Single-Beat Noninvasive Imaging of Cardiac Electrophysiology of Ventricular Pre-Excitation
Thomas Berger, MD*,*,
Gerald Fischer, PhD ,
Bernhard Pfeifer, PhD,
Robert Modre, PhD,
Friedrich Hanser, PhD,
Thomas Trieb, MD ,
Franz X. Roithinger, MD*,
Markus Stuehlinger, MD*,
Otmar Pachinger, MD*,
Bernhard Tilg, PhD and
Florian Hintringer, MD*
* Department of Internal Medicine, Division of Cardiology, Medical University Innsbruck, Innsbruck, Austria
Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
Institute for Biomedical Engineering, University for Health Sciences, Medical Informatics, and Technology, Tirol, Austria.
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Figure 1 Noninvasive imaging of cardiac electrophysiology (NICE) workflow, including duration of the various procedural steps. ECG = electrocardiographic; MRI = magnetic resonance imaging.
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Figure 2 Ventricular surface model from a cardiac short-axis scan. The left panel shows a magnetic resonance imaging (MRI) slice (thickness 6 mm). The middle panel shows a triangulated and remeshed patient cardiac anatomy model with the left ventricle (LV), the right ventricle (RV), and the right ventricular outflow tract (RVOT). The right panel shows the fusion of MRI data and the cardiac anatomy model.
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Figure 3 Patient-specific volume conductor model comprising chest, lungs, and cardiac compartments, including the particular blood masses. The electrode locations on the skin surface are indicated by spherical markers.
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Figure 4 Wilson leads V1 and V5 for "W" (activation sequences during normal atrioventricular [AV] conduction) and "A" (activation sequences during adenosine-induced AV block) morphology in patients 3 (upper panel) and 5 (lower panel). The first 90 ms (patient 3) and 60 ms (patient 5) of ventricular depolarization are marked with bold lines. Note that these initial depolarization upstrokes remain almost unchanged after adenosine administration in contrast to the remaining QRS and T-wave morphology.
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Figure 5 Butterfly plot (upper panels) and root mean square (rms) plot (lower panels) of the electrocardiographic mapping data recorded in patient 1. "W" (activation sequences during normal atrioventricular [AV] conduction) morphology is shown in the left column and "A" (activation sequences during adenosine-induced AV block) morphology in the right column. Vertical calipers mark the automatically detected beginning and end of the QRS complex.
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Figure 6 The location of earliest ventricular activation as computed by noninvasive imaging of cardiac electrophysiology is indicated in red. The ablation points are denoted by grey markers, and the location of successful ablation is given by a purple marker, indicating the ventricular insertion site of the accessory pathway. A left posterolateral accessory pathway was identified in patient 2, a left anterolateral accessory pathway in patient 5, a left posterolateral accessory pathway in patient 4, and a right posteroseptal accessory pathway in patient 6. Upper panels show activation sequences during normal atrioventricular (AV) conduction ("W"), lower panels show activation sequences during adenosine-induced AV block ("A"). Head icons indicate point of view. Isochrones are plotted in 20-ms intervals.
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