Predicting cardiac death risk using a re-usable heart vest

Our hearts rely on electrical signals to regulate heartbeat, and any malfunctions in these signals can lead to rhythm disorders, affecting two million people in the UK and potentially causing sudden death.

Traditionally, detailed mapping of heart's electrical activity has been challenging, often requiring invasive catheter insertion, or using single-use devices that are expensive, time-consuming, and involve radiation. However, the new electrocardiographic imaging (ECGI) vest developed at UCL, as detailed in the Journal of Cardiovascular Magnetic Resonance, offers a reusable, time-efficient solution that only requires five minutes per patient.

The vest's 256 sensors provide electrical data that, when combined with MRI images, create 3D digital models of the heart and its electrical activity. Dr Gaby Captur (UCL Institute of Cardiovascular Science and the Royal Free Hospital, London), who developed the vest with support from the British Heart Foundation (BHF) and the Society for Cardiovascular Magnetic Resonance, said: “We identified a problem in cardiology. Heart imaging has made remarkable progress in recent decades, but the electrics of the heart have eluded us. The standard technology to monitor the heart’s electrical activity, the 12-lead electrocardiogram (ECG), has barely changed in 50 years.

“We believe the vest we have developed could be a quick and cost-effective screening tool and that the rich electrical information it provides could help us better identify people’s risk of life-threatening heart rhythms in the future.

“In addition, it can be used to assess the impact of drugs, new cardiac devices, and lifestyle interventions on heart health.

“Currently, predicting risk of sudden cardiac death is difficult, as it is not known, for instance, how risk might be affected by a particular structural feature or abnormality of the heart.”

Dr Matthew Webber (UCL Institute of Cardiovascular Science), another co-developer of the vest, added: “Cardiac MRI, the gold standard in heart imaging, shows us the health of the heart muscle tissue, including where dead muscle cells might be. In-depth electrocardiographic imaging can help us correlate these features with their consequences – the impact they may be having on the heart’s electrical system. It adds a missing part of the puzzle.”

The researchers believe this technology could improve risk stratification, aiding clinicians in identifying patients who may need an implantable cardioverter defibrillator (ICD). Confirming potential biomarkers for risk prediction through longitudinal studies is a future goal.

The ECGI vest is uniquely reusable due to its dry electrodes, washable between uses, unlike traditional metallic electrodes requiring gel. This innovation has been tested in 77 patients, proving reliable and durable, and subsequently used in 800 patients, far exceeding the numbers in previous heart mapping studies.

Currently, the vest is being employed to map hearts of patients with conditions like hypertrophic cardiomyopathy and dilated cardiomyopathy. Dr Captur, with assistance from UCL Business, has patented the ECGI vest in the US and is collaborating with g.tec medical engineering GmbH, the creators of the prototype, to consider wider manufacturing possibilities.