Development of an automatic real-time personalized non-invasive localization of the site of origin of the earliest ventricular activation

开发最早心室激动起源部位的自动实时个性化无创定位

• 批准号: 10579726
• 负责人: Shijie Zhou
• 金额: $ 40.55万
• 依托单位: MIAMI UNIVERSITY OXFORD
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10579726
• 关键词: 3-Dimensional; Ablation; Academic Research Enhancement Awards; Accounting; Arrhythmia; Biomedical Engineering; Cardiac; Cardiac Electrophysiologic Techniques; Cardiac ablation; Case Series; Catheters; Cause of Death; Cessation of life; Clinical; Clinical Data; Computer software; Data; Data Set; Developed Countries; Development; Diagnosis; Electrocardiogram; Encapsulated; Event; Geometry; Goals; Heart Arrest; Heart Diseases; Image; Implantable Defibrillators; Lead; Learning; Left ventricular structure; MRI Scans; Magnetic Resonance Imaging; Maps; Methodology; Methods; Mission; Modality; Modeling; Morphology; Myocardium; National Heart, Lung, and Blood Institute; Nature; Patient Care; Patients; Population; Procedures; Prospective, cohort study; Public Health; Radiation therapy; Recurrence; Research; Right ventricular structure; Role; Site; Statistical Models; Structure; Surface; System; Techniques; Technology; Time; Tissues; United States; United States National Institutes of Health; Ventricular; Ventricular Arrhythmia; Ventricular Premature Complexes; Ventricular Tachycardia; Work; X-Ray Computed Tomography; clinical database; computerized; high risk; image processing; improved; innovation; mortality; novel; prospective; signal processing; software development; success; time use; usability

Project Summary Sudden cardiac arrest is one of the leading causes of death in developed countries, accounting for approximately 350,000 deaths per year in the United States. The majority of those events are caused by ventricular arrhythmias (VA). Implantable defibrillators reduce mortality in high-risk patients, but do not prevent recurrent arrhythmias. Suppression of recurrent ventricular tachycardia (VT) can be accomplished effectively with catheter ablation; more recently stereotactic body radiotherapy (SBRT) has been shown to have a potential role. Accurate identification of the substrate responsible for the VA is key to the success of either of these modalities and may be facilitated using the standard 12-lead ECG to noninvasively identify the site from which a focal ventricular tachycardia (VT)/premature ventricular complex (PVC) arises or from which a reentrant circuit exits the central isthmus to activate the “normal” myocardium. Currently, there is not an automatic real-time non-invasive patient-specific approach that can be used to accurately identify the site of origin (SoO) of VA using the 12-lead ECG. Rapid 12-lead ECG interpretation to identify the SoO of VA requires expertise and could be facilitated with a computerized method to automatically locate the VT exit/PVC origin site in real-time. The ability to accurately identify the VT exit/PVC origin site enables the electrophysiologist to concentrate mapping/targeting to a specific region. To tackle this problem, this research proposes to develop a novel non-invasive 3D mapping technique that relies on the assembly of personalized ventricular surfaces from CT/MRI scans in combination with a statistical estimate derived from a large clinical database to accurately identify the VT exit/PVC origin site from an induced/recorded VT/PVC ECG in real time. The project is interdisciplinary as it combines expertise in biomedical engineering, clinical cardiac electrophysiology, ECG signal processing, image processing, and computational statistical modeling. To this end, the project will include the following two activities: 1) to develop the proposed system in clinically usable software; 2) to assess the accuracy of the proposed software in a prospective case-series study (with the goal of achieving a mean localization error of less than 10 mm). The proposed software delivered by this project will provide significant accuracy improvement in the VT exit/PVC origin site localization, potentially decrease in the time of an invasive VA ablation procedure, and would be helpful to accurately target VT for non-invasive cardiac SBRT. The proposed project is innovative in proposing to bring computational statistical modeling that integrates structure data (CT/MRI imaging), function data (ECG), and a large clinical dataset into the realm of contemporary patient care. At its core, the project is of translational nature, with personalized computational statistical modeling being used for guidance of clinical therapies.

项目摘要 突然心脏骤停是发达国家的主要死亡原因之一 在美国，每年约350,000人死亡。这些事件中的大多数是由 心室心律不齐（VA）。可植入的除颤器降低了高危患者的死亡率，但不要 防止复发性心律不齐。可以完成抑制复发性心室心动过速（VT） 有效地进行导管消融；最近的立体定向身体放疗（SBRT）已显示为 发挥潜在的作用。准确识别负责VA的基板是成功的关键 这两种方式都可以使用标准的12铅ECG来制备，以无创识别 局灶性心脏心动过速（VT）/过早心室复合物（PVC）的部位是或来自 该回流电路将其退出中央地峡以激活“正常”心肌。目前，有 不是自动实时非侵入性患者特异性方法，可用于准确识别 使用12铅ECG的VA原产地点（SOO）。 快速的12铅ECG解释以确定VA的SOO需要专业知识，并且可以促进 使用计算机化方法，可以自动定位VT出口/PVC原始站点。能力 准确地识别VT出口/PVC起源位点使电生理学家能够集中精力 映射/定位到特定区域。为了解决这个问题，这项研究提案要开发小说 非侵入性3D映射技术依赖于个性化心室表面的组装 CT/MRI扫描与从大型临床数据库得出的统计估计值结合使用 从诱导/记录的VT/PVC ECG实时确定VT出口/PVC原始站点。该项目是 跨学科，因为它结合了生物医学工程专业知识，临床心脏电生理学，ECG 信号处理，图像处理和计算统计建模。为此，项目将 包括以下两个活动：1）在临床上可用的软件中开发拟议的系统； 2）到 在前瞻性案例研究中评估拟议软件的准确性（目的是实现 平均定位误差小于10 mm）。 该项目提供的拟议软件将在VT上提供显着准确的改进 退出/PVC原产地点本地化，可能在侵入性VA消融程序的时间内减少，并且 对于非侵入性心脏SBRT，将有助于准确靶向VT。拟议的项目是创新的 在提议带来集成结构数据（CT/MRI成像）的计算统计建模时， 功能数据（ECG）和大型临床数据集进入当代患者护理领域。以此为核心 项目具有转化性质，具有个性化计算统计建模用于 临床疗法的指导。