Equivalent moving dipole localization of cardiac ectopic activity in a swine model during pacing

Localization of the initial site of cardiac ectopic activity has direct clinical benefits for treating focal cardiac arrhythmias. The aim of the present study is to experimentally evaluate the performance of the equivalent moving dipole technique on noninvasively localizing the origin of the cardiac ectopic activity from the recorded body surface potential mapping (BSPM) data in a well-controlled experimental setting. The cardiac ectopic activities were induced in four well-controlled intact pigs by either single-site pacing or dual-site pacing within the ventricles. In each pacing study, the initiation sites of cardiac ectopic activity were localized by estimating the locations of a single moving dipole (SMD) or two moving dipoles (TMDs) from the measured BSPM data and compared with the precise pacing sites (PSs). For the single-site pacing, the averaged SMD localization error was 18.6 ± 3.8 mm over 16 sites, while the averaged distance between the TMD locations and the two corresponding PSs was slightly larger (24.9 ± 6.2 mm over five pairs of sites), both occurring at the onset of the QRS complex (10-25 ms following the pacing spike). The obtained SMD trajectories originated near the stimulus site and then traversed across the heart during the ventricular depolarization. The present experimental results show that the initial location of the moving dipole can provide the approximate site of origin of a cardiac ectopic activity in vivo, and that the migration of the dipole can portray the passage of an ectopic beat across the heart.