Tomoko Ishizu1, Yoshihiro Seo2, Miyako Igarashi2, Yukio Sekiguchi2, Tomoko Machino-Ohtsuka2, Kojiro Ogawa2, Kenji Kuroki2, Masahiro Yamamoto2, Akihiko Nogami2, Yasushi Kawakami2, Kazutaka Aonuma2. 1. From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan. tomoco@md.tsukuba.ac.jp. 2. From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan.
Abstract
BACKGROUND: We have developed a noninvasive isochrone activation imaging (AI) system with 3-dimensional (3D) speckle tracking echocardiography (STE), which allows visualization of the wavefront image of mechanical propagation of the accessory pathway (ACP) in Wolff-Parkinson-White syndrome. METHODS AND RESULTS: Patients with manifest Wolff-Parkinson-White syndrome were imaged in 3D-STE AI mode, which quantified the time from QRS onset to regional endocardial deformation. In 2 patients with left- and right-side ACP, we confirmed that intraoperative contact endocardial electric mapping and the 3D-STE AI system showed comparable images pre- and postablation. In normal heart assessment by 3D-echo AI, the earliest activation sites were found at the attachment of the papillary muscles in the left ventricle and midseptum in the right ventricle, and none showed earliest activation at the peri-atrioventricular valve annuli. An analyzer who was unaware of the clinical information assessed 39 ACP locations in 38 Wolff-Parkinson-White syndrome patients using 3D-STE. All showed abnormal perimitral or tricuspid annular activations, and the location of 34 ACP (87%) showed agreement with the successful ablation sites within a 2-o'clock range. Especially for left free wall ACP, 17/18 (94%) showed consistency with the ablation site within a 2 o'clock range. Among 15 ACP at the ventricular septum, 9 (60%) showed early local activation in both right and left sides of the septum. CONCLUSIONS: Isochrone AI with 3D-STE may be a promising noninvasive imaging tool to assess cardiac synchronized activation in normal hearts and detect abnormal breakthrough of mechanical activation from both atrioventricular annuli in Wolff-Parkinson-White syndrome.
BACKGROUND: We have developed a noninvasive isochrone activation imaging (AI) system with 3-dimensional (3D) speckle tracking echocardiography (STE), which allows visualization of the wavefront image of mechanical propagation of the accessory pathway (ACP) in Wolff-Parkinson-White syndrome. METHODS AND RESULTS:Patients with manifest Wolff-Parkinson-White syndrome were imaged in 3D-STE AI mode, which quantified the time from QRS onset to regional endocardial deformation. In 2 patients with left- and right-side ACP, we confirmed that intraoperative contact endocardial electric mapping and the 3D-STE AI system showed comparable images pre- and postablation. In normal heart assessment by 3D-echo AI, the earliest activation sites were found at the attachment of the papillary muscles in the left ventricle and midseptum in the right ventricle, and none showed earliest activation at the peri-atrioventricular valve annuli. An analyzer who was unaware of the clinical information assessed 39 ACP locations in 38 Wolff-Parkinson-White syndromepatients using 3D-STE. All showed abnormal perimitral or tricuspid annular activations, and the location of 34 ACP (87%) showed agreement with the successful ablation sites within a 2-o'clock range. Especially for left free wall ACP, 17/18 (94%) showed consistency with the ablation site within a 2 o'clock range. Among 15 ACP at the ventricular septum, 9 (60%) showed early local activation in both right and left sides of the septum. CONCLUSIONS:Isochrone AI with 3D-STE may be a promising noninvasive imaging tool to assess cardiac synchronized activation in normal hearts and detect abnormal breakthrough of mechanical activation from both atrioventricular annuli in Wolff-Parkinson-White syndrome.
Authors: Lea Melki; Christopher S Grubb; Rachel Weber; Pierre Nauleau; Hasan Garan; Elaine Wan; Eric S Silver; Leonardo Liberman; Elisa E Konofagou Journal: JACC Clin Electrophysiol Date: 2019-01-30
Authors: Christopher S Grubb; Lea Melki; Daniel Y Wang; James Peacock; Jose Dizon; Vivek Iyer; Carmine Sorbera; Angelo Biviano; David A Rubin; John P Morrow; Deepak Saluja; Andrew Tieu; Pierre Nauleau; Rachel Weber; Salma Chaudhary; Irfan Khurram; Marc Waase; Hasan Garan; Elisa E Konofagou; Elaine Y Wan Journal: Sci Transl Med Date: 2020-03-25 Impact factor: 17.956