Comparison of Two Pulmonary Vein Ablation Techniques for Persistent AF

NCT ID: NCT03295422

Last Updated: 2020-11-19

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-08-25

Study Completion Date

2021-12-31

Brief Summary

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Investigator initiated, randomized controlled trial of two radiofrequency (RF)ablation protocols currently performed in the electrophysiology lab, but have not been studied prospectively to identify which, if either technique, is superior for individuals with persistent atrial fibrillation (AF). Two-hundred subjects will be consecutively enrolled and randomized to either pulmonary vein isolation only or pulmonary vein isolation plus posterior left atrial wall isolation

Detailed Description

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Atrial fibrillation, the most common type of cardiac arrhythmia in clinical practice, affects approximately 2.7 million U.S. adults. Percutaneous catheter ablation is an effective treatment option for individuals with persistent AF. Pulmonary vein isolation (PVI) has emerged as the gold standard for paroxysmal AF with excellent success rates, however, individuals with persistent AF procedural efficacy from pulmonary vein isolation is not optimal. Therefore, improved ablation strategies for these individuals are needed.

This randomized controlled trial will compare two radiofrequency ablation strategies, PVI alone and pulmonary vein isolation plus left posterior atrial wall (LPAW) isolation in individuals with persistent AF. Both strategies are currently used to treat persistent AF, but no randomized controlled trial ahs been conducted to investigate which strategy is more efficacious.

Two-hundred subjects will be randomized into groups of 50 to undergo a radiofrequency ablation procedure for AF. For group 1, a series of radiofrequency applications will be delivered around both sets of pulmonary veins. For group 2, a series of radiofrequency applications will be delivered around both sets of pulmonary veins and along a roof and low posterior line of the left atrial wall.

All subjects will be followed at 1 month, 3 months, 6 months, and 1 year post ablation. If indicated, antiarrhythmic drugs will be discontinued. For the first month, subjects will receive a continuously recording electrocardiogram heart card to monitor for AF, and then two-week ambulatory monitors at 3 months and one year post ablation.

Conditions

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Chronic Atrial Fibrillation Persistent Atrial Fibrillation

Keywords

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Persistent Atrial Fibrillation Radiofrequency ablation Catheter ablation

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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RF ablation PVI alone

RF catheter ablation of pulmonary veins alone

Group Type ACTIVE_COMPARATOR

RF ablation PVI alone

Intervention Type PROCEDURE

A series of RF applications will be delivered around both sets of pulmonary veins with complete entry and exit block obtained around the antrums of all 4 pulmonary veins.

RF ablation PVI plus LPAW

RF catheter ablation PVI plus left atrial posterior wall

Group Type EXPERIMENTAL

RF ablation PVI plus LPAW

Intervention Type PROCEDURE

A series of RF applications will be delivered around both sets of pulmonary veins with complete entry and exit block obtained around the antrums of all 4 pulmonary veins. In addition, a roof and posterior line will be placed in the left atrium to achieve entrance and exit block on the posterior wall. Entry block will be confirmed by placing a circular mapping catheter in multiple locations along the posterior wall and confirming lack of presence of any local potentials. Exit block will be confirmed on the posterior wall with pacing at 10 amps from the ablation catheter at multiple locations within the box as well as all lines.

Interventions

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RF ablation PVI alone

A series of RF applications will be delivered around both sets of pulmonary veins with complete entry and exit block obtained around the antrums of all 4 pulmonary veins.

Intervention Type PROCEDURE

RF ablation PVI plus LPAW

A series of RF applications will be delivered around both sets of pulmonary veins with complete entry and exit block obtained around the antrums of all 4 pulmonary veins. In addition, a roof and posterior line will be placed in the left atrium to achieve entrance and exit block on the posterior wall. Entry block will be confirmed by placing a circular mapping catheter in multiple locations along the posterior wall and confirming lack of presence of any local potentials. Exit block will be confirmed on the posterior wall with pacing at 10 amps from the ablation catheter at multiple locations within the box as well as all lines.

Intervention Type PROCEDURE

Other Intervention Names

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Catheter ablation of the pulmonary veins Catheter ablation of the pulmonary veins plus posterior wall

Eligibility Criteria

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Inclusion Criteria

1. Have symptomatic persistent AF (i.e., a sustained episode lasting more than 7 days).
2. Refractory to at least one antiarrhythmic agent.
3. Undergoing ablation for the first time.

Exclusion Criteria

1. Paroxysmal AF
2. Sustained atrial fibrillation lasting more than 3 years
3. Left atrial diameter of 60 mm or greater
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sequoia Hospital

OTHER

Sponsor Role lead

Responsible Party

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Christopher E. Woods, MD, PhD

Study Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Christopher E Woods, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Dignity Health, Sequoia Hospital

Locations

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Dignity Health, Sequoia Hospital

Redwood City, California, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Christopher E Woods, MD, PhD

Role: CONTACT

Phone: 650-652-8600

Email: [email protected]

Ann Campbell, RN, MBA

Role: CONTACT

Phone: 650-367-5950

Email: [email protected]

Facility Contacts

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Christopher E Woods, MD, PhD

Role: primary

Ann Campbell, RN, MBA

Role: backup

Provided Documents

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Document Type: Study Protocol

View Document

Other Identifiers

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Persistent AF Study 01

Identifier Type: -

Identifier Source: org_study_id