TY - JOUR
T1 - Electrocardiographic imaging for atrial fibrillation: a perspective from computer models and animal experiments to clinical value
AU - Salinet, João
AU - Molero, Rubén
AU - Schlindwein , Fernando
AU - Karel, Joël
AU - Rodrigo, Miguel
AU - Rojo-Álvarez, José Luis
AU - Berenfeld, Omer
AU - Climent, Andreu
AU - Zenger, Brian
AU - Vanheusden, Frederique
AU - Paredes Jimena, Gabriela Siles
AU - MacLeod, Rob
AU - Atienza, Felipe
AU - Guillem, Maria
AU - Cluitmans, Matthijs
AU - Bonizzi, Pietro
N1 - Funding Information:
JS was supported by Grants #2020/12841-3, #2020/13017-2, and #2018/25606-2, São Paulo Research Foundation (FAPESP). FS was supported by research grants from the Medical Research Council UK (MR/S037306/1), and from the British Heart Foundation (BHF Project Grant No. PG/18/33/33780). JR-Á was supported by the projects (PID2019-106623RBC41) and meHeart (PID2019-104356RB-C42 and PID2019-104356RB-C43) from the Spanish Government. JP was funded by Program of Alliances for Education and Training (Scholarship Brazil—PAEC OEA-GCUB-2017). RM, AC, and MG were supported by the Instituto de Salud Carlos III, and Ministerio de Ciencia, Innovación y Universidades (supported by the FEDER Fondo Europeo de Desarrollo Regional PI17/01106 and RYC2018-024346B-750), EIT Health (Activity code 19600, EIT Health was supported by the EIT, a body of the European Union), received funding from the European Union’s Horizon research and Innovation programme under the Marie Skłodowska-Curie grant agreement no. 860974 and the Generalitat Valenciana Grants (ACIF/2020/265). BZ and RM were supported by the NIH NHLBI Grant No. 1F30HL149327; NIH NIGMS Center
Funding Information:
Funding. JS was supported by Grants #2020/12841-3, #2020/13017-2, and #2018/25606-2, S?o Paulo Research Foundation (FAPESP). FS was supported by research grants from the Medical Research Council UK (MR/S037306/1), and from the British Heart Foundation (BHF Project Grant No. PG/18/33/33780). JR-? was supported by the projects (PID2019-106623RB-C41) and meHeart (PID2019-104356RB-C42 and PID2019-104356RB-C43) from the Spanish Government. JP was funded by Program of Alliances for Education and Training (Scholarship Brazil?PAEC OEA-GCUB-2017). RM, AC, and MG were supported by the Instituto de Salud Carlos III, and Ministerio de Ciencia, Innovaci?n y Universidades (supported by the FEDER Fondo Europeo de Desarrollo Regional PI17/01106 and RYC2018-024346B-750), EIT Health (Activity code 19600, EIT Health was supported by the EIT, a body of the European Union), received funding from the European Union?s Horizon research and Innovation programme under the Marie Sk?odowska-Curie grant agreement no. 860974 and the Generalitat Valenciana Grants (ACIF/2020/265). BZ and RM were supported by the NIH NHLBI Grant No. 1F30HL149327; NIH NIGMS Center for Integrative Biomedical Computing (www.sci.utah.edu/cibc), NIH NIGMS Grants P41GM103545 and R24 GM136986; and the Nora Eccles Treadwell Foundation for Cardiovascular Research. OB was supported in part by research grants from the National Institutes of Health (R01-HL118304 and R21-HL153694), Abbott, Medtronic, and CoreMap. MC was supported by a Veni Grant from the Netherlands Organization for Scientific Research (TTW 16772). FA was supported by the Instituto de Salud Carlos III (PI17/010559 and PI20/01618) and the Consorcio de Investigaci?n Biom?dica en Red de Enfermedades Cardiovasculares (CIBERCV), the Ministerio de Ciencia e Innovaci?n (cofound by FEDER: Fondo Europeo de Desarrollo Regional), EIT Health (AFFINE 19600, EIT Health was supported by EIT, a body of the European Union).
Publisher Copyright:
© Copyright © 2021 Salinet, Molero, Schlindwein, Karel, Rodrigo, Rojo-Álvarez, Berenfeld, Climent, Zenger, Vanheusden, Paredes, MacLeod, Atienza, Guillem, Cluitmans and Bonizzi.
PY - 2021/4/30
Y1 - 2021/4/30
N2 - Electrocardiographic imaging (ECGI) is a technique to reconstruct non-invasively the electrical activity on the heart surface from body-surface potential recordings and geometric information of the torso and the heart. ECGI has shown scientific and clinical value when used to characterize and treat both atrial and ventricular arrhythmias. Regarding atrial fibrillation (AF), the characterization of the electrical propagation and the underlying substrate favoring AF is inherently more challenging than for ventricular arrhythmias, due to the progressive and heterogeneous nature of the disease and its manifestation, the small volume and wall thickness of the atria, and the relatively large role of microstructural abnormalities in AF. At the same time, ECGI has the advantage over other mapping technologies of allowing a global characterization of atrial electrical activity at every atrial beat and non-invasively. However, since ECGI is time-consuming and costly and the use of electrical mapping to guide AF ablation is still not fully established, the clinical value of ECGI for AF is still under assessment. Nonetheless, AF is known to be the manifestation of a complex interaction between electrical and structural abnormalities and therefore, true electro-anatomical-structural imaging may elucidate important key factors of AF development, progression, and treatment. Therefore, it is paramount to identify which clinical questions could be successfully addressed by ECGI when it comes to AF characterization and treatment, and which questions may be beyond its technical limitations. In this manuscript we review the questions that researchers have tried to address on the use of ECGI for AF characterization and treatment guidance (for example, localization of AF triggers and sustaining mechanisms), and we discuss the technological requirements and validation. We address experimental and clinical results, limitations, and future challenges for fruitful application of ECGI for AF understanding and management. We pay attention to existing techniques and clinical application, to computer models and (animal or human) experiments, to challenges of methodological and clinical validation. The overall objective of the study is to provide a consensus on valuable directions that ECGI research may take to provide future improvements in AF characterization and treatment guidance.
AB - Electrocardiographic imaging (ECGI) is a technique to reconstruct non-invasively the electrical activity on the heart surface from body-surface potential recordings and geometric information of the torso and the heart. ECGI has shown scientific and clinical value when used to characterize and treat both atrial and ventricular arrhythmias. Regarding atrial fibrillation (AF), the characterization of the electrical propagation and the underlying substrate favoring AF is inherently more challenging than for ventricular arrhythmias, due to the progressive and heterogeneous nature of the disease and its manifestation, the small volume and wall thickness of the atria, and the relatively large role of microstructural abnormalities in AF. At the same time, ECGI has the advantage over other mapping technologies of allowing a global characterization of atrial electrical activity at every atrial beat and non-invasively. However, since ECGI is time-consuming and costly and the use of electrical mapping to guide AF ablation is still not fully established, the clinical value of ECGI for AF is still under assessment. Nonetheless, AF is known to be the manifestation of a complex interaction between electrical and structural abnormalities and therefore, true electro-anatomical-structural imaging may elucidate important key factors of AF development, progression, and treatment. Therefore, it is paramount to identify which clinical questions could be successfully addressed by ECGI when it comes to AF characterization and treatment, and which questions may be beyond its technical limitations. In this manuscript we review the questions that researchers have tried to address on the use of ECGI for AF characterization and treatment guidance (for example, localization of AF triggers and sustaining mechanisms), and we discuss the technological requirements and validation. We address experimental and clinical results, limitations, and future challenges for fruitful application of ECGI for AF understanding and management. We pay attention to existing techniques and clinical application, to computer models and (animal or human) experiments, to challenges of methodological and clinical validation. The overall objective of the study is to provide a consensus on valuable directions that ECGI research may take to provide future improvements in AF characterization and treatment guidance.
KW - AF characterization
KW - CATHETER ABLATION
KW - DOMINANT FREQUENCY
KW - ECG
KW - INVERSE PROBLEM
KW - MAGNETIC-RESONANCE
KW - PERSISTENT
KW - PULMONARY VEIN ISOLATION
KW - ROTORS
KW - TORSO INHOMOGENEITIES
KW - VOLUME CONDUCTOR
KW - atrial fibrillation
KW - cardiac arrhythmias
KW - catheter ablation
KW - electrocardiographic imaging
KW - inverse solution
KW - treatment guidance
U2 - 10.3389/fphys.2021.653013
DO - 10.3389/fphys.2021.653013
M3 - (Systematic) Review article
C2 - 33995122
SN - 1664-042X
VL - 12
JO - Frontiers in physiology
JF - Frontiers in physiology
M1 - 653013
ER -