Reconstruction of three-dimensional biventricular activation based on the 12-lead ECG via patient-specific modeling
Simone Pezzuto, Frits W. Prinzen, Mark Potse, Francesco Maffessanti, François Regoli, Maria Luce Caputo, Giulio Conte, Rolf Krause, Angelo Auricchio.
EuroPACE 2021 23:640-647.


doi:10.1093/europace/euaa330 (open access)

pre-review manuscript

supplemental methods


Aims   Non-invasive imaging of electrical activation requires high-density body surface potential mapping. The 9 electrodes of the 12-lead ECG are insufficient for a reliable reconstruction with standard inverse methods. Patient-specific modeling may offer an alternative route to physiologically constraint the reconstruction. The aim of the study was to assess the feasibility of reconstructing the fully 3D electrical activation map of the ventricles from the 12-lead ECG and magnetic resonance (CMR).

Methods   Ventricular activation was estimated by iteratively optimizing the parameters (conduction velocity and sites of earliest activation) of a patient-specific model to fit the simulated to the recorded ECG. Chest and cardiac anatomy of 11 patients (QRS duration 126-180 ms, documented scar in two) were segmented from CMR images. Scar presence was assessed by MR contrast enhancement. Activation sequences were modelled with a physiologically based propagation model and ECGs with lead field theory. Validation was performed by comparing reconstructed activation maps with those acquired by invasive electroanatomical mapping of coronary sinus/veins (CS) and right (RV) and left ventricular (LV) endocardium.

Results   The QRS complex was correctly reproduced by the model (Pearson’s correlation r=0.923). Reconstructions accurately located the earliest and latest activated LV regions (median barycenter distance 8.2 mm, IQR 8.8 mm). Correlation of simulated to recorded activation time was very good at LV endocardium (r=0.83), and good at CS (r=0.68) and RV endocardium (r=0.58).

Conclusion   Non-invasive assessment of biventricular 3D activation using the 12-lead ECG and MR imaging is feasible. Potential applications include patient-specific modeling and pre-/per-procedural evaluation of ventricular activation.


The authors acknowledge financial support by the Theo Rossi di Montelera Foundation (Lausanne, Switzerland); Metis Foundation Sergio Mantegazza (Lugano, Switzerland); Fidinam Foundation (Lugano, Swizerland); Swiss Heart Foundation (Bern, Switzerland); SNSF project 32003B_165802 (Bern, Switzerland); Horten Foundation (Castelrotto, Switzerland); CSCS-Swiss National Supercomputing Centre production grant s778 (Lugano, Switzerland).