Spatial Accuracy of a Clinically Established Noninvasive Electrocardiographic Imaging System for the Detection of Focal Activation in an Intact Porcine Model
Spatial Accuracy of a Clinically Established Noninvasive Electrocardiographic Imaging System for the Detection of Focal Activation in an Intact Porcine Model
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DOI：
10.1161/circep.119.007570
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发表时间：
2019-11-01
影响因子：
8.4
通讯作者：
Packer, Douglas L.
中科院分区：
文献类型：
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作者：
Hohmann, Stephan;Rettmann, Maryam E.;Packer, Douglas L.
背景：无创心电成像(ECGi)在临床上用于消融前对心律失常进行标测。尽管它在临床上使用，但关于该系统识别心律失常灶的准确性的验证数据有限。方法：9头猪接受了心内膜基准标记物的闭合放置、计算机断层扫描和ECGi采集的所有心腔的起搏。起搏位置由双平面透视重建，并使用基准点与计算机断层扫描进行配准。盲人研究人员根据ECGi数据预测起搏位置，并计算到真正起搏导管尖端位置的距离。结果：共对9头猪心内膜109个部位和心外膜9个部位进行了起搏。ECGi在85%的心房和92%的心室部位预测到正确的起始腔。在正确的腔室中预测侧方位置的频率高于预测间隔位置的频率(97%对79%，P=0.01)。实际起搏位置和预测起搏位置之间的绝对空间距离为20.7(13.8-25.6)mm(中位数和[1-3]四分位数)。不同心腔的距离没有显著差异。结论：在绝大多数病例中，ECGi系统能够正确识别局部激活的起始室。考虑到这些误差估计，以足够的精度确定真正的起源地是可能的。
Background: Noninvasive electrocardiographic imaging (ECGi) is used clinically to map arrhythmias before ablation. Despite its clinical use, validation data regarding the accuracy of the system for the identification of arrhythmia foci is limited. Methods: Nine pigs underwent closed-chest placement of endocardial fiducial markers, computed tomography, and pacing in all cardiac chambers with ECGi acquisition. Pacing location was reconstructed from biplane fluoroscopy and registered to the computed tomography using the fiducials. A blinded investigator predicted the pacing location from the ECGi data, and the distance to the true pacing catheter tip location was calculated. Results: A total of 109 endocardial and 9 epicardial locations were paced in 9 pigs. ECGi predicted the correct chamber of origin in 85% of atrial and 92% of ventricular sites. Lateral locations were predicted in the correct chamber more often than septal locations (97% versus 79%, P=0.01). Absolute distances in space between the true and predicted pacing locations were 20.7 (13.8-25.6) mm (median and [first-third] quartile). Distances were not significantly different across cardiac chambers. Conclusions: The ECGi system is able to correctly identify the chamber of origin for focal activation in the vast majority of cases. Determination of the true site of origin is possible with sufficient accuracy with consideration of these error estimates.