Photoacoustic Imaging to Guide Catheter Ablation of Cardiac Arrhythmias

光声成像指导心律失常导管消融

• 批准号: 10453093
• 负责人: Nilesh Mathuria
• 金额: $ 25.42万
• 依托单位: METHODIST HOSPITAL RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-18 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10453093
• 关键词: Ablation; Acute; Address; Algorithms; Animal Model; Arrhythmia; Atrial Fibrillation; Cardiac ablation; Catheters; Cell Death; Chest; Cicatrix; Clinical; Collagen; Complication; Data; Development; Edema; Electrophysiology (science); Ensure; Family suidae; Goals; Heart; Hemoglobin; Heterogeneity; Histologic; Hypoxia; Image; Imaging Techniques; Infarction; Institution; Knowledge; Lasers; Lesion; Location; Magnetic Resonance Imaging; Modeling; Monitor; Myocardial; Myocardial tissue; Myocardium; Obstruction; Optics; Outcome; Oxygen; Oxyhemoglobin; Patient-Focused Outcomes; Penetration; Physiologic pulse; Postoperative Period; Procedures; Protein Denaturation; Recurrence; Research; Site; Source; Spatial Distribution; Standardization; Study models; Surface; Techniques; Technology; Thermal Ablation Therapy; Time; Tissue Viability; Tissue imaging; Tissues; Transducers; Ultrasonics; Ultrasonography; Ventricular; Ventricular Tachycardia; Water; Work; absorption; base; cardiac magnetic resonance imaging; curative treatments; experience; experimental study; image guided; imaging biomarker; imaging platform; improved; in vivo; injured; insight; new technology; novel; photoacoustic imaging; porcine model; preclinical trial; real time monitoring; spatiotemporal; success; tissue oxygenation; transmission process; ultrasound

Project Summary Catheter ablation (CA) is a potentially curative treatment for nearly all cardiac arrhythmias, yet clinical outcomes remain suboptimal, leading to repeat procedures. Success rates would improve if all targets for ablation could be identified and if real-time assessment of the durability and continuity of ablation lesions could be determined. These fundamental gaps in knowledge could be overcome by applying spectroscopic photoacoustic imaging (sPAI) techniques to intraoperatively guide and monitor CA. sPAI can provide insight into tissue characterization and ablation lesions based on wavelength-dependent optical absorption differences of tissue. By targeting hemoglobin (total, deoxy-, and oxy-hemoglobin) and water absorption differences, perfused/viable tissue along with local tissue oxygen saturation (StO2) and water content can be determined. The depth of this imaging can go beyond the endocardial or epicardial surfaces of the heart and provide novel tissue characterization in the “mid-myocardial” region of the heart, which is presently unknown via current mapping techniques. Prior work by our group has shown that sPAI can provide real-time quantification of thermal ablation extent and depth. These data are currently unavailable with existing technologies used by clinicians. Consequently, the goal of our research is to develop and validate real-time sPAI techniques assessing tissue oxygen saturation (StO2), total hemoglobin, and water content to 1) identify and differentiate regions of viable myocardium versus scar and 2) determine permanently ablated tissue versus temporarily “injured” yet still viable myocardium. Such a capability promises to identify novel targets for ablation, which would directly improve CA outcomes. Current approaches often cannot directly identify deeper “mid-myocardial” targets for CA and adjunctive ablation techniques to target these regions are based either on operator experience and/or prior failed procedures. sPAI would have the ability to create—for the first time—a standardized workflow for when and how to target currently difficult to access regions of the myocardium. This would have profound clinical implications for CA success rates while reducing procedural complications. We intend to accomplish these aims by first optimizing sPAI techniques with ultrasound (US) incorporation in ex-vivo ventricular tissue. This will determine the specifications needed for optimal (e.g., maximal depth penetration and StO2 accuracy) tissue imaging. Subsequent work will then be focused on optimization of in-vivo, sPAI-based, myocardial tissue characterization using an open-chest porcine infarct model. We intend to identify regions of viable myocardium and scar and validate with grossly co-registered MRI and independent histopathologic assessment. Finally, building on these initial experiments, we intend to differentiate permanently ablated tissue from surrounding edematous (“injured”) and normal myocardial tissue in an open-chest, porcine model. Achieving these goals would pave the way for catheter based sPAI guidance and monitoring during CA, creating a significant paradigm shift in the field with the ability to dramatically improve patient outcomes.

项目概要 导管消融 (CA) 是几乎所有心律失常的潜在治愈方法，但临床结果 仍不理想，如果所有消融目标都能实现，则重复手术的成功率将会提高。 是否可以确定，以及是否可以确定消融损伤的持久性和连续性的实时评估。 这些基本的知识差距可以通过应用光谱光声成像来克服 (sPAI) 术中指导和监测 CA 的技术可以提供对组织特征的深入了解。 以及基于组织的波长依赖性光吸收差异的消融病变。 血红蛋白（总血红蛋白、脱氧血红蛋白和氧合血红蛋白）和吸水率差异、灌注/活组织 可以通过局部组织氧饱和度（StO2）和水含量来确定该成像的深度。 超越心脏的心内膜或心外膜表面，并提供新的组织特征 心脏的“心肌中部”区域，目前通过当前的绘图技术尚不清楚。 我们的团队已经证明，sPAI 可以提供热消融程度和深度的实时量化。 目前，圣徒所使用的现有技术无法提供数据，这是我们的目标。 研究旨在开发和验证实时 sPAI 技术，评估组织氧饱和度 (StO2)、总氧饱和度 血红蛋白和水含量，以 1) 识别并区分存活心肌与疤痕区域，以及 2) 确定永久消融的组织与暂时“受伤”但仍然存活的心肌的这种能力。 有望确定新的消融目标，这将直接改善当前的治疗方法。 通常无法直接识别更深的“心肌中层”靶点以进行 CA 和辅助消融技术来定位 这些区域基于操作员经验和/或先前失败的程序。 首次创建标准化工作流程，确定何时以及如何定位当前难以访问的目标 这将对 CA 成功率产生深远的临床影响，同时降低。 我们打算首先通过优化 sPAI 技术来实现这些目标。 超声（美国）纳入离体心室组织这将确定所需的规格。 随后将进行最佳（例如最大深度穿透和 StO2 精度）组织成像。 专注于使用开胸猪优化体内基于 sPAI 的心肌组织表征 我们打算识别存活的心肌和疤痕区域并通过粗略联合注册进行验证。 最后，在这些初步实验的基础上，我们打算进行 MRI 和独立的组织病理学评估。 将永久消融的组织与周围水肿（“受伤”）和正常心肌组织区分开来 在开胸猪模型中实现这些目标将为基于导管的 sPAI 引导铺平道路。 和 CA 期间的监控，在该领域创造了重大范式转变，并能够显着改进 患者的结果。