title: Statistical accuracy of a moving equivalent dipole method to identify sites of origin of cardiac electrical activation.
abstract: While radio frequency (RF) catheter ablation (RCA) procedures for treating ventricular arrhythmias have evolved significantly over the past several years, the use of RCA has been limited to treating slow ventricular tachycardias (VTs). In this paper, we present preliminary results from computer and animal studies to evaluate the accuracy of an algorithm that uses the single equivalent moving dipole (SEMD) model in an infinite homogeneous volume conductor to guide the RF catheter to the site of origin of the arrhythmia. Our method involves measuring body surface electrocardiographic (ECG) signals generated by arrhythmic activity and by bipolar current pulses emanating from a catheter tip, and representing each of them by a SEMD model source at each instant of the cardiac cycle, thus enabling rapid repositioning of the catheter tip requiring only a few cycles of the arrhythmia. We found that the SEMD model accurately reproduced body surface ECG signals with a correlation coefficients > 0.95. We used a variety of methods to estimate the uncertainty of the SEMD parameters due to measurement noise and found that at the time when the arrhythmia is mostly localized during the cardiac cycle, the estimates of the uncertainty of the spatial SEMD parameters (from ECG signals) are between 1 and 3 mm. We used pacing data from spatially separated epicardial sites in a swine model as surrogates for focal ventricular arrhythmic sources and found that the spatial SEMD estimates of the two pacing sites agreed with both their physical separation and orientation with respect to each other. In conclusion, our algorithm to estimate the SEMD parameters from body surface ECG can potentially be a useful method for rapidly positioning the catheter tip to the arrhythmic focus during an RCA procedure.
authors.affiliation: Massachusetts Institute of Technology, E25-335, 77 Massachusetts Ave., 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: Bin
authors.initials: B
authors.lastname: He
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Mullen
authors.forename: Paul A
authors.initials: PA
authors.lastname: Belk
authors.forename: Yueh Z
authors.initials: YZ
authors.lastname: Lee
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cohen
mesh_terms: D000465:Algorithms; D000818:Animals; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D003198:Computer Simulation; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D008955:Models, Cardiovascular; D015233:Models, Statistical; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*