Statistical Accuracy of a Moving Equivalent Dipole Method to Identify Sites of Origin of Cardiac Electrical Activation

Antonis A. Armoundas, Andrew B. Feldman, Ramakrishna Mukkamala, Bin He, Thomas J. Mullen, Paul A. Belk, Yueh Z. Lee, Richard J. Cohen

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1360-1370
Number of pages11
JournalIEEE Transactions on Biomedical Engineering
Volume50
Issue number12
DOIs
StatePublished - Dec 2003
Externally publishedYes

Bibliographical note

Funding Information:
Manuscript received November 7, 2002; revised April 3, 2003. This work was supported in part by NASA through a grant from the National Space Biomedical Research Institute, and under Grant NAG5-4989. The work of A. A. Armoundas was supported in part by the American Heart Association (AHA) under Fellowship 9920282T. The work of A. B. Feldman was supported in part by the National Institutes of Health (NIH) throught the National Heart, Lung and Blood Institute under Fellowship HL09570. Asterisk indicates corresponding author. *A. A. Armoundas is with the Massachusetts Institute of Technology, E25-335, 77 Massachusetts Ave., Cambridge, MA 02139 USA (e-mail: [email protected]). A. B. Feldman is with Milton S. Eisenhower Research and Technology Development Center, Johns Hopkins University/Applied Physics Laboratory, Laurel, MD 20723-6099 USA. R. Mukkamala is with Michigan State University, East Lansing, MI 48824-1226 USA. B. He is with University of Illinois at Chicago, Chicago, IL 60607-7042 USA. T. J. Mullen is with Medtronic, Inc., Minneapolis, MN 55432 USA. P. A. Belk is with Medtronic, Inc., Minneapolis, MN 55432 USA. Y. Z. Lee is with University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA. R. J. Cohen is with the Massachusetts Institute of Technology, E25-335, Cambridge, MA 02139 USA. Digital Object Identifier 10.1109/TBME.2003.819849

Keywords

  • Arrhythmias
  • Catheter ablation
  • Equivalent moving dipole

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