{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T22:19:35Z","timestamp":1771885175553,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T00:00:00Z","timestamp":1719273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Identifying the origin of nonpulmonary vein atrial fibrillation (AF) triggers (NPVTs) after pulmonary vein isolation (PVI) can be challenging. We aimed to determine if noninvasive electrocardiographic imaging (ECGi) could localize pacing from common NPVT sites. ECGi combines measured body surface potentials with heart\u2010torso geometry acquired from computed tomography (CT) to generate an activation map.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In 12 patients with AF undergoing first time ablation, the ECGi vest was fitted for preprocedural CT scan and worn during the procedure. After PVI, we performed steady\u2010state pacing from 15 typical anatomic NPVT sites at a cycle length of 700\u2013800\u2009ms. We co\u2010registered the invasive anatomic map with the CT\u2010based ECGi epicardial activation map to compare ECGi predicted to true pacing origin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the study cohort (67% male, 58% persistent AF, and 67% with left atrial dilation), 148 (82%) pacing sites had both capture and adequate anatomy acquired from the three\u2010dimensional mapping system to co\u2010register with ECGi activation map. Median distance between true pacing sites and point of earliest epicardial activation derived from the ECGi maps for all sites was 17\u2009mm (interquartile range, 10\u201322\u2009mm). Assuming paced sites treated as regions with a radius of 2.5\u2009cm, the earliest activation site on ECGi map falls within the region with 94% accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ECGi can approximate the origin of paced beats from common NPVT sites to within a median distance of 17\u2009mm. A rapidly identified region may then be the focus of more detailed catheter\u2010based mapping techniques to facilitate successful localization and ablation of NPVTs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.16347","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T05:35:45Z","timestamp":1719380145000},"page":"1738-1746","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Utility of noninvasive electrocardiographic imaging in the localization of nonpulmonary vein triggers of atrial fibrillation determined by pacing common trigger sites"],"prefix":"10.1111","volume":"35","author":[{"given":"Munveer","family":"Thind","sequence":"first","affiliation":[{"name":"Cardiac Electrophysiology Section, Department of Medicine, Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania 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