None listed
Conditions
Brief summary
In the proposed study, the treating electrophysiologist will use a new and more focused method to help him/her in identifying the pathological potentials that are responsible for initiation and maintenance of AF. Despite many efforts globally, there has been a lack of ability to find and prove the best targets for ablation outside the pulmonary veins for AF, which is of particular interest in improving the success of ablation for persistent AF. There is recent evidence for the DEEP method in mapping for VT procedures. The proposed method is based on a mechanistic concept that regions that participate in the initiation of AF will demonstrate significant decremental properties prior to block and reentry, when stressed by a closely coupled premature beat. This method simply requires some additional pacing and mapping of the response to this during the routine post-ablation waiting period while patients are already undergoing AF ablation. In this study, mapping of DEEP will be performed to determine its feasibility in atrial tissue, and the presence of DEEP will be tested as a predictor of recurrence of AF during the follow-up period of 12 months. Areas of DEEP will also be compared in location and extent to abnormal voltage and complex signals seen on standard mapping (such as complex fractionated atrial electrograms and re-entrant areas). Fifteen participants will be recruited at each of 5 international centres for a total of 75 participants.
Interventions
The study procedure involves the addition of pacing manoeuvres to map additional potentials called Decrement Evoked Potentials (DEEP), during standard procedures for ablation of persistent AF in patients who are clinically referred for an AF ablation procedure. The feasibility of delivering this pacing and measuring responses in atrial tissue will be tested, the relationship of DEEP areas to areas of scar and other signal abnormalities on voltage and activation mapping established (DEEP has rece
The study procedure involves the addition of pacing manoeuvres to map additional potentials called Decrement Evoked Potentials (DEEP), during standard procedures for ablation of persistent AF in patients who are clinically referred for an AF ablation procedure. The feasibility of delivering this pacing and measuring responses in atrial tissue will be tested, the relationship of DEEP areas to areas of scar and other signal abnormalities on voltage and activation mapping established (DEEP has recently shown promise in guiding ventricular tachycardia ablation) and the ability of DEEP to predict which patients will have AF recurrence explored. Pacing will be delivered at the end of the procedure by the electrophysiologist, after pulmonary vein isolation ablation, and will be with a drive train (S1=500ms) and extra stimulus (S2) at atrial Effective Refractory Period + 20ms, from specific protocol-specified sites in the left atrium. These include the left atrial appendage, roof, inferior-posterior wall, superior-posterior wall, anterior wall, mitral isthmus, high septum, low septum and inferior left atrium. Pacing for DEEP mapping will occur during the standard post-ablation waiting time, and will be additional to the usual ablation procedure, but will result in minimal additional procedural time compared to standard AF ablation. All analysis of DEEP will be performed offline post-procedure. Follow-up duration will be 12 months.
Sponsors
John Hunter Hospital Cardiology Department
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Recurrent Atrial Fibrillation ablation, referred for catheter ablation.
Exclusion criteria
Unable to provide informed consent. Pregnant women.
Outcome results
None listed