Virtual Electrophysiology Laboratory

描述（由申请人提供）：我建议开发一个高度创新的基于患者特异性mri的心脏建模环境，该环境代表心脏功能，从分子过程到器官水平的电生理和机电相互作用。我将这种环境称为“虚拟电生理实验室”，并建议将其转化为临床，应用于结构性心脏病患者心律和收缩障碍的无创诊断和治疗。这项开创性的努力首次将心脏的计算建模（传统上是一门基础科学学科）整合到当代患者护理的环境中。本文提出的针对个体化心律失常风险分层和电生理治疗指导的稳健且廉价的无创方法将导致优化治疗递送和降低医疗成本，并将对社会产生巨大的个人、医疗和经济影响。该项目旨在通过在与心肌梗死患者相关的三个应用中利用虚拟电生理实验室环境来改变心脏病患者护理的范式：1。无创预测梗死相关性室性心动过速最佳消融目标。重要的电生理实验室将用于在临床手术之前准确地确定每位患者心脏无创消融的最佳目标。消融的递送将迅速而精确，以最小的病变面积根除所有梗死相关的室性心动过速。这将显著提高治疗的疗效和耐受性，并减少术后并发症。2. 心律失常风险评估以确定是否需要部署植入式除颤器。心律失常诱发性的个性化模拟将作为一种无创、廉价、无风险的替代方法用于临床选择

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 th 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, fo the first time, computational modeling of the heart, traditionally a basic-science discipline, withn 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 swit 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 wel 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 elect