Collaborative technique noninvasively assesses cardiac arrhythmias

Fusing body surface electrocardiographic mapping (BSM) and imaging allows for comprehensive assessment of cardiac arrhythmias, according to a study published in the April issue of Radiology.

Accurately locating and characterizing arrhythmias is a challenge, particularly because invasive procedures are often needed to perform the task. BSM, a new advent in noncontact mapping technology, "involves the use of a multielectrode vest to collect body surface potentials and CT to precisely locate in three dimensions each electrode with respect to the heart,” wrote lead author Hubert Cochet, MD, of Hopital Cardiologique Haut Lévêque in Pessac, France, and colleagues.

Cochet and colleagues sought to demonstrate the utility gained by combining BSM and imaging for comprehensive assessment of cardiac arrhythmias. Comprised of 27 patients who were referred for electrophysiologic procedures for ventricular tachycardia, Wolff-Parkinson-White syndrome, atrial fibrillation, and scar-related ventricular tachycardia, the study examined participants by using BSM and either cardiac-gated multidetector CT or delayed contrast-enhanced MRI.

The study reaped many finds, including the feasibility of acquisitions, segmentation, and registration in all patients. The arrhythmia mechanism and location in respect to the myocardial substrate, coronary vessels, and phrenic nerve were noninvasively assessed for those with ventricular tachycardia.  

Understanding of complex accessory pathways that were resistant to previous ablation was also gained in patients with Wollf-Parkinson-White syndrome. Additionally, the arrhythmia mechanisms and the analysis of rotor trajectories was made possible by the combination in patients with atrial fibrillation and scar-related ventricular fibrillation.

“BSM can be regarded as a technologic breakthrough in the management of cardiac arrhythmias, not only because of its noninvasive nature but also because it enables real-time and whole heart assessment of cardiac activation,” wrote Cochet and colleagues. “These elements are key for nonmappable arrhythmias and mandatory for revealing the mechanisms of cardiac fibrillation. In this context, the method will likely become part of the standard assessment of cardiac arrhythmias in the near future,” they surmised.