Key result
CineECG accurately differentiated between conduction defects, correctly classifying 240 of 266 normal, 14 of 17 iRBBB, 55 of 55 RBBB, and 51 of 51 LBBB ECG tracings.
Why the study?
Discriminating between bundle branch blocks and normal 12-lead ECG tracings can be challenging, motivating an evaluation of whether CineECG can improve discrimination between LBBB, RBBB, and incomplete RBBB.
Does CineECG accurately classify and anatomically localize bundle branch blocks compared to gold standard ECG diagnosis?
Observational (n=391)
Does CineECG accurately classify and anatomically localize bundle branch blocks compared to gold standard ECG diagnosis?
CineECG provides accurate anatomical localization and classification of bundle branch blocks, potentially aiding in the discrimination of complex conduction disorders.
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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Boonstra et al. (2020) conducted an observational in Bundle branch blocks (n=391). CineECG vs. Standard 12-lead ECG clinical diagnosis was evaluated on Accuracy of CineECG classification compared to gold standard diagnosis. CineECG accurately differentiated between conduction defects, correctly classifying 240 of 266 normal, 14 of 17 iRBBB, 55 of 55 RBBB, and 51 of 51 LBBB ECG tracings.
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