Risk Factors of Noninvasive Cardiac Electrophysiology

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Background

Effective identification of patients at increased risk of malignant cardiac arrhythmia presently represents a clinically important unmet need. Existing guidelines for the selection of candidates for the prophylactic implantation of cardioverters-defibrillators (ICD) are based solely on the reduction of ventricular haemodynamic performance. Although this guidance is based on statistical results of previously conducted randomized clinical trials, available experience shows that it does not serve clinical needs efficiently. The majority of patients who are implanted with ICDs for prophylactic reasons never utilize the device during its technical longevity whilst, at the same time, many patients who succumb to sudden cardiac death do not have ventricular haemodynamic performance particularly compromised. Recent results also showed that the previous statistical findings of ICD efficacy are not fully reproducible in patients with non-ischemic heart disease and that the reduction of sudden cardiac death after myocardial infarction by external automatic defibrillation vests is lower than expected.

Advances in cardiac electrophysiology are needed for better understanding of the mechanisms that are the basis of different arrhythmic abnormalities. Increased understanding of these mechanisms will allow them to be more effectively classified so that optimum therapeutic options can be offered. Likewise, better understanding of the underlying electrophysiology processes is needed so that novel and more focused randomized clinical trials can be designed. Compared to invasive electrophysiological studies, noninvasive cardiac electrophysiology offers the possibility of screening larger number of patients as well as healthy subjects investigated under different provocations and conditions. To advance the field, broad spectrum of studies is needed together with meta-analyses and reviews facilitating research interactions.

Investigators are welcome to submit original research articles and reviews to this Research Topic that will contribute to the field of Cardiac Noninvasive Electrophysiology. We are particularly interested in articles related to technological innovations of noninvasive electrophysiological signals, association of signal characteristics with electrophysiological processes, comparisons of different signal processing modalities, and evaluations of electrophysiology characteristics in large clinical populations.

Potential sub-topics include, but are not limited to:
• Innovation of electrocardiogram analysis including standard and problem-specific (e.g. atrial) lead configuration,
• Assessment of depolarization and repolarization heterogeneity in the ventricles,
• Quantification of depolarization and repolarization temporal variability,
• Autonomic modulations of cardiac electrophysiology processes,
• Assessment of congenital and drug-induced abnormalities of cardiac electrophysiology,
• Characteristics of arrhythmia modes,
• Noninvasive prediction of the risk of ventricular tachyarrhythmias,
• Mechanisms and risk of sudden arrhythmic death.

Keywords: Electrophysiology, Noninvasive methods, Risk stratification, Electrocardiographic analyses, Population studies, Arrhythmia modes, Sudden cardiac death

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