I-Corps Teams: Magnetic Resonance Imaging Guided Active Robotic Catheter

基于导管的房颤消融是一种治疗房颤的微创技术。在这一过程中，使用透视引导下的导管施加射频能量，在左心房建立消融屏障，以防止不规则电信号的传播，从而导致心律失常。最先进的房颤消融程序的主要问题是造成太小或太大的病变。这些问题的原因是难以准确控制导管尖端，难以保持与心内膜适当的电极接触压力，以及缺乏关于所造成病变的大小和深度的实时反馈。建议的实时磁共振成像引导的机器人主动导管技术有可能通过显著提高房颤消融治疗的准确性和可重复性并潜在地降低手术成本来彻底改变房颤的治疗。建议的范例与最先进的心脏消融治疗技术和技术相比具有几个优势，因为它将允许进行更定制的治疗。具体地说，核磁共振成像的术中实时可用性具有优越的组织识别能力，可以立即评估消融造成的基质深度和损伤。远程转向和高精度的导管尖端位置控制将允许精确的消融。由于术中信息，包括从实时磁共振成像获得的电生理图、导管轨迹和组织测量，可以被映射回来并在心脏解剖的3D静态参考可视化上显示给手术医生，因此操作员将改进情况感知。最后，患者在手术过程中不会暴露在电离辐射中，因为不会使用荧光透视。如果通过i-Corps项目进行的商业化可行性研究产生积极的结果，该团队正计划成立一家初创公司，从凯斯西储大学获得技术许可，并将其商业化。

Catheter-based atrial fibrillation (AF) ablation is a minimally invasive technique used in the treatment of AF. In this procedure, a catheter under fluoroscopy guidance is used to apply radiofrequency energy to build ablation barriers in the left atrium to prevent the spread of the irregular electrical signals, which cause the arrhythmia. The major problems with the state-of-the-art AF ablation procedure entail creating too small or too large of a lesion. These result from difficulties in accurately controlling the catheter tip, difficulties in keeping appropriate electrode contact pressure with the endocardium, and lack of real-time feedback regarding the size and depth of the lesion created. The proposed real-time magnetic resonance imaging-guided robotic active catheter technology has the potential to revolutionize the treatment AF by significantly improving the accuracy and repeatability of AF ablation therapy, and by potentially reducing the cost of the procedure.The proposed paradigm has several advantages over the state-of-the-art techniques and technologies for cardiac ablation therapy, as it would allow a more tailored treatment to be performed. Specifically, intra-operative real-time availability of magnetic resonance imaging, with its superior tissue discrimination capabilities, would allow immediate evaluation of the substrate depth and lesion created by ablation. Remote steering and high accuracy catheter tip position control would allow for precise ablation. The operator would have improved situational awareness, as the intra-operative information, including the electrophysiological map, catheter trajectories, and tissue measurements obtained from real-time magnetic resonance imaging, can be mapped back and displayed to the operating physician on the 3D static reference visualization of the cardiac anatomy. And, finally, the patient will not be exposed to ionizing radiation during the procedure, as fluoroscopy will not be used. If the commercialization feasibility study performed through the I-Corps program yields a positive result, the team is planning to establish a start-up company that will license the technology from Case Western Reserve University and pursue its commercialization.