磁共振三维心肌延迟增强成像引导室性心动过速射频消融的基础研究

Ventricular tachycardia (VT) ablation is a very challenging job in present clinical setting. CARTO 3D system is an useful tool to mark the arrhythmia substrate and guide ablation. However, 3D electro-anatomic mapping (EAM) could not delineate accurate anatomic details and the processing is very time-consuming. 3D late enhancement cardiac MRI provides very accurate location of myocardial scar and could provide good guide for VT substrate ablation. Therefore, VT ablation guided by integration of 3D LGE image and 3D EAM is promising. In our proposal, 3D breath free navigating ECG gating turbo-flash based sequence will be used to acquire images. Based upon our previous study, multiple new technologies will be used to optimize image acquiring. Post processing and 3D visualization technology also will be studied. After that, substrate ablation guided by integration with 3D LGE and 3D EAM will be validated in pigs with chronic myocardial infarction. Our studies will definitely provide important scientific basis for the future clinical ablation.

室速消融是目前心律失常治疗中的一个难点。三维电标测系统应用推动了室速消融的发展。但是三维标测费时,难以精确定位病灶。磁共振三维心肌延迟显像能够清楚地显示心肌局灶纤维化（心律失常基质），同三维电标测系统结合能够极大提高消融的准确性和效率。本项目从制约心肌延迟成像引导室速消融的关键环节入手，在课题组已有的研究基础上，对于呼吸导航三维反转恢复梯度回波序列进行优化改进，同时对于三维可视化技术进行研究，结合最新CARTO-3系统，改进图像配准策略，在猪慢性心梗模型中验证以上技术的可行性和准确性，同时对于这一技术引导下的室速基质消融的准确性进行评价，为下一步临床研究及应用提供技术基础。

本项目立足于室性心律失常射频消融治疗中的磁共振影像引导关键问题开展了系列的研究。完成了有关心脏磁共振三维延迟强化序列优化，新序列研发，提高了目前心脏磁共振三维延迟强化影像的治疗，探索了心律失常患者中心肌延迟强化成像的技术问题。在磁共振三维延迟强化影像分割及三维可视化研究上取得一定成果，显示了心肌瘢痕的三维重建，并实现了在射频消融系统中的图像融合，证明了磁共振三维影像引导室性心律失常精准消融的可行性。在本项目研究中，本项目的研究价值已经在临床中的显现，为未来临床室性心律失常的精准治疗做出了开拓性的探索研究。