Catheter Guidance System for RF Ablation of Arrhythmias

用于心律失常射频消融的导管引导系统

• 批准号: 7278390
• 负责人: GORDON B HIRSCHMAN
• 金额: $ 120.72万
• 依托单位: INFOSCITEX CORPORATION
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-30 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7278390
• 关键词: arrhythmia; bioengineering /biomedical engineering; bioimaging /biomedical imaging; biomedical equipment development; clinical biomedical equipment; computer assisted patient care; computer graphics /printing; computer human interaction; computer program /software; computer system design /evaluation; electrical potential; electrocardiography; electrodes; heart catheterization; heart imaging /visualization /scanning; heart surgery; heart ventricle; image guided surgery /therapy; information display; phantom model; radiowave radiation

DESCRIPTION (provided by applicant): Radio frequency (RF) catheter ablation is an established treatment for patients with cardiac arrhythmias. RF ablation of atrio-ventricular nodal reentrant arrhythmias has been highly successful, since the known anatomy of the atrio-ventricular node enables precise identification of the site of origin of the arrhythmia and thus delivery of the ablative energy. Ablation of ventricular tachycardia (VT) presents a greater challenge, since the origin of the arrhythmia could be anywhere in the ventricles, and existing techniques used to locate the site usually require that patients be maintained in arrhythmia for a significant period of time. These factors combine to limit the procedure primarily to treatment of slow VTs in patients who are hemodynamically stable during arrhythmia. In Phase I of this Fast-Track project, concept feasibility will be demonstrated for a new catheter guidance system that will direct the tip of an ablation catheter to the site of origin of an arrhythmia and reduce the time needed to locate the site such that a patient need only be maintained in the arrhythmia for a few beats. The system will feature an innovative "inverse algorithm" analysis code that uses a single equivalent moving dipole (SEMD) to model both electrocardiograph (EGG) potentials from body-surface electrodes and the current pulses delivered from the tip of an ablation catheter. By processing body surface potentials during a few beats of VT, the system will identify the SEMD location that corresponds to the source of the arrhythmia when the bioelectrical source is most localized. Using the same algorithm, it will then identify, in real time, the location of the catheter tip from analysis of potentials resulting from low-energy dipolar current pulses delivered to electrodes located at the tip. The system will also include a real-time graphical display that will allow a clinician to quickly guide the catheter tip to the source of the arrhythmia for precise delivery of RF energy. Even in the presence of realistic levels of noise in the ECG signals, preliminary work has shown that estimation of the SEMD location from body surface potentials is a breakthrough innovation that will allow for precise, rapid guidance of ablation catheters to arrhythmic foci. Phase I will prove feasibility in a breadboard system developed to demonstrate the ability to guide an ablation catheter to the location of an electrical source within a phantom torso. This work will serve as the foundation for development and in-vivo test of a full prototype guidance system in Phase II.

描述（由申请人提供）：射频（RF）导管消融是心律失常患者的既定治疗方法。房室结折返性心律失常的射频消融非常成功，因为房室结的已知解剖结构能够精确识别心律失常的起源部位，从而输送消融能量。室性心动过速（VT）的消融提出了更大的挑战，因为心律失常的起源可能位于心室的任何地方，而用于定位该部位的现有技术通常要求患者在相当长的一段时间内保持心律失常。这些因素结合在一起，限制了该手术主要用于治疗心律失常期间血流动力学稳定的患者的缓慢室速。 在该快速通道项目的第一阶段，将论证新型导管引导系统概念的可行性，该系统将引导消融导管的尖端到达心律失常的起源部位，并减少定位该部位所需的时间，以便患者只需维持心律失常几次即可。该系统将采用创新的“逆算法”分析代码，使用单个等效移动偶极子（SEMD）来模拟体表电极的心电图（EGG）电位和消融导管尖端传递的电流脉冲。通过处理 VT 几次心跳期间的体表电位，系统将识别生物电源最局部化时与心律失常源相对应的 SEMD 位置。然后，它将使用相同的算法，通过分析传递到位于尖端的电极的低能量偶极电流脉冲产生的电势来实时识别导管尖端的位置。该系统还将包括一个实时图形显示器，使临床医生能够快速引导导管尖端到心律失常的源头，以精确地输送射频能量。 即使心电图信号中存在真实的噪声水平，初步工作也表明，根据体表电位估计 SEMD 位置是一项突破性创新，它将允许精确、快速地将消融导管引导至心律失常病灶。第一阶段将证明面包板系统的可行性，该系统旨在演示将消融导管引导至模型躯干内电源位置的能力。这项工作将作为第二阶段完整原型制导系统的开发和体内测试的基础。