Reconstruction of three-dimensional biventricular activation based on the 12-lead electrocardiogram via patient-specific modelling

Simone Pezzuto*, Frits W. Prinzen, Mark Potse, Francesco Maffessanti, Francois Regoli, Maria Luce Caputo, Giulio Conte, Rolf Krause, Angelo Auricchio

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aims Non-invasive imaging of electrical activation requires high-density body surface potential mapping. The nine electrodes of the 12-lead electrocardiogram (ECG) are insufficient for a reliable reconstruction with standard inverse methods. Patient-specific modelling may offer an alternative route to physiologically constraint the reconstruction. The aim of the study was to assess the feasibility of reconstructing the fully 3D electrical activation map of the ventricles from the 12-lead ECG and cardiovascular magnetic resonance (CMR).

Methods and results Ventricular activation was estimated by iteratively optimizing the parameters (conduction velocity and sites of earliest activation) of a patient-specific model to fit the simulated to the recorded ECG. Chest and cardiac anatomy of 11 patients (QRS duration 126-180 ms, documented scar in two) were segmented from CMR images. Scar presence was assessed by magnetic resonance (MR) contrast enhancement. Activation sequences were modelled with a physiologically based propagation model and ECGs with lead field theory. Validation was performed by comparing reconstructed activation maps with those acquired by invasive electroanatomical mapping of coronary sinus/ veins (CS) and right ventricular (RV) and left ventricular (LV) endocardium. The QRS complex was correctly reproduced by the model (Pearson's correlation r = 0.923). Reconstructions accurately located the earliest and latest activated LV regions (median barycentre distance 8.2 mm, IQR 8.8 mm). Correlation of simulated with recorded activation time was very good at LV endocardium (r = 0.83) and good at CS (r = 0.68) and RV endocardium (r = 0.58).

Conclusion Non-invasive assessment of biventricular 3D activation using the 12-lead ECG and MR imaging is feasible. Potential applications include patient-specific modelling and pre-/per-procedural evaluation of ventricular activation.

Original languageEnglish
Pages (from-to)640-647
Number of pages8
JournalEP Europace
Issue number4
Publication statusPublished - Apr 2021


  • Twelve-lead electrocardiogram
  • Ventricular activation
  • Three-dimensional activation
  • Eikonal model
  • Patient-specific modelling

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