Personalized virtual-heart technology for guiding the ablation of infarct-related ventricular tachycardia
Personalized virtual-heart technology for guiding the ablation of infarct-related ventricular tachycardia
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DOI：
10.1038/s41551-018-0282-2
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发表时间：
2018-10-01
影响因子：
28.1
通讯作者：
Trayanova, Natalia A.
中科院分区：
文献类型：
--
作者：
Prakosa, Adityo;Arevalo, Hermenegild J.;Trayanova, Natalia A.
室性心动过速（VT）可导致心源性猝死，常见于心肌梗塞患者。由于当前的电测绘技术无法准确识别消融目标，基于导管的心脏组织射频消融仅取得了有限的效果，这可能导致广泛的病变以及延长的、耐受性差的手术。在这里，我们证明基于心脏成像和计算模型的个性化虚拟心脏技术可以在回顾性动物（五头猪）和人类研究（21 名患者）以及前瞻性可行性研究（五名患者）中识别最佳的梗塞相关 VT 消融目标。我们首先使用回顾性研究（其中一项包括一定比例的带有伪影的临床图像）评估了该技术确定消除所有室性心动过速的最小尺寸消融目标的能力。在前瞻性研究中，该技术预测的 VT 部位是直接目标，而不依赖于先前的电气映射。该方法可以改善梗死相关的 VT 消融指导，在临床手术之前可以在个性化虚拟心脏上准确识别患者特定的最佳目标。
Ventricular tachycardia (VT), which can lead to sudden cardiac death, occurs frequently in patients with myocardial infarction. Catheter-based radio-frequency ablation of cardiac tissue has achieved only modest efficacy, owing to the inaccurate identification of ablation targets by current electrical mapping techniques, which can lead to extensive lesions and to a prolonged, poorly tolerated procedure. Here, we show that personalized virtual-heart technology based on cardiac imaging and computational modelling can identify optimal infarct-related VT ablation targets in retrospective animal (five swine) and human studies (21 patients), as well as in a prospective feasibility study (five patients). We first assessed, using retrospective studies (one of which included a proportion of clinical images with artefacts), the capability of the technology to determine the minimum-size ablation targets for eradicating all VTs. In the prospective study, VT sites predicted by the technology were targeted directly, without relying on prior electrical mapping. The approach could improve infarct-related VT ablation guidance, where accurate identification of patient-specific optimal targets could be achieved on a personalized virtual heart before the clinical procedure.