Comparison of Two Equivalent Dipole Layer Based Inverse Electrocardiography Techniques for the Non-Invasive Estimation of His-Purkinje Mediated Ventricular Activation

Non-invasive estimation of the cardiac activation sequence through inverse electrocardiography (iECG) based on the equivalent double layer becomes increasingly difficult for multiple activation waves through the myocardium. Earlier studies simulated the effect of the His-Purkinje system through a multi-focal search, which does not completely take into account the effect of multiple near simultaneous activation waves initiated by the His-Purkinje system. In this study, the iECG initial estimation of the cardiac activation sequence was modified to include electro-anatomical structures associated with the His-Purkinje system to provide a physiologically robust initial estimate. The performance of two iECG techniques for the estimation of different His-Purkinje mediated ventricular activation sequences were tested, i. e. normal activation and left and right bundle branch block activation.