Comparing Non-invasive Inverse Electrocardiography With Invasive Endocardial and Epicardial Electroanatomical Mapping During Sinus Rhythm

This study presents a novel non-invasive equivalent dipole layer (EDL) based inverse electrocardiography (iECG) technique which estimates both endocardial and epicardial ventricular activation sequences. We aimed to quantitatively compare our iECG approach with invasive electro-anatomical mapping (EAM) during sinus rhythm with the objective of enabling functional substrate imaging and sudden cardiac death risk stratification in patients with cardiomyopathy. Thirteen patients (77% males, 48 ± 20 years old) referred for endocardial and epicardial EAM underwent 67-electrode body surface potential mapping and CT imaging. The EDL-based iECG approach was improved by mimicking the effects of the His-Purkinje system on ventricular activation. EAM local activation timing (LAT) maps were compared with iECG-LAT maps using absolute differences and Pearson’s correlation coefficient, reported as mean ± standard deviation [95% confidence interval]. The correlation coefficient between iECG-LAT maps and EAM was 0.54 ± 0.19 [0.49–0.59] for epicardial activation, 0.50 ± 0.27 [0.41–0.58] for right ventricular endocardial activation and 0.44 ± 0.29 [0.32–0.56] for left ventricular endocardial activation. The absolute difference in timing between iECG maps and EAM was 17.4 ± 7.2 ms for epicardial maps, 19.5 ± 7.7 ms for right ventricular endocardial maps, 27.9 ± 8.7 ms for left ventricular endocardial maps. The absolute distance between right ventricular endocardial breakthrough sites was 30 ± 16 mm and 31 ± 17 mm for the left ventricle. The absolute distance for latest epicardial activation was median 12.8 [IQR: 2.9–29.3] mm. This first in-human quantitative comparison of iECG and invasive LAT-maps on both the endocardial and epicardial surface during sinus rhythm showed improved agreement, although with considerable absolute difference and moderate correlation coefficient. Non-invasive iECG requires further refinements to facilitate clinical implementation and risk stratification

Influence of head models on neuromagnetic fields and inverse source localizations

BACKGROUND: The magnetoencephalograms (MEGs) are mainly due to the source currents. However, there is a significant contribution to MEGs from the volume currents. The structure of the anatomical surfaces, e.g., gray and white matter, could severely influence the flow of volume currents in a head model. This, in turn, will also influence the MEGs and the inverse source localizations. This was examined in detail with three different human head models. METHODS: Three finite element head models constructed from segmented MR images of an adult male subject were used for this study. These models were: (1) Model 1: full model with eleven tissues that included detailed structure of the scalp, hard and soft skull bone, CSF, gray and white matter and other prominent tissues, (2) the Model 2 was derived from the Model 1 in which the conductivity of gray matter was set equal to the white matter, i.e., a ten tissuetype model, (3) the Model 3 consisted of scalp, hard skull bone, CSF, gray and white matter, i.e., a five tissue-type model. The lead fields and MEGs due to dipolar sources in the motor cortex were computed for all three models. The dipolar sources were oriented normal to the cortical surface and had a dipole moment of 100 μA meter. The inverse source localizations were performed with an exhaustive search pattern in the motor cortex area. A set of 100 trial inverse runs was made covering the 3 cm cube motor cortex area in a random fashion. The Model 1 was used as a reference model. RESULTS: The reference model (Model 1), as expected, performed best in localizing the sources in the motor cortex area. The Model 3 performed the worst. The mean source localization errors (MLEs) of the Model 3 were larger than the Model 1 or 2. The contour plots of the magnetic fields on top of the head were also different for all three models. The magnetic fields due to source currents were larger in magnitude as compared to the magnetic fields of volume currents. DISCUSSION: These results indicate that the complexity of head models strongly influences the MEGs and the inverse source localizations. A more complex head model performs better in inverse source localizations as compared to a model with lesser tissue surfaces

The conductivity of the human skull: Results of in vivo and in vitro measurements

The conductivity of the human skull was measured both in vitro and in vivo. The in vitro measurement was performed on a sample of fresh skull placed within a saline environment. For the in vivo measurement a small current was passed through the head by means of two electrodes placed on the scalp, The potential distribution thus generated on the scalp was measured in two subjects for two locations of the current injecting electrodes, Both methods revealed a skull conductivity of about 0.015 boolean OR /m. For the conductivities of the brain, the skull and the scalp a ratio of 1:1/15:1 was found. This is consistent with some of the reports on conductivities found in the literature, but differs considerably from the ratio 1 :1/80:1 commonly used in neural source localization. An explanation is provided for this discrepancy, indicating that the correct ratio is 1:1/15:1

Methods for Initialization of Activation Based Inverse Electrocardiography Using Graphs Derived from Heart Surface Geometry

The activation-based inverse problem of electrocardiography is non-linear in the desired activation times. Current solutions rely on iterative algorithms. There is considerable interest in improved initialization approaches due to the importance of the initialization used. Recent efforts include the critical point algorithm of Huiskamp and Greensite and the fastest route algorithm of van Dam, Oostendorp, and van Oosterom. In this work we analyze the relationship between these two methods. We also suggest an alternative to the shortest path approach to represent the set of likely activation patterns that may have computational advantages. We also explore modifications to these two methods exploiting their relationship and using the new activation patterns. We use epicardially stimulated data and geometries, recorded at the Cardiovascular Research and Training Institute in Utah, and geometries and forward matrix supplied with the ECGSim software, to compare results. 1