An advanced vision of magnetocardiography as an unrivalled method for a more comprehensive non-invasive clinical electrophysiological assessment

Figures

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  Fig. 1. Overview of the amagnetic cardiac catheterization laboratory at the Catholic University.

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  Fig. 2. (A) The Helsinki BioMag Center Neuromag MCG system. (B) Example of MCG current density imaging (yellow arrows on the green heart model, and white dots in CMR images) of two amagnetic catheters positioned at the antero-septal and apical wall of the right ventricle (highlighted with yellow circles on the frontal fluoroscopy). (C) The realistic torso phantom for simultaneous MCG and Body surface potential mapping experiments. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

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  Fig. 3. (A) Example of simultaneous MCG mapping and single-catheter right ventricular MultiMap recording during sinus rhythm. In (B), the overlay of contactless MCG imaging of the distal terminal of the amagnetic catheter on its fluoroscopic imaging during the EP study. All MCG traces are shown in the “butterfly” mode. MFD: Magnetic Field Distribution. HBE: His Bundle Electrogram. V: ventricular.

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  Fig. 4. Four standard projections of the 3D elastic heart model scalable to the patient's sizes. By changing the degree of transparency is possible to visualize the localization of the source of interest (red dipole arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

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  Fig. 5. Examples of successfully ablated MCG localized arrhythmogenic substrates: (A) Right lateral accessory pathway (multimodal MCG-CT-Carto integration). (B) Right ventricular outflow tract (RVOT) bigeminy (multimodal MCG-MRI-Carto integration). The sites of MCG localization and successful ablation are highlighted with red and yellow circles respectively. MCG: “Butterfly” overlays of the 36-channel waveforms). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

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  Fig. 6. Experimental set-up for percutaneous ventricular MultiMap recording and simultaneous MCG mapping in the spontaneously breathing intact small rodents. WR: Wistar Rat; GP guinea pig.

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  Fig. 7. (A) Action potential (blue waveform) calculated at each MCG grid point from MCG mapping (violet waveform). (B) Direct comparison between the action potential waveform (blue) and the right ventricular monophasic action potential (green) recorded with the MCG-localized amagnetic catheter at the site marked by a red arrow (shown by the scaled overlay of the 3D heart model on the MCG mapping grid) (same patient as in Fig. 3). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

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  Fig. 8. Patient with paroxysmal atrial fibrillation. (A) Normal magnetic field distribution (MFD) during atrial depolarization. (B) Abnormal fragmentation of magnetic field distribution during atrial repolarization (for comparison, the atrial repolarization magnetic field distribution of a normal subject is shown in (C). Simultaneous right atrial MultiMap recording evidences abnormal (60 ms) dispersion of right atrial action potentials' duration.

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  Fig. 9. (A) MCG imaging of a right-sided clockwise macro-reentry (sequence of the magnetic dipoles localization) in a patient with type-2 atrial flutter. (B) 36-channel MCG of the flutter waves. The white circles indicate the MCG sensors' position.