title: Assessing the atrial electromechanical coupling during atrial focal tachycardia, flutter, and fibrillation using electromechanical wave imaging in humans.
abstract: Minimally-invasive treatments of cardiac arrhythmias such as radio-frequency ablation are gradually gaining importance in clinical practice but still lack a noninvasive imaging modality which provides insight into the source or focus of an arrhythmia. Cardiac deformations imaged at high temporal and spatial resolution can be used to elucidate the electrical activation sequence in normal and paced human subjects non-invasively and could potentially aid to better plan and monitor ablation-based arrhythmia treatments. In this study, a novel ultrasound-based method is presented that can be used to quantitatively characterize focal and reentrant arrhythmias. Spatio-temporal maps of the full-view of the atrial and ventricular mechanics were obtained in a single heartbeat, revealing with otherwise unobtainable detail the electromechanical patterns of atrial flutter, fibrillation, and tachycardia in humans. During focal arrhythmias such as premature ventricular complex and focal atrial tachycardia, the previously developed electromechanical wave imaging methodology is hereby shown capable of identifying the location of the focal zone and the subsequent propagation of cardiac activation. During reentrant arrhythmias such as atrial flutter and fibrillation, Fourier analysis of the strains revealed highly correlated mechanical and electrical cycle lengths and propagation patterns. High frame rate ultrasound imaging of the heart can be used non-invasively and in real time, to characterize the lesser-known mechanical aspects of atrial and ventricular arrhythmias, also potentially assisting treatment planning for intraoperative and longitudinal monitoring of arrhythmias.
authors.affiliation: Department of Biomedical Engineering, Columbia University, New York, NY 10032, United States.
authors.forename: Jean
authors.initials: J
authors.lastname: Provost
authors.affiliation: Department of Biomedical Engineering, Columbia University, New York, NY 10032, United States.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Costet
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University, New York, NY 10032, United States.
authors.forename: Elaine
authors.initials: E
authors.lastname: Wan
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University, New York, NY 10032, United States.
authors.forename: Alok
authors.initials: A
authors.lastname: Gambhir
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University, New York, NY 10032, United States.
authors.forename: William
authors.initials: W
authors.lastname: Whang
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University, New York, NY 10032, United States.
authors.forename: Hasan
authors.initials: H
authors.lastname: Garan
authors.affiliation: Department of Biomedical Engineering, Columbia University, New York, NY 10032, United States; Department of Radiology, Columbia University, New York, NY 10032, United States. Electronic address: ek2191@columbia.edu.
authors.forename: Elisa E
authors.initials: EE
authors.lastname: Konofagou
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology; D001282:Atrial Flutter / Q000000981:diagnostic imaging / Q000503:physiopathology; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D013612:Tachycardia, Ectopic Atrial / Q000000981:diagnostic imaging / Q000503:physiopathology; D014463:Ultrasonography
keywords: Arrhythmia; Echocardiography; Electrophysiology mapping; Imaging; Premature ventricular contraction