Method for guiding ablative therapy of cardiac arrythmias

描述(由申请人提供)： 从成本和患者安全的角度来看，脑室导管消融术已被认为是治疗心律失常最理想的方法，但其成功率尚未被广泛接受。这主要是因为这种治疗方式几乎完全依赖于主治医生的经验和能力，通过心内膜标测来识别消融部位。在这项赠款申请中，我们的目标是研究一种新方法的能力，以快速、可靠和安全地确定心律失常的起始点。我们的方法依赖于将等价的运动偶极子的属性分配给心动周期的每个阶段，然后反向求解该偶极子的属性(位置和强度)。我们的假设是，当去极化波从焦点出来时，逆偶极子解将准确地定位心动周期中电活动仍为焦点的点上的致心律失常焦点。我们将建立一个最先进的系统，旨在为心脏电生理学家提供一种工具，该工具将有助于识别心脏中心律失常的位置，并使消融导管能够准确地引导至心律失常的起源位置。我们将通过盐水池和动物实验来评估它的性能。在后一项研究中，我们最终将通过等效偶极子溶液确定的位置与操作员最初确定的位置以及最终导致消除诱发性室性心动过速的位置进行比较。执行三维标测和实时查看心律失常的能力比标准的透视二维成像或激活标测领先了一步。此外，我们的方法承诺减少执行标测所需的时间，并使患者能够很好地耐受标测。成功的室性心动过速导管消融的影响可能是：(1)减少心脏性猝死的发生率，(2)减少植入性心律转复电击的频率，(3)减少抗心律失常药物的需求，这些药物具有潜在的促心律失常和/或其他副作用。 公共卫生相关性： 从成本和患者安全的角度来看，脑室导管消融术已被认为是治疗心律失常最理想的方法，但其成功率尚未被广泛接受。这主要是因为这种治疗方式几乎完全依赖于主治医生的经验和能力，通过心内膜标测来识别消融部位。这项建议调查了一种新方法的能力，该方法能够快速、可靠和安全地识别心律失常的起源部位，并帮助引导消融导管到达该部位。

DESCRIPTION (provided by applicant): Ventricular catheter ablation has been established as the most desirable from cost and patient safety point of view approach in treating cardiac arrhythmias, yet its success rate has not broad acceptance. This is primarily because this treatment modality relies almost entirely on the experience and abilities of the physician in charge to identify the ablative site through endocardial mapping. In this grant application we aim to investigate the ability of a new method to rapidly, reliably and safely identify the site of origin of the arrhythmia. Our method relies on assigning properties of an equivalent moving dipole to each phase of the cardiac cycle and then inversely resolving the properties (location and strength) of the dipole. Our hypothesis is that the inverse dipole solution will accurately locate the arrhythmogenic focus at the point in the cardiac cycle when electrical activity is still focal, as the depolarization wave emerges from the focus. We will build a state-of-art system aimed to provide the cardiac electrophysiologist with a tool that will facilitate the identification of the site of the arrhythmia in the heart and will enable the accurate guiding of the ablation catheter to the site of origin of that arrhythmia. We will evaluate its performance by means of saline tank and animal studies. In the latter study, we will ultimately compare the location of the site identified by means of the equivalent dipole solution with the site initially identified by the operator as well as the site which ultimately results in the abolition of inducibility of ventricular tachycardia. The ability to perform three dimensional mapping and view the arrhythmia in real-time represents a step ahead from the standard fluoroscopic two-dimensional imaging or activation mapping. Furthermore our methodology promises to reduce the time required to perform the mapping and make it well tolerated from the patient. The impact of successful catheter ablation of ventricular tachycardia may be to (i) reduce the incidence of sudden cardiac death, (ii) reduce the frequency of implantable cardioverter shocks, and (iii) decrease the need of anti-arrhythmic medications with their potentially pro-arrhythmic and/or other side effects. PUBLIC HEALTH RELEVANCE: Ventricular catheter ablation has been established as the most desirable from cost and patient safety point of view approach in treating cardiac arrhythmias, yet its success rate has not broad acceptance. This is primarily because this treatment modality relies almost entirely on the experience and abilities of the physician in charge to identify the ablative site through endocardial mapping. This proposal investigates the ability of a new method to rapidly, reliably and safely identify the site of origin of the arrhythmia and help guide the ablation catheter to that site.