Einthoven's triangle adapted for horses: Proposal for the Delta configuration.
arrhythmias
electrocardiography
horse
standardization
vectorcardiography
Journal
Journal of veterinary internal medicine
ISSN: 1939-1676
Titre abrégé: J Vet Intern Med
Pays: United States
ID NLM: 8708660
Informations de publication
Date de publication:
28 Aug 2024
28 Aug 2024
Historique:
received:
25
03
2024
accepted:
06
08
2024
medline:
28
8
2024
pubmed:
28
8
2024
entrez:
28
8
2024
Statut:
aheadofprint
Résumé
Reliable ECGs are crucial for diagnosing arrhythmias, yet a lack of standardization impedes arrhythmia diagnosis and treatment in horses. To objectively determine an optimal position of Einthoven's triangle for ECG recordings in horses at rest, which can form the basis for standardized ECG recording and improve diagnosis and treatment of arrhythmias. The study involved 72 healthy, warmblood horses aged between 3 and 20 years. In view of future 12-lead studies and vectorcardiography, requiring an orthogonal system, Einthoven's triangle was positioned around the heart, in the transverse plane. Therefore, 11 electrodes were placed encircling the thorax behind the olecranon, to construct triangles with a horizontal base. Electrocardiogram recordings from different triangles were analyzed. Signal processing involved filtering, R peak detection, and median complex generation. Principal component analysis (PCA) and Euclidean distance measures were employed for data analysis. The left mid-thoracic and ventral regions had high PCA scores, indicating high information content. Base-down triangles exhibited higher summed Euclidean distances, contributing to enhanced diagnostic capabilities. A base-down triangle, called "Delta (Δ) configuration" emerged as most informative, while meeting all criteria. The base-down "Delta configuration" is the optimal Einthoven's triangle adapted for horses, providing large amplitudes and potential to provide basic insights into the mechanisms and origins of cardiac arrhythmias. Because the Delta configuration is positioned in the transverse plane, it forms the ideal basis for 12-lead ECG recordings that provide vectorcardiograms in an orthogonal coordinate system. Standardizing electrode positioning could improve ECG data comparability in equine cardiology.
Sections du résumé
BACKGROUND
BACKGROUND
Reliable ECGs are crucial for diagnosing arrhythmias, yet a lack of standardization impedes arrhythmia diagnosis and treatment in horses.
OBJECTIVES
OBJECTIVE
To objectively determine an optimal position of Einthoven's triangle for ECG recordings in horses at rest, which can form the basis for standardized ECG recording and improve diagnosis and treatment of arrhythmias.
ANIMALS
METHODS
The study involved 72 healthy, warmblood horses aged between 3 and 20 years.
METHODS
METHODS
In view of future 12-lead studies and vectorcardiography, requiring an orthogonal system, Einthoven's triangle was positioned around the heart, in the transverse plane. Therefore, 11 electrodes were placed encircling the thorax behind the olecranon, to construct triangles with a horizontal base. Electrocardiogram recordings from different triangles were analyzed. Signal processing involved filtering, R peak detection, and median complex generation. Principal component analysis (PCA) and Euclidean distance measures were employed for data analysis.
RESULTS
RESULTS
The left mid-thoracic and ventral regions had high PCA scores, indicating high information content. Base-down triangles exhibited higher summed Euclidean distances, contributing to enhanced diagnostic capabilities. A base-down triangle, called "Delta (Δ) configuration" emerged as most informative, while meeting all criteria.
CONCLUSIONS AND CLINICAL IMPORTANCE
CONCLUSIONS
The base-down "Delta configuration" is the optimal Einthoven's triangle adapted for horses, providing large amplitudes and potential to provide basic insights into the mechanisms and origins of cardiac arrhythmias. Because the Delta configuration is positioned in the transverse plane, it forms the ideal basis for 12-lead ECG recordings that provide vectorcardiograms in an orthogonal coordinate system. Standardizing electrode positioning could improve ECG data comparability in equine cardiology.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
Références
Wilson FN, Johnston FD, Macleod AG, Barker PS. Electrocardiograms that represent the potential variations of a single electrode. Am Heart J. 1934;9:447‐458.
Hamlin RL, Smith CR. Anatomical and physiologic basis for interpretation of the electrocardiogram. Am J Vet Res. 1960;21:701‐708.
Verheyen T, Decloedt A, De Clercq D, et al. Electrocardiography in horses—part 1: how to make a good recording. VDT. 2010;79:331‐336.
Hamlin RL, Smith CR. Categorization of common domestic mammals based upon their ventricular activation process. Ann N Y Acad Sci. 1965;127:195‐203.
Andries E, Stroobandt R, De Pooter J, et al. ECG‐registratie en nomenclatuur. In: Andries E, Roland Stroobandt R, De Pooter J, Verdonck F, Sinnaeve F, eds. ECG uit het hoofd. 6th ed. Antwerpen: Garant Uitgevers; 2016:107‐126.
Muylle E, Oyaert W. Equine electrocardiography: the genesis of the different configurations of the “QRS” complex. Zentralbl Veterinärmed A. 1977;24:762‐771.
Holmes JR, Alps BJ. Studies into equine electrocardiography and vectorcardiography IV. Vector distributions in some arrhythmias. Can J Comp Med Vet Sci. 1967;31:150‐155.
Van Steenkiste G, Delhaas T, Hermans B, et al. An exploratory study on electrocardiographic and vectorcardiographic differentiation of the site of origin of focally induced premature depolarizations in horses, part I: the atria. Animals. 2022;12:549.
Einthoven W. Die galvanometrische Registrirung des menschlichen Elektrokardiogramms, zugleich eine Beurtheilung der Anwendung des Capillar‐Elektrometers in der Physiologie. Arch Für Die Gesamte Physiol Des Menschen Und Der Tiere. 1903;99:472‐480.
Einthoven W. Weiteres über das Elektrokardiogramm. Arch Für Die Gesamte Physiol Des Menschen Und Der Tiere. 1908;122:517‐584.
Hesselkilde E, Isaksen J, Petersen B, et al. A novel approach for obtaining 12‐lead electrocardiograms in horses. J Vet Intern Med. 2021;35:521‐531.
Neuckermans Z, vanSteenkiste G, Decloedt A, et al. Diagnosis of left ventricular hypertrophy diagnosis by vectorcardiography: first confirmed cases. Abstracts European conference. Voorjaarsdagen. 2020.
Vernemmen I, Vera L, Van Steenkiste G, et al. Reference values for 2‐dimensional and M‐mode echocardiography in Friesian and warmblood horses. J Vet Intern Med. 2020;34:2701‐2709.
Ven S, Decloedt A, Van Der Vekens N, et al. Assessing aortic regurgitation severity from 2D, M‐mode and pulsed wave Doppler echocardiographic measurements in horses. Vet J. 2016;210:34‐38.
Hiraga A, Sugano S. History of research in Japan on electrocardiography in the racehorse. J Eq Science. 2015;26(1):1‐13.
Dubois M. Du choix des dérivations et d'une normalisation de l'électrocardiogramme chez quelques ongulés domestiques. Rec Méd Vét. 1961;133:425‐448.
Zeemering S, Lankveld TAR, Bonizzi P, et al. Principal component analysis of body surface potential mapping in atrial fibrillation patients suggests additional ECG lead locations. Conference paper: Computing in Cardiology 2014 at Cambridge, USA, Vol. 41.
Holmes JR, Darke PGGG. Studies on the development of a new lead system for equine electrocardiography. Equine Vet J. 1970;1:84‐92.
Van Steenkiste G, Boussy G, Duytschaever M, et al. Detection of the origin of atrial tachycardia by 3D electro‐anatomical mapping and treatment by radiofrequency catheter ablation in horses. J Vet Intern Med. 2022;36:1481‐1490.
Buschmann E, Van Steenkiste G, Boussy T, et al. Three‐dimensional electro‐anatomical mapping and radiofrequency ablation as a novel treatment for atrioventricular accessory pathway in a horse: a case report. J Vet Intern Med. 2023;37(2):728‐734.
Da Costa CF, Samesima N, Pastore CA. Cardiac mean electrical axis in thoroughbreds—standardization by the Dubois lead positioning system. PLoS One. 2017;12:e0169619.
Frank E. An accurate, clinically practical system for spatial vectorcardiography. Circulation. 1956;13:737‐749.
Van Steenkiste G, Delhaas T, Hermans B, et al. An exploratory study on vectorcardiographic identification of the site of origin of focally induced premature depolarizations in horses, part II: the ventricles. Animals. 2022;12:550.