Comparative Effectiveness of Different Techniques for Repeat Ablation of Atrial Fibrillation

NCT ID: NCT06988202

Last Updated: 2025-11-10

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

630 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-11-30

Study Completion Date

2031-12-31

Brief Summary

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Atrial fibrillation (AF) is the most common type of irregular heartbeat doctors see. People with AF sometimes have a procedure called an ablation to help get their heart back into a normal rhythm. However, this treatment doesn't always work. This study is looking at whether adding an extra step to the usual ablation-specifically treating another area of the heart called the left atrial (LA) posterior wall-can help people feel better overall, compared to just repeating the standard pulmonary vein isolation ablation procedure.

Detailed Description

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Conditions

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Atrial Fibrillation (AF)

Keywords

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atrial fibrillation irregular heart beat posterior wall isolation pulmonary vein isolation ablation REPEAT-AF

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Repeat PVI without LA PWI

Group Type OTHER

Pulmonary Vein Isolation (PVI) without Left Atrial Posterior Wall Isolation (PWI)

Intervention Type PROCEDURE

A doctor inserts a thin, flexible tube (called a catheter) through a blood vessel, usually in the groin, and guides it to the heart.

Once the catheter is in place, the doctor uses pulsed field electroporation, heat (radiofrequency) or cold (cryoablation) to create small scars in the area where the pulmonary veins connect to the left atrium of the heart.

These scars block the faulty electrical signals that cause AF, helping the heart maintain a normal rhythm.

Repeat PVI with LA PWI

Group Type OTHER

Pulmonary Vein Isolation (PVI) with Left Atrial Posterior Wall Isolation (PWI)

Intervention Type PROCEDURE

PVI with an additional step where the doctor also isolates the back wall (posterior wall) of the left atrium.

Interventions

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Pulmonary Vein Isolation (PVI) without Left Atrial Posterior Wall Isolation (PWI)

A doctor inserts a thin, flexible tube (called a catheter) through a blood vessel, usually in the groin, and guides it to the heart.

Once the catheter is in place, the doctor uses pulsed field electroporation, heat (radiofrequency) or cold (cryoablation) to create small scars in the area where the pulmonary veins connect to the left atrium of the heart.

These scars block the faulty electrical signals that cause AF, helping the heart maintain a normal rhythm.

Intervention Type PROCEDURE

Pulmonary Vein Isolation (PVI) with Left Atrial Posterior Wall Isolation (PWI)

PVI with an additional step where the doctor also isolates the back wall (posterior wall) of the left atrium.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age ≥ 18 years on date of consent
* One prior PVI ablation procedure \> 3 months prior for persistent AF
* Recurrent paroxysmal or persistent symptomatic AF confirmed on ECG despite prior PVI
* Eligible for repeat ablation procedure
* Willingness to comply with all post-procedural follow-up requirements and to sign informed consent

Exclusion Criteria

* Inability to undergo AF catheter ablation (e.g., presence of a left atrial thrombus)
* Prior ablation that included non-PVI LA ablation, or more than one prior PVI ablation procedure for persistent AF
* Prior surgical ablation for AF
* Contraindication to systematic anticoagulation
* LA diameter on echocardiogram \> 6.0 cms
* LV ejection fraction \< 35%
* NYHA class III-IV congestive heart failure
* Acute coronary syndrome or coronary artery bypass surgery or percutaneous coronary intervention (balloon and/or stent angioplasty) within 3 calendar months prior to consent date
* Enzyme-positive myocardial infarction within the past 3 calendar months prior to consent
* Severe aortic or mitral valvular heart disease eligible for percutaneous or surgical repair/replacement procedures
* Prior valve replacement with mechanical prosthesis
* Angiographic evidence of coronary disease that requires coronary revascularization and with likelihood of undergoing a CABG or PCI in the next 3 calendar months following consent date
* Stroke within 3 calendar months prior to consent date
* Any medical condition likely to limit survival to \< 1 year
* Renal failure requiring dialysis at time of consent
* Pregnancy
* History of non-compliance to medical therapy
* Participation in other clinical trials (observational/lead registries are allowed) without approval from the CCRC
* Inability or unwillingness to provide informed consent
* Resides at such a distance from the enrolling site so travel to follow-up visits would be unusually difficult
* Does not anticipate residing in the vicinity of the enrolling site for the duration of the trial
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Patient-Centered Outcomes Research Institute

OTHER

Sponsor Role collaborator

University of Rochester

OTHER

Sponsor Role lead

Responsible Party

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Jonathan Steinberg

Research Professor of Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Johnathan Steinberg, MD

Role: PRINCIPAL_INVESTIGATOR

University of Rochester

Wojciech Zareba, MD

Role: PRINCIPAL_INVESTIGATOR

University of Rochester

Locations

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University of Rochester Clinical Cardiovascular Research Center

Rochester, New York, United States

Site Status

Countries

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United States

Central Contacts

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Dustina Phoulavong, MPH

Role: CONTACT

Phone: 585-275-4449

Email: [email protected]

Becky Horn

Role: CONTACT

Phone: 585-275-0683

Email: [email protected]

Other Identifiers

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STUDY00010537

Identifier Type: -

Identifier Source: org_study_id