Resolving Myocardial Activation With Novel Omnipolar Electrograms.
Resolving Myocardial Activation With Novel Omnipolar Electrograms.
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DOI：
10.1161/circep.116.004107
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发表时间：
2016-07
期刊：
影响因子：
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通讯作者：
Nanthakumar K
中科院分区：
文献类型：
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作者：
Massé S;Magtibay K;Jackson N;Asta J;Kusha M;Zhang B;Balachandran R;Radisic M;Deno DC;Nanthakumar K
补充数字内容可在文本中找到。由于其固有的局限性，一个多世纪以来，确定局部激活时间一直是心脏测绘的基础。在这里，我们引入了来自行波自然方向的全极电图，并且可以在任何单一位置计算瞬时传导速度振幅和方向，而无需首先确定激活时间。我们试图验证全极衍生的传导速度，并探索心律失常来源定位的潜在应用。利用4个独立的模型和2种独立的信号采集方法推导并验证了全极映射的电图。我们使用了从单层细胞制备中收集的电信号和光信号，用人类胚胎干细胞衍生的心肌细胞构建的三维结构，同时对兔心脏进行光学和电子定位，并在体内对猪进行电生理研究。通过全极电图计算的传导速度与基于传统局部激活时间方法的光学和电成像研究的波前传播速度进行了比较。Bland-Altman分析表明，光数据的全极测量结果与局部激活时间方法一致，波前方向和速度分别在25 cm/s和30°范围内。在电力数据方面也发现了类似的共识。此外，将旋度和散度等数学运算应用于全极导出的速度矢量场，分别定位旋转源和焦点源。电极取向无关的心脏波前轨迹和速度在单个位置的每一个心脏激活可以准确地确定全极电图。当与数学变换相结合时，全极衍生向量场可能有助于实时检测心脏激活源。
Supplemental Digital Content is available in the text. With its inherent limitations, determining local activation times has been the basis of cardiac mapping for over a century. Here, we introduce omnipolar electrograms that originate from the natural direction of a travelling wave and from which instantaneous conduction velocity amplitude and direction can be computed at any single location without first determining activation times. We sought to validate omnipole-derived conduction velocities and explore potential application for localization of sources of arrhythmias. Electrograms from omnipolar mapping were derived and validated using 4 separate models and 2 independent signal acquisition methodologies. We used both electric signals and optical signals collected from monolayer cell preparations, 3-dimensional constructs built with cardiomyocytes derived from human embryonic stem cells, simultaneous optical and electric mapping of rabbit hearts, and in vivo pig electrophysiology studies. Conduction velocities calculated from omnipolar electrograms were compared with wavefront propagation from optical and electric-mapping studies with a traditional local activation time–based method. Bland–Altman analysis revealed that omnipolar measurements on optical data were in agreement with local activation time methods for wavefront direction and velocity within 25 cm/s and 30°, respectively. Similar agreement was also found on electric data. Furthermore, mathematical operations, such as curl and divergence, were applied to omnipole-derived velocity vector fields to locate rotational and focal sources, respectively. Electrode orientation–independent cardiac wavefront trajectory and speed at a single location for each cardiac activation can be determined accurately with omnipolar electrograms. Omnipole-derived vector fields, when combined with mathematical transforms may aid in real-time detection of cardiac activation sources.