I-Corps Teams: Magnetic Resonance Imaging Guided Active Robotic Catheter

基于导管的心房颤动（AF）消融术是一种用于治疗AF的微创技术。在该手术中，在透视引导下使用导管施加射频能量，在左心房内建立消融屏障，以防止导致心律失常的不规则电信号的传播。最先进的AF消融手术的主要问题是产生太小或太大的损伤。这是由于难以精确控制导管尖端、难以保持与内支架的适当电极接触压力以及缺乏关于所产生的损伤的尺寸和深度的实时反馈。所提出的实时磁共振成像引导的机器人主动导管技术具有通过显著提高AF消融治疗的准确性和可重复性以及通过潜在地降低手术成本来彻底改变AF治疗的潜力。所提出的范例相对于用于心脏消融治疗的最新技术和工艺具有若干优点，因为它将允许进行更有针对性的治疗。具体而言，术中实时可用的磁共振成像，其上级组织辨别能力，将允许立即评估基板深度和消融造成的损伤。远程操纵和高精度导管头端位置控制将允许精确消融。操作者将具有改进的情境感知，因为术中信息，包括电生理图、导管轨迹和从实时磁共振成像获得的组织测量，可以在心脏解剖结构的3D静态参考可视化上映射并显示给手术医师。最后，患者在手术过程中不会暴露于电离辐射，因为不会使用荧光透视。如果通过I-Corps计划进行的商业化可行性研究产生了积极的结果，该团队计划成立一家初创公司，该公司将从凯斯西储大学获得该技术的许可，并追求其商业化。

Catheter-based atrial fibrillation (AF) ablation is a minimally invasive technique used in the treatment of AF. In this procedure, a catheter under fluoroscopy guidance is used to apply radiofrequency energy to build ablation barriers in the left atrium to prevent the spread of the irregular electrical signals, which cause the arrhythmia. The major problems with the state-of-the-art AF ablation procedure entail creating too small or too large of a lesion. These result from difficulties in accurately controlling the catheter tip, difficulties in keeping appropriate electrode contact pressure with the endocardium, and lack of real-time feedback regarding the size and depth of the lesion created. The proposed real-time magnetic resonance imaging-guided robotic active catheter technology has the potential to revolutionize the treatment AF by significantly improving the accuracy and repeatability of AF ablation therapy, and by potentially reducing the cost of the procedure.The proposed paradigm has several advantages over the state-of-the-art techniques and technologies for cardiac ablation therapy, as it would allow a more tailored treatment to be performed. Specifically, intra-operative real-time availability of magnetic resonance imaging, with its superior tissue discrimination capabilities, would allow immediate evaluation of the substrate depth and lesion created by ablation. Remote steering and high accuracy catheter tip position control would allow for precise ablation. The operator would have improved situational awareness, as the intra-operative information, including the electrophysiological map, catheter trajectories, and tissue measurements obtained from real-time magnetic resonance imaging, can be mapped back and displayed to the operating physician on the 3D static reference visualization of the cardiac anatomy. And, finally, the patient will not be exposed to ionizing radiation during the procedure, as fluoroscopy will not be used. If the commercialization feasibility study performed through the I-Corps program yields a positive result, the team is planning to establish a start-up company that will license the technology from Case Western Reserve University and pursue its commercialization.