Magnetic Resonance Guided Electrophysiology Intervention

磁共振引导电生理干预

• 批准号: 7070629
• 负责人: HENRY R HALPERIN
• 金额: $ 85.1万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-09-30 至 2009-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7070629
• 关键词: atrial fibrillation; bioengineering /biomedical engineering; bioimaging /biomedical imaging; biomedical equipment development; clinical research; computer assisted patient care; computer system design /evaluation; dogs; electrocardiography; heart catheterization; heart electrical activity; heart imaging /visualization /scanning; heart surgery; human subject; image guided surgery /therapy; magnetic resonance imaging; tachycardia; therapy design /development; three dimensional imaging /topography

DESCRIPTION (provided by applicant): Ventricular tachyarrhythmias and atrial fibrillation occurring in patients with structurally abnormal hearts are the most important arrhythmias in contemporary cardiology, and despite much progress, remain therapeutic challenges. Invasive electrical studies of the heart (electrophysiologic studies) are often used in the diagnosis and therapy of arrhythmias, and many arrhythmias can be cured by selective destruction of critical electrical pathways with radiofrequency (RF) catheter ablation. A major limitation in studying arrhythmias in patients, however, is the lack of ability to accurately correlate anatomical and electrical information. Another major limitation is the lack of ability to visualize ablated areas of myocardium during catheter ablation procedures, making it difficult to confirm the presence of ablated lesions in the desired locations. We are developing ways of combining the anatomic information from magnetic resonance imaging (MRI), with electrophysiologic testing and ablation. We hypothesize that MRI, with MRI-compatible (non-magnetic) electrode catheters, catheter-tip location sensors, intracardiac receivers, real-time MRI scanner control, remote-control catheter manipulators, and 3- dimensional imaging software can (1) provide the ability to accurately visualize cardiac anatomy, (2) provide accurate navigation of catheters without radiation, (3) provide the ability to visualize ablated lesions, and (4) aid in producing more accurate electrical maps. Our previous project dealt with (1) technology development, (2) demonstration of the feasibility of MRI guidance of catheters in animals, and (3) lesion visualization in animals, and in patients with atrial arrhythmias. This competing continuation deals with (1) additional technology development, (2) improved integration of the different subsystems, (3) study of the determinants of successful ablation in patients undergoing standard ablations, and (4) broadening of the applications to real-time MRI guided therapy in patients with atrial and ventricular arrhythmias. The technologies developed in this project, should, in addition, be applicable to using MRI to guide interventional procedures in general. This project is a partnership between the Johns Hopkins University School of Medicine (Medicine, Radiology, and Biomedical Engineering), Robin Medical Inc., MicroHelix Inc., NaviCath Inc., and Irvine Biomedical, Inc. All entities have supplied resources to the project, and will continue to share the costs of the project. The School of Medicine has an ongoing commitment to developing cardiac MRI, as demonstrated by its substantial investment in MRI scanners, including one adjacent to the cardiac catheterization laboratory. These scanners have a magnet that is short enough to allow access to the groin vessels for placement of catheters for diagnostic and interventional procedures. Robin Medical has developed technologies for precisely localizing the tip of a catheter inside an MRI scanner, and is developing technology for deflecting the tip using the MRI magnetic fields. MicroHelix is developing specialized catheter electrodes that reject MRI electromagnetic interference. NaviCath is developing an MRI-compatible system for remote manipulation of catheters that will allow catheters to be manipulated in patients in MR scanners that are too long to allow easy access to the groin vessels. Irvine Biomedical is supplying non-magnetic electrode catheters for use in the MRI scanner.

描述（由申请人提供）： 心脏结构异常患者发生的室性快速心律失常和心房颤动是当代心脏病学中最重要的心律失常，尽管取得了很大进展，但仍然是治疗挑战。心脏的侵入性电学研究（电生理学研究）通常用于心律失常的诊断和治疗，并且许多心律失常可以通过射频（RF）导管消融选择性破坏关键电通路来治愈。然而，研究患者心律失常的一个主要限制是缺乏准确关联解剖信息和电信息的能力。另一个主要限制是在导管消融过程中缺乏可视化心肌消融区域的能力，因此很难确认所需位置是否存在消融病变。我们正在开发将磁共振成像 (MRI) 的解剖信息与电生理测试和消融相结合的方法。 我们假设 MRI 具有 MRI 兼容（非磁性）电极导管、导管尖端位置传感器、心内接收器、实时 MRI 扫描仪控制、远程控制导管操纵器和 3 维成像软件，可以 (1) 提供能够准确地可视化心脏解剖结构，(2) 提供精确的导管导航而无需辐射，(3) 提供可视化消融病变的能力，以及 (4) 帮助生成更准确的电图。我们之前的项目涉及 (1) 技术开发，(2) 论证 MRI 引导动物导管的可行性，以及 (3) 动物和房性心律失常患者的病变可视化。这一竞争性的延续涉及 (1) 额外的技术开发，(2) 改进不同子系统的集成，(3) 研究接受标准消融的患者成功消融的决定因素，以及 (4) 将应用扩展到实时房性和室性心律失常患者的 MRI 引导治疗。此外，该项目开发的技术还应适用于使用 MRI 来指导一般介入手术。 该项目是约翰霍普金斯大学医学院（医学、放射学和生物医学工程）、Robin Medical Inc.、MicroHelix Inc.、NaviCath Inc. 和 Irvine Biomedical, Inc. 之间的合作伙伴关系。所有实体都为该项目提供了资源，并将继续分担该项目的费用。医学院一直致力于开发心脏 MRI，其对 MRI 扫描仪的大量投资就证明了这一点，其中包括一台毗邻心导管实验室的扫描仪。这些扫描仪具有足够短的磁铁，可以进入腹股沟血管，放置导管以进行诊断和介入手术。 Robin Medical 开发了在 MRI 扫描仪内精确定位导管尖端的技术，并正在开发利用 MRI 磁场偏转尖端的技术。 MicroHelix 正在开发可抑制 MRI 电磁干扰的专用导管电极。 NaviCath 正在开发一种与 MRI 兼容的系统，用于远程操纵导管，该系统将允许在 MR 扫描仪中操纵患者体内的导管，因为导管太长而无法轻松进入腹股沟血管。 Irvine Biomedical 正在供应用于 MRI 扫描仪的非磁性电极导管。