Feature | EP Mapping and Imaging Systems | May 15, 2019| Dave Fornell, Editor

Electromechanical Wave Imaging Can Correctly Localize Cardiac Arrhythmias

New ultrasound imaging technology can noninvasively electromap the heart prior to ablations

Electromechanical Wave Imaging (EWI) is a new, high-frame rate 3-D rendered ultrasound technique that can noninvasively map the electromechanical activation of heart rhythm. This example shows the ECG tracings compared to the EWI image of the heart.

Electromechanical Wave Imaging (EWI) is a new, high-frame rate 3-D rendered ultrasound technique that can noninvasively map the electromechanical activation of heart rhythm. This example shows the ECG tracings compared to the EWI image of the heart.

Electromechanical Wave Imaging (EWI) is a new, high-frame rate 3-D rendered ultrasound technique that can noninvasively map the electromechanical activation of heart rhythm.

May 15, 2019 — A new study shows electromechanical wave imaging is capable of localizing arrhythmias including atrial tachycardia (AT), atrial flutter (AFL), premature ventricular complexes (PVC), and accessory pathways (AP) in Wolff-Parkinson-White syndrome prior to catheter ablation. The double-blinded study for this new technology was presented as a late-breaking session at Heart Rhythm 2019, the Heart Rhythm Society's 40th Annual Scientific Sessions.

Diagnosis and localization of arrhythmias are critical for decision making and treatment planning prior to cardiac ablation. The 12 lead ECG is the main noninvasive tool used to localize arrhythmias, however it can be limited in specificity and subject to interobserver variability. Electromechanical Wave Imaging (EWI) is a novel, high frame rate 3-D rendered ultrasound technique that can noninvasively map the electromechanical activation of heart rhythm.

In this study, EWI was able to correctly predict 96% of arrhythmia locations as compared with 71% for 12-lead ECG analyses (unadjusted for arrhythmia type: OR: 11.8; 95% CI: 2.2-63.2; p=0.004; adjusted for arrhythmia type: OR: 12.1; 95% CI: 2.3-63.2; p=0.003). There was significant inter-observer variability amongst ECG reads.

Ongoing efforts include incorporating EWI isochrones into 3-D anatomical maps prior to ablation to determine whether EWI can affect clinical outcomes, said Elaine Wan, M.D., FHRS, the Esther Aboodi Assistant Professor of Medicine in Cardiology and Cardiac Electrophysiology at Columbia University Medical Center. She explained this includes reducing procedure time and radiation dose, in addition to exploring EWI with transesophageal, intracardiac, and 3-D ultrasound.

In the study, patients presenting for catheter ablation of AT, AFL, PVCs, or an AP underwent transthoracic EWI and 12 lead ECG prior to the ablation. 67 patients were consented, 12 patients were excluded due to withdrawal of consent, poor imaging or not being in the arrhythmia at time of imaging. There were 55 patients who underwent EWI (mean age 56.0±2.3 years, 71% male). Of these, 22% had WPW, 20% had PVCs, 13% had AT and 45% had AFL. Six blinded clinical electrophysiologists predicted arrhythmia origins based on ECG alone. EWI isochrone processing was blinded to all clinical data except arrhythmia type. Operating physicians were blinded to EWI isochrones. EWI and ECG predictions were compared to arrhythmia location as determined by 3-D electroanatomic mapping and ablation using a standardized 21 segment cardiac model.

All the HRS 2019 late-breaking studies 

Link to other HRS 2019 news

 

 

Related Content

News | Cardiovascular Clinical Studies | November 26, 2019
November 26, 2019 — The University of Connecticut (UConn) Department of Kinesiology and Hartford Healthcare have sele
FDA Issues Final Guidance on Live Case Presentations During IDE Clinical Trials
News | Cardiovascular Clinical Studies | July 10, 2019
The U.S. Food and Drug Administration (FDA) issued the final guidance “Live Case Presentations During Investigational...
Veradigm Partners With American College of Cardiology on Next-generation Research Registries
News | Cardiovascular Clinical Studies | July 03, 2019
The American College of Cardiology (ACC) has partnered with Veradigm, an Allscripts business unit, to power the next...
New FDA Proposed Rule Alters Informed Consent for Clinical Studies
News | Cardiovascular Clinical Studies | November 19, 2018
The U.S. Food and Drug Administration (FDA) is proposing to add an exception to informed consent requirements for...
A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development. #SCAI, #SCAI2018

A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development.  

Feature | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 – New clinical evidance shows common therapy options for psoriasis (PSO), a chronic inflammatory skin di
Intravenous Drug Use is Causing Rise in Heart Valve Infections, Healthcare Costs. #SCAI, #SCAI2018
News | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 — The opioid drug epidemic is impacting cardiology, with a new study finding the number of patients hosp
Patient Enrollment Completed in U.S. IDE Study of THERMOCOOL SMARTTOUCH SF Catheter
News | Cardiovascular Clinical Studies | March 15, 2018
March 15, 2018 –  Johnson & Johnson Medical Devices Companies announced today that Biosense Webster, Inc., who wo
Lexington Begins HeartSentry Clinical Trial
News | Cardiovascular Clinical Studies | February 20, 2018
February 20, 2018 – Lexington Biosciences, Inc., a development-stage medical device company, announced the commenceme
Endologix Completes Patient Enrollment in the ELEVATE IDE Clinical Study
News | Cardiovascular Clinical Studies | February 06, 2018
February 6, 2018 – Endologix, a developer and marketer of treatments for aortic disorders, announced the completion o
12-Month Results from Veryan Medical's MIMICS-2 IDE Study Presented at LINC
News | Cardiovascular Clinical Studies | February 01, 2018
February 1, 2018 – Thomas Zeller (Bad Krozingen, Germany) presented the 12-month results from Veryan Medical’s MIMICS
Overlay Init