Novel use of repolarization parameters in electrocardiographic imaging to uncover arrhythmogenic substrate.

Abstract:

BACKGROUND:Measuring repolarization characteristics is challenging and has been reserved for experienced physicians. In electrocardiographic imaging (ECGI), activation-recovery interval (ARI) is used as a measure of local cardiac repolarization duration. We hypothesized that repolarization characteristics, such as local electrogram morphology and local and global dispersion of repolarization timing and duration could be of significance in ECGI. OBJECTIVE:To further explore their potential in arrhythmic risk stratification we investigated the use of novel repolarization parameters in ECGI. MATERIALS AND METHODS:We developed and compared methods for T-peak and T-end detection in reconstructed potentials. All methods were validated on annotated reconstructed electrograms (EGMs). Characteristics of the reconstructed EGMs and epicardial substrate maps in IVF patients were analyzed by using data recorded during sinus rhythm. The ECGI data were analyzed for EGM morphology, conduction, and repolarization. RESULTS:We acquired ECGI data from 8 subjects for this study. In all patients we evaluated four repolarization parameters: Repolarization time, T-wave area, Tpeak-Tend interval, and T-wave alternans. Most prominent findings were steep repolarization time gradients in regions with flat EGMs. These regions were also characterized by low T-wave area and large differences in Tpeak-Tend interval. CONCLUSIONS:Measuring novel repolarization parameters in reconstructed electrograms acquired with ECGI is feasible, can be done in a fully automated manner and may provide additional information on underlying arrhythmogenic substrate for risk stratification. Further studies are needed to investigate their potential use and clinical application.

journal_name

J Electrocardiol

authors

Blom LJ,Groeneveld SA,Wulterkens BM,van Rees B,Nguyen UC,Roudijk RW,Cluitmans M,Volders PGA,Hassink RJ

doi

10.1016/j.jelectrocard.2020.02.003

subject

Has Abstract

pub_date

2020-01-01 00:00:00

pages

116-121

eissn

0022-0736

issn

1532-8430

pii

S0022-0736(19)30902-1

journal_volume

59

pub_type

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