Noninvasive epi-endocardial electrocardiographic imaging of ventricular septal pacing

Noninvasive epi-endocardial ElectroCardioGraphic Imaging (ECGI) allows reconstruction of electrograms and high-resolution visualization of various isoparametric maps based on multichannel ECG recordings and tomography. This study shows results of ECGI accuracy verification based on septal ventricular pacing in patients with pre-implanted pacemakers using new algorithm for solving the inverse problem of electrocardiography.

Methods. 10 patients in this study underwent epi-endocardial ECGI mapping (Amycard 01C EP Lab, Amycard LLC, Russia - EP Solutions SA, Switzerland). An iterative Equal Single Layer algorithm (ESL-iterative) and new Fast Route algorithm in combination with vector approach (FRA-V) were used to reconstruct isopotential and correlation similarity maps. Geodesic distance between noninvasively reconstructed early activate zone and RV reference pacing site were measured to evaluate ECGI accuracy.

Results. The mean (SD) geodesic distance between noninvasively reconstructed and reference pacing site was 22 (15) mm for ESL-iterative and 12 (7) for FRA-V algorithm, median (25-75% IQR) - 23 (8-29) mm and 10 (8-14) mm respectively. Accuracy of ECGI mapping based on FRA-V algorithm was significantly better than ESL-iterative algorithm (p=0,01). Detailed visual analysis of correlation similarity and isopotential maps showed significantly more accurate localization of early activation zones using new FRA-V algorithm.

Conclusions. These results showed a possibility of novel epi-endocardial ECGI mapping to detect early activation zone during septal ventricular pacing with sufficient accuracy (median 10 mm) using new FRA-V algorithm. Therefore, FRA-V algorithm is significantly better for epi-endocardial ECGI mapping and shows a significant advantage of this technique compared to other non-invasive methods of topical diagnostics. Moreover, simultaneous beat-to-beat mapping of entire ventricular septum allows using of this technique for preoperative topical diagnosis of complex unstable and polymorphic ventricular arrhythmias.

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