Long-term atrial arrhythmia characterization and treatment efficacy evaluation using noninvasive echocardiography-based electromechanical cycle length mapping: A case series

Atrial fibrillation (AF) is a prevalent cardiac condition characterized by irregular heart rhythm. Traditional non-invasive diagnostic tools, while useful, have limitations in providing comprehensive information for treatment planning. To address this gap, Electromechanical Cycle Length Mapping (ECLM), a noninvasive echocardiography-based technique, has emerged as a promising approach. ECLM offers quantitative and spatially specific insights into atrial electromechanical activation rate mapping, thereby enhancing our understanding of arrhythmia disease progression in AF patients. In this case series, we present two patient cases demonstrating the potential utility of ECLM in monitoring and evaluating treatment responses in atrial arrhythmia. The first case involved a 61-year-old male with persistent AF who underwent multiple procedures, including direct current cardioversion (DCCV) and radiofrequency ablation. Over three different DCCV encounters, pre- and post-procedure ECLM scans were performed, and the results showed the localization and incomplete elimination of arrhythmic triggers post-DCCV, which were used as early indicators of AF recurrence. The second case involved a 71-year-old male with paroxysmal AF who also underwent cardioversion and ablation procedures. ECLM imaging demonstrated a progressive reduction and elimination of arrhythmia triggers after each encounter, resulting in long-term maintenance of sinus rhythm. The findings from this case series highlight the potential of ECLM as a noninvasive imaging tool for long-term monitoring and evaluating immediate and long-term treatment responses in AF patients. The integration of ECLM with standard echocardiograms holds promise in guiding clinical decisions and improving patient outcomes in managing atrial fibrillation.