The study introduces and validates a novel high-frequency (100-400 Hz bandwidth, 2 kHz sampling frequency) electrocardiographic imaging (HFECGI) technique that measures intramural ventricular electrical activation. Ex-vivo experiments and clinical measurements were employed. Ex-vivo, two pig hearts were suspended in a human-torso shaped tank using surface tank electrodes, epicardial electrode sock, and plunge electrodes. We compared conventional epicardial electrocardiographic imaging (ECGI) with intramural activation by HFECGI and verified with sock and plunge electrodes. Clinical importance of HFECGI measurements was performed on 14 patients with variable conduction abnormalities. From 3 × 4 needle and 108 sock electrodes, 256 torso or 184 body surface electrodes records, transmural activation times, sock epicardial activation times, ECGI-derived activation times, and high-frequency activation times were computed. The ex-vivo transmural measurements showed that HFECGI measures intramural electrical activation, and ECGI-HFECGI activation times differences indicate endo-to-epi or epi-to-endo conduction direction. HFECGI-derived volumetric dyssynchrony was significantly lower than epicardial ECGI dyssynchrony. HFECGI dyssynchrony was able to distinguish between intraventricular conduction disturbance and bundle branch block patients.

Cardiocenter Department of Cardiology 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Cardiology Cardiovascular Research Institute Maastricht Maastricht University Medical Center Maastricht The Netherlands

Department of Physiology Cardiovascular Research Institute Maastricht Maastricht University Medical Center Maastricht The Netherlands

IHU Liryc Fondation Bordeaux Université Pessac Bordeaux France

INSERM CRCTB U1045 Bordeaux France

Institute of Scientific Instruments The Czech Academy of Sciences Kralovopolska 147 Brno 635 00 Czech Republic

International Clinical Research Center St Anne's University Hospital Brno Czech Republic

Univ Bordeaux CRCTB U1045 Bordeaux France

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