Mapping-guided characterization of mechanical and electrical activation patterns in patients with normal systolic...

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Intra-procedural characterization of left ventricular (LV) mechanical activation patterns is crucial for evolving cardiac resynchronization therapy.
• Current technologies face technical challenges in providing real-time LV mechanical activation data.
• A novel sensor-based, real-time tracking technology was investigated for its feasibility in characterizing LV wall motion.

Purpose of the Study:

• To evaluate the feasibility of a novel sensor-based, real-time tracking technology for characterizing left ventricular (LV) wall motion.
• To assess the potential of this technology in guiding cardiac procedures like resynchronization therapy.

Main Methods:

• Ten patients underwent simultaneous endocardial motion and electrical mapping of the LV using electroanatomical mapping and navigational systems (EnSite™ NavX™ and MediGuide™).
• Epicardial motion data were collected from coronary sinus branches at corresponding locations.
• Displacements and activation times were analyzed for standard LV wall segments, comparing mechanical activation with electrical activation and preoperative 2D speckle tracking echocardiography.

Main Results:

• The lateral and septal walls showed the largest and smallest displacements, respectively.
• Radial displacement was significantly greater endocardially than epicardially, while longitudinal displacement was greater epicardially.
• A high concordance (9/10 patients) was observed between latest mechanical and electrical activation segments.
• MediGuide-derived LV chamber volumes strongly correlated with MRI (R²=0.73) and echocardiography (R²=0.75).

Conclusions:

• The feasibility of mapping-guided intra-procedural characterization of LV wall motion using the novel sensor-based technology was established.
• This technology shows promise for real-time assessment of LV mechanical activation patterns.