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Noninvasive reconstruction of cardiac electrical activity: update on current methods, applications and challenges.

Cluitmans MJ, Peeters RL, Westra RL, Volders PG - Neth Heart J (2015)

Bottom Line: However, many assumptions and model choices are involved in its execution, and only limited validation has been performed.It is important for clinicians to realise the influence of certain assumptions and model choices for correct and careful interpretation of the results.This, in combination with more extensive validation, will allow for exploitation of the full potential of noninvasive electrocardiographic imaging as a powerful clinical tool to expedite diagnosis, guide therapy and improve risk stratification.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.

ABSTRACT
Electrical activity at the level of the heart muscle can be noninvasively reconstructed from body-surface electrocardiograms (ECGs) and patient-specific torso-heart geometry. This modality, coined electrocardiographic imaging, could fill the gap between the noninvasive (low-resolution) 12-lead ECG and invasive (high-resolution) electrophysiology studies. Much progress has been made to establish electrocardiographic imaging, and clinical studies appear with increasing frequency. However, many assumptions and model choices are involved in its execution, and only limited validation has been performed. In this article, we will discuss the technical details, clinical applications and current limitations of commonly used methods in electrocardiographic imaging. It is important for clinicians to realise the influence of certain assumptions and model choices for correct and careful interpretation of the results. This, in combination with more extensive validation, will allow for exploitation of the full potential of noninvasive electrocardiographic imaging as a powerful clinical tool to expedite diagnosis, guide therapy and improve risk stratification.

No MeSH data available.


Schematic representation of forward/inverse models. A forward model describes the propagation of electromagnetic activity from the heart to the body surface; an inverse model reverses that relation, allowing for noninvasive reconstruction of electrical heart activity from measured body-surface potentials
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Fig2: Schematic representation of forward/inverse models. A forward model describes the propagation of electromagnetic activity from the heart to the body surface; an inverse model reverses that relation, allowing for noninvasive reconstruction of electrical heart activity from measured body-surface potentials

Mentions: The setup necessary for inverse reconstruction consists of specialised hardware and mathematical algorithms. So-called ‘forward models’ describe the propagation of electromagnetic activity from heart to body surface (Fig. 2). An inverse model is based on a forward model with known ‘output’ and unknown ‘source’; it essentially reverses the natural electromagnetic relationship between heart and body surface. Forward models consist of three parts: the cardiac source (representing the electrical activity of the heart), the model output (the body-surface potentials) and the electromagnetic source–output relation (capturing patient-specific propagation by an anatomical and conductivity reference). Reversing this electromagnetic relationship requires a fourth element, namely regularisation methods, to deal with the reconstruction’s sensitivity to noise. We will discuss these four elements in the next sections. Some technique characteristics are summarised in Table 2.Fig. 2


Noninvasive reconstruction of cardiac electrical activity: update on current methods, applications and challenges.

Cluitmans MJ, Peeters RL, Westra RL, Volders PG - Neth Heart J (2015)

Schematic representation of forward/inverse models. A forward model describes the propagation of electromagnetic activity from the heart to the body surface; an inverse model reverses that relation, allowing for noninvasive reconstruction of electrical heart activity from measured body-surface potentials
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4446282&req=5

Fig2: Schematic representation of forward/inverse models. A forward model describes the propagation of electromagnetic activity from the heart to the body surface; an inverse model reverses that relation, allowing for noninvasive reconstruction of electrical heart activity from measured body-surface potentials
Mentions: The setup necessary for inverse reconstruction consists of specialised hardware and mathematical algorithms. So-called ‘forward models’ describe the propagation of electromagnetic activity from heart to body surface (Fig. 2). An inverse model is based on a forward model with known ‘output’ and unknown ‘source’; it essentially reverses the natural electromagnetic relationship between heart and body surface. Forward models consist of three parts: the cardiac source (representing the electrical activity of the heart), the model output (the body-surface potentials) and the electromagnetic source–output relation (capturing patient-specific propagation by an anatomical and conductivity reference). Reversing this electromagnetic relationship requires a fourth element, namely regularisation methods, to deal with the reconstruction’s sensitivity to noise. We will discuss these four elements in the next sections. Some technique characteristics are summarised in Table 2.Fig. 2

Bottom Line: However, many assumptions and model choices are involved in its execution, and only limited validation has been performed.It is important for clinicians to realise the influence of certain assumptions and model choices for correct and careful interpretation of the results.This, in combination with more extensive validation, will allow for exploitation of the full potential of noninvasive electrocardiographic imaging as a powerful clinical tool to expedite diagnosis, guide therapy and improve risk stratification.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.

ABSTRACT
Electrical activity at the level of the heart muscle can be noninvasively reconstructed from body-surface electrocardiograms (ECGs) and patient-specific torso-heart geometry. This modality, coined electrocardiographic imaging, could fill the gap between the noninvasive (low-resolution) 12-lead ECG and invasive (high-resolution) electrophysiology studies. Much progress has been made to establish electrocardiographic imaging, and clinical studies appear with increasing frequency. However, many assumptions and model choices are involved in its execution, and only limited validation has been performed. In this article, we will discuss the technical details, clinical applications and current limitations of commonly used methods in electrocardiographic imaging. It is important for clinicians to realise the influence of certain assumptions and model choices for correct and careful interpretation of the results. This, in combination with more extensive validation, will allow for exploitation of the full potential of noninvasive electrocardiographic imaging as a powerful clinical tool to expedite diagnosis, guide therapy and improve risk stratification.

No MeSH data available.