Quantitative localization of premature ventricular contractions using myocardial activation ECGI from the standard 12-lead electrocardiogram

Dam, Peter M. van; Tung, Roderick; Shivkumar, Kalyanam; Laks, Michael M.

doi:10.1016/j.jelectrocard.2013.08.005

Cited by 48 publications

(44 citation statements)

References 16 publications

(29 reference statements)

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“…Activated data from endocardial mapping have previously been used as validation for several simulation studies considering a range of inverse formulations. 14,[39][40][41][62][63][64][65] With a recently developed catheter, a median spatial resolution of 2.7 mm was achieved for right atrial endocardial mapping. 66 Note that both standard ECG and ECGI mapping are commonly sampled at 1 kHz.…”

Section: Discussionmentioning

confidence: 99%

Inverse estimation of cardiac activation times via gradient‐based optimization

Kallhovd

Maleckar

Rognes

2017

Numer Methods Biomed Eng

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Computational modeling may provide a quantitative framework for integrating multiscale data to gain insight into mechanisms of heart disease, identify and test pharmacological and electrical therapy and interventions, and support clinical decisions. Patient-specific computational cardiac models can help guide such procedures, and cardiac inverse modeling is a promising alternative to adequately personalize these models. Indeed, full cardiac inverse modeling is currently becoming computationally feasible; however, fundamental work to assess the feasibility of emerging techniques is still needed. In this study, we use a partial differential equation-constrained optimal control approach to numerically investigate the identifiability of an initial activation sequence from synthetic (partial) observations of the extracellular potential using the bidomain approximation and 2D representations of cardiac tissue. Our results demonstrate that activation times and duration of several stimuli can be recovered even with high levels of noise, that it is sufficient to sample the observations at the electrocardiogram-relevant sampling frequency of 1 kHz, and that spatial resolutions that are coarser than the standard in electrophysiological simulations can be used. The optimization of activation times is still effective when synthetic data are generated with a different cell membrane kinetics model than optimized for. The findings thus indicate that the presented approach has potential for finding activation sequences from clinical data modalities, as an extension to existing cardiac imaging approaches.

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Section: Discussionmentioning

confidence: 99%

Inverse estimation of cardiac activation times via gradient‐based optimization

Kallhovd

Maleckar

Rognes

2017

Numer Methods Biomed Eng

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“…Collectively, ECG-imaging techniques have demonstrated potential in a variety of clinical applications, such as the mapping of atrial flutter and fibrillation [14], the localization of premature ventricular contractions [15], and the detection of myocardial ischemia [13]. For scar-related VT, there has been an interest in using ECGimaging to electrically delineate the myocardial scar as an arrhythmogenic substrate for VT [16], [17].…”

Section: Introductionmentioning

confidence: 99%

Non-invasive epicardial and endocardial electrocardiographic imaging for scar-related ventricular tachycardia

et al. 2018

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Background-The majority of life-threatening ventricular tachycardias (VTs) are sustained by heterogeneous scar substrates with narrow strands of surviving tissue. An effective treatment for scar-related VT is to modify the underlying scar substrate by catheter ablation. If activation sequence and entrainment mapping can be performed during sustained VT, the exit and isthmus of the circuit can often be identified. However, with invasive catheter mapping, only monomorphic VT that is hemodynamically stable can be mapped in this manner. For the majority of patients with poorly tolerated VTs or multiple VTs, a close inspection of the reentry circuit is not possible. A noninvasive approach to fast mapping of unstable VTs can potentially allow an improved identification of critical ablation sites.

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“…Collectively, ECG-imaging techniques have demonstrated potential in a variety of clinical applications, such as the mapping of atrial flutter and fibrillation [14], the localization of premature ventricular contractions [15], and the detection of myocardial ischemia [13]. For scar-related VT, there has been an interest in using ECG-imaging to electrically delineate the myocardial scar as an arrhythmogenic substrate for VT [16], [17].…”

Section: Introductionmentioning

confidence: 99%

Noninvasive epicardial and endocardial electrocardiographic imaging of scar-related ventricular tachycardia

Wang

Gharbia

Horáček

et al. 2016

Journal of Electrocardiology

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Background The majority of life-threatening ventricular tachycardias (VTs) are sustained by heterogeneous scar substrates with narrow strands of surviving tissue. An effective treatment for scar-related VT is to modify the underlying scar substrate by catheter ablation. If activation sequence and entrainment mapping can be performed during sustained VT, the exit and isthmus of the circuit can often be identified. However, with invasive catheter mapping, only monomorphic VT that is hemodynamically stable can be mapped in this manner. For the majority of patients with poorly tolerated VTs or multiple VTs, a close inspection of the reentry circuit is not possible. A noninvasive approach to fast mapping of unstable VTs can potentially allow an improved identification of critical ablation sites. Methods For patients who underwent catheter ablation of scar-related VT, CT scan was obtained prior to the ablation procedure and 120-lead body-surface electrocardiograms (ECGs) were acquired during induced VTs. These data were used for noninvasive ECG imaging to computationally reconstruct electrical potentials on the epicardium and on the endocardium of both ventricles. Activation time and phase maps of the VT circuit were extracted from the reconstructed electrograms. They were analyzed with respect to scar substrate obtained from catheter mapping, as well as VT exits confirmed through ablation sites that successfully terminated the VT. Results The reconstructed reentry circuits correctly revealed both epicardial and endocardial origins of activation, consistent with locations of exit sites confirmed from the ablation procedure. The temporal dynamics of the reentry circuits, particularly the slowing of conduction as indicated by the crowding and zig-zag conducting of the activation isochrones, collocated well with scar substrate obtained by catheter voltage maps. Furthermore, the results indicated that some reentry circuits involve both the epicardial and endocardial layers, and can only be properly interpreted by mapping both layers simultaneously. Conclusions This study investigated the potential of ECG-imaging for beat-to-beat mapping of unstable reentrant circuits. It shows that simultaneous epicardial and endocardial mapping may improve the delineation of the 3D spatial construct of a reentry circuit and its exit. It also shows that the use of phase mapping can reveal regions of slow conduction that collocate well with suspected heterogeneous regions within and around the scar.

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Quantitative localization of premature ventricular contractions using myocardial activation ECGI from the standard 12-lead electrocardiogram

Cited by 48 publications

References 16 publications

Inverse estimation of cardiac activation times via gradient‐based optimization

Inverse estimation of cardiac activation times via gradient‐based optimization

Non-invasive epicardial and endocardial electrocardiographic imaging for scar-related ventricular tachycardia

Noninvasive epicardial and endocardial electrocardiographic imaging of scar-related ventricular tachycardia

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