Determining strength and temporal stability of rotational and focal sources during human atrial fibrillation

确定人类心房颤动期间旋转源和焦点源的强度和时间稳定性

• 批准号: 9978611
• 负责人: WOUTER-JAN RAPPEL
• 金额: $ 11.81万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9978611
• 关键词: Ablation; Acute; Address; Advanced Development; Affect; Aging; Algorithms; American; Arrhythmia; Atrial Fibrillation; Automobile Driving; Body Surface; Catheters; Clinical Research; Clinical Trials; Communities; Comparative Study; Complex; Data; Data Set; Economic Burden; Ectopic beats; Electrodes; Freedom; Goals; Health; Heart Atrium; Heart failure; Human; Lead; Left; Lesion; Maps; Measures; Mechanics; Meta-Analysis; Methodology; Methods; Morbidity - disease rate; Multi-Institutional Clinical Trial; Outcome; Patients; Pattern; Pharmacology; Phase; Population; Positioning Attribute; Procedures; Public Health; Publishing; Pulmonary veins; Randomized; Reporting; Resources; Rotation; Site; Source; Stroke; Techniques; Testing; Therapeutic; Tissues; Uncertainty; Validation; algorithmic methodologies; base; cohort; experience; heart function; improved; indexing; insight; interest; large datasets; mortality; multi-electrode arrays; novel; open source; secondary analysis; source localization; spatiotemporal; success; symposium

Project Summary Atrial Fibrillation (AF) is the most common cardiac arrhythmia during which the normal, organized rhythm is disrupted and replaced by irregular wave propagation which compromises the primary mechanical function of the heart. It is a serious health concern that, if left untreated, can lead to increased morbidity and even mortality. With the aging of the population, it is a growing problem that affects millions of Americans and represents a considerable economic burden. Unfortunately, the existing therapies have limited success, mostly because the mechanisms that initiate and maintain AF remain poorly understood. Multi-electrode arrays, which can record unipolar electrograms at many discrete sites, are increasingly used to determine the spatio-temporal activation patterns during AF and have revealed the presence of multiple rotational and focal sources of activation. Targeting these sources with localized ablation results in acute termination in roughly 30-35% of patients but can result in long-term freedom of AF that is much higher than other therapies (75-80%). It is currently not clear why some patients do not terminate acutely, which source drives AF, and which source should be targeted first. We propose to develop a quantitative analysis of the temporal stability and the strength of the rotational and focal sources. We will use an existing and extensive data set of unipolar recordings that used a 64-pole basket electrode that covered most of the atrium. We will consider two groups of patients: one in which targeted ablation at sites of rotational or focal activity terminated AF and one in which it did not. We will construct phase maps using a methodology based on a previously published study and will develop algorithms that can quantify the strength and temporal stability of the sources. A comparison between the two groups will allow us to determine whether the elimination of sources with greater strength or stability can predict the result of targeted ablation. Our findings will then be tested in a validation cohort. Our study should result in improved targeted ablation strategies, enabling and advancing the development of better therapeutic strategies for AF.

项目概要 心房颤动 (AF) 是最常见的心律失常，在此期间，正常的、有组织的节律被破坏。 被不规则的波传播破坏和取代，这损害了主要机械功能 的心。这是一个严重的健康问题，如果不及时治疗，可能会导致发病率增加，甚至 死亡。随着人口老龄化，这是一个日益严重的问题，影响着数百万美国人和 代表着相当大的经济负担。不幸的是，现有疗法的成功有限， 主要是因为人们对房颤的引发和维持机制仍知之甚少。 多电极阵列可以在许多离散位置记录单极电图，越来越多地使用 确定 AF 期间的时空激活模式，并揭示了多个 旋转和焦点激活源。通过局部消融来瞄准这些来源会导致急性 约 30-35% 的患者可终止房颤，但可长期摆脱房颤，远高于 其他疗法（75-80%）。目前尚不清楚为什么有些患者没有急性终止，其来源 驱动自动对焦，以及应首先瞄准哪个来源。 我们建议对时间稳定性和旋转强度进行定量分析 焦点来源。我们将使用现有的广泛的单极记录数据集，该数据集使用 64 极 覆盖大部分心房的篮式电极。我们将考虑两组患者：一组患者 在旋转或局灶性活动部位进行针对性消融可终止房颤，而另一种则不会。我们将 使用基于先前发表的研究的方法构建相图，并将开发 可以量化源的强度和时间稳定性的算法。之间的比较 两组将使我们能够确定是否消除具有更大强度或稳定性的来源 可以预测靶向消融的结果。然后我们的研究结果将在验证队列中进行测试。我们的研究 应导致改进的有针对性的消融策略，从而促进和促进更好的开发 AF 的治疗策略。