Focal atrial tachycardia after pulmonary vein isolation: Noninvasive mapping with electrocardiographic imaging (ECGI)

Abstract

Electrocardiographic imaging (ECGI) is a novel, noninvasive tool for imaging cardiac arrhythmia and defining electrophysiologic properties.1,2 ECGI combines multi-electrode body surface ECG recordings with three-dimensional anatomical heart-torso imaging to reconstruct an epicardial electroanatomical map (Figure 1). ECGI-reconstructed data can be presented as epicardial potential maps, electrograms, or isochrones during activation and repolarization. The ECGI procedure has been extensively tested and validated in experimental preparations with normal and abnormal canine hearts3–10. Recently, ECGI has been validated in humans1,2,11–13. To date, we have presented human ECGI studies of normal activation and repolarization 1,2, right and left bundle branch block1,11, various pacing protocols1,11,13, atrial flutter1, native sinus rhythm and bi-ventricular pacing for cardiac resynchronization (CRT) in heart failure patients11, and focal ventricular tachycardia12. Figure 1 The ECGI procedure. Body surface potential maps (BSPM) are recorded using a multi-channel (256-electrode) mapping system. Non-contrast CT images with the body surface ECGI electrodes applied, simultaneously record the locations of the electrodes (shining ... This report describes the first case in which ECGI was applied in a patient with a focal atrial tachycardia. In particular, ECGI accurately located the earliest site of activation in an atrium which had previously undergone two percutaneous pulmonary vein isolation procedures. The tachyarrhythmia was successfully terminated with radio frequency (RF) ablation in the ECGI-determined location.