To the Editor— Bridging the signal gap: Body surface potential mapping and the future of early arrhythmia detection in the Global South

I read with great interest the recent article by van der Schaaf et al.¹ The study compellingly demonstrates that body surface potential mapping (BSPM) can detect abnormal R-, S-, and T-wave amplitudes even in presymptomatic carriers of PKP2 and PLN pathogenic variants. These subtle electrical alterations, correlating with disease progression, highlight BSPM’s potential as a tool for early detection of arrhythmogenic cardiomyopathy.

What makes this work remarkable is its reimagining of a persistent clinical challenge: detecting cardiac disease before structural or symptomatic manifestation. The data show that BSPM captures early depolarization and repolarization changes often missed by standard electrocardiograms, paving the way for earlier intervention, more precise monitoring, and possibly prevention of sudden cardiac death in high-risk individuals.

In countries such as the Philippines, where sudden cardiac death among young adults remains underreported and access to advanced diagnostics is limited, the implications are profound. BSPM could bridge a critical diagnostic gap by offering a noninvasive and potentially affordable screening tool for communities without access to genetic testing or cardiac magnetic resonance imaging. Properly adapted, BSPM could be used to screen athletes, families with unexplained cardiac histories, or rural patients far from tertiary centers.

To realize this potential, 3 steps are essential. First, normative BSPM reference maps must be developed for diverse populations, as electrical signals vary across ethnicities, body types, and climates.² Second, affordable, portable BSPM systems linked to open-access analytical platforms should be created for resource-limited settings.³ Third, longitudinal community-based studies must evaluate BSPM’s accuracy and reliability beyond specialized centers, particularly in tropical archipelagic regions where follow-up is difficult.

Future research should also extend BSPM applications beyond PKP2 and PLN variants to other genetic and nongenetic causes of arrhythmogenic cardiomyopathy. Integration with artificial intelligence could enhance signal interpretation and enable automatic detection of early electrical drift patterns.4, 5 Ultimately, BSPM signifies more than technological progress, it embodies a shift toward inclusive preventive cardiology, ensuring that early arrhythmia detection transcends geography and income, safeguarding every heartbeat that deserves to be heard.