Improved Targeting and Assessment of Electrophysiology Intervention

描述（由申请人提供）：房颤（AF）和室性心动过速（VT）影响美国数百万患者。这些心律失常可以用导管消融术治愈，但心律失常经常复发。无法确认消融部位是否存在消融损伤是消融后房颤复发率超过30%的主要因素。当前消融技术的其他局限性包括：（1）难以将导管导航到精确位置，从而难以准确放置消融，以及（2）缺乏充分预测室性心动过速通过瘢痕（消融目标）的路径的能力。我们正在开发将来自磁共振成像（MRI）和计算机断层扫描（CT）的解剖信息与导管消融相结合的方法，用于执行高级实时图像引导的干预。然而，对于图像引导介入，MRI或CT是否具有上级优势尚不清楚。这两种技术都包括在这个项目中，因为许多正在开发的技术可以与MRI和CT一起使用。我们假设，使用MRI和/或CT的高分辨率成像，以及兼容的电极导管、导管尖端位置传感器、远程控制的导管操纵器、实时扫描仪控制、热成像和4维（3个空间维度加上时间）成像软件可以（1）提供导管的精确导航，（2）提供滴定和确认所需位置中消融损伤的存在的能力，（3）帮助产生更准确的电标测图，以及（4）帮助预测消除靶向心律失常所需的消融程度。我们之前已经证明了（1）导管的真实的实时MRI引导，（2）使用CT和MRI的病变可视化，（3）瘢痕中保存的心肌组织的高分辨率成像，以及（4）使用计算建模来预测VT电路的位置的可行性。该提议涉及开发（1）改进的导管尖端位置传感器，（2）改进的实时扫描器控制，（3）具有叠加的导管尖端位置信息的动态3维图像重建，（4）改进的心肌的高分辨率成像，使得疤痕内保存的心肌的细节可以充分可视化，（5）可以基于详细的疤痕形态预测个体患者中的VT回路的计算模型，（6）用于预测个体患者对消融的响应的改进方法，（7）用于实时配准多模态信息（包括电图）的方法，和多个图像，（8）MRI热成像，以帮助实时滴定和评估消融损伤形成，和（9）远程控制导管操纵器，以提高导管放置的准确性。我们将把这项技术应用于房性和室性心律失常患者的实时高级图像引导治疗，并有可能将其用于一般的介入手术。该项目是约翰霍普金斯大学医学、放射学和生物医学工程系与行业合作伙伴（费用分摊）之间的合作项目：Irvine Biomedical（临床级导管）、汉森医疗（导管操作系统）和Imricor（导管组件）。公共卫生相关性：心脏节律异常，即心跳过快，影响着美国数百万人。这些异常可能导致严重的症状和/或死亡，有些可以通过烧灼（消融）心脏的一小部分来治愈。正在开发使用磁共振成像和多探测器计算机断层扫描的实时和高质量成像的方法，以大大提高这些消融的安全性和有效性，并将这些方法扩展到涉及其他器官系统的程序

DESCRIPTION (provided by applicant): Atrial fibrillation (AF) and ventricular tachycardia (VT) affect millions of patients in the United States. These arrhythmias can be cured with catheter ablation, but the arrhythmias often recur. The inability to confirm the presence of ablated lesions in the desired locations is the major factor in the greater than 30 % recurrence of AF after ablation. Additional limitations of current ablation technology include: (1) difficulty in navigating catheters to exact locations, making it difficult to accurately place ablations, and (2) the lack of ability to adequately predict the pathways of VT through scar, which are the targets for ablation. We are developing ways of combining the anatomic information from magnetic resonance imaging (MRI) and computed tomography (CT), with catheter ablation, for performing advanced real-time image guided interventions. It is not known, however, whether MRI or CT will be superior for image guided interventions. Both are included in this project because a number of the technologies being developed can be used with both MRI and CT. We hypothesize that high resolution imaging with MRI, and/or CT, with compatible electrode catheters, catheter-tip location sensors, remote-controlled catheter manipulators, real-time scanner control, thermal imaging, and 4-dimensional (3 spatial dimensions plus time) imaging software can (1) provide for accurate navigation of catheters, (2) provide the ability to titrate and confirm the presence of ablated lesions in the desired locations, (3) aid in producing more accurate electrical maps, and (4) aid in predicting the extent of ablation needed to eliminate the target arrhythmia. We have previously demonstrated the feasibility of (1) real- time MRI guidance of catheters, (2) lesion visualization using CT and MRI, (3) high resolution imaging of preserved myocardial tissue in scar, and (4) using computational modeling to predict the location of VT circuits. This proposal deals with developing (1) improved catheter tip location sensors, (2) improved real-time scanner control, (3) dynamic 3-dimensional image reconstruction, with superimposed catheter tip location information, (4) improved high resolution imaging of myocardium so that details of preserved myocardium within scar can be adequately visualized, (5) a computational model that can predict the VT circuits in individual patients based on the detailed scar morphology, (6) improved methods for predicting individual patient's response to ablation, (7) methods for real-time registration of multimodal information, including electrical maps, and multiple images, (8) MRI thermography to aid in real-time titrating and assessing of ablation lesion formation, and (9) remote controlled catheter manipulators to improve the accuracy of catheter placement. We will apply this technology to real-time advanced image guided therapy in patients with atrial and ventricular arrhythmias, and potentially broaden its use to interventional procedures in general. This project is a partnership between the Johns Hopkins University Departments of Medicine, Radiology, and Biomedical Engineering; and industrial partners (with cost sharing): Irvine Biomedical (clinical grade catheters), Hansen Medical (catheter manipulation system), and Imricor (catheter components). PUBLIC HEALTH RELEVANCE: Rhythm abnormalities of the heart, where the heart beats too fast, affect millions of people in the United States. These abnormalities can cause substantial symptoms and/or death, and some can be cured by cauterizing (ablating) a small portion of the heart. Methods are being developed to use the real-time, and high quality imaging of Magnetic Resonance Imaging and Multi-Detector Computed Tomography to improve substantially the safety and efficacy of these ablations, as well as extend these methods to procedures involving other organ systems