Beyond Transmembrane Potential: Why Volumetric Source Imaging Is Less Sensitive to Intracellular Uncertainty

Jorge Vicente Puig1, Judit Chamorro-Servent1, Ernesto Zacur2, Ines Llorente3, Marta Martínez Pérez4, Jana Reventós Presmanes5, Ivo Roca Luque6, Lluis Mont6, Felipe Atienza7, Maria de la Salud Guillem Sánchez3, Andreu M. Climent3, Ismael Hernández-Romero8
1Universitat Autònoma de Barcelona, 2CorifyCare S.L., 3Universitat Politècnica de València, 4Corify Care S.L., Spain, 5Arrhythmias Department, Hospital Clínic de Barcelona, 6Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Catalonia, Spain, 7Hospital General Universitario Gregorio Marañón (Cardiology Department), 8ITACA Institute, Universitat Politècnica de València


Abstract

We present a volumetric electrocardiographic imaging (ECGI) method for the 3D reconstruction of cardiac electrical activity. Typically, volumetric methods estimate transmembrane potential (Vm), which depends explicitly on the intracellular conductivity tensor. To overcome this, we propose Volumetric Source Imaging (VSI), an approach that estimates cardiac sources to isolate the inverse solution from intracellular uncertainties. We compared Local Activation Times (LATs) derived from both formulations. In numerical simulations of 10 ventricular ectopic beats, Vm-based LAT accuracy degraded (CC dropped from 0.66 ± 0.09 to 0.60 ± 0.07 and MAE increased by ≈ 1.5ms ± 0.4ms) under controlled intracellular anisotropy perturbations, whereas VSI maintained a stable error profile (CC = 0.86 ± 0.04; MAE = 0.24 ± 0.08 ms). Furthermore, in four diverse clinical cases, VSI mitigated structural artifacts and provided more coherent 3D activation patterns, enabling accessible global arrhythmia characterization without requiring prior patient-specific intracellular data.