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Tourni M, Weber R, Biviano A, Konofagou E. Long-term atrial arrhythmia characterization and treatment efficacy evaluation using non-invasive echocardiography-based electromechanical cycle length mapping: a case series. Eur Heart J Case Rep 2024; 8:ytae303. [PMID: 39104515 PMCID: PMC11298898 DOI: 10.1093/ehjcr/ytae303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/01/2024] [Accepted: 06/21/2024] [Indexed: 08/07/2024]
Abstract
Background Atrial fibrillation (AF) is a prevalent cardiac condition characterized by irregular heart rhythm. Conventional non-invasive diagnostic techniques, while useful, have limitations in providing comprehensive information for treatment planning. To address this gap, electromechanical cycle length mapping (ECLM), a non-invasive echocardiography-based technique, has emerged as a promising approach. Electromechanical cycle length mapping offers quantitative and spatially specific insights into atrial electromechanical activation rate mapping, thereby enhancing our understanding of arrhythmia disease progression in AF patients. Case summary In this case series, we present two patient cases demonstrating the potential utility of ECLM in monitoring and evaluating treatment responses in atrial arrhythmia. The 1st case involved a 61-year-old male with persistent AF who underwent multiple procedures, including direct current cardioversion (DCCV) and radiofrequency ablation. Over three different DCCV encounters, pre- and post-procedure ECLM scans were performed, and the results showed the localization and incomplete elimination of arrhythmic triggers post-DCCV, which were used as early indicators of AF recurrence. The 2nd case involved a 71-year-old male with paroxysmal AF who also underwent cardioversion and ablation procedures. Electromechanical cycle length mapping imaging demonstrated a progressive reduction and elimination of arrhythmia triggers after each encounter, resulting in long-term maintenance of sinus rhythm. Discussion The findings from this case series highlight the potential of ECLM as a non-invasive imaging tool for long-term monitoring and evaluating immediate and long-term treatment responses in AF patients. The integration of ECLM with standard echocardiograms holds promise in guiding clinical decisions and improving patient outcomes in managing atrial fibrillation.
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Affiliation(s)
- Melina Tourni
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, 680 West 168th Street, Physicians & Surgeons 14-418, New York, NY, 10032, USA
| | - Rachel Weber
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, 680 West 168th Street, Physicians & Surgeons 14-418, New York, NY, 10032, USA
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Avenue, Milstein 5-435F, New York, NY, 10032, USA
| | - Elisa Konofagou
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, 680 West 168th Street, Physicians & Surgeons 14-418, New York, NY, 10032, USA
- Department of Radiology, Columbia University Medical Center, 630 West 168 Street, Physicians & Surgeons Box 28, New York, NY, 10032, USA
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Tourni M, Han SJ, Weber R, Kucinski M, Wan EY, Biviano AB, Konofagou EE. Electromechanical Cycle Length Mapping for atrial arrhythmia detection and cardioversion success assessment. Comput Biol Med 2023; 163:107084. [PMID: 37302374 PMCID: PMC10527498 DOI: 10.1016/j.compbiomed.2023.107084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/26/2023] [Accepted: 05/27/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Direct current cardioversion (DCCV) is an established treatment to acutely convert atrial fibrillation (AF) to normal sinus rhythm. Yet, more than 70% of patients revert to AF shortly thereafter. Electromechanical Cycle Length Mapping (ECLM) is a high framerate, spectral analysis technique shown to non-invasively characterize electromechanical activation in paced canines and re-entrant flutter patients. This study assesses ECLM feasibility to map and quantify atrial arrhythmic electromechanical activation rates and inform on 1-day and 1-month DCCV response. METHODS Forty-five subjects (30 AF; 15 healthy sinus rhythm (SR) controls) underwent transthoracic ECLM in four standard apical 2D echocardiographic views. AF patients were imaged within 1 h pre- and post-DCCV. 3D-rendered atrial ECLM cycle length (CL) maps and spatial CL histograms were generated. CL dispersion and percentage of arrhythmic CLs≤333ms across the entire atrial myocardium were computed transmurally. ECLM results were subsequently used as indicators of DCCV success. RESULTS ECLM successfully confirmed the electrical atrial activation rates in 100% of healthy subjects (R2=0.96). In AF, ECLM maps localized the irregular activation rates pre-DCCV and confirmed successful post-DCCV with immediate reduction or elimination. ECLM metrics successfully distinguished DCCV 1-day and 1-month responders from non-responders, while pre-DCCV ECLM values independently predicted AF recurrence within 1-month post-DCCV. CONCLUSIONS ECLM can characterize electromechanical activation rates in AF, quantify their extent, and identify and predict short- and long-term AF recurrence. ELCM constitutes thus a noninvasive arrhythmia imaging modality that can aid clinicians in simultaneous AF severity quantification, prediction of AF DCCV response, and personalized treatment planning.
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Affiliation(s)
- Melina Tourni
- Depatrment of Biomedical Engineering, Columbia University, 630 W 168th Street, New York, 10032, NY, USA.
| | - Seungyeon Julia Han
- Depatrment of Biomedical Engineering, Columbia University, 630 W 168th Street, New York, 10032, NY, USA
| | - Rachel Weber
- Depatrment of Biomedical Engineering, Columbia University, 630 W 168th Street, New York, 10032, NY, USA
| | - Mary Kucinski
- Depatrment of Biomedical Engineering, Columbia University, 630 W 168th Street, New York, 10032, NY, USA
| | - Elaine Y Wan
- Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, 630 W 168th Street, New York, 10032, NY, USA
| | - Angelo B Biviano
- Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, 630 W 168th Street, New York, 10032, NY, USA
| | - Elisa E Konofagou
- Depatrment of Biomedical Engineering, Columbia University, 630 W 168th Street, New York, 10032, NY, USA; Department of Radiology, Columbia University, 630 W 168th Street, New York, 10032, NY, USA.
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Robert J, Bessiere F, Cao E, Loyer V, Abell E, Vaillant F, Quesson B, Catheline S, Lafon C. Spectral Analysis of Tissue Displacement for Cardiac Activation Mapping: Ex Vivo Working Heart and In Vivo Study. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:942-956. [PMID: 34941506 DOI: 10.1109/tuffc.2021.3137989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Characterizing myocardial activation is of major interest for understanding the underlying mechanism of cardiac arrhythmias. Electromechanical wave imaging (EWI) is an ultrafast ultrasound-based method used to map the propagation of the local contraction triggered by electrical activation of the heart. This study introduces a novel way to characterize cardiac activation based on the time evolution of the instantaneous frequency content of the cardiac tissue displacement curves. The first validation of this method was performed on an ex vivo dataset of 36 acquisitions acquired from two working heart models in paced rhythms. It was shown that the activation mapping described by spectral analysis of interframe displacement is similar to the standard EWI method based on zero-crossing of interframe strain. An average median error of 3.3 ms was found in the ex vivo dataset between the activation maps obtained with the two methods. The feasibility of mapping cardiac activation by EWI was then investigated on two open-chest pigs during sinus and paced rhythms in a pilot trial of cardiac mapping with an intracardiac probe. Seventy-five acquisitions were performed with reasonable stability and analyzed with the novel algorithm to map cardiac contraction propagation in the left ventricle (LV). Sixty-one qualitatively continuous isochrones were successfully computed based on this method. The region of contraction onset was coherently described while pacing in the imaging plane. These findings highlight the potential of implementing EWI acquisition on intracardiac probes and emphasize the benefit of performing short time-frequency analysis of displacement data to characterize cardiac activation in vivo.
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Greillier P, Ankou B, Bour P, Zorgani A, Abell E, Lacoste R, Bessière F, Pernot M, Catheline S, Quesson B, Chevalier P, Lafon C. Myocardial Thermal Ablation with a Transesophageal High-Intensity Focused Ultrasound Probe: Experiments on Beating Heart Models. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2625-2636. [PMID: 30205993 DOI: 10.1016/j.ultrasmedbio.2018.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
Described here is a study of transesophageal thermal ablation of isolated and perfused beating hearts and non-human primates. An endoscope integrating a transesophageal echocardiography probe and a high-intensity focused ultrasound transducer was built and tested on five Langendorff-isolated hearts and three 30-kg baboons. B-Mode ultrasound, passive elastography and magnetic resonance imaging were performed to monitor thermal lesions. In isolated hearts, continuous and gated sonication parameters were evaluated with acoustic intensities of 9-12 W/cm2. Sonication parameters of gated exposures with 12 W/cm2 acoustic intensity for 5 min consistently produced visible lesions in the ventricles of isolated hearts. In animals, left atria and ventricles were exposed to repeated continuous sonications (4-15 times for 16 s) at an acoustic intensity at the surface of the transducer of 9 W/cm2. Clinical states of the baboons during and after the treatment were good. One suspected lesion in the left ventricle could be evidenced by elastography, but was not confirmed by magnetic resonance imaging. The transesophageal procedure therefore has the potential to create thermal lesions in beating hearts and its safety in clinical practice seems promising. However, further technical exploration of the energy deposition in the target would be necessary before the next pre-clinical experiments.
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Affiliation(s)
| | - Bénédicte Ankou
- Hospices Civils de Lyon, Hôpital Cardiovasculaire Louis Pradel, Lyon, France
| | | | - Ali Zorgani
- Universite Lyon, INSERM, UMR1032, LabTAU, Lyon, France
| | | | | | - Francis Bessière
- Universite Lyon, INSERM, UMR1032, LabTAU, Lyon, France; Hospices Civils de Lyon, Hôpital Cardiovasculaire Louis Pradel, Lyon, France
| | - Mathieu Pernot
- Institut Langevin, Ondes et Images, ESPCI ParisTech, CNRS UMR 7587, Paris, France
| | | | | | - Philippe Chevalier
- Hospices Civils de Lyon, Hôpital Cardiovasculaire Louis Pradel, Lyon, France
| | - Cyril Lafon
- Universite Lyon, INSERM, UMR1032, LabTAU, Lyon, France
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Costet A, Wan E, Melki L, Bunting E, Grondin J, Garan H, Konofagou E. Non-invasive Characterization of Focal Arrhythmia with Electromechanical Wave Imaging in Vivo. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2241-2249. [PMID: 30093340 PMCID: PMC6163072 DOI: 10.1016/j.ultrasmedbio.2018.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 06/05/2018] [Accepted: 06/11/2018] [Indexed: 06/02/2023]
Abstract
There is currently no established method for the non-invasive characterization of arrhythmia and differentiation between endocardial and epicardial triggers at the point of care. Electromechanical wave imaging (EWI) is a novel ultrasound-based imaging technique based on time-domain transient strain estimation that can map and characterize electromechanical activation in the heart in vivo. The objectives of this initial feasibility study were to determine that EWI is capable of differentiating between endocardial and epicardial sources of focal rhythm and, as a proof-of-concept, that EWI could characterize focal arrhythmia in one patient with premature ventricular contractions (PVCs) before radiofrequency (RF) ablation treatment. First, validation of EWI for differentiation of surface of origin was performed in seven (n = 7) adult dogs using four epicardial and four endocardial pacing protocols. Second, one (n = 1) adult patient diagnosed with PVC was imaged with EWI before the scheduled RF ablation procedure, and EWI results were compared with mapping procedure results. In dogs, EWI was capable of detecting whether pacing was of endocardial or epicardial origin in six of seven cases (86% success rate). In the PVC patient, EWI correctly identified both regions and surface of origin, as confirmed by results from the electrical mapping obtained from the RF ablation procedure. These results reveal that EWI can map the electromechanical activation across the myocardium and indicate that EWI could serve as a valuable pre-treatment planning tool in the clinic.
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Affiliation(s)
- Alexandre Costet
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Elaine Wan
- Department of Medicine-Cardiology, Columbia University, New York, New York, USA
| | - Lea Melki
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Ethan Bunting
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Julien Grondin
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Hasan Garan
- Department of Medicine-Cardiology, Columbia University, New York, New York, USA
| | - Elisa Konofagou
- Department of Biomedical Engineering, Columbia University, New York, New York, USA; Department of Radiology, Columbia University, New York, New York, USA.
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Wang YN, Song XF, Huang ZJ, Wang Q. Myocardial elastogram using a fast mapping algorithm. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:3236-3239. [PMID: 29060587 DOI: 10.1109/embc.2017.8037546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ultrasound myocardial elastography is a promising technique to estimate regional myocardial function. In this study, we proposed a fast mapping method to map myocardial elastogram. A nude mouse's heart was scanned in supine position by an ultrasound system. The parasternal long-axis view of the heart and the ultrasound radio frequency (RF) signals were acquired for dynamic estimation of myocardial elasticity. The displacement and strain were calculated using analytic minimization (AM) and linear polynomial curve fitting method, respectively. The fast mapping method was proposed to map myocardial elastogram. The results display the contraction of myocardium intuitively. The method in this study is proved to have a potential to estimate viable myocardium in the future.
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Costet A, Wan E, Bunting E, Grondin J, Garan H, Konofagou E. Electromechanical wave imaging (EWI) validation in all four cardiac chambers with 3D electroanatomic mapping in canines in vivo. Phys Med Biol 2016; 61:8105-8119. [PMID: 27782003 DOI: 10.1088/0031-9155/61/22/8105] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Characterization and mapping of arrhythmias is currently performed through invasive insertion and manipulation of cardiac catheters. Electromechanical wave imaging (EWI) is a non-invasive ultrasound-based imaging technique, which tracks the electromechanical activation that immediately follows electrical activation. Electrical and electromechanical activations were previously found to be linearly correlated in the left ventricle, but the relationship has not yet been investigated in the three other chambers of the heart. The objective of this study was to investigate the relationship between electrical and electromechanical activations and validate EWI in all four chambers of the heart with conventional 3D electroanatomical mapping. Six (n = 6) normal adult canines were used in this study. The electrical activation sequence was mapped in all four chambers of the heart, both endocardially and epicardially using the St Jude's EnSite 3D mapping system (St. Jude Medical, Secaucus, NJ). EWI acquisitions were performed in all four chambers during normal sinus rhythm, and during pacing in the left ventricle. Isochrones of the electromechanical activation were generated from standard echocardiographic imaging views. Electrical and electromechanical activation maps were co-registered and compared, and electrical and electromechanical activation times were plotted against each other and linear regression was performed for each pair of activation maps. Electromechanical and electrical activations were found to be directly correlated with slopes of the correlation ranging from 0.77 to 1.83, electromechanical delays between 9 and 58 ms and R 2 values from 0.71 to 0.92. The linear correlation between electrical and electromechanical activations and the agreement between the activation maps indicate that the electromechanical activation follows the pattern of propagation of the electrical activation. This suggests that EWI may be used as a novel non-invasive method to accurately characterize and localize sources of arrhythmias.
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Affiliation(s)
- Alexandre Costet
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
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