RECONSTRUCTION OF ENDOCARDIAL POTENTIALS AND ACTIVATION SEQUENCES FROM INTRACAVITARY PROBE MEASUREMENTS - LOCALIZATION OF PACING SITES AND EFFECTS OF MYOCARDIAL STRUCTURE
RECONSTRUCTION OF ENDOCARDIAL POTENTIALS AND ACTIVATION SEQUENCES FROM INTRACAVITARY PROBE MEASUREMENTS - LOCALIZATION OF PACING SITES AND EFFECTS OF MYOCARDIAL STRUCTURE
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DOI：
10.1161/01.cir.91.3.845
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发表时间：
1995-02-01
期刊：
影响因子：
37.8
通讯作者：
RUDY, Y
中科院分区：
文献类型：
--
作者：
KHOURY, DS;TACCARDI, B;RUDY, Y
背景心内膜激活标测是诊断心律失常和治疗前定位致心律失常部位的重要方法。本研究的目的是开发和测试一种数学方法来重建的endodermal电位和激活序列（isochrones）的电位数据测量与非接触，腔内多电极探头（“逆问题”）。方法和结果基于边界元的数学方法，结合数值正则化技术，开发用于计算逆解。通过将多电极探针置于离体灌注犬左心室腔中测量腔内电位，计算腔内电位。在心肌内不同位置和不同深度施加电刺激诱导的节律期间采集数据。用肌壁内针测量内皮细胞电位，通过直接比较来评价逆解的准确性。与测得的内分泌电位相比，从测得的探针电位中计算出的内分泌电位以良好的精度重建了主要特征（电位最大值和最小值，负电位和正电位区域）。在早期激活期间，计算的内皮细胞电位在起搏部位附近显示出电位最小值，以良好的准确度（误差在10 mm内）确定刺激的位置。多个刺激，彼此接近10至20 mm，可以区分和定位到其原产地的逆重建。与测量的心内膜电位类似，计算的心内膜电位的空间分布反映了潜在的心脏纤维方向，并且计算的心内膜电位的动态变化反映了纤维随壁内深度的旋转。等时线图显示出良好的对应关系的等时线确定从计算的endocardiac电位和那些直接确定从测量endocardiac potential.Conclusions相比，实际测量endocardiac电位和激活序列，endocardiac电位模式和激活序列可以重建的基础上逐拍从腔电位测量的多电极，非接触式probe。这里提出的方法是重建，10毫米的精度和分辨率为10至20毫米，局部事件的心脏兴奋（例如，起搏部位）。此外，重建的内皮细胞电位正确地反映了心肌的潜在纤维结构。这些结果证明了该方法的可行性。在实验中，探头的位置和血管内的几何形状被确定侵入性。为了在临床上适用，重建方法应结合无创方法，用于确定导管插入实验室中的探头腔几何形状。然后，它可以发展成一种基于导管的技术，用于定位致心律失常部位，研究和诊断传导异常、折返活动以及药物和其他干预措施对心脏激活和心律失常的影响。
Background Mapping of endocardial activation is an important procedure for diagnosing cardiac arrhythmias and locating the arrhythmogenic site before treatment. The objective of the present study was to develop and test a mathematical method to reconstruct the endocardial potentials and activation sequences (isochrones) from potential data measured with a noncontact, intracavitary multielectrode probe (the ''inverse problem'').Methods and Results A boundary element based mathematical method, combined with a numeric regularization technique, was developed for computing the inverse solution. Endocardial potentials were computed from intracavitary potentials measured with a multielectrode probe placed in the cavity of an isolated, perfused canine left ventricle. Data were acquired during rhythms induced by electrical stimuli applied at different locations and varying depths within the myocardium. Endocardial potentials were measured using intramural needles to evaluate the accuracy of the inverse solutions by direct comparison. Inversely computed endocardial potentials, from measured probe potentials, reconstruct with good accuracy the major features (potential maxima and minima, regions of negative and positive potentials) compared with the measured endocardial potentials. During early activation, the computed endocardial potentials exhibit a potential minimum in close proximity to the pacing site, determining the location of the stimulus with good accuracy (within 10-mm error). Multiple stimuli, as close as 10 to 20 mm to each other, can be distinguished and localized to their sites of origin by the inverse reconstruction. Similar to the measured endocardial potentials, the spatial distribution of the computed endocardial potentials reflects the underlying cardiac fiber direction, and dynamic changes of the computed endocardial potentials reflect the rotation of fibers with intramural depth. Maps of isochrones show good correspondence between the isochrones determined from the computed endocardial potentials and those determined directly from the measured endocardial potentials.Conclusions Compared with actual, measured endocardial potentials and activation sequences, endocardial potential patterns and activation sequences can be reconstructed on a beat-by-beat basis from cavitary potentials measured with a multielectrode, noncontact probe. The approach presented here is shown to reconstruct, with 10-mm accuracy and resolution of 10 to 20 mm, local events of cardiac excitation (eg, pacing sites). In addition, the reconstructed endocardial potentials correctly reflect the underlying fibrous structure of the myocardium. These results demonstrate the feasibility of the approach. In the experiments, the probe position and endocardial geometry were determined invasively. To be clinically applicable, the reconstruction method should be combined with a noninvasive method for determining the probe-cavity geometry in the catheterization laboratory. It could then be developed into a catheter-based technique for locating arrhythmogenic sites and for studying and diagnosing conduction abnormalities, reentrant activity, and the effects of drugs and other interventions on cardiac activation and arrhythmias.