Localization of Accessory Pathways in Pediatric Patients With Wolff-Parkinson-White Syndrome Using 3D-Rendered Electromechanical Wave Imaging
| Autor: | Hasan Garan, Elaine Wan, Christopher S. Grubb, Rachel Weber, Lea Melki, Eric S. Silver, Pierre Nauleau, Leonardo Liberman, Elisa E. Konofagou |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Noninvasive imaging Adolescent medicine.medical_treatment Catheter ablation Accessory pathway 030204 cardiovascular system & hematology Article Electrocardiography 03 medical and health sciences Imaging Three-Dimensional 0302 clinical medicine Internal medicine medicine Humans 030212 general & internal medicine Child Radiation treatment planning medicine.diagnostic_test business.industry Electromagnetic Radiation Ultrasound Ablation Accessory Atrioventricular Bundle Cardiac Imaging Techniques Catheter Ablation Cardiology Feasibility Studies Female Wolff-Parkinson-White Syndrome business Algorithms Pediatric population |
| Zdroj: | JACC: Clinical Electrophysiology. 5:427-437 |
| ISSN: | 2405-500X |
| Popis: | Objectives This study sought to demonstrate the feasibility of electromechanical wave imaging (EWI) for localization of accessory pathways (AP) prior to catheter ablation in a pediatric population. Background Prediction of AP locations in patients with Wolff-Parkinson-White syndrome is currently based on analysis of 12-lead electrocardiography (ECG). In the pediatric population, specific algorithms have been developed to aid in localization, but these can be unreliable. EWI is a noninvasive imaging modality relying on a high frame rate ultrasound sequence capable of visualizing cardiac electromechanical activation. Methods Pediatric patients with ventricular pre-excitation presenting for catheter ablation were imaged with EWI immediately prior to the start of the procedure. Two clinical pediatric electrophysiologists predicted the location of the AP based on ECG. Both EWI and ECG predictions were blinded to the results of catheter ablation. EWI and ECG localizations were subsequently compared with the site of successful ablation. Results Fifteen patients were imaged with EWI. One patient was excluded for poor echocardiographic windows and the inability to image the entire ventricular myocardium. EWI correctly predicted the location of the AP in all 14 patients. ECG analysis correctly predicted 11 of 14 (78.6%) of the AP locations. Conclusions EWI was shown to be capable of consistently localizing accessory pathways. EWI predicted the site of successful ablation more frequently than analysis of 12-lead ECG. EWI isochrones also provide anatomical visualization of ventricular pre-excitation. These findings suggest that EWI can predict AP locations, and EWI may have the potential to better inform clinical electrophysiologists prior to catheter ablation procedures. |
| Databáze: | OpenAIRE |
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