Reconstruction of three-dimensional biventricular activation based on the 12-lead electrocardiogram via patient-specific modelling

• Published in: Europace (London, England) Vol. 23; no. 4; pp. 640 - 647
• Main Authors: Pezzuto, Simone, Prinzen, Frits W, Potse, Mark, Maffessanti, Francesco, Regoli, François, Caputo, Maria Luce, Conte, Giulio, Krause, Rolf, Auricchio, Angelo
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 06-04-2021; Oxford University Press (OUP)
• Subjects: Cardiology and cardiovascular system; Human health and pathology; Life Sciences; Techincal Issues; Twelve-lead electrocardiogram; Patient-specific modelling; Eikonal model; Ventricular activation • Three-dimensional activation; Three-dimensional activation; Ventricular activation
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euaa330

Abstract
Aims
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).
Methods and results
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).
Conclusion
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.