Evaluation of Bipolar, Tripolar, and Quadripolar Laplacian Estimates of Electrocardiogram via Concentric Ring Electrodes

Surface Laplacian estimates via concentric ring electrodes (CREs) have proven to enhance spatial resolution compared to conventional disc electrodes, which is of great importance for P-wave analysis. In this study, Laplacian estimates for traditional bipolar configuration (BC), two tripolar configurations with linearly decreasing and increasing inter-ring distances (TCLDIRD and TCLIIRD, respectively), and quadripolar configuration (QC) were obtained from cardiac recordings with pentapolar CREs placed at CMV1 and CMV2 positions. Normalized P-wave amplitude (NAP) was computed to assess the contrast to study atrial activity. Signals were of good quality (20–30 dB). Atrial activity was more emphasized at CMV1 (NAP ≃ 0.19–0.24) compared to CMV2 (NAP ≃ 0.08–0.10). Enhanced spatial resolution of TCLIIRD and QC resulted in higher NAP values than BC and TCLDIRD. Comparison with simultaneous standard 12-lead ECG proved that Laplacian estimates at CMV1 outperformed all the limb and chest standard leads in the contrast to study P-waves. Clinical recordings with CRE at this position could allow more detailed observation of atrial activity and facilitate the diagnosis of associated pathologies. Furthermore, such recordings would not require additional electrodes on limbs and could be performed wirelessly, so it should also be suitable for ambulatory monitoring, for example, using cardiac Holter monitors.

[1]  Alastair Gray,et al.  Economic burden of cardiovascular diseases in the enlarged European Union. , 2006, European heart journal.

[2]  Oleksandr Makeyev,et al.  Improving the Accuracy of Laplacian Estimation with Novel Variable Inter-Ring Distances Concentric Ring Electrodes , 2016, Sensors.

[3]  Bin He,et al.  A spline Laplacian ECG estimator in a realistic geometry volume conductor , 2002, IEEE Transactions on Biomedical Engineering.

[4]  P. Tarjan,et al.  An ultra-high common-mode rejection ratio (CMRR) AC instrumentation amplifier for laplacian electrocardiographic measurement. , 1999, Biomedical instrumentation & technology.

[5]  Tse Nga Ng,et al.  Stretchable Dry Electrodes with Concentric Ring Geometry for Enhancing Spatial Resolution in Electrophysiology , 2017, Advanced healthcare materials.

[6]  W. Besio,et al.  Tripolar Laplacian electrocardiogram and moment of activation isochronal mapping , 2007, Physiological measurement.

[7]  Bin He,et al.  On the Estimation of the Laplacian Electrocardiogram during Ventricular Activation , 1999, Annals of Biomedical Engineering.

[8]  N. Townsend,et al.  Trends in the epidemiology of cardiovascular disease in the UK , 2016, Heart.

[9]  W. Besio,et al.  Development of a Tri-polar Concentric Ring Electrode for Acquiring Accurate Laplacian Body Surface Potentials , 2006, Annals of Biomedical Engineering.

[10]  Peter P. Tarjan,et al.  Pasteless, Active, Concentric Ring Sensors for Directly Obtained Laplacian Cardiac Electrograms , 2002 .

[11]  Walter G. Besio,et al.  Improvement of spatial selectivity and decrease of mutual information of tri-polar concentric ring electrodes , 2007, Journal of Neuroscience Methods.

[12]  G. Prats-Boluda,et al.  Towards the clinical use of concentric electrodes in ECG recordings: influence of ring dimensions and electrode position , 2016 .

[13]  Weizhong Dai,et al.  Tri-polar concentric ring electrode development for Laplacian electroencephalography , 2006, IEEE Transactions on Biomedical Engineering.

[14]  Jaakko Malmivuo,et al.  The Basis of ECG Diagnosis , 1995 .

[15]  Robert L. Lux,et al.  Supplemented standard 12-lead electrocardiogram for optimal diagnosis and reconstruction of significant body surface map patterns. , 2008, Journal of electrocardiology.

[16]  Eduardo García-Breijo,et al.  A Flexible Multiring Concentric Electrode for Non-Invasive Identification of Intestinal Slow Waves , 2018, Sensors.

[17]  J. Cheng,et al.  Body surface Laplacian mapping of atrial depolarization in healthy human subjects , 2002, Medical and Biological Engineering and Computing.

[18]  Alan D. Lopez,et al.  Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015 , 2017, Journal of the American College of Cardiology.

[19]  R. Cohen,et al.  Body surface Laplacian ECG mapping , 1992, IEEE Transactions on Biomedical Engineering.

[20]  O. Makeyev.  Solving the general inter-ring distances optimization problem for concentric ring electrodes to improve Laplacian estimation , 2018, BioMedical Engineering OnLine.

[21]  B. Lindsay,et al.  Noninvasive Electroanatomic Mapping of Human Ventricular Arrhythmias with Electrocardiographic Imaging , 2011, Science Translational Medicine.

[22]  Alan D. Lopez,et al.  Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data , 2006, The Lancet.

[23]  Eduardo García-Breijo,et al.  Textile Concentric Ring Electrodes: Influence of Position and Electrode Size on Cardiac Activity Monitoring , 2018, J. Sensors.

[24]  G. Huiskamp.  Difference formulas for the surface Laplacian on a triangulated surface , 1991 .

[25]  Javier Garcia-Casado,et al.  Feasibility and Analysis of Bipolar Concentric Recording of Electrohysterogram with Flexible Active Electrode , 2014, Annals of Biomedical Engineering.

[26]  Yiyao Ye-Lin,et al.  Wireless sensor node for non-invasive high precision electrocardiographic signal acquisition based on a multi-ring electrode , 2017 .

[27]  Willis J. Tompkins,et al.  Quantitative Investigation of QRS Detection Rules Using the MIT/BIH Arrhythmia Database , 1986, IEEE Transactions on Biomedical Engineering.

[28]  Yiyao Ye-Lin,et al.  Active concentric ring electrode for non-invasive detection of intestinal myoelectric signals. , 2011, Medical engineering & physics.

[29]  B He,et al.  Body surface Laplacian electrocardiographic mapping--a review. , 1995, Critical reviews in biomedical engineering.

[30]  Eduardo García-Breijo,et al.  Textile Concentric Ring Electrodes for ECG Recording Based on Screen-Printing Technology , 2018, Sensors.

[31]  R. Maniewski,et al.  An Analysis of the U‐Wave and Its Relation to the T‐Wave in Body Surface Potential Maps for Healthy Subjects and MI Patients , 2014, Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc.

[32]  Oleksandr Makeyev,et al.  Proof of concept Laplacian estimate derived for noninvasive tripolar concentric ring electrode with incorporated radius of the central disc and the widths of the concentric rings , 2017, 2017 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[33]  R J Cohen,et al.  Body surface Laplacian mapping of cardiac electrical activity. , 1992, The American journal of cardiology.

[34]  H. Hosaka,et al.  Body Surface Laplacian Mapping in Patients with Left or Right Ventricular Bundle Branch Block , 1998, Pacing and clinical electrophysiology : PACE.

[35]  G. Prats-Boluda,et al.  Development of a portable wireless system for bipolar concentric ECG recording , 2015 .

[36]  B He,et al.  Laplacian electrocardiography. , 1999, Critical reviews in biomedical engineering.

[37]  Peter P. Tarjan,et al.  Optimization Of Multi-ring Sensing Electrode Set , 1990, [1990] Proceedings of the Twelfth Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[38]  O. Makeyev,et al.  Improving the accuracy of Laplacian estimation with novel multipolar concentric ring electrodes. , 2016, Measurement : journal of the International Measurement Confederation.

[39]  A SippensGroenewegen,et al.  Body surface mapping during pacing at multiple sites in the human atrium: P-wave morphology of ectopic right atrial activation. , 1998, Circulation.