Personalized Atrial Fibrillation Ablation Guided by Non-Invasive Global Mapping

NCT ID: NCT07320560

Last Updated: 2026-01-06

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

45 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-01-15

Study Completion Date

2027-12-31

Brief Summary

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This pilot study investigates if non-invasive global mapping can guide catheter ablation of atrial fibrillation (AF) by defining personalized targets based on the temporal Stability of local Atrial High-Rate Activity (SAHRA). The study also assesses efficacy and safety of this approach and evaluates potential signals of harm. The main questions it aims to answer are:

* Does ablation of targets defined by non-invasive global mapping improve rates of acute atrial fibrillation termination?
* Does such a personalized ablation approach reduce arrhythmia recurrence rates? Researchers will compare the results of the personalized ablation approach with comparable patients that had undergone a conventional "empirical" ablation approach (pulmonary vein isolation).

Participants will:

* Undergo a personalized catheter ablation approach employing both a non-invasive global mapping system and a conventional intracardiac mapping system
* Visit the clinic 3, 6 and 12 months after ablation for clinical follow-up
* Schedule a telephone visit 9 and 24 months after ablation for clinical follow-up

Detailed Description

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The aim of this study is to test the feasibility and potential of a personalized, non-invasive mapping-guided ablation approach in patients with persistent atrial fibrillation (AF), who are unlikely to benefit from empirical pulmonary vein isolation alone. As a pilot study, it is designed to assess feasibility and procedural efficacy as well as potential signals of harm.

General Strategy:

Patients with persistent AF planned for catheter ablation are eligible in case of left atrial enlargement.

The study intervention consists of two steps:

1. Empirical pulmonary vein isolation in all patients (current standard of care).
2. A personalized ablation approach targeting up to three additional atrial regions which harbour critical AF-perpetuating sources:

* Target regions are selected based on the temporal Stability of local Atrial High-Rate Activity (SAHRA) using a non-invasive global mapping system (Acorys, Corify Care).
* Selected target regions displaying stable high-rate activity are isolated or homogenized according to predefined regional borders based on the 15-segment bi-atrial model of the EHRA and EACVI Clinical Consensus on Standardized Atrial Regionalization.

Conditions

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Atrial Fibrillation (AF)

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Non-invasive mapping-guided ablation

In this arm patients undergo a personalized ablation approach: In addition to conventional pulmonary vein isolation, additional target regions will be ablated based on non-invasive global mapping.

Group Type EXPERIMENTAL

Non-invasive mapping-guided ablation

Intervention Type PROCEDURE

The study intervention consists of

1. Empirical pulmonary vein isolation (current standard of care) plus
2. A personalized ablation approach targeting up to three additional atrial regions which harbour critical AF-perpetuating sources:

* Target regions are selected based on the temporal Stability of local Atrial High-Rate Activity (SAHRA) using a non-invasive global mapping system (Acorys, Corify Care). Local high-rate activity is confirmed by endocardial mapping.
* Selected target regions displaying stable high-rate activity are isolated or homogenized according to predefined regional borders based on the 15-segment bi-atrial model of the EHRA and EACVI Clinical Consensus on Standardized Atrial Regionalization (Althoff et al. 2025).

Interventions

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Non-invasive mapping-guided ablation

The study intervention consists of

1. Empirical pulmonary vein isolation (current standard of care) plus
2. A personalized ablation approach targeting up to three additional atrial regions which harbour critical AF-perpetuating sources:

* Target regions are selected based on the temporal Stability of local Atrial High-Rate Activity (SAHRA) using a non-invasive global mapping system (Acorys, Corify Care). Local high-rate activity is confirmed by endocardial mapping.
* Selected target regions displaying stable high-rate activity are isolated or homogenized according to predefined regional borders based on the 15-segment bi-atrial model of the EHRA and EACVI Clinical Consensus on Standardized Atrial Regionalization (Althoff et al. 2025).

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

Ablation-naïve patients with:

1. Persistent AF planned for catheter ablation plus
2. Left atrial enlargement (LA diameter ≥45 mm or LA volume index ≥35ml/m2 or LA area ≥20 cm2)

Exclusion Criteria

* Previous cardiac ablation
* Age \<18 years
* Pregnancy or lactation
* Previous stroke/TIA
* Severe left ventricular dysfunction (LVEF \<35%)
* Renal failure (GFR \<30 ml/min)
* Dermal disease or hypersensitivity predisposing for skin irritation or exanthema
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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German Heart Institute

OTHER

Sponsor Role lead

Responsible Party

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Till Althoff

Head of Research and Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Till F Althoff, M.D.

Role: PRINCIPAL_INVESTIGATOR

German Heart Center of the Charitè, Berlin, Department of Cardiology, Angiology and Intensive Care Medicine

Locations

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German Heart Center of the Charité, Charité University Hospital Berlin

Berlin, , Germany

Site Status RECRUITING

Frankfurt University Heart and Vascular Center

Frankfurt am Main, , Germany

Site Status NOT_YET_RECRUITING

Central Lisbon University Hospital Centre (CHULC), Hospital de Santa Marta

Lisbon, , Portugal

Site Status NOT_YET_RECRUITING

Hospital Clinic, University of Barcelona

Barcelona, , Spain

Site Status NOT_YET_RECRUITING

Gregorio Marañón General University Hospital

Madrid, , Spain

Site Status NOT_YET_RECRUITING

Countries

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Germany Portugal Spain

Central Contacts

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Till F Althoff, M.D.

Role: CONTACT

0049 30 450613163

Gerhard Hindricks, M.D.

Role: CONTACT

030450613163

Facility Contacts

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Till F Althoff, M.D.

Role: primary

0049 30 450613163

Role: backup

Reza Wakili, M.D.

Role: primary

0049 69 63017404

Role: backup

Mario Martins Oliveira, M.D.

Role: primary

0035 121 3594000

Ivo Roca-Luque, M.D. Ph.D.

Role: primary

0034 93 2271778

Felipe Atienza, M.D.

Role: primary

0034 915 86 80 00

References

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Invers-Rubio E, Hernandez-Romero I, Reventos-Presmanes J, Ferro E, Guichard JB, Regany-Closa M, Pellicer-Sendra B, Borras R, Prat-Gonzalez S, Tolosana JM, Porta-Sanchez A, Arbelo E, Guasch E, Sitges M, Brugada J, Guillem MS, Roca-Luque I, Climent AM, Mont L, Althoff TF. Regional conduction velocities determined by noninvasive mapping are associated with arrhythmia-free survival after atrial fibrillation ablation. Heart Rhythm. 2024 Sep;21(9):1570-1580. doi: 10.1016/j.hrthm.2024.04.063. Epub 2024 Apr 16.

Reference Type BACKGROUND
PMID: 38636930 (View on PubMed)

Althoff TF, Anderson RH, Goetz C, Petersen SE, Diaz PM, Nijveldt R, Maurovich-Horvat P, Bax J, Hussain S, Schmidt C, Spicer DE, Sanchez-Quintana D, Corsi C, Dossel O, Climent AM, Rodriguez B, Schotten U, Loewe A, Guillem MS, Cabrera JA, Merino JL, Wijnmaalen AP, Bertrand PB, de Groot N, Derval N, Didenko M, Donal E, Dweck MR, Ho SY. Regionalization of the atria for 3D electroanatomical mapping, cardiac imaging, and computational modelling: a clinical consensus statement of the European Heart Rhythm Association and the European Association of Cardiovascular Imaging of the ESC. Europace. 2025 Jul 1;27(7):euaf134. doi: 10.1093/europace/euaf134.

Reference Type BACKGROUND
PMID: 40736086 (View on PubMed)

Other Identifiers

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EA1/204/25

Identifier Type: -

Identifier Source: org_study_id

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