TY - JOUR
T1 - Ex vivo Validation of Noninvasive Epicardial and Endocardial Repolarization Mapping
AU - van der Waal, Jeanne G.
AU - Meijborg, Veronique M. F.
AU - Belterman, Charly N. W.
AU - Streekstra, Geert J.
AU - Oostendorp, Thom F.
AU - Coronel, Ruben
N1 - Funding Information: This study was supported by the Technology Foundation STW (Grant No. 10959), the Leducq Foundation (RHYTHM transatlantic network, Grant No. 16CVD02), and ZonMw (GALANT, project number 116004202). Publisher Copyright: © Copyright © 2021 van der Waal, Meijborg, Belterman, Streekstra, Oostendorp and Coronel.
PY - 2021/10/22
Y1 - 2021/10/22
N2 - Background: The detection and localization of electrophysiological substrates currently involve invasive cardiac mapping. Electrocardiographic imaging (ECGI) using the equivalent dipole layer (EDL) method allows the noninvasive estimation of endocardial and epicardial activation and repolarization times (AT and RT), but the RT validation is limited to in silico studies. We aimed to assess the temporal and spatial accuracy of the EDL method in reconstructing the RTs from the surface ECG under physiological circumstances and situations with artificially induced increased repolarization heterogeneity. Methods: In four Langendorff-perfused pig hearts, we simultaneously recorded unipolar electrograms from plunge needles and pseudo-ECGs from a volume-conducting container equipped with 61 electrodes. The RTs were computed from the ECGs during atrial and ventricular pacing and compared with those measured from the local unipolar electrograms. Regional RT prolongation (cooling) or shortening (pinacidil) was achieved by selective perfusion of the left anterior descending artery (LAD) region. Results: The differences between the computed and measured RTs were 19.0 ± 17.8 and 18.6 ± 13.7 ms for atrial and ventricular paced beats, respectively. The region of artificially delayed or shortened repolarization was correctly identified, with minimum/maximum RT roughly in the center of the region in three hearts. In one heart, the reconstructed region was shifted by ~2.5 cm. The total absolute difference between the measured and calculated RTs for all analyzed patterns in selectively perfused hearts (n = 5) was 39.6 ± 27.1 ms. Conclusion: The noninvasive ECG repolarization imaging using the EDL method of atrial and ventricular paced beats allows adequate quantitative reconstruction of regions of altered repolarization.
AB - Background: The detection and localization of electrophysiological substrates currently involve invasive cardiac mapping. Electrocardiographic imaging (ECGI) using the equivalent dipole layer (EDL) method allows the noninvasive estimation of endocardial and epicardial activation and repolarization times (AT and RT), but the RT validation is limited to in silico studies. We aimed to assess the temporal and spatial accuracy of the EDL method in reconstructing the RTs from the surface ECG under physiological circumstances and situations with artificially induced increased repolarization heterogeneity. Methods: In four Langendorff-perfused pig hearts, we simultaneously recorded unipolar electrograms from plunge needles and pseudo-ECGs from a volume-conducting container equipped with 61 electrodes. The RTs were computed from the ECGs during atrial and ventricular pacing and compared with those measured from the local unipolar electrograms. Regional RT prolongation (cooling) or shortening (pinacidil) was achieved by selective perfusion of the left anterior descending artery (LAD) region. Results: The differences between the computed and measured RTs were 19.0 ± 17.8 and 18.6 ± 13.7 ms for atrial and ventricular paced beats, respectively. The region of artificially delayed or shortened repolarization was correctly identified, with minimum/maximum RT roughly in the center of the region in three hearts. In one heart, the reconstructed region was shifted by ~2.5 cm. The total absolute difference between the measured and calculated RTs for all analyzed patterns in selectively perfused hearts (n = 5) was 39.6 ± 27.1 ms. Conclusion: The noninvasive ECG repolarization imaging using the EDL method of atrial and ventricular paced beats allows adequate quantitative reconstruction of regions of altered repolarization.
KW - electrocardiographic imaging (ECGI)
KW - equivalent dipole layer
KW - inverse problem of electrocardiography
KW - noninvasive imaging
KW - repolarization heterogeneity
UR - http://www.scopus.com/inward/record.url?scp=85118756543&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fphys.2021.737609
DO - https://doi.org/10.3389/fphys.2021.737609
M3 - Article
C2 - 34744778
SN - 1664-042X
VL - 12
JO - Frontiers in physiology
JF - Frontiers in physiology
M1 - 737609
ER -