Debbie Falconer, BA, MBBS
Royal Free London NHS Foundation Trust

Our team have designed the first high-throughput washable, CMR-compatible garment for recording high-density electrocardiographic imaging (ECGI): SMART-ECGI. ECGI non-invasively maps whole-heart epicardial potentials in vivo through 256 dry electrodes covering the torso. ECGI can detect subtle electrophysiological abnormalities that would be missed by a standard 12-lead ECG, signaling a patient is at risk of arrhythmias. Combining cardiovascular magnetic resonance (CMR) data with ECGI has the potential to help us better understand the arrhythmogenic significance of structural heart disease, allowing us to stratify which patients are most at risk of life-threatening arrhythmias.

Prototype testing demonstrated the garment is CMR-safe and reusable, retaining excellent signal quality for >150 washes. SMART-ECGI in now being used in several CMR deep-phenotyping studies taking place at University College London, investigating patients with dilated cardiomyopathy, hypertrophic cardiomyopathy and in population studies of older age. Combining ECGI and CMR will give us unprecedented insight into how life course events and comorbidities affect heart muscle function, blood flow and electrical abnormalities.