Rapid 12-lead automated localization method: Comparison to electrocardiographic imaging (ECGI) in patient-specific geometry

• Published in: Journal of electrocardiology 2018-11, Vol.51 (6), p.S92-S97
• Main Authors: Zhou, Shijie, Horáček, B. Milan, Warren, James W., AbdelWahab, Amir, Sapp, John L.
• Format: Article
• Language: English
• Subjects: 12-lead ECG; Automation; Cardiac arrhythmia; Catheters; Electrocardiographic imaging (ECGI); Electrocardiography; Electrophysiology mapping; Localization; Pace-mapping; Radio frequency; Radiofrequency ablation; Ventricular tachycardia
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2018.07.022

Rapid accurate localization of the site of ventricular activation origin during catheter ablation for ventricular arrhythmias could facilitate the procedure. Electrocardiographic imaging (ECGI) using large lead sets can localize the origin of ventricular activation. We have developed an automated method to identify sites of early ventricular activation in real time using the 12-lead ECG. We aim to compare the localization accuracy of ECGI and the automated method, identifying pacing sites/VT exit based on a patient-specific model. A patient undergoing ablation of VT on the left-ventricular endocardium and epicardium had 120-lead body-surface potential mapping (BSPM) recorded during the procedure. (1) ECGI methodology: The L1-norm regularization was employed to reconstruct epicardial potentials based on patient-specific geometry for localizing endocardial ventricular activation origin. We used the BSPM data corresponding to known endocardial pacing sites and a VT exit site identified by 3D contact mapping to analyze them offline. (2) The automatedmethod: location coordinates of pacing sites together with the time integral of the first 120 ms of the QRS complex of 3 ECG predictors (leads III, V2 and V6) were used to calculate patient-specific regression coefficients to predict the location of unknown sites of ventricular activation origin (“target” sites). Localization error was quantified over all pacing sites in millimeters by comparing the calculated location and the known reference location. Localization was tested for 14 endocardial pacing sites and 1 epicardial VT exit site. For 14 endocardial pacing sites the mean localization error of the automated method was significantly lower than that of the ECGI (8.9 vs. 24.9 mm, p