Body Surface Potential Research Articles

Noninvasive finding of local repolarization changes in the heart using dipole models and simplified torso geometry

Two inverse methods using dipole models for noninvasive assessment of local repolarization changes were investigated and compared in the simulation study. Lesions with changed repolarization were modeled by shortening of the action potential durations in ventricular regions typically influenced by occlusion of coronary arteries. Corresponding body surface potentials were computed using a multiple dipole model of the cardiac generator and an inhomogeneous torso model. Position of each lesion was then estimated by an inverse solution to a single dipole and to a group of five neighbouring dipoles. For both methods the lesion localization error was evaluated and its dependence on the lesion size and the noise in input data was studied. When no noise was present in the input data, the use of the inverse method to a group of dipoles instead of a single dipole resulted in an unsubstantial reduction of the mean localization error of small lesions from 0.6 to 0.5cm. For medium and especially for large lesions the mean localization errors decreased significantly from 1.1 to 0.6cm and from 2.3 to 1.0cm, respectively. The inverse solution to a group of five dipoles was more sensitive to noise. However, for large lesions it still gave better results than the solution to a single dipole if the signal to noise ratio was higher than 30dB.

Computing Ischemic Regions in the Heart With the Bidomain Model—First Steps Towards Validation

We investigate whether it is possible to use the bidomain model and body surface potential maps (BSPMs) to compute the size and position of ischemic regions in the human heart. This leads to a severely ill posed inverse problem for a potential equation. We do not use the classical inverse problems of electrocardiography, in which the unknown sources are the epicardial potential distribution or the activation sequence. Instead we employ the bidomain theory to obtain a model that also enables identification of ischemic regions transmurally. This approach makes it possible to distinguish between subendocardial and transmural cases, only using the BSPM data. The main focus is on testing a previously published algorithm on clinical data, and the results are compared with images taken with perfusion scintigraphy. For the four patients involved in this study, the two modalities produce results that are rather similar: The relative differences between the center of mass and the size of the ischemic regions, suggested by the two modalities, are 10.8% ± 4.4% and 7.1% ± 4.6%, respectively. We also present some simulations which indicate that the methodology is robust with respect to uncertainties in important model parameters. However, in contrast to what has been observed in investigations only involving synthetic data, inequality constraints are needed to obtain sound results.

Computational assessment of drug‐induced effects on the electrocardiogram: from ion channel to body surface potentials

Background and PurposeUnderstanding drug effects on the heart is key to safety pharmacology assessment and anti-arrhythmic therapy development. Here our goal is to demonstrate the ability of computational models to simulate the effect of drug action on the electrical activity of the heart, at the level of the ion-channel, cell, heart and ECG body surface potential.Experimental ApproachWe use the state-of-the-art mathematical models governing the electrical activity of the heart. A drug model is introduced using an ion channel conductance block for the hERG and fast sodium channels, depending on the IC50 value and the drug dose. We simulate the ECG measurements at the body surface and compare biomarkers under different drug actions.Key ResultsIntroducing a 50% hERG-channel current block results in 8% prolongation of the APD90 and 6% QT interval prolongation, hERG block does not affect the QRS interval. Introducing 50% fast sodium current block prolongs the QRS and the QT intervals by 12% and 5% respectively, and delays activation times, whereas APD90 is not affected.Conclusions and ImplicationsBoth potassium and sodium blocks prolong the QT interval, but the underlying mechanism is different: for potassium it is due to APD prolongation; while for sodium it is due to a reduction of electrical wave velocity. This study shows the applicability of in silico models for the investigation of drug effects on the heart, from the ion channel to the ECG-based biomarkers.

Study on Parameter Optimization for Support Vector Regression in Solving the Inverse ECG Problem

The typical inverse ECG problem is to noninvasively reconstruct the transmembrane potentials (TMPs) from body surface potentials (BSPs). In the study, the inverse ECG problem can be treated as a regression problem with multi-inputs (body surface potentials) and multi-outputs (transmembrane potentials), which can be solved by the support vector regression (SVR) method. In order to obtain an effective SVR model with optimal regression accuracy and generalization performance, the hyperparameters of SVR must be set carefully. Three different optimization methods, that is, genetic algorithm (GA), differential evolution (DE) algorithm, and particle swarm optimization (PSO), are proposed to determine optimal hyperparameters of the SVR model. In this paper, we attempt to investigate which one is the most effective way in reconstructing the cardiac TMPs from BSPs, and a full comparison of their performances is also provided. The experimental results show that these three optimization methods are well performed in finding the proper parameters of SVR and can yield good generalization performance in solving the inverse ECG problem. Moreover, compared with DE and GA, PSO algorithm is more efficient in parameters optimization and performs better in solving the inverse ECG problem, leading to a more accurate reconstruction of the TMPs.

Simultaneous Reconstruction of Epicardial and Endocardial Potentials with Intracardiac Mapping and Inverse Analysis of Body Surface Potentials

Simultaneous Reconstruction of Epicardial and Endocardial Potentials with Intracardiac Mapping and Inverse Analysis of Body Surface Potentials

Impact of amiodarone and cisapride on simulated human ventricular electrophysiology and electrocardiograms

Amiodarone and cisapride are both known to prolong the QT interval, yet the two drugs have different effects on arrhythmia. Cisapride can cause torsades de pointes while amiodarone is found to be anti-arrhythmic. A computational model was used to investigate the action of these two drugs. In a biophysically detailed model, the ion current conductivities affected by both drugs were reduced in order to simulate the pharmacological effects in healthy and ischaemic cells. Furthermore, restitution curves of the action potential duration (APD), effective refractory period, conduction velocity, wavelength, and the vulnerable window were determined in a one-dimensional (1D) tissue strand. Moreover, cardiac excitation propagation was computed in a 3D model of healthy ventricles. The corresponding body surface potentials were calculated and standard 12-lead electrocardiograms were derived. Both cisapride and amiodarone caused a prolongation of the QT interval and the refractory period. However, cisapride did not significantly alter the conduction-related properties, such as e.g. the wavelength or vulnerable window, whereas amiodarone had a larger impact on them. It slightly flattened the APD restitution slope and furthermore reduced the conduction velocity and wavelength. Both drugs show similar prolongation of the QT interval, although they present different electrophysiological properties in the single-cell as well as in tissue simulations of cardiac excitation propagation. These computer simulations help to better understand the underlying mechanisms responsible for the initiation or termination of arrhythmias caused by amiodarone and cisapride.

QT Dispersion and Electrocardiographic Changes in Women With Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) represents additional risks to both mother and infant. Moreover it increases a woman's risk of cardiovascular disease in the postpartum. The aim of our study was therefore to detect changes of both the QT dispersion and the electrical heart field that could be typical for GDM. Body surface potential maps were obtained using the Cardiac 112.2 device from 26 young women with GDM and 54 young healthy pregnant women in the 36th week of pregnancy. The same recordings were obtained from 18 healthy women in the same age (19-36 years). The average QT dispersion (±SD) in women suffering from GDM was significantly higher (107 ± 25 ms) both than in those with physiological pregnancy (73 ± 18 ms) and than in the normal subjects (34 ± 12 ms) (P<0.001). Moreover we have found in GDM patients shorter QRS complex 82.0 ± 6.8 ms vs. 89.5 ± 8.2 ms in healthy pregnant women and 90.8 ± 7.9 ms in the control group (p=0.011), more horizontal electrical heart axis [16.4 ± 20.1° vs. 42.4 ± 28.7° and 74.6 ± 39.2° respectively (P<0.05)] and lower some depolarization and repolarization amplitudes on isopotential and isointegral maps. According to these results we suppose that described electrocardiographic changes reflect a deterioration of the complete process of ventricular depolarization and repolarization in GDM.

Inverse Solution Mapping of Epicardial Potentials

Background— Catheter ablation of ventricular tachycardia (VT) is still one of the most challenging procedures in cardiac electrophysiology, limited, in part, by unmappable arrhythmias that are nonsustained or poorly tolerated. Calculation of the inverse solution from body surface potential mapping (sometimes known as ECG imaging) has shown tremendous promise and can rapidly map these arrhythmias, but we lack quantitative assessment of its accuracy in humans. We compared inverse solution mapping with computed tomography–registered electroanatomic epicardial contact catheter mapping to study the resolution of this technique, the influence of myocardial scar, and the ability to map VT. Methods and Results— For 4 patients undergoing epicardial catheter mapping and ablation of VT, 120-lead body surface potential mappings were obtained during implantable defibrillator pacing, catheter pacing from 79 epicardial sites, and induced VT. Inverse epicardial electrograms computed using individualized torso/epicardial surface geometries extracted from computed tomography images were compared with registered electroanatomic contact maps. The distance between estimated and actual epicardial pacing sites was 13±9 mm over normal myocardium with no stimulus-QRS delay but increased significantly over scar ( P =0.013) or was close to scar ( P =0.014). Contact maps during right ventricular pacing correlated closely to inverse solution isochrones. Maps of inverse epicardial potentials during 6 different induced VTs indicated areas of earliest activation, which correlated closely with clinically identified VT exit sites for 2 epicardial VTs. Conclusions— Inverse solution maps can identify sites of epicardial pacing with good accuracy, which diminishes over myocardial scar or over slowly conducting tissue. This approach can also identify epicardial VT exit sites and ventricular activation sequences.

Noninvasive Mapping of Transmural Potentials During Activation in Swine Hearts From Body Surface Electrocardiograms

The three-dimensional cardiac electrical imaging (3DCEI) technique was previously developed to estimate the initiation site(s) of cardiac activation and activation sequence from the noninvasively measured body surface potential maps (BSPMs). The aim of this study was to develop and evaluate the capability of 3DCEI in mapping the transmural distribution of extracellular potentials and localizing initiation sites of ventricular activation in an in vivo animal model. A control swine model (n = 10) was employed in this study. The heart-torso volume conductor model and the excitable heart model were constructed based on each animal's preoperative MR images and a priori known physiological knowledge. Body surface potential mapping and intracavitary noncontact mapping (NCM) were simultaneously conducted during acute ventricular pacing. The 3DCEI analysis was then applied on the recorded BSPMs. The estimated initiation sites were compared to the precise pacing sites; as a subset of the mapped transmural potentials by 3DCEI, the electrograms on the left ventricular endocardium were compared to the corresponding output of the NCM system. Over the 16 LV and 48 RV pacing studies, the averaged localization error was 6.1±2.3 mm, and the averaged correlation coefficient between the estimated endocardial electrograms by 3DCEI and from the NCM system was 0.62±0.09. The results demonstrate that the 3DCEI approach can well localize the sites of initiation of ectopic beats and can obtain physiologically reasonable transmural potentials in an in vivo setting during focal ectopic beats. This study suggests the feasibility of tomographic mapping of 3D ventricular electrograms from the body surface recordings.

Spatial Pattern of P Waves in Paroxysmal Atrial Fibrillation Patients in Sinus Rhythm and Controls

Measuring body surface potentials in the assessment of the electrical activity of the heart is the most commonly used noninvasive method for diagnosing cardiac arrhythmias. Paroxysmal atrial fibrillation (PAF) patients have disturbed cardiac electrophysiology but the detailed characteristics of atrial activation on the body surface are unknown. P waves from 60 sites on the body surface were analyzed from 10 PAF patients in sinus rhythm (PAF group) and 10 healthy controls (HC group). Evolution of atrial depolarization was described qualitatively by maps of P-wave amplitudes. P-wave dipole evolution was described quantitatively by measuring the changing location (body site) and amplitude of the dipole positive and negative pole peaks. Both groups exhibited similar dipolar structure with an area of positive and an area of negative potentials. Over the depolarization cycle, there were significant changes in the location of the dipole with the positive pole rotating anteriorly right to left by two electrode sites (10 cm) (P = 0.001). There were significant differences between groups with the positive pole in PAF offset to the right of the chest by 0.43 (0.38) strips compared to HC (P < 0.007). Compared to controls, the PAF group positive poles reached peak amplitude sooner (49 [11] ms vs 65 [14] ms, P = 0.012) and negative poles reached peak amplitude later (74 [13] ms vs 62 [8] ms, P = 0.019). Atrial depolarization is characterized by a single dipole with time-varying amplitude and orientation with significant differences in dipole trajectory between patients with PAF and HCs.

Spatial complexity and spectral distribution variability of atrial activity in surface ECG recordings of atrial fibrillation

Considerable research effort has been devoted to the estimation of the degree of organisation of atrial fibrillation (AF), to potentially support clinical decision making. The aims of this study were to: (1) analyse the temporal variability of spatial organisation (complexity) and spectral distribution of AF in body surface potential maps (BSPM), proposing an automated implementation of the analysis and (2) assess the applicability to reduced lead-sets. Twenty-one persistent AF recordings of 3 min each (64 BSPM: 32 anterior, 32 posterior) were analysed. The relationship between spatial organisation (C) and its variability (CV) was quantified on automatically delineated TQ segments. The relationship between spectral concentration (SC) and spectral variability (SV) was quantified on the atrial activity (AA) extracted using principal component analysis. Three different lead-sets: 64, 32 anterior and 10 anterior channels were considered. Significant (p < 0.001) correlation (ρ) was found: ρ(CV, C) ≥ 0.80, ρ(SC, SV) ≤-0.83 for all lead-sets. The results suggest that a higher degree of spatial organisation is associated with reduced variability of spatial organisation over time, and lower spectral variability associated with more prominent spectral peak in the AF frequency band (4-10 Hz).

A Hybrid Model of Maximum Margin Clustering Method and Support Vector Regression for Noninvasive Electrocardiographic Imaging

Noninvasive electrocardiographic imaging, such as the reconstruction of myocardial transmembrane potentials (TMPs) distribution, can provide more detailed and complicated electrophysiological information than the body surface potentials (BSPs). However, the noninvasive reconstruction of the TMPs from BSPs is a typical inverse problem. In this study, this inverse ECG problem is treated as a regression problem with multi-inputs (BSPs) and multioutputs (TMPs), which will be solved by the Maximum Margin Clustering- (MMC-) Support Vector Regression (SVR) method. First, the MMC approach is adopted to cluster the training samples (a series of time instant BSPs), and the individual SVR model for each cluster is then constructed. For each testing sample, we find its matched cluster and then use the corresponding SVR model to reconstruct the TMPs. Using testing samples, it is found that the reconstructed TMPs results with the MMC-SVR method are more accurate than those of the single SVR method. In addition to the improved accuracy in solving the inverse ECG problem, the MMC-SVR method divides the training samples into clusters of small sample sizes, which can enhance the computation efficiency of training the SVR model.

Cardiovascular System Modeling

Cardiovascular System Modeling

Body Surface Potentials Generated by the Heart of Normal Guinea Pigs

Body Surface Potentials Generated by the Heart of Normal Guinea Pigs

The Opposite Polarity of the PQ Segment Compared to the P Wave Isointegral Maps

The aim of our work was to study the opposite polarity of the PQ segment to the P wave body surface potential maps in different groups of patients. We constructed isointegral maps (IIM) in 26 healthy controls (C), 16 hypertensives (HT), 26 patients with arterial hypertension and left ventricular hypertrophy (LVH) and 15 patients with myocardial infarction (MI). We analyzed values and positions of map extrema and compared the polarity of maps using the correlation coefficient. The IIM P maxima appeared mainly over the precordium, the minima mainly in the right subclavicular area. The highest maxima were in the MI group, being significantly higher than in the HT and LVH groups. No differences concerning any values of other extrema were significant. The IIM PQ maxima were distributed over the upper half of the chest; the minima mainly over the middle sternum. A statistically significant opposite polarity between the IIM P and IIM PQ was found in 80 % of cases. The opposite polarity of the P wave and the PQ segment was proved in isointegral body surface maps. The extrema occurred in areas not examined by the standard chest leads. This has to be considered for diagnostic purposes.

Noninvasive reconstruction of the three-dimensional ventricular activation sequence during pacing and ventricular tachycardia in the canine heart

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 ∼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.

Cardiac Position Sensitivity Study in the Electrocardiographic Forward Problem Using Stochastic Collocation and Boundary Element Methods

The electrocardiogram (ECG) is ubiquitously employed as a diagnostic and monitoring tool for patients experiencing cardiac distress and/or disease. It is widely known that changes in heart position resulting from, for example, posture of the patient (sitting, standing, lying) and respiration significantly affect the body-surface potentials; however, few studies have quantitatively and systematically evaluated the effects of heart displacement on the ECG. The goal of this study was to evaluate the impact of positional changes of the heart on the ECG in the specific clinical setting of myocardial ischemia. To carry out the necessary comprehensive sensitivity analysis, we applied a relatively novel and highly efficient statistical approach, the generalized polynomial chaos-stochastic collocation method, to a boundary element formulation of the electrocardiographic forward problem, and we drove these simulations with measured epicardial potentials from whole-heart experiments. Results of the analysis identified regions on the body-surface where the potentials were especially sensitive to realistic heart motion. The standard deviation (STD) of ST-segment voltage changes caused by the apex of a normal heart, swinging forward and backward or side-to-side was approximately 0.2 mV. Variations were even larger, 0.3 mV, for a heart exhibiting elevated ischemic potentials. These variations could be large enough to mask or to mimic signs of ischemia in the ECG. Our results suggest possible modifications to ECG protocols that could reduce the diagnostic error related to postural changes in patients possibly suffering from myocardial ischemia.

A simulation tool for visualizing and studying the effects of electrode misplacement on the 12-lead electrocardiogram

Introduction Studies have shown that between 0.4% and 4% of all 12-lead electrocardiograms (ECGs) are recorded using incorrect electrode positions. Electrode misplacement can cause a misdiagnosis either by concealing a pathology or, on the contrary, by emulating a pathology. Irrespective of this fact, ECG textbooks contain little or no information regarding the effects of electrode misplacement. Moreover, current pedagogic tools, which include physical mannequins, do not allow for the free positioning of electrodes to demonstrate these effects. In recognition of this, an electrode misplacement simulator (EMS) has been developed in this study. Methods The EMS is a Web-based simulation developed using the Adobe Flash technology. The software allows the user to position the electrodes anywhere on the torso while rendering the corresponding ECG leads using body surface potential maps. A beta version of the EMS has been made available on the Internet. Results The EMS has been briefly evaluated by a random selection of delegates (n = 17) from the 37th Annual Conference on Computing in Cardiology. After completing representative tasks and using the EMS for approximately 30 minutes, all 17 participants completed a questionnaire. Overall, the responsiveness of the EMS was rated between 4 and 5 on a Likert scale, 94% of participants rated the “ease of use” between 4 and 5, and 88% of participants also rated the “look and feel” between 4 and 5 on a Likert scale. Conclusion The EMS has the potential to be used to support researchers in enhancing criteria currently used for detecting electrode misplacement. It could also be used to assist academic staff in teaching the effects of electrode misplacement. In this respect, it is currently being used as part of an undergraduate “Clinical Physiology” degree program at the University of Ulster.

In Silico Investigation of Electrically Silent Acute Cardiac Ischemia in the Human Ventricles

Acute cardiac ischemia, which is caused by the occlusion of a coronary artery, often leads to lethal ventricular arrhythmias or heart failure. The early diagnosis of this pathology is based on changes of the electrocardiogram (ECG), i.e., mainly shifts of the ST segment. However, the underlying mechanisms responsible for these shifts are not completely understood. Furthermore, clinical observations indicate that some acute ischemia cases can hardly be detected using standard 12-lead ECG only. Therefore, multiscale computer simulations of cardiac ischemia using realistic models of human ventricles were carried out in this work. For this purpose, the transmembrane voltage distributions in the heart and the corresponding body surface potentials were computed with varying transmural extent of the ischemic region at different ischemia stages. Some of the simulated ischemia cases were " electrically silent," i.e., they could hardly be identified in the 12-lead ECG.

The Inverse Problem Utilizing the Boundary Element Method for a Nonstandard Female Torso

This paper proposes a new method of rapidly deriving the transfer matrix for the boundary element method (BEM) forward problem from a tailored female torso geometry in the clinical setting. The method allows rapid calculation of epicardial potentials (EP) from body surface potentials (BSP). The use of EPs in previous studies has been shown to improve the successful detection of the life-threatening cardiac condition--acute myocardial infarction. The MRI scanning of a cardiac patient in the clinical setting is not practical and other methods are required to accurately deduce torso geometries for calculation of the transfer matrix. The new method allows the noninvasive calculation of tailored torso geometries from a standard female torso and five measurements taken from the body surface of a patient. This scaling of the torso has been successfully validated by carrying out EP calculations on 40 scaled torsos and ten female subjects. It utilizes the BEM in the calculation of the transfer matrix as the BEM depends only upon the topology of the surfaces of the torso and the heart, the former can now be accurately deduced, leaving only the latter geometry as an unknown.