Comparative Intra-procedural Evaluation of Farapulse and FARAWAVE Nav Catheters

NCT ID: NCT07130773

Last Updated: 2025-08-19

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

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

58 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-10-31

Study Completion Date

2026-12-31

Brief Summary

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The FARAPULSE PFA catheter (Boston Scientific), a first-generation Pulsed Field Ablation (PFA) tool, has demonstrated good performance in isolating pulmonary veins (PV). Several centers, including ours, utilize pre-procedural computer tomography (CT) to evaluate individual pulmonary vein anatomy and optimize ablation planning. However, these imaging modalities are costly. Additionally, CT imaging exposes patients to radiation, and introduce significant logistical challenges to the procedural workflow.

The FARAWAVE Nav PFA catheter, a second-generation device, integrates magnetic navigation capabilities with detailed mapping and PFA therapy into a single tool. This system leverages the FARAVIEW Software Module, offering tailored mapping solutions visualized on the FARAPULSE PFA system, including the creation of voltage and activation maps.

These features address the limitations of the first-generation FARAPULSE catheter and have the potential to improve procedural accuracy and the durability of pulmonary vein isolation. Moreover, they may obviate the need for pre-procedural CT, thereby reducing costs and minimizing patient radiation exposure.

Our study evaluates whether the FARAWAVE Nav catheter, used without pre-ablation CT, allows for a reduction in fluoroscopy time and overall patient radiation exposure compared to the conventional workflow with the FARAPULSE catheter. Furthermore, we will assess procedural time, costs, number of PFA applications, and AF recurrence-free survival

Detailed Description

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The FARAPULSE PFA catheter (Boston Scientific), a first-generation Pulsed Field Ablation (PFA) tool, has demonstrated good performance in isolating pulmonary veins (PV) as standard of care for atrial fibrillation (AF) ablation. Several centers, including ours, utilize pre-procedural CT or cardiac magnetic resonance (CMR) imaging to evaluate individual pulmonary vein anatomy and optimize ablation planning. However, these imaging modalities are costly. Additionally, CT imaging exposes patients to radiation, and both CT and CMR add significant logistical challenges to the procedural workflow.

The FARAWAVE Nav PFA catheter, a second-generation device, integrates magnetic navigation capabilities with detailed mapping and PFA therapy into a single device. This system leverages the FARAVIEW Software Module, offering tailored mapping solutions visualized on the FARAPULSE PFA System, including the creation of voltage and activation maps. Key technical enhancements of the FARAWAVE Nav PFA catheter include: Field Tag Technology: Field tagging estimates field volume and indicates energy delivery locations. Tags confirm overlap between applications, ensuring comprehensive PV isolation. Voltage/Activation Maps: Mapping data enhances procedure precision, allowing visualization of electrical activation and PV anatomy without reliance on pre-ablation CT imaging. These features address the limitations of the first-generation FARAPULSE catheter and have the potential to enhance procedural accuracy and the durability of pulmonary vein isolation. Moreover, they may eliminate the need for pre-procedural CT or CMR, thereby reducing costs and minimizing patient exposure to radiation.

Our center, like several others, has used the first-generation catheter in routine clinical practice for over a year. More recently, we have also started using the second-generation catheter as part of standard clinical care. Currently, the two devices are used interchangeably, depending on logistical availability, particularly the presence of specialized technicians from Boston Scientific, who are required for the proper operation of the second-generation catheter.

Our study evaluates whether the FARAWAVE Nav catheter, without pre-ablation CT, allows to reduce fluoroscopy time and total patient radiation load as compared to conventional workflow with FARAPULSE catheter. Furthermore, procedural time, costs, number of PFA applications and AF recurrence free survival will be assessed.

Inclusion Criteria

* Atrial fibrillation (AF) documented on a 12-lead ECG, Holter monitor, or implantable cardiac device.
* Candidate for ablation according to current atrial fibrillation guidelines.
* Age ≥18 years at the time of informed consent.
* Signed informed consent obtained.

Exclusion Criteria

* Previous left atrial ablation or left atrial surgery.
* Presence of intracardiac thrombus.
* Persistent atrial fibrillation lasting \>3 years.
* Severe mitral regurgitation or moderate-to-severe mitral stenosis.
* Pregnancy (all women under 50 years undergo an HCG blood test prior to inclusion to exclude pregnancy).

Primary Endpoint

1\. Fluoroscopy Time (measured in minutes)

Secondary Endpoints 2.1 Total Patient Radiation Load 2.2 Procedural Costs 2.3 Procedure Time 2.4 Left Atrial Dwelling Time 2.5 Fluoroscopy Time After Transseptal Puncture 2.6 Number of PFA Applications 2.7 AF Recurrence-Free Survival 2.8 AF Burden (in Patients with implantable loop recorder) 2.9 AF Burden (All Patients)

Randomization: 58 Patients will be randomized 1:1 to:

1. FARAPULSE + pre-ablation CT (Control Group, n=29).
2. FARAWAVE Nav without pre-ablation CT (Intervention Group, n=29). Randomization will be performed using stratified allocation based on Atrial Fibrillation pattern (paroxysmal vs. persistent AF) in a 1:1 fashion.

Intraprocedural fluoroscopy time will be collected at the time of AF ablation procedure.

To determine the required sample size for this study, we performed calculations based on previous studies, the expected fluoroscopy time are:

Control Group: Mean fluoroscopy time = 12 minutes, SD = 8 minutes \[doi.org/10.1161/CIRCULATIONAHA.123.064959\] Intervention Group: Mean fluoroscopy time = 7 minutes, SD = 7 minutes \[doi:10.1161/CIRCEP.122.011780\] Given these assumptions, that correspond to an effect size (Cohen'd) of 0.80, a power of 80% and a 2-sided alpha of 5%, we will need to enrol 52 patients (26 per group). To ensure the study remains adequately powered despite potential dropouts, protocol deviations, or missing data, an additional 10% buffer may be considered, bringing the total recommended enrolment to 58 patients per group. Calculations have been performed using the Stata software (release 18.5, StataCorp, College Station, TX, USA).

Conditions

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Atrial Fibrillation (AF) Atrial Fibrillation Ablation Pulsed Field Ablation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Intervention

FARAWAVE Nav without pre-ablation CT

Group Type EXPERIMENTAL

Second-generation FARAWAVE Nav catheter without the use of pre-ablation CT

Intervention Type DEVICE

FARAWAVE Nav without pre-ablation CT (Intervention Group, n = 29)

Description of the investigation-specific intervention:

Participants in the intervention group will undergo pulmonary vein isolation (PVI) using the second-generation FARAWAVE Nav pulsed field ablation (PFA) catheter without the use of pre-ablation CT imaging. The FARAWAVE Nav catheter integrates magnetic navigation and electroanatomical mapping capabilities, allowing real-time visualization of left atrial anatomy and electrical signals. Energy delivery is based on non-thermal pulsed electric fields (irreversible electroporation), specifically targeting myocardial tissue while sparing surrounding structures.

Control

FARAPULSE with pre-ablation CT

Group Type ACTIVE_COMPARATOR

FARAPULSE with pre-ablation CT

Intervention Type DEVICE

FARAPULSE with pre-ablation CT (Control Group, n = 29)

Description of the investigation-specific intervention:

Participants in the control group will undergo pulmonary vein isolation (PVI) using the first-generation FARAPULSE pulsed field ablation (PFA) catheter. All patients in this group will undergo pre-procedural cardiac CT imaging to evaluate pulmonary vein anatomy and assist in procedural planning. The FARAPULSE catheter delivers non-thermal pulsed electric fields for selective myocardial ablation, aiming to achieve electrical isolation of the pulmonary veins.

Interventions

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Second-generation FARAWAVE Nav catheter without the use of pre-ablation CT

FARAWAVE Nav without pre-ablation CT (Intervention Group, n = 29)

Description of the investigation-specific intervention:

Participants in the intervention group will undergo pulmonary vein isolation (PVI) using the second-generation FARAWAVE Nav pulsed field ablation (PFA) catheter without the use of pre-ablation CT imaging. The FARAWAVE Nav catheter integrates magnetic navigation and electroanatomical mapping capabilities, allowing real-time visualization of left atrial anatomy and electrical signals. Energy delivery is based on non-thermal pulsed electric fields (irreversible electroporation), specifically targeting myocardial tissue while sparing surrounding structures.

Intervention Type DEVICE

FARAPULSE with pre-ablation CT

FARAPULSE with pre-ablation CT (Control Group, n = 29)

Description of the investigation-specific intervention:

Participants in the control group will undergo pulmonary vein isolation (PVI) using the first-generation FARAPULSE pulsed field ablation (PFA) catheter. All patients in this group will undergo pre-procedural cardiac CT imaging to evaluate pulmonary vein anatomy and assist in procedural planning. The FARAPULSE catheter delivers non-thermal pulsed electric fields for selective myocardial ablation, aiming to achieve electrical isolation of the pulmonary veins.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Atrial fibrillation (AF) documented on a 12-lead ECG, Holter monitor, or implantable cardiac device.
* Candidate for ablation according to current atrial fibrillation guidelines.
* Age ≥18 years at the time of informed consent.
* Signed informed consent obtained

Exclusion Criteria

* Previous left atrial ablation or left atrial surgery.
* Presence of intracardiac thrombus.
* Persistent atrial fibrillation lasting \>3 years.
* Severe mitral regurgitation or moderate-to-severe mitral stenosis.
* Pregnancy (all women under 50 years undergo an HCG blood test prior to inclusion to exclude pregnancy).
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Cardiocentro Ticino

OTHER

Sponsor Role lead

Responsible Party

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Marco Bergonti

MD PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Central Contacts

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Marco Bergonti, MD PhD

Role: CONTACT

+41 (0) 91 811 51 11

Other Identifiers

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BASEC-ID 2025-01638

Identifier Type: OTHER

Identifier Source: secondary_id

CCT2025-FaraRadiation

Identifier Type: -

Identifier Source: org_study_id

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