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Several medicines, including cancer therapies, are known to alter the electrophysiological function of ventricular myocytes resulting in abnormal prolongation and dispersion of ventricular repolarization (quantified by multi-lead QTc measurement). This effect could be amplified by other concomitant factors (e.g., combination with other drugs affecting the QT, and/or electrolyte abnormalities, such as especially hypokalemia, hypomagnesaemia, and hypocalcemia). Usually, this condition results in higher risk of torsade de point and other life-threatening arrhythmias, related to unrecognized unpaired cardiac ventricular repolarization reserve (VRR). Being VRR a dynamic phenomenon, QT prolongation might often not be identified during the 10-s standard 12-lead ECG recording at rest, leaving the patient at increased risk for life-threatening event. We report the case of a 49-year woman, undergoing tamoxifen therapy for breast cancer, which alteration of ventricular repolarization reserve, persisting also after correction of concomitant recurrent hypokalemia, was evidenced only after manual measurements of the corrected QT (QTc) interval from selected intervals of the 12-lead ECG Holter monitoring. This otherwise missed finding was fundamental to drive the discontinuation of tamoxifen, shifting to another “safer” therapeutic option, and to avoid the use of potentially arrhythmogenic antibiotics when treating a bilateral pneumonia in recent COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s12012-021-09659-w.

Background “Fight-or-flight” reaction to perceived danger may affect operational efficiency of police officers (POs), with negative impact on public safety. Therefore, there is a growing interest for methods to investigate stress occurring during highly-demanding operations. Stress-induced reactions are studied in psychophysiology integrating multiple parameters (ECG, EEG, respiration, electrodermal activity, salivary cortisol ...), most of them unrecordable in real-world dynamic situations. Instead ECG, recordable also during physical activity, quantifies stress-related autonomic modulation (AM) through the analysis of heart rate (HR) and its variability (HRVa). We used ECG and a miniaturized wearable wireless telemetric device (mWTD) to monitor AM changes during realistic police tactical training (rPTT), police tactical driving (PTD), oleoresin capsicum exposure (OCE) and live-fire shooting competitions (LFSC). 20 years of research, aimed to understanding of mechanisms underlying human response in force-on-force scenarios and to design more efficient training methods for POs, are reported. Method We selected data of 185 healthy POs (33.6±4.4 years old) investigated during rPTT with different psycho-physiological impact. Until 2015, ECG was recorded with standard ECG-Holter, then the novel mWTD connected to a standard textile sensors garment (Nuubo) has been used featuring simultaneous recording of 3 ECG and 2 Skin potential responses (SPR) for real-time assessment of transient variation of AM with a novel fast algorithm for integration of time-variant HRV spectral parameters (HRVp) and of Root Mean Square value of the two SPR signals (SPRRMS). Results HR increment varied significantly among individuals undergoing the same tasks. Highest HR values (>180 bpm in 66%) were observed during LFSC, often associated with poor operational score. Standard short-term HRVa was inadequate to evidence short-lasting transient changes of AM response due to acute stress (dominant LF at the beginning of task and at medium workload, relative dominance of HF and inversion of LF/HF ratio at the zenith of HR, in high-stress tasks). Under OCE, 83% of POs were able to perform their tasks, despite typical physical symptoms, high HR increment (peak 161 bpm) and HRV decrement with LF prevalence. Discriminant Analysis of HRVp differentiated between physical and psychological stress (accuracy >80%). During PTD good correlation was found between stress-induced increment of SPR activity and driving demands. Conclusion The mWTD is reliable for on-duty compatible recordings and telemetric transmission of AM during highly-demanding operations of POs. Real-time calculation and monitoring of time-varying spectral HRVp with SPRRMS provide immediate multimodal information on AM response to emotional and physical stress reactions to tactical demands. Discriminant Analysis of HRVp is useful to differentiate psychological and physical stress during police operational activity.

Since tangential currents are better detectable as magnetic than electric signals at the body surface, magnetocardiographic mapping (MCG) can be more sensitive than ECG to atrial electrophysiologic alteration, such as abnormal interatrial conduction and/or dispersion of atrial repolarization, as mechanisms underlying the occurrence of paroxysmal atrial fibrillation (PAF). We had previously reported that visual analysis of the magnetic field distribution (MFD) dynamics may evidence an inversion of atrial MFD early during the P-wave suggesting atrial repolarization overlapping depolarization along the descending limb of the P-wave (Guida et al 2018). Aim of this study was to systematically evaluate the reproducibility of such observation and to evaluate the reliability of non-invasive MCG imaging of atrial electrophysiology carried out in our unshielded hospital laboratory. Methods MCG was recorded, in sinus rhythm (SR), with an unshielded 36-channel SQUID-system providing about 30–40 fT/√Hz sensitivity in bandwidth DC-250Hz (sampling frequency 1kHz). MCG data of 40 patients with PAF (PAFp) and 40 age-matched healthy controls (HC), with at least two subsequent recordings to evaluate reproducibility and optimal S/N ratio, were retrospectively analyzed. The dynamics of atrial MFD was studied, at 1 ms time resolution, to identify the onset of atrial repolarization (AR), in respect of the P-wave and PR interval duration. To localize atrial sources, the inverse solution was calculated with the Effective Magnetic Dipole (EMD) model, also after subtraction of the atrial repolarization. MCG parameters of atrial electromagnetic vector (EMV) were also calculated. The reproducibility was evaluated with the intraclass correlation coefficient (ICC). Results High resolution analysis of atrial MFD dynamics confirmed that atrial repolarization field overlaps atrial depolarization during the last third of the P-wave in most investigated subjects. Thus, subtraction of average AR MFD is necessary to discover and image the left atrial depolarization pathway. The reproducibility of MCG estimate of atrial MFD and of EMV parameters was good (average ICC >0.7). In PAFp, MCG evidenced abnormality of AR MFD consistent with dispersion of atrial repolarization (Figure 1), as previously reported with simultaneous MCG and MAP recordings (Fenici & Brisinda, 2007); however, such evaluation is reliable only with optimal S/N ratio during the PR interval. Conclusions Unshielded MCG in SR is sensitive enough to non-invasively image atrial electrophysiology. Visual analysis of atrial MFD dynamics with high temporal resolution reproductively confirmed that AR MFD initiates early, within the descending limb of the P-wave, masking the deeper magnetic field generated by left atrial depolarization currents. MCG can image abnormality of AR MFD in PAFp, suggestive of dispersion of atrial action potential duration. Quantitative estimate of atrial EMV parameters differentiates PAFp from HC.

Background The Wolff-Parkinson-White (WPW) syndrome can be associated with sudden cardiac death, therefore risk assessment (RA) with electrophysiological (EP) testing (EPT) is mandatory to identify patients (pts) requiring catheter ablation (CAb). Our retrospective cohort study aimed to evaluate the variability of EP parameters during follow-up of WPW pts and the reliability of trans-esophageal EPT (TEEPT) for RA, evaluation of treatment efficacy, and EP follow-up of untreated athletes/pts. Method Data of 335 WPW pts, studied with TEEPT between 1985 and 2018, were retrospectively analyzed. Anterograde effective refractory period (ERP) of accessory pathways (AP) and of the atrioventricular node, Wenckebach point, shortest preexcited RR intervals (SPERRI) during atrial fibrillation (AF) and/or atrial pacing (At-P) and inducibility of supraventricular arrhythmias were assessed, at rest (supine and standing) and during effort. An AP was defined at high arrhythmogenic risk (HAR) if the anterograde AP-ERP and/or SPERRI (in AF or At-P) were ≤240 ms at rest or ≤200 ms during effort test. All patients were followed-up as outpatients or telephonically, as clinically required. 195 pts (17% female) were included, having exhaustive clinical information, two or more TEEPT and exhaustive clinical follow-up until late 2018. Time-evolution of EP parameters was evaluated, using parametric and non-parametric tests, as appropriate. Results and discussion Median age at first TEEPT was 20 years (IQR 16–29 years). Median follow- up was 44.3 months (IQR 16.4–122.9 months). Two pts (both identified at HAR and scheduled for surgery when ablation was unavailable) died suddenly, at rest. No other serious arrhythmic complication occurred, during the FU. Out of 19 pts (9.7% - Group A) showing enhanced AP conductivity at follow-up (mean ERP/SPERRI shortening: 30.8 ms, range 10–80 ms), 4 pts were found at HAR and underwent CAb. 176 pts (90.3% – Group B) showed a stable or impaired (25% under pharmacological treatment) AP conductivity during the follow-up. Their mean ERP/SPERRI increase was 39.7 ms (range 0–130 ms). Group A pts were significantly younger (20 vs 28 years old; 88% of Group A pts were Conclusions TEEPT is a safe, non-invasive tool to stratify arrhythmogenic risk of WPW pts. Our data suggest that a watchful waiting is safe for low to moderate risk pts. Younger males with an antero-septal Kent bundle may deserve a more intensive EP follow-up. Aggressive therapy should be considered as mandatory only for symptomatic HAR pts, taking into account complications, risk/benefit ratio and pts' preferences. In other cases, medical therapy and watchful observation could be applied safely under periodical TEEPT, as appropriate.

Ventricular arrhythmias (VAs) with left bundle-branch-block and inferior axis morphology (LBBB-IA), suggestive of outflow tract (OT) origin, are a challenge in sports medicine because they can be benign or expression of a silent cardiomyopathy. Non-invasive classification is essential to plan ablation strategy if required. We aimed to evaluating magnetocardiographic (MCG) discrimination of OT-VAs site of origin (SoO). MCG and ECG data of 26 sports activity practitioners, with OT-VAs were analyzed. OT-VAs-SoO was classified with discriminant analysis (DA) of 8 MCG parameters and with invasively-validated ECG algorithms. MCG inverse source-localization merged with magnetic resonance (CMR) provided three-dimensional electro-anatomical imaging (MCG 3D-EAI). ECG classification was univocal in 73%. MCG-DA differentiated right ventricular OT from aortic sinus cusp VAs, with 94.7% accuracy. MCG 3D-EAI confirmed OT-VAs-SoO in CMR images. In cases undergoing ablation, MCG 3D-EAI was confirmed by CARTO 3D-EAI. MCG-DA improves non-invasive classification of OT-VAs-SoO. Further comparison with interventional results is required.

Background: Psychological profile (PsyP) of patients with transient loss of consciousness (TLoC) is evidence of high prevalence of anxiety and depression. However, the mechanistic link between abnormal PsyP and TLoC is still unclear. Aim: This study aimed to evaluate: 1) prevalence of abnormal PsyP in TLoC patients; 2) cardiac autonomic response to head-up tilt test (HUTT) in patients with (PsyP+) or without abnormal PsyP (PsyP–), developing syncope (HUTT+) or not (HUTT–). Methods: Forty-one patients (66% female, mean age 36 ± 15 years), with history of TLoC, underwent PsyP before HUTT. Short-term heart rate variability analysis was carried out under baseline rest condition and at peak heart rate and/or onset of syncope induced by nitroglycerine (NTG), during HUTT. Results: HUTT+ occurred in 17/41 patients, more frequently in females, who had higher levels of anxiety (p < 0.0001). PsyP+ was prevalent in 70.5% of HUTT+ patients (p < 0.05). Among PsyP+ patients HUTT+ had dominant sympathetic modulation (DSM) at rest, which increased at the onset of syncope, whereas in HUTT patients vagal modulation was prevalent at rest. Among NTG-induced HUTT+ patients, fourfold higher increases of very low frequency (VLF) power were found in PsyP– compared with PsyP+. Conclusions: 58% of patients with history of TLoC were PsyP+. In PsyP+ patients, DSM at rest correlates with higher prob­ability of NTG-induced syncope, which occurs with 60% increment of low frequency and 530% increment of VLF power. Conversely, in patients with prevalent vagal modulation at rest and a decrease in VLF power after NTG, syncope did not occur. This supports interpretation of VLF power as an index of stress-induced sympathetic activity.

Background and aim Obesity plays a dominant role in the etiology of atrial fibrillation (AF), and the maintenance of a normal body mass index (BMI) seems to prevent and even reduce the incidence of the arrhythmia's recurrence. We selected 270 patients (pts) to assess whether this therapeutic effect was statistically significant even in Mediterranean patients. Method and results In this retrospective cohort study, we analyzed every symptomatic AF relapse during a total follow-up of 657 patient-years. Clinical data, BMI variations, and pts' history were available in our clinical database. We divided the pts in four groups (Gs), according to their BMI variation during the follow-up: G1, normal weight pts, maintaining their weight; G2, overweight pts, losing weight; G3, overweight pts, maintaining their weight; G4, pts gaining weight. Their follow-up (in months) was normalized according to their AF relapses, thus obtaining a mean AF-free period for each patient. Among the overweight groups, G2 showed the best AF-free period (9.7 months). However, G3 and G4 showed a reduced AF-free interval (4.6 and 1.7 months, respectively). G1, predictably, had the longest AF-free period (10 months). Conclusion The results of the present study confirm that simple non-invasive intervention aimed to normalize BMI and to control risk factors through appropriate lifestyle can be highly effective in reducing the AF burden, by acting on comorbidities and proarrhythmic mechanisms. Therefore, serious attempt should be made to correct risk factors before an ablation therapy is proposed.

To test the feasibility of a novel method to combine magnetocardiographic (MCG) estimate of ventricular repolarization (VR) and multiple monophasic action potential (MultiMAP) recording in spontaneously breathing rodents with percutaneous sub-xyphoid epicardial placement of a MCG-compatible amagnetic catheter (AC), ten Wistar rats (WRs) and ten guinea pigs (GPs) were studied. Under fluoroscopic control, the AC was moved until four stable MAPs were recorded (fixed inter-electrode distance of 1.2 mm). 36-channel DC-SQUID (sensitivity 20 fT Hz(-½)) were used for MCG mapping. MAPs, differentially amplified (BW: DC-500 Hz), were digitized at 1 kHz. AC pacing provided local ventricular effective refractory period (VERP) estimate. MAP duration (MAPd) was measured at 50% and 90% levels of repolarization. Simultaneous MCG mapping and MultiMAP recording were successful in all animals. Average MAPd50% and MAPd90% were shorter in WRs than in GPs (26.4 ± 2.9 ms versus 110.6 ± 14.3 ms and 60.7 ± 5.4 ms versus 127.7 ± 15.3 ms, respectively). VERP was 51 ± 4.8 ms in WRs and 108.4 ± 12.9 ms in GPs, respectively. The MAP amplitude was 16.9 ± 4.5 in WRs and 16.2 ± 4.2 in GPs. MAP and MCG parameters of VR were in good agreement. All animals survived the procedure. Two also survived a second invasive study; one was followed up until natural death at 52 months. Percutaneous MultiMAP recording is minimally invasive, usually avoids animal sacrifice, is compatible with simultaneous surface MCG mapping and might be used for experimental validation of MCG VR abnormality, to study the arrhythmogenic potential of new drugs and/or animal models of ventricular arrhythmias.

Background: To determine the prevalence of anti-beta-adrenoceptors autoantibodies (a{beta}AA) in patients with idiopathic arrhythmias (IA) and to assess whether a{beta}AA are predictive markers for concealed cardiomyopathy in such patients. Methods and Results: Sixty-seven patients (group 1) with IA [25 supraventricular (SVA) and 42 ventricular (VA)]; 14 patients (group 2) with suspected cardiomyopathy, 12 patients with definite cardiomyopathy (group 3); and 19 healthy controls (group 4) were tested with an enzyme immunoassay, using synthetic peptides corresponding to the second extracellular loop of the human {beta}1- and {beta}2-adrenoceptors. Endomyocardial biopsy was performed in 29 patients. As compared with group 4 [3/19 (15.7%)], anti-{beta}1-adrenoceptor autoantibodies (a{beta}1AA) were more frequent in group-1 patients [38/67 (56.7%; P

BACKGROUND: P‐wave duration, its dispersion and signal‐averaged ECG, are currently used markers of vulnerability to atrial fibrillation (AF). However, since tangential atrial currents are better detectable at the body surface as magnetic than electric signals, we investigated the accuracy of magnetocardiographic mapping (MCG), recorded in unshielded clinical environments, as predictor of AF occurrence. METHODS: MCG recordings, in sinus rhythm (SR), of 71 AF patients and 75 controls were retrospectively analyzed. Beside electric and magnetic P‐wave and PR interval duration, two MCG P‐wave subintervals, defined P‐dep and P‐rep, were measured, basing on the point of inversion of atrial magnetic field (MF). Eight parameters were calculated from inverse solution with “Effective Magnetic Dipole (EMD) model” and 5 from “MF Extrema” analysis. Discriminant analysis (DA) was used to assess MCG predictive accuracy to differentiate AF patients from controls. RESULTS: All but one (P‐rep) intervals were significantly longer in AF patients. At univariate analysis, three EMD parameters differed significantly: in AF patients, the dipole‐angle‐elevation angular speed was lower during P‐dep (p

Guinea pigs (GPs) are used for preclinical evaluation of electrophysiologic effects of new drugs, because their myocytes have human-like action potentials and ventricular repolarization's (VR) ion currents. This study was aimed to assess the reliability of magnetocardiographic (MCG) mapping for longitudinal studies of GP cardiac electrical activity. Eighteen anesthetized GPs were investigated with an unshielded 36-channel MCG instrumentation, at the age of 5 months (268.1 +/- 19 g). Twelve GPs survived and were restudied when 14 months old (595.6 +/- 90.5 g). RR, PR, QRS, QT(peak), QT(end), JT(peak), JT(end) and T(peak-end) intervals were measured from MCG waveforms. Magnetic field (MF) maps, equivalent current dipole (ECD) parameters and current density imaging were also analyzed. A significant prolongation of the PR (p < 0.05) and QRS (p < 0.001) intervals was found at 14 months. Gender-related differences of VR intervals were not significant. P(peak) and QRS(peak) MFs were similar in all animals, while T(peak) MF varied interindividually at 5 months and showed a rotation in some animals, at 14 months. The ECD strengths, measured at the P(peak), QRS(peak) and T(peak) were stronger (p < 0.01) at the age of 14 months than at 5 months. In contrast to findings in Wistar rats, age-related and gender-related differences of MCG VR parameters were not significant in GPs. Further work is necessary to clarify the variability of VR MF observed in healthy GPs.

A surgical approach for subdiaphragmatic-programmed electrical stimulation (PES) in mice has been reported by Gutstein et al. [D.E. Gutstein, S.B. Danik, J.B. Sereysky, G.E. Morley, G.I. Fishman, Subdiaphragmatic murine electrophysiological studies: sequential determination of ventricular refractoriness and arrhythmia induction, Am J Physiol Heart Circ Physiol. 285 (3) (2003) H1091-96.]. We developed a percutaneous method to drive a patented magnetocardiography-compatible amagnetic catheter (AC), specifically designed for multiple monophasic action potentials (Multi-MAP) recording, at the epicardium of spontaneously breathing small animals. The aim of this study was to test the feasibility of simultaneous magnetocardiographic (MCG) estimate of ventricular repolarization (VR) and Multi-MAP recording in 5 rats. Under fluoroscopic control, the AC was introduced with a sub-xyphoid puncture, in all animals, and moved at several epicardial sites until 4 stable MAPs were recorded, with a fixed inter-electrode distance of 1 mm. An unshielded 36-channel DC-SQUID system (sensitivity 20 fT/Hz 1 / 2) was used to record the MCG. MAP signals, differentially amplified and filtered at DC-500 Hz, were digitized at 1 kHz. The same AC was used for programmed PES at pacing cycles between 200 and 250 ms. Ventricular effective refractory period (VERP) was evaluated with the accuracy of 2 ms. MAP duration (MAPd) was measured, at 90% levels of repolarization. Simultaneous MCG and MAP recordings were successful in all animals. One rat died for respiratory arrest. Four animals tolerated well the procedure and survived. In WRs, MAPd 90% and VERP were 67 ± 9.4 ms and 69.6 ± 5.6 ms, respectively. This minimally invasive method is well tolerated, avoids animal sacrifice, can be used to validate the accuracy of surface MCG estimate of dispersion of VR and for assessment of arrhythmogenic potential of new drugs.

The Brugada syndrome (BS) is a genetically transmitted arrhythmogenic disease, which requires risk stratification, especially in asymptomatic subjects. Recent studies have shown that magnetocardiographic mapping (MCG) at rest can detect abnormal current distribution located in the RVOT. Here we describe an asymptomatic 28 years old BS patient, studied with 12-lead ECG and 36-channel MCG for three times at rest, under effort and during flecainide (Flec) tests, along a four years follow-up. He had a type 2 BS ECG at rest, but normal physical examination, echocardiogram and MRI. Molecular screening of the SCNC5A open reading frame revealed a de novo missense mutation in the DII–DIII linker, confirming the diagnosis of BS. For MCG assessment of ventricular repolarization (VR), magnetic field (MF) dynamics and MF gradient orientation, were computed during the ST interval and at the T wave peak. Current density reconstruction (CDR) and the strength of the equivalent current dipole (ECD) were calculated during the JT interval, to evidence potentially arrhythmogenic current flowing. In spite of Flec-induced ECG abnormality (typical type-1 ST elevation in V1–V3), MCG didn't show clear-cut variation of VR parameters, which didn't differ from those of healthy controls, at rest and under effort. After Flec, CDR, calculated every 10 ms from the J point, evidenced a change in the direction of the strongest current toward the right ventricular outflow tract, without a significant increase of the JT ECD strength. During the follow-up the patient was asymptomatic and no arrhythmia occurred. Further work is deserved to establish the predictive value of MCG for non-invasive risk stratification in asymptomatic BS patients with abnormal Flec test.

Magnetocardiographic (MCG) mapping is increasingly used for the non-invasive study of coronary artery disease (CAD), cardiomyopathy (CMP) and arrhythmias. MCG study of small animals with ischemia or CMP would provide useful experimental models for the interpretation of abnormal human patterns. The aim of this study was to assess the range of normality of MCG ventricular repolarization parameters, in intact adult rats.10 adult Wistar rats (weight 250 - 350 grams) were investigated with a 36-channel MCG mapping instrumentation (sensitivity is 20 fT/ radical Hz, at 1 Hz), designed for clinical recordings in unshielded hospital laboratories. To assess ventricular repolarization, MCG Q-T(peak), Q-T(end), J-T(peak), J-T(end), T(peak)-T(end) intervals were measured. MCG imaging was obtained by automatic calculation of isofield contour maps, and with inverse source localization based on the Equivalent Current Dipole and Effective Magnetic Dipole models, in a semi-infinite space with homogeneous conductance. Magnetic field (MF) orientation, dynamics and stability during the J-T(end) segment were also calculated. After averaging 300 s of continuous MCG recording, the S/N ratio was good enough for reproducible reconstruction of both atrial and ventricular magnetic maps and for three-dimensional localization of the underlying cardiac generators. Clear gender-related differences in ventricular repolarization duration were found, evidenced by significantly longer Q-T(end), J-T(end) and T(peak)-T(end) intervals in females. The differences in MF orientation, and stability during the J-T(end) segment were not significant. For J-T(peak) MF dynamics, only the ratio between the strengths of the positive and negative poles was significantly lower in the female group ( p0.05).Contactless MCG recording is a novel approach, which simplifies non-invasive mapping in small animals. In normal rats, gender-related differences of ventricular repolarization parameters equivalent to those reported in previous ECG studies were demonstrated.

We read with much interest the article by Pappone et al1 and the accompanying editorial,2 which revive the long-lasting debate about the appropriate clinical approach to asymptomatic Wolff-Parkinson-White (WPW) patients, balancing between the need to prevent sudden cardiac death and the need to avoid invasiveness and potential complications of unnecessary catheter ablation (CA). We agree with the editorial statements that “Current data including the present study cannot justify a more aggressive ablation approach in the asymptomatic WPW patient,” that “it is yet to be convincingly demonstrated as superior in the real world to the natural history in asymptomatic WPW patients,” and that “ablation provided at the asymptomatic stage has not been demonstrated to produce …

Background Magnetocardiographic mapping (MCG) provides quantitative assessment of the magnetic field (MF) induced by cardiac ionic currents, is more sensitive to tangential currents, and measures vortex currents undetectable by ECG, with higher reported sensitivity of MCG ventricular repolarization (VR) parameters for earlier detection of acute myocardial ischemia. Aims of this study were to validate the feasibility of in-hospital unshielded MCG and to assess repeatability and reproducibility of quantitative VR parameters, considering also possible gender- and age-related variability. Methods MCG of 204 healthy subjects [114 males-mean age 43.4 ± 17.3 and 90 females-mean age 40.2 ± 15.7] was retrospectively analyzed, with a patented proprietary software automatically estimating twelve VR parameters derived from the analysis of the dynamics of the T-wave MF extrema (five parameters) and from the inverse solution with the effective magnetic dipole model giving the effective magnetic vector components (seven parameters). MCG repeatability was calculated as coefficient of variation (CV) ±standard error of the mean (SEM). Reproducibility was assessed as intraclass correlation coefficient (ICC). Results The repeatability of all MCG parameters was 16 ± 1.2 (%) (average CV ± SEM). Optimal (ICC > 0.7) reproducibility was found for 11/12 parameters (mean values) and in 8/12 parameters (single values). No significant gender-related difference was observed; six parameters showed a strong/moderate correlation with age. Conclusion Reliable MCG can be performed into an unshielded hospital ambulatory, with repeatability and reproducibility of quantitative assessment of VR adequate for clinical purposes. Wider clinical use is foreseen with the development of multichannel optical magnetometry.

This study was performed to: (1) evaluate the accuracy of noninvasive magnetocardiographic (MCG) localization of an amagnetic stimulation catheter; (2) validate the feasibility of this multipurpose catheter; and (3) study the characteristics of cardiac evoked fields. A stimulation catheter specially designed to produce no magnetic disturbances was inserted into the heart of five patients after routine electrophysiological studies. The catheter position was documented on biplane cine x-ray images. MCG signals were then recorded in a magnetically shielded room during cardiac pacing. Noninvasive localization of the catheter's tip and stimulated depolarization was computed from measured MCG data using a moving equivalent current-dipole source in patient-specific boundary element torso models. In all five patients, the MCG localizations were anatomically in good agreement with the catheter positions defined from the x-ray images. The mean distance between the position of the tip of the catheter defined from x-ray fluoroscopy and the MCG localization was 11 +/- 4 mm. The mean three-dimensional difference between the MCG localization at the peak stimulus and the MCG localization, during the ventricular evoked response about 3 ms later, was 4 +/- 1 mm calculated from signal-averaged data. The 95% confidence interval of beat-to-beat localization of the tip of the stimulation catheter from ten consecutive beats in the patients was 4 +/- 2 mm. The propagation velocity of the equivalent current dipole between 5 and 10 ms after the peak stimulus was 0.9 +/- 0.2 m/s. The results show that the use of the amagnetic catheter is technically feasible and reliable in clinical studies. The accurate three-dimensional localization of this multipurpose catheter by multichannel MCG suggests that the method could be developed toward a useful clinical tool during electrophysiological studies.

The interesting reading of the excellent articles by Pathak et al. [(1,2)][1] triggered us to retrospectively review a cohort of 1,068 consecutive patients with atrial fibrillation (AF), to evaluate whether the correlation between body mass index (BMI) and AF behavior could also be verified in an

Objective The aim of this study was to determine whether or not heart rate variability (HRV) analysis during the first 20 min of head-up tilt testing could predict whether patients will develop syncope after nitroglycerine administration. Design 64 patients with previous loss of consciousness underwent head-up tilt testing with the Italian protocol, which involves the administration of nitroglycerine after 20 min of tilt. HRV parameters were analysed from 5 min intervals selected during pretest supine rest (phase 1), the first 5 min (phase 2) and the last 5 min (phase 3) of passive 20 min of tilting, prior to the administration of nitroglycerine. Differences in power (ms 2 ) of the spectral components between the various phases of tilting were calculated for each patient and expressed as Δ. Results 20 patients (group 1, 9 women, mean age 43.2±24.5 years) had a syncope during tilt testing after nitroglycerine, while the other 44 (group 2, 24 women, mean age 41±20.5 years) did not. In group 1, the HRV spectral parameters high frequency (HF) and total power (TP) had a significant decrement from phases 2 to 3 (p=0.012 and 0.027, respectively), while in group 2 the average HF and TP values did not change. The Δ of spectral parameters between phases 2 and 3 were able to differentiate between the two groups and to predict syncope after nitroglycerine administration (p Conclusions HRV analysis within the first 20 min of passive tilting demonstrated that patients with nitroglycerine-induced syncope are characterised by a progressive decrement of parasympathetic activity, which does not occur in patients with a negative response to nitroglycerine. If confirmed on a wider population, HRV analysis could replace nitroglycerine administration and shorten the duration of the tilt test.

The purpose of this study was to assess, in patients with ventricular preexcitation, the time dependent physiological variation of antegrade conduction properties in the AV node and in accessory pathways (Aps) as a function of autonomic tone variation induced by posture and physical effort, using noninvasive transesophageal atrial pacing. In 74 WPW patients (mean age 21.31 +/- 9.46 yrs), AV node and Kent antegrade effective refractory periods (at pacing cycle lengths 600, 400, and 320 ms), Wenckebach point, shortest preexcited RR intervals during sustained atrial fibrillation (AF) or atrial pacing, as well as the inducibility of AV reentry tachycardia (AVRT) and AF/flutter (AFL) were assessed. All measurements were carried out at rest, in supine and upright positions, and during effort. A second study was carried out approximately 3 months after the first study. The coefficient of variation (CVs) and reproducibility (CRs) were calculated. For each parameter, the differences between the mean of the two studies were not statistically significant. The CVs and CRs ranged between 0.4% and 4% and between 2 and 28 ms, respectively. AF was induced in 40 (54%) of 74 patients at the first study and in 30 (40.5%) of 74 patients at the second study. AVRT was induced in 33 (45%) of 74 patients at the first study and in 38 (51.3%) of 74 patients at the second study. The reproducibility was 45% for AF/AFL and 65% for reentry tachycardia. Transesophageal atrial pacing is a reliable method for noninvasive reproducible evaluation of antegrade electrophysiological properties of both the AV node and APs in WPW patients. However, the effect of autonomic balance variation has to be taken into account and precisely defined because it may significantly affect the inducibility of supraventricular arrhythmias and the estimation of the absolute values of the vulnerable parameters.

Autonomic nervous system dysfunction (ANSd) heralds or follows motor symptoms (MS) in Parkinson disease (PD), but may precede years and progress more rapidly in multiple system atrophy (MSA). Cardiac dysautonomia severity correlates with disabling symptoms thus a Cardiac Autonomic Nervous System Evaluation protocol (CANSEp) is useful to assess ANSd in PD and MSA patients.Consecutive patients with PD or MSA were studied. The severity of MS was quantified with UPDR III and Hoehn/Yahr scales. CANSEp consisted of the 5-test Ewing protocol (EP) and Heart Rate Variability analysis (HRVa), in time-domain (TD) and frequency-domain (FD). 36 patients with parkinsonian symptoms (23 PD, 13 MSA) and 40 healthy controls were studied. Parkinsonism was more severe in MSA, comparing UPDR III and Hoehn/Yahr scales (p0.0001). Higher EP's scores were found in MSA (mean 5.1±1.98) compared to PD (mean 3.5±2) and controls (score 0.25±0.1). TD and FD-HRVa were abnormal in PD and MSA, compared to controls. In PD depression of vagal tone was predominant during sleep, whereas in MSA depression of sympathetic tone prevailed during daily activity.Whereas its specificity is very high, the sensitivity of the EP was only 43.5% in PD and 76.9% in MSA. HRVa improved diagnosis accuracy in 10 patients, unidentified by the EP alone, with overall sensitivity of 65.2% in PD and 92.3% in MSA. Thus CANSEp provides a better assessment of cardiovascular dysautonomia in parkinsonian syndromes, useful to differentiate PD from MSA and to address clinical and pharmacological management.

Helicobacter pylori virulent strains have been shown to affect cardiovascular diseases through molecular mimicry mechanisms. Silent autoimmune myocarditis has been hypothesized to be the cause of idiopathic dysrhythmias (IA). The aim of this study is to assess the prevalence of virulent H. pylori strains in patients affected by IA. In this study,54 patients (40 men, mean age 44 ± 17 years) affected by IA and 50 healthy subjects (34 men, mean age 45 ± 9) were evaluated. IA, defined as dysrhythmias with no evidence of other cardiac pathology, were either supraventricular (SVA, 23 patients; mean age 45 ± 15 years) or ventricular (VA, 31 patients; mean age 42 ± 18 years). H. pylori infection and gastrointestinal (GI) symptoms were evaluated. H. pylori strains expressing the cytotoxin-associated gene A (cagA) and the vacuolating-cytotoxin A (vacA) were also assessed through western blot. The prevalence of H. pylori is similar in IA patients and in controls (42 vs. 44%; p > 0.05); H. pylori infection is observed in 48 and 39% of the patients are affected by SVA and VA, respectively. The prevalence of CagA-positive strains is increased in IA patients compared to controls (65 vs. 42%; p < 0.01); similarly, the prevalence of VacA-positive strains is also increased in IA patients (74 vs. 46%; p < 0.006). Excluding belching, infected patients did not show any difference in GI symptoms, when compared to non-infected subjects. From this study it is concluded that there is an epidemiological link between CagA and VacA-positive H. pylori strains in IA patients.

Fourteen patients (ten men and four women; mean age, 37 years) with lone atrial fibrillation (AF) (1 to 18 months' duration) were evaluated by thyroid function tests, two-dimensional echocardiography, hemodynamics, coronary angiography, and left ventricular endomyocardial biopsy, because of unresponsiveness to the usual antiarrhythmic therapy. The results of the T3, T4, TSH, and TRH tests were normal in all patients; cardiac valves and ventricular and atrial sizes (left atrium less than 40 mm) were within the normal limits; also normal were LVEDP (less than or equal to 10 mm Hg) and EF (greater than 0.50). Histologic findings were abnormal in all cases, with three patients showing cardiomyopathic changes, three other patients showing active myocarditis (lymphocytic in two and eosinophilic in one), and eight patients with nonspecific necrosis or fibrosis or both. Steroids (prednisone; 50 mg/m2 of body surface area daily) used in addition to antiarrhythmic therapy in patients with eosinophilic and lymphocytic active myocarditis were able to cause reversion to sinus rhythm, while the other patients continued to have AF. This study documents that occult myocardial diseases (myocarditis, cardiomyopathy, and nonspecific necrosis or fibrosis) can underlie "primary" AF. The addition of steroids to antiarrhythmic therapy in patients with refractory AF and histologic evidence of active myocarditis seems to be useful in controlling the arrhythmia.

Ventricular arrhythmias are frequently observed in the elderly population secondary to alterations of electrophysiological properties that occur with the normal aging process of the heart. However, the underlying mechanisms remain poorly understood. The aim of the present study was to determine specific age-related changes in electrophysiological properties and myocardial structure in the ventricles that can be related to a structural-functional arrhythmogenic substrate. Multiple unipolar electrograms were recorded in vivo on the anterior ventricular surface of four control and seven aged rats during normal sinus rhythm and ventricular pacing. Electrical data were related to morphometric and immunohistochemical parameters of the underlying ventricular myocardium. In aged hearts total ventricular activation time was significantly delayed (QRS duration: +69%), while ventricular conduction velocity did not change significantly compared with control hearts. Moreover, ventricular activation patterns displayed variable numbers of epicardial breakthrough points whose appearance could change with time. Morphological analysis in aged rats revealed that heart weight and myocyte transverse diameter increased significantly, scattered microfoci of interstitial fibrosis were mostly present in the ventricular subendocardium, and gap junction connexin expression decreased significantly in ventricular myocardium compared with control rats. Our results show that in aged hearts delayed total ventricular activation time and abnormal activation patterns are not due to delayed myocardial conduction and suggest the occurrence of impaired impulse propagation through the conduction system leading to uncoordinated myocardial excitation. Impaired interaction between the conduction system and ventricular myocardium might create a potential reentry substrate, contributing to a higher incidence of ventricular arrhythmias in the elderly population.

Objective More than two decades of research work have shown that magnetocardiographic mapping (MCG) is reliable for non-invasive three-dimensional electroanatomical imaging (3D-EAI) of arrhythmogenic substrates. Magnetocardiographic mapping is now become appealing to interventional electrophysiologists after recent evidence that MCG-based dynamic imaging of atrial arrhythmias could be useful to classify patients with atrial fibrillation (AF) before ablation and to plan the most appropriate therapeutic approach. This article will review some key-points of 3D-EAI and discuss what is still missing to favor clinical applicability of MCG-based 3D-EAI. Methods Magnetocardiographic mapping is performed with a 36-channel unshielded mapping system, based on DC-SQUID sensors coupled to second-order axial gradiometers (pick-up coil 19 mm and 55-70 mm baselines; sensitivity of 20 fT/Sqrt[Hz] in above 1 Hz), as part of the electrophysiologic investigation protocol, tailored to the diagnostic need of each arrhythmic patient. More than 500 arrhythmic patients have been investigated so far. Results The MCG-based 3D-EAI has proven useful to localize well-confined arrhythmogenic substrates, such as focal ventricular tachycardia or preexcitation, to understand some causes for ablation failure, to study atrial electrophysiology including spectral analysis and localization of dominant frequency components of AF. However, MCG is still missing software tools for automatic and/or interactive 3D imaging, and multimodal data fusion equivalent to those provided with systems for invasive 3D electroanatomical mapping. Conclusion Since there is an increasing trend to favor interventional treatment of arrhythmias, clinical application of MCG 3D-EAI is foreseen to improve preoperative selection of patients, to plan the appropriate interventional approach and to reduce ablation failure.

This article reviews major problems and difficulties faced by the authors along more than twenty years of clinical application of magnetocardiography (MCG) as a tool to improve the diagnosis of arrhythmogenic mechanism(s), noninvasively. It is also emphasized that an exhaustive understanding of individual electrophysiology is mandatory before any intervention, which can modify the substrate and complicate the treatment of patients in the case of ablation failure. The reasons for scarce acceptance of MCG, compared with the success of recent methods for invasive three-dimensional electroanatomical imaging (3D-EAI), are discussed to provide suggestions for needed changes in R&D strategy. MCG might be a powerful method for non-invasive 3D-EAI, but appropriate tools for its clinical applicability are still lacking and need to be urgently developed, through serious investments and interdisciplinary cooperation.

Cardiac arrhythmias are frequent in the elderly population, perhaps secondary to an increased prevalence of hypertension and coronary artery disease as well as aging related changes resulting in loss of pacemaker cells and degenerative alteration of the conduction system. Independent from underlying structural heart disease, advanced age alone appears to be a risk factor for increased susceptibility to ventricular arrhythmia. However, the electrophysiological basis of this phenomenon is still unclear. Thus, it is important to assess and to define the underlying arrhythmogenic substrate. The aim of the present study was to identify a likely structural-functional ventricular arrhythmogenic substrate in aged hearts. For this purpose ventricular activation patterns were measured in control (n = 4) and aged (n = 10) in vivo rat hearts by recording unipolar electrograms with an epicardial, 1 mm resolution, 8 times 8 electrode array, during pacing and spontaneous or induced ventricular ectopic beats. Our results in aged hearts suggest that peripheral conduction system might be involved in perpetuating sequences of ventricular ectopic beats, regardless of their origin.

Three-dimensional electroanatomical imaging is increasingly used in interventional cardiac electrophysiology, to guide catheter ablation of cardiac arrhythmias. At the same time, there is a growing interest for non-invasive methods, such as magnetocardiographic mapping (MCG), to localize the arrhythmogenic substrates, to test their reproducibility and to plan the most appropriate interventional approach. So far electroanatomical imaging has relayed on static mathematical modeling of the heart and more recently on direct merging with three-dimensional rendering of cardiac anatomy from multidetector computer tomography or magnetic resonance imaging. Merging electrophysiological information with static anatomical structures, can surely be a source of uncertainty for MCG-based pre-interventional localization of the arrhythmogenic substrate and causes mismatch between the real-time imaging of moving catheters and the static geometry of the cardiac chambers reconstructed with invasive electroanatomical imaging. The implementation of recent realistic numerical models of the beating heart in a breathing thorax can improve accuracy and fill the gap between non-invasive and interventional electroanatomical imaging.

Background: Ventricular preexcitation (VPx) is usually localized noninvasively by means of electrocardiogram (ECG) algorithms, which vary in their concordance levels. Contactless magnetocardiography (MCG) has been used as an alternate 3-dimensional (3D) method of accessory pathways (AP) localization. The sensitivity of MCG can be increased for preoperative evaluations and planning of ablation procedures by combining it with transesophageal pacing (TEP) and electrophysiological (EP) studies. This study compared the accuracy of VPx localization with MCG with ECG algorithms, and examined the increment in diagnostic accuracy achievable with TEP. Methods: Multisite mapping from the anterior chest wall was performed with a 36-channel MCG system. TEP allowed the evaluation of anterograde conduction properties and inducibility of arrhythmias. The reproducibility of the test and follow-up was examined in 88 patients with Wolff–Parkinson–White (WPW) syndrome. The accuracy of MCG localization was reevaluated during pacing-induced maximal VPx in 36 patients in whom, during MCG, the degree of VPx was highest during TEP. The gold standard for validation was effective ablation of the AP. Results: The MCG classification of VPx was accurate in 94% of AP, versus 64% and 67% with ECG, during sinus rhythm and during pacing-induced maximal VPx, respectively. In 4.5% of cases with unclear ECG localization, MCG suggested a complex septal VPx. In all patients with successful ablations, the 3D MCG localization of the AP corresponded to the ablation site. Conclusions: MCG was more accurate than ECG for the classification of VPx and provided additional information in the non-invasive EP assessment of patients with WPW syndrome.

New “magnetic” technologies for intracardiac three-dimensional electroanatomical imaging (3D-EAI) have been recently developed, which have proven useful to localize the arrhythmogenic targets, to improve the outcome of ablation procedures and to reduce patient irradiation. However their 3D imaging capability cannot be used for preoperative localization of arrhythmogenic substrates. Magnetocardiographic mapping (MCG) is a more feasible and reproducible method to provide non-invasive 3D-EAI of cardiac sources. MCG detection and 3D study of arrhythmias can be enhanced by simultaneous electrophysiologic study with trans-esophageal atrial pacing and by combining MCG with minimally invasive single-catheter, multiple monophasic action potential recording, which provides a better understanding of local arrhythmogenic mechanisms underlying abnormal MCG patterns. MCG is also feasible for non-fluoroscopic imaging of amagnetic catheters in the heart. Furthermore providing 3D numerical coordinates of arrythmogenic targets, MCG could be used to program robotic magnetic navigation and to automatically guide ablation catheters or aimed endomyocardial biopsy.

Magnetocardiographic mapping (MCG) is increasingly used for non-invasive early detection of ischemia in patients with acute chest pain. This study was aimed to evaluate the predictive value of MCG, for the diagnosis of ischemia in patients with coronary artery disease (CAD) and stable angina (StA). 51 pts (age 63 ± 10.7 years) with CAD (all chest pain free at the time of MCG) and 52 healthy volunteers were studied at rest with an unshielded 36-channel MCG system (sensitivity: 20 fT/√Hz, above 1 Hz). 42 pts underwent coronary angiography (CAng) (21 after MCG scan). 39 pts had stress SPECT; 32 had both CAng and SPECT. Analysis of ventricular repolarization (VR) was performed utilizing different methods for interactive and automated analysis of T-wave dynamics and of the effective magnetic vector (EMV) parameters. For all pts, best sensitivity, specificity, PPV, NPV and predictive accuracy of the MCG for the detection of ischemia were 56%, 96%, 94%, 69% and 78%, respectively (with EMV). If pts with previous myocardial infarction (MI) were excluded, best sensitivity, specificity, PPV, NPV and predictive accuracy of the MCG for the detection of ischemia were 83%, 96%, 94%, 89% and 91%, respectively (detected with EMV). Comparative values calculated from ECG were 38%, 100%, 100%, 80% and 82%, respectively. As compared with previous results in pts with ACS, the T-wave analysis seems to be less sensitive in pts with chronic CAD and previous MI. Further work is needed to better define MCG parameters to be used for the diagnosis of myocardial ischemia in pts with CAD and to differentiate VR abnormalities due to coexistent ventricular hypertrophy, previous MI, or other cardiomyopathy.

The aim of this study was to assess the feasibility and reliability of Magnetocardiographic mapping (MCG), for the measurement of cardiac intervals and quantitative estimate of other MCG ventricular repolarization (VR) parameters, in unrestrained conscious Guinea pigs (GPs), taking into account possible gender-related differences, and in comparison with MCG of the same animals under anesthesia. 12 adult GPs (6 males and 6 females) were investigated with an unshielded 36-channel MCG system. Two sets of measurements were performed from each animal, at the age of 14 months: 1) awake (prone posture), 2) under anesthesia (supine). RR, PR, QRS, QTpeak, QTend, JTpeak, JTend and Tpeak-end intervals were measured. MCG imaging and quantitative analysis were automatically obtained as magnetic field maps (MFMs) and with the Equivalent Current Dipole (ECD) inverse solutions. As concerns interval durations, measured in the two sessions, a statistically significant difference was found only for the Tpeak-end interval. No gender-related differences of VR intervals were observed. Although MFMs were different as a function of the posture, the ECD localization at the QRSpeak, was properly centered in the heart and coincided within a 3-D uncertainty of less that 10 mm. MCG mapping is reliable for the assessment of cardiac intervals and VR, both in awake and in anaesthetized GPs. In non-aggressive rodents, MCG mapping does not require anesthesia and can be repeated multiple times, for circadian or long-term longitudinal pharmacological studies.

Guinea pigs (GPs) are used for preclinical investigation of the ability of new drugs to induce QT alterations and arrhythmias. The aim of this study was to evaluate the accuracy of multi-site magnetocardiographic mapping (MCG) for the assessment of age-related variation of ventricular repolarization (VR) maps in GPs. 18 adult GPs (8 males and 10 females) were investigated with an unshielded 36-channel MCG instrumentation, at the age of 5 months. Only 12 survived until the age of 14 months and were restudied. RR, PR, QRS, QTpeak, QTend, JTpeak, JTend and Tpeak-end intervals were measured from MCG waveforms. Magnetic field (MF) maps and the Equivalent Current Dipole (ECD) inverse solution were automatically computed. At the age of 5 months, average values of VR intervals were slightly longer in males. At the age of 14 months, a statistically significant age-related prolongation of the PR (p

Carnitine deficiency can be associated with cardiomyopathy and life-threatening arrhythmias. The aim of this study was to assess changes of ventricular repolarization (VR) intervals by contactless magnetocardiographic mapping (MCG), in a rat model of carnitine deficiency. 21 anesthetized Wistar rats (WR), 11 males and 10 females, were investigated, with an unshielded 36-channel MCG instrumentation. After a basal recording 10 animals were randomized to carnitine-deprivation induced by a 3-weeks diet containing N -trimethyl-hydrazine-3-propionate (THP). All WR were restudied 1 week after the end of THP treatment. RR, QRS, QT peak , QT end , JT peak , JT end and T peak-end intervals were measured from MCG waveforms. A prolongation of all HR-corrected VR intervals was observed in THP-treated animals (range 7.6–12.8%), as compared to their basal values. However, only the lengthening of QT end and T peak-end was statistically significant ( p end and T peak-end in THP-treated animals. The lack of significance versus age-matched controls could be either due to too early re-evaluation after deprivation, or to the effect of aging. In fact, age-related prolongation of VR intervals has been reported in WR at the age of 14 months.

Catheter ablation has significantly changed the diagnostic approach and the treatment of cardiac arrhythmias. Being the appropriate localization of the arrhythmogenic target a key-point for effective ablation, new technologies have been recently developed, for three-dimensional (3D) electroanatomical imaging during ablation procedures. However all of them are invasive and cannot be used for preoperative assessment and localization of arrhythmogenic substrates. Magnetocardiographic mapping (MCG) on the contrary is a feasible method, which provide 3D electroanatomical imaging of cardiac sources non-invasively, therefore it can be repeated on ambulatory patients, to define the characteristics of the arrhythmogenic substrate before intervention. MCG detection of electrophysiologic (EP) abnormalities and 3D electroanatomical imaging of arrhythmogenic substrates can be enhanced by simultaneous EP study with amagnetic trans-esophageal atrial pacing. Alternatively minimally invasive, single-catheter multiple monophasic action potential recordings (Multi-MAP) can be aimed at the arrhythmogenic targets identified by MCG. The MCG-guided Multi-MAP EP study is also useful for direct validation of MCG estimate of atrial and ventricular de-repolarization by comparison with simultaneous MAP recordings in sinus rhythm and under pacing. Future robotic navigation of an ablation catheter guided by 3D MCG coordinates of the arrhythmogenic target is foreseeable.

It has been recently proposed that magnetocardiographic mapping (MCG) can be useful for early diagnosis of IHD also in patients with LBBB; however, MCG patterns of cBBB in the absence of IHD have not so far extensively investigated. This study was aimed to define typical magnetic field distribution (MFD) patterns and several quantitative parameters of ventricular depolarization (QRS) and repolarization (VR), in patients with cBBB. 38 patients (pts) with cBBB at the ECG [15 RBBB, 19 LBBB, 4 RBBB + LAH] and 33 healthy subjects (HS) were consecutively investigated with an unshielded 36-channels DC SQUID MCG system (sensitivity is 20 fT/Hza1/2, above 1 Hz). Quantitative analysis of MFD maps was automatically performed during the QRS and VR intervals. In RBBB pts, the direction of septal depolarization was normal. A significant (p

Magnetocardiography (MCG) is the recording of the magnetic field (MF) generated by cardiac electrophysiological activity. Because it is a contactless method, MCG is ideal for noninvasive cardiac mapping of small experimental animals. The aim of this study was to assess age-related changes of cardiac intervals and ventricular repolarization (VR) maps in intact rats by means of MCG mapping. Twenty-four adult Wistar rats (12 male and 12 female) were studied, under anesthesia, with the same unshielded 36-channel MCG instrumentation used for clinical recordings. Two sets of measurements were obtained from each animal: 1) at 5 mo of age (297.5 ± 21 g body wt) and 2) at 14 mo of age (516.8 ± 180 g body wt). RR and PR intervals, QRS segment, and QTpeak, QTend, JTpeak, JTend, and Tpeak-end were measured from MCG waveforms. MCG imaging was automatically obtained as MF maps and as inverse localization of cardiac sources with equivalent current dipole and effective magnetic dipole models. After 300 s of continuous recording were averaged, the signal-to-noise ratio was adequate for study of atrial and ventricular MF maps and for three-dimensional localization of the underlying cardiac sources. Clear-cut age-related differences in VR duration were demonstrated by significantly longer QTend, JTend, and Tpeak-end in older Wistar rats. Reproducible multisite noninvasive cardiac mapping of anesthetized rats is simpler with MCG methodology than with ECG recording. In addition, MCG mapping provides new information based on quantitative analysis of MF and equivalent sources. In this study, statistically significant age-dependent variations in VR intervals were found.

Magnetocardiography is a noninvasive contactless method to measure the magnetic field generated by the same ionic currents that create the electrocardiogram. The time course of magnetocardiographic and electrocardiographic signals are similar. However, compared with surface potential recordings, multichannel magnetocardiographic mapping (MMCG) is a faster and contactless method for 3D imaging and localization of cardiac electrophysiologic phenomena with higher spatial and temporal resolution. For more than a decade, MMCG has been mostly confined to magnetically shielded rooms and considered to be at most an interesting matter for research activity. Nevertheless, an increasing number of papers have documented that magnetocardiography can also be useful to improve diagnostic accuracy. Most recently, the development of standardized instrumentations for unshielded MMCG, and its ease of use and reliability even in emergency rooms has triggered a new interest from clinicians for magnetocardiography, leading to several new installations of unshielded systems worldwide. In this review, clinical applications of magnetocardiography are summarized, focusing on major milestones, recent results of multicenter clinical trials and indicators of future developments.

OBJECTIVES: To evaluate the feasibility of unshielded in-hospital multichannel mapping of fetal magnetocardiogram (FMCG), with a 36-channel system for standard adult magnetocardiographic (MCG) recordings, and its reliability according to the recommended standards for FMCG. METHODS: FMCG was ambulatory mapped with a 36-channel MCG system, in six normal pregnancies at different gestational ages. MCG analysis included adaptive digital filtering of 50 Hz, signal averaging, reconstruction of magnetic field distribution (MFD) and source localization. Fixed Point Independent Component Analysis algorithm (FastICA) was used to reconstruct the FMCG, separating them from maternal contamination and noise. RESULTS: The quality of FMCG recorded after the 32nd gestational week and reconstructed with FastICA was close to FMCG obtained in shielded rooms, and good enough to measure cardiac intervals and heart rate variability parameters. In two cases, reconstruction of the MFD during the QRS allowed three-dimensional localization of ventricular sources. CONCLUSIONS: A first demonstration has been given that multichannel mapping of FMCG can be performed in unshielded clinical environments, with resolution good enough for contactless assessment of fetal cardiac electrophysiology. FastICA processing on unshielded FMCG, recorded after the 32nd week, provided beat-to-beat analysis and heart rate variability assessment. Further work is needed to improve signal reconstruction in early pregnancy. ispartof: Prenatal diagnosis vol:25 issue:5 pages:376-82 ispartof: location:England status: published