MRI-Guided, Robotically Controlled Cardiac Ablation

MRI 引导机器人控制心脏消融

• 批准号: 7303763
• 负责人: John M. Pauly
• 金额: $ 46.19万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-01 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7303763
• 关键词: Ablation; Acute; Address; Affect; Age; American; Anatomy; Anticoagulants; Atrial Fibrillation; Blood Vessels; Burn injury; Cardiac; Cardiac Surgery procedures; Cardiac ablation; Cardiovascular system; Catheters; Clinical; Closure; Communities; Complex; Coronary; Development; Devices; Effectiveness; Electric Conductivity; Electrical Engineering; Engineering; Environment; Feedback; Freedom; Fright; Goals; Heart Atrium; Image; Imagery; Imaging Device; Individual; Intervention; Invasive; Left; Left atrial structure; Lesion; Location; Magnetic Resonance Imaging; Maps; Mechanics; Methods; Mitral Valve; Monitor; Morbidity - disease rate; Motion; Myocardium; Operative Surgical Procedures; Outcome; Patients; Pattern; Pharmaceutical Preparations; Physics; Physiology; Placement; Population; Positioning Attribute; Prevalence; Procedures; Public Health; Purpose; Radial; Radiofrequency Interstitial Ablation; Range; Rate; Research; Research Personnel; Risk; Robotics; Scientist; Sensory; Shunt Device; Standards of Weights and Measures; Stroke; Sum; Surface; Surgeon; System; Techniques; Technology; Testing; Time; Tissue Viability; Tissues; Translating; United States; Weight; base; experience; haptics; improved; mortality; motor control; repaired; sensory system; success; tool; visual feedback

DESCRIPTION (provided by applicant): The overall goal of this project is the development of an interactive, image-guided system for accurately placing ablation lesions in the left atrium for the treatment of arrythmias. Atrial fibrillation (AF) affects 10% of the population over age 70 and causes about 1/3 of strokes. Only 2/3 of percutaneous procedures for AF succeed even in carefully selected patients due to technical limitations in both visualizing tissue/device interaction and controlling catheter position. We believe that the combination in a single procedure of real-time visualization and guidance, interactive device control, and immediate lesion assessment will be critical in providing reliable, robust atrial ablation and will increase effectiveness far beyond the sum of the individual parts. Guidance and visualization will be provided by MRI, which permits real-time anatomic visualization, allows active tracking of devices, and provides many techniques for ablation monitoring and control. Intuitive, accurate access to the entire left atrium will be accomplished via an interactive, feedback controlled catheter manipulation system integrated with a real-time 3D visualization environment for navigation and device placement. This system will incorporate a haptic interface for robotic control integrating MR visual feedback catheter force feedback. Finally, direct MR visualization of acute lesions will provide immediate verification of ablative success. Imaging the lesion development will be accomplished via delayed enhancement, T2 weighted imaging, and a new MR RF current mapping technique that can potentially highlight tissue conductivity changes in the myocardium post-ablation. Specifically, our aims are to: 1) Develop improved MRI methods and devices for real-time 3D guidance during cardiac ablations. 2) Develop a general purpose intracardiac catheter system integrating sensory inputs and motor controls to provide precise control of the interventional catheter. 3) Develop and test real-time methods to assess tissue viability and electrical conductivity that can accurately predict and visualize the ablation pattern. The combination of visualization, guidance, and verification will allow quick, reliable atrial ablations, dramatically improving patient outcomes. The overarching objective of this proposal is to develop an integrated set of technologies to enable the imaging, mechanical, and control systems needed to replicate the surgeon's visualization, dexterity, and tools for performing percutaneous intracardiac surgery. This project will utilize a multi-disciplinary team (engineers, imaging scientists, and cardiologists) to address all the technical challenges in translating this system to clinical practice. Our initial focus will be intracardiac ablation of atrial fibrillation, given its prevalence, substantial clinical impact, and current suboptimal percutaneous success. This research - developing a minimally invasive system for atrial fibrillation procedures - is important to public health because it may allow many open-heart surgery procedures to be performed instead using less invasive catheters. This research also initially targets atrial fibrillation as it is very common (1 in 4 Americans develop it in their lifetime), leads to 1/3 of strokes, and there is a need for a successful method to cure it less invasively.

描述（由申请人提供）：本项目的总体目标是开发一种交互式图像引导系统，用于在左心房中准确放置消融损伤，以治疗心律失常。房颤（AF）影响70岁以上人口的10%，并导致约1/3的中风。由于组织/器械相互作用可视化和导管位置控制方面的技术限制，即使在精心选择的患者中，也只有2/3的房颤经皮手术成功。我们认为，在一个单一的程序中结合实时可视化和引导、交互式设备控制和即时病变评估，对于提供可靠、稳健的心房消融至关重要，并将提高有效性，远远超过各个部分的总和。MRI将提供引导和可视化，其允许实时解剖可视化，允许主动跟踪器械，并提供许多消融监测和控制技术。通过与实时3D可视化环境集成的交互式反馈控制导管操作系统，可直观、准确地进入整个左心房，以进行导航和器械放置。该系统将包含用于机器人控制的触觉界面，该界面集成MR视觉反馈和导管力反馈。最后，急性病变的直接MR可视化将提供消融成功的即时验证。将通过延迟增强、T2加权成像和新的MR RF电流标测技术对病变发展进行成像，该技术可能突出显示消融后心肌中的组织电导率变化。具体而言，我们的目标是：1）开发改进的MRI方法和设备，用于心脏消融术期间的实时3D引导。2)开发一种集成感觉输入和运动控制的通用心内导管系统，以提供介入导管的精确控制。3)开发和测试实时方法，以评估组织活力和电导率，从而准确预测和可视化消融模式。可视化、引导和验证的结合将允许快速、可靠的心房消融，显著改善患者的预后。该提案的总体目标是开发一套集成的技术，以实现所需的成像、机械和控制系统，从而复制外科医生的可视化、灵活性和工具，用于执行经皮心内手术。该项目将利用多学科团队（工程师，成像科学家和心脏病学家）来解决将该系统转化为临床实践的所有技术挑战。我们最初的重点将是心房颤动的心内消融，考虑到其患病率、实质性临床影响和目前次优的经皮成功率。这项研究-开发一种用于房颤手术的微创系统-对公共卫生很重要，因为它可以允许使用微创导管进行许多心脏直视手术。这项研究最初也针对房颤，因为它非常常见（四分之一的美国人在一生中发展它），导致三分之一的中风，并且需要一种成功的方法来治疗它。