CTI Ablation Guided by Omnipolar Wave Speed and Voltage Maps to Diminish RF and Fluoroscopy Times

NCT ID: NCT05709795

Last Updated: 2024-04-03

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

RECRUITING

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-03-01

Study Completion Date

2025-01-31

Brief Summary

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Prospective randomized study involving patients with typical flutter (TF) undergoing cavo-tricuspid isthmus (CTI) radiofrequency ablation. The aim is to compare the results of 3 different new ablation strategies using Omnipolar technology to classic linear ablation.

The investigators´ aim is to compare the effectiveness, safety and procedure times of CTI ablation with 3 different strategies using the Ensite X navigator in magnetic mode with Omnipolar technology and HDGrid catheter to optimize radiofrequency (RF) and fluoroscopy times with classical linear ablation.

The number of patients needed to prove the investigators´ hypothesis is of at least 50 per group (total of 200 prospective patients

Detailed Description

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Background Ablation procedures for CTI-dependent TF have classically been guided by fluoroscopy and intracavitary electrograms from diagnostic catheters placed in the right atrium (RA), the coronary sinus (CS) and the CTI (ablation catheter). Over the last few years, the use of navigators has increased considerably not only for complex procedures, but also for simple procedures, with the aim of reducing and even completely eliminating irradiation to both the patient and the operator (1). The investigators´ group is looking to characterize the high voltage and the low velocity regions in the CTI to minimize the procedure times. This has been addressed in a recent observational study with very good results.

Rationale There is increasing evidence of the benefits using 3D-systems not only to diminish fluoroscopy, but also to guide ablation targeting high voltage areas in the CTI (2-5). It is well known also the existence of low speed areas in the CTI, facilitating the presence of reentrant circuits (6,7). Currently, the investigators´ center performs all CTI ablation procedures using a 3D-navigator system, mostly with zero or minimal fluoroscopy. The investigators´ group has carried out a preliminary study with 13 patients to assess the effectiveness of CTI ablation with the use of the Ensite X navigator in magnetic mode with Omnipolar technology and HDGrid catheter. In this observational study the investigators were able to characterize the high voltage and the low velocity regions in the CTI to minimize the RF lesions and procedure times. Acute bidirectional block was achieved in 100% of patients with an average fluoroscopy time of 1 ± 2 min (77% patients with zero fluoroscopy) and an average RF time of 5,7 ± 3,2 min (38% below 3 min). This results were significantly lower than results obtained with classical linear ablation: median fluoroscopy time 19.3 min, IQR 12.9 to 36.4 min, median fluoroscopy dose 3520.7 cGycm(2), IQR 1700.0 to 6709.0 cGycm(2).

From the investigators´ point of view this observational study, together with previous evidence justify a randomized study in order to confirm our hypothesis:

Hypothesis Omnipolar technology is able to guide the ablation procedure minimizing both the RF time and the fluoroscopy time (compared to linear ablation) by targeting only the critical regions on the CTI. Therefore Omnipolar technology will diminish RF time and fluoroscopy time/exposition compared to classical CTI ablation, and by means of this the investigators expect an inferior complications rate. Importantly acute success rate and 6 months follow-up recurrences rate will remain similar.

OBJECTIVES

* Primary objectives: to optimize procedure times of CTI ablation with 3 different strategies based in voltage and/or conduction velocity maps using the Ensite X navigator in magnetic mode with Omnipolar technology and HDGrid catheter compared to classical linear ablation.

o Specific objectives: Fluoroscopy time, radiofrequency time, radiation dose, percentage of zero-fluoroscopy procedures, acute efficacy, complications rate.
* Secondary objectives: to increase the effectiveness of CTI ablation with 3 different strategies based in voltage and/or conduction velocity maps using the Ensite X navigator in magnetic mode with Omnipolar technology and HDGrid catheter compared to classical linear ablation.

* Specific objectives: Recurrences rate at 6 months.

Conditions

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Flutter

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Prospective randomized multicentric
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
Patient won´t know what strategy has been followed to achieve CTI block

Study Groups

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Confluent areas

Ablation first of confluent areas of low wave speed and high voltage in the CTI

Group Type EXPERIMENTAL

Confluent areas

Intervention Type PROCEDURE

Use of omnipolar technology to guide CTI ablation in sites with both low wave speed and high voltage. If not successful then ablation of low wave speed sites. If not successful then ablation of high voltage sites. If not successful then CTI line (gold standard)

Wave Speed

Ablation first of areas of low wave speed in the CTI

Group Type EXPERIMENTAL

Wave Speed

Intervention Type PROCEDURE

Use of omnipolar technology to guide CTI ablation in sites with low wave speed. If not successful then ablation of sites with both low wave speed and high voltage. If not successful then ablation of high voltage sites. If not successful then CTI line (gold standard)

Voltage

Ablation first of areas of high voltage in the CTI

Group Type ACTIVE_COMPARATOR

Voltage

Intervention Type PROCEDURE

Use of omnipolar technology to guide CTI ablation in sites with high voltage. If not successful then ablation of sites with both low wave speed and high voltage. If not successful then ablation of low wave speed sites. If not successful then CTI line (gold standard)

CTI line

Direct CTI line performance (gold standard)

Group Type ACTIVE_COMPARATOR

CTI line

Intervention Type PROCEDURE

Do not use omnipolar information. CTI line performance

Interventions

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Confluent areas

Use of omnipolar technology to guide CTI ablation in sites with both low wave speed and high voltage. If not successful then ablation of low wave speed sites. If not successful then ablation of high voltage sites. If not successful then CTI line (gold standard)

Intervention Type PROCEDURE

Wave Speed

Use of omnipolar technology to guide CTI ablation in sites with low wave speed. If not successful then ablation of sites with both low wave speed and high voltage. If not successful then ablation of high voltage sites. If not successful then CTI line (gold standard)

Intervention Type PROCEDURE

Voltage

Use of omnipolar technology to guide CTI ablation in sites with high voltage. If not successful then ablation of sites with both low wave speed and high voltage. If not successful then ablation of low wave speed sites. If not successful then CTI line (gold standard)

Intervention Type PROCEDURE

CTI line

Do not use omnipolar information. CTI line performance

Intervention Type PROCEDURE

Other Intervention Names

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Omnipolar HD Grid catheter

Eligibility Criteria

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Inclusion Criteria

* Patients submitted to CTI ablation for TF
* Age above 18 years

Exclusion Criteria

• Life expectancy of \<1 year
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Abbott

INDUSTRY

Sponsor Role collaborator

Parc de Salut Mar

OTHER

Sponsor Role lead

Responsible Party

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Ermengol Vallès

Doctor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ermengol Valles

Role: PRINCIPAL_INVESTIGATOR

Hospital del Mar

Locations

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Hospital Germans Tries

Badalona, Barcelona, Spain

Site Status RECRUITING

Hospital del Mar

Barcelona, , Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Ermengol Valles, PhD

Role: CONTACT

0034932483118

Facility Contacts

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Victor Bazan

Role: primary

Ermengol Vallès, PhD.

Role: primary

+34932483456 ext. 3456

Carlos González, M.D.

Role: backup

+34932483456 ext. 3456

Other Identifiers

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OMNIFLUTTER

Identifier Type: -

Identifier Source: org_study_id

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