Advanced Real-time MR-Guided Radiofrequency Ablation of Cardiac Arrhythmias

先进的实时 MR 引导心律失常射频消融术

• 批准号: EP/R010935/1
• 负责人: Sébastien Roujol
• 金额: $ 81.58万
• 依托单位: King's College London
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=EP%2FR010935%2F1
• 关键词: Advanced; Real; time; MR; Guided

Cardiac arrhythmias affect 2 million people a year in the UK. Radio-frequency (RF) ablation (RFA) procedures are clinically available to treat the majority of cardiac arrhythmias. Overall, ~20,000 RFA of cardiac arrhythmias are being performed every year in the UK. RFA uses catheter-based localized delivery of radio-frequency energy resulting in localized tissue heating. Sufficient temperature increase (~30-50C for ~30-60sec) is necessary to create permanent tissue destruction (necrosis). The aim of RFA procedures is to create permanent tissue destruction of critical heart tissues causing arrhythmias. This is often achieved by creating lines of permanent ablation lesions to electrically block/isolate these critical sites. Since each ablation point has a maximum size of ~6-8mm, multiple ablations are commonly performed to create ablation lines. Currently, 30-50% of RFA procedures fail due to the presence of gaps in ablation lines and the incorrect location/extent of the permanent RFA lesions. Furthermore, RFA procedures may have severe complications including cardiac perforation which can arise from steam explosion occurring when tissue temperature exceeds 100C. Finally, potential catheter drift during RFA should be prevented to avoid ablation of undesired tissues. Current real time RFA guidance systems (X-ray, electro-anatomical mapping) are unable to monitor tissue temperature and extent of permanent RFA lesions. Indirect parameters such as RF power/duration, catheter tip temperature, catheter contact force/impedance are monitored during RFA but have low predictive values of tissue temperature and permanent RFA lesion extent. Notably, the discrepancy between the catheter-tip temperature and tissue temperature can be >30C. Therefore, real time accurate monitoring of tissue temperature and prediction of permanent RFA lesion extent is very likely to improve the outcome and safety of the procedure.Magnetic resonance (MR)-thermometry is a non-invasive MRI technique which enables real time pixel-wise assessment of temperature, deep in tissue. Permanent tissue destruction can be predicted using the concept of thermal dose (thereafter referred to as MR-dosimetry) which is based on a model of temperature elevation and time of exposure. However, current cardiac MR-thermometry/dosimetry methods that are not ideal for clinical translation (long acquisition window, low spatial resolution, sensitivity to physiological motion, and high noise level in temperature maps) and a clinically feasible method remains still to be demonstrated, as does its accuracy for prevention of ablation gaps and prediction of chronic permanent RFA lesion extent. This research proposal aims to develop a novel clinically feasible real-time cardiac MR-thermometry/dosimetry framework which addresses the current unmet need, to evaluate its performance in a pre-clinical study, and to demonstrate its feasibility in a first-in-man clinical study.

在英国，心律失常每年影响200万人。射频（RF）消融（RFA）手术在临床上可用于治疗大多数心律失常。总体而言，英国每年约有20,000例心律失常RFA手术。RFA使用基于导管的射频能量局部传递，导致局部组织加热。足够的温度升高（~30-50℃~30-60秒）是造成永久性组织破坏（坏死）所必需的。RFA手术的目的是对导致心律失常的关键心脏组织造成永久性的组织破坏。这通常是通过创建永久性消融损伤线来电阻断/隔离这些关键部位来实现的。由于每个烧蚀点的最大尺寸约为6-8mm，因此通常进行多次烧蚀以形成烧蚀线。目前，30-50%的RFA手术由于消融线存在间隙和永久性RFA病变的位置/范围不正确而失败。此外，RFA手术可能有严重的并发症，包括心脏穿孔，当组织温度超过100℃时，可能发生蒸汽爆炸。最后，应防止RFA过程中潜在的导管漂移，以避免消融不需要的组织。目前的实时RFA引导系统（x射线，电解剖测绘）无法监测组织温度和永久性RFA病变的程度。射频消融过程中监测射频功率/持续时间、导管尖端温度、导管接触力/阻抗等间接参数，但对组织温度和永久性射频消融损伤程度的预测值较低。值得注意的是，导管尖端温度与组织温度之间的差异可以达到50 - 30摄氏度。因此，实时准确地监测组织温度和预测永久性RFA损伤程度很有可能改善手术的结果和安全性。磁共振（MR）测温是一种非侵入性MRI技术，可以实时评估组织深处的温度。永久性组织破坏可以使用热剂量（此后称为核磁共振剂量学）的概念来预测，热剂量是基于温度升高和暴露时间的模型。然而，目前的心脏磁共振测温/剂量法在临床翻译方面并不理想（采集窗口长、空间分辨率低、对生理运动敏感、温度图噪声高），临床可行的方法仍有待证实，其在预防消融间隙和预测慢性永久性RFA病变程度方面的准确性也有待证实。本研究计划旨在开发一种新的临床可行的实时心脏磁共振测温/剂量框架，以解决当前未满足的需求，在临床前研究中评估其性能，并在首次人体临床研究中证明其可行性。

项目成果

Quantitative susceptibility mapping (QSM) of the cardiovascular system: challenges and perspectives.

• DOI: 10.1186/s12968-022-00883-z
• 发表时间: 2022-08-18
• 期刊: JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE
• 影响因子: 6.4
• 作者: Aimo, Alberto;Huang, Li;Tyler, Andrew;Barison, Andrea;Martini, Nicola;Saccaro, Luigi F.;Roujol, Sebastien;Masci, Pier-Giorgio
• 通讯作者: Masci, Pier-Giorgio

Quantitative magnetization transfer imaging for non-contrast enhanced detection of myocardial fibrosis

定量磁化转移成像非对比增强检测心肌纤维化

• DOI: 10.1002/mrm.28577
• 发表时间: 2020
• 期刊: Magnetic Resonance in Medicine
• 影响因子: 3.3
• 作者: López K

Assessing the ability of substrate mapping techniques to guide ventricular tachycardia ablation using computational modelling

• DOI: 10.1016/j.compbiomed.2021.104214
• 发表时间: 2021-01-18
• 期刊: COMPUTERS IN BIOLOGY AND MEDICINE
• 影响因子: 7.7
• 作者: Campos, Fernando O.;Orini, Michele;Bishop, Martin J.
• 通讯作者: Bishop, Martin J.

All-systolic first-pass myocardial rest perfusion at a long saturation time using simultaneous multi-slice imaging and compressed sensing acceleration.

• DOI: 10.1002/mrm.28712
• 发表时间: 2021-08
• 期刊: Magnetic resonance in medicine
• 影响因子: 3.3
• 作者: Ferrazzi G;McElroy S;Neji R;Kunze KP;Nazir MS;Speier P;Stäb D;Forman C;Razavi R;Chiribiri A;Roujol S
• 通讯作者: Roujol S

Editorial for "Impact of Wideband Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging on Device-Related Artifacts in Different Implantable Cardioverter-Defibrillator Types"

“宽带晚期钆增强心脏磁共振成像对不同植入式心脏复律除颤器类型中设备相关伪影的影响”的社论

• DOI: 10.1002/jmri.27777
• 发表时间: 2021
• 期刊: Journal of Magnetic Resonance Imaging
• 影响因子: 4.4
• 作者: Huang L