The multielectrode CardioInsight mapping vest captures electrical signals from the body surface and combines them with anatomical data generated from a flash CT image to produce a real-time, electrical 3-D map of the heart. Just how instrumental this technology will be is yet to be determined.
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Members of the UVA advanced imaging program are also working to make it less stressful for patients to undergo treatment for atrial fibrillation and flutter. Previously, on the day before their ablation, patients underwent both a cardiac CT exam to evaluate pulmonary vein anatomy and a transesophageal echocardiogram TEE to evaluate the left atrial appendage for blood clots thrombus. This required patients to undergo an additional invasive procedure and remain fasting for a good part of the day prior to their ablation.
To streamline the process and maximize patient comfort, Bilchick and colleague Michael Salerno, MD, PhD , pioneered a way to integrate cardiac CT angiography acquired for pulmonary vein anatomy into the care of these patients in order to rule out left atrial appendage thrombus.
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Their approach, using delayed imaging after contrast administration, minimizes the false positives, and rules out thrombus in many patients with a high degree of accuracy, according to outcomes recently published in the January edition of Heart Rhythm Journal. Now patients can come in for a cardiac CT and only undergo TEE if there is an equivocal or positive result. Developing this protocol required coordination among electrophysiologists, radiologists, nurses and the Heart Rhythm Quality and Safety Team. Collaborations among members of the advanced imaging program have also led to promising advances in imaging for patients with pulmonary hypertension.
By working together with biomedical engineering investigators Salerno and Frederick Epstein, PhD, the UVA team successfully adapted an MRI method previously used to detect diffuse fibrosis in the left ventricle for use with the thinner right ventricle, the chamber often damaged by pulmonary hypertension. This information was then combined with MRI information on RV function, size and morphology to provide a comprehensive assessment for these patients. In addition, thanks to an effort led by Jamie L. Jude Medical to help patients with heart failure, some of whom also have pulmonary hypertension.
This implantable pulmonary pressure monitor can provide highly useful information on right-sided heart pressures without the requirement for additional heart catheterization procedures.
Body Surface Electrocardiographic Mapping
The use of MRI evaluation of the structure, function, tissue characteristics of the right ventricle, as well as intracardiac monitors of pulmonary pressures, is helping UVA cardiologists guide therapies and monitor their effectiveness. However, they stated that the utility of the system for highly challenging cases like long-standing persistent AF and patients with very short AF cycle length remains to be explored. They stated that further studies are needed to confirm these data and answer the multitude of open questions in this field.
Ueoka and colleagues stated that clinical and experimental studies have shown the existence of an arrhythmogenic substrate in the right ventricular outflow tract RVOT in patients with Brugada syndrome BrS. These researches evaluated the activation pattern of induced ventricular tachyarrhythmias using BSM in patients with BrS. They examined 14 patients with BrS in whom ventricular tachyarrhythmias were induced by programmed electrical stimulation. The lead BSM was recorded during induced ventricular tachyarrhythmias, and an activation map and an isopotential map of QRS complexes every 5 ms were constructed to evaluate the activation pattern of ventricular tachyarrhythmias.
Polymorphic QRS change during ventricular tachyarrhythmias was associated with migration of the earliest activation site and rotor. Body surface mapping during 4 episodes of ventricular fibrillation VF showed that the excitation front moved randomly with formation of multiple wave-fronts. The authors concluded that programmed stimulation initiated repetitive firing from the RVOT. Migration and competition of the earliest activation site and rotor and local conduction delay changed the QRS morphology.
Degeneration of the re-entrant circuit into multiple wave-fronts resulted in VF. Gage and colleagues noted that electrical activation is important in cardiac resynchronization therapy CRT response. Standard electrocardiographic analysis may not accurately reflect the heterogeneity of electrical activation. These researchers compared changes in left ventricular size and function after CRT to native electrical dyssynchrony and its change during pacing. Body surface isochronal maps using 53 anterior and posterior electrodes as well as lead electrocardiograms were acquired after CRT in 66 consecutive patients.
Electrical dyssynchrony was quantified using standard deviation of activation times SDAT. Multiple regression evaluated predictors of response. These preliminary findings need to be validated by well-designed studies. Review History. Clinical Policy Bulletin Notes. Links to various non-Aetna sites are provided for your convenience only.
Aetna Inc. Body Surface Potential Mapping. Print Share. Background The conventional lead electrocardiogram ECG is the principal risk stratification device for patients presenting with chest pain to the emergency department. Evaluation of Brugada Syndrome Ueoka and colleagues stated that clinical and experimental studies have shown the existence of an arrhythmogenic substrate in the right ventricular outflow tract RVOT in patients with Brugada syndrome BrS. Prediction of Response in Cardiac Resynchronization Therapy Gage and colleagues noted that electrical activation is important in cardiac resynchronization therapy CRT response.
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