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Three-dimensional (3-D) cardiac activation imaging (3-DCAI) is a recently developed technique that aims at imaging the activation sequence throughout the the ventricular myocardium. 3-DCAI entails the modeling and estimation of the cardiac equivalent current density (ECD) distribution from which the activation time at any myocardial site is determined as the time point with the peak amplitude of local ECD estimates. In this paper, we report, for the first time, an   in vivo   validation study assessing the feasibility of 3-DCAI in comparison with the 3-D intracardiac mapping, for a group of four healthy rabbits undergoing the ventricular pacing from various locations. During the experiments, the body surface potentials and the intramural bipolar electrical recordings were simultaneously measured in a closed-chest condition. The ventricular activation sequence noninvasively imaged from the body surface measurements by using 3-DCAI was generally in agreement with that obtained from the invasive intramural recordings. The quantitative comparison between them showed a root mean square (rms) error of   ${7.42} \pm {0.61}$   ms, a relative error (RE) of    ${0.24} \pm {0.03}$  , and a localization error (LE) of   ${5.47} \pm {1.57} $  mm. The experimental results were also consistent with our computer simulations conducted in well-controlled and realistic conditions. The present study suggest that 3-DCAI can noninvasively capture some important features of ventricular excitation (e.g., the activation origin and the activation sequence), and has the potential of becoming a useful imaging tool aiding cardiovascular research and clinical diagnosis of cardiac diseases.

Noninvasive Three-Dimensional Cardiac Activation Imaging From Body Surface Potential Maps: A Computational and Experimental Study on a Rabbit Model