Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress
Abstract Aims Abnormal rate adaptation of the action potential is proarrhythmic but is difficult to measure with current electro-anatomical mapping techniques. We developed a method to rapidly quantify spatial discordance in whole heart activation in response to rate cycle length changes. We test th...
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| Veröffentlicht in: | Europace (London, England) England), 2019-09, Vol.21 (9), p.1422-1431 |
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| creator | Shun-Shin, Matthew J Leong, Kevin M W Ng, Fu Siong Linton, Nicholas W F Whinnett, Zachary I Koa-Wing, Michael Qureshi, Norman Lefroy, David C Harding, Sian E Lim, Phang Boon Peters, Nicholas S Francis, Darrel P Varnava, Amanda M Kanagaratnam, Prapa |
| description | Abstract
Aims
Abnormal rate adaptation of the action potential is proarrhythmic but is difficult to measure with current electro-anatomical mapping techniques. We developed a method to rapidly quantify spatial discordance in whole heart activation in response to rate cycle length changes. We test the hypothesis that patients with underlying channelopathies or history of aborted sudden cardiac death (SCD) have a reduced capacity to maintain uniform activation following exercise.
Methods and results
Electrocardiographical imaging (ECGI) reconstructs >1200 electrograms (EGMs) over the ventricles from a single beat, providing epicardial whole heart activation maps. Thirty-one individuals [11 SCD survivors; 10 Brugada syndrome (BrS) without SCD; and 10 controls] with structurally normal hearts underwent ECGI vest recordings following exercise treadmill. For each patient, we calculated the relative change in EGM local activation times (LATs) between a baseline and post-exertion phase using custom written software. A ventricular conduction stability (V-CoS) score calculated to indicate the percentage of ventricle that showed no significant change in relative LAT ( |
| doi_str_mv | 10.1093/europace/euz015 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_TOX</sourceid><recordid>TN_cdi_proquest_miscellaneous_2187518346</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/europace/euz015</oup_id><sourcerecordid>2187518346</sourcerecordid><originalsourceid>FETCH-LOGICAL-c373t-e172c50f9c140b44a0fec93ef52e2b62b4faa8312a5a1dab24a591e89bf649dd3</originalsourceid><addsrcrecordid>eNqFkUtv1TAQRi1U1JbSNbvKywop1I_43pgdqnhJldgA22hiT25c5dqpH1S3f4K_jCFtt6w8ls6c0cxHyBvO3nGm5RWWGBYwWIsHxtULcsqVFI1gWhzVmmndKC70CXmV0i1jbCu0OiYnknWCqQ0_Jb9_os_RmTJDpCZ4W0x2wdOUYXCzyweaMeX3FOge8xQszYE6W3vceKDgLb0rsH7MBH6HiTpP76cwI50QYqZQfb_gn3OBnDH6RG2Jzu_oMh2SC3PYOQNznRgxpdfk5QhzwvPH94z8-PTx-_WX5ubb56_XH24aI7cyN8i3wig2asNbNrQtsBGNljgqgWLYiKEdATrJBSjgFgbRgtIcOz2Mm1ZbK8_I5epdYrgrdcV-75LBeQaPoaRe8G6reCfbTUWvVtTEkFLEsV-i20M89Jz1f1Pon1Lo1xRqx8WjvAx7tM_809kr8HYFQln-a_sDb0mZxA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2187518346</pqid></control><display><type>article</type><title>Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress</title><source>Oxford Journals Open Access Collection</source><creator>Shun-Shin, Matthew J ; Leong, Kevin M W ; Ng, Fu Siong ; Linton, Nicholas W F ; Whinnett, Zachary I ; Koa-Wing, Michael ; Qureshi, Norman ; Lefroy, David C ; Harding, Sian E ; Lim, Phang Boon ; Peters, Nicholas S ; Francis, Darrel P ; Varnava, Amanda M ; Kanagaratnam, Prapa</creator><creatorcontrib>Shun-Shin, Matthew J ; Leong, Kevin M W ; Ng, Fu Siong ; Linton, Nicholas W F ; Whinnett, Zachary I ; Koa-Wing, Michael ; Qureshi, Norman ; Lefroy, David C ; Harding, Sian E ; Lim, Phang Boon ; Peters, Nicholas S ; Francis, Darrel P ; Varnava, Amanda M ; Kanagaratnam, Prapa</creatorcontrib><description>Abstract
Aims
Abnormal rate adaptation of the action potential is proarrhythmic but is difficult to measure with current electro-anatomical mapping techniques. We developed a method to rapidly quantify spatial discordance in whole heart activation in response to rate cycle length changes. We test the hypothesis that patients with underlying channelopathies or history of aborted sudden cardiac death (SCD) have a reduced capacity to maintain uniform activation following exercise.
Methods and results
Electrocardiographical imaging (ECGI) reconstructs >1200 electrograms (EGMs) over the ventricles from a single beat, providing epicardial whole heart activation maps. Thirty-one individuals [11 SCD survivors; 10 Brugada syndrome (BrS) without SCD; and 10 controls] with structurally normal hearts underwent ECGI vest recordings following exercise treadmill. For each patient, we calculated the relative change in EGM local activation times (LATs) between a baseline and post-exertion phase using custom written software. A ventricular conduction stability (V-CoS) score calculated to indicate the percentage of ventricle that showed no significant change in relative LAT (<10 ms). A lower score reflected greater conduction heterogeneity. Mean variability (standard deviation) of V-CoS score over 10 consecutive beats was small (0.9 ± 0.5%), with good inter-operator reproducibility of V-CoS scores. Sudden cardiac death survivors, compared to BrS and controls, had the lowest V-CoS scores post-exertion (P = 0.011) but were no different at baseline (P = 0.50).
Conclusion
We present a method to rapidly quantify changes in global activation which provides a measure of conduction heterogeneity and proof of concept by demonstrating SCD survivors have a reduced capacity to maintain uniform activation following exercise.</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euz015</identifier><identifier>PMID: 30820561</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Action Potentials - physiology ; Adult ; Body Surface Potential Mapping - methods ; Brugada Syndrome - diagnostic imaging ; Brugada Syndrome - physiopathology ; Case-Control Studies ; Death, Sudden, Cardiac ; Electrocardiography - methods ; Exercise Test ; Female ; Heart - diagnostic imaging ; Heart - physiopathology ; Heart Conduction System - diagnostic imaging ; Heart Conduction System - physiopathology ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - physiopathology ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Signal Processing, Computer-Assisted ; Stress, Physiological - physiology ; Survivors ; Tilt-Table Test ; Tomography, X-Ray Computed ; Ventricular Fibrillation - diagnostic imaging ; Ventricular Fibrillation - physiopathology ; Wearable Electronic Devices</subject><ispartof>Europace (London, England), 2019-09, Vol.21 (9), p.1422-1431</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com. 2019</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c373t-e172c50f9c140b44a0fec93ef52e2b62b4faa8312a5a1dab24a591e89bf649dd3</citedby><cites>FETCH-LOGICAL-c373t-e172c50f9c140b44a0fec93ef52e2b62b4faa8312a5a1dab24a591e89bf649dd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1603,27922,27923</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/europace/euz015$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30820561$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shun-Shin, Matthew J</creatorcontrib><creatorcontrib>Leong, Kevin M W</creatorcontrib><creatorcontrib>Ng, Fu Siong</creatorcontrib><creatorcontrib>Linton, Nicholas W F</creatorcontrib><creatorcontrib>Whinnett, Zachary I</creatorcontrib><creatorcontrib>Koa-Wing, Michael</creatorcontrib><creatorcontrib>Qureshi, Norman</creatorcontrib><creatorcontrib>Lefroy, David C</creatorcontrib><creatorcontrib>Harding, Sian E</creatorcontrib><creatorcontrib>Lim, Phang Boon</creatorcontrib><creatorcontrib>Peters, Nicholas S</creatorcontrib><creatorcontrib>Francis, Darrel P</creatorcontrib><creatorcontrib>Varnava, Amanda M</creatorcontrib><creatorcontrib>Kanagaratnam, Prapa</creatorcontrib><title>Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>Abstract
Aims
Abnormal rate adaptation of the action potential is proarrhythmic but is difficult to measure with current electro-anatomical mapping techniques. We developed a method to rapidly quantify spatial discordance in whole heart activation in response to rate cycle length changes. We test the hypothesis that patients with underlying channelopathies or history of aborted sudden cardiac death (SCD) have a reduced capacity to maintain uniform activation following exercise.
Methods and results
Electrocardiographical imaging (ECGI) reconstructs >1200 electrograms (EGMs) over the ventricles from a single beat, providing epicardial whole heart activation maps. Thirty-one individuals [11 SCD survivors; 10 Brugada syndrome (BrS) without SCD; and 10 controls] with structurally normal hearts underwent ECGI vest recordings following exercise treadmill. For each patient, we calculated the relative change in EGM local activation times (LATs) between a baseline and post-exertion phase using custom written software. A ventricular conduction stability (V-CoS) score calculated to indicate the percentage of ventricle that showed no significant change in relative LAT (<10 ms). A lower score reflected greater conduction heterogeneity. Mean variability (standard deviation) of V-CoS score over 10 consecutive beats was small (0.9 ± 0.5%), with good inter-operator reproducibility of V-CoS scores. Sudden cardiac death survivors, compared to BrS and controls, had the lowest V-CoS scores post-exertion (P = 0.011) but were no different at baseline (P = 0.50).
Conclusion
We present a method to rapidly quantify changes in global activation which provides a measure of conduction heterogeneity and proof of concept by demonstrating SCD survivors have a reduced capacity to maintain uniform activation following exercise.</description><subject>Action Potentials - physiology</subject><subject>Adult</subject><subject>Body Surface Potential Mapping - methods</subject><subject>Brugada Syndrome - diagnostic imaging</subject><subject>Brugada Syndrome - physiopathology</subject><subject>Case-Control Studies</subject><subject>Death, Sudden, Cardiac</subject><subject>Electrocardiography - methods</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Heart - diagnostic imaging</subject><subject>Heart - physiopathology</subject><subject>Heart Conduction System - diagnostic imaging</subject><subject>Heart Conduction System - physiopathology</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Image Processing, Computer-Assisted</subject><subject>Imaging, Three-Dimensional</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Signal Processing, Computer-Assisted</subject><subject>Stress, Physiological - physiology</subject><subject>Survivors</subject><subject>Tilt-Table Test</subject><subject>Tomography, X-Ray Computed</subject><subject>Ventricular Fibrillation - diagnostic imaging</subject><subject>Ventricular Fibrillation - physiopathology</subject><subject>Wearable Electronic Devices</subject><issn>1099-5129</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUtv1TAQRi1U1JbSNbvKywop1I_43pgdqnhJldgA22hiT25c5dqpH1S3f4K_jCFtt6w8ls6c0cxHyBvO3nGm5RWWGBYwWIsHxtULcsqVFI1gWhzVmmndKC70CXmV0i1jbCu0OiYnknWCqQ0_Jb9_os_RmTJDpCZ4W0x2wdOUYXCzyweaMeX3FOge8xQszYE6W3vceKDgLb0rsH7MBH6HiTpP76cwI50QYqZQfb_gn3OBnDH6RG2Jzu_oMh2SC3PYOQNznRgxpdfk5QhzwvPH94z8-PTx-_WX5ubb56_XH24aI7cyN8i3wig2asNbNrQtsBGNljgqgWLYiKEdATrJBSjgFgbRgtIcOz2Mm1ZbK8_I5epdYrgrdcV-75LBeQaPoaRe8G6reCfbTUWvVtTEkFLEsV-i20M89Jz1f1Pon1Lo1xRqx8WjvAx7tM_809kr8HYFQln-a_sDb0mZxA</recordid><startdate>20190901</startdate><enddate>20190901</enddate><creator>Shun-Shin, Matthew J</creator><creator>Leong, Kevin M W</creator><creator>Ng, Fu Siong</creator><creator>Linton, Nicholas W F</creator><creator>Whinnett, Zachary I</creator><creator>Koa-Wing, Michael</creator><creator>Qureshi, Norman</creator><creator>Lefroy, David C</creator><creator>Harding, Sian E</creator><creator>Lim, Phang Boon</creator><creator>Peters, Nicholas S</creator><creator>Francis, Darrel P</creator><creator>Varnava, Amanda M</creator><creator>Kanagaratnam, Prapa</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190901</creationdate><title>Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress</title><author>Shun-Shin, Matthew J ; Leong, Kevin M W ; Ng, Fu Siong ; Linton, Nicholas W F ; Whinnett, Zachary I ; Koa-Wing, Michael ; Qureshi, Norman ; Lefroy, David C ; Harding, Sian E ; Lim, Phang Boon ; Peters, Nicholas S ; Francis, Darrel P ; Varnava, Amanda M ; Kanagaratnam, Prapa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c373t-e172c50f9c140b44a0fec93ef52e2b62b4faa8312a5a1dab24a591e89bf649dd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Action Potentials - physiology</topic><topic>Adult</topic><topic>Body Surface Potential Mapping - methods</topic><topic>Brugada Syndrome - diagnostic imaging</topic><topic>Brugada Syndrome - physiopathology</topic><topic>Case-Control Studies</topic><topic>Death, Sudden, Cardiac</topic><topic>Electrocardiography - methods</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Heart - diagnostic imaging</topic><topic>Heart - physiopathology</topic><topic>Heart Conduction System - diagnostic imaging</topic><topic>Heart Conduction System - physiopathology</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Image Processing, Computer-Assisted</topic><topic>Imaging, Three-Dimensional</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Signal Processing, Computer-Assisted</topic><topic>Stress, Physiological - physiology</topic><topic>Survivors</topic><topic>Tilt-Table Test</topic><topic>Tomography, X-Ray Computed</topic><topic>Ventricular Fibrillation - diagnostic imaging</topic><topic>Ventricular Fibrillation - physiopathology</topic><topic>Wearable Electronic Devices</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shun-Shin, Matthew J</creatorcontrib><creatorcontrib>Leong, Kevin M W</creatorcontrib><creatorcontrib>Ng, Fu Siong</creatorcontrib><creatorcontrib>Linton, Nicholas W F</creatorcontrib><creatorcontrib>Whinnett, Zachary I</creatorcontrib><creatorcontrib>Koa-Wing, Michael</creatorcontrib><creatorcontrib>Qureshi, Norman</creatorcontrib><creatorcontrib>Lefroy, David C</creatorcontrib><creatorcontrib>Harding, Sian E</creatorcontrib><creatorcontrib>Lim, Phang Boon</creatorcontrib><creatorcontrib>Peters, Nicholas S</creatorcontrib><creatorcontrib>Francis, Darrel P</creatorcontrib><creatorcontrib>Varnava, Amanda M</creatorcontrib><creatorcontrib>Kanagaratnam, Prapa</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Shun-Shin, Matthew J</au><au>Leong, Kevin M W</au><au>Ng, Fu Siong</au><au>Linton, Nicholas W F</au><au>Whinnett, Zachary I</au><au>Koa-Wing, Michael</au><au>Qureshi, Norman</au><au>Lefroy, David C</au><au>Harding, Sian E</au><au>Lim, Phang Boon</au><au>Peters, Nicholas S</au><au>Francis, Darrel P</au><au>Varnava, Amanda M</au><au>Kanagaratnam, Prapa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2019-09-01</date><risdate>2019</risdate><volume>21</volume><issue>9</issue><spage>1422</spage><epage>1431</epage><pages>1422-1431</pages><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>Abstract
Aims
Abnormal rate adaptation of the action potential is proarrhythmic but is difficult to measure with current electro-anatomical mapping techniques. We developed a method to rapidly quantify spatial discordance in whole heart activation in response to rate cycle length changes. We test the hypothesis that patients with underlying channelopathies or history of aborted sudden cardiac death (SCD) have a reduced capacity to maintain uniform activation following exercise.
Methods and results
Electrocardiographical imaging (ECGI) reconstructs >1200 electrograms (EGMs) over the ventricles from a single beat, providing epicardial whole heart activation maps. Thirty-one individuals [11 SCD survivors; 10 Brugada syndrome (BrS) without SCD; and 10 controls] with structurally normal hearts underwent ECGI vest recordings following exercise treadmill. For each patient, we calculated the relative change in EGM local activation times (LATs) between a baseline and post-exertion phase using custom written software. A ventricular conduction stability (V-CoS) score calculated to indicate the percentage of ventricle that showed no significant change in relative LAT (<10 ms). A lower score reflected greater conduction heterogeneity. Mean variability (standard deviation) of V-CoS score over 10 consecutive beats was small (0.9 ± 0.5%), with good inter-operator reproducibility of V-CoS scores. Sudden cardiac death survivors, compared to BrS and controls, had the lowest V-CoS scores post-exertion (P = 0.011) but were no different at baseline (P = 0.50).
Conclusion
We present a method to rapidly quantify changes in global activation which provides a measure of conduction heterogeneity and proof of concept by demonstrating SCD survivors have a reduced capacity to maintain uniform activation following exercise.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>30820561</pmid><doi>10.1093/europace/euz015</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1099-5129 |
| ispartof | Europace (London, England), 2019-09, Vol.21 (9), p.1422-1431 |
| issn | 1099-5129 1532-2092 |
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| subjects | Action Potentials - physiology Adult Body Surface Potential Mapping - methods Brugada Syndrome - diagnostic imaging Brugada Syndrome - physiopathology Case-Control Studies Death, Sudden, Cardiac Electrocardiography - methods Exercise Test Female Heart - diagnostic imaging Heart - physiopathology Heart Conduction System - diagnostic imaging Heart Conduction System - physiopathology Heart Ventricles - diagnostic imaging Heart Ventricles - physiopathology Humans Image Processing, Computer-Assisted Imaging, Three-Dimensional Male Middle Aged Signal Processing, Computer-Assisted Stress, Physiological - physiology Survivors Tilt-Table Test Tomography, X-Ray Computed Ventricular Fibrillation - diagnostic imaging Ventricular Fibrillation - physiopathology Wearable Electronic Devices |
| title | Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress |
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