Three-dimensional imaging of ventricular activation and electrograms from intracavitary recordings

Three-dimensional (3-D) mapping of the ventricular activation is of importance to better understand the mechanisms and facilitate management of ventricular arrhythmias. The goal of this study was to develop and evaluate a 3-D cardiac electrical imaging (3DCEI) approach for imaging myocardial electrical activation from the intracavitary electrograms (EGs) and heart-torso geometry information over the 3-D volume of the heart. The 3DCEI was evaluated in a swine model undergoing intracavitary noncontact mapping (NCM). Each animal's preoperative MRI data were acquired to construct the heart-torso model. NCM was performed with the Ensite 3000 system during acute ventricular pacing. Subsequent 3DCEI analyses were performed on the measured intracavitary EGs. The estimated initial sites (ISs) were compared to the precise pacing locations, and the estimated activation sequences (ASs) and EGs were compared to those recorded by the NCM system over the endocardial surface. In total, six ventricular sites from two pigs were paced. The averaged localization error of IS was 6.7 ± 2.6 mm. The endocardial ASs and EGs as a subset of the estimated 3-D solutions were consistent with those reconstructed from the NCM system. The present results demonstrate that the intracavitary-recording-based 3DCEI approach can well localize the sites of initiation and can obtain physiologically reasonable ASs as well as EGs in an in vivo setting under control/paced conditions. This study suggests the feasibility of tomographic imaging of 3-D ventricular activation and 3-D EGs from intracavitary recordings.