MRI-Guided, Robotically Controlled Cardiac Ablation

描述(由申请人提供)：该项目的总体目标是开发一种交互式的图像引导系统，用于在左心房准确放置消融病变以治疗心律失常。心房颤动(房颤)影响10%的70岁以上人群，并导致约三分之一的中风。由于在可视化组织/装置相互作用和控制导管位置方面的技术限制，即使在精心挑选的患者中，也只有2/3的经皮房颤手术成功。我们认为，将实时可视化和引导、交互式设备控制和即时病变评估结合在一起，将是提供可靠、可靠的心房消融的关键，并将大大提高效果，远远超过单个部分的总和。MRI将提供指导和可视化，它允许实时解剖可视化，允许主动跟踪设备，并提供许多消融监测和控制技术。通过与实时3D可视化环境集成的交互式反馈控制导管操作系统，可以直观、准确地进入整个左心房，以进行导航和放置设备。该系统将结合用于机器人控制的触觉接口，集成MR视觉反馈、导管力反馈。最后，急性病变的直接磁共振成像将提供消融成功的即时验证。病变发展的成像将通过延迟增强、T2加权成像和一种新的MR RF电流映射技术来完成，该技术可以潜在地突出消融后心肌组织电导率的变化。具体地说，我们的目标是：1)开发改进的MRI方法和设备，用于心脏消融过程中的实时3D指导。2)开发一种通用的心内导管系统，集成了感觉输入和运动控制，以提供对介入性导管的精确控制。3)开发和测试能够准确预测和可视化消融模式的实时评估组织活性和电导率的方法。可视化、指导和验证的结合将允许快速、可靠的心房消融，极大地改善患者的预后。这项建议的首要目标是开发一套集成的技术，以使成像、机械和控制系统能够复制外科医生的可视化、灵活性和执行经皮心脏内手术的工具。该项目将利用一个多学科团队(工程师、成像科学家和心脏病专家)来解决将该系统转化为临床实践中的所有技术挑战。考虑到房颤的盛行率、实质性的临床影响以及目前尚不理想的经皮消融，我们最初的重点将放在房颤的心内消融。这项研究--开发一种用于房颤手术的微创系统--对公众健康很重要，因为它可能会让许多心脏直视手术转而使用侵入性较小的导管。这项研究最初的目标也是房颤，因为它非常常见(四分之一的美国人在一生中会患上这种疾病)，导致三分之一的中风，需要一种成功的方法来治疗它，降低侵袭性。

DESCRIPTION (provided by applicant): The overall goal of this project is the development of an interactive, image-guided system for accurately placing ablation lesions in the left atrium for the treatment of arrythmias. Atrial fibrillation (AF) affects 10% of the population over age 70 and causes about 1/3 of strokes. Only 2/3 of percutaneous procedures for AF succeed even in carefully selected patients due to technical limitations in both visualizing tissue/device interaction and controlling catheter position. We believe that the combination in a single procedure of real-time visualization and guidance, interactive device control, and immediate lesion assessment will be critical in providing reliable, robust atrial ablation and will increase effectiveness far beyond the sum of the individual parts. Guidance and visualization will be provided by MRI, which permits real-time anatomic visualization, allows active tracking of devices, and provides many techniques for ablation monitoring and control. Intuitive, accurate access to the entire left atrium will be accomplished via an interactive, feedback controlled catheter manipulation system integrated with a real-time 3D visualization environment for navigation and device placement. This system will incorporate a haptic interface for robotic control integrating MR visual feedback catheter force feedback. Finally, direct MR visualization of acute lesions will provide immediate verification of ablative success. Imaging the lesion development will be accomplished via delayed enhancement, T2 weighted imaging, and a new MR RF current mapping technique that can potentially highlight tissue conductivity changes in the myocardium post-ablation. Specifically, our aims are to: 1) Develop improved MRI methods and devices for real-time 3D guidance during cardiac ablations. 2) Develop a general purpose intracardiac catheter system integrating sensory inputs and motor controls to provide precise control of the interventional catheter. 3) Develop and test real-time methods to assess tissue viability and electrical conductivity that can accurately predict and visualize the ablation pattern. The combination of visualization, guidance, and verification will allow quick, reliable atrial ablations, dramatically improving patient outcomes. The overarching objective of this proposal is to develop an integrated set of technologies to enable the imaging, mechanical, and control systems needed to replicate the surgeon's visualization, dexterity, and tools for performing percutaneous intracardiac surgery. This project will utilize a multi-disciplinary team (engineers, imaging scientists, and cardiologists) to address all the technical challenges in translating this system to clinical practice. Our initial focus will be intracardiac ablation of atrial fibrillation, given its prevalence, substantial clinical impact, and current suboptimal percutaneous success. This research - developing a minimally invasive system for atrial fibrillation procedures - is important to public health because it may allow many open-heart surgery procedures to be performed instead using less invasive catheters. This research also initially targets atrial fibrillation as it is very common (1 in 4 Americans develop it in their lifetime), leads to 1/3 of strokes, and there is a need for a successful method to cure it less invasively.