Atrial Fibrillation
Conditions
Keywords
atrial fibrillation, pulmonary veins, oral anticoagulant, electrophysiology, anticoagulant drugs
Brief summary
Atrial fibrillation (AF) is the most common cardiac arrhythmias with a constantly growing prevalence AF. The purpose of paroxysmal AF processing is to control outbreaks from these pulmonary veins, medicated way (antiarrhythmic) or interventional. Ablation (radiofrequency or cryotherapy) has become in this context recognized and effective treatment of AF. In addition, antithrombotic treatments in this context is a major treatments for the prevention of stroke (stroke). They are most often associated with antiarrhythmic treatment to prevent recurrence of AF or to slow it during a relapse. Recent experimental studies have highlighted the direct electrophysiological properties of dabigatran and rivaroxaban in the pulmonary veins and the left atrium. Dabigatran demonstrated in this study that it induced a prolongation of potential action in the pulmonary veins and the left atrium and it decreased the incidence of FA-induced by stimulation. Conversely, rivaroxaban induces shortening of the action potential in the left atrium (untested properties in the pulmonary veins). To our knowledge, apixaban and warfarin have not been studied in this context. It is therefore possible that some of the new oral anticoagulants (NACOS) or some AVK (fluindione and warfarin), have direct electrophysiological effects in the pulmonary veins and on the left atrium and could influence AF recurrences (with effect antiarrhythmic-like or rather a pro-arrhythmic effect) after ablation.A retrospective analysis conducted at the University Hospital of Caen on very low numbers suggest that patients on dabigatran would have less pulmonary veins connected in early ablation procedure that patients on warfarin or rivaroxaban. Despite the limitations inherent in this analysis (very low numbers, retrospective analysis, unique setting and having studied his own limits), these results are consistent with the fundamental studies, and thus encourage us to pursue our hypothesis to obtain more statistical power and reliability in our measurements and results. We therefore propose the study of the electrophysiological effects of NACOS (apixaban, dabigatran, rivaroxaban) and warfarin (warfarin and fluindione) on the pulmonary veins and the left atrium of patients referred for ablation of paroxysmal AF (radiofrequency or cryotherapy ) the CHU of Caen and Tours and clinic Saint Martin Caen.
Interventions
None listed
Sponsors
University Hospital, Caen
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All hospitalized patients for ablation of paroxysmal AF * On healthy heart * Sinus rhythm during the procedure * Patient\> 18 years
Exclusion criteria
* Patient \<18 years * Severe Mitral valve disease, * underlying heart disease * Patients refusing to participate to the study
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Reccurence of atrial fibrillation | 6 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| number of active pulmonary veins | 1 day | Measure at the ostia with the lasso |
| Spontaneous cycle length in active pulmonary veins | 1 day | Measure at the ostia with the lasso |
| Number of connected pulmonary veins | 1 day | Measure at the ostia with the lasso |
| Measure of refractory period for each pulmonary veins and left atria | 1 day | Measure at the ostia with the lasso for each VP, and with coronary sinus for the LA. |
| Number of re-connected pulmonary veins with ATP | 1 day | — |
Countries
France
Contacts
Primary ContactJoachim Alexandre, MD
Outcome results
None listed