Shannon Heather Joanne, Navarro Cesar O, Smith Bernie A, McClelland Anthony J, Lau Ernest W, Roberts Michael J D, Anderson John M C, Adgey Jeninifer A
Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom.
J Electrocardiol. 2007 Nov-Dec;40(6 Suppl):S111-7. doi: 10.1016/j.jelectrocard.2007.05.034.
Noncontact endocardial mapping allows accurate beat-to-beat reconstruction of the reentrant pathway of ventricular tachycardia and improves outcomes after ablation. Several studies support electrocardiographic imaging (ECGI) as a means of noninvasively outlining epicardial activation despite constraints of internal geometry. However, few have explored its clinical application. This study aims to evaluate ECGI during selective left ventricular (LV) pacing, relative to an invasive approach.
Multisite pacing was performed within the left ventricles of 3 patients undergoing invasive procedures. Simultaneous recording of endocardial potentials using a noncontact multielectrode array and body surface potentials (BSP) using an 80-electrode torso vest was performed. A total of 16 recordings were made. The inverse solution was applied to BSP to reconstruct epicardial activation. Single-paced beats from real and virtual electrograms were used to construct 3-dimensional isochronal and isopotential maps. Endocardial and epicardial data were then superimposed onto a single geometry to allow quantitative comparison of activation foci.
Good correlation was observed between endocardial activation patterns and those reconstructed from BSP using ECGI. This was repeatedly demonstrated in all LV regions except for the septum (3 recordings). Epicardial isochronal maps were able to locate early and late activation to mean distances of 13.8 +/- 4.7 and 12.5 +/- 3.7 mm from endocardial data. Isopotential maps localized pacing sites with comparable accuracy (14 +/- 5.3 mm).
Body surface potentials and reconstructed epicardial activation patterns during LV pacing correlate well with endocardial data acquired invasively. The exception was during pacing of the septum. Although early results are encouraging, further quantitative data are required to fully validate and apply this noninvasive tool in the clinical arena.
非接触式心内膜标测能够准确逐搏重建室性心动过速的折返路径，并改善消融后的治疗效果。多项研究支持将心电图成像（ECGI）作为一种无创描绘心外膜激动的方法，尽管存在内部几何结构的限制。然而，很少有人探索其临床应用。本研究旨在评估选择性左心室（LV）起搏期间的ECGI，与侵入性方法进行对比。
对3例接受侵入性手术的患者在左心室内进行多部位起搏。使用非接触式多电极阵列同步记录心内膜电位，并使用80电极躯干背心记录体表电位（BSP）。共进行了16次记录。将逆解算法应用于BSP以重建心外膜激动。来自真实和虚拟心电图的单起搏搏动用于构建三维等时线图和等电位图。然后将心内膜和心外膜数据叠加到单一几何结构上，以便对激动灶进行定量比较。
在心内膜激动模式与使用ECGI从BSP重建的激动模式之间观察到良好的相关性。除了间隔（3次记录）外，在所有左心室区域均反复证实了这一点。心外膜等时线图能够将早期和晚期激动定位到距心内膜数据平均距离为13.8±4.7和12.5±3.
