Minimal configuration of body surface potential mapping for discrimination of left versus right dominant frequencies during atrial fibrillation

Abstract

Background Ablation of drivers maintaining Atrial Fibrillation (AF) has been demonstrated as an effective therapy. Drivers in the form of rapidly-activated atrial regions can be non-invasively localized to either left or right atria (LA, RA) with Body Surface Potential Mapping (BSPM) systems. This study quantifies the accuracy of Dominant Frequency (DF) measurements from reduced-leads BSPM systems and assesses the minimal configuration required for ablation guidance. Methods Nine uniformly distributed lead sets of 8 to 66 electrodes were evaluated. BSPM signals were registered simultaneously with intracardiac electrocardiograms (EGMs) in 16 AF patients. DF activity was analyzed on the surface potentials for the 9 leads configurations, and the non-invasive measures were compared with the EGM recordings. Results Surface DF measurements presented similar values than panoramic invasive EGM recordings, showing the highest DF regions in corresponding locations. The non-invasive DFs measures had a high correlation with the invasive discrete recordings; they presented a deviation <0.5 Hz for the highest DF and a correlation coefficient >0.8 for leads configurations with 12 or more electrodes. Conclusions Reduced-leads BSPM systems enable non-invasive discrimination between LA versus RA dominant frequencies with similar results as higher-resolution 66-leads system. Our findings demonstrate the possible incorporation of simplified BSPM systems into clinical planning procedures for AF ablation.

Textile Concentric Ring Electrodes: Influence of Position and Electrode Size on Cardiac Activity Monitoring

“…This was to be expected, since the distance between the outer ring and the central disc was much shorter than the distance across the body between the lead II electrodes. This result agrees with other authors who simultaneously recorded a standard 12-lead ECG signal and BC-ECG signals using CRE [15,18,12]. TCRE50 recorded a higher median signal amplitude than TCRE42, confirming that signal amplitude is dependent on interpole distance.…”

“…The concentric ring design is a physical approximation to the Laplacian filter, which is the second spatial derivative of the measured potentials and essentially assigns more weight to changes in bioelectric dipoles under measurement points, to enable better differentiation between concurrent, closely spaced dipole sources [14]. CREs have been shown to be more effective at increasing spatial resolution than merely increasing the number of electrodes in an array, as in conventional body surface potential mapping [18]. This enhanced spatial resolution is of great interest in studying atrial activity, since there are fewer cardiac cells involved in atrial than ventricular activities.…”

Effects of Reducing the Number of Leads from Body Surface Potential Mapping in Computer Models of Atrial Arrhythmias

“…Several studies have been made in the past to determine an optimal BSPM setting, with lead numbers as limited as 8 [13]. A reduced number of leads is of interest for standardization of the BSPM method, the manufacturing of electrode vests and the reduction of the hardware requirements [13].…”

“…Several studies have been made in the past to determine an optimal BSPM setting, with lead numbers as limited as 8 [13]. A reduced number of leads is of interest for standardization of the BSPM method, the manufacturing of electrode vests and the reduction of the hardware requirements [13]. In this work, analyses in the frequency and phase domains, comprising many of the often used techniques for the processing of BSPM atrial signals, were used to assess the loss in spatial resolution with lead layouts ranging from 16 to 252 leads in comparison with a high resolution (567 leads) setting.…”

Statistical guidance of VT ablation

“…25,26 Noninvasive localization is also applied to guide ablation of atrial fibrillation 27 with similar issues of resolution and preprocedural imaging and may identify critical sites for AF 28 using approaches to ECGI including reduced electrode methods and without pre-procedural imaging. 21,29 Such work continues to expand.…”