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.

房颤是工业化社会中最常见的心律失常，对公共卫生系统造成了巨大的负担。潜在的机制和最佳的治疗策略在目前的研究中得到了深入的讨论。对于处于进展状态的患者，考虑了几个概念，主要是消融显示分形电图的组织和消融旋转兴奋模式。然而，这两个概念都在争论中，仍然缺乏一个将这两种现象联系起来的理论。研究表明，分割电图消融的成功率差异很大，这通常是由于缺乏对目标信号的标准化定量描述。因此，所有中心的医生都制定了相当主观的治疗策略，很难进行比较。转子烧蚀是一个相当新颖的概念，一些基本问题尚未得到解答。其中包括转子的稳定性和需要消融的组织的数量。旋翼的时间和空间稳定性都得到了深入的讨论，提出了旋翼是锚定在某些解剖区域还是蜿蜒穿过心房的问题。该项目的主要目标是将导管消融的现有策略联系起来。特别的重点放在心房底物上，由于电和结构重塑和纤维化，预计心房底物会显示出致心律失常的特性。与新的信号处理技术相结合，可以通过专门的起搏方案来识别对心动过速至关重要的区域。计算机算法将被开发，它可以识别心脏兴奋模式在局部尺度和测量时使用全景篮型映射导管。对纤颤期间观察到的去极化模式的统计分析（如旋翼、波前碰撞等）有望表明病理组织是否易于窝藏旋翼。将在一组患者中使用大磁共振成像进行额外的测量，以获得有关心房底物（例如纤维化）及其对兴奋动力学和电图形态学的影响的扩展信息。确定致心律失常原底物的特征将允许对区域进行前瞻性检测和消融，这些区域目前没有显示转子，但通常具有维持纤颤过程的潜力。通过主要使用电生理实验室已有的设备，我们将确保所获得的结果可以应用于日常临床工作，而不会因额外需要的x射线或MRI诊断而增加患者负担。该项目的结果将有助于了解心房颤动的潜在机制，并在长期内提高消融的成功率。