Method for guiding ablative therapy of cardiac arrythmias

指导心律失常消融治疗的方法

• 批准号: 8121394
• 负责人: ANTONIS A ARMOUNDAS
• 金额: $ 44.11万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-15 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8121394
• 关键词: Ablation; Accounting; Adverse effects; Affect; Algorithms; Anatomy; Animals; Anti-Arrhythmia Agents; Applications Grants; Arrhythmia; Arts; Body Surface; Cardiac; Cardiac ablation; Cardiovascular system; Catheters; Cessation of life; Charge; Complication; Contracts; Developed Countries; Electrocardiogram; Electrodes; Endocardium; Frequencies; Heart; Image; Incidence; Length; Location; Maps; Methodology; Methods; Modality; Modeling; Monitor; Movement; Patients; Performance; Pharmaceutical Preparations; Phase; Physicians; Physiologic pulse; Population; Procedures; Process; Property; Radio; Radiofrequency Catheter Ablation; Relative (related person); Saline; Sampling; Shock; Site; Solutions; Supraventricular tachycardia; Surface; System; Systole; Techniques; Time; United States; Ventricular; Ventricular Arrhythmia; Ventricular Tachycardia; arm; atrioventricular node; cost; experience; heart rhythm; patient safety; prototype; public health relevance; success; sudden cardiac death; time use; tool; two-dimensional

DESCRIPTION (provided by applicant): Ventricular catheter ablation has been established as the most desirable from cost and patient safety point of view approach in treating cardiac arrhythmias, yet its success rate has not broad acceptance. This is primarily because this treatment modality relies almost entirely on the experience and abilities of the physician in charge to identify the ablative site through endocardial mapping. In this grant application we aim to investigate the ability of a new method to rapidly, reliably and safely identify the site of origin of the arrhythmia. Our method relies on assigning properties of an equivalent moving dipole to each phase of the cardiac cycle and then inversely resolving the properties (location and strength) of the dipole. Our hypothesis is that the inverse dipole solution will accurately locate the arrhythmogenic focus at the point in the cardiac cycle when electrical activity is still focal, as the depolarization wave emerges from the focus. We will build a state-of-art system aimed to provide the cardiac electrophysiologist with a tool that will facilitate the identification of the site of the arrhythmia in the heart and will enable the accurate guiding of the ablation catheter to the site of origin of that arrhythmia. We will evaluate its performance by means of saline tank and animal studies. In the latter study, we will ultimately compare the location of the site identified by means of the equivalent dipole solution with the site initially identified by the operator as well as the site which ultimately results in the abolition of inducibility of ventricular tachycardia. The ability to perform three dimensional mapping and view the arrhythmia in real-time represents a step ahead from the standard fluoroscopic two-dimensional imaging or activation mapping. Furthermore our methodology promises to reduce the time required to perform the mapping and make it well tolerated from the patient. The impact of successful catheter ablation of ventricular tachycardia may be to (i) reduce the incidence of sudden cardiac death, (ii) reduce the frequency of implantable cardioverter shocks, and (iii) decrease the need of anti-arrhythmic medications with their potentially pro-arrhythmic and/or other side effects. PUBLIC HEALTH RELEVANCE: Ventricular catheter ablation has been established as the most desirable from cost and patient safety point of view approach in treating cardiac arrhythmias, yet its success rate has not broad acceptance. This is primarily because this treatment modality relies almost entirely on the experience and abilities of the physician in charge to identify the ablative site through endocardial mapping. This proposal investigates the ability of a new method to rapidly, reliably and safely identify the site of origin of the arrhythmia and help guide the ablation catheter to that site.

描述（由申请人提供）： 从成本和患者安全的角度来看，心室导管消融已被认为是治疗心律失常最理想的方法，但其成功率尚未得到广泛接受。这主要是因为这种治疗方式几乎完全依赖于负责医生通过心内膜标测识别消融部位的经验和能力。在这项拨款申请中，我们的目标是研究一种新方法快速、可靠和安全地识别心律失常起源部位的能力。我们的方法依赖于将等效移动偶极子的属性分配给心动周期的每个阶段，然后逆向解析偶极子的属性（位置和强度）。我们的假设是，当去极化波从焦点中出现时，反偶极子解决方案将在心动周期中电活动仍然是焦点的点上准确地定位致心律失常焦点。我们将建立一个最先进的系统，旨在为心脏电生理学家提供一种工具，帮助识别心脏中心律失常的部位，并将消融导管准确引导至心律失常的起源部位。我们将通过盐水池和动物研究来评估其性能。在后一项研究中，我们最终将通过等效偶极子溶液确定的位置与操作员最初确定的位置以及最终导致消除室性心动过速诱发性的位置进行比较。执行三维映射并实时查看心律失常的能力代表着比标准荧光镜二维成像或激活映射向前迈出了一步。此外，我们的方法有望减少执行映射所需的时间，并使患者能够很好地耐受。成功导管消融室性心动过速的影响可能是（i）降低心源性猝死的发生率，（ii）减少植入式心脏复律电击的频率，以及（iii）减少抗心律失常药物的需求，因为抗心律失常药物可能会导致心律失常和/或其他副作用。 公共卫生相关性： 从成本和患者安全的角度来看，心室导管消融已被认为是治疗心律失常最理想的方法，但其成功率尚未得到广泛接受。这主要是因为这种治疗方式几乎完全依赖于负责医生通过心内膜标测识别消融部位的经验和能力。该提案研究了一种新方法快速、可靠和安全地识别心律失常起源部位并帮助引导消融导管到达该部位的能力。