Noninvasive Electroanatomic Mapping of Human Ventricular Arrhythmias with Electrocardiographic Imaging

Wang, Yong; Cuculich, Phillip S.; Zhang, Junjie; Desouza, Kavit A.; Vijayakumar, R.; Chen, Jane; Faddis, Mitchell N.; Lindsay, Bruce D.; Smith, Timothy W.; Rudy, Yoram

doi:10.1126/scitranslmed.3002152

Cited by 163 publications

(162 citation statements)

References 47 publications

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“…7 In a clinical setting, Wang et al further validated this approach: in patients having ventricular tachycardia, the origin of activation was determined in an invasive electrophysiological procedure and compared with results from the epicardial potential inverse. 8 Consistent with findings from Taccardi et al, all 6 patients with epicardial origin showed a strictly negative reconstructed electrogram at the site of earliest activation, whereas an initial R wave was seen on the reconstructed epicardial electrogram for 7 out of 8 patients with endocardial or intramural sites of origin.…”

Section: Oosterhoff Et Alsupporting

confidence: 78%

“…Epicardial activation and repolarization times can be derived from these reconstructed electrograms, and under certain assumptions, some intramural excitation characteristics can be inferred before epicardial breakthrough. [6][7][8] This general approach was first suggested in the 1970s, and a variant of this method is used in the CardioInsight ECVUE system. [9][10][11][12][13] The inverse method used in the current study reconstructs the activation times on both the endocardial and epicardial surface, allowing discrimination of epicardial from endocardial foci.…”

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confidence: 99%

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Experimental Validation of Noninvasive Epicardial and Endocardial Activation Imaging

Oosterhoff

Meijborg

Dam

et al. 2016

Circ: Arrhythmia and Electrophysiology

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We present results from a study in which endocardial and epicardial activation sequences, both for ventricular stimulated and for atrioventricular-conducted activation, were reconstructed from (pseudo) body surface potentials. The study consists of 2 parts. In part I, transmural activation mapping was © 2016 American Heart Association, Inc. Original Article Circ Arrhythm ElectrophysiolBackground-Noninvasive imaging of cardiac activation before ablation of the arrhythmogenic substrate can reduce electrophysiological procedure duration and help choosing between an endocardial or epicardial approach. A noninvasive imaging technique was evaluated that estimates both endocardial and epicardial activation from body surface potential maps. We performed a study in isolated and in situ pig hearts, estimating activation from body surface potential maps during sinus rhythm and localizing endocardial and epicardial stimulation sites. Methods and Results-From 3 Langendorff-perfused pig hearts, 180 intramural unipolar electrograms were recorded during sinus rhythm and ectopic activation, together with pseudo-body surface potential map ECGs in 2 of them. From 4 other anesthetized pigs, 64-lead body surface potential maps were recorded during sinus rhythm and ventricular stimulation from 27 endocardial and epicardial sites. The ventricular activation pattern was computed from the recorded QRS complexes. For both Langendorff-perfused hearts, the calculated epicardial and endocardial activation patterns showed good qualitative correspondence to the patterns obtained with needle electrodes. Absolute timing difference for sinus rhythm was 10±5 and 11±8 ms respectively, and for ectopic activation 6±5 and 7±6 ms, respectively. Calculated activation for the in situ hearts in sinus rhythm was similar to patterns recorded in Langendorff-perfused hearts. During stimulation, the distance between the stimulation site and calculated site of earliest activation was 18 (15-27) mm, and 23 of 27 stimulation sites were correctly mapped to either endocardium or epicardium. performed in Langendorff-perfused, isolated pig hearts, while recording pseudo body surface maps (BSMs) from the boundary of a fluid-filled container with integrated electrodes in which the heart was suspended. In part II, BSMs and catheter electrograms were recorded simultaneously in intact pigs. The data from part I were used to adapt our inverse method to porcine electrophysiology and to evaluate it using a simple, homogeneous volume conductor (ie, the fluid-filled container), with transmural activation mapping as a reference. However, BSMs are measured on the surface of the torso, which is irregularly shaped, and contains organs with low conductivity (eg, lungs) and blood with high conductivity. This will affect the current distribution within the thorax and, thereby, the potentials generated at the body surface. Therefore, experiments in intact adult pigs were used to show the ability of our noninvasive mapping technique to reliably determine ventricular activation and dis...

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Section: Oosterhoff Et Alsupporting

confidence: 78%

mentioning

confidence: 99%

Experimental Validation of Noninvasive Epicardial and Endocardial Activation Imaging

Oosterhoff

Meijborg

Dam

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…16 ECGI correctly identified the right or left ventricular location of the arrhythmia in 100 % of studies (n-23).…”

Section: Wang Et Al Studied 26 Ventricular Arrhythmias In 25 Patientsmentioning

confidence: 99%

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

Hocini

Pascale

Roten

et al. 2013

Arrhythmia &Amp; Electrophysiology Review

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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.

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“…44 Recently, ECGI has also been investigated as a potential additional imaging modality for mapping of VT. Wang et al demonstrated that ECGI accurately identifies the site of origin of VT in more than 90 % of cases when compared with invasive mapping. 45 Further, ECGI identified the mechanism of VT with a high degree of accuracy. Therefore, in addition to the expanding role in atrial arrhythmia, ECGI may emerge as an effective tool for mapping of VT.…”

Section: Advances In Imaging Techniques For Vt Ablationmentioning

confidence: 99%

New Ablation Technologies and Techniques

Mahida

Berte

Yamashita

et al. 2014

Arrhythmia &Amp; Electrophysiology Review

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Since the first catheter ablation for cardiac arrhythmia more than three decades ago, ablation technology has continually evolved at a rapid pace. Much of the early progress in the field was made in ablation of supraventricular tachycardias. Following a seminal study from Haïssaguerre et al. 1 in 1998, which demonstrated that pulmonary vein triggers are important sources of atrial fibrillation (AF), the approach to management of AF underwent a revolution. Electrical isolation of pulmonary veins (PVs) using catheter ablation became an established therapeutic strategy in patients with paroxysmal AF. During subsequent years, the role of ablation in AF expanded, and more extensive strategies involving ablation of non-pulmonary vein triggers and modification of the left atrial substrate were demonstrated to be effective, even in persistent forms of AF. New Technologies and Techniques for AF AblationCurrently, the most widely used technique for PV isolation involves delivery of point-by-point ablation lesions around the circumference of the vein. A number of different variations to the approach have been developed. During the early stages of PV isolation, a 'segmental approach' which involved targeting the earliest PV potentials at the ostium of the PV was commonly used. Due to high reconnection rates and the risk of PV stenosis, the technique has progressively been modified and the prevailing technique involves circumferential antral ablation to achieve PV isolation. AbstractCatheter ablation is an established treatment strategy for a range of different cardiac arrhythmias. Over the past decade two major areas of expansion have been ablation of atrial fibrillation (AF) and ventricular tachycardia (VT) in the context of structurally abnormal hearts. In parallel with the expanding role of catheter ablation for AF and VT, multiple novel technologies have been developed which aim to increase safety and procedural success. Areas of development include novel catheter designs, novel navigation technologies and higher resolution imaging techniques. The aim of the present review is to provide an overview of novel developments in AF ablation and VT ablation in patients with of structural cardiac diseases.

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Noninvasive Electroanatomic Mapping of Human Ventricular Arrhythmias with Electrocardiographic Imaging

Cited by 163 publications

References 47 publications

Experimental Validation of Noninvasive Epicardial and Endocardial Activation Imaging

Experimental Validation of Noninvasive Epicardial and Endocardial Activation Imaging

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

New Ablation Technologies and Techniques

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