Improved Targeting and Assessment of Electrophysiology Intervention

改进电生理干预的针对性和评估

• 批准号: 8511178
• 负责人: HENRY R HALPERIN
• 金额: $ 148.88万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-15 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8511178
• 关键词: 3-Dimensional; Ablation; Affect; Anatomy; Animal Model; Animals; Arrhythmia; Atrial Fibrillation; Biomedical Engineering; Cardiac; Cardiac ablation; Catheters; Cauterize; Cessation of life; Cicatrix; Clinical; Computer Simulation; Computer software; Congenital Heart Defects; Cost Sharing; Development; Dimensions; Electrodes; Electrophysiology (science); Four-dimensional; Generations; Health; Heart; Heart Atrium; Image; Imagery; Individual; Intervention; Lesion; Location; Magnetic Resonance Imaging; Manuals; Maps; Measurement; Medical; Medicine; Methods; Morphology; Myocardial; Myocardial tissue; Myocardium; Pathway interactions; Patients; Physiologic pulse; Procedures; Production; Pulmonary veins; Radiology Specialty; Recurrence; Research; Resolution; Safety; Scanning; Structure; Surface; Symptoms; System; Technology; Testing; Thermography; Time; United States; Universities; Update; Ventricular Arrhythmia; Ventricular Tachycardia; X-Ray Computed Tomography; base; body system; design; detector; image guided intervention; image guided therapy; image reconstruction; improved; remote sensor; response; sensor; software development

DESCRIPTION (provided by applicant): Atrial fibrillation (AF) and ventricular tachycardia (VT) affect millions of patients in the United States. These arrhythmias can be cured with catheter ablation, but the arrhythmias often recur. The inability to confirm the presence of ablated lesions in the desired locations is the major factor in the greater than 30 % recurrence of AF after ablation. Additional limitations of current ablation technology include: (1) difficulty in navigating catheters to exact locations, making it difficult to accurately place ablations, and (2) the lack of ability to adequately predict the pathways of VT through scar, which are the targets for ablation. We are developing ways of combining the anatomic information from magnetic resonance imaging (MRI) and computed tomography (CT), with catheter ablation, for performing advanced real-time image guided interventions. It is not known, however, whether MRI or CT will be superior for image guided interventions. Both are included in this project because a number of the technologies being developed can be used with both MRI and CT. We hypothesize that high resolution imaging with MRI, and/or CT, with compatible electrode catheters, catheter-tip location sensors, remote-controlled catheter manipulators, real-time scanner control, thermal imaging, and 4-dimensional (3 spatial dimensions plus time) imaging software can (1) provide for accurate navigation of catheters, (2) provide the ability to titrate and confirm the presence of ablated lesions in the desired locations, (3) aid in producing more accurate electrical maps, and (4) aid in predicting the extent of ablation needed to eliminate the target arrhythmia. We have previously demonstrated the feasibility of (1) real- time MRI guidance of catheters, (2) lesion visualization using CT and MRI, (3) high resolution imaging of preserved myocardial tissue in scar, and (4) using computational modeling to predict the location of VT circuits. This proposal deals with developing (1) improved catheter tip location sensors, (2) improved real-time scanner control, (3) dynamic 3-dimensional image reconstruction, with superimposed catheter tip location information, (4) improved high resolution imaging of myocardium so that details of preserved myocardium within scar can be adequately visualized, (5) a computational model that can predict the VT circuits in individual patients based on the detailed scar morphology, (6) improved methods for predicting individual patient's response to ablation, (7) methods for real-time registration of multimodal information, including electrical maps, and multiple images, (8) MRI thermography to aid in real-time titrating and assessing of ablation lesion formation, and (9) remote controlled catheter manipulators to improve the accuracy of catheter placement. We will apply this technology to real-time advanced image guided therapy in patients with atrial and ventricular arrhythmias, and potentially broaden its use to interventional procedures in general. This project is a partnership between the Johns Hopkins University Departments of Medicine, Radiology, and Biomedical Engineering; and industrial partners (with cost sharing): Irvine Biomedical (clinical grade catheters), Hansen Medical (catheter manipulation system), and Imricor (catheter components).

描述（由申请人提供）：房颤（AF）和心室心动过速（VT）影响美国数百万患者。这些心律不齐可以用导管消融固化，但心律不齐通常会复发。无法在所需位置确认消融病变的存在是消融后AF复发大于30％的主要因素。当前消融技术的其他局限性包括：（1）将导管导航到确切位置的困难，使其难以准确放置，以及（2）缺乏充分预测VT通过疤痕的途径的能力，这是用于的目标，这是消融。我们正在开发将磁共振成像（MRI）和计算机断层扫描（CT）（CT）与导管消融结合的解剖信息结合的方法，用于执行先进的实时图像引导干预措施。但是，对于图像引导的干预措施，MRI还是CT是否会优越。这两者都包含在该项目中，因为许多正在开发的技术都可以与MRI和CT一起使用。我们假设使用MRI和/或CT进行高分辨率成像，并具有兼容的电极导管，导管尖端的位置传感器，遥控导管操纵器，实时扫描仪控制，热成像和4维）成像软件（1）可以提供准确的导管导航，（2）提供滴定和确认所需位置中蚀出的病变的能力，（3）有助于生成更准确的电气图，（4）辅助在预测消除目标心律不齐所需的消融程度时。以前，我们已经证明了（1）实时MRI指导的可行性，（2）使用CT和MRI的病变可视化，（3）（3）对疤痕中保留的心肌组织的高分辨率成像，以及（4）使用计算建模来预测VT电路的位置。该建议涉及开发（1）改进导管尖端位置传感器，（2）改进的实时扫描仪控制，（3）动态3维图像重建，并具有叠加导管尖端位置信息，（4）改进心肌的高分辨率成像因此，可以充分可视化疤痕中保留的心肌的细节，（5）一种计算模型，可以根据详细的疤痕形态来预测个别患者的VT电路，（6）改进的方法来预测个体患者对消融的反应（7）（7）（7 ）多模式信息实时注册的方法，包括电气图和多个图像，（8）MRI热量表有助于实时滴定和评估消融病变形成，以及（9）遥控导管操纵器以提高准确性导管放置。我们将将这项技术应用于心房和心室心律不齐的患者的实时高级图像指导疗法，并有可能将其用于介入的介入程序。该项目是约翰·霍普金斯大学医学，放射学和生物医学工程系之间的合作伙伴关系；和工业伙伴（具有成本分担）：尔湾生物医学（临床级导管），汉森医疗（导管操纵系统）和Imricor（导管组件）。