Improved arrhythmia ablation via MR-guided robotic catheterization and multimodal clinician feedback

项目概要/摘要： 该提案的目的是创建一个多模态反馈为基础的导航系统和MR- 兼容的机器人平台，可在MR引导下精确、连续和永久地创建病变 射频消融（RFA）治疗房颤（AF）。这项研究的动机是高 美国AF的发病率（1/100人），以及传统方法的次优治疗结局（约30- 50%复发率）。当消融病变之间存在间隙时，房颤复发，这可能是 由多种原因引起，包括1）以到达所有部位的方式操纵导管的能力有限 同时2）保持适当的导管-组织接触力（CTCF）， 消融能量输送。此外，缺乏有效的导航方法来准确地识别站点 并引导导管完成消融。我们最近开发了磁共振追踪 在MRI扫描仪内执行RFA的导管插入工具集和基于MR的成像方法， 术中病变结局。然而，操纵导管朝向期望的位置， 保持适当的联系仍然是一项具有挑战性的任务。为解决这些问题，我们建议制定一套 MR使能术中导航反馈框架和机器人硬件系统。从技术 从这个角度来看，所提出的平台是创新的，因为目前的系统没有集成准确的导管 操作和CTCF反馈，以及基于MRI的监测和病变评估，以提供统一的系统 用于房颤消融计划、治疗和评估。从临床角度来看，拟议的平台 实现精确的导管位置和贴靠力控制，支持创建连续和 慢性消融损伤，以减少心律失常复发。拟议的工作将通过三个目标来实现。 目标1：导航反馈。我们将进一步开发结合多模态感官的导航软件 反馈（即，MR成像、MR导管跟踪、CTCF估计），并将它们可视化在一个集成的 软件环境，以向医生提供反馈。目标2：MRI机器人硬件和控制。我们将 推进我们目前的导管机器人硬件，以创建一个完整的系统，同时导管和引导 鞘管操作。我们将开发混合位置和CTCF控制算法， 稳定的导管放置，以实现有效的消融能量输送。具体目标3：实验验证。我们 将整合机器人硬件和导航反馈系统，并在一个 在1.5 MRI扫描仪中模拟心脏跳动体模，然后在猪上进行16次MR引导左心房消融研究。

Project Summary/Abstract: The objective of this proposal is to create a multi-modal feedback-based navigation system and MR- compatible robotic platform that enables precise, continuous, and permanent lesion creation during MR-guided radiofrequency ablation (RFA) for atrial fibrillation (AF) treatment. This research is motivated by the high incidence of AF in US (1 in 100 people), and the suboptimal treatment outcome of traditional approaches (~30- 50% recurrence rate). Recurrence of AF occurs when there are gaps between ablation lesions, which can be caused by multiple reasons, including 1) limited ability to manipulate the catheter in a manner that reaches all desired ablation targets while also 2) maintaining proper catheter-tissue contact force (CTCF) for effective ablation energy delivery. In addition, there is 3) lack of effective navigation methods that accurately identify sites of incomplete ablation and guide the catheter to complete ablation. We recently developed MR-tracked catheterization toolset to perform RFA inside MRI scanner and the MR-based imaging method to assess the lesion outcome intraoperatively. However, manipulating the catheter towards the desired location and maintaining proper contact remains a challenging task. To address these problems, we propose to develop an MR-enabled intraoperative navigation feedback framework and robotic hardware system. From technical perspective, the proposed platform is innovative since current systems do not integrate accurate catheter manipulation and CTCF feedback with MRI-based monitoring and lesion assessment to provide a unified system for AF ablation planning, treatment, and assessment. From the clinical perspective, the proposed platform enables accurate catheter position and contact force control, which supports the creation of continuous and chronic ablation lesions for reducing arrhythmia recurrence. The proposed work will be achieved via three Aims. Aim 1: Navigation feedback. We will further develop navigation software that combines multi-modal sensory feedback (i.e., MR imaging, MR-catheter tracking, CTCF estimation), and visualizes them in an integrated software environment to provide feedback to the physician. Aim 2: MRI robot hardware and control. We will advance our current catheter robot hardware to create a complete system for simultaneous catheter and guiding sheath manipulation. We will develop hybrid position and CTCF control algorithm that enables accurate and stable catheter placement for effective ablation energy delivery. Specific Aim 3: Experimental validations. We will integrate the robot hardware and navigation feedback system, and validate the integrated system first in a beating heart emulating phantom in a 1.5 MRI scanner, and then in 16 MR-guided LA ablation studies on swine.