Cerebral Embolism (CE) in Catheter Ablation of Atrial Fibrillation (AF)

NCT ID: NCT01361295

Last Updated: 2020-09-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-03-31

Study Completion Date

2017-12-31

Brief Summary

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Radiofrequency catheter ablation of atrial fibrillation (AF) induces a procoagulant state, which leads to an acute risk for symptomatic cerebral embolism (CE) of approximately 1%. The induction of a procoagulant state has been studied in pulmonary vein isolation (PVI) with a non-cooled tip catheter. The induction of a procoagulant state using a cooled-tip catheter has not been studied yet. Due to the avoidance of high endocardial temperatures, it can be expected that these procedures induce a lower level of procoagulation.

Recent studies showed an 11% incidence of CE on diffusion weighted (DW) MRI in patients undergoing cooled-tip catheter ablation of AF. In this study there will be used to different catheters, the cooled-tip catheter and the PVAC Gold catheter. Since the PVAC Gold catheter is equipped with non-cooled electrodes, the risk of endothelial scarring, local thrombosis and CE may be increased.

The goal of this study is to determine the effect of two different ablation catheters on the induction of a procoagulant state and the incidence of CE on DW-MRI in patients with AF undergoing PVI.

Our hypothesis is that patients with AF undergoing PVI using the PVAC gold catheter will show a higher rise in procoagulation and a higher incidence of CE on DW-MRI than patients with AF undergoing PVI with the cooled-tip catheter.

Detailed Description

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A total of 70 patients scheduled for a first ablation of paroxysmal AF will be included. Patients will be 1:1 randomized to PVI using the PVAC gold catheter or the cooled-tip catheter. A control group of 20 patients with AF but without undergoing ablation is included for neuropsychological testing.

Before the procedure, the procoagulant state will be assessed by measuring several markers of endothelial damage, activated coagulation, fibrinolysis and by measurement of fibrinogen and thrombin generation. Measurements will be repeated during and after the procedure.

Documentation of the formation of CE will be established by performing a DW-MRI before and after the ablation. The proportion of symptomatic CE will be quantified by neuropsychological tests and questionnaires.

Finally, transcranial doppler will be performed during the entire procedure to quantify the number and pattern of cerebral microembolic signals (MES).

Conditions

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Atrial Fibrillation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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PVI with PVAC gold

Patient for pulmonal vein isolation using the PVAC Gold Catheter. Intervention.

Group Type ACTIVE_COMPARATOR

PVI with Cooled-RF

Intervention Type PROCEDURE

Pulmonary vein isolation using the Biosense Webster Navistar Thermocool catheter

PVI with Cooled-RF

Patient for pulmonal vein isolation using the Cooled-RF catheter.

Group Type ACTIVE_COMPARATOR

PVI with PVAC gold

Intervention Type PROCEDURE

Pulmonary vein isolation using the Medtronic PVAC gold catheter

Interventions

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PVI with PVAC gold

Pulmonary vein isolation using the Medtronic PVAC gold catheter

Intervention Type PROCEDURE

PVI with Cooled-RF

Pulmonary vein isolation using the Biosense Webster Navistar Thermocool catheter

Intervention Type PROCEDURE

Other Intervention Names

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Medtronic AF solutions CARTO3 system

Eligibility Criteria

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Inclusion Criteria

* suffering from drug-refractory paroxysmal atrial fibrillation
* scheduled for first ablation procedure

Exclusion Criteria

* contra-indications for DW-MRI
* previous AF-ablation
* minors
* any patient unable to undergo neuropsychological testing due to mental retardation
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Serge A. Trines

OTHER

Sponsor Role lead

Responsible Party

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Serge A. Trines

Senior cardiologist

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Serge A. Trines, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Cardiology, LUMC

Locations

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Leiden University Medical Center

Leiden, South Holland, Netherlands

Site Status

Countries

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Netherlands

References

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Sauren LD, VAN Belle Y, DE Roy L, Pison L, LA Meir M, VAN DER Veen FH, Crijns HJ, Jordaens L, Mess WH, Maessen JG. Transcranial measurement of cerebral microembolic signals during endocardial pulmonary vein isolation: comparison of three different ablation techniques. J Cardiovasc Electrophysiol. 2009 Oct;20(10):1102-7. doi: 10.1111/j.1540-8167.2009.01509.x. Epub 2009 Jun 22.

Reference Type BACKGROUND
PMID: 19549035 (View on PubMed)

Schrickel JW, Lickfett L, Lewalter T, Mittman-Braun E, Selbach S, Strach K, Nahle CP, Schwab JO, Linhart M, Andrie R, Nickenig G, Sommer T. Incidence and predictors of silent cerebral embolism during pulmonary vein catheter ablation for atrial fibrillation. Europace. 2010 Jan;12(1):52-7. doi: 10.1093/europace/eup350.

Reference Type BACKGROUND
PMID: 19933517 (View on PubMed)

Bulava A, Slavik L, Fiala M, Heinc P, Skvarilova M, Lukl J, Krcova V, Indrak K. Endothelial damage and activation of the hemostatic system during radiofrequency catheter isolation of pulmonary veins. J Interv Card Electrophysiol. 2004 Jun;10(3):271-9. doi: 10.1023/B:JICE.0000026924.96281.be.

Reference Type BACKGROUND
PMID: 15133367 (View on PubMed)

Kece F, Bruggemans EF, de Riva M, Alizadeh Dehnavi R, Wijnmaalen AP, Meulman TJ, Brugman JA, Rooijmans AM, van Buchem MA, Middelkoop HA, Eikenboom J, Schalij MJ, Zeppenfeld K, Trines SA. Incidence and Clinical Significance of Cerebral Embolism During Atrial Fibrillation Ablation With Duty-Cycled Phased-Radiofrequency Versus Cooled-Radiofrequency: A Randomized Controlled Trial. JACC Clin Electrophysiol. 2019 Mar;5(3):318-326. doi: 10.1016/j.jacep.2018.11.008. Epub 2018 Dec 26.

Reference Type DERIVED
PMID: 30898234 (View on PubMed)

Other Identifiers

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CE-AF-002

Identifier Type: -

Identifier Source: org_study_id

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