title: A single equivalent moving dipole model: an efficient approach for localizing sites of origin of ventricular electrical activation.
abstract: We propose a new method for guiding catheter ablation procedures to abolish sites of origin of arrhythmias. This method models both cardiac electrical activity and current pulses delivered from the tip of the ablation catheter with a single equivalent moving dipole (SEMD). The SEMD parameters are obtained from analysis of body surface potentials. In this paper we examine the feasibility of this method by evaluating the performance of an inverse algorithm we developed to localize the SEMD from the surface potentials. In computer simulations realistic levels of measurement noise led to uncertainties in SEMD location approximately 0.005 cm. Dipole orientation randomization contributed to increased uncertainty (0.04 cm) in SEMD location only when boundary effects were included. In ventricular pacing swine studies, we found that the SEMD model accurately accounted for electrocardiographic wave forms and that measurement noise led to an uncertainty of approximately 0.04 cm in the SEMD at 15 ms after the pacing spike. We have also found that the algorithm we developed to identify the SEMD parameters yielded positions for two spatially separated pacing sites that maintained their direction and were very close to their physical separation. These results suggest that the SEMD method may potentially be used to guide radio-frequency ablation procedures.
authors.affiliation: Harvard University-Massachusetts Institute of Technology, Division of Health Sciences and Technology, Cambridge, MA 02139, USA. antonis@pothos.mit.edu
authors.forename: Antonis A
authors.initials: AA
authors.lastname: Armoundas
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Feldman
authors.forename: Ramakrishna
authors.initials: R
authors.lastname: Mukkamala
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cohen
mesh_terms: D000200:Action Potentials; D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000601:surgery; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods; D003198:Computer Simulation; D005240:Feasibility Studies; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006352:Heart Ventricles / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008955:Models, Cardiovascular; D008959:Models, Neurological; D011786:Quality Control; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013269:Stochastic Processes; D025321:Surgery, Computer-Assisted / Q000379:methods