Investigation into the importance of using natural PVCs and pathological models for potential-based ECGI validation.

Introduction: Premature ventricular contractions (PVCs) are one of the most commonly targeted pathologies for ECGI validation, often through ventricular stimulation to mimic the ectopic beat. However, it remains unclear if such stimulated beats faithfully reproduce spontaneously occurring PVCs, particularly in the case of the R-on-T phenomenon. The objective of this study was to determine the differences in ECGI accuracy when reconstructing spontaneous PVCs as compared to ventricular-stimulated beats and to explore the impact of pathophysiological perturbation on this reconstruction accuracy. Methods: Langendorff-perfused pig hearts (n = 3) were suspended in a human torso-shaped tank, and local hyperkalemia was induced through perfusion of a high-K+ solution (8 mM) into the LAD. Recordings were taken simultaneously from the heart and tank surfaces during ventricular pacing and during spontaneous PVCs (including R-on-T), both at baseline and high K+. Epicardial potentials were reconstructed from torso potentials using ECGI. Results: Spontaneously occurring PVCs were better reconstructed than stimulated beats at baseline in terms of electrogram morphology [correlation coefficient (CC) = 0.74 ± 0.05 vs. CC = 0.60 ± 0.10], potential maps (CC = 0.61 ± 0.06 vs. CC = 0.51 ± 0.12), and activation time maps (CC = 0.86 ± 0.07 vs. 0.76 ± 0.10), though there was no difference in the localization error (LE) of epicardial origin (LE = 14 ± 6 vs. 15 ± 11 mm). High K+ perfusion reduced the accuracy of ECGI reconstructions in terms of electrogram morphology (CC = 0.68 ± 0.10) and AT maps (CC = 0.70 ± 0.12 and 0.59 ± 0.23) for isolated PVCs and paced beats, respectively. LE trended worse, but the change was not significant (LE = 17 ± 9 and 20 ± 12 mm). Spontaneous PVCs were less well when the R-on-T phenomenon occurred and the activation wavefronts encountered a line of block. Conclusion: This study demonstrates the differences in ECGI accuracy between spontaneous PVCs and ventricular-paced beats. We also observed a reduction in this accuracy near regions of electrically inactive tissue. These results highlight the need for more physiologically realistic experimental models when evaluating the accuracy of ECGI methods. In particular, reconstruction accuracy needs to be further evaluated in the presence of R-on-T or isolated PVCs, particularly when encountering obstacles (functional or anatomical) which cause line of block and re-entry.

A Novel Data-Adaptive Regression Framework Based on Multivariate Adaptive Regression Splines for Electrocardiographic Imaging.

OBJECTIVE: Noninvasive electrocardiographic imaging (ECGI) is a promising tool for revealing crucial cardiac electrical events with diagnostic potential. We propose a novel nonparametric regression framework based on multivariate adaptive regression splines (MARS) for ECGI. METHODS: The inverse problem was solved by using the regression model trained with body surface potentials (BSP) and corresponding electrograms (EGM). Simulated data as well as experimental data from torso-tank experiments were used to assess the performance of the proposed method. The robustness of the method to measurement noise and geometric errors were assessed in terms of electrogram reconstruction quality, activation time accuracy, and localization error metrics. The methods were compared with Tikhonov regularization and neural network (NN)-based methods. The resulting mapping functions between the BSPs and EGMs were also used to evaluate the most influential measurement leads. RESULTS: MARS-based method outperformed Tikhonov regularization in terms of reconstruction accuracy and robustness to measurement noise. The effects of geometric errors were remedied to some extent by enriching the training set composition including model errors. The MARS-based method had a comparable performance with NN-based methods, which require the adjustment of many parameters. CONCLUSION: MARS-based method successfully discovers the inverse mapping functions between the BSPs and EGMs yielding accurate reconstructions, and quantifies the contribution of each BSP lead. SIGNIFICANCE: MARS-based method is adaptive, requires fewer parameter adjustments than NN-based methods, and is robust to errors. Thus, it can be a feasible data-driven approach for accurately solving inverse imaging problems.

Improved performance of bayesian solutions for inverse electrocardiography using multiple information sources.

The usual goal in inverse electrocardiography (ECG) is to reconstruct cardiac electrical sources from body surface potentials and a mathematical model that relates the sources to the measurements. Due to attenuation and smoothing that occurs in the thorax, the inverse ECG problem is ill-posed and imposition of a priori constraints is needed to combat this ill-posedness. When the problem is posed in terms of reconstructing heart surface potentials, solutions have not yet achieved clinical utility; limitations include the limited availability of good a priori information about the solution and the lack of a "good" error metric. We describe an approach that combines body surface measurements and standard forward models with two additional information sources: statistical prior information about epicardial potential distributions and sparse simultaneous measurements of epicardial potentials made with multielectrode coronary venous catheters. We employ a Bayesian methodology which offers a general way to incorporate these information sources and additionally provides statistical performance analysis tools. In a simulation study, we first compare solutions using one or more of these information sources. Then, we study the effects of varying the number of sparse epicardial potential measurements on reconstruction accuracy. To evaluate accuracy, we used the Bayesian error covariance as well as traditional error metrics such as relative error. Our results show that including even sparsely sampled information from coronary venous catheters can substantially improve the reconstruction of epicardial potential distributions and that a Bayesian framework provides a feasible approach to using this information. Moreover, computing the Bayesian error standard deviations offers a means to indicate confidence in the results even in the absence of validation data.

Bayesian solutions and performance analysis in bioelectric inverse problems.

In bioelectric inverse problems, one seeks to recover bioelectric sources from remote measurements using a mathematical model that relates the sources to the measurements. Due to attenuation and spatial smoothing in the medium between the sources and the measurements, bioelectric inverse problems are generally ill-posed. Bayesian methodology has received increasing attention recently to combat this ill-posedness, since it offers a general formulation of regularization constraints and additionally provides statistical performance analysis tools. These tools include the estimation error covariance and the marginal probability density of the measurements (known as the "evidence") that allow one to predictively quantify and compare experimental designs. These performance analysis tools have been previously applied in inverse electroencephalography and magnetoencephalography, but only in relatively simple scenarios. The main motivation here was to extend the utility of Bayesian estimation techniques and performance analysis tools in bioelectric inverse problems, with a particular focus on electrocardiography. In a simulation study we first investigated whether Bayesian error covariance, computed without knowledge of the true sources and based on instead statistical assumptions, accurately predicted the actual reconstruction error. Our study showed that error variance was a reasonably reliable qualitative and quantitative predictor of estimation performance even when there was error in the prior model. We also examined whether the evidence statistic accurately predicted relative estimation performance when distinct priors were used. In a simple scenario our results support the hypothesis that the prior model that maximizes the evidence is a good choice for inverse reconstructions.

Multielectrode venous catheter mapping as a high quality constraint for electrocardiographic inverse solution.

A persistent challenge in solving inverse problems in electrocardiography is the application of suitable constraints to the calculation of cardiac sources. Whether one formulates the inverse problem in terms of epicardial potentials or activation wavefronts, the problem is physically ill-posed and hence results in numerically unstable computations. Suitable physiological constraints applied with appropriate weighting can recover useful inverse solutions. However, it is often difficult to determine the best possible constraints and their optimal weighting. We have recently begun to use multielectrode catheters as a means of mapping epicardial signals in animal models. To accommodate the sparse sampling of this venous catheter based approach, we have applied statistical signal processing methods to estimate complete epicardial maps of activation time and epicardial potentials. Such measurements--and the estimated maps from them--also have the potential to provide high quality constraints for electrocardiographic inverse problems because they provide direct--albeit sparse--access to the desired solution. In this presentation we describe several approaches we have applied to extract useful constraints from sparsely sampled epicardial signals as well as a training set of epicardial maps, and use them to improve the quality of computed inverse solutions. Results suggest that combining various information sources provides valuable constraint information. Such a multimodal approach to cardiac mapping is clinically and technically viable and offers a possible means to overcome a major remaining limitation of inverse electrocardiography.