High-resolution noncontact charge-density mapping of endocardial activation
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High-resolution noncontact charge-density mapping of endocardial activation. / Grace, Andrew; Willems, Stephan; Meyer, Christian; Verma, Atul; Heck, Patrick; Zhu, Min; Shi, Xinwei; Chou, Derrick; Dang, Lam; Scharf, Christoph; Scharf, Günter; Beatty, Graydon.
in: JCI INSIGHT, Jahrgang 4, Nr. 6, 21.03.2019.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - High-resolution noncontact charge-density mapping of endocardial activation
AU - Grace, Andrew
AU - Willems, Stephan
AU - Meyer, Christian
AU - Verma, Atul
AU - Heck, Patrick
AU - Zhu, Min
AU - Shi, Xinwei
AU - Chou, Derrick
AU - Dang, Lam
AU - Scharf, Christoph
AU - Scharf, Günter
AU - Beatty, Graydon
PY - 2019/3/21
Y1 - 2019/3/21
N2 - BACKGROUND: Spatial resolution in cardiac activation maps based on voltage measurement is limited by far-field interference. Precise characterization of electrical sources would resolve this limitation; however, practical charge-based cardiac mapping has not been achieved.METHODS: A prototype algorithm, developed from first principles of electrostatic field theory, derives charge density (CD) as a spatial representation of the true sources of the cardiac field. The algorithm processes multiple, simultaneous, noncontact voltage measurements within the cardiac chamber to inversely derive the global distribution of CD sources across the endocardial surface.RESULTS: Comparison of CD to an established computer-simulated model of atrial conduction demonstrated feasibility in terms of spatial, temporal, and morphologic metrics. Inverse reconstruction matched simulation with median spatial errors of 1.73 mm and 2.41 mm for CD and voltage, respectively. Median temporal error was less than 0.96 ms and morphologic correlation was greater than 0.90 for both CD and voltage. Activation patterns observed in human atrial flutter reproduced those established through contact maps, with a 4-fold improvement in resolution noted for CD over voltage. Global activation maps (charge density-based) are reported in atrial fibrillation with confirmed reduction of far-field interference. Arrhythmia cycle-length slowing and termination achieved through ablation of critical points demonstrated in the maps indicates both mechanistic and pathophysiological relevance.CONCLUSION: Global maps of cardiac activation based on CD enable classification of conduction patterns and localized nonpulmonary vein therapeutic targets in atrial fibrillation. The measurement capabilities of the approach have roles spanning deep phenotyping to therapeutic application.TRIAL REGISTRATION: ClinicalTrials.gov NCT01875614.FUNDING: The National Institute for Health Research (NIHR) Translational Research Program at Royal Papworth Hospital and Acutus Medical.
AB - BACKGROUND: Spatial resolution in cardiac activation maps based on voltage measurement is limited by far-field interference. Precise characterization of electrical sources would resolve this limitation; however, practical charge-based cardiac mapping has not been achieved.METHODS: A prototype algorithm, developed from first principles of electrostatic field theory, derives charge density (CD) as a spatial representation of the true sources of the cardiac field. The algorithm processes multiple, simultaneous, noncontact voltage measurements within the cardiac chamber to inversely derive the global distribution of CD sources across the endocardial surface.RESULTS: Comparison of CD to an established computer-simulated model of atrial conduction demonstrated feasibility in terms of spatial, temporal, and morphologic metrics. Inverse reconstruction matched simulation with median spatial errors of 1.73 mm and 2.41 mm for CD and voltage, respectively. Median temporal error was less than 0.96 ms and morphologic correlation was greater than 0.90 for both CD and voltage. Activation patterns observed in human atrial flutter reproduced those established through contact maps, with a 4-fold improvement in resolution noted for CD over voltage. Global activation maps (charge density-based) are reported in atrial fibrillation with confirmed reduction of far-field interference. Arrhythmia cycle-length slowing and termination achieved through ablation of critical points demonstrated in the maps indicates both mechanistic and pathophysiological relevance.CONCLUSION: Global maps of cardiac activation based on CD enable classification of conduction patterns and localized nonpulmonary vein therapeutic targets in atrial fibrillation. The measurement capabilities of the approach have roles spanning deep phenotyping to therapeutic application.TRIAL REGISTRATION: ClinicalTrials.gov NCT01875614.FUNDING: The National Institute for Health Research (NIHR) Translational Research Program at Royal Papworth Hospital and Acutus Medical.
KW - Action Potentials/physiology
KW - Adolescent
KW - Adult
KW - Aged
KW - Algorithms
KW - Atrial Fibrillation/diagnosis
KW - Atrial Flutter/diagnosis
KW - Computer Simulation
KW - Echocardiography
KW - Electrocardiography
KW - Electrophysiologic Techniques, Cardiac/methods
KW - Endocardium/diagnostic imaging
KW - Feasibility Studies
KW - Female
KW - Heart Atria/diagnostic imaging
KW - Heart Rate/physiology
KW - Humans
KW - Male
KW - Middle Aged
KW - Models, Cardiovascular
KW - Spatio-Temporal Analysis
KW - Tachycardia, Supraventricular/diagnosis
KW - Tomography, X-Ray Computed
KW - Young Adult
U2 - 10.1172/jci.insight.126422
DO - 10.1172/jci.insight.126422
M3 - SCORING: Journal article
C2 - 30895945
VL - 4
JO - JCI INSIGHT
JF - JCI INSIGHT
SN - 2379-3708
IS - 6
ER -
