Noninvasive arrhythmia mapping using Electromechanical Wave Imaging

描述（申请人提供）：心脏病仍然是美国男性和女性死亡的最大主要原因。根据心脏病和中风统计的最新报告，每天有2200多名美国人死于心血管疾病（CVD），平均每39秒就有1人死亡。心律失常是指自然心律的中断。这种不规则的心律导致心脏突然停止泵血。心房病变是最常见的心律失常，房颤和房扑是卒中最普遍和最有力的风险因素，在所有年龄段中增加了5倍，每年的相关治疗费用为66.5亿美元。尽管有这种迫切的临床需求，但迄今为止，临床上根本没有成像模式可以无创地映射所有四个心腔中的传导及其在存在异常或疾病时的中断。此外，房性心律失常通常是无症状的，并且在临床上未被检测到。在这项研究中，我们的目标是评估我们实验室开创的一种方法的临床潜力，即，机电波成像（EWI）将来自电（ECG）和机械（超声心动图）心脏功能的信息结合到单个成像模式中，该成像模式可以在存在和不存在疾病的情况下以非常高的帧速率同时映射所有四个心腔中的电和机械心脏功能。EWI是一种独特的技术，可以无创地映射由心脏电激活引起的机械波传播，也称为机电波。多学科团队涵盖所有关键专业领域，如超声换能器设计、超声信号处理、传导标测硬件、动物和人类心脏电生理学以及心律失常的临床诊断和治疗。我们提出了以下具体目标：1）设计和实现能够提供房性心律失常优化EWI成像的新型系统; 2）评价犬体内房性心律失常检测的性能; 3）评估房性心律失常患者射频（RF）消融术的治疗计划和指导能力。这项研究可能会产生广泛的影响，因为相同的成像模式可以很容易地集成到任何商业超声心动图系统中，以便立即转化为临床。此外，它还可以安全和无创地与任何诊断方法结合使用，例如心电图和超声心动图或治疗技术的监测。

DESCRIPTION (provided by applicant): Heart disease remains the largest major cause of death of both men and women in the U.S. According to the latest report on Heart Disease and Stroke Statistics, more than 2200 Americans die of cardiovascular disease (CVD) each day, an average of 1 death every 39 seconds. Arrhythmias refer to the disruption of the natural heart rhythm. This irregular heart rhythm causes the heart to suddenly stop pumping blood. Atrial pathologies are the most common arrhythmias with atrial fibrillation and atrial flutter being the most prevalent and powerful risk factors for stroke with a 5-fold increase throughout all ages and an associated cost of $6.65 billion per year in treatment. Despite this urgent clinical need, t date there is simply no imaging modality available in the clinic that can noninvasively map the conduction in all four cardiac chambers and its disruption in the presence of an abnormality or disease. In addition, atrial arrhythmias are typically asymptomatic and remain clinically undetected. In this study, our objective is to assess the clinical potential of a method pioneered in our laboratory, i.e., Electromechanical Wave Imaging (EWI) that combines the information from both the electrical (ECG) and mechanical (echocardiography) cardiac function into a single imaging modality that can simultaneously map, at very high frame rates, both the electrical and mechanical cardiac function in all four cardiac chambers, at both the presence and absence of disease. EWI is a unique technique that can noninvasively map the mechanical wave propagation as induced by the electrical activation of the heart, also known as the electromechanical wave. The multi-disciplinary team assembled encompasses all critical specialty areas such as ultrasound transducer design, ultrasound signal processing, conduction mapping hardware, cardiac electrophysiology in animals and humans and clinical diagnosis and treatment of arrhythmias. We propose the following specific aims: 1) design and implement novel systems that can provide optimized EWI imaging of atrial arrhythmias; 2) evaluate the performance of detection of atrial arrhythmias in canines in vivo; and 3) assess the treatment planning and guidance capabilities of radio-frequency (RF) ablation procedures of patients with atrial arrhythmias. This study could have a broad impact since the same imaging modality can easily be integrated into any commercial echocardiography system for immediate translation to the clinic. Furthermore, it can also be applied safely and noninvasively in conjunction with any diagnostic method, such as electrocardiography and echocardiography or, monitoring of therapeutic techniques.