Mapping of cardiac electrical activation with electromechanical wave imaging: an in silico-in vivo reciprocity study

Electromechanical wave imaging (EWI) is an entirely noninvasive, ultrasound-based imaging method capable of mapping the electromechanical activation sequence of the ventricles in vivo. Given the broad accessibility of ultrasound scanners in the clinic, the application of EWI could constitute a flexible surrogate for the 3-dimensional electrical activation.

The purpose of this report is to reproduce the electromechanical wave (EW) using an anatomically realistic electromechanical model, and establish the capability of EWI to map the electrical activation sequence in vivo when pacing from different locations.

EWI was performed in 1 canine during pacing from 3 different sites. A high-resolution dynamic model of coupled cardiac electromechanics of the canine heart was used to predict the experimentally recorded electromechanical wave. The simulated 3-dimensional electrical activation sequence was then compared with the experimental EW.

The electrical activation sequence and the EW were highly correlated for all pacing sites. The relationship between the electrical activation and the EW onset was found to be linear, with a slope of 1.01 to 1.17 for different pacing schemes and imaging angles.

The accurate reproduction of the EW in simulations indicates that the model framework is capable of accurately representing the cardiac electromechanics and thus testing new hypotheses. The one-to-one correspondence between the electrical activation and the EW sequences indicates that EWI could be used to map the cardiac electrical activity. This opens the door for further exploration of the technique in assisting in the early detection, diagnosis, and treatment monitoring of rhythm dysfunction.