Bordeaux University Hospital, Bordeaux, France; IHU LIRYC, Bordeaux University, Bordeaux, France.
Bordeaux University Hospital, Bordeaux, France; IHU LIRYC, Bordeaux University, Bordeaux, France.
Heart Rhythm. 2019 Mar;16(3):435-442. doi: 10.1016/j.hrthm.2018.10.010. Epub 2018 Oct 26.
Activation mapping using noninvasive electrocardiographic imaging (ECGi) has recently been used to describe the physiology of different cardiac abnormalities. These descriptions differ from prior invasive studies, and both methods have not been thoroughly confronted in a clinical setting.
The goal of the present study was to provide validation of noninvasive activation mapping in a clinical setting through direct confrontation with invasive epicardial contact measures.
Fifty-nine maps were obtained in 55 patients and aligned on a common geometry. Nearest-neighbor interpolation was used to avoid map smoothing. Quantitative comparison was performed by computing between-map correlation coefficients and absolute activation time errors.
The mean activation time error was 20.4 ± 8.6 ms, and the between-map correlation was poor (0.03 ± 0.43). The results suggested high interpatient variability (correlation -0.68 to 0.82), wide QRS patterns, and paced rhythms demonstrating significantly better mean correlation (0.68 ± 0.17). Errors were greater in scarred regions (21.9 ± 10.8 ms vs 17.5 ± 6.7 ms; P < .01). Fewer epicardial breakthroughs were imaged using noninvasive mapping (1.3 ± 0.5 vs 2.3 ± 0.7; P < .01). Primary breakthrough locations were imaged 75.7 ± 38.1 mm apart. Lines of conduction block (jumps of ≥50 ms between contiguous points) due to structural anomalies were recorded in 27 of 59 contact maps and were not visualized at these same sites noninvasively. Instead, artificial lines appeared in 33 of 59 noninvasive maps in regions of reduced bipolar voltage amplitudes (P = .03). An in silico model confirms these artificial constructs.
Overall, agreement of ECGi activation mapping and contact mapping is poor and heterogeneous. The between-map correlation is good for wide QRS patterns. Lines of block and epicardial breakthrough sites imaged using ECGi are inaccurate. Further work is required to improve the accuracy of the technique.
非侵入性心电图成像（ECGi）的激活图最近已被用于描述不同心脏异常的生理学。这些描述与之前的侵入性研究不同，两种方法都没有在临床环境中得到彻底的对比。
本研究的目的是通过与侵入性心外膜接触测量的直接对比，在临床环境中验证非侵入性激活图。
在 55 名患者中获得了 59 个图，并在共同的几何形状上对齐。使用最近邻插值来避免图平滑。通过计算图之间的相关系数和绝对激活时间误差来进行定量比较。
平均激活时间误差为 20.4 ± 8.6 ms，图之间的相关性较差（0.03 ± 0.43）。结果表明患者间的变异性较大（相关性-0.68 至 0.82），宽 QRS 模式和起搏节律的平均相关性明显更好（0.68 ± 0.17）。疤痕区域的误差较大（21.9 ± 10.8 ms 比 17.5 ± 6.7 ms；P <.01）。非侵入性映射成像的心外膜突破较少（1.3 ± 0.5 比 2.3 ± 0.7；P <.01）。原发性突破位置相隔 75.7 ± 38.1 mm。在 59 个接触图中的 27 个中记录了由于结构异常导致的传导阻滞线（连续点之间的跳跃大于 50 ms），而非侵入性地在这些相同的位置无法可视化。相反，在 59 个非侵入性地图中的 33 个区域中出现了由于双极电压幅度降低而产生的人为线（P =.03）。一个计算机模型证实了这些人为结构。
总的来说，ECGi 激活图和接触图的一致性很差，而且具有异质性。宽 QRS 模式的图之间相关性良好。ECGi 成像的阻滞线和心外膜突破部位的图像不准确。需要进一步的工作来提高该技术的准确性。
