Paroxysmal Atrial Fibrillation
Conditions
Brief summary
This study aims to investigate the effect of reducing ablation time for a hybrid approach of vHPSD and AI-guided ablation using the QDOT Micro catheter in PVI among patients with PAF.
Detailed description
Radiofrequency catheter ablation has become a cornerstone strategy for the rhythm control of AF. During the last decade, catheter technology has revolutionized and, accordingly, clinical outcomes after the ablation and procedural efficacy have been improved. In recent years, the use of the CLOSE protocol employing contiguous, closely spaced applications and targeted ablation index (AI) values has translated into robust acute and long-term success rates for PVI, typically with the power delivery of up to 35 W, and more recently with 40 to 50 W, in power and temperature-controlled mode. Contiguous ablation using very high-power, short-duration ablation at 90 W over 4 seconds is expected to shorten procedure time. However, changes in lesion geometry and the altered impact of catheter stability on lesion quality may influence procedural efficiency, safety, and effectiveness. The Q-FFICIENCY trial showed that the vHPSD (90 W, 4 sec), temperature-controlled radiofrequency ablation (25/50 W) has comparable efficacy to conventional-power temperature-controlled ablation. However, the efficacy of vHPSD ablation may depend on PV thickness due to its lesion characteristics. Therefore, AI-guided ablation may have merits over vHPSD ablation in thickened PV segments. According to the POWER PLUS trial, the proportion of 1st-pass PVI with vHPSD ablation was numerically lower than that of the conventional ablation, although there was marginal significance; 83.9% vs. 90.0%, p-value =0.085. According to the OPTIMUM trial, a study conducted by our group, roof and anterior walls of the left atrium often require higher AI targets due to their thickness. Therefore, a hybrid approach that combines both vHPSD and AI-guided ablations according to PV segments may achieve both high efficacy and short ablation time for PVI. The investigators of the POWER PLUS trial also speculated that the hybrid approach based on tissue thickness might offer the optimal balance of procedural efficacy. However, up to date, no studies have investigated the efficacy and safety of the hybrid approach for PVI. More data is needed to suggest that the hybrid approach could be useful for PVI. Therefore, this study aims to investigate the effect of reducing ablation time for a hybrid approach of vHPSD and AI-guided ablation using the QDOT Micro catheter in PVI among patients with PAF.
Interventions
DEVICEQDOT MicroTM catheter
Novel high power-short duration ablation catheter for atrial fibrillation
DEVICEAI-guided ablation only for PVI
Ablation is the removal or destruction of something from an object by vaporization, chipping, erosive processes, or by other means.
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients undergoing PVI for PAF
Exclusion criteria
* Aged less than 19 years * Patients with persistent AF * Patients with previous ablation or surgery for AF * Patients with intracardiac thrombus or thromboembolic events within the previous 90 days * Patients with cardiac surgery or acute coronary syndrome within the previous 90 days * Patients with contraindication(s) for using oral anticoagulants * Patients with LA anteroposterior diameter of more than 55 mm * Patients with left ventricular ejection fraction less than 35% * Pregnants or those who plan to become pregnant during the study * Life expectancy less than a year
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time for AF ablation | up to 12 months | Including total PVI time, total ablation time, fluoroscopic time, and total procedure time. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Acute PV reconnection rate | up to 12 months | Including residual PV potential and early reconnection after 1st pass PVI. |
| The segment of residual PV potential | up to 12 months | Descript as RSPV roof/anterior/posterior/carina, RIPV anterior/posterior/inferior/carina, LSPV roof/anterior(ridge)/posterior/carina, LIPV anterior(ridge)/posterior/inferior/carina. |
| The segment of early reconnection | up to 12 months | Descript as RSPV roof/anterior/posterior/carina, RIPV anterior/posterior/inferior/carina, LSPV roof/anterior(ridge)/posterior/carina, LIPV anterior(ridge)/posterior/inferior/carina. |
| 1-year AF recurrence | up to 12 months | Using single lead 3-day holter monitoring. |
| 30-day complication associated with procedure | up to 12 months | Including puncture site hematoma, puncture site pseudoaneurysm, puncture site AV fistula, stroke, TIA, thromboembolism, and others. |
Countries
South Korea
Contacts
CONTACTEue-Keun Choi, M.D. Ph.D.
PRINCIPAL_INVESTIGATOREue-Keun Choi, M.D. Ph.D.
Seoul National University Hospital
Outcome results
None listed