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PubMed1999

On selecting a body surface mapping procedure.

Throughout the world, various procedures related to body surface mapping have evolved. The large differences in these procedures make multicenter studies difficult. This paper discusses the problems involved in selecting the number of leads, lead placement, and map format. Methods are highlighted that have been developed for pooling of the data as obtained by different centers. Recommendations are included to newcomers in the field. (The work stems from an international study, the Noninvasive Evaluation of the Myocardium, a study group sponsored by the European Commission, which has as one of its objectives the standardization of body surface mapping procedures.)

Body Surface Potential Mapping↗
PubMed2003

[Non-contact mapping of the left atrium using a multi electrode mapping array].

In contrast to the sequential mapping systems such as the conventional and the electroanatomic mapping, the non-contact mapping provides simultaneous mapping. The non-contact-mapping system detects far-field endocardial potentials from a multielectrode-array catheter and reconstructs over 3,000 unipolar virtual electrograms. Based on the virtual electrograms, the system produces an instantaneous three-dimensional (3-D) isopotential map. High-density mapping of the endocardial activation sequence allows immediate and simultaneous identification of a propagation vector along the line and the identification of an arrhythmogenic focus on a single beat. The methods and results of different ablation strategies for atrial fibrillation using the non-contact-mapping system are reported.

Atrial Fibrillation↗
PubMed2006

Usefulness of body surface maps to demonstrate ventricular activation patterns during left ventricular pacing and reentrant activation during ventricular tachycardia in men with coronary heart disease and left ventricular dysfunction.

Epicardial electrical events were reconstructed using an inverse model for left ventricular (LV) pacing and during ventricular tachycardia (VT) induced during implantation of a biventricular pacemaker and/or internal defibrillator. The electrocardiographic position of the pacing lead, determined from the region of most negative potential 30 ms after the pacing spike, was compared with the radiographic position. Activation characterized by isochronal maps was correlated with the echocardiographic/myocardial scintigraphic data. Reconstructed epicardial isopotential/isochronal maps during VT were used to determine the presence of reentry. In 7 patients during LV pacing, epicardial isopotential maps located the maximum negative potentials anterolaterally (n = 3), posterolaterally (n = 2), and posteriorly (n = 2). Isochronal maps demonstrated activation patterns including regions of delayed activation that, in 5 patients, correlated with areas of akinesia/hypokinesia or fixed defects on echocardiography/myocardial scintigraphy. The mean difference between the radiographically measured right ventricular to LV pacing lead distance and calculated electrocardiographic right ventricular to LV pacing site distance was 1.7 cm. During VT, induced in 5 patients, single-loop reentry was observed in 3 and figure-of-8 reentry in 2. Exit site and regions of fast/slow conduction and conduction block that correlated with anatomic areas of infarction defined by echocardiography/myocardial scintigraphy were demonstrated. In conclusion, epicardial maps reconstructed from the body surface map can identify LV pacing sites and demonstrate reentry during VT. The body surface map could thus identify optimal pacing sites for LV pacing and targets for VT ablation.

Aged↗
PubMed2002

Electrocardiographic potential correlations: rationale and basis for lead selection and ECG estimation.

Einthoven gave to us the electrocardiogram. Electrocardiographic mapping demonstrated that localized electrophysiological events and phenomena have localized body surface electrocardiographic manifestations. Clinical electrocardiography has given us "reasonably good" means (criteria) with which to detect and characterize medically significant cardiac conditions, events, and diseases. However, clinical electrocardiography is imperfect, largely as a consequence of inadequate or redundant spatial sampling. This compromises the sensitivity and specificity of diagnosing cardiac diseases for which electrocardiographic manifestations are present but undetected due to imperfect sampling that results in a low signal-to-noise ratio for the specific abnormality. Correlation structure of body-surface potential distributions between and across populations or individuals provides important insight into and justification for the selection and use of "limited", "reduced", or "derived" lead systems aimed at improving the capture and use of electrocardiographic information. In this paper, we show the electrocardiographic voltage correlation relationships that occur on the body surface, across groups of subjects, either with or without cardiac disease. In addition, we demonstrate the correlation relationships between torso-surface and epicardial-surface potential distributions in experiments incorporating isolated canine hearts in a human-shaped torso tank. Analysis of these correlation relationships provides an explanation for the long-standing success of clinical electrocardiography but also suggests the means to improve its performance by incorporating new leads and/or their estimation from appropriately selected leads.

Body Surface Potential Mapping↗
PubMed2003

Opto-electronic sensing of body surface topology changes during radiotherapy for rectal cancer.

PURPOSE: The CT body surface underpins millimeter scale dose computation in radical radiotherapy. A lack of technology has prevented measurement of surface topology changes during irradiation. Consequently, body changes are incorporated into plans statistically. We describe the technology for dynamic measurement of continuous surface topology at submillimeter resolution and suggest appropriately modified planning. MATERIALS AND METHODS: An interferometer casts cosinusoidal fringes across the surface of a patient on a treatment couch. Motion-induced changes to the spatial phase of the fringes are used to generate dynamic sequences of body height maps. Volume-conserving CT warping, guided by height change, is used to illustrate potential planning perturbations. RESULTS: We present the results for a prone patient with rectal carcinoma. At most of the simultaneously measured 440 x 440 points in each of the 898 body height maps in a dynamic sequence, the standard deviations were <1-2 mm, with occasional points of 6 mm. Surface motion predominantly occurred along the small of the back. This motion was periodic and could take the spine and bladder across the 95% isodose contour. CONCLUSIONS: Surface changes are most likely to be within 3 mm during irradiation, despite the effects of breathing and the discomfort of lying prone. The dosimetric effects are acceptable.

Algorithms↗
PubMed2005

Three dimensional mapping of atrial fibrillation: techniques and necessity.

Over the past 5 years, catheter ablation of atrial fibrillation (AF) has evolved from an experimental procedure to one that is now performed throughout the world. The rapid and widespread acceptance of this procedure reflects encouraging reports of the safety and efficacy of catheter ablation of AF. The improved outcomes of catheter ablation of AF have resulted from a combination of increasing clinical experience, but also several important technological advances. One of the most important of these has been the development and widespread utilization of three dimensional mapping systems during AF ablation The purpose of this article is to briefly review the current status and clinical role of three dimensional mapping systems in catheter ablation of AF.

Atrial Fibrillation↗
PubMed2003

Localization and radiofrequency ablation of atriofascicular pathways using electroanatomic mapping.

Atriofascicular pathways supporting antidromic reentrant tachycardia are uncommon, and may be difficult to ablate. Traditional mapping can be associated with traumatic loss of atriofascicular conduction. Atriofascicular fibers can insert into the right bundle and will, therefore, first activate the right ventricle. In contrast to initial activation of the ventricle near the tricuspid annulus that can be seen in patients with right-sided decremental atrioventricular pathways. We used electroanatomic mapping to map and ablate the ventricular insertion of atriofascicular pathways in two patients during sinus rhythm and during atrial pacing. In our 2 cases an atriofascicular potential was recorded from below the tricuspid valve annulus and tagged. At this site, each pathway was ablated with one radiofrequency lesion. We describe 2 cases where electroanatomic mapping of the right ventricle was used to map and ablate atriofascicular pathways.

Adolescent↗
PubMed2001

Localization of late potential sources in myocardial infarction.

INTRODUCTION: Late potentials (LP) are markers of arrhythmogenic events after myocardial infarction (MI). The localization of LP sources would help to identify arrhythmogenic myocardium. The purpose of this study was to localize these LP sources from non-invasive body surface mapping data. METHODS AND RESULTS: Six patients were investigated with cardiac MRI and signal averaged 62-lead magnetocardiography after MI. Three of them were suffering from sustained ventricular tachycardia (VT). Sophisticated computer algorithms were used in order to compute the current density on the surface of the left ventricle. We compared these current density distributions for the entire QRS complex and the high frequency LP signals. In the three patients which had premature ventricular complexes (PVCs) we localized the exit sites of these arrhythmias. We found a close matching of the low current density areas based on the QRS complexes and the high current density areas based on the LP signals. These areas predominantly corresponded to sites of the infarctions. Exit sites of PVCs were located close to these areas. CONCLUSIONS: By means of sophisticated computer algorithms we were able to localize LP sources. This would be useful in steering catheter ablation and coronary revascularization therapies. However, the method has to be proven with the help of invasive mapping in a larger number of patients.

Adult↗
PubMed2002

Circular mapping catheter entrapment in the mitral valve apparatus: a previously unrecognized complication of focal atrial fibrillation ablation.

Radiofrequency catheter ablation of focal atrial fibrillation triggers within the pulmonary veins is a rapidly developing therapy that relies on both recent technologies and evolving techniques. We describe the entrapment of a circular mapping catheter within the mitral valve apparatus after transseptal catheterization and mapping of the left atrium and pulmonary veins. The occurrence of this previously unreported complication stresses the need for continual monitoring and reporting of adverse effects from new devices and procedures to better inform patients and physicians of the benefits and risks of electrophysiologic interventions.

Atrial Fibrillation↗
PubMed2006

Hybrid therapies for ventricular arrhythmias.

In recent years several trials demonstrated the efficacy of implantable cardioverter-defibrillation (ICD) therapy in reducing cardiac and total mortality in patients affected by rapid ventricular tachycardia (VT) and/or ventricular fibrillation. Nevertheless, ICD do not prevent arrhythmia recurrences, thus being a palliative and not a curative treatment modality. The tolerance to ICD therapy varies greatly, and within individuals, this leading to a nonuniform acceptance of this form of therapy. The very frequent occurrence of VT, defined as an arrhythmic storm, may be a life threatening condition. The majority of ICD patients is under antiarrhythmic drug therapy, to reduce episodes of VT or to make antitachycardia pacing more effective by slowing the tachycardia rate. Drug therapy, however, may cause additional problems, and does not represent the optimal solution. The prevention of VT and/or ventricular fibrillation episodes and excessive ICD therapy, remains a worthwhile goal. Radiofrequency catheter ablation (RFCA) is a curative approach, and can be expected to reduce the frequency of recurrent VT episodes in the majority of patients. The combination of these treatment modalities (ICD and RFCA) is often described as hybrid therapy, implying that the two treatments act providing some form of synergism. In experienced centers, RFCA is now performed, regardless of whether the VT rate is rapid and/or is hemodynamically unstable. Newer mapping and ablation techniques are now available, enhancing the acute success rate of the procedure. In this review the most recent application of VT catheter ablation and the use of advanced mapping and ablation techniques will be discussed.

Body Surface Potential Mapping↗