Electrocardiographic Imaging for Atrial Fibrillation: A Perspective From Computer Models and Animal Experiments to Clinical Value

Author(s):Show less -

Salinet, Joao ^[1] ; Molero, Ruben ^[2] ; Schlindwein, Fernando S. ^{[3, 4]} ; Karel, Joel ^[5] ; Rodrigo, Miguel ^[6] ; Luis Rojo-Alvarez, Jose ^[7] ; Berenfeld, Omer ^[8] ; Climent, Andreu M. ^[2] ; Zenger, Brian ^{[9, 10]} ; Vanheusden, Frederique ^[11] ; Siles Paredes, Jimena Gabriela ^[1] ; MacLeod, Rob ^{[9, 10]} ; Atienza, Felipe ^{[12, 13]} ; Guillem, Maria S. ^[2] ; Cluitmans, Matthijs ^[14] ; Bonizzi, Pietro ^[5]

Affiliation:Show less -

^[1] Fed Univ ABC, Ctr Engn Modelling & Appl Social Sci CECS, Biomed Engn, Sao Bernardo Do Campo - Brazil

^[2] Univ Politecn Valencia, ITACA Inst, Valencia - Spain

^[3] Univ Leicester, Sch Engn, Leicester, Leics - England

^[4] Natl Inst Hlth Res, Leicester Cardiovasc Biomed Res Ctr, Glenfield Hosp, Leicester, Leics - England

^[5] Maastricht Univ, Dept Data Sci & Knowledge Engn, Maastricht - Netherlands

^[6] Univ Valencia, Elect Engn Dept, Valencia - Spain

^[7] Univ Rey Juan Carlos, Dept Signal Theory & Commun & Telemat Syst & Comp, Madrid - Spain

^[8] Univ Michigan, Ctr Arrhythmia Res, Ann Arbor, MI - USA

^[9] Univ Utah, Sci Comp & Imaging Inst SCI, Biomed Engn Dept, Salt Lake City, UT - USA

^[10] Univ Utah, Cardiovasc Res & Training Inst CVRTI, Salt Lake City, UT - USA

^[11] Nottingham Trent Univ, Sch Sci & Technol, Dept Engn, Nottingham - England

^[12] Univ Complutense Madrid, Cardiol Dept, Hosp Gen Univ Gregorio Maranon, Madrid - Spain

^[13] Univ Complutense Madrid, Fac Med, Madrid - Spain

^[14] Maastricht Univ, Cardiovasc Res Inst Maastricht, Dept Cardiol, Maastricht - Netherlands

• Document type: Review article
• Source: FRONTIERS IN PHYSIOLOGY; v. 12, APR 30 2021.
• Web of Science Citations: 0

Abstract

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. (AU)

• FAPESP's process: 20/12841-3 - Validation of a customized method for estimating electrical potentials in the torso from atrial signals: a computational-clinical study
• Grantee: Camila Rocha Restivo
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• FAPESP's process: 18/25606-2 - Accurate mapping of cardiac fibrillation activity: an experimental contribution
• Grantee: João Loures Salinet Júnior
• Support Opportunities: Research Grants - Young Investigators Grants
• FAPESP's process: 20/13017-2 - Mapping of atrial epicardium electrical activity during atrial fibrillation based on signals from the torso: a clinical-computational study
• Grantee: Gabriel Victor Costa
• Support Opportunities: Scholarships in Brazil - Scientific Initiation