Identification of AF Ablation Targets via a Steerable Actuated Catheter(AFIB)

通过可操纵驱动导管 (AFIB) 识别 AF 消融目标

基本信息

批准号：
9327633
负责人：
JAYDEV P. DESAI
金额：
$ 11.17万
依托单位：
GEORGIA INSTITUTE OF TECHNOLOGY
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-05-01 至 2018-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9327633
关键词：
Ablation Acute Aftercare Algorithms American Anatomy Arrhythmia Atrial Fibrillation Caliber Cardiac Cardiology Catheters Classification Clinical Complication Diagnosis Diagnostic Electrodes Electrophysiology (science)Evaluation Feedback Freedom Goals Health Health Care Costs Heart Heart Atrium Human Image Image Analysis Imagery In Situ Left Lesion Location Mechanics Medical Morbidity - disease rate Muscle Myocardial Myocardial tissue Myocardium Necrosis Newly Diagnosed Optical Coherence Tomography Outcome Patients Plant Roots Positioning Attribute Prevalence Procedures Pulmonary veins Radial Radiofrequency Interstitial Ablation Recurrence Reporting Rest Risk Robotics Sheep Signal Transduction Structure Technology Tissue imaging Tissues Training Treatment Failure Ultrasonics Veins accurate diagnosis alternative treatment cardiovascular visualization clinically relevant follow-up histological studies imaging probe innovation interest mechanical drive microsystems mortality novel diagnostics success tool

项目摘要

DESCRIPTION (provided by applicant): Atrial fibrillation (AF) is the most common cardiac arrhythmia and has high patient morbidity, increases mortality two-fold, and increases health care costs. Each year, about 200,000 Americans are newly diagnosed with AF with a prevalence of several million in the U.S. alone. In the majority of cases, AF has been shown to originate from triggers in the pulmonary veins. Histological studies have shown that those triggers are most commonly located in extensions of left atrial myocardium into the proximal pulmonary veins. Recently, radiofrequency ablation of AF has been introduced as a potentially curative alternative treatment. During the ablation of AF, those myocardial sleeves inside the pulmonary veins are identified indirectly by using the local electrical signals and then ablating a the corresponding recording electrodes in the pulmonary veins. Successful isolation of the pulmonary veins has been reported to have short-term success of eliminating AF in 60-90% of patients. However, recurrence rates of 50% or more are reported in longer-term follow-up evaluations as the muscular bundles progressively reconnect with the rest of the left atrial myocardium. One possible solution would be to use optical coherence tomography (OCT) to enable a direct visualization of the muscular bundles to guide the ablation and confirm the curative tissue necrosis thereafter. Hence, the goal of this project is to develop a diagnostic too comprising of a discretely actuated steerable robotic catheter with an integrated OCT probe with an ultrasonic micromotor for radial OCT imager positioning that will reliably visualize the pulmonary vein sleeves. Additionally, the ability to confirm complete necrosis of the muscular sleeve (after treatment) through OCT imaging will provide an extremely helpful clinical endpoint to the procedure and reduce the risk of long-term treatment failure and muscular reconnection. Hence, in this project, we will: Specific Aim 1: Develop a discretely actuated steerable robotic catheter with an integrated OCT imaging probe and micromotor for radial OCT imager positioning to aid in navigating to the vein for placement of the OCT imaging probe in the region of interest. Furthermore, the catheter will be able to move in 3D with multiple degrees-of-freedom. Specific Aim 2: Establish OCT imaging criteria for identifying myocardial vs. fibrous tissue and ablated vs. normal cardiac tissue in situ in ex vivo sheep hearts. Specific Aim 3: Evaluate the accuracy of robotic catheter with integrated OCT in identifying: a) atrial myocardial extensions into the pulmonary veins in the ex vivo human heart and b) acute radiofrequency ablation (RFA) lesions in sheep cardiac tissue.

描述（由申请人提供）：心房颤动 (AF) 是最常见的心律失常，患者发病率很高，死亡率增加两倍，并增加医疗费用。每年，约有 200,000 名美国人新诊断出患有 AF 且患病率较高。仅在美国就有数百万人。在大多数情况下，房颤是由肺静脉触发因素引起的。最常见的是左心房心肌向近端肺静脉的延伸，最近，房颤射频消融已被引入作为一种潜在的治疗性替代治疗。在房颤消融过程中，通过使用间接识别肺静脉内的心肌袖。据报道，成功隔离肺静脉可在短期内成功消除房颤。然而，随着肌束逐渐与左心房心肌的其余部分重新连接，60-90% 的患者的复发率达到 50% 或更高。一种可能的解决方案是使用光学相干技术。断层扫描 (OCT) 能够直接观察肌束，从而指导消融并随后确认治愈性组织坏死。因此，该项目的目标是开发一种包含离散诊断的诊断方法。驱动的可操纵机器人导管，带有集成 OCT 探头和超声微电机，用于径向 OCT 成像仪定位，可可靠地可视化肺静脉套管。此外，通过 OCT 成像确认肌肉套管（治疗后）完全坏死的能力将提供极其准确的结果。因此，在这个项目中，我们将：具体目标 1：开发一种离散驱动的可操纵装置。具有集成 OCT 成像探头和微电机的机器人导管，用于径向 OCT 成像仪定位，以帮助导航到静脉，以便将 OCT 成像探头放置在感兴趣的区域。此外，导管将能够以多个角度进行 3D 移动。具体目标 2：建立 OCT 成像标准，用于识别离体绵羊心脏中的心肌与纤维组织以及消融与正常心脏组织。具有集成 OCT 的机器人导管在识别以下方面的准确性：a) 离体人类心脏中的心房心肌延伸至肺静脉；b) 绵羊心脏组织中的急性射频消融 (RFA) 病变。