ECG imaging of ventricular tachycardia: evaluation against simultaneous non-contact mapping and CMR-derived grey zone

Abstract

ECG imaging is an emerging technology for the reconstruction of cardiac electric activity from non-invasively measured body surface potential maps. In this case report, we present the first evaluation of transmurally imaged activation times against endocardially reconstructed isochrones for a case of sustained monomorphic ventricular tachycardia (VT). Computer models of the thorax and whole heart were produced from MR images. A recently published approach was applied to facilitate electrode localization in the catheter laboratory, which allows for the acquisition of body surface potential maps while performing non-contact mapping for the reconstruction of local activation times. ECG imaging was then realized using Tikhonov regularization with spatio-temporal smoothing as proposed by Huiskamp and Greensite and further with the spline-based approach by Erem et al. Activation times were computed from transmurally reconstructed transmembrane voltages. The results showed good qualitative agreement between the non-invasively and invasively reconstructed activation times. Also, low amplitudes in the imaged transmembrane voltages were found to correlate with volumes of scar and grey zone in delayed gadolinium enhancement cardiac MR. The study underlines the ability of ECG imaging to produce activation times of ventricular electric activity-and to represent effects of scar tissue in the imaged transmembrane voltages.

Electrocardiographic imaging for cardiac arrhythmias and resynchronization therapy

“… 21 Three case reports demonstrated the successful application of ECGi in guiding the diagnosis and therapy of VT by accurately localizing pathologic foci. 64 , 66 , 67 …”

Validation and Opportunities of Electrocardiographic Imaging: From Technical Achievements to Clinical Applications

“…This database is called the Experimental Data and Geometric Analysis Repository (EDGAR 3 ) and is hosted at the University of Utah, as described in Aras et al (2015) . EDGAR has already supported a number of cross-laboratory validation studies published in both journals and relevant conferences ( Chamorro-Servent et al, 2016 ; Schulze et al, 2017 ; Cluitmans et al, 2018 ; Svehlikova et al, 2018 ).…”

Noninvasive Activation Imaging of Ventricular Arrhythmias by Spatial Gradient Sparse in Frequency Domain—Application to Mapping Reentrant Ventricular Tachycardia

“…In the past decades, a number of efforts have been made in this field, which can be classified based on different aspects. 1) The input could be body surface potentials [4]- [35] or endocardial potentials [36], [37]. Using body surface potentials as input is predominant because of a larger covering area with more electrodes.…”

“…2) The source model could be a single moving dipole model [5], [11], [21] or equivalent distributed source model [6], [9], [14], [32]. 3) The solution space could be twoThe solution space could be two-dimensional [4], [6], [9], [12], [13], [22], [28], [34], [38] or three-dimensional [24], [39], [25], [29], [17], [18], [26], [16], [20], [23], [27], [31], [40], [33], [32], [35]. Since He and coworkers⣙ early work to solve ECG inverse imaging in 3D heart [7], [8], [10], [41], several approaches have been taken to address the challenge of imaging cardiac electrical activity in 3D space or throughout the myocardium.…”