J Korean Med Sci.  2012 Dec;27(12):1517-1523. 10.3346/jkms.2012.27.12.1517.

Posterior Body Surface Potential Mapping Using Capacitive-Coupled Electrodes and Its Application

• Cho Y
• Lee S
• Choi EK
• Park HE
• Park KS
• Oh S

• KMID: 2157975
• DOI: http://doi.org/10.3346/jkms.2012.27.12.1517

Abstract

Using 49 capacitive-coupled electrodes, mattress-type harness was developed to obtain posterior body surface potential map (P-BSPM) in dressed individuals. The aim of this study was to investigate how valuable information P-BSPM could provide, especially in discrimination of old myocardial infarction (OMI). P-BSPM of 59 individuals were analyzed; 23 normal control, 11 right bundle branch block (RBBB), 3 left bundle branch block (LBBB) and 19 OMI patients. Principal component analysis and linear hyper-plane approach were used to evaluate diagnostic performance. The axes of P-BSPM vector potential corresponded well with 12-lead electrocardiogram. During QRS, the end point of P-BSPM vector potential demonstrated characteristic clockwise rotation in RBBB, and counterclockwise rotation in LBBB patients. In OMI, initial negativity on P-BSPM during QRS was more frequently located at lower half, and also stronger in patients with inferior myocardial infarction (MI). The area under the receiver-operating characteristic curve of P-BSPM during QRS in diagnosing overall OMI, anterior MI, and inferior MI was 0.83 (95% confidence interval, 0.70-0.97), 0.71 (0.47-0.94), and 0.98 (0.94-1.0), respectively (P = 0.022 for anterior vs inferior MI groups). In conclusion, the novel P-BSPM provides detailed information for cardiac electrical dynamics and is applicable to diagnosing OMI, especially inferior myocardial infarction.

Keyword

Body Surface Potential Map; Electrocardiography; Myocardial Infarction

MeSH Terms

Adult
Aged
Area Under Curve
Body Surface Potential Mapping/instrumentation/*methods
Bundle-Branch Block/diagnosis
Electrocardiography
Electrodes
Humans
Male
Middle Aged
Myocardial Infarction/diagnosis
Principal Component Analysis
ROC Curve

Figure

• 

  Fig. 1 Posterior body surface potential mapping (P-BSPM) system. (A) Geometry of capacitive-coupled electrode including preamp, insulator, electrode face and shielding case. (B) Photograph of the mattress-type P-BSPM harness.

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  Fig. 2 Example of P-BSPM isopotential map and its vector potential. Potential increases from blue to red color. Small black arrows represent potential gradient vector at each electrode, which sum to vector potential of P-BSPM, the large blue arrow. Rt, right; Lt, left.

• 

  Fig. 3 Averaged iso-potential P-BSPM at specific time. (A) Normal control, (B) right bundle branch block, and (C) left bundle branch block group. Potential interval is 0.05, 0.20, and 1.0 between green, blue, and black lines, respectively. N indicates minimum negativity on the map.

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  Fig. 4 Representative tracing of vector potential during QRS. (A) Normal control, (B) right bundle branch block, and (C) left bundle branch block patients. The end point of vector was displayed in 3D-cylindrical coordinate, with averaged potential of 49 electrodes as z-axis. Each circle on the line represents 5 ms time interval and darker circles indicates later events.

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  Fig. 5 Locations of initial negativities during the ventricular depolarization normal control, anterior MI, and inferior MI groups. Four patients of anterior MI group had no negativity, and excluded from this plotting. NC, normal control; MI, myocardial infarction.

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  Fig. 6 Receiver-operating characteristic curves of P-BSPM during the QRS in diagnosing OMI. The method of the linear hyperplane approach and the principal component analysis was used. Area under the curve was 0.83 (95% confidence interval, 0.70-0.97), 0.71 (0.47-0.94), and 0.98 (0.94-1.0) for total OMI, anterior MI, and inferior MI group, respectively. OMI, old myocardial infarct; MI, myocardial infarction.

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