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(Circulation. 2000;101:533.)
© 2000 American Heart Association, Inc.

Basic Science Reports

Noninvasive ECG Imaging of Electrophysiologically Abnormal Substrates in Infarcted Hearts

A Model Study

John E. Burnes, MS; Bruno Taccardi, MD; Robert S. MacLeod, PhD; Yoram Rudy, PhD

From the Cardiac Bioelectricity Research and Training Center and the Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio (J.E.B., Y.R.), and the Cardiovascular Research and Training Institute, University of Utah, Salt Lake City (B.T., R.S.M.).

Correspondence to Yoram Rudy, Cardiac Bioelectricity Center, 505 Wickenden Bldg, Case Western Reserve University, Cleveland, OH 44106-7207. E-mail yxr{at}po.cwru.edu

Background—Myocardial infarction and subsequent remodeling create substrates with altered electrophysiological (EP) properties that are highly arrhythmogenic. Existing ECG methods cannot always detect the existence of such substrates nor provide any detailed information about their EP characteristics. A noninvasive method with such capabilities is greatly needed for identifying patients at risk of arrhythmias and for guidance and evaluation of therapy. Recently, we developed a noninvasive ECG imaging modality that can reconstruct epicardial EP information from body surface potentials. We extended its application to hearts with structural disease and examined its ability to detect and characterize abnormal EP substrates.

Methods and Results—Epicardial potentials were recorded with a 490-electrode sock from an open-chest dog. Recordings were obtained from a normal heart and from the same heart 2 hours after left anterior descending coronary artery occlusion and ethanol injection to create an infarct. Body surface potentials were generated from these epicardial potentials in a human torso model. Realistic geometry errors and measurement noise were added to the torso data, which were then used to noninvasively reconstruct epicardial potentials and electrograms (EGMs), with excellent accuracy. EP characteristics associated with the infarct substrate were reconstructed, including (1) a negative region over the infarct, (2) EGMs with large predominant negative deflections (eg, Q-wave EGMs), (3) Q-wave EGMs with superimposed RS deflections reflecting local activation of surviving myocardium within the infarct border zone, (4) reduced magnitudes of EGM negative derivatives, and (5) negative QRS integrals of EGMs over the infarct.

Conclusions—ECG imaging can noninvasively detect and map abnormal EP substrates associated with infarction and structural heart disease.

Key Words: infarction • electrocardiography • potentials

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