Abstract:

ECG imaging is an emerging technology for the reconstruction of cardiac electric activity from non-invasively measured body surface potential maps. In this case report, we present the first evaluation of transmurally imaged activation times against endocardially reconstructed isochrones for a case of sustained monomorphic ventricular tachycardia (VT). Computer models of the thorax and whole heart were produced from MR images. A recently published approach was applied to facilitate electrode localization in the catheter laboratory, which allows for the acquisition of body surface potential maps while performing non-contact mapping for the reconstruction of local activation times. ECG imaging was then realized using Tikhonov regularization with spatio-temporal smoothing as proposed by Huiskamp and Greensite and further with the spline-based approach by Erem et al. Activation times were computed from transmurally reconstructed transmembrane voltages. The results showed good qualitative agreement between the non-invasively and invasively reconstructed activation times. Also, low amplitudes in the imaged transmembrane voltages were found to correlate with volumes of scar and grey zone in delayed gadolinium enhancement cardiac MR. The study underlines the ability of ECG imaging to produce activation times of ventricular electric activity-and to represent effects of scar tissue in the imaged transmembrane voltages.

Abstract:

Electrocardiographic imaging (ECG imaging) is a method to depict electrophysiological processes in the heart. It is an emerging technology with the potential of making the therapy of cardiac arrhythmia less invasive, less expensive, and more precise. A major challenge for integrating the method into clinical workflow is the seamless and correct identification and localization of electrodes on the thorax and their assignment to recorded channels. This work proposes a camera-based system, which can localize all electrode positions at once and to an accuracy of approximately 1+/-1 mm. A system for automatic identification of individual electrodes is implemented that overcomes the need of manual annotation. For this purpose, a system of markers is suggested, which facilitates a precise localization to subpixel accuracy and robust identification using an error-correcting code. The accuracy of the presented system in identifying and localizing electrodes is validated in a phantom study. Its overall capability is demonstrated in a clinical scenario.

Abstract:

The most important ECG marker for the diagnosis of ischemia or infarction is a change in the ST segment. Baseline wander is a typical artifact that corrupts the recorded ECG and can hinder the correct diagnosis of such diseases. For the purpose of finding the best suited filter for the removal of baseline wander, the ground truth about the ST change prior to the corrupting artifact and the subsequent filtering process is needed. In order to create the desired reference, we used a large simulation study that allowed us to represent the ischemic heart at a multiscale level from the cardiac myocyte to the surface ECG. We also created a realistic model of baseline wander to evaluate five filtering techniques commonly used in literature. In the simulation study, we included a total of 5.5 million signals coming from 765 electrophysiological setups. We found that the best performing method was the wavelet-based baseline cancellation. However, for medical applications, the Butterworth high-pass filter is the better choice because it is computationally cheap and almost as accurate. Even though all methods modify the ST segment up to some extent, they were all proved to be better than leaving baseline wander unfiltered.

Abstract:

Electrocardiographic imaging (ECGI) has recently gained attention as a viable diagnostic tool for reconstructing cardiac electrical activity in normal hearts as well as in cardiac arrhythmias. However, progress has been limited by the lack of both standards and unbiased comparisons of approaches and techniques across the community, as well as the consequent difficulty of effective collaboration across research groups.. To address these limitations, we created the Consortium for Electrocardiographic Imaging (CEI), with the objective of facilitating collaboration across the research community in ECGI and creating standards for comparisons and reproducibility. Here we introduce CEI and describe its two main efforts, the creation of EDGAR, a public data repository, and the organization of three collaborative workgroups that address key components and applications in ECGI. Both EDGAR and the workgroups will facilitate the sharing of ideas, data and methods across the ECGI community and thus address the current lack of reproducibility, broad collaboration, and unbiased comparisons.

Abstract:

INTRODUCTION: The "Experimental Data and Geometric Analysis Repository", or EDGAR is an Internet-based archive of curated data that are freely distributed to the international research community for the application and validation of electrocardiographic imaging (ECGI) techniques. The EDGAR project is a collaborative effort by the Consortium for ECG Imaging (CEI, ecg-imaging.org), and focused on two specific aims. One aim is to host an online repository that provides access to a wide spectrum of data, and the second aim is to provide a standard information format for the exchange of these diverse datasets. METHODS: The EDGAR system is composed of two interrelated components: 1) a metadata model, which includes a set of descriptive parameters and information, time signals from both the cardiac source and body-surface, and extensive geometric information, including images, geometric models, and measure locations used during the data acquisition/generation; and 2) a web interface. This web interface provides efficient, search, browsing, and retrieval of data from the repository. RESULTS: An aggregation of experimental, clinical and simulation data from various centers is being made available through the EDGAR project including experimental data from animal studies provided by the University of Utah (USA), clinical data from multiple human subjects provided by the Charles University Hospital (Czech Republic), and computer simulation data provided by the Karlsruhe Institute of Technology (Germany). CONCLUSIONS: It is our hope that EDGAR will serve as a communal forum for sharing and distribution of cardiac electrophysiology data and geometric models for use in ECGI research.

Abstract:

Over the last decades, the information content derived from cardiac electric and magnetic field measurements has been debated. Our co-workers Wilhelms et al. inves- tigated electrically silent acute ischemia in human ven- tricles caused by occlusion of a coronary artery. In the present work, we extend the previous study by calculating associated magnetic fields produced by early stage acute ischemia with varying transmural extent. Multiscale com- putational simulations were performed for calculations of body surface potential maps (BSPM) and magnetocardio- grams (MCG) on a magnetometer sensor matrix situated above the anterior chest wall. Depending on the ischemia size, the ST-segments of the simulated electrocardiograms (ECG) experienced depression for subendocardial cases and elevation for transmural ischemia. One intermedi- ate extent resulted in a zero ST-segment which makes it diagnostically indistinguishable from the healthy case. Magnetic field calculations for this electrically silent is- chemia also revealed no difference compared to the control case. Otherwise, both ECG and MCG signals during ST- segments showed either depression or elevation from zero line. In this simulation study, MCG did not deliver addi- tional information to uncover electrically silent ischemia. For a general conclusion, further in-silico investigations with different ischemia shapes, sizes and positions should be performed and clinical studies with recordings of both ECG and MCG signals have to be conducted.

Abstract:

In case of chest pain, immediate diagnosis of myocardial ischemia is required to respond with an appropriate treatment. The diagnostic capability of the electrocardiogram (ECG), however, is strongly limited for ischemic events that do not lead to ST elevation. This computational study investigates the potential of different electrode setups in detecting early ischemia at 10 minutes after onset: standard 3-channel and 12-lead ECG as well as body surface potential maps (BSPMs). Further, it was assessed if an additional ECG electrode with optimized position or the right-sided Wilson leads can improve sensitivity of the standard 12-lead ECG. To this end, a simulation study was performed for 765 different locations and sizes of ischemia in the left ventricle. Improvements by adding a single, subject specifically optimized electrode were similar to those of the BSPM: 211% increased detection rate depending on the desired specificity. Adding right-sided Wilson leads had negligible effect. Absence of ST deviation could not be related to specific locations of the ischemic region or its transmurality. As alternative to the ST time integral as a feature of ST deviation, the K point deviation was introduced: the baseline deviation at the minimum of the ST-segment envelope signal, which increased 12-lead detection rate by 7% for a reasonable threshold.

Abstract:

The goal of ECG-imaging (ECGI) is to reconstruct heart electrical activity from body surface potential maps. The problem is ill-posed, which means that it is extremely sensitive to measurement and modeling errors. The most commonly used method to tackle this obstacle is Tikhonov regularization, which consists in converting the original problem into a well-posed one by adding a penalty term. The method, despite all its practical advantages, has however a serious drawback: The obtained solution is often over-smoothed, which can hinder precise clinical diagnosis and treatment planning. In this paper, we apply a binary optimization approach to the transmembrane voltage (TMV)-based problem. For this, we assume the TMV to take two possible values according to a heart abnormality under consideration. In this work, we investigate the localization of simulated ischemic areas and ectopic foci and one clinical infarction case. This affects only the choice of the binary values, while the core of the algorithms remains the same, making the approximation easily adjustable to the application needs. Two methods, a hybrid metaheuristic approach and the difference of convex functions (DC), algorithm were tested. For this purpose, we performed realistic heart simulations for a complex thorax model and applied the proposed techniques to the obtained ECG signals. Both methods enabled localization of the areas of interest, hence showing their potential for application in ECGI. For the metaheuristic algorithm, it was necessary to subdivide the heart into regions in order to obtain a stable solution unsusceptible to the errors, while the analytical DC scheme can be efficiently applied for higher dimensional problems. With the DC method, we also successfully reconstructed the activation pattern and origin of a simulated extrasystole. In addition, the DC algorithm enables iterative adjustment of binary values ensuring robust performance.

Abstract:

Computational atrial models aid the understanding of pathological mechanisms and therapeutic measures in basic research. The use of biophysical models in a clinical environment requires methods to personalize the anatomy and electrophysiology (EP). Strategies for the automation of model generation and for evaluation are needed. In this manuscript, the current efforts of clinical atrial modeling in the euHeart project are summarized within the context of recent publications in this field. Model-based segmentation methods allow for the automatic generation of ready-to-simulate patient-specific anatomical models. EP models can be adapted to patient groups based on a-priori knowledge, and to the individual without significant further data acquisition. ECG and intracardiac data build the basis for excitation personalization. Information from late enhancement (LE) MRI can be used to evaluate the success of radio-frequency ablation (RFA) procedures and interactive virtual atria pave the way for RFA planning. Atrial modeling is currently in a transition from the sole use in basic research to future clinical applications. The proposed methods build the framework for model-based diagnosis and therapy evaluation and planning. Complex models allow to understand biophysical mechanisms and enable the development of simplified models for clinical applications.

Abstract:

The loss of cardiac pump function accounts for a significant increase in both mortality and morbidity in Western society, where there is currently a one in four lifetime risk, and costs associated with acute and long-term hospital treatments are accelerating. The significance of cardiac disease has motivated the application of state-of-the-art clinical imaging techniques and functional signal analysis to aid diagnosis and clinical planning. Measurements of cardiac function currently provide high-resolution datasets for characterizing cardiac patients. However, the clinical practice of using population-based metrics derived from separate image or signal-based datasets often indicates contradictory treatments plans owing to inter-individual variability in pathophysiology. To address this issue, the goal of our work, demonstrated in this study through four specific clinical applications, is to integrate multiple types of functional data into a consistent framework using multi-scale computational modelling.

Abstract:

This handout describes the simulation dataset KIT-20-PVC_Simulation-1906-10-30, which was contributed by the Karlsruhe Institute of Technology (KIT) to the Experimental Data and Geometric Analysis Repository (EDGAR) database.

Abstract:

Electrocardiographic imaging (ECGI) facilitates the non-invasive reconstruction of electrical activity in the entire heart at once. ECGI requires both recordings of multi-channel ECG signals as well as an MRI-based model of the thorax. The model is used to solve the underlying Poissons problem, which relates the gradient of transmembrane voltages in the heart to the ECG and is a spatial differential equation. In ECGI, this relationship has to be established before starting inverse calculations, i.e. the forward problem has to be solved. It solution depends strongly on the spatial discretization of the model, as its resolution affects the representation of the source gradients. To study the convergence of resolution-related effects in the forward problem, we use a simplified thorax model which allows for very high resolutions. An ECG is produced for the excitation origin of a premature ventricular contraction in the apex. The study reveals that the greatest resolution-related effects vanish below a resolution of 5 mm of the cardiac tissue. At below 1 mm, resolution effects stabilize and only marginal effects from the spatial structure of the mesh persist down to a resolution of 0.25 mm.

Abstract:

(Poster)

Abstract:

ECG imaging is a non-invasive technique of characterizing the electrical activity and the corresponding excitation conduction of the heart using body surface ECG. The method may provide great opportunities in the planning of cardiac interventions and in the diagnosis of cardiac diseases. This work introduces an algorithm for the imaging of transmembrane voltages that is based on a Kalman filter with an augmented measurement model. In the latter, a regularization term is integrated as additional measurement. The filter is trained using a-priori-knowledge from a simulation model. Two effects are investigated: the influence of the training data on the reconstruction quality and the representation of a-priori knowledge in the trained covariance matrices. The proposed algorithm shows a promising quality of reconstruction and may be used in the future to introduce generic physiological knowledge in solutions of cardiac source imaging.

Abstract:

With ECG imaging it is possible to reconstruct cardiac electrical activity noninvasively from measurements of the electrocardiogram (ECG). To facilitate the recon- struction, an MRI- or CT- based model of the body is re- quired, which is represented as a volume conductor. A mathematically ill-posed problem is solved to reconstruct the cardiac sources from potentials collected on the body surface. To obtain a body surface potential map (BSPM) electrodes are ideally placed allover the entire thorax. In practical applications, however, the number of electrodes is limited and the placing is subject to constraints. We in- vestigate the effect of different electrode setups on the ill- posedness of the inverse problem. In particular, electrode setups are chosen to comply with constraints for female pa- tients in the catheter lab.

Abstract:

In this work, a simulation study is performed that demonstrates how activation times of cardiac action potentials can be reconstructed from body surface potential maps (BSPMs). An extrasystole is simulated in the ventricles, which are affected by myocardial ischemia or necrosis, and the related BSPM is calculated. Initial estimates are required for iterative algorithms that solve the related non-linear reconstruction problem. As a good initial estimate is essential for a proper reconstruction, the robustness of two methods is tested against the influence of pathological conditions: the critical times method and a linear timeintegral based method. While the first method extrapolates activation times into inactive tissue in this study, the latter carves out ischemic or necrotic tissue as homogeneous regions. In an outlook, a concept for the combination of both methods is proposed.

Abstract:

Tikhonov methods usually lead to solutions of low amplitude that are distributed around zero. When reconstructing transmembrane voltages (TMVs) in the myocardium, the signal is therefore often not in the physiological range of between around -80mV and 10mV. In this article, we propose an adjusted Tikhonov method that reconstructs TMVs in the correct range, given an estimate of one polarized node in the heart and an estimated set of nodes that have depolarized in the preceding time step. It is shown that when feeding the reconstructed TMVs into a simple cellular automaton recursively, and when using the computed excitation propagation as a prior for the Tikhonov method, it is possible to reconstruct the excitation propagation throughout the ventricular myocardium. The method requires an estimate of the region of initial activation.

Abstract:

# BackgroundMethods for the non-invasive imaging of atrial activation times could provide cardiologists with valuable information on pathological excitation conduction patterns, e.g. for treatment planning.In this study, the source representation functions used in the critical times method (Greensite et al. 1997) are expanded with a range adjustment to generate more accurate activation time maps from ECG measurements.# Materials and methodsExcitation conduction in the atria was simulated for various excitation origins with a cellular automaton. Body surface potential maps were obtained from forward calculations using a bidomain approach.As introduced in Greensite et al. 1995, the method of critical times can be used to quantitatively localize critical point locations and times, and to reconstruct surface activation in a qualitative manner. To this end, all atrial surface nodes were treated as critical points and the corresponding critical times were reconstructed using the zero-crossing method by Greensite, which is the subtraction of the two representation functions.For the heart surface nodes, it was observed that the minuend representation function in the zero-crossing term is often by magnitudes greater than the subtrahend. For the minuend to not dominate the subtrahend before the desired zero-crossing, which is supposed to occur at the time of depolarization, the minuend was therefore weighted with a sigmoid function and normalized to the range of the subtrahend.# ResultsAtrial activation times were reconstructed with both the zero-crossing method by Greensite and the sigmoid-weighted zero-crossing. Two effects were observed. The overall reconstruction quality of the established method improves in the presence of 30dB additive white Gaussian noise. This effect results from a gradual offset that is imposed on the reconstructed critical times under these circumstances (see Huiskamp and Greensite 1997). Second, it could be shown that a significant reduction of reconstruction error can be achieved in the absence of noise with the sigmoid-weighted adaptation of the formula.# ConclusionWith the newly introduced sigmoidal normalization, the quality of reconstruction can be improved significantly if noise levels are below 30dB. Clinical studies need to be made in order to validate the method and assess its performance in a realistic environment.

Abstract:

A common treatment of focal ventricular tachycardia is the catheter ablation of triggering sites. They have to be found manually by the physician during an intervention in a catheter lab. Thus, a method for determining the position of the focus automatically is desired. The inverse problem of electrocardiography addresses this problem by reconstructing the source of the ectopic beats using the surface ECG. This problem is ill-posed and therefore needs specific methods for solving it. We propose a machine learning approach for localisation of the ectopic foci in the heart to assist cardiologists with their therapy planning.We simulated 600 120-lead ECGs with different known excitation origins in the heart using a cellular automaton followed by a forward calculation. Features from the ECGs were used as input for a support vector regression (SVR). We assumed a functional relation between features from the ECG and the excitation origin. To benchmark SVR, we also used the well-known Tikhonov 0th order regularisation to reconstruct the transmembrane potentials in the heart and detect the location of the ectopic foci. Parameters for SVR and regularisation were chosen using a grid search minimising the error between estimated and true excitation origin. Compared to the Tikhonov regularisation method, SVR achieved a smaller deviation between estimated and real excitation origin evaluated with 6-fold cross validation. Future work could investigate on the behaviour on data from simulations with other torso and electrophysiological models, the influence of other methods for feature extraction and finally the evaluation with clinical data.

Abstract:

This work investigates the impact of time constant offset in the body surface potential map (BSPM) on the recon- struction quality in electrocardiographic imaging (ECGI). For this purpose, a study comparing four different approaches for the reconstruction of the transmembrane voltage distribution (TMV) was carried out. From this four methods two of them were newly designed to estimate and remove the offset from the BSPM. The first approach uses a new formulation of the Tikhonov-Greensite method as augmented regularization to estimate and remove the time constant offset during the reconstruction. The second algorithm is related to classical signal processing. It applies a mode filter to remove the time constant offset in the BSPM and afterwards reconstructs the ventricular ectopic beat (VEB) using the Tikhonov-Greensite regularization. It can be shown that the time constant offset has a significant influence on the reconstruction quality and should be removed. The preferred method to remove time constant offset is the mode filter.

Abstract:

Baseline wander removal is one important part of electrocardiogram (ECG) filtering. This can be achieved by many different approaches. This work investigates the influence of three different baseline wander removal techniques on ST changes. The chosen filters were phase-free Butterworth filtering, median filtering and baseline correction with cubic spline interpolation. 289 simulated ECGs containing ischemia were used to determine the influence of these filtering processes on the ST segment. Synthetic baseline wander and offsets were added to the simulated signals. All methods proved to be good approaches by removing most of the baseline wander in all signals. Correlation coefficients between the original signals and the filtered signals were greater than 0.93 for all ECGs. Cubic spline interpolation performed best regarding the preservation of the ST segment amplitude change when compared to the original signal. The approach modified the ST segment by 0.10mV±0.06mV at elevated K points. Median filtering introduced a variation of 0.33mV±0.29mV, Butterworth filtering reached 0.16mV±0.14mV at elevated K points. Thus, all methods manipulate the ST segment.

Abstract:

ECG imaging as noninvasive method is aiming to reconstruct the distribution of the transmembrane voltage amplitudes (TMVs) from the body surface potential map (BSPM). Due to the ill-posedness, standard approaches like the Tikhonov regularization method cause blurring and artefacts in the solution. To suppress blurring and artefacts, this work investigated a model based approach, the unscented Kalman filter (UKF). The intention of this paper is to show the potential of an UKF approach by using an idealized parametrization.

Abstract:

Electrocardiographic imaging (ECGI) is a non-invasive diagnostical tool solving the inverse problem of ECG, which means the reconstruction of electrical potentials in the heart from the ECG data. The ill-posednees of this problem makes necessary addition of a-priori information. A typical approach is the Tikhonov regularization looking for the best balance between minimizing the data misfit and the regularization term which characterizes desired properties of the solution. However, the quality of an obtained solution, and as a result its clinical relevance, could be significantly improved by application of methods for non-smooth regularization. In this work we introduced a possible dictionary definition for the electrical sources in the heart: we subdivided the heart into 100 pieces and considered them to constitute the columns of our dictionary. We also provided a short discussion on differences between synthesis and analysis models, tested the analysis algorithm with a penalty matrix which is not related to the defined dictionary (discrete gradient operator for all heart points) and compared the performance of these three algorithms for two simulated ventricular ectopic foci. The analysis method with the gradient operator showed a slightly superior performance although all methods correctly identified the regions of interest.

Abstract:

The problem of non-invasively finding cardiac electri- cal sources from body surface potential maps (BSPM) is ill-posed. A standard Tikhonov regularization approach to the problem produces a solution biased toward the elec- trodes and thus to the left ventricular epicardium, which limits its potential to reconstruct endocardial sources. In this work we consider a transmembrane voltages based in- verse problem of ECG for the identification of extrasys- tole origins from simulated BSPM. With use of a pair of heart wall epicardial/endocardial extrasystoles and a pair of septal ectopic foci we demonstrate the performance of the inverse procedures while firstly solving the problem for all nodes, then for epicardium and endocardium sep- arately. Based on the observations and the logic behind the gradient of sources we define simple rules on how to classify an extrasystole under consideration according to these 3 reconstructions. Furthermore, when the amount of noise is known, we propose a new method with two regu- larization parameters which assign different weightings to endocardial and epicardial components of the solution.

Abstract:

Solving the inverse problem of electrocardiography could help to diagnose and to plan the treatment of heart diseases. The conductivity distribution within the body is important to solve the inverse problem. In this work the influence of neglecting an organ as an inhomogeneity on the forward and inverse problem was investigated. For different simplified body models optimal conductivities were determined by minimizing the error between the BSPMs produced by this model and reference BSPMs calculated with a complex model containing eight segmented organs. The BSPMs from simulated catheter stimulations were used for the optimization. With the obtained optimal conductivities lead-field matrices were calculated and compared to the lead-field matrix of the complex model. Besides the heart, the lungs and the intracardial blood, we found that the liver also plays an important role to describe the relationship between the activation in the heart and the body surface potential map correctly.

Abstract:

A new method to predict changes in a lead-field matrix induced by conductivity variations of a single body tissue is proposed. The approach is based on the princi- ple component analysis (PCA) with three initial lead-field matrices transformed to vectors as input. For each tissue blood, lungs, muscles and fat a PCA was carried out. Further, for each tissue the default conductivity value and the conductivity varied by ±50 % were used to calculate the sample lead-field matrices. The results of the PCAs in- dicate that for every tissue the first principle component suffices to predict the conductivity-induced changes in the samples. With an interpolation of the scores we addition- ally show that the prediction is not bound to the sample ma- trices but moreover every matrix within each conductivity range is possibly estimated and conclusively predicted.

Abstract:

The inverse problem of ECG is the task of cardiac source reconstruction from the measured body surface potential maps (BSPM). It is ill posed and therefore requires regularization, which is usually applied uniformly to the whole heart geometry. In order to improve the solution quality and localize potentials extrema we propose a local regularization method: the weighting is done iteratively according to the solution spatial content. The performed test showed the ability of the new method to overcome over smoothing and to better reconstruct strong solution gradients.

Abstract:

The goal of ECG imaging is the reconstruction of cardiac electrical activities from the potentials measured on the thorax sur- face. The tool can gain prominent clinical value for diagnosis and pre- interventional planning. The problem is however ill-posed, i.e. it is highly sensitive to modelling and measurement errors. In order to overcome this obstacle a regularization technique must be applied. In this paper we pro- pose a new optimization based method for simultaneous reconstruction of transmembrane voltages and epicardial potentials for localizing the origin of ventricular ectopic beats.Compared to second-order Tikhonov regularization, the new approach showed superior performance in marking activated regions and provided meaningful results where Tikhonov method failed.

Abstract:

Body surface potential mapping (BSPM) can be used to non- invasively measure the electrical activity of the heart using a dense set of thorax electrodes and a CT/MR scan of the thorax to solve the inverse problem of electrophysiology (ECGi). This technique now shows potential clinical value for the assessment and treatment of patients with arrhythmias. Co-localisation of the electrode positions and the CT/MR thorax scan is essential. This manuscript describes a method to perform the co-localisation using multiple biplane X-ray images. The electrodes are automatically detected and paired in the X-ray images. Then the 3D positions of the electrodes are computed and mapped onto the thorax surface derived from CT/MR. The proposed method is based on a multi-scale blob detection algorithm and the generalized Hough transform, which can automatically discriminate the leads used for BSPM from other ECG leads. The pairing method is based on epi-polar constraint matching and line pattern detection which assumes that BSPM electrodes are arranged in strips. The proposed methods are tested on a thorax phantom and two clinical cases. Results show an accuracy of 0.33 ± 0.20mm for detecting electrodes in the X-ray images and a success rate of 95.4%. The automatic pairing method achieves a 91.2% success rate.

Abstract:

In this paper we propose an iteratively regularized Gauss-Newton method to solve the inverse ECG problem and efficiently choose the parameter of regularization. The classical stopping criterium for this regularization technique Morozov discrepancy principle, cannot be used in our application because the noise level estimate and problem model error are typically not available. We formulate the stopping rule based on the statistical formulation of the parameter and the physiological nature of the sought solution. With Laplace operator as a regularization matrix, the regularization parameter can be seen as an indirect measure of deviation in the solution: smaller parameters lead to a broader solution range. From our knowledge about electrophysiology of the heart we can assume values of −85 mV and +25 mV as a lower and an upper estimates for transmembrane potentials. Under this assumption we stop Gaus-Newton iteration as soon as the difference between solution smallest and largest values achieves 110 mV. Three simulation protocols confirm our ansatz: the proposed method was compared with the commonly used in the feld L-curve based Tikhonov method, showing superior performance during an initial phase of an ectopic heart activation sequence.

Abstract:

Cardiac electrophysiology procedures are routinely used to treat patients with rhythm disorders. The success rates of ablation procedures and cardiac resynchronization therapy are still sub-optimal. Recent advances in medical imaging, image processing and cardiac biophysical modeling have the potential to improve patient outcome. This manuscript provides an overview of how these advances have been translated into the clinical environment.

Abstract:

A method to reconstruct integrals of transmembrane voltages in the heart from measured integrals of Body Surface Potential Maps (BSPM) is proposed. It is applied to localize the origin of premature beats in the heart (extrasystoles). In contrast to other proposals no specific assumption about the slope of the transmembrane voltage during depolarization is made, in particular it must not be a step function. This way the non-linear problem of localizing ectopic foci based on activation times is translated into a linear inverse problem. A Maximum-A-Posteriori (MAP) estimator is applied to solve the ill-posed linear inverse problem. Successful localization of ventricular extrasystoles is demonstrated using computer simulations. Even endocardial, midmyocardial and epicardial foci can be separated.

Abstract:

The objective of personalised modelling of the atria is to improve comprehension of the etiology of atrial arrhythmias, to enable specific diagnosis and to optimise therapy. We start with CT or MR datasets and use adapted segmentation procedures to build a patient-specific 3D-model of the atria. Then we include fibre direction based on the rules of atrial anatomy. Work in progress is also considering late enhancement MRI in order to add areas of fibrotic tissue. Next we can use BSPM data of the P-wave and solve the inverse problem of ECG to get a hypothesis about the spread of depolarisation. Finally we use intracardiac catheter signals (e.g. using a circular catheter) to measure direction and conduction velocity of depolarisation waves (sinus rhythm, atrial flutter, or following stimulation). All this is integrated into a personalised model of the atria of an individual patient. Our next goal will be to properly add ablation lines into the model.The research leading to these results has partly received funding from the European Communitys Seventh Framework Programme (FP7/2007-2013) under grant agreement n 224495 (euHeart project).

Abstract:

A framework for step-by-step personalization of a computational model of human atria is presented. Beginning with anatomical modeling based on CT or MRI data, next fiber structure is superimposed using a rule-based method. If available, late-enhancement-MRI images can be considered in order to mark fibrotic tissue. A first estimate of individual electrophysiology is gained from BSPM data solving the inverse problem of ECG. A final adjustment of electrophysiology is realized using intracardiac measurements. The framework is applied using several patient data. First clinical application will be computer assisted planning of RF-ablation for treatment of atrial flutter and atrial fibrillation.

Abstract:

The early detection of myocardial ischemia is an essential lever for its successful treatment. We investigated an ECG monitoring system with 3 electrodes. Optimal electrode positions are determined using a cellular automaton. The spatially heterogeneous effects of myocardial ischemia were modeled by altering 4 electrophysiological parameters: action potential amplitude and duration, conduction velocity as well as resting membrane voltage. Both, transmural heterogeneity and the influence of the border zone were considered in the simulations on three patient models. The detection of myocardial ischemia is based on ST segment deviation from the physiological case. The signals used to find the best electrode positions comprise ischemic regions with different transmural extents in all 17 AHA segments. We show which ischemic ECGs can be detected given a realistic signal-to-noise ratio, false positive rate and maximum response time of the system.

Abstract:

ECG imaging was performed in humans to reconstruct ventricular activation patterns and localize their excitation origins. The precision of the non-invasive reconstructions was evaluated against invasive measurements and found to be in line with the state-of-the-art literature. Statistics were produced for various excitation origins and reveal the beat-to-beat robustness of the imaging method.