InSPACE-VT_Development and Validation of Virtual Pace Mapping to Guide Catheter Ablation of Ventricular Tachycardia

更广泛的研究背景：缺血性心脏病是世界范围内最常见的死亡原因，室性心动过速（VT）是其直接后果。导管消融治疗室性心动过速是一个重要的治疗选择。尽管消融工具有了进步，但手术时间仍然很高，并发症的风险也很高，而成功率也很低。该过程通常以确定与疤痕相关的慢传导地峡的出口位置为指导，这些地峡提供了可重新进入的基质。通过将不同心肌部位导管刺激心跳的体表心电图QRS与临床心室搏动QRS相匹配，“心速映射”识别出退出部位。目的：我们建议开发和临床验证虚拟映射作为识别关键峡部的术前规划工具。我们的解决方案旨在减少导管消融手术时间，提高安全性，并显着提高目标选择的准确性，改善患者护理和长期预后。方法：将开发先进的CMR协议，以促进以足够的分辨率获取疤痕数据，以创建详细的患者特异性模型，并在此基础上构建虚拟心率图。这将使我们能够进行不确定性分析，对我们的虚拟预测对输入数据和参数的敏感性进行必要的定量理解。开发的方法随后将应用于从25名VT消融患者收集的临床数据，为我们的虚拟方法提供一系列精心控制的特定测试。独创性水平：建议的研究如何利用接受室速消融的患者的临床数据来识别关键峡部是完全新颖的。关于如何利用接受房室消融的患者的临床数据来识别关键峡部的建议研究以前没有被考虑过。

Wider research context:Ischemic heart disease is the most common cause of death world-wide with ventricular tachycardia (VT) as direct consequence of it. Catheter ablation for VT is an important therapeutic option. Despite advances in ablation tools, procedure times remain high with a relevant risk of complications, whilst success rates are punitively low. The procedure is frequently guided by the identification of exit sites of scar-related slow-conducting isthmuses which provide the reentrant substrate. "Pace mapping" identifies exit sites by matching the surface ECG QRS of catheter-stimulated beats from different myocardial locations with the QRS of the clinical VT.Objectives:We propose the development and clinical validation of virtual mapping as a pre-procedural planning tool to identify critical isthmuses. Our solution aims to reduce catheter ablation procedure times, increase safety, and significantly improve the accuracy of target selection, improving patient care and long-term outcomes.Methods:Advanced CMR protocols will be developed to facilitate the acquisition of scar data at a resolution adequate to create detailed patient-specific models, upon which virtual pace maps will be constructed. This will enable us to perform uncertainty analysis, developing an imperative quantitative understanding of the sensitivity of our virtual predictions to the inputted data and parameters. The developed methodology will later be applied to clinical data collected from 25 VT ablation patients, providing a carefully controlled series of specific tests of our virtual approach.Level of Originality:The suggested studies on how virtual pace-mapping can identify critical isthmuses using clinical data of patients undergoing VT ablation are entirely novel. The suggested study on how virtual pace-mapping can identify critical isthmuses using clinical data of patients undergoing VT ablation have not been entertained previously.