This proposal describes a five-year multidisciplinary career development program, which will enable the Principal Investigator, an MRI and cardiovascular radiologist, to become a productive independent patient-oriented investigator in cardiovascular imaging. Cardiac arrhythmias, frequent in patients with ischemic heart disease, may lead to sudden cardiac arrest, which claims over 450 000 lives per year in the US. They can be prevented by medication, which has a high failure rate and frequent toxicity, or corrected by an Implantable Cardioverter Defibrillator (ICD). 150 000 ICDs were implanted in the US in 2003, number that is growing every year. ICDs have a significant impact on quality of life, as the discharge from an ICD is described as similar to being kicked in the chest by a horse. Radiofrequency ablation under guidance of cardiac electrical mapping, a therapy rapidly growing in importance and popularity, can be used to cure non-life threatening arrhythmias, and minimize or even eliminate the painful discharges experienced by patients with prospective ICDs. The focus of this research is the development and application of novel magnetic resonance imaging (MRI) techniques to improve cardiac ablation therapy. The principal aims are: (1) to develop novel techniques to perform high resolution MRI to assess myocardial damage, (2) to show that MRI can predict the distribution of abnormalities on cardiac electrical mapping due to myocardial damage, making cardiac ablation therapy more efficient, and (3) use MRI to characterize the distribution and progression of cardiac ablation lesions, in order to predict failure of therapy and complications. The career development program has two major components: a technical component, and a translational component. The technical component involves the development of the imaging techniques, to be performed under the mentorship of a leading scientist in biomedical imaging. The translational component involves a didactic component, provided by the University of Michigan's Training Program in Clinical Research, which leads to a Masters degree in Clinical Research Design and Statistical Analysis, and a clinical research component, that involves the testing of the imaging techniques in clinical studies in cardiac electrophysiology, under the mentorship of an internationally recognized pioneer in the field. The program would take place in an environment which has a long tradition of support for junior patient- oriented investigators, and which is at the cutting edge of both medical imaging and cardiac electrophysiology, with extensive clinical, educational and research resources. Relevance: MRI has the potential to make cardiac ablation therapy more efficient and to predict failure and complications of this therapy. This can dramatically improve the lives of people with arrhythmias.

Agency
National Institute of Health (NIH)
Institute
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23EB006481-04
Application #
7658064
Study Section
Special Emphasis Panel (ZEB1-OSR-C (M1))
Program Officer
Erim, Zeynep
Project Start
2006-08-01
Project End
2011-07-31
Budget Start
2009-08-01
Budget End
2010-07-31
Support Year
4
Fiscal Year
2009
Total Cost
$190,620
Indirect Cost
Name
University of Pennsylvania
Department
Radiation-Diagnostic/Oncology
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Yokokawa, Miki; Desjardins, Benoit; Crawford, Thomas et al. (2013) Reasons for recurrent ventricular tachycardia after catheter ablation of post-infarction ventricular tachycardia. J Am Coll Cardiol 61:66-73
Desjardins, Benoit; Yokokawa, Miki; Good, Eric et al. (2013) Characteristics of intramural scar in patients with nonischemic cardiomyopathy and relation to intramural ventricular arrhythmias. Circ Arrhythm Electrophysiol 6:891-7
Gupta, Sanjaya; Desjardins, Benoit; Baman, Timir et al. (2012) Delayed-enhanced MR scar imaging and intraprocedural registration into an electroanatomical mapping system in post-infarction patients. JACC Cardiovasc Imaging 5:207-10
Hutchinson, Mathew D; Gerstenfeld, Edward P; Desjardins, Benoit et al. (2011) Endocardial unipolar voltage mapping to detect epicardial ventricular tachycardia substrate in patients with nonischemic left ventricular cardiomyopathy. Circ Arrhythm Electrophysiol 4:49-55
Yoshida, Kentaro; Yokokawa, Miki; Desjardins, Benoit et al. (2011) Septal involvement in patients with post-infarction ventricular tachycardia: implications for mapping and radiofrequency ablation. J Am Coll Cardiol 58:2491-500
Bala, Rupa; Ren, Jian-Fang; Hutchinson, Mathew D et al. (2011) Assessing epicardial substrate using intracardiac echocardiography during VT ablation. Circ Arrhythm Electrophysiol 4:667-73
Crawford, Thomas; Cowger, Jennifer; Desjardins, Benoit et al. (2010) Determinants of postinfarction ventricular tachycardia. Circ Arrhythm Electrophysiol 3:624-31
Desjardins, Benoit; Morady, Fred; Bogun, Frank (2010) Effect of epicardial fat on electroanatomical mapping and epicardial catheter ablation. J Am Coll Cardiol 56:1320-7
Yokokawa, Miki; Good, Eric; Desjardins, Benoit et al. (2010) Predictors of successful catheter ablation of ventricular arrhythmias arising from the papillary muscles. Heart Rhythm 7:1654-9
Desjardins, Benoit; Crawford, Thomas; Good, Eric et al. (2009) Infarct architecture and characteristics on delayed enhanced magnetic resonance imaging and electroanatomic mapping in patients with postinfarction ventricular arrhythmia. Heart Rhythm 6:644-51

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