Novel non-invasive ECG imaging method based on the 12-lead ECG for reconstruction of ventricular activation: A proof-of-concept study

Patricia Zerlang Fruelund*, Peter M. Van Dam, Jacob Melgaard, Anders Sommer, Søren Lundbye-Christensen, Peter Søgaard, Tomas Zaremba, Claus Graff, Sam Riahi

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

1 Citation (Scopus)
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Abstract

Aim: Current non-invasive electrocardiographic imaging (ECGi) methods are often based on complex body surface potential mapping, limiting the clinical applicability. The aim of this pilot study was to evaluate the ability of a novel non-invasive ECGi method, based on the standard 12-lead ECG, to localize initial site of ventricular activation in right ventricular (RV) paced patients. Validation of the method was performed by comparing the ECGi reconstructed earliest site of activation against the true RV pacing site determined from cardiac computed tomography (CT).

Methods: This was a retrospective study using data from 34 patients, previously implanted with a dual chamber pacemaker due to advanced atrioventricular block. True RV lead position was determined from analysis of a post-implant cardiac CT scan. The ECGi method was based on an inverse-ECG algorithm applying electrophysiological rules. The algorithm integrated information from an RV paced 12-lead ECG together with a CT-derived patient-specific heart-thorax geometric model to reconstruct a 3D electrical ventricular activation map.

Results: The mean geodesic localization error (LE) between the ECGi reconstructed initial site of activation and the RV lead insertion site determined from CT was 13.9 ± 5.6 mm. The mean RV endocardial surface area was 146.0 ± 30.0 cm2 and the mean circular LE area was 7.0 ± 5.2 cm2 resulting in a relative LE of 5.0 ± 4.0%.

Conclusion: We demonstrated a novel non-invasive ECGi method, based on the 12-lead ECG, that accurately localized the RV pacing site in relation to the ventricular anatomy.
Original languageEnglish
Article number1087568
JournalFrontiers in Cardiovascular Medicine
Volume10
ISSN2297-055X
DOIs
Publication statusPublished - 2 Feb 2023

Bibliographical note

Copyright © 2023 Fruelund, Van Dam, Melgaard, Sommer, Lundbye-Christensen, Søgaard, Zaremba, Graff and Riahi.

Keywords

  • 12-lead electrocardiogram
  • cardiac pacing
  • electrocardiography
  • non-invasive imaging
  • patient-specific modeling
  • ventricular activation

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