Localization of a ventricular tachycardia-focus with multichannel magnetocardiography and three-dimensional current density reconstruction

ECG imaging of ventricular tachycardia: evaluation against simultaneous non-contact mapping and CMR-derived grey zone

ECG imaging is an emerging technology for the reconstruction of cardiac electric activity from non-invasively measured body surface potential maps. In this case report, we present the first evaluation of transmurally imaged activation times against endocardially reconstructed isochrones for a case of sustained monomorphic ventricular tachycardia (VT). Computer models of the thorax and whole heart were produced from MR images. A recently published approach was applied to facilitate electrode localization in the catheter laboratory, which allows for the acquisition of body surface potential maps while performing non-contact mapping for the reconstruction of local activation times. ECG imaging was then realized using Tikhonov regularization with spatio-temporal smoothing as proposed by Huiskamp and Greensite and further with the spline-based approach by Erem et al. Activation times were computed from transmurally reconstructed transmembrane voltages. The results showed good qualitative agreement between the non-invasively and invasively reconstructed activation times. Also, low amplitudes in the imaged transmembrane voltages were found to correlate with volumes of scar and grey zone in delayed gadolinium enhancement cardiac MR. The study underlines the ability of ECG imaging to produce activation times of ventricular electric activity-and to represent effects of scar tissue in the imaged transmembrane voltages.

Examining the Impact of Prior Models in Transmural Electrophysiological Imaging: A Hierarchical Multiple-Model Bayesian Approach

Noninvasive cardiac electrophysiological (EP) imaging aims to mathematically reconstruct the spatiotemporal dynamics of cardiac sources from body-surface electrocardiographic (ECG) data. This ill-posed problem is often regularized by a fixed constraining model. However, a fixed-model approach enforces the source distribution to follow a pre-assumed structure that does not always match the varying spatiotemporal distribution of actual sources. To understand the model-data relation and examine the impact of prior models, we present a multiple-model approach for volumetric cardiac EP imaging where multiple prior models are included and automatically picked by the available ECG data. Multiple models are incorporated as an Lp-norm prior for sources, where p is an unknown hyperparameter with a prior uniform distribution. To examine how different combinations of models may be favored by different measurement data, the posterior distribution of cardiac sources and hyperparameter p is calculated using a Markov Chain Monte Carlo (MCMC) technique. The importance of multiple-model prior was assessed in two sets of synthetic and real-data experiments, compared to fixed-model priors (using Laplace and Gaussian priors). The results showed that the posterior combination of models (the posterior distribution of p) as determined by the ECG data differed substantially when reconstructing sources with different sizes and structures. While the use of fixed models is best suited in situations where the prior assumption fits the actual source structures, the use of an automatically adaptive set of models may have the ability to better address model-data mismatch and to provide consistent performance in reconstructing sources with different properties.

Clinical application of magnetocardiography

Magnetocardiography is a noninvasive contactless method to measure the magnetic field generated by the same ionic currents that create the electrocardiogram. The time course of magnetocardiographic and electrocardiographic signals are similar. However, compared with surface potential recordings, multichannel magnetocardiographic mapping (MMCG) is a faster and contactless method for 3D imaging and localization of cardiac electrophysiologic phenomena with higher spatial and temporal resolution. For more than a decade, MMCG has been mostly confined to magnetically shielded rooms and considered to be at most an interesting matter for research activity. Nevertheless, an increasing number of papers have documented that magnetocardiography can also be useful to improve diagnostic accuracy. Most recently, the development of standardized instrumentations for unshielded MMCG, and its ease of use and reliability even in emergency rooms has triggered a new interest from clinicians for magnetocardiography, leading to several new installations of unshielded systems worldwide. In this review, clinical applications of magnetocardiography are summarized, focusing on major milestones, recent results of multicenter clinical trials and indicators of future developments.

Usefulness of ventricular endocardial electric reconstruction from body surface potential maps to noninvasively localize ventricular ectopic activity in patients

As radio frequency (RF) catheter ablation becomes increasingly prevalent in the management of ventricular arrhythmia in patients, an accurate and rapid determination of the arrhythmogenic site is of important clinical interest. The aim of this study was to test the hypothesis that the inversely reconstructed ventricular endocardial current density distribution from body surface potential maps (BSPMs) can localize the regions critical for maintenance of a ventricular ectopic activity. Patients with isolated and monomorphic premature ventricular contractions (PVCs) were investigated by noninvasive BSPMs and subsequent invasive catheter mapping and ablation. Equivalent current density (CD) reconstruction (CDR) during symptomatic PVCs was obtained on the endocardial ventricular surface in six patients (four men, two women, years 23-77), and the origin of the spontaneous ectopic activity was localized at the location of the maximum CD value. Compared with the last (successful) ablation site (LAS), the mean and standard deviation of localization error of the CDR approach were 13.8 and 1.3 mm, respectively. In comparison, the distance between the LASs and the estimated locations of an equivalent single moving dipole in the heart was 25.5 ± 5.5 mm. The obtained CD distribution of activated sources extending from the catheter ablation site also showed a high consistency with the invasively recorded electroanatomical maps. The noninvasively reconstructed endocardial CD distribution is suitable to predict a region of interest containing or close to arrhythmia source, which may have the potential to guide RF catheter ablation.

Localization of endocardial ectopic activity by means of noninvasive endocardial surface current density reconstruction

Localization of the source of cardiac ectopic activity has direct clinical benefits for determining the location of the corresponding ectopic focus. In this study, a recently developed current-density (CD)-based localization approach was experimentally evaluated in noninvasively localizing the origin of the cardiac ectopic activity from body-surface potential maps (BSPMs) in a well-controlled experimental setting. The cardiac ectopic activities were induced in four well-controlled intact pigs by single-site pacing at various sites within the left ventricle (LV). In each pacing study, the origin of the induced ectopic activity was localized by reconstructing the CD distribution on the endocardial surface of the LV from the measured BSPMs and compared with the estimated single moving dipole (SMD) solution and precise pacing site (PS). Over the 60 analyzed beats corresponding to ten pacing sites (six for each), the mean and standard deviation of the distance between the locations of maximum CD value and the corresponding PSs were 16.9 mm and 4.6 mm, respectively. In comparison, the averaged distance between the SMD locations and the corresponding PSs was slightly larger (18.4 ± 3.4 mm). The obtained CD distribution of activated sources extending from the stimulus site also showed high consistency with the endocardial potential maps estimated by a minimally invasive endocardial mapping system. The present experimental results suggest that the CD method is able to locate the approximate site of the origin of a cardiac ectopic activity, and that the distribution of the CD can portray the propagation of early activation of an ectopic beat.

Lorentz-force-induced motion in conductive media

This project was designed to assess whether MRI imaging could detect Lorentz-force-induced motion in conductive samples. Experiments were performed by applying alternating voltages across 2% agar and 18% bovine gels placed in the field of a 1.5-T MRI scanner. Motion-sensitized time-gated MRI images that were obtained and analyzed with custom-developed software used in previous studies revealed the production of movement in both agar and gel samples. Motion was most pronounced in the plane vertical to the sample and had the greatest amplitude when the current path was perpendicular to the scanner's magnetic field. These findings are compatible with the vector cross product nature of the Lorentz force and suggest that the imaging of Lorentz-force-induced motion in conductive samples is feasible. Whether this approach can be extended to study electrically active tissues such as the peripheral nerves, brain and heart remains to be seen.

Fetal magnetocardiographic mapping using independent component analysis

Fetal magnetocardiography (fMCG) is the only noninvasive technique allowing effective assessment of fetal cardiac electrical activity during the prenatal period. The reconstruction of reliable magnetic field mapping associated with fetal heart activity would allow three-dimensional source localization. The efficiency of independent component analysis (ICA) in restoring reliable fetal traces from multichannel fMCG has already been demonstrated. In this paper, we describe a method of reconstructing a complete set of fetal signals hidden in multichannel fMCG preserving their correct spatial distribution, waveform, polarity and amplitude. Fetal independent components, retrieved with an ICA algorithm (FastICA), were interpolated (fICI method) using information gathered during FastICA iterations. The restored fetal signals were used to reconstruct accurate magnetic mapping for every millisecond during the average beat. The procedure was validated on fMCG recorded from the 22nd gestational week onward with a multichannel MCG system working in a shielded room. The interpolated traces were compared with those obtained with a standard technique, and the consistency of fetal mapping was checked evaluating source localizations relative to fetal echocardiographic information. Good magnetic field distributions during the P-QRS-T waves were attained with fICI for all gestational periods; their reliability was confirmed by three-dimensional source localizations.

Time course reconstruction of fetal cardiac signals from fMCG: independent component analysis versus adaptive maternal beat subtraction

M-mode and pulsed Doppler echocardiography, cardiotocography and transabdominal fetal ECG are available in clinical practice to monitor fetal cardiac activity during advancing gestation, but none of these methods allows the direct measurement of morphological and temporal parameters for fetal rhythm assessment. Fetal magnetocardiograms (fMCGs) are noninvasive recordings of magnetic field variations associated with electrical activity of the fetal heart obtained with superconducting sensors positioned over the maternal abdomen inside a shielded room. Because of maternal cardiac activity, fMCGs are contaminated by maternal components that need to be eliminated to reconstruct fetal cardiac traces. The aim of the present work was to use two methods working in the time domain, an independent component analysis algorithm (FastICA) and an adaptive maternal beat subtraction technique (AMBS), for the retrieval of fetal cardiac signals from fMCGs. Detection rates of both methods were calculated, and FastICA and AMBS performances were compared in the context of clinical applications by estimating several temporal and morphological characteristics of the retrieved fetal traces, such as the shape and duration P-QRS-T waves, arrhythmic beat detection and classification, and noise reduction. Quantitative and qualitative comparison produced figures that always suggested that FastICA was superior to AMBS from the perspective of clinical use of the recovered fetal signals.

Independent component analysis: fetal signal reconstruction from magnetocardiographic recordings

Independent component analysis (ICA) was used for the processing of cardiological signals obtained by means of fetal magnetocardiography (fMCG), a technique allowing the non-invasive recording of the weak magnetic field variations associated to the electrical activity of the fetal heart. Purpose of the present work was to verify whether a computational-light ICA algorithm (FastICA), tailored to the characteristics of fMCG, could reconstruct reliable signals of the fetal cardiac activity during the last gestational trimester, when good electrophysiological traces are difficult to obtain although being extremely important for clinical diagnosis of severe fetal dysrhythmias. Several combinations of input recordings and output components were examined in order to assess the best configuration to successfully use FastICA. The reconstructed traces were compared with those obtained with deterministic techniques already used for this purpose, and they showed to be stable and reliable, unaffected by overlapped maternal and fetal beats and suitable for clinical applications.

Concentric Remodeling Detection by Magnetocardiography in Patients with Recent Onset Arterial Hypertension

The aim of this work was to evaluate a number of magnetocardiographic (MCG) indices in their predictive ability for left ventricular (LV) concentric remodeling. Twenty-five male patients affected by essential hypertension for no longer than 15 months and presenting signs of LV remodeling participated in the study; 25 normal men volunteers of comparable age were evaluated as controls. All participants underwent echocardiography (ECHO), electrocardiography (ECG), and magnetocardiography (MCG). Several MCG based indices were evaluated, namely the QRS Integral, T Integral, QRS-T Integral, T/QRS Integral, RS Index, and the variations of the electrical cardiac axis (ECA) orientation. MCG indices were compared with ECHO parameters, i.e., left ventricular mass index (LVMI) and relative wall thickness (RWT), and with ECG parameters, i.e., 12-lead standard ECG LVH Sokolow-Lyon and Cornell voltages. QRS Integral values for patients and controls were significantly different (P = 0.03), whereas T Integral values showed only a tendency to differentiate between patients and controls (P = 0.15). No significant correlation between MCG and echocardiographic indices in patients was found; RWT showed a tendency to correlate with QRS Integral (r = 0.34, P = 0.17) and with RS Index (r = 0.49, P = 0.15), and LVMI showed a tendency to correlate with the variations of the ECA orientation (r = 0.38, P = 0.10). Our findings, also supported by preliminary results on patients affected by hypertension induced LV hypertrophy, suggest a potential role of MCG in the evaluation of early electrophysiological alterations due to LV concentric remodeling.