Reconstruction of three-dimensional biventricular activation based on the 12-lead electrocardiogram via patient-specific modelling

Simone Pezzuto, Frits W Prinzen, Mark Potse, Francesco Maffessanti, François Regoli, Maria Luce Caputo, Giulio Conte, Rolf Krause, Angelo Auricchio, Simone Pezzuto, Frits W Prinzen, Mark Potse, Francesco Maffessanti, François Regoli, Maria Luce Caputo, Giulio Conte, Rolf Krause, Angelo Auricchio

Abstract

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.

Keywords: Patient-specific modelling; Eikonal model; Twelve-lead electrocardiogram; Ventricular activation • Three-dimensional activation.

© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.

Figures

Figure 1
Figure 1
Summary of the method. The workflow starts with the CMR acquisition of the anatomy of the heart and the torso (with electrode positions) and the standard 12-lead ECG (blue box). In the pre-processing phase (yellow box), a 3D anatomy of the patient is reconstructed from CMR/CT sequences. The parameter identification phase (light green box) aims at fitting the parameters of the model (CVs and EASs) to minimize the difference between recorded and simulated ECG. The reconstructed activation map was eventually validated against invasive EAM (dashed light blue box). CMR, cardiovascular magnetic resonance; CT, computed tomography; CV, conduction velocity; EASs, early activation sites; ECG, electrocardiogram.
Figure 2
Figure 2
Illustrative reconstruction. Example of the activation reconstruction for Patient #4. (A) Recorded (blue) and fitted (orange) ECG. (B) 3D cut view of the activation map with collected EAM points, and epicardial views. (C) LV bull’s-eye plot. (D) LV endocardial view of interpolated EAM (scar in purple). EAM, electro-anatomical maps; ECG, electrocardiogram; LV, left ventricular.
Figure 3
Figure 3
Validation against invasive mapping. Bull’s-eye plots for each patient showing the EAR (blue) and LAR (red) in the LV. The solid-coloured regions refer to the recorded maps, while the hatched-coloured regions are the reconstructed ones. Scar is in purple. BPs are marked by stars. BP, breakthrough point; EAR, earliest activated region; LAR, latest activated region; LV, left ventricular.

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Source: PubMed

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