Transmural Electrophysiological Imaging to Guide Catheter Ablation of Arrhythmias

透壁电生理成像指导心律失常导管消融

基本信息

批准号：
8967583
负责人：
Linwei Wang
金额：
$ 22.21万
依托单位：
ROCHESTER INSTITUTE OF TECHNOLOGY
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-11-12 至 2017-10-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8967583
关键词：
Ablation Algorithms Anatomy Animal Model Animals Arrhythmia Body Surface Body Surface Potential Mapping Cardiac ablation Catheters Cicatrix Clinical Clinical Research Clinical Trials Collaborations Complication Computational algorithm Coronary Data Disease Electrocardiogram Electrophysiology (science)Family suidae Fruit Goals Health Heart Heart Diseases Histology Hospitals Human Image Imaging Device Imaging technology Infarction Institutes Investigation Lead Life Magnetic Resonance Imaging Maps Modality Modeling Morbidity - disease rate Morphology Outcome Patients Performance Physicians Procedures Recurrence Research Resolution Safety Scientist Sinus Site Surface Technology Therapeutic Time Tissues United States Universities Ventricular Ventricular Arrhythmia Ventricular Tachycardia base clinical practice contrast enhanced cost design heart rhythm imaging system improved mortality standard of care success sudden cardiac death voltage

项目摘要

DESCRIPTION (provided by applicant): Ventricular tachycardia (VT) causes about 400,000 out-of-hospital sudden cardiac deaths each year in the United States. An important therapeutic strategy is to interrupt the arrhythmic circuit by catheter ablation of the culprit tissue. The staus quo of VT ablation is tightly interwoven with a catheter mapping procedure that assembles voltage and/or activation maps point-by-point on the heart surface. This mapping procedure is invasive, time-consuming, lacking complete 3D data beneath the heart surface, and limited in spatial resolution. With this practice, physicians are engaged in a prolonged clinical procedure to acquire information at only limited sites where the catheter tip is placed. These fundamental limitations have contributed to high recurrence and high complication rates of VT ablation. The long-term goal of the proposed research is to develop a noninvasive transmural electrophysiological imaging (TEPI) system to map ventricular arrhythmia and to provide pre-procedural planning of VT ablation. Based on our strong preliminary data, the overall objective of this proposal is to optimize and determine the clinical value of TEPI in two critical pre-ablatin utilities. First, we will determine the performance of TEPI in electroanatomical scar imaging and in predicting the inducibility of TEPI. Our hypothesis is that, in comparison to invasive electroanatomical voltage mapping, noninvasive TEPI is more consistent with delayed contrast-enhanced imaging in scar delineation and its scar metrics are more predictive of VT inducibility. Second, we will determine the ability of TEPI to map ventricular arrhythmia and to predict ablation targets. Our hypothesis is that TEPI can be used to map ventricular arrhythmia and identify successful ablation sites. These investigations will be carried out in detailed animal models using post-infarction porcine hearts, involving collaborations between an interdisciplinary team of computational, experimental, and clinical scientists. At the completion of this project, we will be able to determine the clinical utility of TEPI in VT ablation, and to generate important pilot data for designing a R01 clinical study with increased statistical power. We will obtain a noninvasive, transmural, and high-resolution imaging tool to characterize both the substrate and dynamics of ventricular arrhythmia, which is expected to improve the clinical outcome of VT ablation by providing better pre-procedural planning and targeting. In the long term, this research will contribute to the fundamental change of clinical electrophysiological studies from being invasive, surface-based, and point-by-point to being noninvasive, transmural, and high-resolution. It will improve the efficacy and safety of electrophysiological study while reducing its duration and cost in routine clinical practice for a broader spectrum of heart rhythm disorders.

描述（由申请人提供）：美国每年在美国每年造成约400,000个院外突然心脏死亡。一个重要的治疗策略是通过导管消融罪犯组织中断心律失常。 VT消融的Staus Quo与导管映射程序紧密地交织在一起，该过程在心脏表面逐点组装电压和/或激活图。这种映射过程是侵入性的，耗时的，缺乏心脏表面下方的完整3D数据，并且空间分辨率有限。通过这种做法，医生进行了长时间的临床程序，仅在放置导管尖端的有限地点获取信息。这些基本局限性导致了VT消融的高复发和高并发症率。拟议的研究的长期目标是开发非侵入性的透射电生理成像（TEPI）系统，以绘制心室心律不齐并提供VT消融前的术前核心手术计划。根据我们强大的初步数据，该提案的总体目标是优化和确定TEPI在两个关键的启动前公用事业中的临床价值。首先，我们将确定TEPI在电解剖疤痕成像中的性能以及预测TEPI的诱导性。我们的假设是，与侵入性的电解压映射相比，非侵入性TEPI与疤痕描述中延迟的对比度增强成像更加一致，其疤痕指标更可预测VT诱导性。其次，我们将确定TEPI绘制心室心律失常并预测消融靶标的能力。我们的假设是，TEPI可用于绘制心室心律不齐并确定成功的消融位点。这些研究将在详细的动物模型中使用连接后的猪心进行，涉及计算，实验和临床科学家的跨学科团队之间的合作。该项目完成后，我们将能够确定TEPI在VT消融中的临床实用性，并生成重要的试点数据，以设计具有统计能力增加的R01临床研究。我们将获得一种非侵入性，透壁和高分辨率成像工具，以表征心室心律不齐的底物和动力学，预计通过提供更好的术前计划和靶向，预计将改善VT消融的临床结果。从长远来看，这项研究将有助于临床电生理学研究的根本变化，从侵入性，基于表面和逐点变为无创，透壁和高分辨率。它将提高电生理研究的疗效和安全性，同时减少其常规临床实践的持续时间和成本，以获得更广泛的心律疾病。