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FOCUS ISSUE: CARDIAC IMAGING: CLINICAL RESEARCH

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, Innsbruck Medical University, Innsbruck, Austria
Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
Institute for Biomedical Engineering, University for Health Sciences, Medical Informatics, and Technology, Tirol, Austria

Manuscript received March 1, 2006; revised manuscript received May 16, 2006, accepted May 22, 2006.

^_* Reprint requests and correspondence: Dr. Thomas Berger, Department of Internal Medicine, Division of Cardiology, Medical University Innsbruck, Anichstrasse 35, A–6020 Innsbruck, Austria. (Email: t.berger{at}uibk.ac.at).

OBJECTIVES: The aim of this study was to determine whether noninvasive imaging of cardiac electrophysiology (NICE) is feasible in patients with Wolff-Parkinson-White (WPW) syndrome in the clinical setting of a catheter laboratory and to test the accuracy of the noninvasively obtained ventricular activation sequences as compared with that of standard invasive electroanatomic mapping.

BACKGROUND: NICE of ventricular activation could serve as a useful tool in the treatment of cardiac arrhythmias and might help improve our understanding of arrhythmia mechanisms.

METHODS: NICE works by fusing the data from high-resolution electrocardiographic mapping and a model of the patient's cardiac anatomy obtained by magnetic resonance imaging. The ventricular activation sequence was computed with a bidomain theory-based heart model to solve this inverse problem. Noninvasive imaging of cardiac electrophysiology was performed in 7 patients with WPW syndrome undergoing catheter ablation of the accessory pathway. The position error of NICE was defined as the distance between the site of earliest activation computed by NICE and the successful ablation site identified by electroanatomic mapping (CARTO; Biosense Webster, Diamond Bar, California) for normal atrioventricular (AV) conduction as well as for adenosine-induced AV block.

RESULTS: The error introduced by geometric coupling of the CARTO data and the NICE model was 5 ± 3 mm (model discretization 10 mm). All ventricular accessory pathway insertion sites were identified with an accuracy of 18.7 ± 5.8 mm (baseline) and 18.7 ± 6.4 mm (adenosine).

CONCLUSIONS: The individual cardiac anatomy model obtained for each patient enables accurate noninvasive electrocardiographic imaging of ventricular pre-excitation in patients with WPW syndrome. Noninvasive imaging of cardiac electrophysiology might be used as a complementary noninvasive approach to localize the origin and help identify and understand the underlying mechanisms of cardiac arrhythmias.

Abbreviations and Acronyms   AV = atrioventricular   CT = computed tomography   ECG = electrocardiogram/electrocardiography   MRI = magnetic resonance imaging   NICE = noninvasive imaging of cardiac electrophysiology   rms = root mean square   WPW = Wolff-Parkinson-White syndrome

This article has been cited by other articles:

				T. Berger, F. Hintringer, and G. Fischer Letter by Berger et al Regarding Article, "Cardiac Memory in Patients With Wolff-Parkinson-White Syndrome: Noninvasive Imaging of Activation and Repolarization Before and After Catheter Ablation" Circulation, February 24, 2009; 119(7): e209 - e209. [Full Text] [PDF]