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Imageless electrocardiographic Imaging has emerged as an accessible non-invasive alternative for cardiac electrical mapping from body surface potentials. However, conventional electrocardiographic imaging is restricted to epicardial reconstructions, reducing its reliability in accurately identifying arrhythmias arising from deeper myocardial structures. We aim to overcome this limitation by reconstructing three-dimensional cardiac activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We introduce a volumetric formulation, which extends beyond epicardial potential estimation by solving an inverse source problem using Green\u2019s functions. This technique enables three-dimensional reconstructions of cardiac activation, improving arrhythmia localization in anatomically complex regions. We evaluate the method on simulated premature ventricular beats and on four patients representing clinical challenges, including a premature ventricular contraction from the right ventricular outflow tract, a left bundle branch block, a ventricular tachycardia, and a Wolff-Parkinson-White. We also assess performance on an open-source dataset for myocardial infarction estimation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our results indicate that volumetric electrocardiographic imaging reconstructs three-dimensional activation and enhances the localization of arrhythmia origins, yielding a 59.3% reduction in geodesic error between the estimated and simulated origins compared to surface-only approaches. In patient cases, the recovered activation patterns are consistent with the clinical diagnoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Imageless volumetric electrocardiographic imaging enables non-invasive, accessible, three-dimensional mapping of cardiac activation, addressing a fundamental limitation of surface-restricted methods. This capability may support more accurate pre-procedural planning, may help guide ablation targets, and could refine selection and optimization of cardiac resynchronization therapy candidates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s43856-025-01332-5","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T17:46:05Z","timestamp":1768326365000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Volumetric non-invasive cardiac mapping for accessible global arrhythmia characterization"],"prefix":"10.1038","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8870-5539","authenticated-orcid":false,"given":"Jorge","family":"Vicente-Puig","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judit","family":"Chamorro-Servent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9647-7417","authenticated-orcid":false,"given":"Ernesto","family":"Zacur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00e9s","family":"Llorente-Lipe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Mart\u00ednez-P\u00e9rez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"S\u00e1nchez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Reventos-Presmanes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo","family":"Roca-Luque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Llu\u00eds","family":"Mont","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Atienza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreu M.","family":"Climent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria S.","family":"Guillem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0525-7476","authenticated-orcid":false,"given":"Ismael","family":"Hern\u00e1ndez-Romero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"1332_CR1","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","volume":"42","author":"G Hindricks","year":"2021","unstructured":"Hindricks, G. et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. 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