Echocardiographic Detection of Cardiac Ectopy: A Possible Alternative to Electrophysiological Mapping?

Authors

  • Christoph Bara
  • Michael Niehaus
  • Ali Ghodsizad
  • Payam Akhyari
  • Matthias Karck
  • Arjang Ruhparwar

DOI:

https://doi.org/10.1532/HSF98.20101030

Abstract

Purpose: Three-dimensional (3-D) visualization of ventricular activation sequence is imperative for the diagnosis and treatment of malignant cardiac arrhythmias. Modern mapping systems that serve as the gold standard for detection and localization of the focus are costly and require an invasive approach into the cavity of the ventricles. The aim of our study was the development of a noninvasive and 3-D mapping system based upon echocardiography.

Methods: In a porcine model, animals underwent ablation of the atrioventricular node (AV-node). 3-D electrophysiological cardiac mapping was performed using the ENSITE™ electro-anatomical system (St. Jude Medical, Minneapolis, MN, USA). Simultaneously, transesophageal echocardiography (TEE) including pulse wave (Pw) tissue Doppler was performed, and time to peak early diastolic velocity (PEDV) was measured. Both ENSITE-mapping and tissue Pw-Doppler were compared as to their ability to pinpoint the origin of ventricular ectopic focus.

Results: PEDV corresponded well with the results as determined by noncontact mapping with ENSITE.

Conclusions: Tissue Doppler is a reliable method to deliver information about the topography of first onset of myocardial excitation. Further development of this method with a higher regional resolution and integration of color Doppler as well as 3-D echocardiography may eventually lead to the development of a completely noninvasive and echo-based electromechanical mapping system.

References

Gepstein L, Hayam G, Ben-Haim SA. 1997. A novel method for non-fluoroscopic catheter-based electroanatomical mapping of the heart. In vitro and in vivo accuracy results. Circulation 95:1611-22.nHo CY, Solomon SD. 2006. A clinician's guide to tissue Doppler imaging. Circulation 113:e396-8.nKrishnamoorthy VK, Sengupta PP, Gentile F, Khandheria BK. 2007. History of echocardiography and its future applications in medicine. Crit Care Med 35(8 Suppl):S309-13.nKroll M, Kriebel T, Windhagen-Mahnert B, et al. 2003. Origin of electrical activation within the right atrial and left ventricular walls: differentiation by electrogram characteristics using the noncontact mapping system. Pacing Clin Electrophysiol 26:1970-8.nMorton JB, Kalman JM. 2005. Intracardiac echocardiographic anatomy for the interventional electrophysiologist. J Interv Card Electrophysiol 13:11-6.nMügge A. 2000. Transoesophageal echocardiography (TEE) [in German]. Z Kardiol 89:110-8.nMyerburg RJ, Kessler KM, Castellanos A. 1993. Sudden cardiac death: epidemiology, transient risk, and intervention assessment. Ann Intern Med 119:1187-97.nPai RG, Gill KS. 1998. Amplitudes, durations, and timings of apically directed left ventricular myocardial velocities: II. Systolic and diastolic asynchrony in patients with left ventricular hypertrophy. J Am Soc Echocardiogr 11:112-8.nSchiller NB, Shah PM, Crawford M, et al. 1989. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 2:358-67.nStevenson WG, Delacretaz E. 2000. Radiofrequency catheter ablation of ventricular tachycardia. Heart 84:553-9.nZhang X, Ramachandra I, Liu Z, Muneer B, Pogwizd SM, He B. 2005. Noninvasive three-dimensional electrocardiographic imaging of ventricular activation sequence. Am J Physiol Heart Circ Physiol 289:H2724-32.n

Published

2010-10-19

How to Cite

Bara, C., Niehaus, M., Ghodsizad, A., Akhyari, P., Karck, M., & Ruhparwar, A. (2010). Echocardiographic Detection of Cardiac Ectopy: A Possible Alternative to Electrophysiological Mapping?. The Heart Surgery Forum, 13(5), E324-E327. https://doi.org/10.1532/HSF98.20101030

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