InSPACE-VT_Development and Validation of Virtual Pace Mapping to Guide Catheter Ablation of Ventricular Tachycardia

更广泛的研究背景：缺血性心脏病是世界范围内最常见的死亡原因，室性心动过速（VT）是其直接后果。室性心动过速的导管消融术是一种重要的治疗选择。尽管消融工具取得了进步，但手术时间仍然很长，并发症的风险也很高，而成功率却非常低。该程序通常由识别瘢痕相关慢传导峡部的出口部位来指导，该峡部提供折返基底。“起搏映射”确定出口网站匹配的表面心电图QRS的导管刺激的心跳从不同的心肌位置与QRS的临床VT。Objectives：我们提出了虚拟映射的开发和临床验证作为一个程序前的规划工具，以确定关键峡部。我们的解决方案旨在减少导管消融手术时间，增加安全性，并显着提高目标选择的准确性，改善患者护理和长期outcomes.Methods：先进的CMR协议将开发，以促进疤痕数据的采集，在足够的分辨率，以创建详细的患者特定的模型，虚拟起搏地图将被构建。这将使我们能够进行不确定性分析，对我们的虚拟预测对输入数据和参数的敏感性进行必要的定量理解。开发的方法将被应用于收集的临床数据，从25室性心动过速消融患者，提供了一个精心控制的一系列具体的测试，我们的虚拟approach.Level的独创性：建议研究如何虚拟起搏映射可以识别关键峡部使用的临床数据进行室性心动过速消融的患者是完全新颖的。关于虚拟起搏标测如何使用接受室性心动过速消融术患者的临床数据识别关键峡部的建议研究以前尚未接受。

Wider research context:Ischemic heart disease is the most common cause of death world-wide with ventricular tachycardia (VT) as direct consequence of it. Catheter ablation for VT is an important therapeutic option. Despite advances in ablation tools, procedure times remain high with a relevant risk of complications, whilst success rates are punitively low. The procedure is frequently guided by the identification of exit sites of scar-related slow-conducting isthmuses which provide the reentrant substrate. "Pace mapping" identifies exit sites by matching the surface ECG QRS of catheter-stimulated beats from different myocardial locations with the QRS of the clinical VT.Objectives:We propose the development and clinical validation of virtual mapping as a pre-procedural planning tool to identify critical isthmuses. Our solution aims to reduce catheter ablation procedure times, increase safety, and significantly improve the accuracy of target selection, improving patient care and long-term outcomes.Methods:Advanced CMR protocols will be developed to facilitate the acquisition of scar data at a resolution adequate to create detailed patient-specific models, upon which virtual pace maps will be constructed. This will enable us to perform uncertainty analysis, developing an imperative quantitative understanding of the sensitivity of our virtual predictions to the inputted data and parameters. The developed methodology will later be applied to clinical data collected from 25 VT ablation patients, providing a carefully controlled series of specific tests of our virtual approach.Level of Originality:The suggested studies on how virtual pace-mapping can identify critical isthmuses using clinical data of patients undergoing VT ablation are entirely novel. The suggested study on how virtual pace-mapping can identify critical isthmuses using clinical data of patients undergoing VT ablation have not been entertained previously.