Atrial fibrillation ablation assessment and guidance using native-contrast T1 weighted MRI

使用自然对比 T1 加权 MRI 进行心房颤动消融评估和指导

• 批准号: 10182527
• 负责人: Aravindan Kolandaivelu
• 金额: $ 78.27万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10182527
• 关键词: 3-Dimensional; Ablation; Acute; Animal Model; Animals; Arrhythmia; Atrial Fibrillation; Atrial Flutter; Cardiac ablation; Chronic; Clinical; Contrast Media; Edema; Failure; Feedback; Health Care Costs; Heart; Heart Atrium; Histologic; Histology; Iatrogenesis; Image; Injury; Intravenous; Lesion; Location; Magnetic Resonance Imaging; Measures; Medical; Methods; Morbidity - disease rate; Myocardium; Necrosis; Operative Surgical Procedures; Outcome; Patients; Procedures; Pulmonary veins; Radiofrequency Interstitial Ablation; Recurrence; Reporting; Site; Symptoms; Techniques; Thinness; Time; Tissues; Translating; Treatment Efficacy; Treatment Failure; Ventricular Tachycardia; base; contrast enhanced; cooking; effective therapy; follow-up; healing; imaging modality; improved; improved outcome; necrotic tissue; porcine model; soft tissue; success; tissue injury

Project Summary: Atrial fibrillation (Afib) is a common arrhythmia that is currently difficult to manage. Afib catheter ablation is more effective than medical therapy for maintaining normal rhythm. However, treatment failure is common, around 50% for persistent forms of Afib. Attempts to improve outcomes by performing more extensive ablation have been limited by new arrhythmias, like atrial flutter, which can be caused by the procedure. Outcomes can be improved by repeat procedures, but arrhythmia recurrence is still common. Surgical procedures have higher success for treating Afib, but the successful techniques are prohibitively invasive for treating most patients. Methods to improve the success of the first Afib catheter ablation procedure are needed. Ablation failure is thought to be due to the inability to create properly placed, permanent ablation lesions. Currently, transient tissue injury and edema caused by ablation can make ablation appear complete at the end of the procedure. However, as transient injury resolves over days to weeks, arrhythmia can recur. Current methods for determining whether ablation is finished cannot tell the difference between permanent and transient tissue injury. Methods that show where additional ablation needs to be performed and confirm that permanent ablation has been completed are expected to improve the success of Afib ablation. We have developed a non-contrast MRI method for seeing permanent ablation lesions. We recently showed this method can see ablation lesions in the thin walled atrium, which is the part of the heart that causes Afib. Because this method does not need intravenous contrast, it can be repeated during a procedure until complete ablation is confirmed. This proposal will find out if this method can 1) detect sites of incomplete Afib ablation, 2) guide additional ablation to these sites, and 3) confirm ablation is complete at the end of the procedure. This proposal also translates this method, previously developed in animals, to patients undergoing Afib ablation. Effective acute assessment of ablative treatment would provide an important component of feedback not currently available for procedure guidance. Successful completion of these aims will introduce a new paradigm for confirming ablation completion in order to reduce arrhythmia recurrence following AFib ablation. These methods could also be applied to other arrhythmias where incomplete ablation contributes to poor ablation outcomes, like ventricular tachycardia.

项目摘要： 心房颤动（AFIB）是一种常见的心律不齐，目前难以管理。 AFIB导管 消融比维持正常节奏的药物治疗更有效。但是，治疗失败是 常见，持续形式的AFIB约50％。尝试通过更多 广泛的消融受到新的心律不齐的限制，例如心房颤动，这可能是由 程序。重复程序可以改善结果，但是心律不齐的复发仍然很常见。 手术程序在治疗AFIB方面取得了更高的成功，但是成功的技术是过时的 用于治疗大多数患者的侵入性。改善第一AFIB导管消融成功的方法 需要程序。 人们认为消融失败是由于无法创建正确的永久消融 病变。目前，瞬态组织损伤和由消融引起的水肿可以使消融看起来完整 在程序结束时。但是，随着瞬时损伤在数天到几周内消失，心律不齐。 确定消融是否完成的当前方法无法分辨永久性的差异 和瞬态组织损伤。显示需要执行其他消融并确认的方法 预计永久消融将改善AFIB消融的成功。 我们已经开发了一种非对比度MRI方法，用于查看永久消融病变。我们最近 证明这种方法可以看到薄壁壁中庭中的消融病变，这是心脏的一部分 导致AFIB。因为此方法不需要静脉对比，因此可以在过程中重复 直到确认完成。 该建议将找出此方法是否可以1）检测不完整的AFIB消融位点，2）指南 对这些站点的额外消融，以及3）确认在过程结束时消融已完成。这 提案还将以前在动物中开发的方法转化为接受AFIB消融的患者。 有效对烧蚀治疗的急性评估将为 反馈目前尚未用于程序指导。这些目标的成功完成将 引入一个新的范式，以确认消融完成，以减少心律不齐的复发 遵循AFIB消融。这些方法也可以应用于其他不完整的心律失常 消融有助于消融结果，例如心室心动过速。