A new algorithm to diagnose atrial ectopic origin from multi lead ECG systems--insights from 3D virtual human atria and torso.
A new algorithm to diagnose atrial ectopic origin from multi lead ECG systems--insights from 3D virtual human atria and torso.
复制标题
DOI：
10.1371/journal.pcbi.1004026
复制
发表时间：
2015-01
影响因子：
4.3
通讯作者：
Zhang H
中科院分区：
文献类型：
--
作者：
Alday EA;Colman MA;Langley P;Butters TD;Higham J;Workman AJ;Hancox JC;Zhang H
快速房性心律失常，如心房颤动（AF），易导致室性心律失常、心源性猝死和中风。从心电图（ECG）中识别心房异位活动的起源有助于以具有成本效益的方式诊断AF的早期发作。房颤期间复杂而快速的心房电活动使得仅使用标准12导联ECG难以获得关于心房激动的详细信息。与传统的12导联ECG相比，更详细的ECG导联配置可以提供关于心房兴奋期间体表电位（BSP）的时空动态的进一步信息。我们应用最近开发的三维人体心房模型来模拟正常窦性心律和异位起搏过程中的电活动。心房模型被放置到一个新开发的躯干模型，考虑肺，肝和脊髓的存在。边界元法用于计算心房兴奋产生的BSP。选择与标准12导联和更详细的64导联ECG配置中电极放置位置对应的躯干网格元素。异位局灶性活动在心房所有不同区域的不同起源处进行模拟。将正常心房兴奋（即窦房结兴奋）期间的模拟BSP标测图与实验观察到的标测图（从64导联ECG系统获得）进行比较，显示ECG的P波形态和偶极演变中模拟数据和实验数据的时间演变之间的高度一致性。提出了一种从64导联心电图系统中获取刺激位置的算法。该算法的成功率为93%，这意味着它在75/80次模拟中正确识别了心房病灶的起源，并且涉及与任何多导联ECG系统相关的一般方法。这代表了对先前开发的算法的显著改进。异位活动与多种心脏疾病有关，并与自我维持折返性兴奋的启动有关。识别异位活动的存在和起源可能对改善诸如心房颤动等疾病的诊断和治疗至关重要，并且已经成为多项研究的主题。心脏的电活动可以通过心电图进行无创监测。然而，标准的12导联心电图可能无法提供足够的信息来满意和准确地解决异位活动的焦点;更详细的多导联心电图可以提供更多的信息，以便能够产生定位异位活动起源的算法。使用我们实验室开发的3D计算心房躯干模型，我们模拟了正常和不同异位条件下心房的电活动。该模型首先通过与实验数据的比较进行验证，然后用于开发一种算法，使用64导联心电图识别心房异位病灶的位置。所开发的算法能够在75/80模拟中识别心房异位活动的起源，与先前开发的算法相比，这是一个显著的改进。此外，该研究表明，多导联心电图比标准的12导联配置提供了显着的好处。
Rapid atrial arrhythmias such as atrial fibrillation (AF) predispose to ventricular arrhythmias, sudden cardiac death and stroke. Identifying the origin of atrial ectopic activity from the electrocardiogram (ECG) can help to diagnose the early onset of AF in a cost-effective manner. The complex and rapid atrial electrical activity during AF makes it difficult to obtain detailed information on atrial activation using the standard 12-lead ECG alone. Compared to conventional 12-lead ECG, more detailed ECG lead configurations may provide further information about spatio-temporal dynamics of the body surface potential (BSP) during atrial excitation. We apply a recently developed 3D human atrial model to simulate electrical activity during normal sinus rhythm and ectopic pacing. The atrial model is placed into a newly developed torso model which considers the presence of the lungs, liver and spinal cord. A boundary element method is used to compute the BSP resulting from atrial excitation. Elements of the torso mesh corresponding to the locations of the placement of the electrodes in the standard 12-lead and a more detailed 64-lead ECG configuration were selected. The ectopic focal activity was simulated at various origins across all the different regions of the atria. Simulated BSP maps during normal atrial excitation (i.e. sinoatrial node excitation) were compared to those observed experimentally (obtained from the 64-lead ECG system), showing a strong agreement between the evolution in time of the simulated and experimental data in the P-wave morphology of the ECG and dipole evolution. An algorithm to obtain the location of the stimulus from a 64-lead ECG system was developed. The algorithm presented had a success rate of 93%, meaning that it correctly identified the origin of atrial focus in 75/80 simulations, and involved a general approach relevant to any multi-lead ECG system. This represents a significant improvement over previously developed algorithms. Ectopic activity is associated with multiple cardiac disorders and has been implicated in the initiation of self-sustaining re-entrant excitation. Identifying the presence and origin of ectopic activity may be vital in improving diagnosis and treatment of disorders such as atrial fibrillation, and has been the subject of multiple studies. The electrical activity of the heart can be non-invasively monitored through the electrocardiogram. However, the standard 12-lead electrocardiogram may not provide sufficient information to resolve the focus of ectopic activity satisfactorily and accurately; more detailed multi-lead electrocardiograms may provide more information to be able to produce an algorithm to locate the origin of ectopic activity. Using a 3D computational atria-torso model developed in our laboratory, we simulated the electrical activity of the atria under normal and different ectopic conditions. The model was first validated by comparison to experimental data, and then used to develop an algorithm to identify the location of atrial ectopic focus using a 64-lead electrocardiogram. The algorithm developed was able to identify the origin of atrial ectopic activity in 75/80 simulations, which is a significant improvement compared to previously developed algorithms. Furthermore, the study suggests that multi-lead electrocardiograms provide significant benefits over the standard 12-lead configuration.
登录
查看更多内容
心房颤动引起的电重塑的致心律失常效应：来自三维虚拟人体心房的见解
DOI：
10.1113/jphysiol.2013.254987
发表时间：
2013-09-01
期刊：
The Journal of physiology
影响因子：
--
作者：
Colman MA;Aslanidi OV;Kharche S;Boyett MR;Garratt C;Hancox JC;Zhang H
通讯作者：
Zhang H
影响因子：
10.6
作者：
Krueger, Martin W.;Seemann, Gunnar;Doessel, Olaf
通讯作者：
Doessel, Olaf
影响因子：
24
作者：
Kumagai, K;Ogawa, M;Saku, K
通讯作者：
Saku, K
影响因子：
4.6
作者：
Keller, David U. J.;Weber, Frank M.;Doessel, Olaf
通讯作者：
Doessel, Olaf
影响因子：
7.7
作者：
Homaeinezhad, M. R.;ErfanianMoshiri-Nejad, M.;Naseri, H.
通讯作者：
Naseri, H.