Non-invasive localization of the ventricular arrhythmia lesion

Non-invasive preoperative localization of the site of premature ventricular activation can significantly shorten the time and increase the success of ablation therapy. A method was proposed to locate the lesion by solving the inverse problem of electrocardiography as finding the position of the dipole representing the onset of ectopic activation. The method requires surface ECG mapping and a 3D model of the patient’s chest obtained from CT. It was tested on 5 patients in Prague (96 ECG leads) and 2 patients in Bratislava (128 ECG leads). In solving the problem, an inhomogeneous (NT) or homogeneous (HT) chest model and potential maps from all measured, or only from 64, 48, 32 selected leads were used. The calculated dipole positions were compared to the catheter position during successful ablation of the arrhythmogenic lesion. In 3 patients in Prague and both patients in Bratislava the lesion was in the outflow tract of the right ventricle (RVOT), in the other 2 patients it was in the left ventricle (LV). The proposed method determined the lesion in the correct area of ​​the heart with an error of up to 2 cm in all patients, except one, where the lesion in the RVOT was located in the LV, while the error was also less than 2 cm. The use of HT did not show a significant increase in localization error, leading to less variance of results from different ectopic cycles. The use of 48 or fewer leads increased the number of incorrect locations, and the use of NT also increased the number of incorrect locations out of 64 leads.

 

 

Fig. 1: Example of localization of an ectopic activation locus in the basal inferior region of the left ventricle of the heart (rear view). Left: chest and heart model with ablation catheter positions. Right: localization of the lesion from 5 ectopic cycles using different numbers of leads and different heart models.

 

Related projects:
• APVV-14-0875 “Non-invasive localization of ectopic ventricular arrhythmias using ECG mapping and its use for causal treatment.”
• VEGA 2/0071/16 “Modeling of the electric field of the heart to investigate the manifestations of functional and structural changes of the myocardium in the measured ECG signals.”

 

Publications:

  1. PUNSHCHYKOVA, O. – ŠVEHLÍKOVÁ, J. – KNEPPO, P. – MAKSYMENKO, V. – TYŠLER, M. Noninvasive localization of the ectopic focus using time integral ECG mapping. In Experimental and Clinical Cardiology, 2014, vol. 20, no. 7, p. 1564-1570. (0.758 – IF2013). ISSN 1205-6626.
  2. TYŠLER, M. – ŠVEHLÍKOVÁ, J. – PUNSHCHYKOVA, O. – KNEPPO, P. – MAKSYMENKO, V.: Noninvasive localization of ectopic ventricular activity using BSPM and different patient torso models. In ELNANO 2015 – Conference Proceedings. Kyiv: National Technical University of Ukraine, 2015, p. 325-329. ISBN 1467365343.
  3. PUNSHCHYKOVA, O. – ŠVEHLÍKOVÁ, J. – KNEPPO, P. – GRÜNES, R. – SEDOVA, K. – SENYSH, B. – OSMANČÍK, P. – ŽĎÁRSKÁ, J. – HEŘMAN, D. – TYŠLER, M. Influence of modeled heart cavities on the noninvasive localization of ectopic ventricular activity. In MEASUREMENT 2015 : 10th International Conference on Measurement. Editors J. Maňka, M. Tyšler, V. Witkovský, I. Frollo. – Bratislava : Institute of Measurement Science, SAS, 2015, p. 109-112. ISBN 978-80-969672-9-2.
  4. PUNSHCHYKOVA, O. – SVEHLIKOVA, J. – KNEPPO, P. – TYSLER, M.: Time integral mapping for noninvasive localization of ectopic ventricular activity. ECG-Imaging workshop, Bad Herrenalb, Nemecko, 25.3.-28.3.2015.
  5. SVEHLIKOVA, J. – TYSLER, M.: Identification of local events in myocardial ventricles. ECG-Imaging workshop, Bad Herrenalb, Nemecko, 25.3.-28.3.2015.
  6. PUNSHCHYKOVA, O. – ŠVEHLÍKOVÁ, J. – TYŠLER, M. – GRÜNES, R. – SEDOVA, K. – OSMANČÍK, P. – ŽĎÁRSKÁ, J. – HEŘMAN, D. – KNEPPO, P. Influence of torso model complexity on the noninvasive localization of ectopic ventricular activity. In Measurement Science Review, 2016, vol. 16, no. 2, p. 96-102. ISSN 1335-8871.
  7. TYŠLER, M. – PUNSHCHYKOVA, O. – ŠVEHLÍKOVÁ, J. – K. – OSMANČÍK, P. – ŽĎÁRSKÁ, J. – KNEPPO, P. Noninvasive localization of ectopic ventricular activity using homogeneous and inhomogeneous torso models. In ICE 2016 : 43rd International Congress on Electrocardiology: Abstract Book. International Society of Electrocardiology, 2016, p.49-50.
  8. ŠVEHLÍKOVÁ, J. – TYŠLER, M. Geometrical Constraints in Noninvasive Localization of Premature Ventricular Contractions. Abstracts. In ICE 2016 : 43rd International Congress on Electrocardiology: Abstract Book. International Society of Electrocardiology, 2016, p.47-48.
  9. SVEHLIKOVA, J. – TYSLER, M. Noninvasive Localization of Premature Ventricular Activity using Different Equivalent Point Sources. Computing in Cardiology 2016; 43:313-316. ISSN 2325-8861-2 (print)
  10. TYŠLER, M. – PUNSHCHYKOVA, O. – ŠVEHLÍKOVÁ, J. – OSMANČÍK, P. – ŽĎÁRSKÁ, J. – KNEPPO, P.: Neinvazívna identifikácia lokálnych porúch elektrogenézy pri komorových arytmiách / Noninvasive identification of local disorders of electrogenesis in ventricular arrhythmias. Cardiology Lett. Vol.26, No.1 p.39-46 2017. print: ISSN 1338-3655, on line: ISSN 1338-3760.
  11. TYŠLER, M. – PUNSHCHYKOVA, O. – ŠVEHLÍKOVÁ, J. – OSMANČÍK, P. – ŽĎÁRSKÁ, J. – KNEPPO, P. Impact of the Number of ECG Leads on the Noninvasive Localization of Premature Ventricular Activity. In Trendy v biomedicínském inženýrství. 12. Česko-slovenská konference 25.-27. Září 2017, Horní Lomná, ČR. VŠB – TU Ostrava, 2017. ISBN 978-80-248-4099-4. CD-ROM.
  12. PUNSHCHYKOVA, O. – ŠVEHLÍKOVÁ, J. – TYŠLER, M. – KNEPPO, P. Accuracy of noninvasive PVC focus localization depending on its position in the ventricles: A simulation study. In MEASUREMENT 2017 : Proceedings of the 11th International Conference on Measurement. Editors: J. Maňka, M. Tyšler, V. Witkovský, I. Frollo. – Bratislava, Slovakia : Institute of Measurement Science, Slovak Academy of Sciences, 2017, p. 209-212. ISBN 978-80-972629-0-7.
  13. ŠVEHLÍKOVÁ, J. – PUNSHCHYKOVA, O. – KROMKOVÁ, K. – TYŠLER, M. – HATALA, R. First experience with PVC localization from clinical data. In MEASUREMENT 2017 : Proceedings of the 11th International Conference on Measurement. Editors: J. Maňka, M. Tyšler, V. Witkovský, I. Frollo. – Bratislava, Slovakia : Institute of Measurement Science, Slovak Academy of Sciences, 2017, p. 213-216. ISBN 978-80-972629-0-7.
  14. TYSLER, M. – PUNSHCHYKOVA, O. – SVEHLIKOVA, J. – OSMANCIK, P. – ZDARSKA, J. – KNEPPO, P. Evaluation of using reduced number of mapping leads for noninvasive localization of ectopic ventricular activity. In: Abstracts. 44th International Congress on Electrocardiology, 17th Congress of the International Society for Holter and Noninvasive Electrocardiology. Portland, Oregon, USA, June 24-27, 2017.