Trajectories of the Single Moving Equivalent Dipole in Subjects With Left Fascicular Block

Vito Starc1 and Cees A. Swenne2
1University of Ljubljana Faculty of Medicine, 2Leiden University Medical Center


Abstract

Aims: At CinC 2017 we presented an application based on a spherically bounded model with homogeneous volume conductor to determine location, strength and orientation of a single moving equivalent dipole (SMED) in 12-lead ECGs. To initially explore its potential clinical use, we wanted to verify that the SMEDs in conduction defects will be in other locations than those in a healthy heart. To this purpose, we studied ECGs with left fascicular blocks. Methods: Applying ECG criteria of RS patterns in the extremity leads in the absence of other ECG abnormalities, we studied subjects with left anterior fascicular block (LAFB, n=10) and subjects with left posterior fascicular block (LPFB, n=18), and contrasted these with subjects with normal ECGs (n=42, with two recordings within one year), focusing on the initial 60 ms of the QRS complex. The SMEDs were determined in 5-min supine resting 12-lead ECGs with a time resolution of 1 ms. Results: Subjects with a normal ECG exhibited diverse, but characteristic SMED trajectory patterns, stable over time. The trajectories were confined into a narrow space with initial orientation anteriorly and towards the septum and later orientation along the long ventricular axis. In LPFB ECGs the SMEDs appeared in 15/18 cases above the center with anterior and basal orientation and moved after ~10-20 ms downward with apical and slightly posterior orientation, exhibiting a typical flip. In LAFB ECGs, the SMED trajectories were less typical and exhibited a to-and-fro movement in the postero-basal to antero-apical direction with initial apical and posterior orientation that flipped in ~10-20 ms to a predominant anterior orientation. Conclusions: This initial study with single moving equivalent dipole assessment shows promising, so far unexplored, ECG-derived information. Further research in ECGs with various pathology is needed to investigate the possible applicability of this analysis in future ECG diagnostic algorithms.