Salinet João, Molero Rubén, Schlindwein Fernando S, Karel Joël, Rodrigo Miguel, Rojo-Álvarez José Luis, Berenfeld Omer, Climent Andreu M, Zenger Brian, Vanheusden Frederique, Paredes Jimena Gabriela Siles, MacLeod Rob, Atienza Felipe, Guillem María S, Cluitmans Matthijs, Bonizzi Pietro
Biomedical Engineering, Centre for Engineering, Modelling and Applied Social Sciences (CECS), Federal University of ABC, São Bernardo do Campo, Brazil.
ITACA Institute, Universitat Politècnica de València, València, Spain.
Front Physiol. 2021 Apr 30;12:653013. doi: 10.3389/fphys.2021.653013. eCollection 2021.
Electrocardiographic imaging (ECGI) is a technique to reconstruct non-invasively the electrical activity on the heart surface from body-surface potential recordings and geometric information of the torso and the heart. ECGI has shown scientific and clinical value when used to characterize and treat both atrial and ventricular arrhythmias. Regarding atrial fibrillation (AF), the characterization of the electrical propagation and the underlying substrate favoring AF is inherently more challenging than for ventricular arrhythmias, due to the progressive and heterogeneous nature of the disease and its manifestation, the small volume and wall thickness of the atria, and the relatively large role of microstructural abnormalities in AF. At the same time, ECGI has the advantage over other mapping technologies of allowing a global characterization of atrial electrical activity at every atrial beat and non-invasively. However, since ECGI is time-consuming and costly and the use of electrical mapping to guide AF ablation is still not fully established, the clinical value of ECGI for AF is still under assessment. Nonetheless, AF is known to be the manifestation of a complex interaction between electrical and structural abnormalities and therefore, true electro-anatomical-structural imaging may elucidate important key factors of AF development, progression, and treatment. Therefore, it is paramount to identify which clinical questions could be successfully addressed by ECGI when it comes to AF characterization and treatment, and which questions may be beyond its technical limitations. In this manuscript we review the questions that researchers have tried to address on the use of ECGI for AF characterization and treatment guidance (for example, localization of AF triggers and sustaining mechanisms), and we discuss the technological requirements and validation. We address experimental and clinical results, limitations, and future challenges for fruitful application of ECGI for AF understanding and management. We pay attention to existing techniques and clinical application, to computer models and (animal or human) experiments, to challenges of methodological and clinical validation. The overall objective of the study is to provide a consensus on valuable directions that ECGI research may take to provide future improvements in AF characterization and treatment guidance.
心电图成像（ECGI）是一种通过体表电位记录以及躯干和心脏的几何信息来无创重建心脏表面电活动的技术。ECGI在用于表征和治疗房性和室性心律失常时已显示出科学和临床价值。对于心房颤动（AF），由于该疾病的进展性和异质性及其表现、心房的小体积和壁厚度以及微观结构异常在房颤中的相对较大作用，电传播和有利于房颤的潜在基质的表征本质上比室性心律失常更具挑战性。同时，ECGI相对于其他标测技术具有优势，能够在每次心房搏动时对心房电活动进行全局表征且为无创性。然而，由于ECGI耗时且成本高，并且使用电标测来指导房颤消融仍未完全确立，ECGI对房颤的临床价值仍在评估中。尽管如此，已知房颤是电和结构异常之间复杂相互作用的表现，因此，真正的电解剖结构成像可能阐明房颤发生、进展和治疗的重要关键因素。因此，至关重要的是确定在房颤表征和治疗方面，哪些临床问题可以通过ECGI成功解决，哪些问题可能超出其技术限制。在本手稿中，我们回顾了研究人员在使用ECGI进行房颤表征和治疗指导（例如，房颤触发因素和维持机制的定位）方面试图解决的问题，并讨论了技术要求和验证。我们阐述了ECGI在理解和管理房颤方面的实验和临床结果、局限性以及未来挑战。我们关注现有技术和临床应用、计算机模型以及（动物或人体）实验、方法学和临床验证的挑战。该研究的总体目标是就ECGI研究可能采取的有价值方向达成共识，以在房颤表征和治疗指导方面实现未来的改进。
