High-Resolution Electrocardiographic Localization

[201939]目前，定位心律失常的源头需要一种侵入性的复杂手术。对心律失常起源部位进行无创定位对许多患者具有巨大的价值，使心脏病专家能够将干预重点放在心律失常的源头上，而不需要冗长的心脏内测绘。目前，与程序化刺激技术相结合的侵入性测图程序与新的治疗技术（包括心脏内自动除颤器植入和心肌组织选择性射频消融）的使用正在稳步增加。在三维（3D）心肌中定位激活起始位置的无创方法的可用性将极大地提高帮助监测和指导有创治疗和诊断技术的能力，如程序性刺激和选择性导管尖端消融。该项目的目标是开发和评估一种新的心电图定位方法，用于从无创心电图（ECG）测量中准确快速地定位心脏激活的起源位置。为了实现这一目标，以下目标将被解决：(1)开发和评估一种新的基于心脏模型的方法，在各向异性真实形状心脏模型的帮助下，通过无创体表ECG测量快速准确地定位心脏激活的起源位置。(2)在一系列控制良好的计算机模拟中系统地评估所提出的三维心电图定位方法的能力。(3)在临床环境中验证所提出的三维心电图定位方法。这些目标的工作假设是，通过结合生理过程的先验信息，人们将能够在解决反问题时获得更高的稳定性和准确性，从而准确定位心脏激活的起源位置。

0201939HeLocating the source of cardiac arrhythmia currently requires an invasive and complex procedure. Noninvasive localization of sites of origin of arrhythmia would be of enormous value for numerous patients and would allow cardiologists to focus the intervention at the source of the arrhythmia without the need for lengthy intra-cardiac mapping. Currently, invasive mapping procedures in conjunction with programmed stimulation techniques have been steadily increasing in use in combination with newer therapeutic techniques including implantation of automatic intra-cardiac defibrillators and selective radio-frequency ablation of myocardial tissue. The availability of a noninvasive means of localizing sites of origin of activation in three-dimensional (3D) myocardium will greatly increase the ability to help monitor and guide invasive therapeutic and diagnostic techniques such as programmed stimulation and selective catheter-tip ablation. The goal of this project is to develop and evaluate a novel electrocardiographic localization methodology for accurate and rapid localization of sites of origin of cardiac activation from noninvasive electrocardiogram (ECG) measurements. To accomplish this goal the following aims will be addressed: (1) To develop and evaluate a novel heart-model-based approach to rapidly and accurately localize sites of origin of cardiac activation from noninvasive body surface ECG measurements, with the aid of an anisotropic realistically shaped heart model. (2) To systematically evaluate the capability of the proposed 3D electrocardiographic localization approach in a series of well-controlled computer simulations. (3) To validate the proposed 3D electrocardiographic localization approach in a clinical setting. The working hypothesis for these aims is that, by incorporating a priori information on physiological processes, one will be able to achieve greater stability and accuracy when solving the inverse problem, allowing accurately localizing sites of origin of cardiac activation.