Atrial fibrillation ablation assessment and guidance using native-contrast T1 weighted MRI

项目总结： 心房颤动(AFib)是一种常见的心律失常，目前难以处理。AFIB导尿管 消融治疗比药物治疗更能有效地维持正常节律。然而，治疗失败是 常见，持续性房颤约占50%。试图通过更多的表现来改善结果 广泛的消融受到了新的心律失常的限制，如心房扑动，这可能是由 程序。重复手术可以改善预后，但心律失常复发仍然很常见。 外科手术治疗房颤的成功率较高，但成功的技术令人望而却步。 用于治疗大多数患者的侵入性。提高首次房颤导管消融成功率的方法 是需要程序的。 消融失败被认为是由于不能创造适当的、永久性的消融。 损伤。目前，消融引起的一过性组织损伤和水肿可以使消融看起来完全。 在手术结束时。然而，随着一过性损伤在几天到几周内消失，心律失常可能会复发。 目前确定消融是否结束的方法不能区分永久性消融和永久消融 和一过性组织损伤。显示需要进一步消融的位置的方法，并确认 永久性消融已经完成，有望提高房颤消融的成功率。 我们开发了一种非对比度MRI方法来观察永久性消融损伤。我们最近 显示这种方法可以看到薄壁心房的消融病变，这是心脏的一部分 导致房颤。因为这种方法不需要静脉造影剂，所以在手术过程中可以重复使用。 直到确认完全消融为止。 这项建议将查明该方法是否可以1)检测不完全房颤消融部位，2)指导 对这些部位的额外消融，以及3)在手术结束时确认消融完成。这 Proposal还将这种先前在动物身上开发的方法翻译到接受房颤消融的患者身上。 对消融治疗进行有效的急性评估将提供 反馈目前不适用于程序指导。这些目标的成功实现将 引入确认消融完成的新范式，以减少心律失常的复发 房颤消融后。这些方法也可以应用于其他不完全心律失常。 消融会导致较差的消融结果，如室性心动过速。

Project Summary: Atrial fibrillation (Afib) is a common arrhythmia that is currently difficult to manage. Afib catheter ablation is more effective than medical therapy for maintaining normal rhythm. However, treatment failure is common, around 50% for persistent forms of Afib. Attempts to improve outcomes by performing more extensive ablation have been limited by new arrhythmias, like atrial flutter, which can be caused by the procedure. Outcomes can be improved by repeat procedures, but arrhythmia recurrence is still common. Surgical procedures have higher success for treating Afib, but the successful techniques are prohibitively invasive for treating most patients. Methods to improve the success of the first Afib catheter ablation procedure are needed. Ablation failure is thought to be due to the inability to create properly placed, permanent ablation lesions. Currently, transient tissue injury and edema caused by ablation can make ablation appear complete at the end of the procedure. However, as transient injury resolves over days to weeks, arrhythmia can recur. Current methods for determining whether ablation is finished cannot tell the difference between permanent and transient tissue injury. Methods that show where additional ablation needs to be performed and confirm that permanent ablation has been completed are expected to improve the success of Afib ablation. We have developed a non-contrast MRI method for seeing permanent ablation lesions. We recently showed this method can see ablation lesions in the thin walled atrium, which is the part of the heart that causes Afib. Because this method does not need intravenous contrast, it can be repeated during a procedure until complete ablation is confirmed. This proposal will find out if this method can 1) detect sites of incomplete Afib ablation, 2) guide additional ablation to these sites, and 3) confirm ablation is complete at the end of the procedure. This proposal also translates this method, previously developed in animals, to patients undergoing Afib ablation. Effective acute assessment of ablative treatment would provide an important component of feedback not currently available for procedure guidance. Successful completion of these aims will introduce a new paradigm for confirming ablation completion in order to reduce arrhythmia recurrence following AFib ablation. These methods could also be applied to other arrhythmias where incomplete ablation contributes to poor ablation outcomes, like ventricular tachycardia.