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的主要死亡原因。根据最新的心脏病和中风统计报告，美国每天有超过2200人死于心血管疾病(CVD)，平均每39秒就有1人死亡。心律失常指的是自然心律的紊乱。这种不规则的心律会导致心脏突然停止供血。心房病理是最常见的心律失常，心房颤动和心房扑动是中风最普遍和最强大的危险因素，在所有年龄段增加5倍，相关的治疗费用为每年66.5亿美元。尽管有这种迫切的临床需求，但临床上根本没有可用的成像方法来非侵入性地标示所有四个心腔的传导及其在存在异常或疾病时的破坏。此外，房性心律失常通常是无症状的，临床上仍未发现。在这项研究中，我们的目标是评估我们实验室首创的一种方法的临床潜力，即机电波成像(EWI)，它将来自电(ECG)和机械(超声)心功能的信息结合到单一成像模式中，该成像模式可以在有无疾病的情况下以非常高的帧速率同时映射所有四个心腔的电和机械心功能。EWI是一种独特的技术，它可以非侵入性地标测由心脏电激活引起的机械波的传播，也称为机电波。组建的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、动物和人类的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)设计和实施能够提供优化的房性心律失常EWI成像的新型系统；2)评估在体犬体内检测房性心律失常的性能；以及3)评估射频消融术对房性心律失常患者的治疗规划和指导能力。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，立即转移到临床上。此外，它还可以安全和非侵入性地与任何诊断方法结合使用，如心电图术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.