Non-invasive focus localization, right ventricular epicardial potential mapping in patients with an MRI-conditional...

Area of Science:

• Cardiovascular Imaging
• Electrophysiology
• Medical Device Technology

Background:

• Advancements in MRI-conditional pacemakers enable MRI scans in patients with these devices.
• MRI offers detailed cardiac volume and function assessment.
• Non-invasive inverse potential mapping (IPM) reconstructs epicardial potentials from body surface potentials (BSP).

Purpose of the Study:

• To investigate the feasibility of using IPM with limited electrodes for non-invasive focus localization.
• To apply IPM in pacemaker patients, simulating ventricular ectopic foci using paced beats.

Main Methods:

• Ten patients with MRI-conditional pacemakers and normal hearts were studied.
• Patient-specific 3D thorax models were created from MRI data.
• Body surface potentials (BSP) were recorded during ventricular pacing, and epicardial potentials were calculated via IPM.

Main Results:

• The site of earliest epicardial depolarization was successfully identified in all patients.
• When pacing leads were near the epicardium (RV apex/outflow tract), the distance to epicardial breakthrough was 6.0 ± 1.9 mm.

Conclusions:

• The combined MRI and IPM approach is clinically applicable.
• This method accurately identifies sites of earliest depolarization with clinically relevant precision.