Non-invasive inverse electrocardiography showed moderate correlation with invasive mapping for epicardial activation (r=0.54; 95% CI 0.49-0.59) alongside considerable absolute timing differences.
Observational (n=13)
Does non-invasive inverse electrocardiography accurately estimate ventricular activation sequences compared to invasive electro-anatomical mapping in patients referred for EAM?
This first-in-human quantitative comparison shows that non-invasive inverse electrocardiography has moderate correlation with invasive electro-anatomical mapping for ventricular activation sequences, but requires further refinement for clinical use.
Effect estimate: r=0.54 (epicardial) (95% CI 0.49-0.59)
This study presents a novel non-invasive equivalent dipole layer (EDL) based inverse electrocardiography ( i ECG) technique which estimates both endocardial and epicardial ventricular activation sequences. We aimed to quantitatively compare our i ECG approach with invasive electro-anatomical mapping (EAM) during sinus rhythm with the objective of enabling functional substrate imaging and sudden cardiac death risk stratification in patients with cardiomyopathy. Thirteen patients (77% males, 48 ± 20 years old) referred for endocardial and epicardial EAM underwent 67-electrode body surface potential mapping and CT imaging. The EDL-based i ECG approach was improved by mimicking the effects of the His-Purkinje system on ventricular activation. EAM local activation timing (LAT) maps were compared with i ECG-LAT maps using absolute differences and Pearson’s correlation coefficient, reported as mean ± standard deviation 95% confidence interval. The correlation coefficient between i ECG-LAT maps and EAM was 0.54 ± 0.19 0.49–0.59 for epicardial activation, 0.50 ± 0.27 0.41–0.58 for right ventricular endocardial activation and 0.44 ± 0.29 0.32–0.56 for left ventricular endocardial activation. The absolute difference in timing between i ECG maps and EAM was 17.4 ± 7.2 ms for epicardial maps, 19.5 ± 7.7 ms for right ventricular endocardial maps, 27.9 ± 8.7 ms for left ventricular endocardial maps. The absolute distance between right ventricular endocardial breakthrough sites was 30 ± 16 mm and 31 ± 17 mm for the left ventricle. The absolute distance for latest epicardial activation was median 12.8 IQR: 2.9–29.3 mm. This first in-human quantitative comparison of i ECG and invasive LAT-maps on both the endocardial and epicardial surface during sinus rhythm showed improved agreement, although with considerable absolute difference and moderate correlation coefficient. Non-invasive i ECG requires further refinements to facilitate clinical implementation and risk stratification.
Roudijk et al. (Mon,) conducted a observational in Cardiomyopathy (n=13). Non-invasive equivalent dipole layer (EDL) based inverse electrocardiography (iECG) vs. Invasive electro-anatomical mapping (EAM) was evaluated on Correlation coefficient and absolute differences in local activation timing (LAT) between iECG and EAM (r=0.54 (epicardial), 95% CI 0.49-0.59). Non-invasive inverse electrocardiography showed moderate correlation with invasive mapping for epicardial activation (r=0.54; 95% CI 0.49-0.59) alongside considerable absolute timing differences.
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