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PubMed1990

Noninvasive evaluation of supraventricular tachycardias.

In this article we discuss the role of noninvasive methods in evaluation of supraventricular tachycardias. The limitation of Holter monitoring and exercise testing is discussed. A significant portion of the article is devoted to the role of esophageal recording, body surface potential mapping, and phase image analysis, areas that are often underutilized but that have potential in the diagnosis of supraventricular tachycardias.

Atrial Flutter↗
PubMed1988

[Noninvasive registration of His bundle potentials with temporal and spatial averaging].

On the body surface of ten people with healthy hearts, His bundle signals were measured using a high-resolution IBM-PC-controlled, 64-channel ECG unit. From these, body surface potential maps (BSPM) were recorded in the PQ-segment. Separation from the disturbance-causing atrium potentials was carried out using two methods: the difference method and the differentiation method. The His maps formed the basis for improvement of the measuring method of non-invasive, beat-to-beat recording of the His bundle potentials. Different combinations and electrode placements for measurements of the His signal were tested using the beat-to-beat method. It was found that both unipolar, as well as bipolar measurements yield good results. Two of the unipolar and two of the bipolar electrode arrangements were included on our short list, one of which is particularly recommended for clinical application. In the case of unipolar measurements, the best combination is that with eight electrodes on the chest, whose sum-potential is measured using CTP as reference. The PQ-times and the HV intervals were stable in the ten healthy people tested, so that we were able to carry out time averaging in addition. For practical clinical purposes, we recommend the unipolar beat-to-beat measurement method for non-invasive His electrocardiography. The bipolar method only yields better results in the presence of weak His signals.

Adult↗
PubMed1987

The spatial distribution of late ventricular potentials.

Body surface potential mapping (BSPM) was used to study the spatial distribution of late ventricular potentials. In a group of 15 normals and 21 patients with documented ventricular tachycardia (VT), BSPM performed with 63 averaged and high-pass filtered ECG leads (LP-BSPM) showed that late potentials have a mostly dipolar distribution and that they can be reasonably well detected with only three orthogonal leads. In a group of 17 VT patients who also had BSPM performed during induced VT (VT-BSPM), six patients had LP-BSPM similar to one of the VT-BSPM, suggesting that the locations and orientations of both types of sources are similar. In a group of 12 VT patients who had epi-endo VT mapping at surgery, LP-BSPM showed close extrema (reflecting antero-apical delay) for patients with anterior or apical VT sites, suggesting that VT originates in delayed regions. BSPM thus provides useful information about the detection and significance of late potentials.

Adult↗
PubMed1985

Sudden cardiac death: the search for a non-invasive means to detect the electrical substrate for the development of life-threatening cardiac arrhythmias.

Cardiovascular diseases remain the major cause of death in the adult North American population. Most of these deaths are sudden, occurring secondary to ventricular tachycardia/fibrillation (VT/VF). Based on the results of recent clinical trials, it seems likely that many of these deaths could be prevented if reliable means were available to select those patients at highest risk. To date, however, no totally satisfactory means to establish risk has been identified. The purpose of this paper is to review the currently utilized techniques and to draw attention to some new and potentially useful technology involving computer processing of surface recorded electrocardiographic (ECG) signals. ECG monitoring during rest and activity is neither sensitive nor specific. Invasive studies, using programmed ventricular stimulation to reproduce clinical arrhythmias, have proven extremely useful in the management of patients with recurrent VT/VF; this technique allows the selection of effective therapy as documented by subsequent inability to induce the arrhythmia. However, this technique does not have broad applicability given the complexity of these studies and the significant potential for morbidity. Recent efforts have focused on the detection of the abnormal electrical substrate giving rise to VT/VF by using body-surface electrocardiographic recording. Two approaches are being investigated. In one, high-gain, signal-averaged ECG signals are being utilized to detect (delayed) depolarization potentials occurring during the repolarization process - an electrophysiologic state known to give rise to re-entrant arrhythmias. Initial results with this technique are encouraging. We have focused on another approach - that of body-surface potential mapping.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1994

Diagnosis of acute myocardial infarction.

A number of new techniques have been shown to be superior to creatine kinase and the 12-lead ECG for the diagnosis of acute myocardial infarction. Myoglobin and heart fatty acid-binding protein are more sensitive than creatine kinase for the diagnosis of acute myocardial infarction; myoglobin is also a superior marker for estimating infarct size. Cardiac troponin is a protein specific for the myocardium. It can be used to differentiate myocardial necrosis when creatine kinase levels are elevated from other clinical conditions. Body surface potential mapping and vectorcardiography are better for localizing the site of acute myocardial infarction than the standard 12-lead ECG. Although echocardiography is frequently used for evaluating infarct remodeling, in the future it could be replaced by ultrafast computed tomography or magnetic resonance imaging. Two excellent techniques for the determination of myocardial viability are late thallium redistribution imaging and positron-emission tomography with 18F-fluorodeoxyglucose.

Biomarkers↗
PubMed1993

Analysis of ventricular activation in patients with chronic non-Q wave myocardial infarction: comparison with left ventricular asynergy and myocardial perfusion defects.

In this report, we dealt with ventricular activation abnormalities in 30 patients with previous non-Q myocardial infarction (MI) by means of the CARDIAG 128.1 device, which enables analysis of ECGs, VCGs and body surface potential maps. The diagnosis was verified by left ventriculography, echocardiography and perfusion scintigraphy. Twenty-nine healthy subjects served as the control group. Morphological findings confirmed the presence of a significant subgroup with serious left ventricular asynergy. Seven electrocardiological variables, which significantly differed from control values, disclosed that non-Q MI is responsible for localized activation time prolongation, and that inferoposterior scars tend to delay the entire activation of ventricles, and to cause disturbances of the terminal depolarization phase together with a decrease in voltage production during QRS. Lesions of the anterior wall and the apicomesial part of the inferoposterior wall affect the distribution of the Q wave more often than the posterior basal ones. The probability of such abnormalities increases with the degree of asynergy. Some VCG criteria increase the sensitivity of electrocardiological analysis. These parameters will be used for evaluating the diagnostic value of electrocardiological analysis in the chronic non-Q MI. Non-Q myocardial infarctions represent a heterogeneous group of infarctions from both electrophysiological and morphological aspects.

Adult↗
PubMed1993

The methodology of clinical analysis of electric heart field.

A brief description of the methodology of analysis of the electric heart field using electrocardiograms, vectorcardiograms, diagrams of potential maxima/minima and body surface potential maps is presented. The text is focused on the description of different kinds of isopotential and isointegral maps and their diagnostic possibilities. A detailed description of the diagram of potential maxima/minima and its place in diagnostic of different disturbances of the heart muscle and conduction defects is given.

Bundle-Branch Block↗
PubMed1981

Inverse solution in electrocardiography: determining epicardial from body surface maps by using the finite element method.

A new method of determining epicardial potentials from body surface maps is presented. Epicardial potentials can be estimated via the forward transfer matrix computed by using the finite element method. Due to smoothing and decrease in value in potential distribution of the body surface, the inverse problem involved becomes, in nature, ill-conditioned and direct application of the usual inversion technique will give an extremely oscillatory solution. Therefore, in order to obtain a practically meaningful solution, an appropriate regularizing procedure must be developed and, in the present paper, an effective regularization based on the generalized inverse matrix is proposed and its usefulness is demonstrated. Numerical experiments suggest that if the epicardial map includes high components of spatial frequency the inverted epicardial map will have poor resolution. This is especially true at the epicardial surface distant from the body surface, such as on the diaphragmatic side of the ventricle. If the epicardial maps have to be inverted over the entire region of the epicardium with a clinically allowable accuracy, about 180 body surface lead points and 3 significant figures in the measurements of body surface potentials will be needed.

Computers↗
PubMed1989

Prognostic significance of ST potentials determined by body surface mapping in inferior wall acute myocardial infarction.

Electrocardiographic body surface mapping on admission to coronary care has been shown to predict prognosis in a previous study of 100 patients with inferior wall acute myocardial infarction (AMI). A further 98 patients with first inferior wall AMI were now studied by body surface mapping on admission to coronary care to confirm that both the spatial distribution or map pattern of ST-segment potentials and the precise measurement of the maxima and minima are of prognostic significance. Each ST-segment map was compared by correlation coefficient to the average map pattern of the 4 groups derived in a previous study and placed in the group with the highest correlation coefficient. Analysis of these groups against outcome confirmed that the group dominated by a large area of marked anterior ST depression was associated with a high rate of complications and a significantly lower survival free of coronary artery bypass grafting (p less than 0.01). Patients in this group had more extensive and severe coronary artery disease than patients in the other groups. Increasing values of maximal ST depression correlated with mortality and complication rates. The extent by which the magnitude of ST-segment depression exceeded the magnitude of ST-segment elevation correlated with mortality and incidence of left ventricular failure. The results confirm the findings of the original study. Body surface mapping is of prognostic significance in inferior wall AMI.

Adult↗
PubMed1976

Body-surface maps of heart potentials: tentative localization of pre-excited areas in forty-two Wolff-Parkinson-White patients.

Heart potentials were recorded from the entire chest surface in 42 patients suffering from Wolff-Parkinson-White syndrome. We were able to identify six types of surface maps, according to the location of the potential maximum and minimum during the delta wave. For each of these types we suggested the most likely location of the pre-excited region around the A-V rings (types 1 to 5) or in the interventricular septum (type 6). In 13 patients belonging to Types 1, 2, 3, 5 and 6 our hypotheses were in agreement with intracardiac recordings, epicardial maps or surgical results obtained by others. Isopotential surface maps provide more information on the location of the pre-excited area than conventional ECGs, particularly when these exhibit intermediate features between Types A and B.

Action Potentials↗
PubMed2000

New body surface isopotential map evaluation method to detect minor potential losses in non-Q-wave myocardial infarction.

BACKGROUND: Potential losses caused by stable non-Q-wave myocardial infarction (MI) are too small to diagnose with the use of standard ECG. The aim of the present study was to obtain accurate diagnostic criteria for this prognostically important disease with the help of body surface mapping. METHODS AND RESULTS: Body surface potentials were recorded with the use of 63 unipolar leads in 45 patients with a non-Q-wave MI (41 to 75 years old); 24 healthy adults, 42 patients with unstable angina, and 70 patients with Q-wave MI served as reference groups. Qualitative pathological features of the isopotential maps, such as onset time and site and magnitude of the first right-anterior/anterior minimum, as well as pathological negativities at that time, were defined in non-Q-wave MI cases. These features, which account for the activation sequence and the body surface projections of specific cardiac regions (Selvester classification), showed a 91% sensitivity and an 88% specificity for the detection of non-Q-wave MI. In comparison, the different departure maps (first third QRS, QRS, and QRST isoarea) resulted in less favorable specificities (50% to 58%). Concordance between the isopotential maps and the acute-phase ECG (90%), hypokinesis (64%), fixed perfusion defects (59%), and significant stenosis of the infarct-related coronary artery (87%) supported the concept that these isopotential map changes correspond to the supposed sites of MI. There were pathological features in 69% of patients with unstable angina, with similar concordances as in non-Q-wave MI. CONCLUSIONS: Isopotential maps revealed characteristic features that were suitable for the detection and localization of non-Q-wave MI in the clinical setting of unstable coronary artery disease.

Adult↗
PubMed1987

Spatial distribution and prognostic significance of ST segment potential determined by body surface mapping in patients with acute inferior myocardial infarction.

We investigated the mechanism and significance of ST segment changes in inferior infarction by studying 100 patients with acute inferior infarction in whom body surface maps were recorded on admission. The magnitude of the maximum ST segment elevation (denoted Vmax) and magnitude of the maximum ST segment depression (denoted Vmin), as well as the ST depression on the standard 12-lead electrocardiogram were analyzed against morbidity and mortality (at a median follow-up time of 14 months). A value obtained by subtracting Vmax from Vmin correlated (p less than .0002) with outcome. Correlations were also found between Vmin and complications, Vmin and mortality, and between increasing levels of ST depression on the 12-lead electrocardiogram and mortality. The maps were also studied by grouping the 100 ST segment map patterns into five groups by cluster analysis techniques. One group showed marked anterior negativity and had 37% mortality compared with an overall 5% mortality for the remaining groups. The limited arteriographic and autopsy data available indicated that the findings of a diseased artery or arteries corresponded with the results of mapping. The mean map patterns of the five groups showed that, in most patients with inferior infarction, the standard chest leads V1 to V6 are over a region of steep voltage gradient. Small changes in the position of the standard chest lead can cause large changes in the displayed potentials. This study indicates that patients at high risk after acute inferior infarction can be identified by surface mapping on admission to the coronary care unit.

Electrocardiography↗
PubMed1991

Spatial distribution of late potentials assessed by signal-averaged body surface mapping.

In order to evaluate the spatial location of late potentials (LPs), we designed a new system for the body surface mapping of signal-averaged, filtered ECG using 45 thoracic unipolar leads (5 X 9 array). Signals from patients with old myocardial infarction (MI, N = 8), arrhythmogenic right ventricular dysplasia (N = 1) and dilated cardiomyopathy (N = 2) were amplified and passed through a digital bandpass filter (60-300Hz). Departure maps, LP isopotential maps, and LP30 area maps were generated and superimposed. The LP30 duration was determined as the section between the filtered QRS endpoints and points 30 msec before. Isopotential maps of the LPs showed distinct positive and negative regions. In 8 cases with MI, the extreme was related to the zones indicated by departure maps, and LP30 area maps also corresponded to the departure areas. Most importantly, the spatial distribution for the LP30 area map was different for each type of disease. In conclusion, body surface LP isopotential maps and LP30 area maps may provide useful information concerning the spatial distribution of LPs.

Arrhythmias, Cardiac↗
PubMed2004

Relationships between depolarization abnormality and repolarization abnormality in patients with Brugada syndrome: using body surface signal-averaged electrocardiography and body surface maps.

INTRODUCTION: Repolarization and depolarization abnormalities have been reported to be related to Brugada syndrome. METHODS AND RESULTS: We evaluated the relationships between repolarization abnormality and depolarization abnormality using 48-lead unipolar signal-averaged electrocardiograms and 87-lead unipolar body surface maps in 15 patients with Brugada-type ECGs. Data were compared with those from healthy control subjects (n = 5) and within subgroups of Brugada syndrome with (n = 8) and without (n = 7) ventricular arrhythmias (VA) induced by programmed electrical stimulation (PES). Eighty-seven-lead body surface maps were recorded, and potential maps were constructed to evaluate elevation of the ST segment 20 ms after the J point. Forty-eight-lead signal-averaged ECGs were recorded, and isochronal maps of duration of the delayed potential (dDP) were constructed to evaluate the dDP in each lead. Potential maps showed that patients with Brugada-type ECG, especially those with VA induced by programmed electrical stimulation, had greater elevation of the ST segment in the right ventricular outflow tract, especially at E5. Isochronal maps of dDP in the Brugada-type ECG group showed that maximum dDP was located at E5 and that the area with long dDP was larger than that in the control subjects. The dDPs at E7, E5, F7, and F5 in the VA-inducible group were significantly longer than those in the VA-noninducible group. These results showed that the location of greater elevation in the ST segment coincided with the location of longer dDP. CONCLUSION: Repolarization abnormality and depolarization abnormality in the walls of both ventricles, especially in the right ventricular outflow tract, are related to the VA of Brugada syndrome.

Adult↗
PubMed1996

Temporal and spatial analysis of potential maps via multiresolution decompositions.

Cardiac potentials recorded on the epicardium or the body surface by an array of electrodes are usually analyzed either as spatial distributions or temporal waveforms. Thus, the analysis often involves temporal descriptors (eg. max dV/dt) or spatial descriptors (eg. location of local extrema) only. The best known transform technique that has been applied to these data that combines both spatial and temporal characteristics is the Karhunen-Loeve transform, a global transform applied to temporal and/or spatial bases obtained by statistical analysis of a database. As an alternative, multiresolution decompositions and related wavelet-type transforms have recently seen great development in signal processing and related fields. They offer flexibility, employing transformations onto local (rather than global) and fixed (rather than data-dependent) databases, and allow transformation of distributions, waveforms, or both, as desired. The utility of this method as applied to temporal and spatial segmentation and analysis of map data from both epicardial plaques and body surface potentials recorded during percutaneous transluminal coronary angioplasty is illustrated.

Body Surface Potential Mapping↗
PubMed1996

[Body surface mapping].

The body-surface map provides an integral picture containing more information on the activation sequence of the heart than is available from a standard 12-lead electrocardiogram (ECG) or vectorcardiogram (VCG), because the body-surface map has a larger number of lead points that the ECG, and they are uniformly distributed over the entire thorax and back. It supplies instant-by-instant information about the distribution of the positive and negative potential areas over the body surface. Therefore, body-surface mapping is a very powerful diagnostic tool for assessing the activation sequence of the heart and is likely to play an important role in determining the focus of various arrhythmias and the site of bypass tract and also clarifying the physiological mechanism of arrhythmias.

Arrhythmias, Cardiac↗
PubMed1997

Body surface Laplacian mapping of bioelectrical activity.

A method is described to process and interpret multi-channel bioelectrical signals. The bioelectrical signals were recorded noninvasively over the body surface of human subjects at 120 sites. The body surface Laplacian maps were then constructed from the multi-channel bioelectrical potential measurement. The method was evaluated by means of computer simulations, and applied to imaging cardiac electrical activity. The present investigation suggests body surface Laplacian mapping provides an important means in interpreting bioelectrical signals.

Body Surface Potential Mapping↗