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. 2016 Oct 5;11(10):e0163445.
doi: 10.1371/journal.pone.0163445. eCollection 2016.

Noninvasive Imaging of Human Atrial Activation during Atrial Flutter and Normal Rhythm from Body Surface Potential Maps

Zhaoye Zhou  1 , Qi Jin  2 , Long Yu  1 , Liqun Wu  2 , Bin He  1   3
Affiliations

Noninvasive Imaging of Human Atrial Activation during Atrial Flutter and Normal Rhythm from Body Surface Potential Maps

Zhaoye Zhou et al. PLoS One. .

Abstract

Background: Knowledge of atrial electrophysiological properties is crucial for clinical intervention of atrial arrhythmias and the investigation of the underlying mechanism. This study aims to evaluate the feasibility of a novel noninvasive cardiac electrical imaging technique in imaging bi-atrial activation sequences from body surface potential maps (BSPMs).

Methods: The study includes 7 subjects, with 3 atrial flutter patients, and 4 healthy subjects with normal atrial activations. The subject-specific heart-torso geometries were obtained from MRI/CT images. The equivalent current densities were reconstructed from 208-channel BSPMs by solving the inverse problem using individual heart-torso geometry models. The activation times were estimated from the time instant corresponding to the highest peak in the time course of the equivalent current densities. To evaluate the performance, a total of 32 cycles of atrial flutter were analyzed. The imaged activation maps obtained from single beats were compared with the average maps and the activation maps measured from CARTO, by using correlation coefficient (CC) and relative error (RE).

Results: The cardiac electrical imaging technique is capable of imaging both focal and reentrant activations. The imaged activation maps for normal atrial activations are consistent with findings from isolated human hearts. Activation maps for isthmus-dependent counterclockwise reentry were reconstructed on three patients with typical atrial flutter. The method was capable of imaging macro counterclockwise reentrant loop in the right atrium and showed inter-atria electrical conduction through coronary sinus. The imaged activation sequences obtained from single beats showed good correlation with both the average activation maps (CC = 0.91±0.03, RE = 0.29±0.05) and the clinical endocardial findings using CARTO (CC = 0.70±0.04, RE = 0.42±0.05).

Conclusions: The noninvasive cardiac electrical imaging technique is able to reconstruct complex atrial reentrant activations and focal activation patterns in good consistency with clinical electrophysiological mapping. It offers the potential to assist in radio-frequency ablation of atrial arrhythmia and help defining the underlying arrhythmic mechanism.

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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: ZZ and BH are co-inventors of a pending patent application. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Schematic diagram of the present study.
BSPM = Body surface potential map.
Fig 2
Fig 2. Imaged normal atrial activation from subject NS5.
IVC = Inferior vena cava; LA = Left atrium; LAA = Left atrial appendage; RA = Right atrium; SVC = Superior vena cava.
Fig 3
Fig 3. Imaged normal atrial activation from subject NS7.
IVC = Inferior vena cava; LA = left atrium; LAA = Left atrial appendage; RA = right atrium; SVC = Superior vena cava.
Fig 4
Fig 4. Activation maps for patient AX4.
(A) Noninvasively imaged AFL reentry circuit from one single beat. Solid black lines represent propagation wavefronts in RA. (B) Average AFL reentry circuit. (C) CARTO activation map. AFL = Atrial flutter; IVC = Inferior vena cava; LA = Left atrium; MA = Mitral annulus; RA = Right atrium; SVC = Superior vena cava; TA = Tricuspid annulus.
Fig 5
Fig 5. Activation maps for patient AL2.
(A) Noninvasively imaged AFL reentry circuit from one single beat. Solid black lines represent propagation wavefronts in RA. (B) Average AFL reentry circuit. (C) CARTO activation map. AFL = Atrial flutter; IVC = Inferior vena cava; LA = Left atrium; MA = Mitral annulus; RA = Right atrium; SVC = Superior vena cava; TA = Tricuspid annulus.
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