Noninvasive electrocardiographic imaging of arrhythmogenesis: insights from modeling and human studies

摘要: Abstract Background Sudden cardiac death remains the leading cause of death, claiming more than 1000 lives per day in United States alone. Noninvasive means to diagnose rhythm disorders heart have relied heavily on 12-lead electrocardiogram and, a lesser extent, higher-resolution body-surface mapping. These lack sensitivity and specificity due smoothing effect torso volume conductor. In contrast, noninvasive electrocardiographic imaging (ECGI) reconstructs potentials, electrograms, activation sequences directly surface from electrocardiograms has been applied animal as well clinical studies. This presentation summarizes application ECGI for epicardial arrhythmogenic substrates associated properties, particular, dispersion myocardial repolarization, fractionated heterogeneous multipolar potential distributions. Methods Electrocardiographic was evaluated canine model temperature-induced repolarization through localized warming cooling 3 patients with preserved left ventricular ejection fraction (≥50%) undergoing open surgery. Noninvasively reconstructed electrograms (and derived measures), were compared their measured counterparts. Results Epicardial measures (activation recovery intervals [ARIs] QRST integrals) accurately reflected underlying properties: prolonged ARIs increased (warming), shortened decreased (cooling), gradients adjacent (increased QRST) during simultaneous cooling. open-heart surgery patients, substrate by noninvasively reconstructing (cross-correlation = 0.72 ± 0.25), regions distributions, areas slow conduction. Conclusion studies demonstrate that can capture localize important electrophysiologic properties heart. Its significance lies mapping substrates, evaluation guidance therapy, risk stratification.