title: Feasibility and Accuracy of Cardiac Magnetic Resonance Imaging-Based Whole-Heart Inverse Potential Mapping of Sinus Rhythm and Idiopathic Ventricular Foci.
abstract: BACKGROUND
  Inverse potential mapping (IPM) noninvasively reconstructs cardiac surface potentials using body surface potentials. This requires a volume conductor model (VCM), usually constructed from computed tomography; however, computed tomography exposes the patient to harmful radiation and lacks information about tissue structure. Magnetic resonance imaging (MRI) is not associated with this limitation and might have advantages for mapping purposes. This feasibility study investigated a magnetic resonance imaging-based IPM approach. In addition, the impact of incorporating the lungs and their particular resistivity values was explored.
  
  
  RESULTS
  Three volunteers and 8 patients with premature ventricular contractions scheduled for ablation underwent 65-electrode body surface potential mapping. A VCM was created using magnetic resonance imaging. Cardiac surface potentials were estimated from body surface potentials and used to determine the origin of electrical activation. The IPM-defined origin of sinus rhythm corresponded well with the anatomic position of the sinus node, as described in the literature. In patients, the IPM-derived premature ventricular contraction focus was 3-dimensionally located within 8.3±2.7 mm of the invasively determined focus using electroanatomic mapping. The impact of lungs on the IPM was investigated using homogeneous and inhomogeneous VCMs. The inhomogeneous VCM, incorporating lung-specific conductivity, provided more accurate results compared with the homogeneous VCM (8.3±2.7 and 10.3±3.1 mm, respectively; P=0.043). The interobserver agreement was high for homogeneous (intraclass correlation coefficient 0.862, P=0.003) and inhomogeneous (intraclass correlation coefficient 0.812, P=0.004) VCMs.
  
  
  CONCLUSIONS
  Magnetic resonance imaging-based whole-heart IPM enables accurate spatial localization of sinus rhythm and premature ventricular contractions comparable to electroanatomic mapping. An inhomogeneous VCM improved IPM accuracy.
authors.affiliation: Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.).
authors.forename: Pranav
authors.initials: P
authors.lastname: Bhagirath
authors.affiliation: Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.).
authors.forename: Maurits
authors.initials: M
authors.lastname: van der Graaf
authors.affiliation: Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.).
authors.forename: Elise
authors.initials: E
authors.lastname: van Dongen
authors.affiliation: Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.).
authors.forename: Jacques
authors.initials: J
authors.lastname: de Hooge
authors.affiliation: Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.).
authors.forename: Vincent
authors.initials: V
authors.lastname: van Driel
authors.affiliation: Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.).
authors.forename: Hemanth
authors.initials: H
authors.lastname: Ramanna
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (N.G.).
authors.forename: Natasja
authors.initials: N
authors.lastname: de Groot
authors.affiliation: Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.).
authors.forename: Marco J W
authors.initials: MJ
authors.lastname: Götte
mesh_terms: D000200:Action Potentials; D000328:Adult; D018780:Body Surface Potential Mapping / Q000379:methods*; D016022:Case-Control Studies; D017115:Catheter Ablation; D005240:Feasibility Studies; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006339:Heart Rate; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery
keywords: cardiac magnetic resonance imaging; catheter ablation; noninvasive cardiac imaging; premature ventricular contractions