AUTHOR=Roudijk Robert W. , Boonstra Machteld J. , Brummel Rolf , Kassenberg Wil , Blom Lennart J. , Oostendorp Thom F. , te Riele Anneline S. J. M. , van der Heijden Jeroen F. , Asselbergs Folkert W. , van Dam Peter M. , Loh Peter 

TITLE=Comparing Non-invasive Inverse Electrocardiography With Invasive Endocardial and Epicardial Electroanatomical Mapping During Sinus Rhythm

JOURNAL=Frontiers in Physiology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2021.730736

DOI=10.3389/fphys.2021.730736

ISSN=1664-042X

ABSTRACT=<p>This study presents a novel non-invasive equivalent dipole layer (EDL) based inverse electrocardiography (<italic>i</italic>ECG) technique which estimates both endocardial and epicardial ventricular activation sequences. We aimed to quantitatively compare our <italic>i</italic>ECG approach with invasive electro-anatomical mapping (EAM) during sinus rhythm with the objective of enabling functional substrate imaging and sudden cardiac death risk stratification in patients with cardiomyopathy. Thirteen patients (77% males, 48 ± 20 years old) referred for endocardial and epicardial EAM underwent 67-electrode body surface potential mapping and CT imaging. The EDL-based <italic>i</italic>ECG approach was improved by mimicking the effects of the His-Purkinje system on ventricular activation. EAM local activation timing (LAT) maps were compared with <italic>i</italic>ECG-LAT maps using absolute differences and Pearson’s correlation coefficient, reported as mean ± standard deviation [95% confidence interval]. The correlation coefficient between <italic>i</italic>ECG-LAT maps and EAM was 0.54 ± 0.19 [0.49–0.59] for epicardial activation, 0.50 ± 0.27 [0.41–0.58] for right ventricular endocardial activation and 0.44 ± 0.29 [0.32–0.56] for left ventricular endocardial activation. The absolute difference in timing between <italic>i</italic>ECG maps and EAM was 17.4 ± 7.2 ms for epicardial maps, 19.5 ± 7.7 ms for right ventricular endocardial maps, 27.9 ± 8.7 ms for left ventricular endocardial maps. The absolute distance between right ventricular endocardial breakthrough sites was 30 ± 16 mm and 31 ± 17 mm for the left ventricle. The absolute distance for latest epicardial activation was median 12.8 [IQR: 2.9–29.3] mm. This first in-human quantitative comparison of <italic>i</italic>ECG and invasive LAT-maps on both the endocardial and epicardial surface during sinus rhythm showed improved agreement, although with considerable absolute difference and moderate correlation coefficient. Non-invasive <italic>i</italic>ECG requires further refinements to facilitate clinical implementation and risk stratification.</p>