Electrocardiographic imaging metrics to predict the risk of arrhythmia in patients with ischemic cardiomyopathy

Abstract Background The leading cause of death in patients with ischemic cardiomyopathy is sudden cardiac death caused by ventricular arrhythmias. Accurate determination of arrhythmic risk in these patients is vital to allow clinicians to take appropriate preventive measures. Objective To review and summarize the literature on electrocardiographic imaging (ECGi) metrics that could be used to predict arrhythmic risk in patients with ischemic cardiomyopathy. Methods A comprehensive literature search was performed to retrieve research articles on non‐invasive electrocardiographic mapping techniques. Inclusion criteria of the studies required the involvement of patients with ischemic cardiomyopathy or ischemic heart disease. Results A total of 17 papers were identified, five of which specifically utilized ECGi to acquire metrics associated with an increased risk of ventricular arrhythmia (VA). ECGi metrics, including activation time, repolarization time, activation‐recovery interval, and voltage amplitude, were distinguishable between patients with ischemic cardiomyopathy, patients with a history of VA, and healthy controls. Conclusion ECGi allows non‐invasive measurement of metrics which are associated with an increased risk of ventricular arrhythmias in patients with ischemic cardiomyopathy. ECGi may be a useful tool for risk assessment in these patients. Prospective studies are warranted for further validation and prediction of clinical endpoints.