Ventricular excitation maps using tissue Doppler acceleration imaging: Potential clinical application

OVJECTIVE. The purpose of this study is to validate the use of tissue Doppl er acceleration imaging (TDAI) for evaluation of the onset of ventricular c ontraction in humans. BACKGROUND. Tissue Doppler acceleration imaging can display the distributio n, direction and value of ventricular acceleration responses to myocardial contraction and electrical excitation. METHODS. Twenty normal volunteers underwent TDAT testing to determine the n ormal onset of ventricular acceleration. Two patients with paroxysmal supra ventricular tachycardia and 30 patients with permanent pacemakers underwent introduction of esophageal and right ventricular pacing electrodes, respec tively, and were studied to visualize the onset of pacer-induced ventricula r acceleration. Eight patients with dual atrioventricular (AV) node and 20 patients with Wolff-Parkinson-White (WPW) syndrome underwent TDAI testing t o localize the abnormal onset of ventricular acceleration, and the results were compared with those of intracardiac electrophysiology (ICEP) tests. RESULTS. The normal onset and the onset of dual AV node were localized at t he upper interventricular septum (IVS) under the right coronary cusp within 25 ms before the beginning of the R wave in the electrocardiogram (ECG). I n all patients in the pacing group, the location and timing of the onset co nformed to the positions and timing of electrodes (100%). In patients with WPW syndrome, abnormal onset was localized to portions of the ventricular w all other than the upper IVS at the delta wave or within 25 ms after the de lta wave in the EGG. The agreement was 90% (18 of 20) between the abnormal onset and the position of the accessory pathways determined by ICEP testing . CONCLUSIONS. These results suggest that TDAI is a useful noninvasive method that frequently is successful in visualizing the intramural site of origin of ventricular mechanical contraction. (C) 1999 by the American College of Cardiology.