Noninvasive electrocardiographic imaging can evaluate arrhythmias in pediatric patients

Electrocardiographic imaging can be used to determine electrical dyssynchrony in pediatric patients with congenital heart disease.

Researchers enrolled eight pediatric patients with congenital heart disease who were either being evaluated for or who were undergoing cardiac resynchronization therapy. The researchers applied electrocardiographic imaging to each patient and calculated an electrical dyssynchrony index from the resulting epicedial activation maps, setting a normal electrical dyssynchrony of 20 ± 4 ms for control.

According to the study results, four of the patients received an assessment for cardiac resynchronization therapy but did not undergo an implant procedure. Two of the patients had an abnormal electrical dyssynchrony who then later went on to receive an implant with a resynchronization device. A total of four patients went on to receive cardiac resynchronization therapy and had post-therapy monitoring in multiple rhythms. Two of the patients were recommended to receive orthotopic heart transplants, and one of these patients died while awaiting transplantation. They also reported a weak correlation between QRS duration and electrical dyssynchrony (r=.56).

“This study reports the first experience with application of a novel, noninvasive cardiac electrophysiologic imaging modality for evaluation of cardiac resynchronization therapy in a small group of pediatric CHD patients,” the researchers concluded. “In the future, electrocardiographic imaging may be used to optimize clinical response in patients selected for cardiac resynchronization therapy. It could also be used in noninvasive follow-ups for assessing synchrony and the electrophysiologic substrate over time.”

Silva J. Heart Rhythm. 2009;6:1178-1185.