AUTHOR=Fruelund Patricia Zerlang , Van Dam Peter M. , Melgaard Jacob , Sommer Anders , Lundbye-Christensen Søren , Søgaard Peter , Zaremba Tomas , Graff Claus , Riahi Sam 

TITLE=Novel non-invasive ECG imaging method based on the 12-lead ECG for reconstruction of ventricular activation: A proof-of-concept study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1087568

DOI=10.3389/fcvm.2023.1087568

ISSN=2297-055X

ABSTRACT=Aim: Current non-invasive electrocardiographic imaging (ECGi) methods are often based on complex body surface potential mapping, limiting the clinical applicability. The aim of this pilot study was to validate a novel non-invasive ECGi method that reconstructs ventricular activation in 3D based on the readily available standard 12-lead electrocardiogram (ECG) using clinical data from right ventricular (RV) paced patients. Validation of the method was performed by comparing the ECGi reconstructed earliest site of activation against the true RV pacing site determined from cardiac computed tomography (CT).
Methods: This was a retrospective study using data from 34 patients, previously implanted with a dual chamber pacemaker due to advanced atrioventricular block. True RV lead position was determined from analysis of a post-implant cardiac CT scan. The ECGi method was based on an inverse-ECG algorithm applying electrophysiological rules. The algorithm integrated information from an RV paced 12-lead ECG together with a CT-derived patient-specific heart-thorax geometric model to reconstruct a 3D electrical ventricular activation map. 
Results: The mean geodesic localization error between the ECGi reconstrcuted initial site of activation and the RV lead insertion site determined from CT was 13.6 ±5.7 mm. The mean RV endocardial surface area was 146.0 ±30.0 cm2 and the mean circular localization error area was 7.0 ±5.2 cm2 resulting in a relative localization error of 5.0 ±4.0%.   
Conclusion: We demonstrated a novel non-invasive ECGi method, based on 12-lead ECG, that accurately localized the RV pacing site in relation to the ventricular anatomy.