Cardiac arrhythmia (an irregular heartbeat) is a leading cause of death worldwide. The tool used to diagnose arrhythmia is called an electrocardiogram (ECG), but its accuracy is limited, and it doesn’t provide clinicians with a visual location of the source of the arrhythmia, but that may be about to change. Researchers from Columbia University have been able to use Electromechanical Wave Imaging (EWI) to accurately locate both atrial and ventricular arrhythmias. EWI is an ultrasound-based imaging method that can non-invasively map the activity of all four chambers of the heart and provide real-time feedback. The study is published in Science Translational Medicine.
According to the director of the Alliance for Cardiovascular Diagnostic and Treatment innovation at Johns Hopkins University, Dr. Natalia Trayanova, “This study presents a significant advancement in addressing a major unmet clinical need: the accurate arrhythmia localization in patients with a variety of heart rhythm disorders. The non-invasive nature of EWI using standard hospital hardware, and its ability to visualize the arrhythmia sources in 3D render it an attractive component for inclusion in the clinical ablation procedure."
One of the study authors, Elisa Konofagou, says, “We knew EWI was feasible in individual patients and we wanted to see if it made a difference in the clinical setting where they treat many people with different types of arrhythmias. So, we joined forces with cardiac electrophysiologists to determine clinical utility for the first time. We were able to show that not only does our imaging method work in difficult cases of arrhythmia but that it can also predict the optimal site of radiofrequency ablation before the procedure where there is no other imaging tool currently available to do that in the clinic. Using EWI as a clinical visualization tool in conjunction with ECG and clinical workflow could improve discussions with patients about treatment options and pre-procedural planning as well as potentially reducing redundant ablation sites, prolonged procedures, and anesthesia times."
The first co-author of the study, Lea Melki, a PhD student, says, “The accuracy of EWI was higher than that of clinical diagnosis by electrophysiologists reading standard 12-lead ECGs. It's really clear now that, when used in conjunction with standard 12-lead ECG, EWI can be a valuable tool for diagnosis, clinical decision making, and treatment planning of patients with arrhythmias. We believe our EWI technique, with minimal training, will result in higher accuracy in the site of ablation, a faster procedure, and fewer complications and repeat visits after the procedure. This is a win-win for everyone, both patients and clinicians."