Long-term atrial arrhythmia characterization and treatment efficacy evaluation using non-invasive echocardiography-based electromechanical cycle length mapping: a case series

Author:

Tourni Melina1ORCID,Weber Rachel1,Biviano Angelo2ORCID,Konofagou Elisa13ORCID

Affiliation:

1. Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University , 680 West 168th Street, Physicians & Surgeons 14-418, New York, NY, 10032 , USA

2. 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

3. Department of Radiology, Columbia University Medical Center , 630 West 168 Street, Physicians & Surgeons Box 28, New York, NY, 10032 , USA

Abstract

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.

Funder

National Institutes of Health

Onassis Foundation

Publisher

Oxford University Press (OUP)

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