JACC: Clinical Electrophysiology
Localization of Accessory Pathways in Pediatric Patients With Wolff-Parkinson-White Syndrome Using 3D-Rendered Electromechanical Wave Imaging
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Author + information
- Lea Melki, MSc, MPhila,∗,
- Christopher S. Grubb, BSb,∗,
- Rachel Weber, BA, RDCS, RVTa,
- Pierre Nauleau, PhDa,
- Hasan Garan, MDb,
- Elaine Wan, MDb,
- Eric S. Silver, MDc,
- Leonardo Liberman, MDc,† and
- Elisa E. Konofagou, PhDa,d,†∗ (ek2191{at}columbia.edu)
- aUltrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
- bDivision of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
- cPediatric Electrophysiology, Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, New York
- dDepartment of Radiology, Columbia University Medical Center, New York, New York
- ↵∗Address for correspondence:
Dr. Elisa E. Konofagou, Biomedical Engineering, Columbia University Medical Center, 630 West 168th Street, Physicians and Surgeons 19-418, New York, New York 10032.
Graphical abstract
Abstract
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.
Footnotes
↵∗ Mrs. Melki and Mr. Grubb contributed equally to this work and are joint first authors.
↵† Drs. Liberman and Konofagou contributed equally to this work and are joint senior authors.
Supported in part by the National Institutes of Health grant nos. R01 HL114358, R01 HL140646-01, and R01 EB006042. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received August 15, 2018.
- Revision received December 2, 2018.
- Accepted December 4, 2018.
- 2019 American College of Cardiology Foundation
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