Comparison of dipole-based and potential-based ECGI methods for premature ventricular contraction beat localization with clinical data.

Introduction: Localization of premature ventricular contraction (PVC) origin to guide the radiofrequency ablation (RFA) procedure is one of the prominent clinical goals of non-invasive electrocardiographic imaging. However, the results reported in the literature vary significantly depending on the source model and the level of complexity in the forward model. This study aims to compare the paced and spontaneous PVC localization performances of dipole-based and potential-based source models and corresponding inverse methods using the same clinical data and to evaluate the effects of torso inhomogeneities on these performances. Methods: The publicly available EP solution data from the EDGAR data repository (BSPs from a maximum of 240 electrodes) with known pacing locations and the Bratislava data (BSPs in 128 leads) with spontaneous PVCs from patients who underwent successful RFA procedures were used. Homogeneous and inhomogeneous torso models and corresponding forward problem solutions were used to relate sources on the closed epicardial and epicardial-endocardial surfaces. The localization error (LE) between the true and estimated pacing site/PVC origin was evaluated. Results: For paced data, the median LE values were 25.2 and 13.9 mm for the dipole-based and potential-based models, respectively. These median LE values were higher for the spontaneous PVC data: 30.2-33.0 mm for the dipole-based model and 28.9-39.2 mm for the potential-based model. The assumption of inhomogeneities in the torso model did not change the dipole-based solutions much, but using an inhomogeneous model improved the potential-based solutions on the epicardial-endocardial ventricular surface. Conclusion: For the specific task of localization of pacing site/PVC origin, the dipole-based source model is more stable and robust than the potential-based source model. The torso inhomogeneities affect the performances of PVC origin localization in each source model differently. Hence, care must be taken in generating patient-specific geometric and forward models depending on the source model representation used in electrocardiographic imaging (ECGI).

The effect of interpolating low amplitude leads on the inverse reconstruction of cardiac electrical activity.

Electrocardiographic imaging is an imaging modality that has been introduced recently to help in visualizing the electrical activity of the heart and consequently guide the ablation therapy for ventricular arrhythmias. One of the main challenges of this modality is that the electrocardiographic signals recorded at the torso surface are contaminated with noise from different sources. Low amplitude leads are more affected by noise due to their low peak-to-peak amplitude. In this paper, we have studied 6 datasets from two torso tank experiments (Bordeaux and Utah experiments) to investigate the impact of removing or interpolating these low amplitude leads on the inverse reconstruction of cardiac electrical activity. Body surface potential maps used were calculated by using the full set of recorded leads, removing 1, 6, 11, 16, or 21 low amplitude leads, or interpolating 1, 6, 11, 16, or 21 low amplitude leads using one of the three interpolation methods - Laplacian interpolation, hybrid interpolation, or the inverse-forward interpolation. The epicardial potential maps and activation time maps were computed from these body surface potential maps and compared with those recorded directly from the heart surface in the torso tank experiments. There was no significant change in the potential maps and activation time maps after the removal of up to 11 low amplitude leads. Laplacian interpolation and hybrid interpolation improved the inverse reconstruction in some datasets and worsened it in the rest. The inverse forward interpolation of low amplitude leads improved it in two out of 6 datasets and at least remained the same in the other datasets. It was noticed that after doing the inverse-forward interpolation, the selected lambda value was closer to the optimum lambda value that gives the inverse solution best correlated with the recorded one.

The Impact of Torso Signal Processing on Noninvasive Electrocardiographic Imaging Reconstructions.

GOAL: To evaluate state-of-the-art signal processing methods for epicardial potential-based noninvasive electrocardiographic imaging reconstructions of single-site pacing data. METHODS: Experimental data were obtained from two torso-tank setups in which Langendorff-perfused hearts (n = 4) were suspended and potentials recorded simultaneously from torso and epicardial surfaces. 49 different signal processing methods were applied to torso potentials, grouped as i) high-frequency noise removal (HFR) methods ii) baseline drift removal (BDR) methods and iii) combined HFR+BDR. The inverse problem was solved and reconstructed electrograms and activation maps compared to those directly recorded. RESULTS: HFR showed no difference compared to not filtering in terms of absolute differences in reconstructed electrogram amplitudes nor median correlation in QRS waveforms (p > 0.05). However, correlation and mean absolute error of activation times and pacing site localization were improved with all methods except a notch filter. HFR applied post-reconstruction produced no differences compared to pre-reconstruction. BDR and BDR+HFR significantly improved absolute and relative difference, and correlation in electrograms (p < 0.05). While BDR+HFR combined improved activation time and pacing site detection, BDR alone produced significantly lower correlation and higher localization errors (p < 0.05). CONCLUSION: BDR improves reconstructed electrogram morphologies and amplitudes due to a reduction in lambda value selected for the inverse problem. The simplest method (resetting the isoelectric point) is sufficient to see these improvements. HFR does not impact electrogram accuracy, but does impact post-processing to extract features such as activation times. Removal of line noise is insufficient to see these changes. HFR should be applied post-reconstruction to ensure over-filtering does not occur.

Evaluation of multivariate adaptive non-parametric reduced-order model for solving the inverse electrocardiography problem: a simulation study.

In the inverse electrocardiography (ECG) problem, the goal is to reconstruct the heart's electrical activity from multichannel body surface potentials and a mathematical model of the torso. Over the years, researchers have employed various approaches to solve this ill-posed problem including regularization, optimization, and statistical estimation. It is still a topic of interest especially for researchers and clinicians whose goal is to adopt this technique in clinical applications. Among the wide range of mathematical tools available in the fields of operational research, inverse problems, optimization, and parameter estimation, spline-based techniques have been applied to inverse problems in several areas. If proper spline bases are chosen, the complexity of the problem can be significantly reduced while increasing estimation accuracy. However, there are few studies within the context of the inverse ECG problem that take advantage of this property of the spline-based approaches. In this paper, we evaluate the performance of Multivariate Adaptive Regression Splines (MARS)-based method for the solution of the inverse ECG problem using two different collections of simulated data. The results show that the MARS-based method improves the inverse ECG solutions and is "robust" to modeling errors, especially in terms of localizing the arrhythmia sources. Graphical Abstract Multivariate adaptive non-parametric model for inverse ECG problem.

Genetic algorithm-based regularization parameter estimation for the inverse electrocardiography problem using multiple constraints.

In inverse electrocardiography, the goal is to estimate cardiac electrical sources from potential measurements on the body surface. It is by nature an ill-posed problem, and regularization must be employed to obtain reliable solutions. This paper employs the multiple constraint solution approach proposed in Brooks et al. (IEEE Trans Biomed Eng 46(1):3-18, 1999) and extends its practical applicability to include more than two constraints by finding appropriate values for the multiple regularization parameters. Here, we propose the use of real-valued genetic algorithms for the estimation of multiple regularization parameters. Theoretically, it is possible to include as many constraints as necessary and find the corresponding regularization parameters using this approach. We have shown the feasibility of our method using two and three constraints. The results indicate that GA could be a good approach for the estimation of multiple regularization parameters.

Noise reduction using anisotropic diffusion filter in inverse electrocardiology.

Filtering has been widely used in biomedical signal processing and image processing applications to cancel noise effects in signals recorded from the body. However, it is important to keep the desired characteristics of the physiological signal of interest while suppressing the noise characteristics. In this study, we used anisotropic diffusion filter (ADF) to cancel the noise on the body surface potentials measurements (BSPM) with the goal of improving the corresponding solutions of the inverse problem of electrocardiology (ECG). ADFs have been applied to image processing and they have the advantage of preserving sharp edges while rejecting the noise, thus we have chosen ADFs instead of more conventional filtering techniques. We used unfiltered and filtered BSPMs to estimate the epicardial potential distributions. We compared Tikhonov regularization results when the data included measurement noise and geometric errors. In both cases, filtering of BSPMs using the ADF improved our solutions.

A Kalman filter-based approach to reduce the effects of geometric errors and the measurement noise in the inverse ECG problem.

In this article, we aimed to reduce the effects of geometric errors and measurement noise on the inverse problem of Electrocardiography (ECG) solutions. We used the Kalman filter to solve the inverse problem in terms of epicardial potential distributions. The geometric errors were introduced into the problem via wrong determination of the size and location of the heart in simulations. An error model, which is called the enhanced error model (EEM), was modified to be used in inverse problem of ECG to compensate for the geometric errors. In this model, the geometric errors are modeled as additive Gaussian noise and their noise variance is added to the measurement noise variance. The Kalman filter method includes a process noise component, whose variance should also be estimated along with the measurement noise. To estimate these two noise variances, two different algorithms were used: (1) an algorithm based on residuals, (2) expectation maximization algorithm. The results showed that it is important to use the correct noise variances to obtain accurate results. The geometric errors, if ignored in the inverse solution procedure, yielded incorrect epicardial potential distributions. However, even with a noise model as simple as the EEM, the solutions could be significantly improved.

Detection of post apnea sounds and apnea periods from sleep sounds.

Obstructive Sleep Apnea Syndrome (OSAS) is defined as a sleep related breathing disorder that causes the body to stop breathing for about 10 seconds and mostly ends with a loud sound due to the opening of the airway. OSAS is traditionally diagnosed using polysomnography, which requires a whole night stay at the sleep laboratory of a hospital, with multiple electrodes attached to the patient's body. Snoring is a symptom which may indicate the presence of OSAS; thus investigation of snoring sounds, which can be recorded in the patient's own sleeping environment, has become popular in recent years to diagnose OSAS. In this study, we aim to develop a new method to detect post-apnea snoring episodes with the goal of diagnosing apnea or creating new criteria similar to apnea / hypopnea index. Emphasis is placed on detecting post apnea episodes, hence the apnea periods. In this method, first segmentation is done to eliminate the silence parts. Then, these episodes are represented by distinctive features; some of these features are available in literature but some of them are novel. Finally, episodes are classified using supervised methods. False alarm rates are reduced by adding additional constraints into the detection algorithm. These methods are applied to snoring sound signals of OSAS patients, recorded in Gulhane Military Medical Academy, to verify the success of our algorithms.

Use of genetic algorithm for selection of regularization parameters in multiple constraint inverse ECG problem.

Tikhonov regularization is one of the most widely used regularization approaches in literature to overcome the ill-posedness of the inverse electrocardiography problem. However, the resulting solutions are biased towards the constraint used for regularization. One alternative to obtain improved results is to employ multiple constraints in the cost function. This approach has been shown to produce better results; however finding appropriate regularization parameters is a serious limitation of the method. In this study, we propose estimating multiple regularization parameters using a genetic algorithm based approach. Applicability of the approach is demonstrated here using two and three constraints. The results show that GA based multiple constraints approach improves the Tikhonov regularization solutions.