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CN101035467A - 治疗心房颤动和其它心律失常的方法和系统 - Google Patents

治疗心房颤动和其它心律失常的方法和系统 Download PDF

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CN101035467A
CN101035467A CNA2005800339927A CN200580033992A CN101035467A CN 101035467 A CN101035467 A CN 101035467A CN A2005800339927 A CNA2005800339927 A CN A2005800339927A CN 200580033992 A CN200580033992 A CN 200580033992A CN 101035467 A CN101035467 A CN 101035467A
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J·S·斯拉
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Abstract

提供了一种用于治疗心律失常如心房颤动的方法，该方法包括：采用数字图像系统获取心脏图像数据；从上述心脏图像数据产生心腔和周围结构的3D模型；用介入系统寄存3D模型；在介入系统上视觉化寄存的3D模型；将一导管装置定位在心腔内；在介入系统寄存的心腔3D模型上视觉化导管装置；使用寄存的3D模型在心腔内导航导管装置；和将生物物质通过导管装置递送至心腔内选定部位处的心脏组织。优选地，生物物质是移植细胞或抗体。在本发明的另一方面，提供了一种用于治疗心律失常的系统，该系统包括：数字图像系统，用于获取心脏图像数据；图像产生系统，以从上述心脏图像数据产生心腔及周围结构的3D模型；将3D模型寄存到介入系统上的工作站，从而能够在介入系统上视觉化寄存的3D模型；和将生物物质如移植细胞或抗体递送到选定部位处心腔内心脏组织的导管装置，可通过介入系统在寄存的3D模型上视觉化导管装置。

Description

治疗心房颤动和其它心律失常的方法和系统
发明领域
本发明一般涉及用于治疗心房颤动和其它心律失常的方法和系统，具体涉及将生物物质递送至心脏内房室的方法和系统。
发明背景
心房颤动是一种心律失常症状，其中，心房或上心室由于形成原纤维而停止收缩。来自肺静脉的房性期前收缩(期外搏动)可作为触发因素，导致心房颤动的发作。由于左心房复杂的三维几何结构，不能重现性地诱导早搏并且不能精确鉴别肺静脉与左心房的入孔或接合处，使得消融疗法在许多患者中的使用受到限制。还存在并发症的风险，例如中风、心脏周围出血、射频导管消融术期间肺静脉的狭窄。
研究发现活性，提示左心房肺静脉接合处传导组织的存在。因此，通过递送能够阻断细胞传导的生物物质以在细胞或分子水平阻断传导的新型方法提供了在这种复杂性心律失常的治疗中的显著优点。上述递送系统可包括移植细胞或注射抗体。
如果能够精确定位并递送细胞、抗体和类似生物物质如基因，上述方法也有利于治疗其它心律失常和其它病症。
发明概述
本发明的一方面提供了一种治疗心律失常的方法，该方法包括以下步骤：(1)采用数字图像系统，优选计算机X射线断层扫描(CT)系统来获取心脏图像数据，(2)从上述心脏图像数据产生心腔和周围结构的3D模型，(3)用介入系统(interventional system)寄存3D模型，(4)在介入系统中视觉化寄存的3D模型，(5)将一导管装置设置在心腔内，(6)在介入系统寄存的心腔3D模型上视觉化导管装置，(7)采用寄存的3D模型在心腔内导航导管装置，和(8)将生物物质通过导管装置递送至心腔内选定部位处的心脏组织。
在某些优选的实施方式中，导管装置递送的生物物质是能够改变心脏内选定部位处电脉冲的移植细胞。尤其优选地，移植细胞是成肌细胞。在另一希望的实施方式中，递送至心腔内心脏组织的生物物质是抗体，选定部位处的电脉冲将被这些抗体所改变。
最优选上述介入系统是荧光系统。更优选地，心律失常是心房颤动，3D模型是左心房和肺静脉的3D模型。在更加优选的实施方式中，导管装置具有主体，该主体具有适合递送生物物质的中央管腔；以及连接于主体的控制机构，从而能够控制生物物质从主体的递送。
在本发明的另一方面中，提供了用于治疗心律失常的系统，该系统包括：数字图像系统，以获取心脏图像数据；图像产生系统，以从心脏图像数据产生心腔及其周围结构的3D模型；将3D模型寄存到介入系统上的工作站，从而在介入系统上视觉化寄存的3D模型；和将生物物质递送到某些选定部位处的心腔内心脏组织的导管装置，在介入系统寄存的3D模型上视觉化导管装置。
在该系统的优选例中，递送的生物物质是移植细胞，最优选成肌细胞。并且更加优选地，生物物质是抗体。
在该系统优选的实施方式中，介入系统是荧光系统。在最优选的实施方式中，数字图像系统是计算机X射线断层扫描(CT)系统。在某些优选例中，心律失常是心房颤动，3D模型是左心房和肺静脉的3D模型。更加优选地，导管装置包括主体，该主体具有适合递送生物物质的中央管腔；以及连接于主体的控制系统，以控制从装置的递送。
附图简要说明
图1是本发明用于治疗心律失常的系统的示意性概括图，以及一部分导管的放大纵截面图。
图2A显示了左心房的3D心脏图像。
图2B显示了标准映射(standard mapping)和消融导管在寄存在介入系统中的左心房心内视图上的定位。
图3是根据本发明的治疗心房颤动和其它心律失常方法的流程图。
优选实施方式的详细描述
图1显示了根据本发明，用于治疗心律失常如心房颤动的示例性系统的示意概括图。使用数字图像系统如CT扫描系统10获取心脏图像数据。虽然后文讨论的实施方式描述了CT扫描系统的内容，应理解还涵盖了本领域已知的其它图像系统，如MRI和超声。
心脏图像数据12是CT扫描系统10在较短的获取时间内以连续顺序收集的一系列心脏连续图像。通过使用更快捷的CT扫描系统以及同步化CT扫描仪与患者ECG信号上的QRS能缩短扫描时间，减少搏动器官如心脏图像中的运动伪差。所得心脏图像数据12能够重建真实几何描述其结构的心脏图像。
然后，通过图像产生系统14，采用对左心房和肺动脉最优的方案分段心脏图像数据12。应理解，可以类似的方式获取其它心脏房室及其周围结构(的图像数据)。图像产生系统14进一步加工分段的数据，以利用3D表面和/或体积透视图(rending)产生左心房和肺动脉的3D模型。可进行额外的后处理以产生这些结构的导航图(从内部观察)。
然后，将3D模型16输出到工作站18，用介入系统如荧光系统20寄存。3D模型16、包括导航视图的传输可以几种格式如DICOM格式和几何线网模型进行。因此，来自扫描系统10的信息将与荧光系统20整合。一旦用荧光系统20寄存3D模型16，可在荧光系统上观察到3D模型16及任何导航视图。
图2A显示了左心房和肺静脉的详细3D模型，包括心内或内部视图。可从3D图像提前计算肺静脉及其它关键(strategic)区域的距离和取向，以产生消融手术期间使用的路标。
采用经中隔导管插入术，即可实现到达左心房的标准技术，将导管装置22引入左心房中，导管装置22包括具有中央管腔26的弹性导管24。在荧光系统20寄存的3D模型16上视觉化导管24。然后，在3D模型16上将导管24实时导航至左心房内的适当部位。图2B显示了标准映射和消融导管在寄存在介入系统上的左心房心内视图上的定位。
导管装置22具有控制机构28，用于开放和闭合管腔26的远端。当用生物物质30填充管腔26时，导管装置22可用作递送装置，以在心脏内具体选定的部位释放生物物质30。在将导管24引导至鉴定为需要改变或阻断电传导的关键区域的部位之后，启动控制机构28，以在该部位递送生物物质30如移植细胞。这些移植细胞可以是成肌细胞或平滑肌细胞。也可以上述方式注射抗体，在细胞水平改变或阻断异常电活性，尤其是响应可能负责触发引起心房颤动的脉冲的抗原。
图3显示了根据本发明消融心房颤动和其它心律失常的方法的概括图。如图所示，在步骤110中，获取心脏3D图像。可采用CT扫描或MRI产生心脏3D图像。在步骤120中，采用对于适当结构最优的方案，通过将图像数据分段产生感兴趣心腔如左心房的3D模型。一旦获得3D模型，采用各种储存方式将其以电子数据文件形式储存。然后，将储存的模型传输至连接于介入系统的计算机工作站。
如步骤130所示，传输至工作站之后，用介入系统寄存3D模型。寄存处理使得医务人员能够建立心腔3D模型与特定患者使用的介入系统的关联，从而在介入手术期间视觉化3D模型。
下一步骤140涉及在寄存的3D模型上视觉化已定位在左心房内的导管。这就使得能够在寄存的图像上，将导管在心腔内实时引导至选择进行治疗的部位。
在步骤150中，在选定部位从导管的中央管腔释放移植细胞如成肌细胞，以改变或阻断该部位的电活性。或者，在步骤160中，将抗体和基因在导管管腔内输送至左心房之后，在治疗心律失常的部位插入抗体或基因。本领域技术人员应理解，上述方式也可靶向治疗其它心律失常如室性心动过速。而且，可采用自动技术进行任何上述步骤。
涵盖了各种改变形式和实施方式，落在所附权利要求书的范围内，权利要求书中具体指出和清楚要求了本发明的发明主题。

Claims (16)

1.一种治疗心律失常的方法，所述方法包括：
-从数字图像系统获取心脏图像数据；
-从所述心脏图像数据产生心腔和周围结构的3D模型；
-用介入系统寄存该3D模型；
-在介入系统上视觉化寄存的3D模型；
-将导管装置定位在心腔内；
-在介入系统寄存的3D模型上视觉化该导管装置；
-利用寄存的3D模型在心腔内导航导管装置；和
-将生物物质通过导管装置递送至选定部位处的心脏组织。
2.如权利要求1所述的方法，其特征在于，所述生物物质是移植细胞，所述移植细胞在所述选定部位处改变电脉冲。
3.如权利要求2所述的方法，其特征在于，所述移植细胞是成肌细胞。
4.如权利要求1所述的方法，其特征在于，所述生物物质是抗体，所述抗体在所述选定部位处改变电脉冲。
5.如权利要求1所述的方法，其特征在于，所述介入系统是荧光系统。
6.如权利要求1所述的方法，其特征在于，所述数字图像系统是计算机X射线断层扫描(CT)系统。
7.如权利要求1所述的方法，其特征在于，所述心律失常是心房颤动，所述3D模型是左心房和肺静脉的3D模型。
8.如权利要求1所述的方法，其特征在于，所述导管装置包括：
-主体，它具有适合递送生物物质的中央管腔；和
-连接于主体的控制机构，以控制生物物质从主体的递送。
9.一种治疗心律失常的系统，所述系统包括：
-数字图像系统，用于获取心脏图像数据；
-图像产生系统，以从所述心脏图像数据产生心腔及周围结构的3D模型；
-用介入系统寄存3D模型的工作站，以在介入系统上视觉化寄存的3D模型；和
-将生物物质递送到选定部位处的心腔内心脏组织的导管装置，其中在介入系统寄存的3D模型上视觉化该导管装置。
10.如权利要求9所述的系统，其特征在于，所述生物物质是移植细胞，所述移植细胞在所述选定部位处改变电脉冲。
11.如权利要求10所述的系统，其特征在于，所述移植细胞是成肌细胞。
12.如权利要求9所述的系统，其特征在于，所述生物物质是抗体，所述抗体在所述选定部位处改变电脉冲。
13.如权利要求9所述的系统，其特征在于，所述介入系统是荧光系统。
14.如权利要求9所述的系统，其特征在于，所述数字图像系统是计算机X射线断层扫描(CT)系统。
15.如权利要求9所述的系统，其特征在于，所述心律失常是心房颤动，所述3D模型是左心房和肺静脉的3D模型。
16.如权利要求9所述的系统，其特征在于，所述导管装置包括：
-主体，它具有适合递送生物物质的中央管腔；和
-连接于主体的控制机构，以控制生物物质从主体的递送。
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