Pulsed Field Ablation in Three Different Substrate Ablation Strategies for Persistent Atrial Fibrillation

NCT ID: NCT06739512

Last Updated: 2024-12-18

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

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

600 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-12-25

Study Completion Date

2026-12-01

Brief Summary

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This multicenter, randomized, controlled trial aims to evaluate the efficacy and safety of pulsed field ablation (PFA) in patients with persistent atrial fibrillation (PeAF). We will compare three distinct substrate ablation strategies: anatomical guided ablation (ANAT group), electrogram guided ablation (EGM group), and extensive electro-anatomical guided ablation (EXT group). The study seeks to identify which ablation strategy yields the highest efficacy and safety profiles to potentially guide future clinical practice in the management of PeAF.

Detailed Description

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Conditions

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Atrial Fibrillation (AF)

Keywords

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ablation atrial fibrillation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Anatomical Guided Ablation Group

This group will undergo pulmonary vein isolation (PVI) combined with anatomical linear ablation based on predefined anatomical landmarks (a complete posterior wall box isolation to ensure comprehensive atrial substrate modification), including lines such as the mitral isthmus and roofline. The ablation will aim to create bidirectional block without relying on electrogram-based mapping.

Group Type PLACEBO_COMPARATOR

Anatomical Guided Ablation

Intervention Type PROCEDURE

Ablation using PFA. Guided by anatomical landmarks without potential mapping

Electrogram Guided Ablation Group

This group will undergo PVI and targeted ablation of atrial fibrillation "drivers" identified through electrogram-guided mapping. The mapping will focus on electrograms with characteristics such as spatial-temporal dispersion, high-frequency potentials, and short local cycle lengths.

Group Type ACTIVE_COMPARATOR

Electrogram Guided Ablation

Intervention Type PROCEDURE

Ablation using PFA. Guided by real-time electrogram characteristics from a multi-electrode catheter.

Extensive Electro-Anatomical Guided Ablation Group

This group will receive PVI and a combination of anatomical linear ablation (a complete posterior wall box isolation to ensure comprehensive atrial substrate modification) and electrogram-guided ablation. It represents an extensive strategy that integrates both anatomical and potential-based mapping for optimized ablation targeting.

Group Type EXPERIMENTAL

Extensive Electro-Anatomical Guided Ablation

Intervention Type PROCEDURE

Ablation using PFA. Combination of anatomical and electrogram-guided ablation techniques.

Interventions

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Extensive Electro-Anatomical Guided Ablation

Ablation using PFA. Combination of anatomical and electrogram-guided ablation techniques.

Intervention Type PROCEDURE

Anatomical Guided Ablation

Ablation using PFA. Guided by anatomical landmarks without potential mapping

Intervention Type PROCEDURE

Electrogram Guided Ablation

Ablation using PFA. Guided by real-time electrogram characteristics from a multi-electrode catheter.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Adults aged 18-80 years diagnosed with persistent atrial fibrillation.
2. Ineffectiveness or intolerance to at least one Class I or III anti-arrhythmic drug.

Exclusion Criteria

1. Major valvular diseases needing surgical intervention.
2. Presence of a left atrial thrombus on recent imaging.
3. Recent myocardial infarction or severe heart failure (LVEF ≤ 30%).
4. Current Severe Infection.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Albert Einstein College of Medicine and Montefiore Medical Center

UNKNOWN

Sponsor Role collaborator

Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine

UNKNOWN

Sponsor Role collaborator

Shandong University of Traditional Chinese Medicine

OTHER

Sponsor Role collaborator

Yuhuan Second People's Hospital

UNKNOWN

Sponsor Role collaborator

Changshu Hospital of Traditional Chinese Medicine

OTHER

Sponsor Role collaborator

Jinan People's Hospital

UNKNOWN

Sponsor Role collaborator

Xuzhou Central Hospital

OTHER

Sponsor Role collaborator

The PLA Navy Anqing Hospital

UNKNOWN

Sponsor Role collaborator

Shanghai Chest Hospital

OTHER

Sponsor Role lead

Responsible Party

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Xu Liu

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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No. 241, West Huaihai Road

Shanghai, Shanghai Municipality, China

Site Status

Countries

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China

Central Contacts

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Xu Liu, MD

Role: CONTACT

Phone: +86 021-22200000

Email: [email protected]

Facility Contacts

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Xu Liu, MD

Role: primary

Other Identifiers

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EXT-II

Identifier Type: -

Identifier Source: org_study_id