Tailored vs. Anatomical Ablation Strategy for Persistent Atrial Fibrillation

NCT ID: NCT04702451

Last Updated: 2025-09-12

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

377 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-02-12

Study Completion Date

2023-12-27

Brief Summary

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Atrial Fibrillation (AF) ablation is typically performed in predefined anatomic regions of the left atrium without attempting to identify patient-specific areas of interest. This procedure is referred to as Pulmonary Vein Isolation (PVI).

The hypothesis in this Study is that a tailored ablation strategy targeting areas of spatio-temporal dispersion in combination with PVI is superior to an anatomical ablation strategy targeting PVI alone for the treatment of persistent AF.

Detailed Description

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Conditions

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Atrial Fibrillation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized Controlled Trial
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Tailored

Tailored ablation strategy

Group Type EXPERIMENTAL

Dispersion ablation + PVI

Intervention Type PROCEDURE

Ablation of spatio-temporal dispersion electrograms in combination with pulmonary vein antrum isolation

VX1

Intervention Type DEVICE

VX1-based dispersion mapping

Anatomical

Anatomical ablation strategy

Group Type ACTIVE_COMPARATOR

PVI

Intervention Type PROCEDURE

Pulmonary vein antrum isolation

Interventions

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Dispersion ablation + PVI

Ablation of spatio-temporal dispersion electrograms in combination with pulmonary vein antrum isolation

Intervention Type PROCEDURE

VX1

VX1-based dispersion mapping

Intervention Type DEVICE

PVI

Pulmonary vein antrum isolation

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients 18 years of age or older candidates for a first AF ablation
* Symptomatic AF, refractory to at least one antiarrhythmic medication
* Persistent or long-standing persistent AF with documentation of (ECG, Holter, physician's letter): AF duration of ≥ 3 months and ≤ 5 years (≥ 3 months and \< 1 year in the United States) or 1 effective cardioversion followed by AF recurrence lasting ≥ 3 months
* Continuous anticoagulation with warfarin (INR 2-3) or NOAC for \> 4 weeks prior to ablation
* Patients must be able and willing to provide written informed consent to participate in the clinical trial
* At least 60% of patients (224 patients) in persistent AF ≥ 6 months including at least 15% (56 patients) of long-standing persistent AF ≥ 12 months

* LA thrombus on Transesophageal Echocardiography (TEE) or CT Scan prior to procedure
* Contraindications to anticoagulation (heparin, warfarin or NOAC)
* Patients who are or may potentially be pregnant
* Previous surgical or catheter ablation for AF
* Any cardiac surgery within the past 2 months (60 days) (includes PCI)
* Myocardial infarction within the past 2 months (60 days)
* Previous atrioventricular valve surgery
* History of blood clotting or bleeding abnormalities
* Documented arterial thromboembolic event (including TIA) within the past 12 months (365 days)
* Rheumatic Heart Disease
* Chronic severe Heart Failure (NYHA functional class IV and/or LVEF \< 25%)
* Awaiting cardiac transplantation or other cardiac surgery within the next 12 months (365 days)
* Unstable angina within the past month
* Acute illness or active systemic infection or sepsis
* AF secondary to electrolyte imbalance, thyroid disease, or reversible or non-cardiac cause
* Diagnosed atrial myxoma
* Significant severe pulmonary disease, (e.g. patients with restrictive pulmonary disease, constrictive or chronic obstructive pulmonary disease in GOLD stage IV) or any other disease or malfunction of the lungs or respiratory system that produces chronic symptoms (e.g. unstable or untreated sleep apnea)
* Significant congenital anomaly or medical problem that in the opinion of the investigator would preclude enrollment
* Enrollment in an investigational study evaluating another device, biologic, or drug
* Presence of intramural thrombus, tumor or other abnormality or condition that precludes vascular access, or manipulation of the catheter
* Life expectancy or other disease processes likely to limit survival to less than 12 months
* Acute Covid-19 infection (fever and/or biological inflammatory syndrome, and positive test documented)

Exclusion Criteria

* Paroxysmal and short-standing AF \< 3 months
* Long-standing persistent AF \> 5 years (≥ 1 year in the United States)
* ≥ 2 previous ineffective cardioversion sessions in case of undetermined AF duration
* Severe obesity (BMI \> 40)
* Very dilated Left Atrium (LA)(e.g. LA diameter \> 60 mm and/or LA surface \> 40 cm2 determined by 2D echocardiography)
* Patients with AF secondary to an obvious reversible cause
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fortrea

INDUSTRY

Sponsor Role collaborator

CardiaBase

OTHER

Sponsor Role collaborator

Volta Medical

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Isabel Deisenhofer, MD

Role: STUDY_CHAIR

Deutsches Herzzentrum Muenchen

Locations

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Grandview Medical Center

Birmingham, Alabama, United States

Site Status

Ascension St. Vincent's

Jacksonville, Florida, United States

Site Status

Washington University

St Louis, Missouri, United States

Site Status

Northwell Health

New York, New York, United States

Site Status

New York Presbyterian Queens Hospital

Queens, New York, United States

Site Status

Ohio State University

Columbus, Ohio, United States

Site Status

Rhode Island Hospital

Providence, Rhode Island, United States

Site Status

Inova Fairfax

Falls Church, Virginia, United States

Site Status

OLV Aalst

Aalst, , Belgium

Site Status

UZ Leuven

Leuven, , Belgium

Site Status

Pôle Santé République

Clermont-Ferrand, , France

Site Status

Hôpital Saint Philibert

Lomme, , France

Site Status

Hôpital Louis Pradel - Hospices Civils de Lyon

Lyon, , France

Site Status

Hôpital Saint-Joseph

Marseille, , France

Site Status

Hôpital Privé Jacques Cartier

Massy, , France

Site Status

Hôpital Privé du Confluent

Nantes, , France

Site Status

Clinique Saint George

Nice, , France

Site Status

Centre Cardiologique du Nord

Saint-Denis, , France

Site Status

Clinique Rhéna

Strasbourg, , France

Site Status

Clinique Pasteur

Toulouse, , France

Site Status

CHRU Nancy

Vandœuvre-lès-Nancy, , France

Site Status

Klinikum Coburg

Coburg, , Germany

Site Status

Städtisches Klinikum Karlsruhe

Karlsruhe, , Germany

Site Status

Deutsches Herzzentrum München

München, , Germany

Site Status

OLVG Amsterdam

Amsterdam, , Netherlands

Site Status

Isala Hartcentrum Zwolle

Zwolle, , Netherlands

Site Status

Countries

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United States Belgium France Germany Netherlands

References

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Seitz J, Bars C, Theodore G, Beurtheret S, Lellouche N, Bremondy M, Ferracci A, Faure J, Penaranda G, Yamazaki M, Avula UM, Curel L, Siame S, Berenfeld O, Pisapia A, Kalifa J. AF Ablation Guided by Spatiotemporal Electrogram Dispersion Without Pulmonary Vein Isolation: A Wholly Patient-Tailored Approach. J Am Coll Cardiol. 2017 Jan 24;69(3):303-321. doi: 10.1016/j.jacc.2016.10.065.

Reference Type BACKGROUND
PMID: 28104073 (View on PubMed)

Seitz J, Durdez TM, Albenque JP, Pisapia A, Gitenay E, Durand C, Monteau J, Moubarak G, Theodore G, Lepillier A, Zhao A, Bremondy M, Maluski A, Cauchemez B, Combes S, Guyomar Y, Heuls S, Thomas O, Penaranda G, Siame S, Appetiti A, Milpied P, Bars C, Kalifa J. Artificial intelligence software standardizes electrogram-based ablation outcome for persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2022 Nov;33(11):2250-2260. doi: 10.1111/jce.15657. Epub 2022 Sep 18.

Reference Type BACKGROUND
PMID: 35989543 (View on PubMed)

Deisenhofer I, Albenque JP, Busch S, Gitenay E, Mountantonakis SE, Roux A, Horvilleur J, Bakouboula B, Oza S, Abbey S, Theodore G, Lepillier A, Guyomar Y, Bessiere F, Jan Smit J, Mohr Durdez T, Milpied P, Appetiti A, Guerrero D, De Potter T, De Chillou C, Goldbarg S, Verma A, Hummel JD; TAILORED-AF Investigators. Artificial intelligence for individualized treatment of persistent atrial fibrillation: a randomized controlled trial. Nat Med. 2025 Apr;31(4):1286-1293. doi: 10.1038/s41591-025-03517-w. Epub 2025 Feb 14.

Reference Type RESULT
PMID: 39953289 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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CLIPL-01-002

Identifier Type: -

Identifier Source: org_study_id

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