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（由适用提供）：心房颤动（AF）是最常见的心律失常，患者发病率高，发病率增加了两倍，并增加了医疗保健成本。每年，仅在美国，就有大约200,000名美国人被新诊断出患有数百万的AF。在大多数情况下，AF已显示出源自肺静脉中的触发因素。组织学研究表明，这些触发因素通常位于左心肌的延伸中，进入近端肺静脉。最近，已引入了AF的射频消融，作为一种潜在的治愈性替代方法。在AF消融过程中，通过使用局部电信号间接识别肺静脉内部的心肌套，然后在肺静脉中烧毁相应的记录电子。据报道，成功分离肺静脉，在60-90％的患者中取消了AF的短期成功。但是，随着肌肉束逐渐与左心心肌的其余部分重新连接，在长期随访评估中报告了50％或以上的复发率。一种可能的解决方案是使用光学相干断层扫描（OCT）使肌肉束的直接可视化指导消融并确认治疗组织坏死。因此，该项目的目的是开发一个过于完整的诊断，该诊断已被离散激活的可传统机器人导管，其集成的OCT探针具有超声波微动物的集成探针，可用于径向OCT成像器定位，以可靠地可视化肺静脉袖子。此外，通过OCT成像确认肌肉套筒完全坏死的能力将为手术提供极为有用的临床终点，并降低长期治疗失败和肌肉重新连接的风险。因此，在这个项目中，我们将：特定目标1：开发一个具有综合的OCT成像探针和微型径向OCT成像器定位的综合激活的机器人导管，以帮助导航到静脉，以将OCT成像探针放置在利益区域。此外，导管将能够以多个自由度的3D移动。特定目标2：建立OCT成像标准，用于鉴定心肌组织与纤维组织，消融与正常心脏组织的原位在离体绵羊心脏中。具体目标3：评估机器人导管在识别中具有综合OCT的精度：a）在体内人心脏中的肺静脉和b）急性辐射频率消融（RFA）病变中的心肌心肌延伸。