Inverse solution mapping of epicardial potentials: quantitative comparison with epicardial contact mapping.
نویسندگان
چکیده
BACKGROUND Catheter ablation of ventricular tachycardia (VT) is still one of the most challenging procedures in cardiac electrophysiology, limited, in part, by unmappable arrhythmias that are nonsustained or poorly tolerated. Calculation of the inverse solution from body surface potential mapping (sometimes known as ECG imaging) has shown tremendous promise and can rapidly map these arrhythmias, but we lack quantitative assessment of its accuracy in humans. We compared inverse solution mapping with computed tomography-registered electroanatomic epicardial contact catheter mapping to study the resolution of this technique, the influence of myocardial scar, and the ability to map VT. METHODS AND RESULTS For 4 patients undergoing epicardial catheter mapping and ablation of VT, 120-lead body surface potential mappings were obtained during implantable defibrillator pacing, catheter pacing from 79 epicardial sites, and induced VT. Inverse epicardial electrograms computed using individualized torso/epicardial surface geometries extracted from computed tomography images were compared with registered electroanatomic contact maps. The distance between estimated and actual epicardial pacing sites was 13 ± 9 mm over normal myocardium with no stimulus-QRS delay but increased significantly over scar (P=0.013) or was close to scar (P=0.014). Contact maps during right ventricular pacing correlated closely to inverse solution isochrones. Maps of inverse epicardial potentials during 6 different induced VTs indicated areas of earliest activation, which correlated closely with clinically identified VT exit sites for 2 epicardial VTs. CONCLUSIONS Inverse solution maps can identify sites of epicardial pacing with good accuracy, which diminishes over myocardial scar or over slowly conducting tissue. This approach can also identify epicardial VT exit sites and ventricular activation sequences.
منابع مشابه
Multielectrode venous catheter mapping as a high quality constraint for electrocardiographic inverse solution.
A persistent challenge in solving inverse problems in electrocardiography is the application of suitable constraints to the calculation of cardiac sources. Whether one formulates the inverse problem in terms of epicardial potentials or activation wavefronts, the problem is physically ill-posed and hence results in numerically unstable computations. Suitable physiological constraints applied wit...
متن کاملDirect and inverse methods for cardiac mapping using multielectrode catheter measurements
Detection of cardiac activation and reentry is critical in the diagnosis and treatment of arrhythmia, a heart disorder which affects some 4 million people in the US. Present approaches typically map the sequence of activation by using multiple catheters, or in particularly severe cases, by applying electrode arrays directly to the heart. Catheter based approaches usually measure signals from in...
متن کاملThe incidence and clinical significance of epicardial late potentials in patients with recurrent sustained ventricular tachycardia and coronary artery disease.
Seventy-eight patients with ventricular tachycardia associated with coronary artery disease underwent intraoperative mapping while in sinus rhythm to evaluate the frequency and significant of late potentials. In 30 of these patients, the surface ECG was subjected to signal averaging to correlate the incidence and duration of low-amplitude, delayed electrograms with the presence of late potentia...
متن کاملCombined epicardial and endocardial electroanatomic mapping in a porcine model of healed myocardial infarction.
BACKGROUND Substrate mapping of post-myocardial infarction ventricular tachycardia involves electroanatomic delineation of scarred tissue on the basis of electrogram characteristics during sinus rhythm. A percutaneous transthoracic technique was recently described that allows catheter mapping of the epicardial surface of the heart. This study sought to determine whether the epicardial extent of...
متن کاملInverse calculation of QRS-T epicardial potentials from body surface potential distributions for normal and ectopic beats in the intact dog.
Inverse epicardial potential distributions were calculated from potential distributions measured from the body surface in 12 intact dogs, divided into six pairs. The calculation procedure made use of measurements from the initial dog of each pair, giving the geometric location of each epicardial and body surface electrode and the approximate variance of the epicardial potentials and of the body...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Circulation. Arrhythmia and electrophysiology
دوره 5 5 شماره
صفحات -
تاریخ انتشار 2012