Patient-specific modelling using 12-lead ECG and CMR accurately reconstructed 3D biventricular activation compared to invasive mapping, with strong correlation at the LV endocardium (r=0.83).
Observational (n=11)
Does patient-specific modelling using 12-lead ECG and CMR accurately reconstruct 3D biventricular electrical activation compared to invasive electroanatomical mapping in patients with prolonged QRS?
Non-invasive assessment of biventricular 3D activation using standard 12-lead ECG and CMR is feasible and correlates well with invasive electroanatomical mapping.
AIMS: Non-invasive imaging of electrical activation requires high-density body surface potential mapping. The nine electrodes of the 12-lead electrocardiogram (ECG) are insufficient for a reliable reconstruction with standard inverse methods. Patient-specific modelling may offer an alternative route to physiologically constraint the reconstruction. The aim of the study was to assess the feasibility of reconstructing the fully 3D electrical activation map of the ventricles from the 12-lead ECG and cardiovascular magnetic resonance (CMR). METHODS AND RESULTS: Ventricular activation was estimated by iteratively optimizing the parameters (conduction velocity and sites of earliest activation) of a patient-specific model to fit the simulated to the recorded ECG. Chest and cardiac anatomy of 11 patients (QRS duration 126-180 ms, documented scar in two) were segmented from CMR images. Scar presence was assessed by magnetic resonance (MR) contrast enhancement. Activation sequences were modelled with a physiologically based propagation model and ECGs with lead field theory. Validation was performed by comparing reconstructed activation maps with those acquired by invasive electroanatomical mapping of coronary sinus/veins (CS) and right ventricular (RV) and left ventricular (LV) endocardium. The QRS complex was correctly reproduced by the model (Pearson's correlation r = 0.923). Reconstructions accurately located the earliest and latest activated LV regions (median barycentre distance 8.2 mm, IQR 8.8 mm). Correlation of simulated with recorded activation time was very good at LV endocardium (r = 0.83) and good at CS (r = 0.68) and RV endocardium (r = 0.58). CONCLUSION: Non-invasive assessment of biventricular 3D activation using the 12-lead ECG and MR imaging is feasible. Potential applications include patient-specific modelling and pre-/per-procedural evaluation of ventricular activation.
Pezzuto et al. (Thu,) conducted a observational in QRS prolongation (126-180 ms) (n=11). Patient-specific modelling using 12-lead ECG and CMR vs. Invasive electroanatomical mapping was evaluated on Correlation of simulated with recorded activation time. Patient-specific modelling using 12-lead ECG and CMR accurately reconstructed 3D biventricular activation compared to invasive mapping, with strong correlation at the LV endocardium (r=0.83).