Volumetric non-invasive cardiac mapping for accessible global arrhythmia characterization.

BACKGROUND

Cardiac arrhythmias are a major cause of morbidity and mortality increasing the risk of stroke, heart failure, and sudden cardiac death. Imageless electrocardiographic Imaging has emerged as an accessible non-invasive alternative for cardiac electrical mapping from body surface potentials. However, conventional electrocardiographic imaging is restricted to epicardial reconstructions, reducing its reliability in accurately identifying arrhythmias arising from deeper myocardial structures. We aim to overcome this limitation by reconstructing three-dimensional cardiac activity.

METHODS

We introduce a volumetric formulation, which extends beyond epicardial potential estimation by solving an inverse source problem using Green's functions. This technique enables three-dimensional reconstructions of cardiac activation, improving arrhythmia localization in anatomically complex regions. We evaluate the method on simulated premature ventricular beats and on four patients representing clinical challenges, including a premature ventricular contraction from the right ventricular outflow tract, a left bundle branch block, a ventricular tachycardia, and a Wolff-Parkinson-White. We also assess performance on an open-source dataset for myocardial infarction estimation.

RESULTS

Our results indicate that volumetric electrocardiographic imaging reconstructs three-dimensional activation and enhances the localization of arrhythmia origins, yielding a 59.3% reduction in geodesic error between the estimated and simulated origins compared to surface-only approaches. In patient cases, the recovered activation patterns are consistent with the clinical diagnoses.

CONCLUSIONS

Imageless volumetric electrocardiographic imaging enables non-invasive, accessible, three-dimensional mapping of cardiac activation, addressing a fundamental limitation of surface-restricted methods. This capability may support more accurate pre-procedural planning, may help guide ablation targets, and could refine selection and optimization of cardiac resynchronization therapy candidates.