Single-Beat Noninvasive Imaging of Cardiac Electrophysiology of Ventricular Pre-Excitation

• Published in: Journal of the American College of Cardiology 2006-11, Vol.48 (10), p.2045-2052
• Main Authors: Berger, Thomas, Fischer, Gerald, Pfeifer, Bernhard, Modre, Robert, Hanser, Friedrich, Trieb, Thomas, Roithinger, Franz X., Stuehlinger, Markus, Pachinger, Otmar, Tilg, Bernhard, Hintringer, Florian
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Cardiac arrhythmia; Cardiology; Cardiology. Vascular system; Catheter Ablation; Catheters; Electrocardiography; Electrodiagnosis; Electroencephalography; Feasibility Studies; Female; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Models, Cardiovascular; Personal computers; Wolff-Parkinson-White Syndrome - diagnosis; Wolff-Parkinson-White Syndrome - surgery
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2006.08.019

Single-Beat Noninvasive Imaging of Cardiac Electrophysiology of Ventricular Pre-Excitation Thomas Berger, Gerald Fischer, Bernhard Pfeifer, Robert Modre, Friedrich Hanser, Thomas Trieb, Franz X. Roithinger, Markus Stuehlinger, Otmar Pachinger, Bernhard Tilg, Florian Hintringer The aim of this study was to determine whether noninvasive imaging of cardiac electrophysiology (NICE) is feasible in clinical practice. Noninvasive imaging of cardiac electrophysiology was performed in 7 patients with Wolff-Parkinson-White syndrome with high-resolution electrocardiographic mapping and a patient-specific cardiac magnetic resonance imaging model. The position error of NICE was validated by comparing them with CARTO (Biosense Webster, Diamond Bar, California) maps for normal atrioventricular (AV) conduction and for adenosine-induced AV block. Noninvasive imaging of cardiac electrophysiology was able to identify all ventricular accessory pathway insertion sites with an accuracy of 18.7 ± 5.8 mm (baseline) and 18.7 ± 6.4 mm (adenosine). Noninvasive imaging of cardiac electrophysiology might be used as a complementary noninvasive approach to localize the origin of cardiac arrhythmias. The aim of this study was to determine whether noninvasive imaging of cardiac electrophysiology (NICE) is feasible in patients with Wolff-Parkinson-White (WPW) syndrome in the clinical setting of a catheter laboratory and to test the accuracy of the noninvasively obtained ventricular activation sequences as compared with that of standard invasive electroanatomic mapping. NICE of ventricular activation could serve as a useful tool in the treatment of cardiac arrhythmias and might help improve our understanding of arrhythmia mechanisms. NICE works by fusing the data from high-resolution electrocardiographic mapping and a model of the patient’s cardiac anatomy obtained by magnetic resonance imaging. The ventricular activation sequence was computed with a bidomain theory-based heart model to solve this inverse problem. Noninvasive imaging of cardiac electrophysiology was performed in 7 patients with WPW syndrome undergoing catheter ablation of the accessory pathway. The position error of NICE was defined as the distance between the site of earliest activation computed by NICE and the successful ablation site identified by electroanatomic mapping (CARTO; Biosense Webster, Diamond Bar, California) for normal atrioventricular (AV) conduction as well as for adenosine-induced AV block. The error intr