Predictive value of unshielded magnetocardiographic mapping to differentiate atrial fibrillation patients from healthy subjects

Guida, Gianluigi; Sorbo, Anna Rita; Fenici, Riccardo; Brisinda, Donatella

doi:10.1111/anec.12569

Cited by 3 publications

(2 citation statements)

References 49 publications

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“…The usefulness of MCG for a better understanding of the arrhythmogenic mechanisms underlying the high-risk J syndromes ( 225 , 327 – 336 ); the identification of atrial arrhythmogenic vulnerability ( 248 ), of left atrial dysfunction ( 330 ), and of the atrial propagation pathways ( 228 ); and the dominant frequencies ( 181 , 183 , 189 , 232 ) in patients with atrial fibrillation, as well as providing accurate pre-interventional 3D localization of arrhythmogenic substrates ( 128 , 193 , 247 , 249 , 331 ), has been widely reported. However, the lack of a clinical breakthrough at scale is evident.…”

Section: Discussionmentioning

confidence: 99%

Clinical magnetocardiography: the unshielded bet—past, present, and future

Brisinda,

Fenici,

Fenici

2023

Front. Cardiovasc. Med.

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Magnetocardiography (MCG), which is nowadays 60 years old, has not yet been fully accepted as a clinical tool. Nevertheless, a large body of research and several clinical trials have demonstrated its reliability in providing additional diagnostic electrophysiological information if compared with conventional non-invasive electrocardiographic methods. Since the beginning, one major objective difficulty has been the need to clean the weak cardiac magnetic signals from the much higher environmental noise, especially that of urban and hospital environments. The obvious solution to record the magnetocardiogram in highly performant magnetically shielded rooms has provided the ideal setup for decades of research demonstrating the diagnostic potential of this technology. However, only a few clinical institutions have had the resources to install and run routinely such highly expensive and technically demanding systems. Therefore, increasing attempts have been made to develop cheaper alternatives to improve the magnetic signal-to-noise ratio allowing MCG in unshielded hospital environments. In this article, the most relevant milestones in the MCG's journey are reviewed, addressing the possible reasons beyond the currently long-lasting difficulty to reach a clinical breakthrough and leveraging the authors’ personal experience since the early 1980s attempting to finally bring MCG to the patient's bedside for many years thus far. Their nearly four decades of foundational experimental and clinical research between shielded and unshielded solutions are summarized and referenced, following the original vision that MCG had to be intended as an unrivaled method for contactless assessment of the cardiac electrophysiology and as an advanced method for non-invasive electroanatomical imaging, through multimodal integration with other non-fluoroscopic imaging techniques. Whereas all the above accounts for the past, with the available innovative sensors and more affordable active shielding technologies, the present demonstrates that several novel systems have been developed and tested in multicenter clinical trials adopting both shielded and unshielded MCG built-in hospital environments. The future of MCG will mostly be dependent on the results from the ongoing progress in novel sensor technology, which is relatively soon foreseen to provide multiple alternatives for the construction of more compact, affordable, portable, and even wearable devices for unshielded MCG inside hospital environments and perhaps also for ambulatory patients.

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Section: Discussionmentioning

confidence: 99%

Clinical magnetocardiography: the unshielded bet—past, present, and future

Brisinda,

Fenici,

Fenici

2023

Front. Cardiovasc. Med.

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“…Magnetocardiography enables the measurement of electrical vectors in the heart in 3D, and with recent advances in clinical measurements of atrial and ventricular activation and repolarization without geomagnetic field shielding, it has become significantly more accessible [ 140 , 141 ]. However, (i) it requires additional imaging to project electrical source information to the underlying cardiac structure, (ii) it cannot be used to measure transmembrane voltages, and (iii) it works best in combination with ECG due to different sensitivities to in-plane versus out-of-plane wave propagation [ 142 , 143 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiac Conduction Velocity, Remodeling and Arrhythmogenesis

Han

Trew

Zgierski-Johnston

2021

Cells

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Cardiac electrophysiological disorders, in particular arrhythmias, are a key cause of morbidity and mortality throughout the world. There are two basic requirements for arrhythmogenesis: an underlying substrate and a trigger. Altered conduction velocity (CV) provides a key substrate for arrhythmogenesis, with slowed CV increasing the probability of re-entrant arrhythmias by reducing the length scale over which re-entry can occur. In this review, we examine methods to measure cardiac CV in vivo and ex vivo, discuss underlying determinants of CV, and address how pathological variations alter CV, potentially increasing arrhythmogenic risk. Finally, we will highlight future directions both for methodologies to measure CV and for possible treatments to restore normal CV.

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