Intraprocedure Model-Guided Electrophysiology

术中模型引导电生理学

• 批准号: 10186741
• 负责人: HENRY R HALPERIN
• 金额: $ 51.6万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186741
• 关键词: 3-Dimensional; Ablation; Affect; Anatomy; Animals; Arrhythmia; Atrial Fibrillation; Cardiac ablation; Cauterize; Cessation of life; Cicatrix; Collaborations; Complex; Complication; Computer Models; Detection; Development; Electrophysiology (science); Future; Goals; Heart; Heart Abnormalities; Individual; Infarction; Intervention; Lesion; Location; Magnetic Resonance Imaging; Maps; Methodology; Methods; Modeling; Morphology; Myocardium; Nature; Necrosis; Normal tissue morphology; Pathway interactions; Patients; Procedures; Recurrence; Resolution; Risk; Running; Site; Symptoms; Techniques; Technology; Time; Tissues; United States; Universities; Update; Ventricular Tachycardia; body system; electrical property; hemodynamics; high resolution imaging; imaging modality; improved; improved outcome; necrotic tissue; novel strategies; pre-clinical; predictive modeling; success

Atrial fibrillation (AF) and ventricular tachycardia (VT) affect millions of patients in the United States. These arrhythmias can be cured with catheter ablation, but the arrhythmias often recur, and these recurrences are generally due to reversible conduction block from incomplete ablation. The inability to confirm the presence of completely ablated lesions in the desired locations is the major factor in the greater than 40% recurrence of VT after ablation, and the greater than 30 % recurrence of AF after ablation. In addition, it is not possible with current technology to adequately predict the pathways of VT through scar, which are the targets for ablation. The overall goal of this project is to combine high resolution Magnetic Resonance Imaging (MRI) and limited invasive mapping, with fast computational modeling, to predict arrhythmia circuits and targets for ablation. This goal includes using this technology to update ablation targets during a procedure to allow for identification and ablation of any remaining arrhythmogenic substrate as ablation is proceeding. We hypothesize that computational modeling, optimized with high-resolution MRI, and limited invasive mapping, can (1) aid in predicting the locations of arrhythmia circuits (2) aid in predicting the locations of critical ablation targets, and (3) aid in assessing the completeness of ablation. Once validated, these enhanced capabilities could help to dramatically improve the outcomes from complex ablations, become part of ablation methods of the future, and become a platform for improving outcomes from other interventions. We have already developed improved high resolution imaging methods that allow accurate differentiation of infarct scar and border zone from normal tissue. This high resolution imaging may also allow for detection of conducting channels that may be present in otherwise dense scar, and which may be a critical part of some VT circuits. We are also pursuing limited invasive mapping as a means to detect the presence of late potentials in scar to aid in the detection and/or verification of conducting channels, which may be difficult to identify with current MRI methods. We will further improve high resolution imaging for input for a computational model that along with the detection and/or confirmation of conduction channels from invasive mapping, will predict arrhythmia circuit locations, and allow the fast and accurate determination of optimal targets for ablation. In addition, since the model can be run in near real time, and since we can perform intra-procedure MRI, we will also study the use of the computational model for predicting when additional ablation is needed to complete the ablation of all arrhythmogenic substrate. Finally, we have developed imaging methods that differentiate incompletely ablated (reversibly damaged) tissue from completely ablated (necrotic) tissue. If ablation of some lesions is found to be incomplete during a procedure, additional ablation can be performed to complete the ablation, and likely substantially reduce arrhythmia recurrences. This project is a collaboration between the Johns Hopkins University (High Resolution MRI, invasive mapping), and Siemens (computational modeling).

在美国，房颤(AF)和室性心动过速(VT)影响着数百万患者。 这些心律失常可以通过导管消融治愈，但心律失常经常复发，这些复发 通常是由于不完全消融造成的可逆传导阻滞。无法确认是否存在 在所需位置完全消融的病变是超过40%的复发的主要因素 消融后室性心动过速，消融后房颤复发率大于30%。此外，这是不可能的 目前的技术可以充分预测VT通过SCAR的路径，而SCAR是消融的目标。 该项目的总体目标是将高分辨率磁共振成像(MRI)和 有限侵入性标测，通过快速计算建模，预测心律失常回路和靶点 消融。这一目标包括在手术过程中使用该技术更新消融目标，以允许 随着消融的进行，识别和消融任何剩余的致心律失常底物。 我们假设，通过高分辨率核磁共振优化的计算模型和有限的侵入性 标测可以(1)帮助预测心律失常回路的位置(2)帮助预测危重心律失常的位置 消融目标，以及(3)帮助评估消融的完整性。经过验证后，这些功能得到增强 能力可以帮助显著改善复杂消融的结果，成为消融的一部分 这是一种未来的方法，并成为改进其他干预措施成果的平台。 我们已经开发了改进的高分辨率成像方法，可以准确地区分 从正常组织中分离出梗死区和边缘区。这种高分辨率成像还可以检测到 传导通道可能存在于其他致密的疤痕中，并且可能是某些 VT电路。我们还在寻求有限的侵入性标测作为检测晚期潜伏期存在的一种手段。 以帮助检测和/或验证传导通道，其可能难以识别 目前的核磁共振检查方法。我们将进一步改进计算模型的输入的高分辨率成像 随着来自侵入性标测的传导通道的检测和/或确认，将预测 它能够快速、准确地确定最佳消融目标。在……里面 此外，由于模型可以近乎实时地运行，而且我们可以在过程中执行核磁共振，因此我们将 还要研究使用计算模型来预测何时需要额外消融才能完成 消融所有致心律失常的基质。最后，我们已经开发出区别于 完全消融(坏死)组织形成的不完全消融(可逆性损伤)组织。如果消融了一些 在手术过程中发现病变不完整时，可以进行额外的消融以完成 消融，并有可能大大减少心律失常的复发。这个项目是由 约翰霍普金斯大学(高分辨率磁共振成像，侵入性测绘)和西门子(计算建模)。