Ultrasound can more accurately map arrhythmic sites in the heart for improved success of ablation procedures than the more commonly used electrocardiogram (ECG), researchers found.
Typically, catheter ablation is used to kill off misfiring regions, and ECG is often used to identify those regions. However, ECG mapping accuracy is limited and results in inaccurate or incomplete ablation, according to Elisa Konofagou, PhD, of Columbia University.
To solve that problem, Konofagou and her team developed an ultrasound-based technique, electromechanical wave imaging (EWI), to better target those misfiring regions.
Using ultrasound, EWI creates 3D cardiac maps that noninvasively pinpoint the electromechanical activity causing arrhythmias EWI can also be used during procedures to guide ablation catheters.
Konofagou and colleagues put EWI to the test in a study published in Science Translational Medicine (March 25, 2020). They compared EWI with standard 12-lead ECG on 51 patients undergoing catheter ablation.
They found EWI correctly predicted 96% of arrhythmia locations compared with 71% for ECG. Konofagou and colleagues are planning a larger, long-term clinical trial to further evaluate the technique.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
