Noninvasive activation imaging accurately localized the site of earliest activation with a median error of 18 mm and correctly mapped 23 of 27 sites to the endocardium or epicardium in pig hearts.
Does noninvasive activation imaging accurately estimate endocardial and epicardial activation compared to invasive mapping in pig heart models?
Noninvasive activation imaging using body surface potential maps can accurately localize the origin of ventricular activation and discriminate between endocardial and epicardial sites in a preclinical pig model.
BACKGROUND: Noninvasive imaging of cardiac activation before ablation of the arrhythmogenic substrate can reduce electrophysiological procedure duration and help choosing between an endocardial or epicardial approach. A noninvasive imaging technique was evaluated that estimates both endocardial and epicardial activation from body surface potential maps. We performed a study in isolated and in situ pig hearts, estimating activation from body surface potential maps during sinus rhythm and localizing endocardial and epicardial stimulation sites. METHODS AND RESULTS: From 3 Langendorff-perfused pig hearts, 180 intramural unipolar electrograms were recorded during sinus rhythm and ectopic activation, together with pseudo-body surface potential map ECGs in 2 of them. From 4 other anesthetized pigs, 64-lead body surface potential maps were recorded during sinus rhythm and ventricular stimulation from 27 endocardial and epicardial sites. The ventricular activation pattern was computed from the recorded QRS complexes. For both Langendorff-perfused hearts, the calculated epicardial and endocardial activation patterns showed good qualitative correspondence to the patterns obtained with needle electrodes. Absolute timing difference for sinus rhythm was 10±5 and 11±8 ms respectively, and for ectopic activation 6±5 and 7±6 ms, respectively. Calculated activation for the in situ hearts in sinus rhythm was similar to patterns recorded in Langendorff-perfused hearts. During stimulation, the distance between the stimulation site and calculated site of earliest activation was 18 (15-27) mm, and 23 of 27 stimulation sites were correctly mapped to either endocardium or epicardium. CONCLUSIONS: Noninvasive activation imaging is able to determine earliest ventricular activation and discriminate endocardial from epicardial origin of activation with clinically relevant accuracy.
Oosterhoff et al. (Thu,) reported a other. Noninvasive activation imaging vs. Invasive mapping with needle electrodes was evaluated on Distance between stimulation site and calculated site of earliest activation. Noninvasive activation imaging accurately localized the site of earliest activation with a median error of 18 mm and correctly mapped 23 of 27 sites to the endocardium or epicardium in pig hearts.