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图像引导系统，用于准确定位左心房消融病灶，以治疗心律失常。房颤（AF）影响10%的70岁以上人口，导致约1/3的中风。由于观察组织/装置相互作用和控制导管位置的技术限制，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。我们相信，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，对于提供可靠、稳健的心房消融至关重要，并且将大大提高疗效，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，允许设备的主动跟踪，并提供许多消融监测和控制技术。通过一个交互式的、反馈控制的导管操作系统，将实现对整个左心房的直观、准确的访问，该系统集成了用于导航和设备放置的实时3D可视化环境。该系统将包含一个用于机器人控制的触觉界面，集成了MR视觉反馈导管力反馈。最后，急性病变的直接MR可视化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射频电流成像技术来完成，该技术可以潜在地突出消融后心肌组织电导率的变化。具体来说，我们的目标是：1)开发改进的MRI方法和设备，用于心脏消融期间的实时3D引导。2)开发一种集感觉输入和运动控制于一体的通用心内导管系统，以提供对介入导管的精确控制。3)开发和测试实时评估组织活力和电导率的方法，以准确预测和可视化消融模式。可视化，指导和验证的结合将允许快速，可靠的心房消融，显着改善患者的预后。本提案的总体目标是开发一套集成的技术，使成像、机械和控制系统能够复制外科医生的可视化、灵活性和工具，以进行经皮心内手术。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的所有技术挑战。鉴于房颤的患病率、重大的临床影响和目前经皮穿刺成功率不理想，我们最初的重点将是心房颤动的心内消融。这项研究——开发心房颤动手术的微创系统——对公众健康很重要，因为它可以让许多心内直视手术手术使用侵入性较小的导管。这项研究最初也针对心房颤动，因为它很常见（1 / 4的美国人在他们的一生中发展），导致1/3的中风，需要一种成功的方法来治疗它的侵入性更小。

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.