Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Via Giuseppe Buffi 13, CH-6904 Lugano, Switzerland.
Department of Physiology, CARIM, Maastricht University, Maastricht, The Netherlands.
Europace. 2021 Apr 6;23(4):640-647. doi: 10.1093/europace/euaa330.
Non-invasive imaging of electrical activation requires high-density body surface potential mapping. The nine electrodes of the 12-lead electrocardiogram (ECG) are insufficient for a reliable reconstruction with standard inverse methods. Patient-specific modelling may offer an alternative route to physiologically constraint the reconstruction. The aim of the study was to assess the feasibility of reconstructing the fully 3D electrical activation map of the ventricles from the 12-lead ECG and cardiovascular magnetic resonance (CMR).
Ventricular activation was estimated by iteratively optimizing the parameters (conduction velocity and sites of earliest activation) of a patient-specific model to fit the simulated to the recorded ECG. Chest and cardiac anatomy of 11 patients (QRS duration 126-180 ms, documented scar in two) were segmented from CMR images. Scar presence was assessed by magnetic resonance (MR) contrast enhancement. Activation sequences were modelled with a physiologically based propagation model and ECGs with lead field theory. Validation was performed by comparing reconstructed activation maps with those acquired by invasive electroanatomical mapping of coronary sinus/veins (CS) and right ventricular (RV) and left ventricular (LV) endocardium. The QRS complex was correctly reproduced by the model (Pearson's correlation r = 0.923). Reconstructions accurately located the earliest and latest activated LV regions (median barycentre distance 8.2 mm, IQR 8.8 mm). Correlation of simulated with recorded activation time was very good at LV endocardium (r = 0.83) and good at CS (r = 0.68) and RV endocardium (r = 0.58).
Non-invasive assessment of biventricular 3D activation using the 12-lead ECG and MR imaging is feasible. Potential applications include patient-specific modelling and pre-/per-procedural evaluation of ventricular activation.
电活动的无创成像需要高密度的体表电位图。标准逆方法的 12 导联心电图（ECG）的 9 个电极不足以进行可靠的重建。患者特定的建模可能提供了一种替代途径，可以对重建进行生理约束。本研究旨在评估从 12 导联 ECG 和心血管磁共振（CMR）重建心室全 3D 电活动图的可行性。
通过迭代优化患者特定模型的参数（传导速度和最早激活部位）来估计心室激活，以拟合模拟到记录的 ECG。从 CMR 图像中分割了 11 名患者的胸腔和心脏解剖结构（QRS 持续时间 126-180ms，两名患者有记录的疤痕）。通过磁共振（MR）对比增强评估疤痕的存在。使用基于生理的传播模型和导联场理论对激活序列进行建模。通过比较与经冠状窦/静脉（CS）和右心室（RV）和左心室（LV）心内膜的侵入性电解剖图获得的重建激活图来进行验证。模型正确地再现了 QRS 复合体（皮尔逊相关 r=0.923）。重建准确地定位了最早和最晚激活的 LV 区域（中位数质心距离 8.2mm，IQR 8.8mm）。模拟与记录的激活时间的相关性在 LV 心内膜（r=0.83）和 CS（r=0.68）和 RV 心内膜（r=0.58）非常好。
使用 12 导联 ECG 和 MR 成像无创评估双心室 3D 激活是可行的。潜在的应用包括患者特定的建模和心室激活的术前/术中评估。
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