Localization of the ventricular pacing site from BSPM and standard 12-lead ECG: a comparison study

 Cardiac resynchronization therapy (CRT) is an accepted treatment strategy for patients with heart failure with 
reduced ejection fraction and impaired intraventricular conduction. However, a variable proportion of patients 
do not improve their clinical  status1. The optimal pacing lead placement and follow-up monitoring to verify the 
pacing electrode position have been considered essential determinants of benefit from CRT 2. Recently, body 
surface potential mapping (BSPM) and derived inverse ECG imaging methods (ECGI) have been proposed for 
the optimization of CRT 3,4. However, BSPM and ECGI are not widely used in clinical practice due to logistic 
reasons and limited evidence of superiority over standard 12-lead ECG. One of the few commercially available 
ECGI systems using the standard 12-lead ECG is  ViVo5–8. This system localizes the ectopic origin of a PVC or 
VT anywhere in the ventricles, which makes the computation time relative long (minutes). To support patient 
selection for CRT and guide CRT implants, the system needs only to search the targeted implantation area, right 
ventricular endocardium, or left epicardium. Recently, we have developed a 12-lead inverse ECG method (iECG) 
to estimate the endocardial and epicardial ventricular  activation9,10.
 T
 his proof-of-the-concept study aimed to evaluate the accuracy of our novel PaceView iECG method to 
localize the left or right ventricular (LV and RV, respectively) pacing leads, using either a 99-electrode BSPM 
or the 12-lead ECG