Novel use of repolarization parameters in electrocardiographic imaging to uncover arrhythmogenic substrate

Measuring repolarization characteristics is challenging and has been reserved for experienced physicians. In electrocardiographic imaging (ECGI), activation-recovery interval (ARI) is used as a measure of local cardiac repolarization duration. We hypothesized that repolarization characteristics, suc...

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Bibliographic Details
Published in:	Journal of electrocardiology Vol. 59; pp. 116 - 121
Main Authors:	Blom, L.J., Groeneveld, S.A., Wulterkens, B.M., van Rees, B., Nguyen, U.C., Roudijk, R.W., Cluitmans, M., Volders, P.G.A., Hassink, R.J.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-03-2020 Elsevier Science Ltd
Subjects:	Cardiac arrhythmia Cardiovascular disease Electrocardiographic imaging Electrocardiography Electrograms Electrophysiology Medical imaging Repolarization Substrates Ventricular arrhythmias Ventricular arrhythmias Electrophysiology Repolarization Electrograms Electrocardiographic imaging
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Summary:	Measuring repolarization characteristics is challenging and has been reserved for experienced physicians. In electrocardiographic imaging (ECGI), activation-recovery interval (ARI) is used as a measure of local cardiac repolarization duration. We hypothesized that repolarization characteristics, such as local electrogram morphology and local and global dispersion of repolarization timing and duration could be of significance in ECGI. To further explore their potential in arrhythmic risk stratification we investigated the use of novel repolarization parameters in ECGI. We developed and compared methods for T-peak and T-end detection in reconstructed potentials. All methods were validated on annotated reconstructed electrograms (EGMs). Characteristics of the reconstructed EGMs and epicardial substrate maps in IVF patients were analyzed by using data recorded during sinus rhythm. The ECGI data were analyzed for EGM morphology, conduction, and repolarization. We acquired ECGI data from 8 subjects for this study. In all patients we evaluated four repolarization parameters: Repolarization time, T-wave area, Tpeak-Tend interval, and T-wave alternans. Most prominent findings were steep repolarization time gradients in regions with flat EGMs. These regions were also characterized by low T-wave area and large differences in Tpeak-Tend interval. Measuring novel repolarization parameters in reconstructed electrograms acquired with ECGI is feasible, can be done in a fully automated manner and may provide additional information on underlying arrhythmogenic substrate for risk stratification. Further studies are needed to investigate their potential use and clinical application.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0022-0736 1532-8430
DOI:	10.1016/j.jelectrocard.2020.02.003