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Correlations between cardiac imaging and electrophysiological studies: what is the state of the art?
J B Martins1, S M Collins, D J Fisher
1Department of Medicine, University of Iowa, Iowa City, 52242.
Insights
Noninvasive cardiac imaging, including body surface potential mapping, can accurately assess ventricular activation sequences. This method overcomes limitations of wall motion analysis for studying conditions like bundle branch block and ventricular tachycardia.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Ventricular activation changes due to bundle branch block, pre-excitation, and ventricular tachycardia are critical to understand.
- Various cardiac imaging modalities have been employed to study these electrical activation patterns.
Purpose of the Study:
- To review and correlate existing and new imaging data with electrophysiological studies.
- To evaluate the effectiveness of different noninvasive imaging techniques in assessing ventricular activation sequences.
Main Methods:
- Review of published and new imaging data.
- Correlation with known or measured electrophysiological studies.
- Comparison of echocardiography, radionuclide phase analysis, cine-computed tomography, and body surface potential mapping.
Main Results:
- Echocardiography shows gross correlation with abnormal wall motion but is limited.
- Radionuclide and cine-CT phase analysis provide detailed, reasonably accurate noninvasive activation data.
- Wall motion analysis may fail to predict activation sequence in damaged muscle or with excessive heart movement.
- Body surface potential mapping accurately and noninvasively registers electrical activation images, circumventing contraction sequence imaging issues.
Conclusions:
- Body surface potential mapping offers a superior noninvasive method for assessing cardiac electrical activation.
- This technique circumvents limitations of wall motion analysis and other imaging modalities.
- Body surface potential mapping warrants wider clinical and experimental use for studying ventricular activation.
Abstract:
Changes in ventricular activation produced by bundle branch block, pre-excitation, and ventricular tachycardia and pacing have been studied by various cardiac imaging modalities. We reviewed results of previously published and newly generated imaging data correlated with known or measured electrophysiological studies. Echocardiography has been demonstrated to grossly correlate with abnormal ventricular wall motion when activation sequence was altered. However, phase analysis of radionuclide and cine-computed tomography have provided detailed noninvasive activation data that correlated reasonably well with measured electrical activation sequence in both animals and man. Analysis of wall motion may not predict activation sequence when muscle is damaged or excessive translational movement of the heart occurs. Body surface mapping of electrical potentials has the capability to accurately but noninvasively register an electrical activation image of the heart that circumvents the problems of imaging contraction sequence. In the future, body surface potential mapping should be more widely used clinically and experimentally.