Atrial Fibrillation (AFib) Support Group
Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). Heart beats in a normal heart begin after electricity generated in the atria by the sinoatrial node spread through the heart and cause contraction of the heart muscle and pumping of blood.
The following is from a 2013 Boston Symposium. Source: a-fibcures. Interesting reading.....
NONINVASIVE IMAGING
The most innovative and important presentations for A-Fib patients dealt with "Noninvasive Electrocardiographic Imaging (ECGI)." Two presenters gave complimentary talks on this subject---Dr. Phillip Cuculich of Barnes Jewish Hospital in St. Louis and Dr. Michel Haissaguerre of the French Bordeaux group.
During a standard catheter ablation, doctors use a special mapping catheter that has to be positioned inside the heart to map and identify A-Fib producing spots in the heart. This can take a good deal of time and effort depending on the complexity of the A-Fib case.
But the new Noninvasive Electrocardiological Imaging (ECGI) system does not go inside the heart, but instead uses a vest-like device which a patient wears to image the inside of the heart and to pinpoint sites in the heart producing A-Fib signals. A patient lies down on his/her back and a technician places this vest-like device with 256 electrodes over his/her chest and stomach. These electrodes combine with rapid CT (Computed Tomography) scans to produce a very detailed 3D color map of the heart with an accuracy of about six millimeters.
Unlike catheter mapping systems, ECGI can map an arrhythmia in a single beat. The multielectrode vest records 224 body-surface electrocardiograms (ECGs). (In comparison a standard ECG records only 12 low resolution projections.) The ECGI records electrical potentials, electrograms, and Isochrones (activation sequences), then reconstructs and images them on the heart's surface using geometric information from CT scans. (It was amazing to watch this system produce clearly identifiable rotors and focal point arrhythmia signals in living color. I have asked the authors for permission to post these remarkable videos on A-Fib.com.) According to Dr. Cuculich, who has been working with the ECGI system for six years, "For patients, this ultimately translates into safer treatment plans with better cure rates."
One of the beauties of the ECGI system is it doesn't have to be done in an EP lab or have an EP doctor present. There is no need to move as fast as possible as when using a mapping catheter inside the heart. And a trained technician can do it. Unlike a busy EP lab, the technician and patient doing the ECGI looked very relaxed, comfortable and un-pressured.
The ECGI system was invented by Yoram Rudy, PhD, director of the Cardiac Bioelectricity and Arrhythmia Center at Washington University in St. Louis.1 It is related to and uses Body Surface Potential Mapping (BSPM). (Readers may be interested in reading about Body Surface Mapping described in the 2007 Boston A-Fib Symposium.)
The next presentation on the ECGI system was by Dr. Michel Haissaguerre of the French Bordeaux Group. (In a private conversation with the author before his presentation, Dr. Haissaguerre was obviously excited about this "extraordinaire" new, breakthrough treatment for A-Fib patients. [The author was Dr. Haissaguerre's first US patient back in 1998.]) Dr. Haissaguerre's emphasis was on the clinical effectiveness of ECGI. He had used the ECGI system for three months. 10 patients were in Paroxysmal A-Fib. He described and showed examples of how the ECGI system showed sources of A-Fib coming from the PVs and the posterior left atrium. The ECGI showed a rotor coming from a PV, and in another example a rotor coming from the left atrial appendage. In another patient a rotor came from the septum. In one patient he was able to identify and terminate A-Fib in seven minutes using the ECGI system.
But in patients with persistent A-Fib, things were a bit more challenging. Most had multiple sources or spots in the heart producing A-Fib signals. There could be as many as six different rotors swirling around in the heart. (This is similar to the finding of Dr. Narayan's FIRM system which uses a large basket catheter inside the heart to map and identify A-Fib sources.) Dr. Haissaguerre talked about using "inner windows" in the ECGI and a "brushing technique" (these are terms the author didn't understand and has written Dr. Haissaguerre for further explanation). Of 58 persistent patients (the hardest to cure), he was able to terminate A-Fib in 51 (88% success rate) using the ECGI system.
Editor's Comments:
The ECGI system is a major medical breakthrough for A-Fib patients. The ECGI system seems to have a greater sensitivity and specificity---the ability to identify spots in the heart which are producing A-Fib signals with remarkable precision, and in color and 3D. And the mapping can be done outside of the EP lab by a technician rather than by an EP doctor.
When the doctor does an ablation on a particular patient, using the ECGI system they have a complete, detailed, precise, 3D, color video of each spot in the patient's heart producing A-Fib signals which a technician has produced before the ablation. The ECGI map is a better, more accurate, more complete map than the EP could produce by using mapping catheters inside the patient's heart.
And the EP no longer has to spend time mapping, but can concentrate all his attention on the actual ablations that need to be performed.
This author predicts that the ECGI system, barring unforeseen circumstances, will rapidly supersede all other mapping systems and will become the standard of care in the treatment of A-Fib patients.
1 Ramanathan, C. at al. (and Yoram Rudy). "Noninvasive electrocardiographic imaging for cardiac electrophysiology and arrhythmia." Nature Medicine 10, 422-428 , March 14, 2004. Doi:10.1038/nm1011.
A-FibFriendSteve
NONINVASIVE IMAGING
The most innovative and important presentations for A-Fib patients dealt with "Noninvasive Electrocardiographic Imaging (ECGI)." Two presenters gave complimentary talks on this subject---Dr. Phillip Cuculich of Barnes Jewish Hospital in St. Louis and Dr. Michel Haissaguerre of the French Bordeaux group.
During a standard catheter ablation, doctors use a special mapping catheter that has to be positioned inside the heart to map and identify A-Fib producing spots in the heart. This can take a good deal of time and effort depending on the complexity of the A-Fib case.
But the new Noninvasive Electrocardiological Imaging (ECGI) system does not go inside the heart, but instead uses a vest-like device which a patient wears to image the inside of the heart and to pinpoint sites in the heart producing A-Fib signals. A patient lies down on his/her back and a technician places this vest-like device with 256 electrodes over his/her chest and stomach. These electrodes combine with rapid CT (Computed Tomography) scans to produce a very detailed 3D color map of the heart with an accuracy of about six millimeters.
Unlike catheter mapping systems, ECGI can map an arrhythmia in a single beat. The multielectrode vest records 224 body-surface electrocardiograms (ECGs). (In comparison a standard ECG records only 12 low resolution projections.) The ECGI records electrical potentials, electrograms, and Isochrones (activation sequences), then reconstructs and images them on the heart's surface using geometric information from CT scans. (It was amazing to watch this system produce clearly identifiable rotors and focal point arrhythmia signals in living color. I have asked the authors for permission to post these remarkable videos on A-Fib.com.) According to Dr. Cuculich, who has been working with the ECGI system for six years, "For patients, this ultimately translates into safer treatment plans with better cure rates."
One of the beauties of the ECGI system is it doesn't have to be done in an EP lab or have an EP doctor present. There is no need to move as fast as possible as when using a mapping catheter inside the heart. And a trained technician can do it. Unlike a busy EP lab, the technician and patient doing the ECGI looked very relaxed, comfortable and un-pressured.
The ECGI system was invented by Yoram Rudy, PhD, director of the Cardiac Bioelectricity and Arrhythmia Center at Washington University in St. Louis.1 It is related to and uses Body Surface Potential Mapping (BSPM). (Readers may be interested in reading about Body Surface Mapping described in the 2007 Boston A-Fib Symposium.)
The next presentation on the ECGI system was by Dr. Michel Haissaguerre of the French Bordeaux Group. (In a private conversation with the author before his presentation, Dr. Haissaguerre was obviously excited about this "extraordinaire" new, breakthrough treatment for A-Fib patients. [The author was Dr. Haissaguerre's first US patient back in 1998.]) Dr. Haissaguerre's emphasis was on the clinical effectiveness of ECGI. He had used the ECGI system for three months. 10 patients were in Paroxysmal A-Fib. He described and showed examples of how the ECGI system showed sources of A-Fib coming from the PVs and the posterior left atrium. The ECGI showed a rotor coming from a PV, and in another example a rotor coming from the left atrial appendage. In another patient a rotor came from the septum. In one patient he was able to identify and terminate A-Fib in seven minutes using the ECGI system.
But in patients with persistent A-Fib, things were a bit more challenging. Most had multiple sources or spots in the heart producing A-Fib signals. There could be as many as six different rotors swirling around in the heart. (This is similar to the finding of Dr. Narayan's FIRM system which uses a large basket catheter inside the heart to map and identify A-Fib sources.) Dr. Haissaguerre talked about using "inner windows" in the ECGI and a "brushing technique" (these are terms the author didn't understand and has written Dr. Haissaguerre for further explanation). Of 58 persistent patients (the hardest to cure), he was able to terminate A-Fib in 51 (88% success rate) using the ECGI system.
Editor's Comments:
The ECGI system is a major medical breakthrough for A-Fib patients. The ECGI system seems to have a greater sensitivity and specificity---the ability to identify spots in the heart which are producing A-Fib signals with remarkable precision, and in color and 3D. And the mapping can be done outside of the EP lab by a technician rather than by an EP doctor.
When the doctor does an ablation on a particular patient, using the ECGI system they have a complete, detailed, precise, 3D, color video of each spot in the patient's heart producing A-Fib signals which a technician has produced before the ablation. The ECGI map is a better, more accurate, more complete map than the EP could produce by using mapping catheters inside the patient's heart.
And the EP no longer has to spend time mapping, but can concentrate all his attention on the actual ablations that need to be performed.
This author predicts that the ECGI system, barring unforeseen circumstances, will rapidly supersede all other mapping systems and will become the standard of care in the treatment of A-Fib patients.
1 Ramanathan, C. at al. (and Yoram Rudy). "Noninvasive electrocardiographic imaging for cardiac electrophysiology and arrhythmia." Nature Medicine 10, 422-428 , March 14, 2004. Doi:10.1038/nm1011.
A-FibFriendSteve
Thank you for sharing~
Thanks tor the update.
The ECGI showed a rotor coming from a PV, and in another example a rotor coming from the left atrial appendage. In another patient a rotor came from the septum. In one patient he was able to identify and terminate A-Fib in seven minutes using the ECGI system.
Dr Narayan has also be able to shut down persistent cases in some cases seconds and minuets.
petey
Exactly a non invasive method of identifying the hot spots would be remarkable. I would love to know what is triggering my AFIB or rather what is sustaining it before I go forward with an ablation. Then maybe you target only those areas and not burn the whole heart up creating fences. Is this ready for Prime time? Is it cheaper that catheter mapping? If yes then it should take off.
Videos?
petey