Atrial Fibrillation
Conditions
Brief summary
Recent publications suggest that neither empirical nor individualized substrate modification strategies could improve single-procedure efficacy beyond pulmonary vein (PV) isolation for persistent atrial fibrillation (AF). However, persistent AF represent a broad spectrum of the same disease and if PV isolation may be sufficient for some patient with self-terminated AF or with a small left atrium, a more extended substrate ablation may be required for other patients, for which a second procedure for atrial tachycardia (AT) recurrence is then frequently needed. In addition, a lot of progress has recently been made in the field of ablation techniques using contiguous and optimized ablation radiofrequency (RF) lesions and also for AT mapping with promising results using repetitive but discontinuous Holter monitoring. This trial aims at 1. To objectively compare atrial tachyarrhythmia (ATA) burden \> 2 months before ablation and after one or two 'CLOSEMAZE'-guided ablation(s) using continuous monitoring and echo data as a guide for the ablation strategy during the first ablation. 2. To assess ATA burden using continuous monitoring up to 3 years after ablation. 3. To identify baseline structural and electrical properties of the atria or procedural characteristics that predict 1-year and 3-year outcome.
Interventions
PROCEDUREPVI only
Patients in this group receive PVI only
PROCEDUREPVI with substrate ablation
Patients in this group receive PVI as well as substrate ablation
Sponsors
AZ Sint-Jan AV
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patients with symptomatic persistent AF (history of continuous AF \> 7 days), meeting following criteria at the out-patient clinic: * patient has AF at the time of the visit * AF episodes are symptomatic, and patient is drug-resistant (at least one class Ic or III), or drug-intolerant (palpitations, fatigue, dyspnea, cardiomyopathy,…) * If the patient has heart failure (LVEF\<50%), first line AF ablation (instead of amiodarone) is indicated 2. Signed Patient Informed Consent Form. 3. Age 18 years or older. 4. Able and willing to comply with all follow-up testing and requirements.
Exclusion criteria
1. Longstanding persistent atrial fibrillation (Suspected continuous AF\>1 year) 2. Previous ablation for AF 3. left atrial antero-posterior diameter \> 55 mm (parasternal long axis view (PLAX)) 4. LVEF \< 30% (ejection fraction) 5. AF secondary to electrolyte imbalance, thyroid disease, or reversible or non-cardiac cause 6. Coronary artery bypass graft within the last three months 7. Awaiting cardiac transplantation or other cardiac surgery 8. Documented left atrial thrombus on imaging 9. Diagnosed atrial myxoma 10. Women who are pregnant or breastfeeding 11. Acute illness or active systemic infection or sepsis 12. Unstable angina 13. Uncontrolled heart failure 14. Myocardial infarction within the previous two months 15. History of blood clotting or bleeding abnormalities 16. Contraindication to anticoagulation therapy (ie, heparin or warfarin) 17. Life expectancy less than 12 months 18. Enrollment in any other study evaluating another device or drug 19. Presence of intramural thrombus, tumor or other abnormality that precludes catheter introduction
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Atrial tachyarrhythmia (ATA) burden before and after 'CLOSEMAZE'-guided based ablation and off anti-arrhythmic drug (AAD) therapy | CLR implant to 3 year post ablation | ATA burden (= time that a subject experiences AF) will be monitored with continuous loop recording (CLR) from time of CLR implant until 3 years after ablation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Atrial tachyarrhythmia burden after one CLOSEMAZE guided ablation | 3 years after ablation | ATA burden after first ablation documented through continuous loop recordings |
| Atrial tachyarrhythmia burden after two CLOSEMAZE guided ablation | 3 years after ablation | ATA burden after two ablations documented through continuous loop recordings |
Countries
Belgium
Outcome results
None listed