CineECG for visualization of changes in ventricular electrical activity during ischemia

CineECG offers a visual representation of the location and direction of the average ventricular electrical activity throughout a single cardiac cycle, based on the 12‑lead ECG. Currently, CineECG has not been used to visualize ventricular activation patterns during ischemia. To determine the changes in ventricular activity during acute ischemia with the use of CineECG, and relating this to changes in the ECG. Continuous ECG's during percutaneous coronary intervention with prolonged balloon inflation from the STAFF III database were analyzed with CineECG at baseline and every 10 s throughout the first 150 s of balloon inflation. The CineECG direction was determined for the initial QRS-complex, terminal QRS-complex, ST-segment and T-wave. Changes in the CineECG were quantified by calculating the Δangle between the direction at baseline and the direction at every 10 s of inflation. Additionally, the root mean square amplitude (rmsA) of the ST-segment was computed. 94 patients were included. At start inflation, the median Δangle was 14.7° [7.5–33.4], 21.8° [11.4–34.2], 20.6° [8.0–43.9], and 23.5° [11.8–48.0] for the initial QRS-complex, terminal QRS-complex, ST-segment and T-wave, respectively. Meanwhile, the median rmsA increased from 0.039 mV [0.027–0.058] at baseline to 0.045 mV [0.033–0.075] at start of inflation. CineECG was able to detect immediate changes in ventricular electrical activity during induced ischemia, while changes in the ST-segment of the ECG were still subtle. Therefore, CineECG might support the early detection of acute ischemia, even before distinct ECG changes become visible.