Electrotomographic mapping: clinical translation for multipolar principal component referenced unipolar electrograms
Notice bibliographique
Résumé
Abstract Introduction Focal ventricular arrhythmias from an intramural location pose a significant challenge to map and ablate. The paradigm of QS on the unipolar electrogram (EGM) and pre-QRS activation on the bipolar EGM only holds for superficial foci and is lost for deeper sources owing to mass depolarization of myocardium leading to a dual breakout pattern over a large surface area. We recently reported multipoles with principal component referenced unipolar electrograms (UniPCR) have a superior near-field view and demonstrated a lower fractional area of QS EGMs with a deep pacing source. Purpose We hypothesized multipoles with UniPCR would be a better predictor of intramural source location irrespective of depth on the surface of the heart by acting as a local unipolar EGM with a better specificity for QS morphology. Methods Five explanted healthy swine hearts were used in a Langendorff perfused heart model. Mapping data was collected using a custom-made, 2mm spaced, 56-electrode rectangular array placed on the epicardium of the left ventricle. Pacing was performed from the center of the array, varying the intramural stimulation source depth by plunge needle in 1mm increments from 6mm (deepest) to 3mm (shallowest). A comparison of unipolar versus UniPCR EGMs was performed to measure the predictive accuracy of the source location including amplitude, width, QS% and fractional area of QS. Data are presented as mean±SEM. Results The percentage of EGMs displaying a QS morphology was lower in UniPCR vs. Unipolar EGMs at all depths (p<0.001; Table). This produced a smaller fractional area of QS on the array irrespective of source depth (p<0.001). A representative example from one swine is shown in the figure. UniPCR EGMs had a smaller amplitude and narrower width than unipoles (both p<0.001), however there was no difference in the amplitude or width of UniPCR EGMs across the different depths of the pacing source (p=0.957 and p=0.372 respectively). Electrodes on the array were subdivided into 1st neighborhood (four electrode square around source), 2nd neighborhood (twelve electrode square around 1st neighborhood) and remote (all remaining electrodes). The percentage of EGMs displaying a QS morphology was lower in UniPCR vs. Unipolar EGMs at all depths in the 1st neighborhood (p<0.001), 2nd neighborhood (p<0.001) and remote (p<0.001). A non-QS signal on UniPCR had much better specificity for being at an electrode outside the 1st neighborhood (unipolar: 60.4% vs. UniPCR: 91.5%). Conclusion Multipoles with UniPCR improves the ability to map an intramural focus by creating a narrower area of QS on the mapping surface due to reduced far-field influence on the EGM. Traditional unipoles show a larger area of QS due to far-field summation. Multipoles allows for effective source localization on the surface irrespective of depth and has the potential to improve targeted ablation of focal ventricular arrhythmias.QS vs. R wave maps Characteristics of EGMs
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».