Variant patterns of electrical activation and recovery in normal human hearts revealed by noninvasive electrocardiographic imaging
Abstract Aims Although electrical activity of the normal human heart is well characterized by the electrocardiogram, detailed insights into within-subject and between-subject variations of ventricular activation and recovery by noninvasive electroanatomic mapping are lacking. We characterized human...
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| Veröffentlicht in: | Europace (London, England) England), 2024-07, Vol.26 (7) |
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| creator | Stoks, Job Patel, Kiran Haresh Kumar van Rees, Bianca Nguyen, Uyen Chau Mihl, Casper Deissler, Peter M ter Bekke, Rachel M A Peeters, Ralf Vijgen, Johan Dendale, Paul Ng, Fu Siong Cluitmans, Matthijs J M Volders, Paul G A |
| description | Abstract
Aims
Although electrical activity of the normal human heart is well characterized by the electrocardiogram, detailed insights into within-subject and between-subject variations of ventricular activation and recovery by noninvasive electroanatomic mapping are lacking. We characterized human epicardial activation and recovery within and between normal subjects using non-invasive electrocardiographic imaging (ECGI) as a basis to better understand pathology.
Methods and results
Epicardial activation and recovery were assessed by ECGI in 22 normal subjects, 4 subjects with bundle branch block (BBB) and 4 with long-QT syndrome (LQTS). We compared characteristics between the ventricles [left ventricle (LV) and right ventricle (RV)], sexes, and age groups ( |
| doi_str_mv | 10.1093/europace/euae172 |
| format | Article |
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Aims
Although electrical activity of the normal human heart is well characterized by the electrocardiogram, detailed insights into within-subject and between-subject variations of ventricular activation and recovery by noninvasive electroanatomic mapping are lacking. We characterized human epicardial activation and recovery within and between normal subjects using non-invasive electrocardiographic imaging (ECGI) as a basis to better understand pathology.
Methods and results
Epicardial activation and recovery were assessed by ECGI in 22 normal subjects, 4 subjects with bundle branch block (BBB) and 4 with long-QT syndrome (LQTS). We compared characteristics between the ventricles [left ventricle (LV) and right ventricle (RV)], sexes, and age groups (<50/≥50years). Pearson’s correlation coefficient (CC) was used for within-subject and between-subject comparisons. Age of normal subjects averaged 49 ± 14 years, 6/22 were male, and no structural/electrical heart disease was present. The average activation time was longer in LV than in RV, but not different by sex or age. Electrical recovery was similar for the ventricles, but started earlier and was on average shorter in males. Median CCs of between-subject comparisons of the ECG signals, activation, and recovery patterns were 0.61, 0.32, and 0.19, respectively. Within-subject beat-to-beat comparisons yielded higher CCs (0.98, 0.89, and 0.82, respectively). Activation and/or recovery patterns of patients with BBB or LQTS contrasted significantly with those found in the normal population.
Conclusion
Activation and recovery patterns vary profoundly between normal subjects, but are stable individually beat to beat, with a male preponderance to shorter recovery. Individual characterization by ECGI at baseline serves as reference to better understand the emergence, progression, and treatment of electrical heart disease.
Graphical Abstract
Graphical Abstract
Application of electrocardiographic imaging in healthy controls allows studying normal epicardial activation and recovery patterns. Top: Although all subjects had a normal ECG, we found that their underlying activation time (AT) and recovery time (RT) patterns could be profoundly different. Still, beat-to-beat AT and RT patterns within one subject were relatively similar. Bottom: On a population level, we found that average right ventricular (RV) AT was lower than left ventricular (LV) AT, and both first and average RT were lower in males than in females.</description><identifier>ISSN: 1099-5129</identifier><identifier>ISSN: 1532-2092</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euae172</identifier><identifier>PMID: 38970395</identifier><language>eng</language><publisher>UK: Oxford University Press</publisher><subject>Action Potentials ; Adult ; Age ; Age Factors ; Aged ; Bundle-Branch Block - diagnosis ; Bundle-Branch Block - physiopathology ; Cardiovascular disease ; Case-Control Studies ; Clinical Research ; EKG ; Electrocardiography ; Epicardial Mapping ; Female ; Heart diseases ; Heart Rate ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - physiopathology ; Humans ; Long QT Syndrome - diagnosis ; Long QT Syndrome - physiopathology ; Male ; Middle Aged ; Predictive Value of Tests ; Time Factors ; Ventricle</subject><ispartof>Europace (London, England), 2024-07, Vol.26 (7)</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. 2024</rights><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c377t-5737c1ed34dc51c5e5bea4e07b339fb92080a0a11b75e4e2a773a470f5f600a63</cites><orcidid>0000-0003-4278-0132 ; 0000-0002-4992-914X ; 0000-0001-8881-5498 ; 0000-0003-0821-4559 ; 0000-0002-3456-7668 ; 0000-0002-8681-4368 ; 0000-0002-2652-1598 ; 0000-0002-4836-2946 ; 0000-0002-7499-0815 ; 0000-0002-9973-8181 ; 0000-0003-1348-6970 ; 0000-0002-1388-3039 ; 0000-0003-4928-4836</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226755/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226755/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,886,1605,27929,27930,53796,53798</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38970395$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stoks, Job</creatorcontrib><creatorcontrib>Patel, Kiran Haresh Kumar</creatorcontrib><creatorcontrib>van Rees, Bianca</creatorcontrib><creatorcontrib>Nguyen, Uyen Chau</creatorcontrib><creatorcontrib>Mihl, Casper</creatorcontrib><creatorcontrib>Deissler, Peter M</creatorcontrib><creatorcontrib>ter Bekke, Rachel M A</creatorcontrib><creatorcontrib>Peeters, Ralf</creatorcontrib><creatorcontrib>Vijgen, Johan</creatorcontrib><creatorcontrib>Dendale, Paul</creatorcontrib><creatorcontrib>Ng, Fu Siong</creatorcontrib><creatorcontrib>Cluitmans, Matthijs J M</creatorcontrib><creatorcontrib>Volders, Paul G A</creatorcontrib><title>Variant patterns of electrical activation and recovery in normal human hearts revealed by noninvasive electrocardiographic imaging</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>Abstract
Aims
Although electrical activity of the normal human heart is well characterized by the electrocardiogram, detailed insights into within-subject and between-subject variations of ventricular activation and recovery by noninvasive electroanatomic mapping are lacking. We characterized human epicardial activation and recovery within and between normal subjects using non-invasive electrocardiographic imaging (ECGI) as a basis to better understand pathology.
Methods and results
Epicardial activation and recovery were assessed by ECGI in 22 normal subjects, 4 subjects with bundle branch block (BBB) and 4 with long-QT syndrome (LQTS). We compared characteristics between the ventricles [left ventricle (LV) and right ventricle (RV)], sexes, and age groups (<50/≥50years). Pearson’s correlation coefficient (CC) was used for within-subject and between-subject comparisons. Age of normal subjects averaged 49 ± 14 years, 6/22 were male, and no structural/electrical heart disease was present. The average activation time was longer in LV than in RV, but not different by sex or age. Electrical recovery was similar for the ventricles, but started earlier and was on average shorter in males. Median CCs of between-subject comparisons of the ECG signals, activation, and recovery patterns were 0.61, 0.32, and 0.19, respectively. Within-subject beat-to-beat comparisons yielded higher CCs (0.98, 0.89, and 0.82, respectively). Activation and/or recovery patterns of patients with BBB or LQTS contrasted significantly with those found in the normal population.
Conclusion
Activation and recovery patterns vary profoundly between normal subjects, but are stable individually beat to beat, with a male preponderance to shorter recovery. Individual characterization by ECGI at baseline serves as reference to better understand the emergence, progression, and treatment of electrical heart disease.
Graphical Abstract
Graphical Abstract
Application of electrocardiographic imaging in healthy controls allows studying normal epicardial activation and recovery patterns. Top: Although all subjects had a normal ECG, we found that their underlying activation time (AT) and recovery time (RT) patterns could be profoundly different. Still, beat-to-beat AT and RT patterns within one subject were relatively similar. Bottom: On a population level, we found that average right ventricular (RV) AT was lower than left ventricular (LV) AT, and both first and average RT were lower in males than in females.</description><subject>Action Potentials</subject><subject>Adult</subject><subject>Age</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Bundle-Branch Block - diagnosis</subject><subject>Bundle-Branch Block - physiopathology</subject><subject>Cardiovascular disease</subject><subject>Case-Control Studies</subject><subject>Clinical Research</subject><subject>EKG</subject><subject>Electrocardiography</subject><subject>Epicardial Mapping</subject><subject>Female</subject><subject>Heart diseases</subject><subject>Heart Rate</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Long QT Syndrome - diagnosis</subject><subject>Long QT Syndrome - physiopathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>Time Factors</subject><subject>Ventricle</subject><issn>1099-5129</issn><issn>1532-2092</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNqNksuLFDEQxhtR3IfePUnAi7C05tHpdE6yLL5gwYt6DdXp6pksPUmbpBvm6l9uhpld1IueUvD96ktV8lXVC0bfMKrFW1ximMFiKQCZ4o-qcyYFrznV_HGpqda1ZFyfVRcp3VFKFdfyaXUmOq2o0PK8-vkdogOfyQw5Y_SJhJHghDZHZ2EiYLNbIbvgCfiBRLRhxbgnzhMf4q4Q22UHnmwRYk5FXxEmHEi_L7p3foXkVjw5BgtxcGETYd46S9wONs5vnlVPRpgSPj-dl9W3D--_3nyqb798_HxzfVtboVSupRLKMhxEM1jJrETZIzRIVS-EHnvNaUeBAmO9ktggB6UENIqOcmwphVZcVu-OvvPS73Cw6HOEycyxzBH3JoAzfyrebc0mrIYxzlslZXF4fXKI4ceCKZudSxanCTyGJRlBu1Z0omub_0BV23AumwP66i_0LizRl6cwgvECdB0_3E2PlI0hpYjjw-CMmkMYzH0YzCkMpeXl7ws_NNz_fgGujkBY5n_b_QJ9f8YJ</recordid><startdate>20240702</startdate><enddate>20240702</enddate><creator>Stoks, Job</creator><creator>Patel, Kiran Haresh Kumar</creator><creator>van Rees, Bianca</creator><creator>Nguyen, Uyen Chau</creator><creator>Mihl, Casper</creator><creator>Deissler, Peter M</creator><creator>ter Bekke, Rachel M A</creator><creator>Peeters, Ralf</creator><creator>Vijgen, Johan</creator><creator>Dendale, Paul</creator><creator>Ng, Fu Siong</creator><creator>Cluitmans, Matthijs J M</creator><creator>Volders, Paul G A</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>TOX</scope><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>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4278-0132</orcidid><orcidid>https://orcid.org/0000-0002-4992-914X</orcidid><orcidid>https://orcid.org/0000-0001-8881-5498</orcidid><orcidid>https://orcid.org/0000-0003-0821-4559</orcidid><orcidid>https://orcid.org/0000-0002-3456-7668</orcidid><orcidid>https://orcid.org/0000-0002-8681-4368</orcidid><orcidid>https://orcid.org/0000-0002-2652-1598</orcidid><orcidid>https://orcid.org/0000-0002-4836-2946</orcidid><orcidid>https://orcid.org/0000-0002-7499-0815</orcidid><orcidid>https://orcid.org/0000-0002-9973-8181</orcidid><orcidid>https://orcid.org/0000-0003-1348-6970</orcidid><orcidid>https://orcid.org/0000-0002-1388-3039</orcidid><orcidid>https://orcid.org/0000-0003-4928-4836</orcidid></search><sort><creationdate>20240702</creationdate><title>Variant patterns of electrical activation and recovery in normal human hearts revealed by noninvasive electrocardiographic imaging</title><author>Stoks, Job ; Patel, Kiran Haresh Kumar ; van Rees, Bianca ; Nguyen, Uyen Chau ; Mihl, Casper ; Deissler, Peter M ; ter Bekke, Rachel M A ; Peeters, Ralf ; Vijgen, Johan ; Dendale, Paul ; Ng, Fu Siong ; Cluitmans, Matthijs J M ; Volders, Paul G A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c377t-5737c1ed34dc51c5e5bea4e07b339fb92080a0a11b75e4e2a773a470f5f600a63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Action Potentials</topic><topic>Adult</topic><topic>Age</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Bundle-Branch Block - diagnosis</topic><topic>Bundle-Branch Block - physiopathology</topic><topic>Cardiovascular disease</topic><topic>Case-Control Studies</topic><topic>Clinical Research</topic><topic>EKG</topic><topic>Electrocardiography</topic><topic>Epicardial Mapping</topic><topic>Female</topic><topic>Heart diseases</topic><topic>Heart Rate</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Long QT Syndrome - diagnosis</topic><topic>Long QT Syndrome - physiopathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>Time Factors</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stoks, Job</creatorcontrib><creatorcontrib>Patel, Kiran Haresh Kumar</creatorcontrib><creatorcontrib>van Rees, Bianca</creatorcontrib><creatorcontrib>Nguyen, Uyen Chau</creatorcontrib><creatorcontrib>Mihl, Casper</creatorcontrib><creatorcontrib>Deissler, Peter M</creatorcontrib><creatorcontrib>ter Bekke, Rachel M A</creatorcontrib><creatorcontrib>Peeters, Ralf</creatorcontrib><creatorcontrib>Vijgen, Johan</creatorcontrib><creatorcontrib>Dendale, Paul</creatorcontrib><creatorcontrib>Ng, Fu Siong</creatorcontrib><creatorcontrib>Cluitmans, Matthijs J M</creatorcontrib><creatorcontrib>Volders, Paul G A</creatorcontrib><collection>Access via Oxford University Press (Open Access Collection)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stoks, Job</au><au>Patel, Kiran Haresh Kumar</au><au>van Rees, Bianca</au><au>Nguyen, Uyen Chau</au><au>Mihl, Casper</au><au>Deissler, Peter M</au><au>ter Bekke, Rachel M A</au><au>Peeters, Ralf</au><au>Vijgen, Johan</au><au>Dendale, Paul</au><au>Ng, Fu Siong</au><au>Cluitmans, Matthijs J M</au><au>Volders, Paul G A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Variant patterns of electrical activation and recovery in normal human hearts revealed by noninvasive electrocardiographic imaging</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2024-07-02</date><risdate>2024</risdate><volume>26</volume><issue>7</issue><issn>1099-5129</issn><issn>1532-2092</issn><eissn>1532-2092</eissn><abstract>Abstract
Aims
Although electrical activity of the normal human heart is well characterized by the electrocardiogram, detailed insights into within-subject and between-subject variations of ventricular activation and recovery by noninvasive electroanatomic mapping are lacking. We characterized human epicardial activation and recovery within and between normal subjects using non-invasive electrocardiographic imaging (ECGI) as a basis to better understand pathology.
Methods and results
Epicardial activation and recovery were assessed by ECGI in 22 normal subjects, 4 subjects with bundle branch block (BBB) and 4 with long-QT syndrome (LQTS). We compared characteristics between the ventricles [left ventricle (LV) and right ventricle (RV)], sexes, and age groups (<50/≥50years). Pearson’s correlation coefficient (CC) was used for within-subject and between-subject comparisons. Age of normal subjects averaged 49 ± 14 years, 6/22 were male, and no structural/electrical heart disease was present. The average activation time was longer in LV than in RV, but not different by sex or age. Electrical recovery was similar for the ventricles, but started earlier and was on average shorter in males. Median CCs of between-subject comparisons of the ECG signals, activation, and recovery patterns were 0.61, 0.32, and 0.19, respectively. Within-subject beat-to-beat comparisons yielded higher CCs (0.98, 0.89, and 0.82, respectively). Activation and/or recovery patterns of patients with BBB or LQTS contrasted significantly with those found in the normal population.
Conclusion
Activation and recovery patterns vary profoundly between normal subjects, but are stable individually beat to beat, with a male preponderance to shorter recovery. Individual characterization by ECGI at baseline serves as reference to better understand the emergence, progression, and treatment of electrical heart disease.
Graphical Abstract
Graphical Abstract
Application of electrocardiographic imaging in healthy controls allows studying normal epicardial activation and recovery patterns. Top: Although all subjects had a normal ECG, we found that their underlying activation time (AT) and recovery time (RT) patterns could be profoundly different. Still, beat-to-beat AT and RT patterns within one subject were relatively similar. Bottom: On a population level, we found that average right ventricular (RV) AT was lower than left ventricular (LV) AT, and both first and average RT were lower in males than in females.</abstract><cop>UK</cop><pub>Oxford University Press</pub><pmid>38970395</pmid><doi>10.1093/europace/euae172</doi><orcidid>https://orcid.org/0000-0003-4278-0132</orcidid><orcidid>https://orcid.org/0000-0002-4992-914X</orcidid><orcidid>https://orcid.org/0000-0001-8881-5498</orcidid><orcidid>https://orcid.org/0000-0003-0821-4559</orcidid><orcidid>https://orcid.org/0000-0002-3456-7668</orcidid><orcidid>https://orcid.org/0000-0002-8681-4368</orcidid><orcidid>https://orcid.org/0000-0002-2652-1598</orcidid><orcidid>https://orcid.org/0000-0002-4836-2946</orcidid><orcidid>https://orcid.org/0000-0002-7499-0815</orcidid><orcidid>https://orcid.org/0000-0002-9973-8181</orcidid><orcidid>https://orcid.org/0000-0003-1348-6970</orcidid><orcidid>https://orcid.org/0000-0002-1388-3039</orcidid><orcidid>https://orcid.org/0000-0003-4928-4836</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Europace (London, England), 2024-07, Vol.26 (7) |
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| subjects | Action Potentials Adult Age Age Factors Aged Bundle-Branch Block - diagnosis Bundle-Branch Block - physiopathology Cardiovascular disease Case-Control Studies Clinical Research EKG Electrocardiography Epicardial Mapping Female Heart diseases Heart Rate Heart Ventricles - diagnostic imaging Heart Ventricles - physiopathology Humans Long QT Syndrome - diagnosis Long QT Syndrome - physiopathology Male Middle Aged Predictive Value of Tests Time Factors Ventricle |
| title | Variant patterns of electrical activation and recovery in normal human hearts revealed by noninvasive electrocardiographic imaging |
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