Peri-procedural transmural electrophysiological imaging of scar-related ventricular tachycardia

项目摘要 室性心动过速(VT)是心脏病患者死亡和发病的重要原因。 大多数危及生命的室性心动过速发作是由一种由狭窄的 心肌瘢痕内存活组织的通道。治疗瘢痕相关性室上性心动过速的一个重要方法是靶向和 摧毁这些罪魁祸首的慢传导通道。有效的消融需要能够描绘出 电路的形态，以便识别慢传导通道。不幸的是，与传统的 导管标测中，高达90%的VT回路寿命太短而无法标测。对于10%的可映射的VT， 他们的数据仅在消融过程中可用，且仅限于一个脑室表面。这一不足之处 功能性室速数据在很大程度上限制了我们目前对疤痕相关室速和消融策略的了解，并且 降低了临床医生识别消融目标和评估消融结果的能力。这样做的目的是 建议开发一种新技术，以提供消融前和消融后功能性VT数据-与 三维LGE-MRI SCAR数据-通过术前识别消融靶点和 消融失败的术后机制解释。它建立在迅速增长的临床兴趣的基础上 心电成像(ECGi)，一种新兴的技术，通过 从体表心电图进行逆向重建。其具体目标包括： 1)开发和验证用于标测SCAR相关VT回路的围术期ECGI。 2)将LGE-MRI SCAR整合到ECGI中，以改进VT回路的电解剖研究。 3)对瘢痕相关性室上性心动过速消融前后的MRI-ECGI进行临床评价。 这些调查将在40名VT患者的前瞻性队列中进行，这些患者因既往的 脑梗塞。这项研究建立在我们之前建立的透壁ECGi和 在我们的探索性NIH拨款的支持下产生了有希望的初步数据。它还得到了以下支持 每个分包商实验室以前的技术和临床进展，包括基于相机的躯干 模型(西门子)、室壁内标测和消融(NSHA)和室速的LGE-MRI疤痕成像(UPenn)。这个 这一研究成果将对瘢痕相关的解剖机制产生新的认识 室性心动过速和消融失败的机制。它将启用3D功能的术前和术后映射 所有可诱发室速的循环，提高临床医生识别消融目标和评估消融的能力 结果。最后，它将及时交付下一代ECGi技术，以进一步推动我们的一般技术 在更多种类的心脏中进行更安全和更有效的心脏电生理研究的能力 疾病。

Project Summary Ventricular tachycardia (VT) is an important cause of mortality and morbidity in patients with heart diseases. The majority of life-threatening VT episodes are caused by an electrical "short circuit", formed by a narrow channel of surviving tissue inside myocardial scar. An important treatment for scar-related VT is to target and destroy these culprit slow-conducting channels. Effective ablation requires the ability to delineate the morphology of the circuit in order to identify the slow-conducting channels. Unfortunately, with conventional catheter mapping, up to 90% of the VT circuits are too short-lived to be mapped. For the 10% “mappable” VTs, their data are available only during ablation and limited to one ventricular surface. This inadequacy of functional VT data largely limits our current knowledge about scar-related VT and ablation strategies, and reduces the ability of clinicians to identify ablation targets and assess ablation outcome. The goal of this proposal is to develop a novel technique to provide pre- and post-ablation functional VT data – integrated with LGE-MRI scar data in 3D – to improve VT ablation with pre-procedural identification of ablation targets and post-procedural mechanistic elucidation of ablation failure. It builds on the rapidly increasing clinical interest in electrocardiographic imaging (ECGi), an emerging technique that obtains cardiac electrical activity through inverse reconstructions from body-surface ECGs. Its specific objectives include: 1) To develop and validate a peri-procedural ECGi for mapping scar-related VT circuits. 2) To integrate LGE-MRI scar into ECGi for improved electroanatomical investigations of VT circuits. 3) To perform clinical evaluation of pre-ablation and post-ablation MRI-ECGi of scar-related VT. These investigations will be carried out on a prospective cohort of 40 patients with VT due to previous infarction. This research builds on our previously established technical foundation for transmural ECGi and promising preliminary data generated under the support of our exploratory NIH grant. It is further supported by previous technical and clinical advances in each of the subcontractors' lab, including camera-based torso modeling (Siemens), intramural mapping and ablation (NSHA), and LGE-MRI scar imaging in VT (UPenn). The outcome of this research will generate new knowledge about the electroanatomical mechanism of scar-related VT and the mechanism behind ablation failure. It will enable pre- and post-procedural mapping of 3D functional circuits of all inducible VTs, improving the ability of clinicians to identify ablation targets and assess ablation outcome. Finally, it will timely deliver the next generation of ECGi techniques to further our general technical capability for safer and more efficient cardiac electrophysiological studies in a broader variety of heart diseases.