jelectrocard.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE Cardiac resynchronization therapy (CRT) reduces ventricular activation times and electrical dyssynchrony, however the effect on repolarization is unclear. In this study, we sought to investigate the effect of CRT and left ventricular (LV) remodeling on dispersion of repolarization using electrocardiographic imaging (ECGi). METHODS 11 patients with heart failure and electrical dyssynchrony underwent ECGi 1-day and 6-months post CRT. Reconstructed epicardial electrograms were used to create maps of activation time, repolarization time (RT) and activation recovery intervals (ARI) and calculate measures of RT, ARI and their dispersion. ARI was corrected for heart rate (cARI). RESULTS Compared to baseline rhythm, LV cARI dispersion was significantly higher at 6 months (28.2 ± 7.7 vs 36.4 ± 7.2 ms; P = 0.03) but not after 1 day (28.2 ± 7.7 vs 34.4 ± 6.8 ms; P = 0.12). There were no significant differences from baseline to CRT for mean LV cARI or RT metrics. Significant LV remodeling (>15% reduction in end-systolic volume) was an independent predictor of increase in LV cARI dispersion (P = 0.04) and there was a moderate correlation between the degree of LV remodeling and the relative increase in LV cARI dispersion (R = -0.49) though this was not statistically significant (P = 0.12). CONCLUSION CRT increases LV cARI dispersion, but this change was not fully apparent until 6 months post implant. The effects of CRT on LV cARI dispersion appeared to be dependent on LV reverse remodeling, which is in keeping with evidence that the risk of ventricular arrhythmia after CRT is higher in non-responders compared to responders.
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Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nilanka N Mannakkara
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tom Jackson
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Helder Pereira
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan M Behar
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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13
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OUP accepted manuscript. Eur Heart J 2022; 43:1248-1250. [DOI: 10.1093/eurheartj/ehab912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Schuler S, Schaufelberger M, Bear LR, Bergquist JA, Cluitmans MJM, Coll-Font J, Onak ON, Zenger B, Loewe A, MacLeod RS, Brooks DH, Dossel O. Reducing Line-of-block Artifacts in Cardiac Activation Maps Estimated Using ECG Imaging: A Comparison of Source Models and Estimation Methods. IEEE Trans Biomed Eng 2021; 69:2041-2052. [PMID: 34905487 DOI: 10.1109/tbme.2021.3135154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate cardiac activation maps estimated using electrocardiographic imaging and to find methods reducing line-of-block (LoB) artifacts, while preserving real LoBs. METHODS Body surface potentials were computed for 137 simulated ventricular excitations. Subsequently, the inverse problem was solved to obtain extracellular potentials (EP) and transmembrane voltages (TMV). From these, activation times (AT) were estimated using four methods and compared to the ground truth. This process was evaluated with two cardiac mesh resolutions. Factors contributing to LoB artifacts were identified by analyzing the impact of spatial and temporal smoothing on the morphology of source signals. RESULTS AT estimation using a spatiotemporal derivative performed better than using a temporal derivative. Compared to deflection-based AT estimation, correlation-based methods were less prone to LoB artifacts but performed worse in identifying real LoBs. Temporal smoothing could eliminate artifacts for TMVs but not for EPs, which could be linked to their temporal morphology. TMVs led to more accurate ATs on the septum than EPs. Mesh resolution had a negligible effect on inverse reconstructions, but small distances were important for cross-correlation-based estimation of AT delays. CONCLUSION LoB artifacts are mainly caused by the inherent spatial smoothing effect of the inverse reconstruction. Among the configurations evaluated, only deflection-based AT estimation in combination with TMVs and strong temporal smoothing can prevent LoB artifacts, while preserving real LoBs. SIGNIFICANCE Regions of slow conduction are of considerable clinical interest and LoB artifacts observed in non-invasive ATs can lead to misinterpretations. We addressed this problem by identifying factors causing such artifacts and methods to reduce them.
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15
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Cluitmans MJM, Bear LR, Nguyên UC, van Rees B, Stoks J, Ter Bekke RMA, Mihl C, Heijman J, Lau KD, Vigmond E, Bayer J, Belterman CNW, Abell E, Labrousse L, Rogier J, Bernus O, Haïssaguerre M, Hassink RJ, Dubois R, Coronel R, Volders PGA. Noninvasive detection of spatiotemporal activation-repolarization interactions that prime idiopathic ventricular fibrillation. Sci Transl Med 2021; 13:eabi9317. [PMID: 34788076 DOI: 10.1126/scitranslmed.abi9317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Matthijs J M Cluitmans
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands.,Philips Research, 5656 AE Eindhoven, Netherlands
| | | | - Uyên C Nguyên
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Bianca van Rees
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Job Stoks
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Rachel M A Ter Bekke
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Casper Mihl
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands.,Department of Radiology, Maastricht University Medical Centre, 6200 MD Maastricht, Netherlands
| | - Jordi Heijman
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Kevin D Lau
- Philips Research, 5656 AE Eindhoven, Netherlands
| | | | | | - Charly N W Belterman
- Department of Experimental Cardiology, Amsterdam University Medical Centre, 1105 AZ Amsterdam, Netherlands
| | | | - Louis Labrousse
- IHU LIRYC, 33600 Pessac, France.,University of Bordeaux, 33000 Bordeaux, France.,Hôpital Haut Lévêque, University Hospital of Bordeaux, 33604 Bordeaux, France
| | - Julien Rogier
- IHU LIRYC, 33600 Pessac, France.,University of Bordeaux, 33000 Bordeaux, France.,Hôpital Haut Lévêque, University Hospital of Bordeaux, 33604 Bordeaux, France
| | - Olivier Bernus
- IHU LIRYC, 33600 Pessac, France.,University of Bordeaux, 33000 Bordeaux, France
| | - Michel Haïssaguerre
- IHU LIRYC, 33600 Pessac, France.,University of Bordeaux, 33000 Bordeaux, France.,Hôpital Haut Lévêque, University Hospital of Bordeaux, 33604 Bordeaux, France
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, 3584 CX Utrecht, Netherlands
| | | | - Ruben Coronel
- IHU LIRYC, 33600 Pessac, France.,Department of Experimental Cardiology, Amsterdam University Medical Centre, 1105 AZ Amsterdam, Netherlands
| | - Paul G A Volders
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
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16
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van der Waal JG, Meijborg VMF, Belterman CNW, Streekstra GJ, Oostendorp TF, Coronel R. Ex vivo Validation of Noninvasive Epicardial and Endocardial Repolarization Mapping. Front Physiol 2021; 12:737609. [PMID: 34744778 PMCID: PMC8569864 DOI: 10.3389/fphys.2021.737609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The detection and localization of electrophysiological substrates currently involve invasive cardiac mapping. Electrocardiographic imaging (ECGI) using the equivalent dipole layer (EDL) method allows the noninvasive estimation of endocardial and epicardial activation and repolarization times (AT and RT), but the RT validation is limited to in silico studies. We aimed to assess the temporal and spatial accuracy of the EDL method in reconstructing the RTs from the surface ECG under physiological circumstances and situations with artificially induced increased repolarization heterogeneity. Methods: In four Langendorff-perfused pig hearts, we simultaneously recorded unipolar electrograms from plunge needles and pseudo-ECGs from a volume-conducting container equipped with 61 electrodes. The RTs were computed from the ECGs during atrial and ventricular pacing and compared with those measured from the local unipolar electrograms. Regional RT prolongation (cooling) or shortening (pinacidil) was achieved by selective perfusion of the left anterior descending artery (LAD) region. Results: The differences between the computed and measured RTs were 19.0 ± 17.8 and 18.6 ± 13.7 ms for atrial and ventricular paced beats, respectively. The region of artificially delayed or shortened repolarization was correctly identified, with minimum/maximum RT roughly in the center of the region in three hearts. In one heart, the reconstructed region was shifted by ~2.5 cm. The total absolute difference between the measured and calculated RTs for all analyzed patterns in selectively perfused hearts (n = 5) was 39.6 ± 27.1 ms. Conclusion: The noninvasive ECG repolarization imaging using the EDL method of atrial and ventricular paced beats allows adequate quantitative reconstruction of regions of altered repolarization.
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Affiliation(s)
- Jeanne G van der Waal
- Department of Experimental and Clinical Cardiology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
| | - Veronique M F Meijborg
- Department of Experimental and Clinical Cardiology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
| | - Charly N W Belterman
- Department of Experimental and Clinical Cardiology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
| | - Geert J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
| | - Thom F Oostendorp
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ruben Coronel
- Department of Experimental and Clinical Cardiology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
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17
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Affiliation(s)
- Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center Washington University in St. Louis MO
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18
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Bear LR, Cluitmans M, Abell E, Rogier J, Labrousse L, Cheng LK, LeGrice I, Lever N, Sands GB, Smaill B, Haïssaguerre M, Bernus O, Coronel R, Dubois R. Electrocardiographic Imaging of Repolarization Abnormalities. J Am Heart Assoc 2021; 10:e020153. [PMID: 33880931 PMCID: PMC8200734 DOI: 10.1161/jaha.120.020153] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Dispersion and gradients in repolarization have been associated with life‐threatening arrhythmias, but are difficult to quantify precisely from surface electrocardiography. The objective of this study was to evaluate electrocardiographic imaging (ECGI) to noninvasively detect repolarization‐based abnormalities. Methods and Results Ex vivo data were obtained from Langendorff‐perfused pig hearts (n=8) and a human donor heart. Unipolar electrograms were recorded simultaneously during sinus rhythm from an epicardial sock and the torso‐shaped tank within which the heart was suspended. Regional repolarization heterogeneities were introduced through perfusion of dofetilide and pinacidil into separate perfusion beds. In vivo data included torso and epicardial potentials recorded simultaneously in anesthetized, closed‐chest pigs (n=5), during sinus rhythm, and ventricular pacing. For both data sets, ECGI accurately reconstructed T‐wave electrogram morphologies when compared with those recorded by the sock (ex vivo: correlation coefficient, 0.85 [0.52–0.96], in vivo: correlation coefficient, 0.86 [0.52–0.96]) and repolarization time maps (ex‐vivo: correlation coefficient, 0.73 [0.63–0.83], in vivo: correlation coefficient, 0.76 [0.67–0.82]). ECGI‐reconstructed repolarization time distributions were strongly correlated to those measured by the sock (both data sets, R2 ≥0.92). Although the position of the gradient was slightly shifted by 8.3 (0–13.9) mm, the mean, max, and SD between ECGI and recorded gradient values were highly correlated (R2=0.87, 0.75, and 0.86 respectively). There was no significant difference in ECGI accuracy between ex vivo and in vivo data. Conclusions ECGI reliably and accurately maps potentially critical repolarization abnormalities. This noninvasive approach allows imaging and quantifying individual parameters of abnormal repolarization‐based substrates in patients with arrhythmogenesis, to improve diagnosis and risk stratification.
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Affiliation(s)
- Laura R Bear
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France
| | - Matthijs Cluitmans
- CARIM School for Cardiovascular Diseases Maastricht UMC Maastricht Netherlands
| | - Emma Abell
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France
| | | | - Louis Labrousse
- IHU-LIRYCFondation Bordeaux Université Pessac France.,Department of Cardiac Surgery CHU Pessac France
| | - Leo K Cheng
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Ian LeGrice
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Nigel Lever
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Gregory B Sands
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Bruce Smaill
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Michel Haïssaguerre
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France.,Department of Cardiac Electrophysiology and Stimulation Bordeaux University Hospital (CHU) Pessac France
| | - Olivier Bernus
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France
| | - Ruben Coronel
- IHU-LIRYCFondation Bordeaux Université Pessac France.,Department of Experimental Cardiology Academic Medical Center Amsterdam the Netherlands
| | - Rémi Dubois
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France
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