Noninvasive Electrocardiographic Imaging of Arrhythmogenic Substrates in Humans

Abstract

Cardiac excitation is determined by interactions between the source of electrical activation (membrane depolarization) and the load that cardiac tissue presents. This relationship is altered in pathology by remodeling processes that often create a substrate favoring the development of cardiac arrhythmias. Most studies of arrhythmia mechanisms and arrhythmogenic substrates have been conducted in animal models, which may differ in important ways from the human pathologies they are designed to represent. Electrocardiographic imaging (ECGI) is a noninvasive method for mapping the electrical activity of the heart in humans, under “real world” conditions. This review summarizes results from ECGI studies of arrhythmogenic substrates associated with human clinical arrhythmias. Examples include: heart failure, myocardial infarction scar, atrial fibrillation and abnormal ventricular repolarization.

Introduction to the Series on Computational Approaches to Cardiac Arrhythmias

“…In the third and final article of this series, Dr Yoram Rudy,19 from the University of Washington in St. Louis, reviews for us recent advances using a modern, computationally based, noninvasive imaging modality (electrocardiographic imaging, ECGI) for the diagnosis and guided therapy of cardiac arrhythmias. ECGI brings electrocardiography to an unprecedented level of sophistication, one that was almost impossible to imagine 25 years ago.…”

Source Localization Probability Maps for Uncertainty Quantification in Electrocardiographic Imaging

“…This inverse problem of electrocardiography may one day become a standard in ablation procedures, allowing clinicians to more quickly and accurately locate pathological heart tissue, since the ECGI prediction for the source of an arrhythmia essentially tells a clinician ahead of time where to ablate [3]. ECGI involves solving Laplace's equation [4,5] to obtain the system…”

“…dure times and the risk of recurrence is known as electrocardiographic imaging (ECGI). ECGI uses a patient's CT and MRI images to approximate a computational geometry, and combines this with ECG recordings into a mathematical model that predicts the origin of an arrhythmia.This inverse problem of electrocardiography may one day become a standard in ablation procedures, allowing clinicians to more quickly and accurately locate pathological heart tissue, since the ECGI prediction for the source of an arrhythmia essentially tells a clinician ahead of time where to ablate [3]. ECGI involves solving Laplace's equation [4,5] to obtain the system…”

Reconstruction of Atrial Ectopic Focal and Re:entrant Excitations from Body Surface Potentials: Insights from 3D Virtual Human Atria and Torso

“…The electrocardiographic imaging, based on the cardiac inverse problem solution, provides a promising method for non-invasive diagnosis and locating the origins of cardiac arrhythmias (1). However, due to the ill-posedness of the problem, prior empiric information is required to constrain the problem in order to achieve a reliable solution (1).…”

“…However, due to the ill-posedness of the problem, prior empiric information is required to constrain the problem in order to achieve a reliable solution (1). Due to the limited number of electrodes (i.e., the spatial resolution of the measured signals) on the body surface and unavoidable noise of the measured signals, it is still a challenge to obtain a reliable and accurate solution of the cardiac inverse problem.…”