Cardiac arrhythmias are a major cause of morbidity and mortality worldwide. The 12-lead electrocardiogram (ECG) is the current noninvasive clinical tool used to diagnose and localize cardiac arrhythmias. However, it has limited accuracy and is subject to operator bias. Here, we present electromechanical wave imaging (EWI), a high-frame rate ultrasound technique that can noninvasively map with high accuracy the electromechanical activation of atrial and ventricular arrhythmias in adult patients. This study evaluates the accuracy of EWI for localization of various arrhythmias in all four chambers of the heart before catheter ablation. Fifty-five patients with an accessory pathway (AP) with Wolff-Parkinson-White (WPW) syndrome, premature ventricular complexes (PVCs), atrial tachycardia (AT), or atrial flutter (AFL) underwent transthoracic EWI and 12-lead ECG. Three-dimensional (3D) rendered EWI isochrones and 12-lead ECG predictions by six electrophysiologists were applied to a standardized segmented cardiac model and subsequently compared to the region of successful ablation on 3D electroanatomical maps generated by invasive catheter mapping. There was significant interobserver variability among 12-lead ECG reads by expert electrophysiologists. EWI correctly predicted 96% of arrhythmia locations as compared with 71% for 12-lead ECG analyses [unadjusted for arrhythmia type: odds ratio (OR), 11.8; 95% confidence interval (CI), 2.2 to 63.2; P = 0.004; adjusted for arrhythmia type: OR, 12.1; 95% CI, 2.3 to 63.2; P = 0.003]. This double-blinded clinical study demonstrates that EWI can localize atrial and ventricular arrhythmias including WPW, PVC, AT, and AFL. EWI when used with ECG may allow for improved treatment for patients with arrhythmias.

中文翻译：

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使用机电波成像对心律失常进行无创定位。


心律失常是全世界发病和死亡的主要原因。 12 导联心电图 (ECG) 是当前用于诊断和定位心律失常的无创临床工具。然而，它的准确性有限，并且容易受到操作员偏差的影响。在这里，我们提出了机电波成像（EWI），这是一种高帧率超声技术，可以无创地高精度绘制成人患者房性和室性心律失常的机电激活情况。本研究评估了 EWI 在导管消融前定位心脏所有四个心室中各种心律失常的准确性。 55 名患有旁路 (AP) 且患有 Wolff-Parkinson-White (WPW) 综合征、室性早搏 (PVC)、房性心动过速 (AT) 或心房扑动 (AFL) 的患者接受了经胸 EWI 和 12 导联心电图检查。六位电生理学家将三维 (3D) 渲染的 EWI 等时线和 12 导联心电图预测应用于标准化分段心脏模型，随后与侵入性导管标测生成的 3D 电解剖图上成功消融的区域进行比较。电生理学家专家读取的 12 导联心电图读数存在显着的观察者间差异。 EWI 正确预测了 96% 的心律失常位置，而 12 导联 ECG 分析的正确预测率为 71% [未根据心律失常类型进行调整：比值比 (OR)，11.8； 95% 置信区间 (CI)，2.2 至 63.2； P=0.004；针对心律失常类型进行调整：OR，12.1； 95% CI，2.3 至 63.2； P = 0.003]。这项双盲临床研究表明，EWI 可以定位房性和室性心律失常，包括 WPW、PVC、AT 和 AFL。 EWI 与心电图结合使用可以改善心律失常患者的治疗。