Sensitivity- and effort-gain analysis: multilead ECG electrode array selection for activation time imaging.

Methods for noninvasive imaging of electric function of the heart might become clinical standard procedure the next years. Thus, the overall procedure has to meet clinical requirements as an easy and fast application. In this paper, we propose a new electrode array which improves the resolution of methods for activation time imaging considering clinical constraints such as easy to apply and compatibility with routine leads. For identifying the body-surface regions where the body surface potential (BSP) is most sensitive to changes in transmembrane potential (TMP), a virtual array method was used to compute local linear dependency (LLD) maps. The virtual array method computes a measure for the LLD in every point on the body surface. The most suitable number and position of the electrodes within the sensitive body surface regions was selected by constructing effort gain (EG) plots. Such a plot depicts the relative attainable rank of the leadfield matrix in relation to the increase in number of electrodes required to build the electrode array. The attainable rank itself was computed by a detector criterion. Such a criterion estimates the maximum number of source space eigenvectors not covered by noise when being mapped to the electrode space by the leadfield matrix and recorded by a detector. From the sensitivity maps, we found that the BSP is most sensitive to changes in TMP on the upper left frontal and dorsal body surface. These sensitive regions are covered best by an electrode array consisting of two L-shaped parts of approximately 30 cm x 30 cm and approximately 20 cm x 20 cm. The EG analysis revealed that the array meeting clinical requirements best and improving the resolution of activation time imaging consists of 125 electrodes with a regular horizontal and vertical spacing of 2-3 cm.