Comparison of electrical dyssynchrony parameters between electrocardiographic imaging and a simulated ECG belt

• Published in: Journal of electrocardiology 2021-09, Vol.68, p.117-123
• Main Authors: Elliott, Mark K., Blauer, Joshua, Mehta, Vishal S., Sidhu, Baldeep S., Gould, Justin, Jackson, Tom, Sieniewicz, Benjamin, Niederer, Steven, Ghosh, Subham, Rinaldi, Christopher A.
• Format: Article
• Language: English
• Subjects: Body surface potential mapping; Cardiac arrhythmia; Cardiac resynchronization therapy; ECG belt; Electrocardiographic imaging; Electrocardiography; Heart attacks; Heart failure; Kuiper Belt; Studies
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2021.08.003

Electrocardiographic imaging (ECGi) and the ECG belt are body surface potential mapping systems which can assess electrical dyssynchrony in patients undergoing cardiac resynchronization therapy (CRT). ECGi-derived dyssynchrony metrics are calculated from reconstructed epicardial potentials based on body surface potentials combined with a thoracic CT scan, while the ECG belt relies on body surface potentials alone. The relationship between dyssynchrony metrics from these two systems is unknown. In this study we aim to compare intra-ventricular and inter-ventricular dyssynchrony metrics between ECGi and the ECG belt. Seventeen patients underwent ECGi after CRT. A subsample of 40 body surface potentials was used to simulate the ECG belt. ECGi dyssynchrony metrics, calculated from reconstructed epicardial potentials, and ECG belt dyssynchrony metrics, calculated from the sampled body surface potentials were compared. There was a strong positive correlation between ECGi left ventricular activation time (LVAT) and ECG belt left thorax activation time (LTAT) (R = 0.88 ; P < 0.001) and between ECGi standard deviation of activation times (SDAT) and ECG belt-SDAT (R = 0.76; P < 0.001) during intrinsic rhythm. The correlation for both pairs was also strong during biventricular pacing. Ventricular electrical uncoupling, a well validated ECGi inter-ventricular dyssynchrony metric, correlated strongly with ECG belt-SDAT during intrinsic rhythm (R = 0.76; P < 0.001) but not biventricular pacing (R = 0.29; P = 0.26). Cranial or caudal displacement of the simulated ECG belt did not affect LTAT or SDAT. ECGi- and ECG belt-derived intra-ventricular and inter-ventricular dyssynchrony metrics were strongly correlated. The ECG belt may offer comparable dyssynchrony assessment to ECGi, with associated practical and cost advantages. •ECGi and the ECG belt are two methods of assessing electrical dyssynchrony in patients undergoing CRT•ECGi uses epicardial potentials to assess electrical activation while the ECG belt uses body surface potentials•LVAT derived from ECGi and LTAT derived from the ECG belt are strongly correlated•SDAT from ECGi and the ECG belt are also strongly correlated•VEU derived from ECGi correlates strongly with ECG belt-SDAT during intrinsic rhythm but not during biventricular pacing•The ECG belt may provide comparable dyssynchrony assessment to ECGi, particularly during intrinsic rhythm