Validation and Opportunities of Electrocardiographic Imaging: From Technical Achievements to Clinical Applications

Matthijs Cluitmans*, Dana H. Brooks, Rob MacLeod, Olaf Dossel, Maria S. Guillem, Peter M. van Dam, Jana Svehlikova, Bin He, John Sapp, Linwei Wang, Laura Bear*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

Electrocardiographic imaging (ECGI) reconstructs the electrical activity of the heart from a dense array of body-surface electrocardiograms and a patient-specific heart-torso geometry. Depending on how it is formulated, ECGI allows the reconstruction of the activation and recovery sequence of the heart, the origin of premature beats or tachycardia, the anchors/hotspots of re-entrant arrhythmias and other electrophysiological quantities of interest. Importantly, these quantities are directly and non-invasively reconstructed in a digitized model of the patient's three-dimensional heart, which has led to clinical interest in ECGI's ability to personalize diagnosis and guide therapy. Despite considerable development over the last decades, validation of ECGI is challenging. Firstly, results depend considerably on implementation choices, which are necessary to deal with ECGI's ill-posed character. Secondly, it is challenging to obtain (invasive) ground truth data of high quality. In this review, we discuss the current status of ECGI validation as well as the major challenges remaining for complete adoption of ECGI in clinical practice. Specifically, showing clinical benefit is essential for the adoption of ECGI. Such benefit may lie in patient outcome improvement, workflow improvement, or cost reduction. Future studies should focus on these aspects to achieve broad adoption of ECGI, but only after the technical challenges have been solved for that specific application/pathology. We propose 'best' practices for technical validation and highlight collaborative efforts recently organized in this field. Continued interaction between engineers, basic scientists, and physicians remains essential to find a hybrid between technical achievements, pathological mechanisms insights, and clinical benefit, to evolve this powerful technique toward a useful role in clinical practice.
Original languageEnglish
Article number1305
Number of pages19
JournalFrontiers in physiology
Volume9
DOIs
Publication statusPublished - 20 Sept 2018

Keywords

  • ECG imaging
  • validation
  • electrocardiography
  • electrophysiology
  • experiment
  • PERSISTENT ATRIAL-FIBRILLATION
  • PREMATURE VENTRICULAR CONTRACTIONS
  • CARDIAC RESYNCHRONIZATION THERAPY
  • SURFACE SOURCE MODEL
  • BUNDLE-BRANCH BLOCK
  • EPICARDIAL POTENTIALS
  • CATHETER ABLATION
  • NONINVASIVE CHARACTERIZATION
  • MYOCARDIAL ACTIVATION
  • HEART-FAILURE

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