Real-Time Localization of VentricularTachycardia Origin From the 12-Lead Electrocardiogram.
Real-Time Localization of VentricularTachycardia Origin From the 12-Lead Electrocardiogram.
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DOI：
10.1016/j.jacep.2017.02.024
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发表时间：
2017-07-01
期刊：
影响因子：
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通讯作者：
Horacek, B Milan
中科院分区：
文献类型：
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作者：
Sapp, John L;Bar-Tal, Meir;Horacek, B Milan
背景：结构性心脏病患者的室性心动过速的导管消融通常依赖于一种基于底物的方法，这种方法可以使用体表心电图引导的起搏标测来识别罪魁祸首的出口部位。方法：38例接受疤痕相关性室速消融的患者在三维电解剖图上记录到左室心内膜起搏时的12导联心电图(n=1012)，并登记在分为16个节段和238个三角形的普通左室心内膜表面；将每个导联的心电数据简化为1个变量，包括QRS时间积分。提出了两种估计激活起始点的方法：1)离散法，使用模板匹配估计激活起始点的分段；2)连续法，使用基于总体的多元线性回归估计激活起始点的三角形。结果：最佳的QRS时间积分包括QRS间期的前120ms。总体回归的平均定位误差为12±8 mm。当使用至少10个训练组起搏部位时，特定患者的回归可以达到5 mm以上的定位精度；这种精度随着每个起搏部位的增加而进一步增加。结论：计算术中方法可以使用新的算法自动识别左心室激活的节段和部位，精度在
OBJECTIVES: The aim of this study was to develop rapid computational methods for identifying the site of origin of ventricular activation from the 12-lead electrocardiogram.BACKGROUND: Catheter ablation of ventricular tachycardia in patients with structural heart disease frequently relies on a substrate-based approach, which may use pace mapping guided by body-surface electrocardiography to identify culprit exit sites.METHODS: Patients undergoing ablation of scar-related VT (n= 38) had 12-lead electrocardiograms recorded during pacing at left ventricular endocardial sites (n= 1,012) identified on 3-dimensional electroanatomic maps and registered to a generic left ventricular endocardial surface divided into 16 segments and tessellated into 238 triangles; electrocardiographic data were reduced for each lead to 1 variable, consisting of QRS time integral. Two methods for estimating the origin of activation were developed: 1) a discrete method, estimating segment of activation origin using template matching; and 2) a continuous method, using population-based multiple linear regression to estimate triangle of activation origin. A variant of the latter method was derived, using patient-specific multiple linear regression.RESULTS: The optimal QRS time integral included the first 120 ms of the QRS interval. The mean localization error of population-based regressions was 12 ± 8 mm. Patient-specific regressions can achieve localization accuracy better than 5mm when at least 10 training-set pacing sites are used; this accuracy further increases with each added pacing site.CONCLUSIONS: Computational intraprocedure methods can automatically identify the segment and site of left ventricular activation using novel algorithms, with accuracy within