Noninvasive Electrocardiographic Imaging (ECGI) of a univentricular heart with Wolff-Parkinson-White syndrome

Abstract

Electrocardiographic imaging (ECGI) is a noninvasive functional imaging modality which reconstructs epicardial potentials, electrograms, and activation and recovery maps from body-surface ECG potentials. For this purpose, up to 256 ECGs are recorded by a 256-channel body surface potential mapping (BSPM) system and the heart-torso geometry is obtained using thoracic computed tomography (CT)1,2. This technique was developed and validated extensively in normal and abnormal canine hearts3–11. More recently, ECGI was validated in humans by comparison with direct intra-operative epicardial mapping in patients undergoing open-heart surgery12. To date, ECGI has been applied in adult human subjects for the following purposes: 1. To study cardiac electrophysiology of the normal adult human heart2. 2. To image electrophysiologic responses to pacing in heart failure patients undergoing cardiac resynchronization therapy13 (pacing sites were localized with an accuracy better than 10 mm)14. 3. To guide catheter ablation of focal ventricular and atrial tachycardias15,16. 4. To image typical atrial flutter prior to catheter ablation1 and atypical atrial flutter prior to a surgical Cox-Maze procedure17. Here we describe for the first time, a case where ECGI was applied to a pediatric patient with a congenital structural heart defect. The patient had a univentricular heart and Wolff-Parkinson-White syndrome, and ECGI was used to localize the accessory pathway and help guide catheter ablation. To date, there have been no reported cases of ECGI in the pediatric population.