High frame rate speckle tracking echocardiography to image the left ventricular mechanical activation sequence in healthy participants and patients with left bundle branch block

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ID: 313616
2026
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Abstract
Abstract Objective Electrical activation mapping is essential for identifying ablation targets in the treatment of cardiac arrhythmias. This study investigates high-frame-rate (HFR) speckle-tracking echocardiography (STE) as a non-invasive alternative to conventional electrophysiologic studies for constructing mechanical activation maps and defining left ventricular (LV) activation onset. Methods 20 healthy volunteers (HV) and 25 patients with a biventricular pacemaker (BiV) underwent HFR ultrasound scanning. Patients were scanned during BiV on and off, hence reintroducing native activation - left bundle branch block (LBBB) pattern. 5 patients were additionally scanned after changing the LV lead pacing pole. A custom-made 2D-HFR-STE algorithm tracked the cardiac wall in the 3 conventional apical echocardiographic views. Strain rate (SR) curves were computed for each wall segment in a 16-segment LV model to measure the time between electrical and mechanical activation (i.e. time between QRS onset and first positive-to-negative zero-crossing in the SR curve). The timings were displayed in a bull’s-eye plot, representing each subject’s activation map. Results For most HV, activation started from mid-anteroseptum, at 23±5ms, spreading basal-inferolaterally at 50±8ms. During BiV off, the average septal activation was 36±2ms; the average lateral was 81±21ms (p<0.01). During BiV on, the respective times were 53±6ms and 52±6ms (p=0.3). Altering the LV lead pacing pole changed the lateral wall activation onset accordingly. Conclusions HFR-STE was able to map normal activation, measure the known septal-to-lateral LBBB dyssynchrony and identify the paced segment in 92% of the cases. HFR-STE could be a promising tool in constructing LV activation maps.
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Authors K Papangelopoulou, Laurine Wouters, M Orlowska, Annette Caenen, Gábor Vörös, Joris Ector, Jan D’hooge
Journal European Heart Journal - Imaging Methods and Practice
Year 2026
DOI
10.1093/ehjimp/qyag086
URL
https://doi.org/10.1093/ehjimp/qyag086
Keywords Keywords not found

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