Mapping Electrical Activation in Atrial Fibrillation

绘制心房颤动的电激活图

• 批准号: 8480041
• 负责人: OMER BERENFELD
• 金额: $ 35.95万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8480041
• 关键词: Ablation; Acute; Affect; Algorithms; American; Anti-Arrhythmia Agents; Arrhythmia; Atrial Fibrillation; Automobile Driving; Cardiac; Catheters; Complex; Computer Simulation; Computers; Cryosurgery; Data; Development; Devices; Diagnostic; Electrophysiology (science); Fibrosis; Fluorescence; Frequencies; Functional disorder; Future; Goals; Heart; Heart Atrium; Heterogeneity; Human; Image; Individual; Ion Channel; Knowledge; Lead; Left atrial structure; Lesion; Location; Long-Term Effects; Maintenance; Maps; Measures; Methods; Metric; Modality; Modeling; Nature; Optics; Pathway interactions; Patients; Pattern; Pharmaceutical Preparations; Play; Prevalence; Property; Pulmonary veins; Resolution; Rest; Risk; Scheme; Sheep; Simulate; Site; Solid; Source; Spatial Distribution; Stratification; Stroke; System; Testing; Therapeutic Intervention; Time; Translating; Translations; base; design; heart electrical activity; improved; in vivo; novel; novel strategies; public health relevance; reconstruction; simulation; success; tool

DESCRIPTION (provided by applicant): This project aims at developing, validating and using novel mapping approaches to enhance the understanding of excitation dynamics in atrial fibrillation (AF) and to improve its treatment. AF is the most common sustained arrhythmia in humans afflicting more than 2.5 million Americans and is the leading cause of embolic stroke. For patients with AF, anti-arrhythmic drugs perform poorly and ablation, with controversial success rate and long-term effects, is often the only therapy available. Thus, advancing our understanding of the mechanisms of the arrhythmia and how to device better therapies for it are of paramount importance. It is generally accepted that fibrillation is a common end-pathway of various insults to the heart with multi-factorial alterations in the electrophysiology of the substrate and its activation patterns. It is also acceptable that the alterations promoting the onset and controlling the maintenance of fibrillation have significant regional as well as inter-patient heterogeneity. It is therefore the general objective of this proposal to develop a set of novel mapping approaches that will improve the capability of characterizing the patterns of electrical activation specific to underlying ionic heterogeneities. The proposed study will include full-view (panoramic) intracardiac optical/electrical recordings in isolated sheep hearts and electrical recordings in-vivo sheep. We will take advantage of our previous developments in fluorescence endoscopic imaging of the electrical activity of the heart and singularity value decomposition (SVD) algorithms to design and test a novel approach that in its final form will enable a better correlation between the space-time and frequency properties of the fibrillating atria, with direct possible applicability to individual patients. Our approach builds on a novel SV factorization into ranked space, time and frequency interrelated components to better localize and track potential drivers of AF. This numerical scheme will be included in 3 specific aims as follows: (i) To develop increasingly detailed computer models of the atria to simulate different AF scenarios and validate the SVD ability to point to a driver location, or whether such a driver exists. (ii) To apply the SVD approach to panoramic optical mapping data from two intact atria of isolated sheep heart. The panoramic high resolution optical mapping will be used as a reference for the SVD analysis performed on electrical intracadiac recordings. (iii) To apply the validated electrical mapping algorithms to AF in-vivo in the sheep. Reversible atrial lesions induced by cryoablation will be used to test successful localization of drivers and termination of AF. Accomplishing the aims of the study will provide a solid framework for mapping AF dynamics in patients to improve its understanding and therapy.

描述（由申请人提供）：该项目旨在开发、验证和使用新颖的绘图方法，以增强对心房颤动（AF）激励动力学的理解并改善其治疗。 AF 是人类最常见的持续性心律失常，困扰着超过 250 万美国人，也是栓塞性中风的主要原因。对于房颤患者，抗心律失常药物效果不佳，而消融往往是唯一可用的治疗方法，但其成功率和长期效果存在争议。因此，增进我们对心律失常机制的理解以及如何为其设计更好的治疗方法至关重要。人们普遍认为，颤动是各种心脏损伤的常见最终途径，其底物的电生理学及其激活模式发生多因素改变。促进颤动发作和控制颤动维持的改变具有显着的区域和患者间异质性也是可以接受的。因此，该提案的总体目标是开发一套新颖的绘图方法，以提高表征特定于潜在离子异质性的电激活模式的能力。拟议的研究将包括 离体羊心脏的全视图（全景）心内光学/电记录和活体羊的电记录。我们将利用我们之前在心脏电活动荧光内窥镜成像和奇异值分解（SVD）算法方面的进展来设计和测试一种新方法，其最终形式将能够在时空和时空之间建立更好的相关性。颤动心房的频率特性，可能直接适用于个体患者。我们的方法建立在一种新颖的 SV 分解为排序的空间、时间和频率相关组件的基础上，以更好地定位和跟踪 AF 的潜在驱动因素。该数值方案将包含以下 3 个具体目标：（i）开发越来越详细的心房计算机模型，以模拟不同的 AF 场景并验证 SVD 指向驾驶员位置或是否存在此类驾驶员的能力。 (ii) 将 SVD 方法应用于来自离体羊心脏的两个完整心房的全景光学测绘数据。全景高分辨率光学映射将用作对心脏内电记录进行 SVD 分析的参考。 (iii) 将经过验证的电图算法应用于绵羊体内 AF。冷冻消融引起的可逆心房损伤将用于测试驱动因素的成功定位和房颤的终止。实现该研究的目标将为绘制患者房颤动力学提供坚实的框架，以提高对房颤的理解和治疗。