![]() Patients with all ECG leads in situ underwent non-contrast CT imaging of the chest (Somatom Definition Flash, Siemens, Erlangen, Germany) to derive a patient-specific model of the heart and torso (Fig. 1c.įull size image Imaging and model reconstruction A subset of the 99 BSPM electrodes was selected to represent the 12-lead ECG, indicated by red circles in Fig. Each BSPM signal was sampled at 1000 Hz, with a lowpass filter of 250 Hz and no high-pass filter used. All signals were referenced to the Wilson central terminal (Fig. ECG dataįor each patient, a 99-lead BSPM was recorded in a grid of 12 strips with eight electrodes and three limb electrodes (Fig. After recording of spontaneous sinus rhythm, the device was programmed to the sequential LV pacing and sequential RV pacing (atrial pacing at 10 bpm above the sinus rate, AV-delay 120 ms). The local ethics committee- The Ethics Committee of the Institute for Clinical and Experimental Medicine and Thomayer Hospital approved the study protocol.Īll patients underwent BSPM examination using the 99-lead system ProCardio-8 11. The study was conducted according to the declaration of Helsinki, and all patients gave informed consent. Patients were followed in the outpatient clinic. In most cases, the system consisted of an ICD (12 subjects). The study recruited outpatients with dilated cardiomyopathy and LBBB, implanted previously with CRT. ![]() This proof-of-the-concept study aimed to evaluate the accuracy of our novel PaceView iECG method to localize the left or right ventricular (LV and RV, respectively) pacing leads, using either a 99-electrode BSPM or the 12-lead ECG. ![]() Recently, we have developed a 12-lead inverse ECG method (iECG) to estimate the endocardial and epicardial ventricular activation 9, 10. To support patient selection for CRT and guide CRT implants, the system needs only to search the targeted implantation area, right ventricular endocardium, or left epicardium. This system localizes the ectopic origin of a PVC or VT anywhere in the ventricles, which makes the computation time relative long (minutes). One of the few commercially available ECGI systems using the standard 12-lead ECG is ViVo 5, 6, 7, 8. However, BSPM and ECGI are not widely used in clinical practice due to logistic reasons and limited evidence of superiority over standard 12-lead ECG. Recently, body surface potential mapping (BSPM) and derived inverse ECG imaging methods (ECGI) have been proposed for the optimization of CRT 3, 4. The optimal pacing lead placement and follow-up monitoring to verify the pacing electrode position have been considered essential determinants of benefit from CRT 2. However, a variable proportion of patients do not improve their clinical status 1. ![]() Thus, the noninvasive lead localization using the 12-lead ECG was accurate enough and comparable to 99-lead BSPM, potentially increasing the capability of 12-lead ECG for the optimization of the LV/RV pacing sites during CRT implant or for the most favorable programming.Ĭardiac resynchronization therapy (CRT) is an accepted treatment strategy for patients with heart failure with reduced ejection fraction and impaired intraventricular conduction. The localization error for the RV/LV lead was 9.0 / 7.7 mm using the 12-lead ECG and 9.1 / 9.8 mm for the BSPM. Consecutive patients with dilated cardiomyopathy, previously implanted with a CRT device, were enrolled (n = 19). Both BSPM and 12-lead ECG were used to localize the RV and LV lead, and the localization error was calculated. From a BSPM, nine signals were selected to obtain the 12-lead ECG. The non-contrast CT was performed to localize precisely both ECG electrodes and CRT leads. A 99-lead BSPM was recorded in patients with cardiac resynchronization therapy (CRT) during sinus rhythm and sequential LV/RV pacing. This study evaluated the accuracy of PaceView inverse ECG method to localize the left or right ventricular (LV and RV, respectively) pacing leads using either a 99-lead BSPM or the 12-lead ECG. Inverse ECG imaging methods typically require 32–250 leads to create body surface potential maps (BSPM), limiting their routine clinical use.
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