Improved Targeting and Assessment of Electrophysiology Intervention

改进电生理干预的针对性和评估

• 批准号: 7568516
• 负责人: HENRY R HALPERIN
• 金额: $ 154.82万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-15 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7568516
• 关键词: 3-Dimensional; Ablation; Affect; Anatomy; Animal Model; Animals; Arrhythmia; Atrial Fibrillation; Biomedical Engineering; Cardiac; Cardiac ablation; Catheters; Cauterize; Cessation of life; Cicatrix; Clinical; Computer Simulation; Computer software; Congenital Heart Defects; Cost Sharing; Development; Dimensions; Electrodes; Electrophysiology (science); Four-dimensional; Generations; Heart; Heart Atrium; Image; Imagery; Individual; Intervention; Lesion; Location; Magnetic Resonance Imaging; Manuals; Maps; Measurement; Medical; Medicine; Methods; Morphology; Myocardial; Myocardial tissue; Myocardium; Pathway interactions; Patients; Physiologic pulse; Procedures; Production; Pulmonary veins; Radiology Specialty; Recurrence; Research; Resolution; Safety; Scanning; Structure; Surface; Symptoms; System; Technology; Testing; Thermography; Time; United States; Universities; Update; Ventricular Arrhythmia; Ventricular Tachycardia; X-Ray Computed Tomography; base; body system; design; detector; image guided intervention; image guided therapy; image reconstruction; improved; public health relevance; remote sensor; response; sensor; software development

DESCRIPTION (provided by applicant): Atrial fibrillation (AF) and ventricular tachycardia (VT) affect millions of patients in the United States. These arrhythmias can be cured with catheter ablation, but the arrhythmias often recur. The inability to confirm the presence of ablated lesions in the desired locations is the major factor in the greater than 30 % recurrence of AF after ablation. Additional limitations of current ablation technology include: (1) difficulty in navigating catheters to exact locations, making it difficult to accurately place ablations, and (2) the lack of ability to adequately predict the pathways of VT through scar, which are the targets for ablation. We are developing ways of combining the anatomic information from magnetic resonance imaging (MRI) and computed tomography (CT), with catheter ablation, for performing advanced real-time image guided interventions. It is not known, however, whether MRI or CT will be superior for image guided interventions. Both are included in this project because a number of the technologies being developed can be used with both MRI and CT. We hypothesize that high resolution imaging with MRI, and/or CT, with compatible electrode catheters, catheter-tip location sensors, remote-controlled catheter manipulators, real-time scanner control, thermal imaging, and 4-dimensional (3 spatial dimensions plus time) imaging software can (1) provide for accurate navigation of catheters, (2) provide the ability to titrate and confirm the presence of ablated lesions in the desired locations, (3) aid in producing more accurate electrical maps, and (4) aid in predicting the extent of ablation needed to eliminate the target arrhythmia. We have previously demonstrated the feasibility of (1) real- time MRI guidance of catheters, (2) lesion visualization using CT and MRI, (3) high resolution imaging of preserved myocardial tissue in scar, and (4) using computational modeling to predict the location of VT circuits. This proposal deals with developing (1) improved catheter tip location sensors, (2) improved real-time scanner control, (3) dynamic 3-dimensional image reconstruction, with superimposed catheter tip location information, (4) improved high resolution imaging of myocardium so that details of preserved myocardium within scar can be adequately visualized, (5) a computational model that can predict the VT circuits in individual patients based on the detailed scar morphology, (6) improved methods for predicting individual patient's response to ablation, (7) methods for real-time registration of multimodal information, including electrical maps, and multiple images, (8) MRI thermography to aid in real-time titrating and assessing of ablation lesion formation, and (9) remote controlled catheter manipulators to improve the accuracy of catheter placement. We will apply this technology to real-time advanced image guided therapy in patients with atrial and ventricular arrhythmias, and potentially broaden its use to interventional procedures in general. This project is a partnership between the Johns Hopkins University Departments of Medicine, Radiology, and Biomedical Engineering; and industrial partners (with cost sharing): Irvine Biomedical (clinical grade catheters), Hansen Medical (catheter manipulation system), and Imricor (catheter components). PUBLIC HEALTH RELEVANCE: Rhythm abnormalities of the heart, where the heart beats too fast, affect millions of people in the United States. These abnormalities can cause substantial symptoms and/or death, and some can be cured by cauterizing (ablating) a small portion of the heart. Methods are being developed to use the real-time, and high quality imaging of Magnetic Resonance Imaging and Multi-Detector Computed Tomography to improve substantially the safety and efficacy of these ablations, as well as extend these methods to procedures involving other organ systems

描述（由申请人提供）：心房颤动 (AF) 和室性心动过速 (VT) 影响着美国数百万患者。这些心律失常可以通过导管消融治愈，但心律失常经常复发。无法确认所需位置是否存在消融病灶是消融后 AF 复发率超过 30% 的主要因素。当前消融技术的其他局限性包括：(1) 难以将导管导航到精确位置，从而难以准确放置消融，以及 (2) 缺乏充分预测 VT 通过疤痕的途径的能力，而疤痕是治疗的目标。消融。我们正在开发将磁共振成像 (MRI) 和计算机断层扫描 (CT) 的解剖信息与导管消融相结合的方法，以执行先进的实时图像引导干预措施。然而，尚不清楚 MRI 还是 CT 是否更适合图像引导干预。两者都包含在该项目中，因为正在开发的许多技术可同时用于 MRI 和 CT。我们假设 MRI 和/或 CT 的高分辨率成像，具有兼容的电极导管、导管尖端位置传感器、远程控制导管操纵器、实时扫描仪控制、热成像和 4 维（3 个空间维度加时间） ) 成像软件可以 (1) 提供导管的精确导航，(2) 提供滴定和确认所需位置是否存在消融病灶的能力，(3) 帮助生成更准确的电子图，以及 (4) 帮助在预测程度时消除目标心律失常所需的消融。我们之前已经证明了以下方面的可行性：(1) 导管的实时 MRI 引导，(2) 使用 CT 和 MRI 进行病变可视化，(3) 疤痕中保存的心肌组织的高分辨率成像，以及 (4) 使用计算模型进行预测VT 电路的位置。该提案涉及开发 (1) 改进的导管尖端位置传感器，(2) 改进的实时扫描仪控制，(3) 动态 3 维图像重建，叠加导管尖端位置信息，(4) 改进的心肌高分辨率成像以便可以充分可视化疤痕内保存的心肌的细节，（5）可以根据详细的疤痕形态预测个体患者的 VT 回路的计算模型，（6）用于预测个体患者对消融反应的改进方法， (7) 多模态信息实时配准方法，包括电图和多图像，(8) MRI 热成像辅助实时滴定和评估消融病变形成，以及 (9) 远程控制导管操纵器，以改进导管放置的准确性。我们将将该技术应用于房性和室性心律失常患者的实时先进图像引导治疗，并有可能将其用途扩大到一般介入手术。该项目是约翰·霍普金斯大学医学系、放射学系和生物医学工程系之间的合作项目；和工业合作伙伴（费用分摊）：Irvine Biomedical（临床级导管）、Hansen Medical（导管操纵系统）和 Imricor（导管组件）。公众健康相关性：心律异常（即心跳过快）影响着数以百万计的美国人。这些异常可能会导致严重的症状和/或死亡，有些可以通过烧灼（消融）心脏的一小部分来治愈。正在开发使用磁共振成像和多探测器计算机断层扫描的实时高质量成像的方法，以大幅提高这些消融的安全性和有效性，并将这些方法扩展到涉及其他器官系统的手术