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Results for “Body Surface Potential Mapping”

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PubMed2006

Body-surface potential mapping to aid ablation of scar-related ventricular tachycardia.

We investigated whether body-surface potential mapping (BSPM) during catheter ablation of scar-related ventricular tachycardia (VT) could assist with the identification of VT exit sites. The study population consisted of 9 patients who underwent catheter ablation for VT, among whom 12 induced VTs with known exit sites were identified by entrainment criteria, pace mapping, or site of successful ablation. Paced activation was initiated at various intracardiac sites (20 +/- 4 sites per patient, a total of 180) documented by nonfluoroscopic electroanatomic mapping. During all episodes of VT and pacing, patients had a 120-lead electrocardiogram recorded, and we analyzed these electrocardiographic data--by means of a similarity coefficient (SC) calculated over 100 milliseconds after the initiation of depolarization--to assess the similarity between the BSPM sequences occurring during VTs and those induced by pacing. Based on 245 observations, the relationship between the SC and the distance of the pacing site from the VT exit site was then obtained for each individual VT by linear regression analysis: the distance D (in millimeters) from the VT exit site was related to SC by the regression equation D = slope (1 - SC2) + intercept. The parameters in this equation varied widely for the 12 VTs, but, in general, the nearer the pacing site was to the exit site, the better the goodness of match. This suggests that, although there is no universally applicable relationship between D and SC, BSPM could provide a useful adjunct to standard pace mapping, although additional processing--namely, an inverse calculation of epicardial potentials/isochrones--may be needed to reliably identify VT exit sites from body-surface electrocardiograms.

Aged↗

PubMed1990

Application of the Karhunen-Loeve expansion to evaluate regional cardiac excitation in body surface potential maps.

The authors investigated the usefulness of the Karhunen-Loeve technique applied to body surface maps to study regional cardiac excitation. Eigenvectors were derived from the body surface potential maps of 120 healthy adults using the Karhunen-Loeve expansion theory. Then, in the maps of various types of ventricular hypertrophy, each eigenvector coefficient was calculated for a statistical comparison. The first eigenvector coefficient in early QRS and the second in mid QRS were larger in patients with asymmetrical septal hypertrophy and in patients with left ventricular hypertrophy, respectively. The third was larger in patients with right ventricular hypertrophy. In the maps of patients with previous anteroseptal myocardial infarction, the second eigenvector coefficient decreased with asynergy of the anterior to apical wall, and the first decreased with the asynergy of the interventricular septum. They conclude that some eigenvector components and coefficients at particular times in the QRS are sensitive to changes in regional cardiac excitation and that they may facilitate the detection of local excitation changes such as occur in hypertrophy or infarction.

Adult↗

PubMed1989

Body surface potential mapping in anterior myocardial infarction--a longitudinal study in acute, convalescent and chronic phases.

Body surface potential mapping (BSPM) was performed to evaluate the infarct size and the viability of myocardium in the infarct area in 20 patients with anterior myocardial infarction (MI). BSPM was performed at the early acute phase, 1 week, 1 month and 2 months after onset of the symptoms. The departure areas were obtained according to the potential distribution below the mean normal range and were compared with the value for creatine phosphokinase (CPK), hemodynamic parameters, ejection fraction measured by radionuclide ventriculography, extent score (ES) and severity score (SS) of thallium-201 single photon emission computed tomogram. Two months after the infarction, the ergometer exercise was performed and departure areas before and after exercise were compared. With the departure map technique, the departure areas in all cases were found in the anterior region of the thorax; From 1 week to 2 months after MI, the departure areas were significantly reduced. One week after MI, the departure areas had a positive significant relation with peak CPK and sigma CPK. One month after MI the departure areas also had a positive relation with ES or SS. One week and 1 month after MI, the departure areas had a negative relation with the left ventricular stroke work index or the left ventricular ejection fraction. After exercise test in the chronic phase, the departure areas were significantly enlarged. In conclusion, the departure map is useful in evaluating the location, sequential changes of size of anterior MI including the ischemic area around the infarct site and the left ventricular function. It is suggested that the enlarged departure areas after exercise might be the ischemic areas provoked by exercise.

Adult↗

PubMed2005

Composition of approximated body-surface-potential-maps by utilizing a common 12-lead-ECG device.

A procedure is introduced that allows approximations of body surface potential maps (BSPM) to be obtained by utilizing commonly available digital 12-lead-electrocardiogram (ECG) systems. These Pseudo-BSPMs contain most of the averaged spatio-temporal information for a single characteristic beat. The underlying signal processing is described in detail. The algorithms including an online method verification may easily be added to the software of commercial 12-lead ECG devices.

Algorithms↗

PubMed1992

Characteristic abnormal features of body surface potential maps predictive of ventricular tachycardia following coronary artery occlusion in dogs.

In a search for features predictive of ventricular arrhythmias in myocardial ischemia, the body surface potential maps of 17 dogs with coronary artery occlusion were studied. Ventricular tachycardia occurred in 9 (53%) of the 17 dogs. Multiple distribution of the abnormal potential minimum was found in 6 (67%) of the 9 dogs with (group A) and none of the 8 dogs without ventricular tachycardia (group B). The difference was statistically significant (p less than 0.01). The abnormal "early reversal" phenomenon of potential distribution was observed in 6 (67%) of group A and 7 (88%) of group B. The difference was not statistically significant (p greater than 0.05). The area of abnormal negative potential was 28.0 +/- 8.5 cm2 for group A and 14.5 +/- 5.5 cm2 for group B (p less than 0.001). The abnormal negative potential lasted for 25.4 +/- 3.5 ms in group A and 10.1 +/- 5.1 ms in group B (p less than 0.001). The abnormally early appearance of potential minimum lasted for 24.2 +/- 5.1 ms in group A and 10.5 +/- 5.4 ms in group B (p less than 0.001). The data suggest that the distribution, area, and duration of the abnormal negative potential of the body surface potential map are useful in the prediction of ventricular tachycardia associated with coronary artery occlusion.

Animals↗

PubMed1993

Quantitative evaluation of body surface potential mapping of heart electrical field in ischaemic heart disease.

New possibilities of quantitative evaluation of body surface potential mapping were studied in 78 patients with ischaemic heart disease. Integral maps of the Q wave, QRS and ST-T intervals were plotted and isochronous maps of ventricular activation time and maps of asynchronous potential minima of the Q wave were determined. Minimum and maximum potential values and their time relations were evaluated in the maps. Left ventricular contraction abnormality detected by left ventricular angiography was determined by a point score and expressed as an index of asynergy. The number of coronary artery branches with significant narrowing was assessed and the extent of coronary artery damage was evaluated by an arbitrary defined index. Using quantitative parameters from the maps, multiple stepwise linear regression was performed. The relationship between map parameters and index of asynergy corresponded to multiple correlation coefficient r = 0.69 (p = 0.01) in the whole group of patients. In the group of patients with left ventricular contraction abnormality the relationship between these parameters was found to be r = 0.87 (p = 0.01). The relationship between map parameters and the number of coronary artery branches with significant stenosis was r = 0.60 (p = 0.01) in the group of patients with positive coronary angiography. In the same group of patients the relationship between map parameters and the index evaluating coronary artery damage was equal to r = 0.63 (p = 0.01). The data obtained from body surface integral maps enable to quantify cardiac ischaemic damage.

Coronary Angiography↗

PubMed1998

Spatial resolution of body surface potential maps and magnetic field maps: a simulation study applied to the identification of ventricular pre-excitation sites.

The spatial resolution of body surface potential maps (BSPMs) and magnetic field maps (MFMs) is investigated by means of an anatomically accurate computer model of the human ventricular myocardium. BSPMs and MFMs are calculated for the simulated activation sequences initiated at 35 pre-excitation sites located along the atrioventricular (AV) ring of the epicardium. Changes in the BSPMs and MFMs corresponding to different pre-excitation sites are quantified in terms of the correlation coefficient r. The spatial resolution (selectivity) for a given pre-excitation site is defined as the half-distance between those neighbouring locations at which morphological features of maps, in terms of r, become distinct (r < 0.95). It is found that, at 28 ms after the onset of pre-excitation and with no noise added, this distance +/- SD, for all sites along the AV ring for the 117-lead BSPMs, is 0.83 +/- 0.32 cm, and for the 64-lead and 128-lead MFMs it is 1.54 +/- 0.84 cm and 1.15 +/- 0.43 cm, respectively. The findings suggest that, when features of non-invasively recorded electrocardiographic and magnetocardiographic map patterns are used for identifying accessory pathways in patients suffering from WPW syndrome, BSPMs are likely to provide more detailed information for guiding the ablative treatment than MFMs. For some sites MFMs provide more information. Both modalities may provide additional assistance to the cardiologist in locating the site of the accessory pathway.

Body Surface Potential Mapping↗

PubMed1986

Non-Q-wave acute myocardial infarction: body surface potential map and ventriculographic patterns.

Day 5 body surface map and radionuclide angiographic patterns were compared among 56 patients with first non-Q-wave or Q-wave acute myocardial infarction (AMI). Three radionuclide angiographic patterns were recognized in patients with non-Q infarction: no wall motion abnormalities (n = 8), single-segment wall motion abnormalities (n = 10) and multiple-segment wall motion abnormalities (n = 9). In contrast, only 2 radionuclide angiographic patterns were identified in patients with Q-wave infarction: multiple-segment wall motion abnormalities (n = 25) and single-segment wall motion abnormalities (n = 4). The Q-wave distributions of 14 of 18 patients with non-Q infarction with 0 or 1 wall motion abnormalities were normal; 2 patients had "missed" anterior; 1 patient had inferior; and 1 had posterior AMI patterns. Of 9 patients with non-Q infarction who had multiple-segment wall motion abnormalities, 8 had infarct Q waves on the posterior torso. Q-wave patterns in patients with anterior (n = 17) and inferior (n = 12) Q-wave infarctions were typical and homogeneous for each group. Quantitative analysis of minimum Q-zone integral, sigma Q-wave integrals, ST-integral maximum, wall motion abnormality score and ejection fraction revealed no differences between patients with non-Q-wave and those with inferior Q-wave infarction. In contrast, patients with anterior AMI had significantly more abnormal values of all variables than either of the other groups. Overall, the data support the concept of non-Q-wave AMI as a distinct, if heterogeneous, pathophysiologic entity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1986

Q-wave infarction: pathophysiology of body surface potential map and ventriculographic patterns in anterior and inferior groups.

To define and relate the body surface electrocardiographic and left ventricular wall motion patterns in the acute phase of Q-wave infarction, we recorded 120-lead body surface potential maps and radionuclear angiograms in 29 patients on the fifth day of their first infarction. By standard 12-lead electrocardiographic criteria, 17 patients were designated as anterior infarction and 12 as inferior infarction. Body surface map infarct patterns in the anterior group were characterized primarily by abnormal Q-wave, negative Q-zone and positive ST-segment integral patterns over the anterior torso and little reciprocal change. The maps of the inferior patient group were characterized primarily by depolarization and repolarization infarct patterns over the inferior torso and marked reciprocal changes in all integral patterns over the anterior torso. Both groups displayed infarct patterns over a common area of the right anterior-inferior torso. In the anterior group depolarization minima and repolarization maxima were clustered in a small precordial area; in the inferior group the same extrema were widely scattered over the inferior torso, both anteriorly and posteriorly. Segmental left ventricular wall motion analysis revealed that the 3 most commonly and most severely involved segments were the same in both infarct groups--apical, infero-apical and antero-lateral. Basal septum and antero-basal segmental dysfunction were exclusive to the anterior group; postero-lateral and infero-basal involvement, to the inferior group.(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗

PubMed1990

QRS onset and offset detection accuracy improvement by additional spatial information in body surface potential maps.

A new automatic spatiotemporal algorithm has been developed for detecting QRS onset and offset in body surface potential mapping. The new algorithm, based on a spatial and temporal approach, along with three other algorithms (total energy, 3-lead, and median), was tested in 73 normal and abnormal patients. The reference or gold standard onset and offset times were determined visually by two experienced investigators. The results demonstrate that the new method is less sensitive to noise, to the temporal overlap of the QRS and other components, and to the spatial location changes of QRS initial and final activation. The spatiotemporal method resulted in very consistent findings, with a standard deviation of less than one third of the standard deviation in the next best method.

Algorithms↗

PubMed1990

The value of body surface potential maps in detecting abnormal ventricular wall motion.

In an effort to enlarge the clinical application of body surface potential maps (BSPMs), the authors studied the relationship between abnormal ventricular wall motion and BSPMs in 98 consecutive patients with angiographically proven coronary artery disease (CAD). Forty-nine of the patients (50%) had wall motion abnormalities as seen on single-plane left cine ventriculograms. During early ventricular depolarization, normal BSPMs have a potential maximum that is greater than the absolute value of the potential minimum; this reverses in late depolarization such that the absolute value of the potential minimum is the greater. The patients showed a significantly early reversal (p less than 0.001), and 55 (56.1%) had abnormal "early reversal" BSPMs. This abnormal "early reversal" is closely related to abnormal ventricular wall motion. Using it as an indicator of abnormal wall motion, the authors obtained the sensitivity, specificity, positive predictive value, and negative predictive value of the following conditions: LAD lesions, LCX, RCA, LAD and RCA lesions, LAD and LCX, and three-vessel disease, and for all patients. A relatively high sensitivity (85%) and specificity (80%) was found in patients with LAD lesions only or multivessel lesions in addition to LAD lesions.

Adult↗

PubMed1984

The spectrum of right bundle branch block as manifested in electrocardiographic body surface potential maps.

A wide spectrum of types of right bundle branch block (RBBB) were studied utilizing the body surface potential maps (BSPMs) of 37 children. Although the spectrum varied from very advanced RBBB to minimal partial RBBB, a common diagnostic feature was the absence of evidence for right ventricular breakthrough in the maps of all patients. Evidence for left ventricular breakthrough was usually seen, the exceptions being five patients with partial RBBB and one of 29 with advanced RBBB. The appearance of evidence for activation of the right ventricle by way of the septum was late in onset. In addition, especially in advanced RBBB, the BSPM pattern reflecting right ventricular activation was prolonged in such a manner that it appeared that utilization of right ventricular Purkinje tissue was minimal and inefficient. The BSPMs during ST-T, which were of inverse polarity, reflect repolarization that is determined by the sequence of depolarization to a greater degree than in the normal. In general, the more extensive the surgery, the more advanced the RBBB (as reflected in the BSPM), although there were exceptions. The one parameter that linked all patients with RBBB together was the absence of evidence for right ventricular epicardial breakthrough.

Adolescent↗

PubMed2005

Localization of the site of origin of reentrant arrhythmia from body surface potential maps: a model study.

We have developed a model-based imaging approach to estimate the site of origin of reentrant arrhythmia from body surface potential maps (BSPMs), with the aid of a cardiac arrhythmia model. The reentry was successfully simulated and maintained in the cardiac model, and the simulated ECG waveforms over the body surface corresponding to a maintained reentry have evident characteristics of ventricular tachycardia. The performance of the inverse imaging approach was evaluated by computer simulations. The present simulation results show that an averaged localization error of about 1.5 mm, when 5% Gaussian white noise was added to the BSPMs, was detected. The effects of the heart-torso geometry uncertainty on the localization were also initially assessed and the simulation results suggest that no significant influence was observed when 10% torso geometry uncertainty or 10 mm heart position shifting was considered. The present simulation study suggests the feasibility of localizing the site of origin of reentrant arrhythmia from non-invasive BSPMs, with the aid of a cardiac arrhythmia model.

Arrhythmias, Cardiac↗

PubMed2003

Spatiotemporal characterization of paced cardiac activation with body surface potential mapping and self-organizing maps.

In this study self-organizing maps (SOM) were utilized for spatiotemporal analysis and classification of body surface potential mapping (BSPM) data. Altogether 86 cardiac depolarization (QRS) sequences paced by a catheter in 18 patients were included. Spatial BSPM distributions at every 5 ms over the QRS complex were first presented to an untrained SOM. The learning process of the SOM units organized the maps in such a way that similar BSPMs are represented in particular areas of the SOM network. Thereafter, time trajectories and distance maps were created on the trained SOM from sequential maps in a selected paced QRS. The trajectories and distance maps can be applied as such for the localization of abnormal ventricular activation, as well as quantitative input for statistical classification. The results indicate that the method has potential for locating endocardial sites of abnormal ventricular activation, despite the patient material being too limited to provide a reliable statistical evaluation of the source localization accuracy.

Algorithms↗

PubMed1999

Comparison of 18-lead ECG and selected body surface potential mapping leads in determining maximally deviated ST lead and efficacy in detecting acute myocardial ischemia during coronary occlusion.

Kornreich identified 6 body surface potential mapping (BSPM) leads outside the standard 12-lead electrocardiographic (ECG) sites for optimal recognition of ST segment elevation (+) and depression (-) during acute ischemia in anterior, inferior, and posterior myocardial zones (A+, A-, I+, I-, P+, P-). No comparison has been made between the 6 selected BSPM leads and 18-lead ECG (12 + V3-5R + V7-9) in detecting acute myocardial ischemia during coronary occlusion. Continuous 18-lead ECG and 6 selected BSPM leads were recorded in 68 patients (77 vessels) undergoing coronary angioplasty during balloon occlusion. Ischemia was defined as ST segment deviation (deltaST) > or = 100 microV > or = 1 lead from the preinflation baseline. The 18-lead ECG was a more frequent source of the maximal deltaST lead during left anterior descending artery, right coronary artery, and left circumflex artery occlusion (71 [92%]) than the 6 selected BSPM leads (5 [7%]). The 18-lead ECG was more efficacious than the 6 selected BSPM leads for detecting acute myocardial ischemia in the group as whole. The 18-lead ECG was also more efficacious for detecting right ventricular ischemia associated with proximal right coronary artery occlusion and for detecting ST segment elevation during left circumflex artery occlusion. Our findings indicate that the 18-lead ECG is the most frequent source of maximally deviated lead and is more efficacious in detecting myocardial ischemia during balloon occlusion than the 6 selected BSPM leads. The 6 selected BSPM leads do not add information above and beyond the 12- or 18-lead ECG, and thus cannot be recommended as optimal sites for continuous ST segment monitoring of patients with acute coronary syndromes.

Aged↗

PubMed1995

Clinical applications of body surface potential mapping.

Accumulated evidence suggests that the electrocardiographic information provided by the standard 12-lead electrocardiogram can be improved by use of multilead electrocardiograms. The clinical utility of body surface potential mapping is related to the selective regional information provided by the increased number of leads. That clinical utility includes such things as improved localization of accessory pathways in preexcitation syndromes, improved localization of pacing sites within the ventricles, localization of late potentials, and improved recognition of acute myocardial ischemia. Recording equipment and interpretation schemes are available to make possible more widespread application of potential mapping.

Arrhythmias, Cardiac↗

PubMed1999

Characteristic findings of body surface potential map during ventricular repolarization in patients with coronary heart disease.

The objective of the present study was to investigate the characteristics of body surface potential map (BSPM) findings during ventricular repolarization in patients with coronary artery disease (CAD). A total of 108 consecutive patients, 99 men and 9 women with angina pectoris and positive treadmill exercise test results as well as angiographically documented CAD underwent BSPM study in a fasting state. Their ages ranged from 30 to 70 years. There were 13 patients with right coronary artery (RCA) lesions, 37 with left anterior descending artery (LAD) lesions, 5 with left circumflex artery (LCX) lesions, 17 with both RCA and LAD lesions, 12 with both LCX and LAD lesions, and 24 with 3-vessel disease. The BSPMs were obtained by using the heart potential map system designed by Toyama et al. There were 59 lead points on the anterior chest wall and 28 on the back. The BSPMs in isopotential distribution were made every one msec throughout the ventricular activation period. The distribution of positive and negative potentials, potential maximum and potential minimum, polarity of potential distribution, and the reversal of potential distribution during ventricular repolarization were analyzed. The following information on BSPMs was obtained: (1) In early ventricular repolarization, the negative potential and the potential minimum appeared abnormally on the anterior thorax. The potential abnormality displayed on the right portion or the inferior portion in patients with RCA lesions, on the middle portion or the left portion in patients with LAD lesions, and on the left-superior portion or the left-middle portion in patients with LCX lesions. In patients with multi-vessel disease, the abnormal potential distribution showed a combined pattern of individual vessel lesions. (2) In some cases, the multipolar potential distribution appeared abnormally during the initial stage and the peak of the T wave. (3) The reversal of potential distribution was observed in about half of the patients. The characteristic findings of the BSPM during ventricular repolarization, including abnormal potential distribution, multipolar potential distribution and reversal of potential distribution, will be of clinical value in patients with CAD.

Adult↗

PubMed2003

Baseline reconstruction for localization of rapid ventricular tachycardia from body surface potential maps.

Determination of an accurate electrocardiographic (ECG) baseline is generally needed for localization of ventricular arrhythmias with body surface potential mapping (BSPM). We suggest a novel signal processing method for ECG baseline reconstruction during monomorphic ventricular tachycardias (VT). The method is based on an assumption that VT consists of similar ventricular extrasystolic beats with overlapping depolarization and repolarization. The sequential reconstruction algorithm utilizes information of small variations in the heart rate and yields a non-overlapping QRST-signal, provided that the measurement set-up has a high enough temporal resolution to avoid distortions due to sampling differences and misalignment of individual beats. The reconstructed QRST-signal is utilized to subtract overlapping T-waves from the QRS complexes during VT. The use of the method is demonstrated with clinically measured BSPM data.

Body Surface Area↗