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COMPREHENSIVE ARRYTHMIA RESEARCH & MANAGEMENT CENTER DBP: Image Analysis for Atrial Arrhythmias Rob MacLeod, PhD SCI Institute, Dept. of Bioengineering CVRTI, CARMA University of Utah
COMPREHENSIVE ARRYTHMIARESEARCH & MANAGEMENT CENTER
DBP: Image Analysis for Atrial Arrhythmias
Rob MacLeod, PhDSCI Institute, Dept. of Bioengineering
CVRTI, CARMAUniversity of Utah
Driven (Crazy?) by Doctors
The CARMA Team
COMPREHENSIVE ARRYTHMIARESEARCH & MANAGEMENT CENTER
CARMA = Comprehensive Arrhythmia Research and
MAnagement
Normal Contraction Atrial Fibrillation
What We Know About AF
Substrate Triggers
*
PulmonaryVeins
Left Atrium
**
*
What We Do Not Know about AF: Everything Else
Mechanisms Time Course EnvironmentalFactors
Genetics
The Million $ Mechanistic QuestionAfib begets Afib
Afib is a tissue disease
Structure is Important
The CARMA Mantra“AF is a heart tissue disease”
“Fibrotic Atrial Cardiac Myopathy (FACM)” Kottkamp H: J Cardiovasc Electrophysiol 2012;23:797-799
Ausma J, .... Allessie M ...J mol Cell Cardiol. 2001: 2083.
Normal Early stage Mid stage Late stage
Effective Treatment of AF Eventually Involves Intervention
TriggeringFoci
Atrial Septum
SuperiorVena Cava
InferiorVena Cava
LeftAtrium
PulmonaryVeins
RightVentricle
LeftVentricle
RightAtrium
MappingCatheter
AblationCatheter
CARMA Started HerePseudo-color
Normal
Low-voltageEnhanced(fibrosis?)
Pseudo-color
Normal
Low-voltageEnhanced(fibrosis?)
Electroanatomical Map
Electroanatomical Map
Utah Scoring Scheme: 2011
Akoum et al. J Cardiovasc Electrophysiol, 22:16-22, 2011
< 5% 5-20%
20-35% > 35%
Nazem Akoum
Fibrosis Predicts Outcome of Ablation Therapy
!
Utah I
Utah II
Utah III
Utah IV
Utah Stages: Latest Edition
<10% 10-20%
20-30% >30%
Chris McGann
Utah Stages: Latest Edition
Utah IUtah IIUtah III
Utah IV
It is MRI but is it Real?
Blue is Normal
epi
endo
Chris McGann
Amit Patel
Green is Fibrosis
endo
epi
Histology SummaryControl AF-mix AF-fibrosis
Not All Lesions Can Be Effective
Epicardial
Not Effective
Potentially Effective
Likely Effective
COMPREHENSIVE ARRYTHMIARESEARCH & MANAGEMENT CENTER
DE-MRI Determinant of Successful Catheter
Ablation of Atrial Fibrillation (DECAAF)
Inclusion
CARMA/SCI - Univeristy of Utah
DE-MRI Ablation Followup
AFIS
Image Processing& Analysis
Statistics Core
FTP (SCI) WWW
Collaborator
DECAAF Organization
COMPREHENSIVE ARRYTHMIARESEARCH & MANAGEMENT CENTER
Late Breaking Abstract at
AmericanCollege of Cardiology Meeting
COMPREHENSIVE ARRYTHMIARESEARCH & MANAGEMENT CENTER
Along Came NAMIC
AF Specific Aims
SegmentationRegistration Quantification
The CARMA AF Workflow
Implementing the Workflow
Corview to Slicer
Commercialization
Research
Slicer: Intensity Correction
Slicer: Registration
Slicer: Scar Detection
Slicer: Pulmonary Vein Removal
Slicer: CARMA Workflow
CARMA Makes Data Available!
60 Patients with multiple MRI scans
http://www.insight-journal.org/midas
COMPREHENSIVE ARRYTHMIARESEARCH & MANAGEMENT CENTER
What Does CARMA Bring to NA-MIC?
Access to Image Based Medicine
Access to Data
Real World Testing
• KCL: Left atrium segmentation for atrial fibrillation ablation, Karim, et al., Proc. SPIE Medical Imaging, 2008
• MIT: Robust atlas-based segmentation of highly variable anatomy: left atrium segmentation, Depa, et al., Statistical Atlases and Computational Models of the Heart, 2010
• GA Tech: Segmentation of the Endocardial Wall of the Left Atrium using Local Region-Based Active Contours and Statistical Shape Learning, Gholami, et al., 2010
DisseminationCARMA
