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）： 在结构异常心脏的患者中发生的心室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，尽管进展很大，但仍会遇到治疗挑战。心脏（电生理研究）的侵入性电研究经常用于心律不齐的诊断和治疗，并且可以通过选择性破坏临界电路（RF）导管消融来治愈许多心律不齐。然而，研究患者心律不齐的主要局限性是缺乏准确相关的解剖学和电气信息的能力。另一个主要限制是缺乏在导管消融过程中可视化心肌消融区域的能力，因此很难在所需的位置确认存在消融的病变。我们正在开发将磁共振成像（MRI）以及电生理测试和消融的解剖信息结合的方法。 我们假设MRI具有MRI兼容（非磁性）电极导管，导管尖端的位置传感器，心脏内接收器，实时MRI扫描仪控制，遥控器导管操纵器和3尺寸成像软件可以（1）提供（1），不提供可视化范围的能力，可提供型号的范围（2）范围（2）范围（2）范围（2）范围（2）navel（2）naviation（2）消融的病变，（4）有助于产生更准确的电图。我们以前的项目涉及（1）技术开发，（2）表明动物中导管对MRI指导的可行性，以及（3）动物的病变可视化以及心房心律不齐的患者。这种竞争的延续涉及（1）额外的技术开发，（2）改善不同子系统的整合，（3）研究在接受标准消融的患者中成功消融的决定因素，以及（4）在心脏和心律失常心律失常的患者中扩大对实时MRI指导疗法的应用。此外，该项目开发的技术还应适用于使用MRI通常指导介入程序。 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），罗宾医疗公司，Microhelix Inc.，Navicath Inc.和Irvine Biomedical，Inc。之间的合作伙伴关系。医学院一直致力于发展心脏MRI，这证明了其对MRI扫描仪的大量投资，其中包括与心脏导管实验室相邻的一项。这些扫描仪具有足够短的磁铁，可以允许进入腹股沟容器以放置导管以进行诊断和介入程序。 Robin Medical开发了用于精确定位MRI扫描仪内导管尖端的技术，并正在开发用于使用MRI磁场偏转尖端的技术。 MicroHelix正在开发拒绝MRI电磁干扰的专门导管电极。 Navicath正在开发一个与MRI兼容的系统，用于远程操纵导管，该系统将使MR扫描仪中的患者操纵导管，而MR扫描仪的患者太长，无法轻松进入腹股沟容器。 Irvine生物医学正在提供非磁电极导管，用于MRI扫描仪。