Electromechanical Cycle Length Mapping for atrial arrhythmia detection and cardioversion success assessment

Melina Tourni; Seungyeon Julia Han; Rachel Weber; Mary Kucinski; Elaine Y Wan; Angelo B Biviano; Elisa E Konofagou

doi:10.1016/j.compbiomed.2023.107084

Electromechanical Cycle Length Mapping for atrial arrhythmia detection and cardioversion success assessment

Comput Biol Med. 2023 Sep:163:107084. doi: 10.1016/j.compbiomed.2023.107084. Epub 2023 May 30.

Authors

Melina Tourni¹, Seungyeon Julia Han², Rachel Weber², Mary Kucinski², Elaine Y Wan³, Angelo B Biviano³, Elisa E Konofagou⁴

Affiliations

¹ Depatrment of Biomedical Engineering, Columbia University, 630 W 168th Street, New York, 10032, NY, USA. Electronic address: mt3393@columbia.edu.
² Depatrment of Biomedical Engineering, Columbia University, 630 W 168th Street, New York, 10032, NY, USA.
³ Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, 630 W 168th Street, New York, 10032, NY, USA.
⁴ Depatrment of Biomedical Engineering, Columbia University, 630 W 168th Street, New York, 10032, NY, USA; Department of Radiology, Columbia University, 630 W 168th Street, New York, 10032, NY, USA. Electronic address: ek2191@columbia.edu.

Abstract

Background: Direct current cardioversion (DCCV) is an established treatment to acutely convert atrial fibrillation (AF) to normal sinus rhythm. Yet, more than 70% of patients revert to AF shortly thereafter. Electromechanical Cycle Length Mapping (ECLM) is a high framerate, spectral analysis technique shown to non-invasively characterize electromechanical activation in paced canines and re-entrant flutter patients. This study assesses ECLM feasibility to map and quantify atrial arrhythmic electromechanical activation rates and inform on 1-day and 1-month DCCV response.

Methods: Forty-five subjects (30 AF; 15 healthy sinus rhythm (SR) controls) underwent transthoracic ECLM in four standard apical 2D echocardiographic views. AF patients were imaged within 1 h pre- and post-DCCV. 3D-rendered atrial ECLM cycle length (CL) maps and spatial CL histograms were generated. CL dispersion and percentage of arrhythmic CLs≤333ms across the entire atrial myocardium were computed transmurally. ECLM results were subsequently used as indicators of DCCV success.

Results: ECLM successfully confirmed the electrical atrial activation rates in 100% of healthy subjects (R²=0.96). In AF, ECLM maps localized the irregular activation rates pre-DCCV and confirmed successful post-DCCV with immediate reduction or elimination. ECLM metrics successfully distinguished DCCV 1-day and 1-month responders from non-responders, while pre-DCCV ECLM values independently predicted AF recurrence within 1-month post-DCCV.

Conclusions: ECLM can characterize electromechanical activation rates in AF, quantify their extent, and identify and predict short- and long-term AF recurrence. ELCM constitutes thus a noninvasive arrhythmia imaging modality that can aid clinicians in simultaneous AF severity quantification, prediction of AF DCCV response, and personalized treatment planning.

Keywords: Atrial cycle length; Atrial fibrillation; Cardioversion; Echocardiography; Electromechanical activation; High frame rate ultrasound; Response prediction.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Animals
Atrial Fibrillation* / diagnostic imaging
Atrial Fibrillation* / therapy
Dogs
Echocardiography / methods
Electric Countershock* / methods
Heart Atria / diagnostic imaging
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding