Novel CineECG enables anatomical 3D localization and classification of bundle branch blocks

Machteld J Boonstra; Bashar N Hilderink; Emanuela T Locati; Folkert W Asselbergs; Peter Loh; Peter M van Dam

doi:10.1093/europace/euaa396

Novel CineECG enables anatomical 3D localization and classification of bundle branch blocks

Machteld J Boonstra, Bashar N Hilderink, Emanuela T Locati, Folkert W Asselbergs, Peter Loh, Peter M van Dam

IRCCS Policlinico San Donato

Research output: Contribution to journal › Article › peer-review

Abstract

AIMS: Ventricular conduction disorders can induce arrhythmias and impair cardiac function. Bundle branch blocks (BBBs) are diagnosed by 12-lead electrocardiogram (ECG), but discrimination between BBBs and normal tracings can be challenging. CineECG computes the temporo-spatial trajectory of activation waveforms in a 3D heart model from 12-lead ECGs. Recently, in Brugada patients, CineECG has localized the terminal components of ventricular depolarization to right ventricle outflow tract (RVOT), coincident with arrhythmogenic substrate localization detected by epicardial electro-anatomical maps. This abnormality was not found in normal or right BBB (RBBB) patients. This study aimed at exploring whether CineECG can improve the discrimination between left BBB (LBBB)/RBBB, and incomplete RBBB (iRBBB).

METHODS AND RESULTS: We utilized 500 12-lead ECGs from the online Physionet-XL-PTB-Diagnostic ECG Database with a certified ECG diagnosis. The mean temporo-spatial isochrone trajectory was calculated and projected into the anatomical 3D heart model. We established five CineECG classes: 'Normal', 'iRBBB', 'RBBB', 'LBBB', and 'Undetermined', to which each tracing was allocated. We determined the accuracy of CineECG classification with the gold standard diagnosis. A total of 391 ECGs were analysed (9 ECGs were excluded for noise) and 240/266 were correctly classified as 'normal', 14/17 as 'iRBBB', 55/55 as 'RBBB', 51/51 as 'LBBB', and 31 as 'undetermined'. The terminal mean temporal spatial isochrone contained most information about the BBB localization.

CONCLUSION: CineECG provided the anatomical localization of different BBBs and accurately differentiated between normal, LBBB and RBBB, and iRBBB. CineECG may aid clinical diagnostic work-up, potentially contributing to the difficult discrimination between normal, iRBBB, and Brugada patients.

Original language	English
Pages (from-to)	i80-i87
Journal	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
Volume	23
Issue number	23 Suppl 1
DOIs	https://doi.org/10.1093/europace/euaa396
Publication status	Published - Mar 4 2021

Keywords

Action Potentials
Arrhythmias, Cardiac/diagnosis
Bundle-Branch Block/diagnosis
Electrocardiography
Heart Ventricles
Humans

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10.1093/europace/euaa396

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Boonstra, M. J., Hilderink, B. N., Locati, E. T., Asselbergs, F. W., Loh, P., & van Dam, P. M. (2021). Novel CineECG enables anatomical 3D localization and classification of bundle branch blocks. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 23(23 Suppl 1), i80-i87. https://doi.org/10.1093/europace/euaa396

Novel CineECG enables anatomical 3D localization and classification of bundle branch blocks. / Boonstra, Machteld J; Hilderink, Bashar N; Locati, Emanuela T et al.

In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Vol. 23, No. 23 Suppl 1, 04.03.2021, p. i80-i87.

Research output: Contribution to journal › Article › peer-review

Boonstra, MJ, Hilderink, BN, Locati, ET, Asselbergs, FW, Loh, P & van Dam, PM 2021, 'Novel CineECG enables anatomical 3D localization and classification of bundle branch blocks', Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, vol. 23, no. 23 Suppl 1, pp. i80-i87. https://doi.org/10.1093/europace/euaa396

Boonstra MJ, Hilderink BN, Locati ET, Asselbergs FW, Loh P, van Dam PM. Novel CineECG enables anatomical 3D localization and classification of bundle branch blocks. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2021 Mar 4;23(23 Suppl 1):i80-i87. doi: 10.1093/europace/euaa396

Boonstra, Machteld J ; Hilderink, Bashar N ; Locati, Emanuela T et al. / Novel CineECG enables anatomical 3D localization and classification of bundle branch blocks. In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2021 ; Vol. 23, No. 23 Suppl 1. pp. i80-i87.

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abstract = "AIMS: Ventricular conduction disorders can induce arrhythmias and impair cardiac function. Bundle branch blocks (BBBs) are diagnosed by 12-lead electrocardiogram (ECG), but discrimination between BBBs and normal tracings can be challenging. CineECG computes the temporo-spatial trajectory of activation waveforms in a 3D heart model from 12-lead ECGs. Recently, in Brugada patients, CineECG has localized the terminal components of ventricular depolarization to right ventricle outflow tract (RVOT), coincident with arrhythmogenic substrate localization detected by epicardial electro-anatomical maps. This abnormality was not found in normal or right BBB (RBBB) patients. This study aimed at exploring whether CineECG can improve the discrimination between left BBB (LBBB)/RBBB, and incomplete RBBB (iRBBB).METHODS AND RESULTS: We utilized 500 12-lead ECGs from the online Physionet-XL-PTB-Diagnostic ECG Database with a certified ECG diagnosis. The mean temporo-spatial isochrone trajectory was calculated and projected into the anatomical 3D heart model. We established five CineECG classes: 'Normal', 'iRBBB', 'RBBB', 'LBBB', and 'Undetermined', to which each tracing was allocated. We determined the accuracy of CineECG classification with the gold standard diagnosis. A total of 391 ECGs were analysed (9 ECGs were excluded for noise) and 240/266 were correctly classified as 'normal', 14/17 as 'iRBBB', 55/55 as 'RBBB', 51/51 as 'LBBB', and 31 as 'undetermined'. The terminal mean temporal spatial isochrone contained most information about the BBB localization.CONCLUSION: CineECG provided the anatomical localization of different BBBs and accurately differentiated between normal, LBBB and RBBB, and iRBBB. CineECG may aid clinical diagnostic work-up, potentially contributing to the difficult discrimination between normal, iRBBB, and Brugada patients.",

keywords = "Action Potentials, Arrhythmias, Cardiac/diagnosis, Bundle-Branch Block/diagnosis, Electrocardiography, Heart Ventricles, Humans",

author = "Boonstra, {Machteld J} and Hilderink, {Bashar N} and Locati, {Emanuela T} and Asselbergs, {Folkert W} and Peter Loh and {van Dam}, {Peter M}",

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doi = "10.1093/europace/euaa396",

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T1 - Novel CineECG enables anatomical 3D localization and classification of bundle branch blocks

AU - Boonstra, Machteld J

AU - Hilderink, Bashar N

AU - Locati, Emanuela T

AU - Asselbergs, Folkert W

AU - Loh, Peter

AU - van Dam, Peter M

PY - 2021/3/4

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N2 - AIMS: Ventricular conduction disorders can induce arrhythmias and impair cardiac function. Bundle branch blocks (BBBs) are diagnosed by 12-lead electrocardiogram (ECG), but discrimination between BBBs and normal tracings can be challenging. CineECG computes the temporo-spatial trajectory of activation waveforms in a 3D heart model from 12-lead ECGs. Recently, in Brugada patients, CineECG has localized the terminal components of ventricular depolarization to right ventricle outflow tract (RVOT), coincident with arrhythmogenic substrate localization detected by epicardial electro-anatomical maps. This abnormality was not found in normal or right BBB (RBBB) patients. This study aimed at exploring whether CineECG can improve the discrimination between left BBB (LBBB)/RBBB, and incomplete RBBB (iRBBB).METHODS AND RESULTS: We utilized 500 12-lead ECGs from the online Physionet-XL-PTB-Diagnostic ECG Database with a certified ECG diagnosis. The mean temporo-spatial isochrone trajectory was calculated and projected into the anatomical 3D heart model. We established five CineECG classes: 'Normal', 'iRBBB', 'RBBB', 'LBBB', and 'Undetermined', to which each tracing was allocated. We determined the accuracy of CineECG classification with the gold standard diagnosis. A total of 391 ECGs were analysed (9 ECGs were excluded for noise) and 240/266 were correctly classified as 'normal', 14/17 as 'iRBBB', 55/55 as 'RBBB', 51/51 as 'LBBB', and 31 as 'undetermined'. The terminal mean temporal spatial isochrone contained most information about the BBB localization.CONCLUSION: CineECG provided the anatomical localization of different BBBs and accurately differentiated between normal, LBBB and RBBB, and iRBBB. CineECG may aid clinical diagnostic work-up, potentially contributing to the difficult discrimination between normal, iRBBB, and Brugada patients.

AB - AIMS: Ventricular conduction disorders can induce arrhythmias and impair cardiac function. Bundle branch blocks (BBBs) are diagnosed by 12-lead electrocardiogram (ECG), but discrimination between BBBs and normal tracings can be challenging. CineECG computes the temporo-spatial trajectory of activation waveforms in a 3D heart model from 12-lead ECGs. Recently, in Brugada patients, CineECG has localized the terminal components of ventricular depolarization to right ventricle outflow tract (RVOT), coincident with arrhythmogenic substrate localization detected by epicardial electro-anatomical maps. This abnormality was not found in normal or right BBB (RBBB) patients. This study aimed at exploring whether CineECG can improve the discrimination between left BBB (LBBB)/RBBB, and incomplete RBBB (iRBBB).METHODS AND RESULTS: We utilized 500 12-lead ECGs from the online Physionet-XL-PTB-Diagnostic ECG Database with a certified ECG diagnosis. The mean temporo-spatial isochrone trajectory was calculated and projected into the anatomical 3D heart model. We established five CineECG classes: 'Normal', 'iRBBB', 'RBBB', 'LBBB', and 'Undetermined', to which each tracing was allocated. We determined the accuracy of CineECG classification with the gold standard diagnosis. A total of 391 ECGs were analysed (9 ECGs were excluded for noise) and 240/266 were correctly classified as 'normal', 14/17 as 'iRBBB', 55/55 as 'RBBB', 51/51 as 'LBBB', and 31 as 'undetermined'. The terminal mean temporal spatial isochrone contained most information about the BBB localization.CONCLUSION: CineECG provided the anatomical localization of different BBBs and accurately differentiated between normal, LBBB and RBBB, and iRBBB. CineECG may aid clinical diagnostic work-up, potentially contributing to the difficult discrimination between normal, iRBBB, and Brugada patients.

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KW - Arrhythmias, Cardiac/diagnosis

KW - Bundle-Branch Block/diagnosis

KW - Electrocardiography

KW - Heart Ventricles

KW - Humans

U2 - 10.1093/europace/euaa396

DO - 10.1093/europace/euaa396

M3 - Article

C2 - 33751077

SN - 1099-5129

VL - 23

SP - i80-i87

JO - Europace

JF - Europace

IS - 23 Suppl 1

ER -

Novel CineECG enables anatomical 3D localization and classification of bundle branch blocks

Abstract

Keywords

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