Virtual Electrophysiology Laboratory

描述(由申请者提供)：我建议开发一个高度创新的基于患者特定MRI的心脏建模环境，该环境代表 心脏功能从分子过程到电生理和机电相互作用 器官水平。我将这种环境称为虚拟电生理实验室，并建议将其应用于临床。 并将其应用于心绞痛患者心律和收缩功能障碍的无创诊断和治疗。 结构性心脏病。这项开创性的工作首次提出将计算模型与 心脏，传统上是一门基础科学学科，在当代病人护理的环境中。健壮的和 低成本无创个性化心律失常危险分层及电生理指导 这里提出的治疗方法将导致优化治疗提供和降低医疗保健成本，以及 将对社会产生巨大的个人、医疗和经济影响。 该项目试图通过利用虚拟电生理学实验室来改变心脏病人护理的模式 与心肌梗死患者相关的三种应用程序的环境： 1.无创预测梗死性室性心动过速的最佳消融靶点。这个 生命电生理学实验室将被用来准确地确定每个患者心脏的最佳消融目标 在临床手术前非侵入性的。然后，消融将迅速而准确地进行，根除所有 病变面积最小的梗塞相关性室性心动过速。这将大大改善 治疗的有效性和耐受性，以及在减少术后并发症方面。 2.进行心律失常风险评估，以确定是否需要部署植入式除颤器。个性化 心律失常诱发能力的模拟将作为一种非侵入性、廉价和无风险的替代品用于 临床电生理研究预测左低位心肌梗死患者发生致死性心律失常的风险 心室射血分数。室内室性心律失常诱发性试验的结果将结合 变成了一个新的指标，用于对心律失常的风险进行分层，从而从根本上改变了患者选择的过程 用于植入除颤器装置。 3.确定心脏再同步化治疗的最佳左心室起搏部位(S)。这个 虚拟电生理学实验室方法将用于预测心肌梗死患者的最佳 CRT起搏电极的个体化定位。这些研究的成功实施将消除“一” LV CRT起搏的“大小适合所有人”的方法，从而改变再同步治疗。

DESCRIPTION (provided by applicant): I propose to develop a highly innovative patient-specific MRI-based heart modeling environment that represents cardiac functions from molecular processes to electrophysiological and electromechanical interactions at the organ level. I term this environment “virtual electrophysiology lab”, and propose to translate it into the clinic and apply it to the non-invasive diagnosis and treatment of heart rhythm and contractile disorders in patients with structural heart disease. This pioneering effort offers to integrate, for the first time, computational modeling of the heart, traditionally a basic-science discipline, within the milieu of contemporary patient care. The robust and inexpensive non-invasive approaches for individualized arrhythmia risk stratification and guidance of electrophysiological therapies proposed here will lead to optimized therapy delivery and reduction in health care costs, and will have a dramatic personal, medical and economic impact on society. This project seeks to shift the paradigm of cardiac patient care by utilizing the virtual electrophysiology laboratory environment in three applications pertinent to patients with myocardial infarction: 1. Noninvasive prediction of the optimal ablation targets for infarct-related ventricular tachycardia. The vital electrophysiology lab will be used to accurately identify the optimal targets of ablation in each patient heart non-invasively prior to the clinical procedure. Delivery of ablation will then be swift and precise, eradicating all infarct-related ventricular tachycardias with minimum lesion sizes. This will result in a dramatic improvement in the efficacy of and tolerance for the therapy, as well as in reduction of post-procedure complications. 2. Arrhythmia risk assessment to determine the need for implantable defibrillator deployment. Personalized simulations of arrhythmia inducibility will be used as a noninvasive, inexpensive, and risk-free surrogate for a clinical electrophysiological study to predict lethal arrhythmia risk in patients with myocardial infarction and low left ventricular ejection fraction. The results of the in-silico ventricular arrhythmia inducibility tests will be combined into a new index and used to stratify risk of arrhythmias, thus radically changing the process of patient selection for defibrillator device implantation. 3. Determining the optimal left ventricular pacing location(s) for cardiac resynchronization therapy. The virtual electrophysiology lab approach will be used to predict, in patients with myocardial infarction, the optimal individualized location of the LV pacing lead for CRT. Successful execution of the studies will eliminate the “one size fits all” approach to LV CRT pacing and thus transform resynchronization therapy.