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

项目摘要： 心房颤动（Afib）是一种常见的心律失常，目前难以管理。房颤导管 消融术对于维持正常节律比药物治疗更有效。然而，治疗失败是 常见，约50%为持续性房颤。尝试通过执行更多操作来改善结果 广泛的消融术受到新的心律失常的限制，如心房扑动，这可能是由心脏病引起的。 procedure.结果可以通过重复手术得到改善，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，但成功的技术是禁止的 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 程序是必要的。 消融失败被认为是由于无法创建正确放置的永久消融 病变目前，消融引起的短暂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，随着短暂性损伤在数天至数周内消退，心律失常可能复发。 目前用于确定消融是否完成的方法无法区分永久性消融和永久性消融。 和短暂的组织损伤。显示需要进行额外消融并确认 永久性消融已完成，预期可提高房颤消融的成功率。 我们开发了一种非造影MRI方法，用于观察永久性消融病变。我们最近 显示这种方法可以看到薄壁心房中的消融损伤，这是心脏的一部分， 引起房颤。由于这种方法不需要静脉造影剂，因此可以在手术过程中重复使用 直到确认完全消融。 该提案将查明该方法是否能够1）检测不完全房颤消融的部位，2）指导 对这些部位进行额外消融，以及3）在手术结束时确认消融完成。这 该提案还将先前在动物中开发的这种方法转化为接受房颤消融的患者。 消融治疗的有效急性评估将提供一个重要组成部分， 目前没有反馈可用于程序指南。成功实现这些目标将 引入确认消融完成的新范例，以减少心律失常复发 房颤消融后。这些方法也可以应用于其他心律失常， 消融导致不良的消融结果，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.