Clinical evaluation of the new 12-lead ECG noninvasive epi-endocardial mapping technology

新型12导联心电图无创心外膜-心内膜标测技术的临床评估

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作者：Martini,Nicolò,Calore,Federico,Cauti,Filippo Maria,Machowicz,J,Dyrbus,M,Pyka,Ł,Kurek,A,Niedziela,J,Adamowicz-Czoch,E,Ostrega,M,Sokola,K,Pres,D,Skrzypek,M,Tajstra,M,Gasior,M,Bucci,T,Proietti,R,Lip,G Y H,Dinov,B D,Seidemann,J S,Henfling,C H,Ebbinghaus,H E,Latuscynski,C L,Paetsch,I P,Jahnke,C J,Laufs,U L,Sossalla,S S,Ueberham,L U,Hamacher,L,Wessely,E,Jost,J,Rohla,M,Panzer,B,Kaufmann,C,Pogran,E,Burger,A,Ahmed,A,Freynhofer,M,El Kilany,N,Tinhofer,F,Huber,K,Zweiker,D,Schipper,J,Woermann,J,Van Den Bruck,J,Filipovic,K,Dittrich,S,Scheurlen,C,Erlhoefer,S,Pavel,F,Iliadis,C,Pfister,R,Sultan,A,Lueker,J,Steven,D,Migliore,F,Schiavone,M,Pittorru,R,Forleo,G B,Mitacchione,G,Biffi,M,Gulletta,S,Kuschyk,J,Rovaris,G,Tilz,R,Tondo,C,Di Biase,L,Gasperetti,A,Tarzia,V,Gerosa,G,Isenegger,C,Mannhart,D,Weidlich,S,Arnet,R,Du Fay De Lavallaz,J,Krisai,P,Knecht,S,Kuehne,M,Sticherling,C,Badertscher,P,Marcon,L,Della Rocca,D,Magnocavallo,M,Mene',R,Pannone,L,Mohanty,S,Glowniak,A,Sousonis,V,Sorgente,A,Sarkozy,A,Rossi,P,Boveda,S,Natale,A,De Asmundis,C,Chierchia,G B,Kim,H J,Kim,D H,Kim,K P,Choi,S H,Kim,M H,Park,J W,Yu,H T,Kim,T H,Uhm,J S,Joung,B Y,Lee,M H,Pak,H N,Stangl,D,Buia,V,Walascheck,J,Bastian,D,Rittger,H,Vitali-Serdoz,L,Peichl,P,Wichterle,D,Stojadinovic,P,Borisincova,E,Stiavnicky,P,Haskova,J,Cihak,R,Kautzner,J,Van Der Schaaf,I,Kloosterman,M,Van Dam,P M,Loh,P,Ribes,F,Perez-Rosello,V,Gunturiz-Beltran,C,De La Cruz-Cereceda,S,Bellver-Navarro,A,Lee,K N,Soh,M S,Park,B H,Kim,D Y,Roh,S Y,Marchetti,M,Haddad,C,Luca,A,Gentil,P,Le Bloa,M,Teres,C,Domenichini,G,Pia-Porretta,A,Herrera,C,Pruvot,E,Pascale,P,Hytting,J,Celik,S,Bodestrom Eriksson,L,Mallios,P,Digerfeldt,C,Waldemar,A,Wijkman,M,Hubbert,L,Manninger,M,Lercher,I,Hermans,A N L,Isaksen,J L,Prassl,A J,Zirlik,A,Vernooy,K,Chaldoupi,S M,Luermans,J,Ter Bekke,R M A,Kanters,J K,Plank,G,Scherr,D,Pock,T,Linz,D,Cherrett,C,Adonopulos,A,Phan,J,Lee,W,Walker,B,Jansz,P,Subbiah,R,Macdonald,P,De Lucia,R,Micheli,A,Parlato,A,Podda,M,Pedrelli,L,Aliprandi,F,Parollo,M,Segreti,L,Di Cori,A,Canu,A,Grifoni,G,Barletta,V,Viani,S,Zucchelli,G,Gybel,C,Madsen,M,Nielsen,J M,Acosta Martinez,J,Regal Somet,M,Frutos Lopez,M,Sanchez Brotons,J A,Gonzalez De La Portilla-Concha,C,Lopez Baizan,J,Arana Rueda,E,Pedrote,A,Boehmer,A A,Rothe,M,Wiedenmann,L,Nussbaum,E,Schneider,K Y,Spork,P,Keim,C,Dobre,B C,Kaess,B M,Ehrlich,J R,Leo,D,Trevisan,C,Graffigna,G,Bosio,C,Lobban,T,Lane,D,Hachisuka,M,Murata,H,Yodogawa,K,Toida,Y,Okajima,S,Ito,N,Arai,T,Kobayashi,S,Fujimoto,Y,Hagiwara,K,Aizawa,Y,Shimizu,W,Asai,K,Iwasaki,Y,Jung,L,Kim,S H,Kim,D H,Compagnucci,P,Casella,M,Narducci,M L,Conte,E,Cammarano,M,Pelargonio,G,Andreini,D,Palmieri,V,Lo Russo,G,Pontone,G,Natale,A,Tondo,C,Crea,F,Zeppilli,P,Dello Russo,A,Ouali,S,Jebbari,Z,Boudiche,S,Ben Rejab,R,Mgaieth,F,Ben Halima,M,Elias,A,Eyal,A,Beinart,R,Nof,E,Michowitz,Y,Glikson,M,Konstantino,Y,Haim,M,Luria,D,Omelchenko,A,Marai,I,Laish-Farkash,A,Suleiman,M,Kiliszek,M,Beata Uzieblo-Zyczkowska,B U Z,Krystian Krzyzanowski,K K,Pawel Krzesinski,P K,Guckel,D,El Hamriti,M,Fink,T,Sciacca,V,Braun,M,Khalaph,M,Isgandarova,K,Sommer,P,Sohns,C,Noelker,G,Chung,S,Yang,P S,Jang,E,Kim,D,Yu,H T,Kim,T H,Uhm,J S,Sung,J H,Pak,H N,Lee,M H,Joung,B,Baek,Y,Kim,D Y,Lee,S W,Lee,D H,Lee,S C,Jang,J H,Shin,S H,Choi,W I,Kim,D H,Chen,Y Y,Lin,Y L,Lee,C L,Chien,K L,Hsieh,Y C,Lip,G Y H,Chen,S A,Suthahar,N,Zwartkruis,V,Middeldorp,M E,Van Veldhuisen,D J,Bakker,S J L,Gansevoort,R T,Kardys,I,Rienstra,M,De Boer,R A,Albarran-Rincon,R,Barragan Campos,J,Ramos Ardanaz,P,Garcia De Yebenes Castro,M,Garcia-Bolao,I,Alothman,O,Borisov,G,Keelani,A,Issa,K,Fink,A,Frommhold,M,Raffa,S,Geller,C,Navara,R,Mchugh,W,Pallod,A,Raj,K,Sinha,A,Deshpande,M,Wang,Y,De,S,Deleon,R,Bolaji,O,Asfaha,D,Okoroanyanwu,S,Paudel,B,Manohar,R,Patel,K,Nakasone,K,Del Monte,A,Della Rocca,D G,Pannone,L,Gauthey,A,Overeinder,I,Bala,G,Sorgente,A,Sieira,J,Almorad,A,Sarkozy,A,Chierchia,G B,De Asmundis,C,Tanaka,K,Stroker,E,Albarran-Rincon,R,Rodaev,V,De La Torre Carazo,F,Ramos Ardanaz,P,Garcia De Yebenes,M,Garcia-Bolao,I,Van Der Schaaf,I,Kloosterman,M,Loh,P,Van Dam,P M,Debreceni,D,Kristof-Ferenc,J,Toth,D,Bocz,B,Simor,T,Kupo,P,Frederiksen,T C,Christiansen,M K,Benjamin,E J,Olsen,A,Jensen,H K,Dahm,C C,Bernardini,A,Bindini,L,Berteotti,M,Antonucci,E,Palareti,G,Poli,D,Frasconi,P,Marcucci,R,Mohsen,Y,Vatsaraj,I,Loeffler,S,Horlitz,M,Stoeckigt,F,Trayanova,N,Park,H,Kim,D H,Park,J W,Yu,H T,Kim,T H,Uhm,J S,Joung,B Y,Lee,M H,Hwang,C,Pak,H N,Torma,D,Debreceni,D,Janosi,K F,Simor,T,Kupo,P,Georgi,C,Bannehr,M,Lochmann,M,Reiners,D,Haase-Fielitz,A,Seifert,M,Butter,C,Hassouna,S,Herman,D,Hozman,M,Osmancik,P,Vesela,J,Plesinger,F,Bures,Z,Cecchini,F,Mugnai,G,Di Vilio,A,Almorad,A,Del Monte,A,Artale,P,Filannino,P,Petretta,A,Colella,J,Statuto,G,Maj,R,Sieira,J,Chierchia,G B,De Asmundis,C,Iacopino,S,Mueller-Leisse,J,Hillmann,H A K,Eiringhaus,J,Hohmann,S,Karfoul,N,Duncker,D,Duckwitz,N,Herzer,L,Kirsch,K,Mettke,F,Hamadanchi,A,Schulze,P C,Surber,R,Grosse,A,Marcantoni,L,Deluca,F,Valenza,S,Pastore,G,Bejko,A,Diaferio,A,Porcelli,G,Follesa,A,Zanon,F,Jacinto,S,Teixeira,A R,Santos,H,Portugal,G,Valente,B,Lousinha,A,Cunha,P,Cacela,D,Morais,L,Santana,A,Oliveira,E,Ferreira,R,Martins Oliveira,M,Willert,S,Demmig,T,Maslova,V,Zaman,A,Popera,J,Nicholson,L,Sprenger,L,Kleinhans,L,Jahn,O,Frank,D,Lyan,E,Lee,Y,Yang,P S,Jang,E S,Kim,D,Yu,H T,Kim,T H,Uhm,J S,Sung,J H,Pak,H N,Lee,M H,Joung,B,Biagi,A,Rossi,L,Bolognesi,M G,Gibiino,F,Aschieri,D,Poggi,S,Lepiliier,A,Grimaldi,M,Scaglione,M,Zucchelli,G,Iacopino,S,Rossi,L,Mantovan,R,Pandozzi,C,Giomi,A,Strisciuglio,T,Stabile,G,Solimene,F,Esato,M,Kikuchi,S,Kaneshiro,M,Mori,T,Tominaga,S,Kametani,R,Yoshioka,S,Palmisano,P I E T R O,Pieragnoli,P,Viani,S,Nigro,G,Francia,P,Biffi,M,De Filippo,P,Pisano,E,Bisignani,G,Giammaria,M,Ottaviano,L,Tordini,A,Migliore,F,Valsecchi,S,Bianchi,V,Bucci,T,Baratta,F,Pastori,D,Pignatelli,P,Violi,F,Lip,G Y H,Coluccia,G,Ziacchi,M,Dell'era,G,Donateo,P,Ammendola,E,Aspromonte,V,Guido,A,Ghiglieno,C,Parlavecchio,A,Nigro,G,Senes,J,Patti,G,Biffi,M,Accogli,M,Palmisano,P,Boegner,M,Bock,M,Huettemeister,J,Jeising,T,Schallopp,L,Eggert-Doktor,D,Falk,V,Hindricks,G,Gerds-Li,J H,Hohendanner,F,Yorgun,H,Coteli,C,Kilic,S,Aytemir,K,Foeldvary,M,Grigoryan,A,Tribunyan,S,Bachour,C,Feldmann,T,Israel,C,Lin,Y,Chen,Y Y,Ling,L C,Hsieh,Y C,Chien,K L,Ling,C H,Chen,S A,Cardelli,L S,Laumont,T,Beghian,J,Achahli,Y,Cardoso,M,Peltier,M,Pasquie',J L,Granier,M,Matsuda,Y,Masuda,M,Uematsu,H,Sugino,A,Ooka,H,Kudo,S,Fujii,S,Asai,M,Okamoto,S,Ishihara,T,Nanto,K,Tsujimura,T,Hata,Y,Higashino,N,Mano,T,Zarebski,L,Futyma,P,Wu,S,Chen,K,Serban,T,Badertscher,P,Du Fay De Lavallaz,J,Providencia,R,Migliore,F,Mugnai,G,Penela,D,Perrotta,L,Kuehne,M,Sticherling,C,Chun,K R J,Clemens,M,Fodor,Z S,Gaal,R,Sandorfi,G,Nagy,L T,Csanadi,Z,Devesa Neto,V,Costa,G,Santos,L F,Costa,A,Teixeira,R,Goncalves,L,Tajstra,M,Dyrbus,M,Stapor-Fudzinska,M,Rutkowski,T,Gasior,M,Blamek,S,Parreira,L,Quintal,J,Mesquita,D,Marques,L,Marinheiro,R,Silva,J,Chambel,D,Encarnacao,C,Costa,F,Duarte,L,Seixo,F,Lee,K,Rhee,T M,Choi,J M,Ahn,H J,Kwon,S,Lee,S R,Choi,E K,Oh,S,De Melo Junior,J,Naser,J,Chamberlain,A,Gersh,B,Noseworthy,P,Siontis,K,Massoullie,G,Bordachar,P,Ploux,S,Souteyrand,G,Mondoly,P,Amabile,N,Jean,F,Combaret,N,Motreff,P,Clerfond,G,Eschalier,R,Mannhart,D,Krisai,P,Weidlich,S,Knecht,S,Isenegger,C,Katic,J,Voellmin,G,Osswald,S,Sticherling,C,Kuehne,M,Badertscher,P,Rossi,L,Bolognesi,M G,Biagi,A,Bricoli,S,Aschieri,D,Cheng,C C,Huang,P S,Chen,J J,Chang,S N,Chiu,F C,Wu,C K,Hwang,J J,Wang,Y C,Tsai,C T,Benezet Mazuecos,J,Lozano,A,Miracle,A,Crosa,J,Esteban,I,Elosegui,C,Illescas,C,Iglesias,J A,Reijrink-De Boer,M,Wolsink,I,Frenaij,I,Beukema,K F,Brouns,B,Van Dijk,V F,Liebregts,M,Wijffels,M C E F,Boersma,L V A,Balt,J C,Scrocco,C,Lee,D,Ensam,B,Bastiaenen,R,Specterman,M,Behr,E R,Hwang,T,Yang,P,Jang,E,Choi,S,Kim,D,Yu,H,Kim,T,Uhm,J,Song,J,Pak,H,Lee,M,Joung,B,Tanaka,N,Okada,M,Tanaka,K,Hirao,Y,Harada,S,Miyazaki,N,Iwasa,K,Koyama,Y,Watanabe,H,Iwakura,K,Iwanaga,Y,Okamura,A,Dinatale,A,Crocamo,A,Bearzot,L,Gonzi,G,Guidorossi,A,Giacopelli,D,Bassini,M,Grassini,D,Niccoli,G,Ardissino,D,Notarangelo,M F,Park,J,Yang,P S,Kim,D,Sung,J H,Jang,E,Yu,H T,Kim,T H,Uhm,J S,Pak,H N,Lee,M H,Joung,B,Hirokami,J,Schmidt,B,Bordignon,S,Tohoku,S,Chen,S,Schaack,D,Urbanek,L,Ebrahimi,R,Plank,K,Chun,J,Kim,M H,Kwon,O S,Kim,D,Kim,K,Yu,H T,Kim,T H,Uhm,J S,Joung,B,Lee,M H,Pak,H N,Solana-Munoz,J,Teres,C,Luca,A,Herrera-Siklody,C,Domenichini,G,Pascale,P,Pruvot,E,Le Bloa,M,Vetta,G,Della Rocca,D G,Parlavecchio,A,Magnocavallo,M,Pannone,L,Sorgente,A,Sieira,J,Almorad,A,Bala,G,Stroker,E,Rossi,P,Boveda,S,Sarkozy,A,De Asmundis,C,Chierchia,G B,Allgaier,R,Strack,C,Wallner,S,Hubauer,U,Lehn,P,Luchner,A,Maier,L,Jungbauer,C,Sales Belles,C,Minchole,A,Cabrera-Ramos,M,Pueyo,E,Ramos-Maqueda,J,Kettering,K,Tamborrino,P P,Segreti,L,Barletta,V,Fiorentini,F,Torre,M,Di Cori,A,De Lucia,R,Viani,S M,Paperini,L,Grifoni,G,Soldati,E,Parollo,M,Bongiorni,M G,Zucchelli,G,Santos,A R,Albuquerque,F,Castelo,A,Ferreira,V,Rio,P,Timoteo,A T,Galrinho,A,Branco,L,Varela,F,Leal,A,Santos,H,Valente,B,Osorio,P,Oliveira,M,Ferreira,R,Peischard,S,Strutz-Seebohm,N,Seebohm,G,Giomi,A,Paoletti Perini,A,Bernardini,A,Padeletti,M,Signorini,U,Zaccaria,C,Ciliberti,D,Milli,M,Erhard,N,Prommersberger,S,Neuner,B,Bahlke,F,Englert,F,Popa,M A,Krafft,H,Abdiu,E,Reents,T,Lennerz,C,Telishevska,M,Lengauer,S,Hessling,G,Deisenhofer,I,Bourier,F,Pasara,V,Prepolec,I,Ban,B,Pezo-Nikolic,B,Puljevic,D,Milicic,D,Velagic,V,Rodionova,I,Kutya,I N N A,Hilova,Y,Kopytsya,M Y K O L A,Samburg,Y A N A,Shelest,B O R Y S,Sattin,T,Fassini,G,Cellucci,S,Tundo,F,Riva,S,Moltrasio,M,Bianchini,L,Majocchi,B,Pizzamiglio,F,Sicuso,R,Vettor,G,Ribatti,V,Dessanai,M,Tondo,C,Hwang,T,Kwon,O,Lim,B,Jin,Z,Yang,S,Kim,D,Park,J,Yu,H,Kim,T,Uhm,J,Joung,B,Lee,M,Hwang,C,Pak,H,Gomes,D,Cunha,G,Freitas,P,Guerreiro,S,Abecasis,J,Rodrigues,G,Matos,D,Carmo,J,Galvao Santos,P,Moscoso Costa,F,Carmo,P,Belo Morgado,F,Cavaco,D,M Ferreira,A,Adragao,P,Carboni,L,Casella,M,Malacrida,M,Iovinella,A,Cipolletta,L,Procicchiani,L,Fori,S,Masci,F,Volpato,G,Compagnucci,P,Enrico,R,Parisi,Q,Natale,A,Munch,C,Dello Russo,A,Chatzikyriakou,S,Xaplanteris,P,Sofianos,D,Goethals,P,Purnode,P,Rassias,I,Theodorakis,G,Foading,B,Van Der Velden,R,Engdahl,J,Crijns,H,Friberg,L,Kemp-Gudmundsdottir,K,Linz,D,Svennberg,E,Kaza,N,Sakatsume,R,Bachtiger,P,Noar,A,Miyazawa,A,Fudge,M,Shun-Shin,M J,Keene,D,Marciniak,M,Albatat,M,Hammersboen,L E,Stugaard,M,Frostelid,V C,Finstad,E,Remme,E,Odland,H,Komlosi,F,Toth,P,Bohus,G Y,Tokodi,M,Vamosi,P,Szegedi,N,Sallo,Z,Piros,K,Perge,P,Osztheimer,I,Abraham,P,Szeplaki,G,Merkely,B,Geller,L,Nagy,K V,Garcia Fernandez,F,Calvo Simal,S,Cano,O,Calvo,D,Villagraz,L,Martin,J,Cantero,D,Aguilar Iglesias,L,Fernandez Lozano,I,Pombo,M,Nagy,Z,Szonyi,M,Csakany,L,Major,T,Mladoniczky,S,Kassa,K,Som,Z,Foldesi,C,Kardos,A,Kotb,A,Armstrong,S,Koev,I,Antoun,I,Vali,Z,Barker,J,Panchal,G,Mavilakandy,A,Chin,S H,Lazdam,M,Ibrahim,M,Sandilands,A,Somani,R,Ng,G A,Taleski,J,Pocesta,B,Janusevski,F,Risteski,D,Poposka,L,Kirstein,B,Heeger,C H,Phan,H L,Eitel,C,Feher,M,Vogler,J,Popescu,S S,Hatahet,S,Keelani,A,Breithaupt,C,Wolf,C,Kuck,K H,Tilz,R R,Tanaka,M,Hayashi,S,Yasuda,T,Kida,R,Hashimoto,S,Ooka,J,Shimoda,Y,Tanaka,T,Kondo,M,Thuraiaiyah,J,Jensen,A S,Philbert,B T,Sondergaard,L,Jons,C,Gant Lopez,J,Cueto,A F,Peidro,R M,Colque,F,Fitz Maurice,M D,Cilio,M,Sansalone,R A,Speranza,R,Meiller,F,Guillen,R H,Medesani,L A,Jimenez-Candil,J,Hernandez,J,Morinigo,J L,Sanchez Garcia,M,Cruz,A,Oterino,A,Sanchez,P L,Lee,S 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期刊：Europace影响因子：7.400
时间：2023起止号：2023 Jun;25(Suppl 1)
doi：10.1093/europace/euae286

Abstract

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Private company. Main funding source(s): XSpline S.p.a. AIM: Noninvasive electrocardiographic mapping systems may require multichannel (150-250) ECG body surface recordings which is a huge limitation for the adoption into clinical practice. However, most of the currently available noninvasive mapping systems accurately represent epicardial activation. Over the last few years, various technical solutions have been implemented to increase the accuracy of ECG forward-inverse calculations including machine learning algorithms. We developed a novel 12-lead ECG-based, fully automated system for noninvasive full transmural (epi-endocardial) mapping. The aim of this study was to evaluate accuracy of this system in heart failure patients with typical LBBB. METHODS: Eight consecutive patients (median age: 65; 25-75% range 59-64; 5 male) with typical LBBB QRS morphology (QRS duration 146–224 ms), scheduled for CRT implantation underwent a cardiac CT scan and 12-lead ECG recording, followed by detailed bi-ventricular endocardial electroanatomical contact mapping (EAM). A median of 258 (181-576) local electrograms in LV and 86 (70-139) in RV were collected during EAM. Cardiac CT data were semiautomatically processed using a Unet-like neural network to obtain meshes containing the heart (each chamber with both endocardial and epicardial contour as well as coronary sinus and its branches), lungs and torso using different segmentation module. Noninvasive epi-endocardial activation maps were calculated using state-of-the-art mathematical models including machine learning methods. These data were compared with EAM from the invasive mapping system using Spearman correlation (r), mean absolute error (MAE) and relative distance metrics. RESULTS: All early and latest activation patterns were correctly identified (see figure). The average correlation (r) of endocardial activation maps was 0.92 for all cases (min-max: 0.82-0.96). MAE was rather small (9-15 mm) when the non-invasive late activation zone nearly matches the CARTO data (average distance error 14 mm). Overall, the QRS complex was correctly reproduced by our method in all cases (r = 0.96). CONCLUSIONS: This study shows that new mapping technique can accurately reconstruct endocardial electrical activation maps based on 12-lead ECG and cardiac CT scan. The approach may be very useful in pre-procedural planning of device implantation and catheter ablation. Larger validation studies are however needed for confirming method accuracy at epicardial site. [Figure: see text]

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