Artificial Intelligence Enabled Dielectric Fingerprinting of Arrhythmogenic Substrates: A Precision Paradigm for Tissue Characterization Guided Cardiac Electrophysiology

Background: Electrical and dielectric properties of the myocardium depend on its composition, fibrosis, edema, ischemia, and heat damage, and hence may play an important role in defining the electrophysiologic substrate. Local impedance and other impedance-based methods give information about these parameters that is available to clinicians, but not direct or substitutable for intrinsic conductivity and permittivity of the tissue. The use of artificial intelligence has been thoroughly studied for the ECGs, electrograms, images, and computational data analysis, but not for dielectric or impedance measurements. Objective: The study aims to review the scientific basis of dielectric properties of heart muscle critically in cardiology and electrophysiology, to differentiate between existing clinical and conceptual applications of myocardial dielectrics, and to estimate current and potential contributions of artificial intelligence to their interpretation. Data Sources and Study Selection: The current work represents a structured narrative review in PubMed, Scopus, and Google Scholar databases from inception until May 2026 based on various combinations of keywords that refer to myocardial impedance, dielectric properties, conductivity, permittivity, local impedance, dielectric imaging, cardiac electrophysiology, catheter ablation, machine learning, and artificial intelligence. This review included experimental, ex vivo, animal, computational, and human studies related to myocardial dielectric properties and their use in electrophysiology. Evidence was classified according to four categories: direct human clinical evidence; preclinical/translation evidence; indirect evidence from related techniques; and extrapolation concept. As a result of heterogeneity between studies, sensing technologies, and outcomes, the results have been analyzed narratively. Key Findings: Evidence regarding the usage of AI algorithms, which have been primarily trained on myocardial dielectric or catheter-based local impedance data, is extremely scarce and mostly consists of preclinical or ex vivo data. On the contrary, the majority of clinically used AI algorithms in the field of electrophysiology make use of ECG data, intracardiac electrogram data, image processing, or computational modeling without any inputs related to dielectrics or local impedance. Conclusions and Implications for Practice: Dielectric sensing is an attractive supplement to traditional methods of voltage mapping and imaging, although the clinical readiness of dielectric sensing greatly varies depending on the application. At the present time, the existing data provide a basis for utilizing the local impedance measurement in the ablation procedure and evaluation of the myocardium properties, while the combination of artificial intelligence and dielectric sensing is still experimental. Before being introduced into the clinical electrophysiology practice, signal acquisition standardization and prospective multicenter trials are needed.