Improved Targeting and Assessment of Electrophysiology Intervention

描述(申请人提供)：房颤(AF)和室性心动过速(VT)在美国影响数以百万计的患者。这些心律失常可以通过导管消融治愈，但心律失常经常复发。房颤消融后30%以上复发率的主要原因是不能确定消融部位是否存在消融病变。当前消融技术的其他局限性包括：(1)难以将导管导航到准确的位置，从而难以准确地放置消融，以及(2)无法充分预测VT通过SCAR的路径，而SCAR是消融的目标。我们正在开发将磁共振成像(MRI)和计算机断层扫描(CT)的解剖信息与导管消融相结合的方法，以执行先进的实时图像引导干预。然而，目前还不清楚在影像引导的介入中，MRI和CT哪个更好。这两种技术都包括在这个项目中，因为许多正在开发的技术可以同时用于核磁共振和CT。我们假设，MRI和/或CT的高分辨率成像，加上兼容的电极导管、导管尖端位置传感器、遥控导管操纵器、实时扫描仪控制、热成像和4维(3空间加时间)成像软件，可以(1)提供导管的准确导航，(2)提供滴定和确认所需位置是否存在消融病变的能力，(3)帮助生成更准确的电子地图，以及(4)帮助预测消除靶点心律失常所需的消融程度。我们以前已经证明了(1)导管的实时MRI引导，(2)使用CT和MRI进行病变可视化，(3)对疤痕中保存的心肌组织进行高分辨率成像，以及(4)使用计算模型来预测VT回路的位置是可行的。该建议涉及开发(1)改进的导管尖端位置传感器，(2)改进的实时扫描仪控制，(3)动态三维图像重建，具有叠加的导管尖端位置信息，(4)改进的心肌的高分辨率成像，以便可以充分地可视化疤痕内保存的心肌的细节，(5)可以基于详细的疤痕形态预测个体患者的VT回路的计算模型，(6)改进的预测个体患者对消融的反应的方法，(7)实时配准包括电图和多图像的多模式信息的方法，(8)MRI温度成像，以帮助实时滴定和评估消融病变的形成；(9)远程控制导管操作器，以提高导管放置的准确性。我们将把这项技术应用于房性和室性心律失常患者的实时先进图像引导治疗，并有可能将其广泛应用于介入治疗。该项目是约翰霍普金斯大学医学系、放射学系和生物医学工程系与工业合作伙伴(分摊成本)之间的合作伙伴关系：欧文生物医疗(临床级导管)、汉森医疗(导管操纵系统)和Imricor(导管组件)。公共卫生相关性：心脏节律异常，即心跳过快，影响着美国数百万人。这些异常可能会导致实质性的症状和/或死亡，有些可以通过烧灼(消融)一小部分心脏来治愈。正在开发使用磁共振成像和多探测器计算机断层扫描的实时和高质量成像的方法，以显著提高这些消融的安全性和有效性，并将这些方法扩展到涉及其他器官系统的手术

DESCRIPTION (provided by applicant): Atrial fibrillation (AF) and ventricular tachycardia (VT) affect millions of patients in the United States. These arrhythmias can be cured with catheter ablation, but the arrhythmias often recur. The inability to confirm the presence of ablated lesions in the desired locations is the major factor in the greater than 30 % recurrence of AF after ablation. Additional limitations of current ablation technology include: (1) difficulty in navigating catheters to exact locations, making it difficult to accurately place ablations, and (2) the lack of ability to adequately predict the pathways of VT through scar, which are the targets for ablation. We are developing ways of combining the anatomic information from magnetic resonance imaging (MRI) and computed tomography (CT), with catheter ablation, for performing advanced real-time image guided interventions. It is not known, however, whether MRI or CT will be superior for image guided interventions. Both are included in this project because a number of the technologies being developed can be used with both MRI and CT. We hypothesize that high resolution imaging with MRI, and/or CT, with compatible electrode catheters, catheter-tip location sensors, remote-controlled catheter manipulators, real-time scanner control, thermal imaging, and 4-dimensional (3 spatial dimensions plus time) imaging software can (1) provide for accurate navigation of catheters, (2) provide the ability to titrate and confirm the presence of ablated lesions in the desired locations, (3) aid in producing more accurate electrical maps, and (4) aid in predicting the extent of ablation needed to eliminate the target arrhythmia. We have previously demonstrated the feasibility of (1) real- time MRI guidance of catheters, (2) lesion visualization using CT and MRI, (3) high resolution imaging of preserved myocardial tissue in scar, and (4) using computational modeling to predict the location of VT circuits. This proposal deals with developing (1) improved catheter tip location sensors, (2) improved real-time scanner control, (3) dynamic 3-dimensional image reconstruction, with superimposed catheter tip location information, (4) improved high resolution imaging of myocardium so that details of preserved myocardium within scar can be adequately visualized, (5) a computational model that can predict the VT circuits in individual patients based on the detailed scar morphology, (6) improved methods for predicting individual patient's response to ablation, (7) methods for real-time registration of multimodal information, including electrical maps, and multiple images, (8) MRI thermography to aid in real-time titrating and assessing of ablation lesion formation, and (9) remote controlled catheter manipulators to improve the accuracy of catheter placement. We will apply this technology to real-time advanced image guided therapy in patients with atrial and ventricular arrhythmias, and potentially broaden its use to interventional procedures in general. This project is a partnership between the Johns Hopkins University Departments of Medicine, Radiology, and Biomedical Engineering; and industrial partners (with cost sharing): Irvine Biomedical (clinical grade catheters), Hansen Medical (catheter manipulation system), and Imricor (catheter components). PUBLIC HEALTH RELEVANCE: Rhythm abnormalities of the heart, where the heart beats too fast, affect millions of people in the United States. These abnormalities can cause substantial symptoms and/or death, and some can be cured by cauterizing (ablating) a small portion of the heart. Methods are being developed to use the real-time, and high quality imaging of Magnetic Resonance Imaging and Multi-Detector Computed Tomography to improve substantially the safety and efficacy of these ablations, as well as extend these methods to procedures involving other organ systems