title: Experimental Validation of Noninvasive Epicardial and Endocardial Activation Imaging.
abstract: Noninvasive imaging of cardiac activation before ablation of the arrhythmogenic substrate can reduce electrophysiological procedure duration and help choosing between an endocardial or epicardial approach. A noninvasive imaging technique was evaluated that estimates both endocardial and epicardial activation from body surface potential maps. We performed a study in isolated and in situ pig hearts, estimating activation from body surface potential maps during sinus rhythm and localizing endocardial and epicardial stimulation sites.
  
  
  
  From 3 Langendorff-perfused pig hearts, 180 intramural unipolar electrograms were recorded during sinus rhythm and ectopic activation, together with pseudo-body surface potential map ECGs in 2 of them. From 4 other anesthetized pigs, 64-lead body surface potential maps were recorded during sinus rhythm and ventricular stimulation from 27 endocardial and epicardial sites. The ventricular activation pattern was computed from the recorded QRS complexes. For both Langendorff-perfused hearts, the calculated epicardial and endocardial activation patterns showed good qualitative correspondence to the patterns obtained with needle electrodes. Absolute timing difference for sinus rhythm was 10±5 and 11±8 ms respectively, and for ectopic activation 6±5 and 7±6 ms, respectively. Calculated activation for the in situ hearts in sinus rhythm was similar to patterns recorded in Langendorff-perfused hearts. During stimulation, the distance between the stimulation site and calculated site of earliest activation was 18 (15-27) mm, and 23 of 27 stimulation sites were correctly mapped to either endocardium or epicardium.
  
  
  
  Noninvasive activation imaging is able to determine earliest ventricular activation and discriminate endocardial from epicardial origin of activation with clinically relevant accuracy.
authors.affiliation: From the Donders Institute for Brain, Cognition & Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (P.O., P.M.v.D., T.F.O.); Department of Clinical and Experimental Cardiology (P.O., V.M.F.M., P.F.H.M.v.D., C.N.W.B., J.M.T.d.B., R.C.), and Department of Biomedical Engineering and Physics (G.J.S.), Academic Medical Center, Amsterdam, The Netherlands; ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (V.M.F.M., J.M.T.d.B.); and IHU Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, Pessac, France (R.C.). P.Oosterhoff@gmail.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Oosterhoff
authors.affiliation: From the Donders Institute for Brain, Cognition & Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (P.O., P.M.v.D., T.F.O.); Department of Clinical and Experimental Cardiology (P.O., V.M.F.M., P.F.H.M.v.D., C.N.W.B., J.M.T.d.B., R.C.), and Department of Biomedical Engineering and Physics (G.J.S.), Academic Medical Center, Amsterdam, The Netherlands; ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (V.M.F.M., J.M.T.d.B.); and IHU Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, Pessac, France (R.C.).
authors.forename: Veronique M F
authors.initials: VM
authors.lastname: Meijborg
authors.affiliation: From the Donders Institute for Brain, Cognition & Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (P.O., P.M.v.D., T.F.O.); Department of Clinical and Experimental Cardiology (P.O., V.M.F.M., P.F.H.M.v.D., C.N.W.B., J.M.T.d.B., R.C.), and Department of Biomedical Engineering and Physics (G.J.S.), Academic Medical Center, Amsterdam, The Netherlands; ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (V.M.F.M., J.M.T.d.B.); and IHU Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, Pessac, France (R.C.).
authors.forename: Peter M
authors.initials: PM
authors.lastname: van Dam
authors.affiliation: From the Donders Institute for Brain, Cognition & Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (P.O., P.M.v.D., T.F.O.); Department of Clinical and Experimental Cardiology (P.O., V.M.F.M., P.F.H.M.v.D., C.N.W.B., J.M.T.d.B., R.C.), and Department of Biomedical Engineering and Physics (G.J.S.), Academic Medical Center, Amsterdam, The Netherlands; ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (V.M.F.M., J.M.T.d.B.); and IHU Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, Pessac, France (R.C.).
authors.forename: Pascal F H M
authors.initials: PF
authors.lastname: van Dessel
authors.affiliation: From the Donders Institute for Brain, Cognition & Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (P.O., P.M.v.D., T.F.O.); Department of Clinical and Experimental Cardiology (P.O., V.M.F.M., P.F.H.M.v.D., C.N.W.B., J.M.T.d.B., R.C.), and Department of Biomedical Engineering and Physics (G.J.S.), Academic Medical Center, Amsterdam, The Netherlands; ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (V.M.F.M., J.M.T.d.B.); and IHU Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, Pessac, France (R.C.).
authors.forename: Charly N W
authors.initials: CN
authors.lastname: Belterman
authors.affiliation: From the Donders Institute for Brain, Cognition & Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (P.O., P.M.v.D., T.F.O.); Department of Clinical and Experimental Cardiology (P.O., V.M.F.M., P.F.H.M.v.D., C.N.W.B., J.M.T.d.B., R.C.), and Department of Biomedical Engineering and Physics (G.J.S.), Academic Medical Center, Amsterdam, The Netherlands; ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (V.M.F.M., J.M.T.d.B.); and IHU Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, Pessac, France (R.C.).
authors.forename: Geert J
authors.initials: GJ
authors.lastname: Streekstra
authors.affiliation: From the Donders Institute for Brain, Cognition & Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (P.O., P.M.v.D., T.F.O.); Department of Clinical and Experimental Cardiology (P.O., V.M.F.M., P.F.H.M.v.D., C.N.W.B., J.M.T.d.B., R.C.), and Department of Biomedical Engineering and Physics (G.J.S.), Academic Medical Center, Amsterdam, The Netherlands; ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (V.M.F.M., J.M.T.d.B.); and IHU Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, Pessac, France (R.C.).
authors.forename: Jacques M T
authors.initials: JM
authors.lastname: de Bakker
authors.affiliation: From the Donders Institute for Brain, Cognition & Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (P.O., P.M.v.D., T.F.O.); Department of Clinical and Experimental Cardiology (P.O., V.M.F.M., P.F.H.M.v.D., C.N.W.B., J.M.T.d.B., R.C.), and Department of Biomedical Engineering and Physics (G.J.S.), Academic Medical Center, Amsterdam, The Netherlands; ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (V.M.F.M., J.M.T.d.B.); and IHU Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, Pessac, France (R.C.).
authors.forename: Ruben
authors.initials: R
authors.lastname: Coronel
authors.affiliation: From the Donders Institute for Brain, Cognition & Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (P.O., P.M.v.D., T.F.O.); Department of Clinical and Experimental Cardiology (P.O., V.M.F.M., P.F.H.M.v.D., C.N.W.B., J.M.T.d.B., R.C.), and Department of Biomedical Engineering and Physics (G.J.S.), Academic Medical Center, Amsterdam, The Netherlands; ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (V.M.F.M., J.M.T.d.B.); and IHU Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, Pessac, France (R.C.).
authors.forename: Thom F
authors.initials: TF
authors.lastname: Oostendorp
mesh_terms: D000818:Animals; D018780:Body Surface Potential Mapping; D006328:Cardiac Catheterization; D004562:Electrocardiography; D004699:Endocardium / Q000502:physiology*; D005471:Fluoroscopy; D006329:Heart Conduction System / Q000502:physiology; D021621:Imaging, Three-Dimensional; D010496:Pericardium / Q000502:physiology*; D013552:Swine; D014057:Tomography, X-Ray Computed
keywords: electrocardiography; imaging; inverse electrocardiography; mapping; multimodality imaging; noninvasive imaging