Body Surface Electrocardiographic Mapping for Non-invasive Identification of Arrhythmic Sources

Abstract

The structural and/or functional abnormality of the cardiac electrovascular system is the most common cause of world mortality accounting for 29.0 % of deaths, followed by infectious diseases (16.2 %) and cancers (12.6 %) (WHO 2008 report).1 Abnormalities in the cardiac electrical system (arrhythmias and sudden death) and/or mechanical function (heart failure) constitute one of the major causes of disability and death, which heavily burden the health care systems across the globe. In cardiac electrophysiology and arrhythmias, several decades of research has led to the development of electrocardiographic imaging (ECGI), a novel three-dimensional (3D), 252-lead, body surface ECG-based, non-invasive epicardial imaging modality. This technique images potentials, electrograms and activation sequences (isochrones) on the epicardial surface of the heart. 2 This tool has been investigated in the normal cardiac electrophysiology and various tachyarrhythmic, conduction and anomalous depo-repolarisation disorders. It has been emerging as a tool of potentially higher clinical value than the 12-lead ECG in terms of sensitivity, specificity and accuracy in the diagnostic and therapeutic management of cardiac rhythm disorders.Here we describe the potential of this non-invasive mapping technique developed by Rudy 2 in identifying the sources of electrical disorders of the heart like atrial arrhythmias (premature atrial beat, atrial tachycardia, AbstractThe authors describe a novel three-dimensional, 252-lead electrocardiography (ECG) and computed tomography (CT)-based non-invasive cardiac imaging and mapping modality. This technique images potentials, electrograms and activation sequences (isochrones) on the epicardial surface of the heart. This tool has been investigated in the normal cardiac electrophysiology and various tachyarrhythmic, conduction and anomalous depo-repolarisation disorders. The clinical application of this system includes a wide range of electrical disorders like atrial arrhythmias (premature atrial beat, atrial tachycardia, atrial fibrillation), ventricular arrhythmias (premature ventricular beat, ventricular tachycardia) and ventricular pre-excitation (Wolff-Parkinson-White syndrome). In addition, the system has been used in exploring abnormalities of the His-Purkinje conduction like the bundle branch block and intraventricular conduction disturbance and thereby useful in electrically treating the associated heart failure (cardiac resynchronisation). It has a potential role in furthering our understanding of abnormalities of ventricular action potential (depolarisation [Brugada syndrome and repolarisation], long QT and early repolarisation syndromes) and in evaluating the impact of drugs on His-Purkinje conduction and cardiac action potential.

Combining Biophysical Modeling and Machine Learning to Predict Location of Atrial Ectopic Triggers

“…The development of non-invasive techniques based on surface ECG data that can assist electrophysiologist intraoperatively to track the electrical triggers could improve radio-frequency ablation success rates. Atrial arrhythmic events induced artificially from an intracardiac catheter have been successfully related to indices derived from body surface potential maps (BSPM) [3]. Decision trees have also been proposed to help identify the source of FAT from BSPM data [4], although within a limited number of regions.…”

Performance of Inverse Problem Regularization Methods for Driver Location during Atrial Fibrillation

“…Recently, some works have focused on techniques for locating AF drivers [2][3][4] since the isolation of AF sources (by ablation) has been reported to be an effective approach in restoring sinus rhythm [5,6].…”

Inverse Problem of Electrocardiography: Estimating the Location of Cardiac Ischemia in a 3D Realistic Geometry

“…Cardiac arrhythmias are disturbances in the normal rhythm of the heart produced by an abnormal electrical activity. They are one of the major causes of death worldwide [19]. Cardiac arrhythmias can be analyzed by means of noninvasive procedures aiming to characterize the cardiac electric sources (membrane potential, epicardial or endocardical potentials, activation times) and/or the cardiac substrate (ischemia regions, post-infarct scars) from voltages recorded by electrodes systems which are not in direct contact with the cardiac tissue [17,2].…”