Understanding the Utility of Endocardial Electrocardiographic Imaging in Epi-Endocardial Mapping of 3D Reentrant Circuits.
Understanding the Utility of Endocardial Electrocardiographic Imaging in Epi-Endocardial Mapping of 3D Reentrant Circuits.
复制标题
了解心内膜心电图成像在 3D 折返回路心外膜标测中的效用。
DOI：
10.1101/2024.03.13.24304259
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Wang,Linwei
中科院分区：
文献类型：
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作者：
Toloubidokhti,Maryam;Gharbia,OmarA;Parkosa,Adityo;Trayanova,Natalia;Nazarian,Saman;Sapp,JohnL;Wang,Linwei
室性心动过速机制的研究在很大程度上是基于心脏表面上可重入回路的二维图像。这简化了涉及心肌深度的3D电路。同时心外膜和心内膜（epi-endo）作图可促进室性室速电路的三维描绘，然而，通过有创作图是困难的。目的本研究探讨无创心外膜-心内膜心电图成像（ECGI）在阐明室性心动过速电路三维结构中的能力，强调心外膜、心内膜和壁内电路的区分，并确定中壁出口与心外膜或心内膜表面的接近程度。方法采用120导联心电图结合受检者心脏-躯干几何图形计算心室心外膜和心内膜单极电图。构造激活等时线，并在每个表面上计算VT周期长度内的激活百分比。这将VT电路分为二维（仅表面）、均匀跨壁、非均匀跨壁和中心肌（聚焦表面）。此外，利用拉普拉斯特征映射精确测量心内膜突破时间，并通过关联外内膜突破的延迟时间，确定中壁出口到心外膜或心内膜表面的相对距离。结果分析了23条梗死后猪心脏模拟和活体VT电路。在模拟电路中，ECGI将21%分类为2D， 78%分类为3D：其中82.6%分类正确。在所有病例中，心外膜和心内膜突破之间的相对时间被正确捕获。在体内电路中，ECGI将25%分类为2D， 75%分类为3D：在所有病例中，电路出口和入口与LGE-MRI和导管测绘数据联合描绘的潜在临界峡部一致。结论secgi外腔内窦测图具有快速描绘三维室速回路的潜力，可为室速消融增加详细的导管测图。
BackgroundStudies of VT mechanisms are largely based on a 2D portrait of reentrant circuits on one surface of the heart. This oversimplifies the 3D circuit that involves the depth of the myocardium. Simultaneous epicardial and endocardial (epi-endo) mapping was shown to facilitate a 3D delineation of VT circuits, which is however difficult via invasive mapping.ObjectiveThis study investigates the capability of noninvasive epicardial-endocardial electrocardiographic imaging (ECGI) to elucidate the 3D construct of VT circuits, emphasizing the differentiation of epicardial, endocardial, and intramural circuits and to determine the proximity of mid-wall exits to the epicardial or endocardial surfaces.Methods120-lead ECGs of VT in combination with subject-specific heart-torso geometry are used to compute unipolar electrograms (CEGM) on ventricular epicardium and endocardia. Activation isochrones are constructed, and the percentage of activation within VT cycle length is calculated on each surface. This classifies VT circuits into 2D (surface only), uniform transmural, nonuniform transmural, and mid-myocardial (focal on surfaces). Furthermore, the endocardial breakthrough time was accurately measured using Laplacian eigenmaps, and by correlating the delay time of the epi-endo breakthroughs, the relative distance of a mid-wall exit to the epicardium or the endocardium surfaces was identified.ResultsWe analyzed 23 simulated and in-vivo VT circuits on post-infarction porcine hearts. In simulated circuits, ECGI classified 21% as 2D and 78% as 3D: 82.6% of these were correctly classified. The relative timing between epicardial and endocardial breakthroughs was correctly captured across all cases. In in-vivo circuits, ECGI classified 25% as 2D and 75% as 3D: in all cases, circuit exits and entrances were consistent with potential critical isthmus delineated from combined LGE-MRI and catheter mapping data.ConclusionsECGI epi-endo mapping has the potential for fast delineation of 3D VT circuits, which may augment detailed catheter mapping for VT ablation.