Noninvasive reconstruction of the three-dimensional ventricular activation sequence during pacing and ventricular tachycardia in the canine heart
Noninvasive reconstruction of the three-dimensional ventricular activation sequence during pacing and ventricular tachycardia in the canine heart
复制标题
DOI：
10.1152/ajpheart.00618.2011
复制
发表时间：
2012-01-01
影响因子：
4.8
通讯作者：
He, Bin
中科院分区：
文献类型：
--
作者：
Han, Chengzong;Pogwizd, Steven M.;He, Bin
韩超，Pogwizd SM，Killingsworth CR，He B.起搏及室性心动过速时三维心室激动序列的无创重建。Am J Physiol心圈Physiol 302：H2 44-H2 52,2012。2011年10月7日首次出版；doi：10.1152/ajpheart.00618.2011。-心肌单搏动成像有望帮助心血管研究和临床医学。在本研究中，我们验证了一种三维(3D)心脏电成像(3DCEI)技术，借助于同步3D心内标测来评估其在起搏和室性心动过速(VT)期间定位心内膜和心外膜起始点以及成像整体激活序列的能力。在闭胸状态下，用双极电记录同时测量健康犬的体表电位。映射研究后获得CT图像，以构建逼真的几何模型。对去甲肾上腺素(NE)诱发的起搏节律和室性心动过速进行数据分析。无创性重建的激活序列与三维心电标测的同步测量结果吻合良好，相关系数为0.74+/-0.06，相对误差为0.29+/-0.05，均方根误差为9+/-3ms，平均460个起搏和96个异位心动过速，包括室性早搏、双房室早、非持续性单形性室速和多形性室速。在左心室起搏期间，分别有72%和86%的病例能够成功预测起搏的心内膜和心外膜起源。去甲肾上腺素引起的心内膜下异位搏动是一种局灶性机制。据估计，起搏和异位起搏的初始激活点都与测量的起始点7 mm相似。对于多形性室性心动过速，起始点和激活模式的起始点和激活模式的动态变化通过重建来表征。结果表明，3DCEI可以无创性地成像犬心脏的3D激活序列，并能准确定位起搏和去甲肾上腺素诱发的室性心动过速的起始点。这种3DCEI技术有可能辅助介入治疗心外膜或心内膜部位的室性心律失常，并无创地评估这些心律失常的机制。
Han C, Pogwizd SM, Killingsworth CR, He B. Noninvasive reconstruction of the three-dimensional ventricular activation sequence during pacing and ventricular tachycardia in the canine heart. Am J Physiol Heart Circ Physiol 302: H244-H252, 2012. First published October 7, 2011; doi:10.1152/ajpheart.00618.2011.-Single-beat imaging of myocardial activation promises to aid in both cardiovascular research and clinical medicine. In the present study we validate a three-dimensional (3D) cardiac electrical imaging (3DCEI) technique with the aid of simultaneous 3D intracardiac mapping to assess its capability to localize endocardial and epicardial initiation sites and image global activation sequences during pacing and ventricular tachycardia (VT) in the canine heart. Body surface potentials were measured simultaneously with bipolar electrical recordings in a closed-chest condition in healthy canines. Computed tomography images were obtained after the mapping study to construct realistic geometry models. Data analysis was performed on paced rhythms and VTs induced by norepinephrine (NE). The noninvasively reconstructed activation sequence was in good agreement with the simultaneous measurements from 3D cardiac mapping with a correlation coefficient of 0.74 +/- 0.06, a relative error of 0.29 +/- 0.05, and a root mean square error of 9 +/- 3 ms averaged over 460 paced beats and 96 ectopic beats including premature ventricular complexes, couplets, and nonsustained monomorphic VTs and polymorphic VTs. Endocardial and epicardial origins of paced beats were successfully predicted in 72% and 86% of cases, respectively, during left ventricular pacing. The NE-induced ectopic beats initiated in the subendocardium by a focal mechanism. Sites of initial activation were estimated to be similar to 7 mm from the measured initiation sites for both the paced beats and ectopic beats. For the polymorphic VTs, beat-to-beat dynamic shifts of initiation site and activation pattern were characterized by the reconstruction. The present results suggest that 3DCEI can noninvasively image the 3D activation sequence and localize the origin of activation of paced beats and NE-induced VTs in the canine heart with good accuracy. This 3DCEI technique offers the potential to aid interventional therapeutic procedures for treating ventricular arrhythmias arising from epicardial or endocardial sites and to noninvasively assess the mechanisms of these arrhythmias.