Noninvasive electrocardiographic imaging of chronic XXXX scar.

@entity1 @entity1165 @entity1188 @entity583 @entity2287
BACKGROUND: @entity583 constitutes a substrate for @entity1165 ( @entity1165 ), and an accurate delineation of @entity1188 may help to identify reentrant circuits and thus facilitate catheter ablation. One of the recent advancements in characterization of a @entity1165 substrate is its volumetric delineation within the ventricular wall by noninvasive electrocardiographic imaging. This paper compares, in four specific cases, epicardial and volumetric inverse solutions, using magnetic resonance imaging (MRI) with late @entity2287 enhancement as a gold standard. METHODS: For @entity1 with chronic @entity583 , who presented at Glasgow Western Infirmary, delayed-enhancement MRI and 120-lead body surface potential mapping (BSPM) data were acquired and 4 selected cases were later made available to a wider community as part of the 2007 PhysioNet/Computers in Cardiology Challenge. These data were used to perform @entity1 -specific inverse solutions for epicardial electrograms and morphology-based criteria were applied to delineate @entity1188 on the epicardial surface. Later, the Rochester group analyzed the same data by means of a novel inverse solution for reconstructing intramural transmembrane potentials, to delineate @entity1188 in three dimensions. Comparison of the performance of three specific inverse-solution algorithms is presented here, using scores based on the 17-segment ventricular division scheme recommended by the American Heart Association. RESULTS: The noninvasive methods delineating @entity1188 as three-dimensional (3D) intramural distribution of transmembrane action potentials outperform estimates providing scar delineation on the epicardial surface in all scores used for comparison. In particular, the extent of @entity1188 (its percentage mass relative to the total ventricular mass) is rendered more accurately by the 3D estimate. Moreover, the volumetric rendition of scar border provides better clues to potential targets for catheter ablation. CONCLUSIONS: Electrocardiographic inverse solution providing transmural distribution of ventricular action potentials is a promising tool for noninvasively delineating the extent and location of chronic @entity583 . Further validation on a larger data set with detailed gold-standard data is needed to confirm observations reported in this study.
