Abstract
Background
Cardiac arrhythmias are a major cause of morbidity and mortality increasing the risk of stroke, heart failure, and sudden cardiac death. 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.
Methods
We introduce a volumetric formulation, which extends beyond epicardial potential estimation by solving an inverse source problem using Green’s 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.
Results
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.
Conclusions
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.
Plain Language Summary
Heart rhythm disorders are common and often require invasive procedures to be diagnosed and treated. To reduce that need, advanced non-invasive methods such as electrocardiographic imaging use signals from chest sensors, the person’s body geometry, and a physics-based computational model to create maps of the heart’s electrical activity. Most current maps cover only the heart’s surface. We developed a non-invasive approach that maps activation within the heart muscle in three dimensions. We tested it in computer simulations, in four patients with representative rhythm problems, and on a public dataset from people with heart problems. We show that it identifies where abnormal beats start more accurately than surface-only maps and agrees with clinical assessments. In the future studies with larger cohorts will aim to evaluate whether this technique can improve planning for operations and help when selecting possible approaches for treatments.
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Data availability
We adhere to the Communications Medicine data availability policy. The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. The source data underlying the comparison of activation maps between simulated and reconstructed PVCs in Fig. 4 are provided in Supplementary Data 1. The source data underlying the comparison of distance errors between simulated and reconstructed PVCs in Fig. 5 are provided in Supplementary Data 2. The source data underlying the volumetric reconstruction of the clinical cases in Figs. 6–9 are provided in Supplementary Data 3.
Code availability
The volumetric source imaging reconstruction algorithm is restricted due to copyright and integrated into the ACORYS Mapping System, a proprietary software product commercially available from Corify Care S.L. In addition, to support academic reproducibility, the custom code used for the data analysis and generation of all figures and tables in this manuscript is available from the corresponding author upon reasonable request for non-commercial research purposes.
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Acknowledgements
This research has received funding from grants n° DIN2022-012606, PTQ2022-012632, PTQ2023-013018, PID2023-149812OB-I00, PID2023-149812OB-I00, PI23/01569, CNS2022-135512, RYC2018-024346-I, CNS2022-135512, CERCA Program (Generalitat de Catalunya), AGAUR (2022 DI 022 and GRC-2021 SGR 00113), UAB PPC2023_575610, CPP2021-008562, CPP2024-011368, CPP2023-01050 funded by MCIN/AEI/10.13039/501100011033, by European Union NextGenerationEU/PRTR and by FEDER, EU. This research has also received funding from the European Institute of Innovation and Technology (EIT) under grant agreement No 250027. This European body receives support from the Horizon 2020 research and innovation programme. Additional support has been received by the Generalitat Valenciana with grant CIAICO/2022/020.
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J.V.-P.: conceptualization, data curation, software development, writing, manuscript review, and editing. J.C.-S.: conceptualization, manuscript review, and editing. E.Z.: software development, clinical data curation, manuscript revision. I.L.-L.: numerical simulations generation, manuscript revision. M.M.: clinical data collection, manuscript revision. J.S.: numerical simulations generation, manuscript revision. J.R.: clinical protocols, clinical data collection, manuscript revision. I.R.-L.: clinical protocols, clinical data collection, manuscript revision. L.M.: clinical protocols, clinical data collection, manuscript revision. F.A.: clinical protocols, clinical data collection, manuscript revision. A.M.C.: conceptualization, manuscript review, and editing. M.S.G.: manuscript revision. I.H.-R.: conceptualization, software development, manuscript review, and editing. All authors read and approved the final manuscript.
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J.V.-P. is pursuing an industrial PhD co-supervised by Universitat Autónoma de Barcelona and Corify Care. E.Z. and J.R.-P. are employees of Corify Care. A.M.C., M.S.G., and F.A. report board membership and ownership of equity or stocks in Corify Care. I.H.-R. reports employment and ownership of equity or stocks in Corify Care. F.A. reports honoraria from the Advisory Board of Medtronic. L.M. reports honoraria as a consultant, lecturer, and Advisory Board member from Boston-Scientific, Abbott Medical, Johnson&Johnson, and Medtronic, and is a shareholder of Galgo Medical SL. and Corify Care S.L. I.R.-L. has received honoraria as a lecturer and consultant from Boston-Scientific, Abbott Medical, Corify Care S.L. and Biosense-Webster, and is a shareholder of Corify Care S.L. All other authors declare no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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Vicente-Puig, J., Chamorro-Servent, J., Zacur, E. et al. Volumetric non-invasive cardiac mapping for accessible global arrhythmia characterization. Commun Med (2026). https://doi.org/10.1038/s43856-025-01332-5
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DOI: https://doi.org/10.1038/s43856-025-01332-5
