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.

中文翻译：

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新型 CineECG 可实现束支传导阻滞的解剖学 3D 定位和分类

摘要

宗旨

心室传导障碍可诱发心律失常并损害心脏功能。束支传导阻滞 (BBB) 由 12 导联心电图 (ECG) 诊断，但区分 BBB 和正常描记可能具有挑战性。CineECG从 12 导联心电图计算 3D 心脏模型中激活波形的时空轨迹。最近，在 Brugada 患者中，CineECG已将心室去极化的终末成分定位到右心室流出道 (RVOT)，与心外膜电解剖图检测到的致心律失常基质定位一致。在正常或右侧 BBB (RBBB) 患者中未发现这种异常。本研究旨在探讨CineECG 可以提高左 BBB (LBBB)/RBBB 和不完全 RBBB (iRBBB) 之间的区分。

方法和结果

我们使用了来自在线 Physionet-XL-PTB-Diagnostic ECG 数据库的 500 个 12 导联 ECG，并具有经过认证的 ECG 诊断。计算平均时空等时线轨迹并将其投影到解剖 3D 心脏模型中。我们建立了五个CineECG类：“正常”、“iRBBB”、“RBBB”、“LBBB”和“未确定”，每个跟踪都分配给这些类。我们用金标准诊断确定了CineECG分类的准确性。总共分析了 391 个心电图（9 个心电图因噪音而被排除），240/266 被正确归类为“正常”，14/17 被正确归类为“iRBBB”，55/55 被归类为“RBBB”，51/51 被归类为“LBBB” , 31 为“未定”。终端平均时空等时线包含有关 BBB 定位的大部分信息。

结论

CineECG提供不同BBB的解剖定位，并准确区分正常、LBBB 和 RBBB 以及 iRBBB。CineECG可能有助于临床诊断检查，可能导致难以区分正常、iRBBB 和 Brugada 患者。