MRI-based visualization and acute targeting of gaps in atrial ablation lesions

基于 MRI 的可视化和心房消融病变间隙的急性靶向

• 批准号: 8535193
• 负责人: Ravi Ranjan
• 金额: $ 14.34万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-23 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8535193
• 关键词: Ablation; Acute; Affect; Animal Model; Animals; Area; Arrhythmia; Atrial Fibrillation; Basic Science; Biometry; Burn injury; Cardiac; Cardiac ablation; Catheters; Clinical; Clinical Management; Clinical Research; Clinical Trials; Data; Effectiveness; Electrophysiology (science); Evaluation; Family suidae; Fluoroscopy; Frequencies; Funding; Goals; Grant; Heart Atrium; Heating; Human; Image; Image Analysis; Imagery; Imaging Techniques; K-Series Research Career Programs; Lead; Left; Lesion; Magnetic Resonance Imaging; Maps; Mentors; Metric; Myocardium; Outcome; Patients; Principal Investigator; Procedures; Pulmonary veins; Radiofrequency Interstitial Ablation; Recurrence; Research; Research Personnel; Resolution; Rest; Risk; Role; Site; Source; Subgroup; Techniques; Temperature; Testing; Time; Tissues; Training; Training Programs; Treatment Protocols; United States National Institutes of Health; Universities; Utah; Veins; Ventricular Tachycardia; attenuation; base; career; cost; experience; group intervention; image processing; image visualization; improved; interest; new technology; novel; programs; skills; soft tissue; success

DESCRIPTION (provided by applicant): This proposal describes a five-year training program to develop an academic career in cardiac electrophysiology. The principal investigator has a long-standing interest in cardiac electrophysiology research. Over the course of this grant, the applicant will obtain the training and funding to become an independent investigator with the long-term goal of understanding arrhythmia mechanisms and developing new technologies, leading to more efficacious treatment regimens. Over the next five years the applicant will undergo formal didactic training in Magnetic Resonance Imaging (MRI) techniques and clinical investigation. The investigator will be mentored by Dr. Dennis Parker, along with a committee comprised of experts in the field of MRI research, clinical electrophysiology, image processing and biostatistics. Dr. Parker is a leader in the field of MRI research with independent NIH funding and many years of mentoring experience. At the onset of this training program, the research program will be focused on developing MRI visualization techniques to visualize gaps in ablation lesion sets with the goal to test the hypothesis that targeting these gaps acutely will lead to improved outcomes. The success rate for ablation in atrial fibrillation remains persistently low and can require multiple procedures, leaving room for significant improvement. The goal in most of these ablation procedures is to isolate a region with sources of electrical "triggers" from tissue susceptible to such triggers by creating a line of tissue burns or ablation lesions. For such ablation lines to be effective, the lines should have no gaps. Currently, there i no effective means to provide direct proof of successful lines of lesion or ablation and the evaluation of success depends on indirect markers that are often poor predictors. MRI has exceptional capabilities for visualizing soft tissue. These proposed studies aim to develop MRI-based techniques to visualize and evaluate radiofrequency ablation lesions and target gaps in lesion sets. The specific aims for this project are: 1) to determine the smallest gap in ablation lesion sets that can be detected by MRI and then targeted acutely, 2) to test the hypothesis that identifying and targeting gaps acutely will lead to significant improvement in maintaining electrical isolation over time, and 3) to test the hypothesis that gaps detected by MRI in ablation lines will predict electrical reconnection and arrhythmia recurrence in humans. Success in these studies will greatly expand our ability to target gaps in ablation lesion sets acutely leading to improved outcomes from ablation procedures. Moreover, these studies, didactic training in MRI, and clinical investigation and mentoring during this period, will prepare the applicant to pursue rigorous hypothesis testing research. These studies will also form the basis of the next set of studies in animal models of atrial fibrillation, and finally, in humans. We already have a number of species of large animal models of atrial fibrillation as part of another funded project, which makes this research all the more attractive.

描述（由申请人提供）：该提案描述了一个为期五年的培训计划，以发展心脏电生理学的学术生涯。主要研究者对心脏电生理学研究有着长期的兴趣。在这笔资助的过程中，申请人将获得培训和资金，成为一名独立研究者，其长期目标是了解心律失常机制和开发新技术，从而制定更有效的治疗方案。在接下来的五年中，申请人将接受磁共振成像 (MRI) 技术和临床研究方面的正式教学培训。该研究人员将由 Dennis Parker 博士以及由 MRI 研究、临床电生理学、图像处理和生物统计学领域的专家组成的委员会指导。 Parker 博士是 MRI 研究领域的领导者，拥有独立的 NIH 资助和多年的指导经验。在本培训计划开始时，研究计划将重点开发 MRI 可视化技术，以可视化消融病变组中的间隙，目的是检验以下假设：敏锐地瞄准这些间隙将 带来更好的结果。房颤消融的成功率仍然很低，并且可能需要多次手术，因此仍有显着改善的空间。大多数这些消融手术的目标是通过产生一系列组织烧伤或消融损伤，将具有电“触发”源的区域与易受此类触发影响的组织隔离开来。为了使这种消融线有效，这些线应该没有间隙。目前，没有有效的方法来提供成功的病变线或消融线的直接证据，并且成功的评估取决于间接标记，而这些标记通常是较差的预测因子。 MRI 具有软组织可视化的卓越功能。这些拟议的研究旨在开发基于 MRI 的技术来可视化和评估射频消融病变和病变组中的目标间隙。该项目的具体目标是：1) 确定可通过 MRI 检测到的消融病灶组中的最小间隙，然后进行精确定位，2) 检验这样的假设，即快速识别和定位间隙将导致随着时间的推移在维持电隔离方面取得显着改善，3) 检验 MRI 在消融中检测到间隙的假设 线路将预测人类的电重新连接和心律失常复发。这些研究的成功将极大地扩展我们针对消融病灶组间隙的能力，从而迅速改善消融手术的结果。此外，这些研究、MRI 教学培训以及在此期间的临床调查和指导，将为申请人进行严格的假设检验研究做好准备。这些研究也将构成下一组房颤动物模型研究的基础，最后是人类研究的基础。作为另一个资助项目的一部分，我们已经拥有了多种大型心房颤动动物模型，这使得这项研究更具吸引力。