Non-invasive estimation of the activation sequence in the atria during sinus rhythm and atrial tachyarrhythmia

Ablation procedures have become one of the most efficient treatments for termination of atrial arrhythmias. The aim of the present study is the evaluation of the potential use of noninvasive imaging as a clinical tool for the identification of atrial tachycardia origin prior to an ablation procedure. Simultaneous 67-lead body surface potential recordings and 15 intracardiac electrograms (EGM) were obtained for one patient during sinus rhythm and pacing the left superior pulmonary vein. 3D heart and torso geometries were obtained by using computed axial tomography images. Epicardial activation sequences were computed by solving the inverse problem of the electrocardiology. Reconstructed activation sequences were consistent with recorded EGMs. Measured and estimated activation time differences between right and left atria were 93 ms and 102 ms during sinus rhythm respectively and 49 ms and 71 ms respectively during left atrial pacing.