Format

Send to

Choose Destination
Ultrasound Med Biol. 2020 Feb;46(2):405-414. doi: 10.1016/j.ultrasmedbio.2019.10.017. Epub 2019 Nov 22.

High Frame Rate Ultrasound for Electromechanical Wave Imaging to Differentiate Endocardial From Epicardial Myocardial Activation.

Author information

1
Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France; LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France; Université de Lyon, Lyon, France. Electronic address: francis.bessiere@chu-lyon.fr.
2
LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France; Université de Lyon, Lyon, France.
3
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, 33000 Bordeaux, France.
4
Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Lyon, France.

Abstract

Differentiation between epicardial and endocardial ventricular activation remains a challenge despite the latest technologies available. The aim of the present study was to develop a new tool method, based on electromechanical wave imaging (EWI), to improve arrhythmogenic substrate activation analysis. Experiments were conducted on left ventricles (LVs) of four isolated working mode swine hearts. The protocol aimed at demonstrating that different patterns of mechanical activation could be observed whether the ventricle was in sinus rhythm, paced from the epicardium or from the endocardium. A total of 72 EWI acquisitions were recorded on the anterior, lateral and posterior segments of the LV. A total of 54 loop records were blindly assigned to two readers. EWI sequences interpretations were correct in 89% of cases. The overall agreement rate between the two readers was 83%. When in a paced ventricle, the origin of the wave front was focal and originated from the endocardium or the epicardium. In sinus rhythm, wave front was global and activated within the entire endocardium toward the epicardium at a speed of 1.7 ± 0.28 m·s-1. Wave front speeds were respectively measured when the endocardium or the epicardium were paced at a speed of 1.1 ± 0.35 m·s-1 versus 1.3 ± 0.34 m·s-1 (p = NS). EWI activation mapping allows activation localization within the LV wall and calculation of the wave front propagation speed through the muscle. In the future, this technology could help localize activation within the LV thickness during complex ablation procedures.

KEYWORDS:

Cardiac mapping; Electromechanical wave imaging; Endocardial versus epicardial activation; Ultrasound; Ventricular arrhythmia

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center