Linking Activation Patterns with Substrate Based Electrogram Characteristics to Develop Individualized Ablation Strategies for Atrial Fibrillation

将激活模式与基于基底的电图特征联系起来，制定针对心房颤动的个体化消融策略

• 批准号: 394433254
• 负责人: Professor Dr. Olaf Dössel, Ph.D.
• 金额: --
• 依托单位: Städtisches Klinikum Karlsruhe gGmbH
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2018
• 资助国家: 德国
• 起止时间: 2017-12-31 至 2022-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/394433254?language=en
• 关键词: Linking; Activation; Patterns; Substrate; Based

Atrial fibrillation is the most common cardiac arrhythmia in industrialized societies and poses immense burdens on public healthcare systems. Underlying mechanisms and best treatment strategies are intensively discussed in current research. Several concepts are considered for patients in a progressed state, mainly the ablation of tissue showing fractionated electrograms and the ablation of rotational excitation patterns. Both concepts, however, are under debate and a theory is still lacking which links both phenomena. Studies have shown strongly varying success rates for the ablation of fractionated electrograms, which is often explained by the missing standardized quantitative description of the targeted signals. Consequently, physicians in all centers develop rather subjective treatment strategies, which are difficult to compare. Rotor ablation is a rather novel concept, and basic questions have not been answered yet. Among those is the stability of rotors and the amount of tissue, which is to be ablated. Both temporal and spatial stability of rotors are intensively discussed, raising the question whether rotors anchor at certain anatomical regions or meander through the atria.Major goal of the proposed project is to link existing strategies of catheter ablation. Special focus is laid on the atrial substrate, which is expected to show proarrhythmogenic properties due to electrical and structural remodeling and fibrosis. Areas which are critical to the tachycardia can be identified by specialized pacing protocols, in combination with novel signal processing techniques. Computer algorithms will be developed, which can identify the cardiac excitation pattern both on the local scale and when measured using panoramic basket type mapping catheters. The statistical analysis of depolarization patterns observed during fibrillation (e.g. rotors, wave-front collisions, ... ) is expected to indicate, whether or not pathological tissue is prone to harboring rotors. Additional measurements with LGE-magnetic resonance imaging will be conducted in a subgroup of patients to obtain extended information about the atrial substrate (e.g. fibrosis) and its impact on excitation dynamics and electrograms morphology. Determination of characteristics of proarrhythmogenic substrate would allow for prospective detection and ablation of areas, which did not currently show rotors, but generally have the potential to maintain the fibrillatory process. By dominantly using equipment which is already available in electrophysiological laboratories, we will ensure that the obtained results can be applied in everyday's clinical work, without increasing the patient burden by additionally required X-ray or MRI diagnostics. The outcome of this project will help to understand the underlying mechanisms of atrial fibrillation and improve success rates of ablations in the long term.

心房颤动是工业化社会中最常见的心律失常，并对公共医疗保健系统造成了巨大负担。目前的研究中对基本机制和最佳治疗策略进行了深入讨论。考虑到进展状态的患者，考虑了几种概念，主要是组织的消融，显示出分离的电图和旋转激发模式的消融。然而，这两个概念都在辩论中，并且仍然缺乏将两种现象联系起来的理论。研究表明，分馏电图的消融的成功率很大，这通常是通过靶向信号的标准化定量描述来解释的。因此，所有中心的医生都制定了相当主观的治疗策略，难以比较。转子消融是一个相当新颖的概念，尚未回答基本问题。其中是转子的稳定性和组织的量，这将是消融。对转子的时间稳定性和空间稳定性都进行了深入讨论，这提出了一个问题，即在某些解剖区域的锚定或蜿蜒穿过心房弯曲的问题。拟议项目的Major目标是将导管消融的现有策略联系起来。特殊的重点放在心房底物上，预计由于电和结构重塑和纤维化而导致的肾上腺动物性特性。对于心动过速至关重要的区域，可以通过专业的起搏方案以及新型的信号处理技术来识别。将开发计算机算法，该算法可以在局部规模和使用全景篮型映射导管进行测量时识别心脏激发模式。预期在纤颤期间观察到的去极化模式的统计分析预计是否表明病理组织是否容易藏有转子。通过LGE磁共振成像进行的其他测量将在患者亚组中进行，以获取有关心房基材（例如纤维化）的扩展信息及其对激发动力学和电触电形态的影响。确定前心律基础底物的特征将允许前瞻性检测和消融区域，而区域目前尚未显示转子，但通常具有维持原纤维过程的潜力。通过主要使用电生理实验室中已经可以使用的设备，我们将确保可以在每天的临床工作中应用所获得的结果，而不会增加患者负担，而另外需要X射线或MRI诊断。该项目的结果将有助于了解房颤的基本机制，并长期提高消融的成功率。