The pre-clinical training program entitled, "Training for Intracardiac Imaging and Intervention", is integrated into a more comprehensive training of physicians and associated support staff for multi-modality image directed interventions. Currently, catheter-based cardiovascular interventions are routinely performed with fluoroscopic guidance, which results in relatively high radiation exposures to the patients and operators, and inadequate 3-dimensional (3-D) visualization of the heart and vasculature resulting in potential procedural related complications.
We provide a comprehensive training program which includes:
- didactic lectures,
- hands on training with state-of-the-art equipment and multi-modality image directed interventional approaches in an appropriate large animal model in the Y-TRIC, and
- subsequent exposure to the clinical translation of similar equipment and procedures in patients at Yale New Haven Hospital.
Participants have lectures, followed by hands on training, followed by clinical exposure. The procedures are directly supervised by individuals with established expertise with the equipment and techniques in both animals and humans. The care of the animals is completely managed by the Y-TRIC staff under the direction of Dr. Sinusas. Participants have the opportunity to position and manipulate the imaging devices and interventional catheters in the animal lab with direct supervision of highly trained staff.
The goal is to promote utilization of these new image-directed procedures in patients, and to improve treatment efficacy and safety for trans-septal puncture (passing a sheath and catheter across the intra-atrial septum of the heart) and radiofrequency ablation of the left ventricle, right and left atria, and pulmonary veins for treatment of potentially life threatening atrial and ventricular arrhythmias (abnormal heart rhythms).
The multi-modality procedure involves obtaining 3-D high-resolution CT images of the chest and heart that are used as a foundation for procedural guidance using X-ray fluoroscopy, and either real time intracardiac echocardiography (ICE), and/or transthoracic echocardiography (TTE). These real-time ultrasound images are used to help guide the placement of sheaths, and catheters within the heart, reducing the need for fluoroscopy, and improving safety. The interventional or ablation catheters are tracked in 3-D space using a methodology that employs low energy magnetic fields. The catheters can cause some displacement and deformation of the tissues when manipulated within the heart, and are moving within the heart over the cardiac cycle and with respiration. Operators who generally perform these procedures only with X-ray fluoroscopic guidance will be taught how to apply the non-invasive imaging technologies to improve treatment efficacy and safety.