Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO 63110, USA.
Sci Transl Med. 2011 Aug 31;3(98):98ra84. doi: 10.1126/scitranslmed.3002152.
The rapid heartbeat of ventricular tachycardia (VT) can lead to sudden cardiac death and is a major health issue worldwide. Efforts to identify patients at risk, determine mechanisms of VT, and effectively prevent and treat VT through a mechanism-based approach would all be facilitated by continuous, noninvasive imaging of the arrhythmia over the entire heart. Here, we present noninvasive real-time images of human ventricular arrhythmias using electrocardiographic imaging (ECGI). Our results reveal diverse activation patterns, mechanisms, and sites of initiation of human VT. The spatial resolution of ECGI is superior to that of the routinely used 12-lead electrocardiogram, which provides only global information, and ECGI has distinct advantages over the currently used method of mapping with invasive catheter-applied electrodes. The spatial resolution of this method and its ability to image electrical activation sequences over the entire ventricular surfaces in a single heartbeat allowed us to determine VT initiation sites and continuation pathways, as well as VT relationships to ventricular substrates, including anatomical scars and abnormal electrophysiological substrate. Thus, ECGI can map the VT activation sequence and identify the location and depth of VT origin in individual patients, allowing personalized treatment of patients with ventricular arrhythmias.
室性心动过速 (VT) 的快速心跳可导致心源性猝死，是全球范围内的一个主要健康问题。通过基于机制的方法来识别有风险的患者、确定 VT 的机制以及有效地预防和治疗 VT，都将得益于对整个心脏的心律失常进行持续的、非侵入性的成像。在这里，我们使用心电图成像 (ECGI) 呈现了人类室性心律失常的非侵入性实时图像。我们的结果揭示了人类 VT 的不同激活模式、机制和起始部位。ECGI 的空间分辨率优于常规使用的 12 导联心电图，后者仅提供整体信息，并且 ECGI 具有明显优于目前使用的经皮导管应用电极映射方法的优势。这种方法的空间分辨率及其在单个心跳内对整个心室表面的电激活序列成像的能力，使我们能够确定 VT 起始部位和延续途径，以及 VT 与心室基质的关系，包括解剖瘢痕和异常电生理基质。因此，ECGI 可以绘制 VT 的激活序列，并确定个体患者中 VT 的位置和深度，从而实现对室性心律失常患者的个性化治疗。
