External ablation of ischemic ventricular tachycardia in an animal infarct model using a scanned proton beam

使用扫描质子束对动物梗塞模型中缺血性室性心动过速进行外部消融

• 批准号: 380200397
• 负责人: Dr. Stephan Hohmann
• 金额: --
• 依托单位: Division of Cardiovascular Diseases
• 依托单位国家: 德国
• 项目类别: Research Fellowships
• 财政年份: 2017
• 资助国家: 德国
• 起止时间: 2016-12-31 至 2018-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/380200397?language=en
• 关键词: External; ablation; ischemic; ventricular; tachycardia

Patients with ischemic cardiomyopathy after myocardial infarction are at high risk for developing life-threatening ventricular arrhythmias. Every year there are over 4 million cases of sudden cardiac death worldwide, most of which are caused by ventricular arrhythmias. In addition to implantation of implantable cardioverters/defibrillators, catheter ablation of ventricular tachycardia (VT) has increasingly been adopted in recent years. Arrhythmogenic areas in the ventricular myocardium are ablated using radio-frequency current. Although being established in everyday clinical practice, this method currently results in long term freedom from VT in no more than 50% of cases. One reason for this limited success lies in the difficulty of homogenizing the arrhythmogenic infarct border zone in its entire intramural extent.Preliminary work by the group of Prof. Packer and others has shown that myocardial ablation is possible using radiotherapeutic approaches. Due to their physical properties, proton beams are particularly suitable for targeted energy application while protecting surrounding organs at risk. Proton therapy is therefore increasingly used in radio-oncology. In this project, we will investigate catheter-free ablation of ventricular tachycardias after myocardial infarction using proton beam therapy in vivo. After developing methods for treatment planning in an established swine model for VT after myocardial infarction, proton beam therapy is applied. Treatment effects are then analyzed by electrophysiological studies and multi-modal imaging in the intact animal before the lesions are examined histologically. Catheter-free ablation has the potential to bring about a paradigm shift in the clinical treatment of ventricular arrhythmia.

心肌梗死后缺血性心肌病患者发生危及生命的室性心律失常的风险很高。全世界每年有超过400万例心脏性猝死病例，其中大多数是由室性心律失常引起的。除了植入心律转复器/复律器外，近年来越来越多地采用导管消融术治疗室性心动过速（VT）。使用射频电流消融心室肌中的致心律失常区域。尽管在日常临床实践中已经确立，但该方法目前在不超过50%的病例中导致长期无VT。这种有限成功的原因之一在于难以在其整个壁内范围内对致瘤性梗死边缘区进行消融。Packer教授和其他人的小组的初步工作表明，使用放射性方法进行心肌消融是可能的。由于其物理特性，质子束特别适合于靶向能量应用，同时保护周围处于危险中的器官。因此，质子治疗越来越多地用于放射肿瘤学。在这个项目中，我们将研究在体内使用质子束治疗心肌梗死后室性心动过速的无导管消融。在建立了心肌梗死后VT的猪模型中开发治疗计划方法后，应用质子束治疗。然后在组织学检查病变之前，通过电生理学研究和多模态成像在完整动物中分析治疗效果。无导管消融有可能带来室性心律失常临床治疗的范式转变。