Epicardial Mapping from Venous Catheter Measurements, Body Surface Potential Maps, and an Electrocardiographic Inverse Solution Robert S. MacLeod, Yesim.

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Volume 111, Issue 2, Pages (July 2016)

Presentation transcript:

Epicardial Mapping from Venous Catheter Measurements, Body Surface Potential Maps, and an Electrocardiographic Inverse Solution Robert S. MacLeod, Yesim Serinagaoglu*, Bulent Yilmaz, and Dana H. Brooks* NEH Cardiovascular Research and Training Institute (CVRTI), U of Utah *Communications and Digital Signal Processing (CDSP), Northeastern U

Combining Information Sources Forward Inverse

Venous Catheter Based Mapping

Statistical Estimation Estimation Matrix Training Data Covariance Matrix * = Sparse Test Data Estimate

Estimated Activation Maps OriginalMixed RV-only LV-only Training set composition Lead selection

Augmented Inverse Problem Forward Inverse Torso geometry Body-Surface Potentials Sparse Epicardial Potentials Inverse Solution Epicardial Map + + +

Subtraction Approach KnownUnknown Inverse (Tikhonov) 1) Subtract known epicardial potentials 2) Solve reduced inverse problem

Epicardial Estimation t1t1 t 2 …..….t N... Estimation

Combined Estimation Estimation

Bayesian Approach Inverse (MAP) 

Hybrid Approach Inverse (MAP)  Estimate

Tank/Heart Geometry

Test Lead Sets Anterior Posterior 42 leads 21 leads10 leads

Simulation Study 490 lead measured sock data Surrogate catheter potentials –42 sites –+ Gaussian noise Torso potentials –Calculated noise-free using forward model –+ Gaussian noise

Leave-One-Experiment Out Protocol Training Data Dec 13, 2000 Test Data Dec 18, 2000 Dec 13, 2000 LV Paced Beats Mixed Paced Beats

LV Pacing (LV-23 ms) OrigSubtMAP Est EpiEst AllHybrid MAP 31: LV-MEpiP-23 ms

LV Pacing (LV-38 ms) OrigSubtMAP Est EpiEst AllHybrid MAP 31: LV-MEpiP-38 ms

LV Pacing (LV-47 ms) OrigSubtMAP Est EpiEst AllHybrid MAP 31: LV-MEpiP-47 ms

LV Pacing (Mixed-23 ms) OrigSubtMAP Est EpiEst AllHybrid MAP 31: LV-RV-MEpiP-23 ms

LV Pacing (Mixed-38 ms) OrigSubtMAP Est EpiEst AllHybrid MAP 31: LV-RV-MEpiP-38 ms

LV Pacing (Mixed-47 ms) OrigSubtMAP Est EpiEst AllHybrid MAP 31: LV-RV-MEpiP-47 ms

Relative Error (31-LV) Relative Error Time [ms] MAP Estim-Epi Estim-All MAP-Hybrid Subtr

Relative Error (31-Mixed) MAP Estim-Epi Estim-All MAP-Hybrid Subtr Relative Error Time [ms]

Estimation Findings Estimation alone: noisy, unstable results Estimation + inverse: smoothing improves stability

Inverse Solution Findings All solutions better than simple Tikhonov MAP usually improved with addition of catheter measurements (Hybrid MAP)

Role of Statistics (Training) Generally helps But can add artifacts, e.g., spurious breakthroughs or wavefronts Torso potentials can reduce artifacts

Conclusion More (bigger) is better….. … but not always