The Maintenance of Human Atrial Fibrillation

人类心房颤动的维持

• 批准号: 8891062
• 负责人: Sanjiv M Narayan
• 金额: $ 18.33万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8891062
• 关键词: Ablation; Address; Affect; American; Animals; Arrhythmia; Atrial Fibrillation; Atrial Tachycardia; Biomedical Engineering; Cardiac; Cardiovascular system; Caring; Cauterization - action; Cessation of life; Clinical; Clinical Research; Clinical Trials; Complex; Computing Methodologies; Data; Disease; Dizziness; Ectopic beats; Electrophysiology (science); Exhibits; Faculty; Fibrosis; Freedom; Funding; Future; Gadolinium; Geometry; Glossary; Heart; Heart Atrium; Heart failure; Hospitalization; Human; Image; Individual; Institute of Medicine (U.S.); Lead; Magnetic Resonance Imaging; Maintenance; Maps; Mentors; Mentorship; Methods; Modeling; Multicenter Studies; Outcomes Research; Paper; Patients; Phenotype; Physicians; Procedures; Process; Progress Reports; Public Health; Pulmonary veins; Relative (related person); Reporting; Research; Research Proposals; Risk; Science; Scientist; Sinus; Site; Source; Stroke; Structural defect; Structure; Tachycardia; Testing; Time; Tissues; Training; Translating; career development; clinically relevant; computer studies; drug development; effective therapy; gadolinium oxide; gene therapy; heart rhythm; improved; interest; novel; patient oriented research; prevent; programs; public health relevance; randomized trial; success; therapy design; voltage

 DESCRIPTION (provided by applicant): The Maintenance of Human Atrial Fibrillation Project Summary. Atrial fibrillation (AF) is the most common heart rhythm disorder, affecting 2-5 million Americans in whom it may cause skipped heart beats, dizziness, stroke and even death. Unfortunately, therapy for AF is limited. One of the major drawbacks in developing better therapy for AF is that our understanding of what causes AF (its `mechanisms') is not clear. This renewal outlines a program of career development for the applicant, of Mentored training for young clinician-scientists, and of mechanistic patient-oriented research in atrial fibrillation The Research Plan builds upon discoveries in the last cycle, that human AF is often not random, but instead maintained (driven) by a small number of `sources' in the form of rotors (akin to electrical spinning tops) or focal beats, that are stable over time. Sources may lie in regions of the heart (the atria, or top chambers) that are different in each patient, often away from where physicians currently apply cautery therapy (ablation). In this project, we will study 1) how much additional benefit is achieved by ablating at trigger sites (at the pulmonary veins) over and above these rotor source; 2) how rotors actually cause disorganized rhythms, and not just simple organized circuits; 3) whether this process is altered by structural abnormalities in the atria. We will pursue these aims in a clinical trial, by making detailed recordings of AF, usin bioengineering methods and by integrating imaging. These patient-specific analyses will be among the most detailed and clinically-relevant in the field, and will form a platform for future hypothesis testing and clinical trials. This project is significant because it tests the success of novel therapy at recently discovered AF rotors against current standard-of-care, because it studies the fundamental mechanisms that cause cardiac fibrillation in humans, and because it also tests novel imaging strategies. This project will be performed in patients with AF and a limited number of patients without AF, during electrophysiologic study, so that its results can be translated directly to practice. This approach may also allow a more rational general approach to drug development and gene therapy.

 描述（由适用提供）：维护人类房颤项目摘要。心房颤动（AF）是最常见的心律障碍，影响了2-5万美国人，可能会导致跳过心跳，头晕，中风甚至死亡。不幸的是，对AF的治疗是有限的。为AF开发更好疗法的主要缺点之一是，我们对引起AF（其“机制”）的理解尚不清楚。 这种更新概述了针对应用的职业发展计划，对年轻临床科学家的指导培训以及在房颤中的机械性培训方面的研究计划基于最后一个周期中的发现，该计划通常不是随机的，而不是随机的（驱动（驱动）以少量的“来源”（来源）以旋转的形式（又有一个旋翼），或者是旋转型的旋转型，或者启动了旋转的量表，或者是旋转的型号。来源可能位于每个患者中不同的心脏区域（心房或顶级阶层），通常与当前医生进行分配疗法（消融）相比。在这个项目中，我们将研究1） 通过在这些转子源以外的触发部位（肺静脉）上消融，从而实现了多少其他好处； 2）转子实际上是如何引起混乱的节奏，而不仅仅是简单的有组织电路； 3）该过程是否会因心房的结构异常而改变。我们将通过对AF，USIN生物工程方法和整合成像进行详细记录来实现这些目标。这些特定于患者的分析将是该领域最详细且与临床上最详细的分析之一，并将成为未来假设检验和临床试验的平台。 该项目之所以重要，是因为它测试了最近发现的新AF转子与当前护理标准的成功疗法的成功，因为它研究了引起人类心脏纤维化的基本机制，并且还测试了新型的成像策略。在电生理研究期间，该项目将在AF患者和有限数量的没有AF的患者中进行，以便可以将其结果直接转换为练习。这种方法 还可以允许一种更合理的一般药物开发和基因治疗方法。