Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA.
SentiAR, St. Louis, MO, USA.
Comput Biol Med. 2021 Jun;133:104366. doi: 10.1016/j.compbiomed.2021.104366. Epub 2021 Apr 2.
Recently, an augmented reality (AR) solution allows the physician to place the ablation catheter at the designated lesion site more accurately during cardiac electrophysiology studies. The improvement in navigation accuracy may positively affect ventricular tachycardia (VT) ablation termination, however assessment of this in the clinic would be difficult. Novel personalized virtual heart technology enables non-invasive identification of optimal lesion targets for infarct-related VT. This study aims to evaluate the potential impact of such catheter navigation accuracy improvement in virtual VT ablations.
2 MRI-based virtual hearts with 2 in silico induced VTs (VT 1, VT 2) were included. VTs were terminated with virtual "ground truth" endocardial ablation lesions. 106 navigation error values that were previously assessed in a clinical study evaluating the improvement of ablation catheter navigation accuracy guided with AR (53 with, 53 without) were used to displace the "ground truth" ablation targets. The corresponding ablations were simulated based on these errors and VT termination for each simulation was assessed.
In 54 VT 1 ablation simulations, smaller error with AR significantly resulted in more VT termination (25) compared to the error without AR (16) (P < 0.01). In 52 VT 2 ablation simulations, no significant difference was observed from error with (11) and without AR (13) (P = 0.58). The substrate characteristic may impact the effect of improved accuracy to an improved VT termination.
Virtual heart shows that the increased catheter navigation accuracy provided by AR guidance can affect the VT termination.
最近，一种增强现实（AR）解决方案可帮助医生在心脏电生理研究期间更准确地将消融导管放置在指定的病变部位。导航精度的提高可能会对室性心动过速（VT）消融的终止产生积极影响，但在临床上评估这一点将非常困难。新型个性化虚拟心脏技术可实现对梗死相关 VT 的最佳病变靶点的非侵入性识别。本研究旨在评估这种导管导航精度改进在虚拟 VT 消融中的潜在影响。
本研究纳入了 2 个基于 MRI 的虚拟心脏和 2 个模拟诱导的 VT（VT1、VT2）。使用虚拟“真实”心内膜消融病灶终止 VT。此前在评估 AR 引导消融导管导航精度改进的临床研究中评估了 106 个导航误差值（53 个有 AR，53 个无 AR），并使用这些误差值来移动“真实”消融靶点。根据这些误差模拟相应的消融，并评估每次模拟的 VT 终止情况。
在 54 次 VT1 消融模拟中，AR 引导的较小误差显著导致更多的 VT 终止（25 次），而没有 AR 引导的误差导致更少的 VT 终止（16 次）（P<0.01）。在 52 次 VT2 消融模拟中，从误差有 AR（11 次）和没有 AR（13 次）的消融中没有观察到显著差异（P=0.58）。基质特征可能会影响提高准确性对改善 VT 终止的影响。
虚拟心脏显示，AR 引导提供的增加的导管导航精度可能会影响 VT 的终止。
