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Noninvasive electrocardiographic imaging for cardiac electrophysiology and arrhythmia

Abstract

Over 7 million people worldwide die annually from erratic heart rhythms (cardiac arrhythmias), and many more are disabled. Yet there is no imaging modality to identify patients at risk, provide accurate diagnosis and guide therapy. Standard diagnostic techniques such as the electrocardiogram (ECG) provide only low-resolution projections of cardiac electrical activity on the body surface. Here we demonstrate the successful application in humans of a new imaging modality called electrocardiographic imaging (ECGI), which noninvasively images cardiac electrical activity in the heart. In ECGI, a multielectrode vest records 224 body-surface electrocardiograms; electrical potentials, electrograms and isochrones are then reconstructed on the heart's surface using geometrical information from computed tomography (CT) and a mathematical algorithm. We provide examples of ECGI application during atrial and ventricular activation and ventricular repolarization in (i) normal heart (ii) heart with a conduction disorder (right bundle branch block) (iii) focal activation initiated by right or left ventricular pacing, and (iv) atrial flutter.

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Figure 1: Block diagram of the ECGI procedure.
Figure 2: Ventricular activation of subjects N and R.
Figure 3: Ventricular activation in subject P during RV (top) and LV (bottom) pacing.
Figure 4: Ventricular repolarization in subjects N, R and P.
Figure 5: Atrial activation.

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Acknowledgements

This study was supported by National Institutes of Health/National Heart, Lung and Blood Institute grants R37-HL-33343 and R01-HL-49054 to Y.R. We thank L. Ciancibello for technical assistance in CT imaging; J. Haaga for access to CT; J. Sahadevan, A. Markowitz, A. Waldo, N. Varma and P. Dorostkar for their time, expert advice and access to electrophysiology facilities and patients; and E.T. DuPont for assistance in transporting images from the hospital to our computer facility.

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Correspondence to Yoram Rudy.

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C.R., R.N.G., P.J. and Y.R. are inventors on pending patent applications related to this technology. C.R. and P.J. have the prospect of future employment by a company for application of this technology.

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Ramanathan, C., Ghanem, R., Jia, P. et al. Noninvasive electrocardiographic imaging for cardiac electrophysiology and arrhythmia. Nat Med 10, 422–428 (2004). https://doi.org/10.1038/nm1011

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