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. 2013 Apr;2(1):16-22.
doi: 10.15420/aer.2013.2.1.16.

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

Ashok J Shah  1 , Meleze Hocini  1 , Patrizio Pascale  1 , Laurent Roten  1 , Yuki Komatsu  1 , Matthew Daly  1 , Khaled Ramoul  1 , Arnaud Denis  1 , Nicolas Derval  1 , Frederic Sacher  1 , Remi Dubois  1 , Ryan Bokan  2 , Sandra Eliatou  2 , Maria Strom  2 , Charu Ramanathan  2 , Pierre Jais  1 , Philippe Ritter  1 , Michel Haissaguerre  1
Affiliations

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

Ashok J Shah et al. Arrhythm Electrophysiol Rev. 2013 Apr.

Abstract

The 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.

Keywords: Body surface mapping; arrhythmia sources; electrocardiographic imaging; electrocardiomapping; non-invasive mapping.

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Figures

Figure 1:
Figure 1:. The 252-lead Vest Records Torso Surface Electrograms
Figure 2:
Figure 2:. Biatrial Activaton Maps During Sinus Rhythm Show the Centrifugal Spread from the Sinus Node to the Rest of the Biatrial Geometry
Figure 3:
Figure 3:. Biventricular Activaton Maps During Impulse Conduction Over the Normal His-Purkinje System Show the Anterior Right Ventricular Breakthrough in Red and the Latest Activation of the Basal Lateral Left Ventricle in Blue. The Broken White Line Demarcates the Interventricular Septum
Figure 4:
Figure 4:. A 12-lead Electrocardiography Showing Atrial Tachycardia After Pulmonary Vein Isolation and Left Atrial Defractionation
Figure 5:
Figure 5:. Focal Source Premature Ectopic Complex Arising from the Anterior Wall of the Right Superior Pulmonary Venous Ostium was Mapped Accurately with the ECM System (Isochronal Map Shown) and Successfully Ablated at the Corresponding Site Seen on the Fluoroscopic Image. Premature Ectopic Complex Terminated After 9 Seconds of Radiofrequency Application
Figure 6:
Figure 6:. Biventricular Isopotential Map (Yellow Colour Denotes the Earliest Activation) During Premature Ventricular Complex (12-Lead ECG). Inserted is an Epicardial Virtual Electrogram (QS Morphology) from the Earliest Site. The Fluoroscopic Image at the Site of Successful Ablation and Local Intracardiac Electrogram are Shown As Well
Figure 7:
Figure 7:. Biventricular Isopotential Map (Yellow Colour Denotes the Earliest Activation) During Pre-excitation from a Right Posteroseptal Accessory Pathway (12-lead ECG), which was Successfully Ablated (Fluoroscopic Image) at the Corresponding Site. Also Inserted is a Virtual Electrogram (QS Morphology) from the Site of Earliest Ventricular Activation Over the Manifest Pathway
Figure 8:
Figure 8:. Intraprocedural Use of Biventricular Electrocardiomapping to Guide the Left Ventricular Lead Placement for Cardiac Resynchronisation Therapy
See this image and copyright information in PMC

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